11. Contracting out
The MNU is opposed to contracting out of bargaining unit work. It is our belief that sufficient numbers of full-time, part-time and casual nurses should be employed to eliminate the need for agency nurses.
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12. Volunteers
The MNU supports the following position that:
- Volunteers will not be used to replace and displace paid staff.
- The number of paid staff is to be determined without consideration of volunteer contributions.
- Volunteers are not to be providers of service, but rather only to add something extra, for instance, more personal contact.
- Volunteers must not run programs.
- If volunteer activity illustrates an ongoing need, then the work should be paid. Once the pioneering is over, the jobs should be permanent.
- An essential job on a continuing basis should be paid.
- No one should voluntarily do a job for which people normally get paid, or for which there is a job description.
- Volunteers should only be used on a "by-need", "special occasion" basis, but should not supplement a program on an ongoing basis.
- Volunteers make a valuable contribution to society and we are not opposed to the principle of volunteering. However, we are opposed to volunteers replacing or doing the job that someone gets paid to do.
[This is the Canadian Union of Public Employees (CUPE) position adopted by the MNU in 1986].
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13. Free Trade
The MNU is opposed to the Free Trade agreement signed between Canada and the United States in 1989. The MNU continues to monitor the potential impact of the trade agreement and subsidy negotiations on our social programs. This is done in order that public awareness and opposition to social spending cuts and privatization can be mobilized if necessary.
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14. Abused women and children
The MNU supports the need for changes in the legal, social and economic conditions of women and children. The MNU also supports the need for shelters and crisis centres for abused women and children. (1986)
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15. Elimination of violence against women
Violence is intentional harm directed against another member of the community or society. Hundreds of Canadian women are murdered each year. Sexual assault now occurs every seventeen minutes in Canada; ninety percent of the victims are women. As many as eighty to ninety percent of all working women are estimated to have experienced workplace violence. This violence affects us, our families, and our society. Violence is now in epidemic proportion.
The Manitoba Nurses' Union (MNU), in representing its members' concerns, supports all reasonable methods of reducing the risk, severity and prevalence of violence.
Nurses, as professionals, promote health lifestyles as well as safe and healthy environments for society. Nurses, as the largest health care profession, can play a key role in the prevention of violence. In addition, they play a major role in the identification and management of the victims of violence.
In an attempt to reduce the risk of violence, various aspects must be considered. Women must become aware of their surroundings, become knowledgeable and practice techniques of prevention. Women must learn to analyze their specific situations and use appropriate preventative methods. For instance, women should leave buildings together, go to one vehicle and drive the others to their cars. Women should be especially conscious of their surroundings when walking alone and have keys ready to enter their car quickly. While individuals have a responsibility to take positive steps to reduce risk, society also has a responsibility to provide a safer environment.
Components necessary for the reduction and elimination of violence are: a strong educational campaign, a strong legal system, a strong community service program and active support from the general public.
The MNU supports improved public education and is willing to participate in the education of its members. It is essential that nurses become involved in the programs available within the community with the aim of violence reduction. Through research, a greater understanding of the causes and predisposing factors of violence must be developed if these programs are to be more effective. Public awareness campaigns to reduce violence, with the goal of eliminating it, must be comprehensive. Campaigns like the white ribbon campaign sponsored by the White Ribbon Foundation have increased public awareness of the problem. Education programs must start in the preschool years and continue through to the adult years. Campaigns like the White Ribbon Campaign should be supported.
Educational programs cannot succeed alone. The MNU must assist lobbying efforts for better legislation and increased enforcement. Stricter gun and anti-stalking legislation, better enforcement of restraining orders and severe penalties for not obeying them are essential.
Much can be done within the realm of community service. A few examples are publicly funded Wen-Do for high school students, conflict management courses, as well as better shelters. The conflict management programs in the public school system have shown initial success. More such programs are needed.
Widespread support of the general public is necessary for the success of these measures if the goal of reducing and eliminating violence is to be met.
