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Posts from the ‘Theory’ Category

Decolonizing the Language of Nursing

Daniel Suárez-Baquero

The current featured ANS article is titled “Critical Analysis of the Nursing Metaparadigm in Spanish-Speaking Countries Is the Nursing Metaparadigm Universal?” by Daniel F. M. Suárez-Baquero, MSN, RN;and Lorraine Olszewski Walker, EdD, MPH, RN. This article is available to download at no cost while it is featured, and we welcome your comments and questions here. Here is author Suárez-Baquero’s message for ANS readers about this work:


This paper presents a critical analysis about the dominance of the English language as tool for colonization. We start from the use of the nursing metaparadigm – as the central component of Nursing knowledge – to elucidate the conceptual differences in Nursing foundations that exist due to social and linguistic differences.

For those nurses who learn Nursing in Spanish, the concept of Cuidado – amalgamation of the nuances of Care and Caring – is the cornerstone of the core disciplinary Nursing knowledge. However, this foundational perspective, rooted in most of the Nursing spoken in Romance languages, has been historically underrecognized. Several academic discussions about Nursing concepts and theories that I had with well-known nursing theorists during my doctoral studies brought up an overlooked issue: Meanings differences in the nuances and concepts from languages other than English.

Importantly, this issue has limited the expansion of disciplinary nursing knowledge. Therefore, in several instances, Nursing knowledge turns into a dogmatic believe that cannot be discussed; so that we, scholars who discuss the universality of Nursing knowledge, are seen as heretics in a seemingly homogenous and hegemonic vision of nursing.

This paper is an invitation to discuss, it is an awareness of the multiculturality that must be addressed for the growth of Nursing as a Science; it is a call to the nurses of color around the world, to let them know that the time has come to speak up and share our vision of Nursing. Nonetheless, the decolonization of disciplinary Nursing knowledge cannot be done without the support by the nursing community that dictates “what [Nursing] is, and what it is not.”



Este artículo presenta un análisis crítico acerca del dominio de la lengua inglesa como herramienta de colonización. Partimos del uso del metaparadigma de Enfermería – como el componente central del conocimiento enfermero – para elucidar las diferencias conceptuales en los fundamentos de la Enfermería que existen debido a las diferencias sociales y lingüísticas.

Para aquellas enfermeras y enfermeros que aprenden Enfermería en español, el concepto de Cuidado – amalgama del acto de enfermería y el acto de cuidar con amor o cariño – es la piedra angular del conocimiento central de la Enfermería. Sin embargo, esta perspectiva fundacional, arraigada en la mayor parte de la Enfermería hablada en lenguas romances, ha sido históricamente poco reconocida. Varias discusiones académicas sobre conceptos y teorías de enfermería que mantuve con conocidas teóricas de la enfermería durante mis estudios de doctorado sacaron a relucir una cuestión que se había pasado por alto: Las diferencias de significado en los matices y conceptos de otros idiomas distintos al inglés.

Es importante destacar que este problema ha limitado la expansión del conocimiento disciplinar de la Enfermería. Por lo tanto, en varios casos, el conocimiento de Enfermería se convierte en una creencia dogmática que no puede ser discutida; de modo que nosotros, los académicos que discutimos la universalidad del conocimiento enfermero, somos vistos como herejes en una visión aparentemente homogénea y hegemónica de la enfermería

Este artículo es una invitación a la discusión, es una toma de conciencia de la multiculturalidad que debe ser abordada para el crecimiento de la Enfermería como ciencia; es un llamado a las enfermeras y enfermeros de color de todo el mundo, para hacerles saber que ha llegado el momento de hablar y compartir nuestra visión de la Enfermería. Sin embargo, la descolonización del conocimiento disciplinar de Enfermería no puede hacerse sin el apoyo de la comunidad enfermera que dicta “qué es, y qué no es [Enfermería] “.


The Roy Adaptation Model to guide nursing practice

Karen Jennings, PhD, RN, PMHNP-BC is the author of our current featured article titled “The Roy Adaptation Model: A Theoretical Framework for Nurses Providing Care to Individuals With Anorexia Nervosa.” Her article is available for download at no cost while it is featured – we invite you to read the article and return here to share your ideas, questions and comments!  Here is Karen, sharing more about her work.

Palliative Care Nursing: A Concept Analysis

The current featured ANS article is titled “A Concept Analysis of Palliative Care Nursing: Advancing Nursing Theory” by Amanda J. Kirkpatrick, MSN, RN-BC; Mary Ann Cantrell, PhD, RN, FAAN; and Suzanne C. Smeltzer, EdD, RN, FAAN. The article is available for download at no cost while it is featured, and we welcome your comments about the article here!  Here is a message from Amanda Kirpatrick about her work:

When I first graduated with my BSN and began working as a nurse I quickly realized how unprepared I felt to deliver palliative care to seriously ill patients, and to handle patient issues surrounding the end of life. I am now an experienced nurse and nurse educator who teaches students about the importance of early referral to palliative care to ensure that patients receive the best symptom

Amanda J. Kirkpatrick

management and achieve the highest quality of life possible while managing a serious life-limiting illness. In support of this aim, and as part of my doctoral studies, I began researching how nurses attain competence in palliative care nursing. I discovered that there was a gap in the literature related to palliative care nursing theory, and