Overall strategies must be co-operatively developed by government, educators, health care professionals, the legal community, as well as, the public. (February 1993)
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16. Child care
The MNU supports the need for a comprehensive, government funded, high quality, non-profit childcare system that is accessible and available 24 hours a day to all Canadians.
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17. Medicare
The MNU endorses the five principles of Medicare:
- Universality
- Comprehensiveness
- Accessibility
- Portability
- Public (not-for-profit) administration.
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18. Health care reform
The Manitoba Nurses Union supports the need for reform of our health care system. We have long advocated for a shift in emphasis from acute care institutional settings to a more effective, community-based preventative approach.
We believe that improved patient care must be the focus of any reform. A reform plan must be implemented in which community services are in place before institutional services are eliminated. A plan, which reduces hospital service without community services in place, puts patients at risk.
Any reform plans should include all stakeholders in the health care system. Nurses, doctors and other direct caregivers must have meaningful input for any changes to be effective. Community members i.e. patients, potential patients and their families should be included in the process. It is our belief that Manitobans are committed to an improved health care system and their advice should be sought.
Our Union supports the concept of a community-based delivery system, which would provide primary health services using salaried physicians, nurses and other health care workers. Such a system would generate cost savings and is preferable to the current physician fee-for-service reimbursement system, which encourages over-servicing of patients.
The Manitoba Nurses Union advocates a greater emphasis on community-based care, prevention, and education through an expanded role for nurses. As well, nurses should be an entry point for access to the health care system. If nurses were allowed to practice to their full potential, cost savings would be realized and care improved. Our Union does not, however, believe that nursing functions should be undertaken by those not licensed to perform these functions. This endangers both the patients' well being and the professional standards of the nurses whose responsibility it is to oversee the care of the patient. (October 1993)
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19. Health care funding
The MNU supports publicly funded and publicly delivered health care.
The MNU believes that the federal funding for health care must be restored to a 50/50 cost shared basis. (2002)
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20. Employee Assistance Programs
The MNU endorse the concept of Local/Worksite Employee Assistance Programs that will provide members with access to effective professional support services.
The Local/Worksite Employee Assistance Program should provide for equal representation from unions concerned and management.
The Employee Assistance Program endorsed at a Local/Worksite must stress voluntary referral and must provide strict confidentiality.
The MNU staff is available for consultation during the establishment and/or maintenance of Employee Assistance Programs. (1984 & 1988)
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21. Nursing education
Nursing Education:
The MNU supports the pursuit if improving accessibility to, and support for, continuing education for all nurses in Manitoba. (1985)
The MNU supports the need for government funded education programs in all areas of the province. (2002)
Entry to Practice:
As a Union, the MNU is concerned about issues that affect the working lives of our members now and in the future. The MNU has a duty and an obligation to fairly represent our members.
There has been considerable discussion and debate among nurses concerning the issue of educational requirements for nurses entering the workforce. In spite of the various provincial and national entry to practice statements, nurses currently practicing have expressed many concerns about these statements.
Nursing has changed and will continue to do so. As well, the health care system in which nurses' work is changing. Thus, we recognize the educational needs of nurses will also change. The MNU is supportive of the need for various types of education including a variety of entry-level programs, postgraduate clinical programs and continuing education programs.
The MNU strongly supports that an efficient health care system must include all levels of nurses i.e., registered nurses (diploma and baccalaureate prepared), licensed practical nurses and registered psychiatric nurses (diploma and baccalaureate prepared). We believe all nurses prepared at various levels can provide a valuable contribution to the health care "team" including care coordinated from community health centres. We believe there should be well prepared nurses at all levels of nursing.
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22. Clinical ladders (levels of practice)
The Manitoba Nurses Union believes that the approach to any study or project involving the concept of Clinical Ladder programs be:
- That discussion must involve the union; and
- That discussion on this concept must be in the context of the Collective Agreement.
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23. Abortion
It was the decision of the Executive several years ago that the Union should not take a position on abortion because it was a very volatile issue and one they felt we could not reach consensus on.
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24. Mandatory drug testing
The Manitoba Nurses' Union is strongly opposed to mandatory drug testing in the workplace. The Manitoba Nurses' Union promotes the need to focus on education, prevention and rehabilitation regarding the issue of chemical dependency. (1987)
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25. Non-discrimination
A commitment to a more just and equal society is one of the fundamentals of trade unionism. The Manitoba Nurses Union believes that all policies and activities of the Union should reflect a commitment to equality for all members. In keeping with this, there shall be no discrimination exercised by reason of race, colour, creed, national origin, place of residence, political or religious affiliation, sex, marital status, sexual orientation, age, physical or mental disability.
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26. Proliferation of health care workers
The Manitoba Nurses' Union does not support the proliferation of new categories of health care workers. It is our strong belief that nursing functions must be carried out by nurses licensed to practice. Any move to add new categories of health care workers will only dilute the quality of nursing care, potentially to a level of great risk to the patients.
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27. Work restructuring
The definition of work restructuring is to simplify, reduce and where possible, eliminate tasks and redesign operating systems. Nurses want meaningful input into any redesign of their work environment, as opposed to token representation and the appearance of consultation on committees.
The MNU position on nursing representation on task forces/committees related to work restructuring is as follows:
The Union must appoint the nurse representatives to the task forces/committees that are developed to explore changes in the health care facilities.
Union Representatives must have the right to sit in on task force/committee meetings or to monitor task force/committee activities.
The Union must receive copies of all minutes of task force/committee meetings and any other pertinent information including questionnaires.
The Union reserves the right to withdraw all its members' participation in the task forces/committee if the above criteria are not met and/or if patient care in the facility will be compromised when recommendations are formulated. (October 1993)
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28. Initial registration and Career Mobility for Registered Nurses
As of 2010, a Baccalaureate Degree in Nursing is the minimal educational requirement to enter the practice of nursing as a Registered Nurse.
Given that the vast majority of our members are diploma prepared nurses, the Manitoba Nurses Union believes that the College of Registered Nurses of Manitoba must guarantee diploma prepared nurses eligible for registration will continue to:
(a) Be recognized as equal members of value within the nursing profession;
(b) Be eligible for registration and registration renewal in order to maintain all rights of practice in accordance with the current Registered Nurses’ Act of Manitoba or any amendments to the Act hereafter;
(c) Be given unrestricted opportunity to access refresher programs under the jurisdiction of the College of Registered Nurses of Manitoba;
(d) Be given equal access for job opportunity based on their diploma education and experience.
Educational requirements for initial registration of baccalaureate prepared nurses shall not affect the renewal of registration of a diploma prepared nurse, neither will it restrict the right to practice of a diploma prepared nurse, or the right of a diploma prepared nurse to enter refresher programs offered at any time.
prepared nurses are and will continue to be valuable members of the nursing profession.
Diploma prepared nurses must not be disadvantaged from pursuing career opportunities. Employment opportunities, mobility, or privilege within the profession shall not be restricted due to educational requirements. Past experience and career accomplishments will be recognized and acknowledged as having value. Individual nurse’s knowledge, skills and abilities gained through education, both formal and informal, and experience must be recognized equally by employers when hiring and appraising the performance of a nurse.
The Manitoba Nurses Union will actively pursue the development of strategies that will enhance access to continuing education while recognizing the needs of the adult learner. Such strategies shall be used to decrease the many barriers to L - 13 April 2010 POSITION STATEMENTS continuing education. Barriers such as time, location and cost must be minimized to the point where real equal access exists. Distance education, part-time studies and the recognition of experience and knowledge is required.
Employers also have a major responsibility in relation to continuing education. Developing structures that allow for flexible scheduling, leave of absences, cost sharing and other related strategies will help minimize many of the barriers that now exist for nurses attempting to continue their education.
The College of Registered Nurses of Manitoba must agree to fully cooperate with the Union when disputes arise with Employers regarding equivalence of nursing experience and formal/informal education to ensure that the spirit and intent of this position statement is applicable.
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29. Agency nurses
The MNU believes that each health care facility should be staffed with sufficient numbers of full-time and part-time nurses and casual nurses, employed on a permanent basis to provide safe and quality health care services on a twenty-four (24) hour, seven (7) day a week basis.
The utilization of agency nurses:
- Is a violation of the integrity of the MNU Bargaining Unit.
- Is contracting out of Bargaining Unit Work.
- Increases regular facility nurses’ workloads and impacts negatively on patient care.
- The MNU position is that agency nurses, as a condition of employment, shall be required to pay dues. Their working conditions, wages and benefits shall be in accordance with the relevant Collective Agreement. This method utilized to provide wages and benefits shall not differ from the method used to provide same to permanent full-time, part-time nurses and casual nurses employed by the facility.
- Agency nurses shall not be utilized, nor shall they permit themselves to be utilized as scabs during a labour dispute involving any MNU Local/Worksite.
- All MNU Locals/Worksites must take a strong stand against use of for-profit agency nurses and MNU takes the position that for-profit agency nurses should be required to pay dues and receive salary and benefits in accordance with the MNU Collective Agreement.
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30. The role of Licensed Practical Nurses in the health care system
The Manitoba Nurses Union, and the College of Licensed Practical Nurses of Manitoba, jointly and strongly advocate for Licensed Practical Nurses to be reintroduced and maintained in all health care settings and that LPNs be allowed to fulfill the role for which they have been educated in the health care system.
There appears to be ongoing reluctance on the part of some nursing administrators to allow Licensed Practical Nurses to practice their full range of nursing skills. Continuance of this restrictive practice by nursing administration affects both the consumers of care and impacts on the cost effectiveness of nursing care delivery.
Licensed Practical Nurses, as a regulated nursing profession, receive formal training in government approved programs and must complete a comprehensive registration exam to enter the profession. Once registered with the College of Licensed Practical Nurses of Manitoba, LPNs are qualified to carry out nursing duties in accordance with established professional nursing standards.
It is distressing to Licensed Practical Nurses that they are prevented from using all of their skills at a time when staff and bed cuts make consumer needs much more urgent. We believe such reductions make it more essential that the skills of Licensed Practical Nurses be fully utilized.
Licensed Practical Nurses have also experienced a disproportionate number of layoffs and position deletions in many health care facilities in Manitoba.
It is hoped that a better understanding of the knowledge base and professional obligations of LPNs will lead health authorities and facility administration to utilize LPNs to their optimal potential. Licensed Practical Nurses provide excellent direct nursing care and are a valuable nursing resource in the delivery of cost-effective health care.
The Manitoba Nurses Union and the College of Licensed Practical Nurses of Manitoba take the position that LPNs be reintroduced and maintained in all health care facilities in Manitoba.
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31. Barriers to practice for Licensed Practical Nurses
The Manitoba Nurses Union (MNU) and the College of Licensed Practical Nurses of Manitoba (CLPNM) are concerned about two issues, which are negatively impacting on the practice and working lives of Licensed Practical Nurses. The MNU and CLPNM believe it is important to raise awareness of government supported and/or imposed barriers which limit the practice of LPNs and have an impact on LPN employment in all regional health authorities. Although the competencies required to carry out these functions are well within the scope of practice of LPNs they are restricted from doing so by regulation and policy. Continuance of this restrictive practice affects, the client, the LPN, the employer and the cost effectiveness of the system.
Specifically LPNs are restricted from:
- Viewing the Body Following Death – the Chief Medical Examiner has designated, for nursing, only registered nurses and registered psychiatric nurses can carry out this function. It has been reported that this barrier exists at the direction of Manitoba Health and was implemented to be consistent with Manitoba Health policy related to personal care homes. This has negatively affected the practice of LPNs.
- Restraint Regulation – the Manitoba Personal Care Home Standard Regulation 17(3) states, “if positive methods of preventing harm have been explored and determined to be ineffective, a physician, registered nurse or a registered psychiatric nurse may order a physical restraint to be used”. Enactment of this regulation has also negatively impacted the practice of LPNs.
Limiting the practice of LPNs below their potential, wastes precious nursing human resources at a time when the health care system can ill afford it. Eliminating practice barriers is essential to ensuring the public receives safe, affordable, accessible, and timely care. As well, these barriers unnecessarily increase cost to the system. There has been considerable discussion and concern raised by both LPNs and nursing managers regarding these practice restrictions and their impact on staffing and facility financial resources. Many LPNs are concerned that if these restrictive practices continue, employment opportunities for LPNs will diminish.
Educational programs in Manitoba provide licensed practical nurses with knowledge of the normal changes that occur after death; differentiation of normal changes from bruises, lesions, fractures or other types of injuries that require investigation and the assessment skills to conduct a thorough examination.
As well inherent in the educational program are competencies related to professional/clinical judgment and critical thinking to assess and intervene in situations where the safety of a resident or others may be compromised.
Viewing the Body Following Death
When viewing the body, the nurse recognizes this might be the last time the body is examined by medical personnel. The unclothed body is to be examined for bruises, factures, or any other type of injury that could have contributed to the death. If there are any concerns or suspicions, notification must be made immediately to the local medical examiner or Office of the Chief Medical Examiner.
Impact on LPN
Pronouncement of death and viewing the body following death has always been a part of LPN practice. Restricting LPNs from carrying out “viewing of the body” did not surface until the early 2000’s. LPNs are extremely frustrated, what was once common practice is now a practice barrier, which is impacting on their employment and in some instances, creating dissension within the workplace.
Impact on Health Facility
From a human resource perspective the MNU and CLPNM believe, when unnecessary barriers well within the LPNs scope of practice are imposed, it not only impacts on the LPN, other nurses working with the LPN, it also effects staffing pattern decisions and increases cost.
Restraint Policy
Licensed Practical Nurses recognize that physical restraint is an intervention of last resort. In an emergency situation where it is deemed necessary to protect the resident or others, it is within the LPNs knowledge base and scope of practice to assess and determine if a physical restraint is temporarily required.
Prior to the enactment of the current regulation nurses (LPNs, RNs and RPNs), carried out such assessments and decision making as part of their practice. All nurses were faced with the same barrier – a physician order was required prior to implementation. All nurses expressed concern regarding this barrier and their ability to, in an urgent situation, address in a timely manner the safety needs of the resident or others. Enactment of the Personal Care Home Standards removed the barrier for RNs and RPNs by allowing them to order a physical restraint. However, the barrier remains for LPNs. LPNs are frustrated and are questioning why this barrier continues to be imposed on their practice.
Licensed practical nurses currently do the assessment and if they determine a physical restraint is advisable they must contact a registered nurse, registered psychiatric nurse or physician to obtain an order. The order to apply the physical restraint is based on THEIR assessment of the situation. Why is this extra step imposed on the LPN?
Impact on LPN
Licensed Practical Nurses are frustrated that this barrier continues to be imposed on their practice and are concerned regarding their ability to address an urgent safety need of the resident or others. LPNs are also concerned that if this barrier remains it will negatively impact on the employment of LPNs in personal care homes.
Impact on Resident
The resident is placed at risk as prompt and timely intervention is delayed due to the time required to contact and consult with a registered nurse, registered psychiatric nurse or physician.
Impact on Health Facility
The facility/nurse may be at risk for failure to provide timely intervention to prevent injury. There is an increased cost in nursing human resources to the facility.
The MNU and CLPNM strongly support quality practice environments, which support nurses in practice resulting in job satisfaction and improved staff retention. Therefore, the MNU and CLPNM strongly believe that these barriers must be eliminated and encourage Manitoba Health to work closely with MNU and CLPNM to enact the necessary changes in government policy and regulation to remove these barriers.
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32. Multilateral Agreement on Investments (MAI)
The Manitoba Nurses Union opposes the Multilateral Agreement on Investments (MAI). We believe the MAI will accelerate the corporate takeover of social programs and public services and we oppose it for the following reasons:
- The MAI would force elected democratic governments around the world to answer to private un-elected corporations.>
- The MAI would allow the United States based profit oriented Health Maintenance Organizations (HMOs) to open new markets in Canada and take over parts of our Medicare system.
- The MAI will not respect safety in the workplace, fair wage laws, or reasonable hours of work.
- The MAI will give foreign companies the right to bring in their own labour force.
- The MAI has no provision for equal opportunity or employment equity, pay equity, or seniority rights.
- The MAI would prevent the federal government from carrying out its election promise of a national pharmacare program if it is based on the “least-cost” route of using Canada’s generic drug industry.
- The MAI would restrict government at any level from introducing a new public service like universal non-profit childcare.
- The MAI could prevent CPP funds from being used as a source of capital for provincial governments for such things as social benefits and public services.
- The MAI would allow foreign companies to bid equally with Canadian firms if a government decides to contract out public services like bus transportation or garbage pick-up.
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33. Internationally Educated Nurses throughout
"Whereas there is currently a shortage of nurses in the Province of Manitoba; and,
Whereas, it is the position of the Manitoba Nurses Union that such shortage has been contributed to by the lack of permanent full-time nursing positions; and,
Whereas, it is the position of the Manitoba Nurses Union the shortage is compounded by the failure of governments and employers to ensure adequate funding for training in specialty nursing areas,
Now, therefore…The following is a description of the steps required in order to obtain MNU endorsement in the matter of the recruitment of internationally educated nurses at Union and Non-Union Worksites on a without prejudice basis.
Collective Agreement Provisions
All Collective Agreement provisions must be met.
Where there are no applicants, the employer will advertise vacant positions locally, provincially and nationally, and provide proof of such advertisements to the Union.
No employee validation will be granted for less than permanent 0.7 EFT positions. (as per immigration policies)
Employment validation will be granted for general duty positions where conditions have been met.
Employment validations will only be granted for specialty nursing positions where the employer:
i. Has offered specialty nursing training to nurses provincially and have been unable to find sufficient applicants; and,
ii. Where the employer has advertised locally, provincially and nationally; and,
iii. Commits to train Canadian nurses in a ratio of eight to one internationally educated nurses. (2000)
Letter of Endorsement
Where employment validations as above have been met, the MNU will provide a letter of endorsement that must accompany the application to recruit an internationally educated nurse.
The Internationally Educated Nurse
The prospective internationally educated nurse must prove eligibility to write the Manitoba nursing qualifying exam (related to the category of nursing applicable) L - 21 April 2010 POSITION STATEMENTS
and prove qualification and experience requirements prior to being issued a one-year employment authorization.
Extensions
Requests for extensions for subsequent employment authorizations must be accompanied by a letter of endorsement from the MNU conditional to MNU review of the progress of the commitment to train Canadians.
Endorsements for employee extensions may be granted for less than full-time positions as long as the position is permanent.
There is no requirement to re-advertise the position at the time the extension is applied for.
Permanent Validation
Before the end of the internationally educated nurse’s second year as a temporary foreign worker, the employer will make a decision whether to request a permanent validation and Union authorization will be obtained providing labour market circumstances have not changed.
Extenuating Circumstances
Given the training efforts of the employer and the shortages of nurses, MNU endorsement for third year extensions, without an offer of permanent validation, will only be given in unusual and extenuating circumstances.
Labour Disputes
The provisions of this policy become null and void during the period of a labour dispute between the MNU and the employer. Human Resources Development Canada is unable to validate offers of employment during labour disputes as the validation of a foreign worker may affect the outcome.
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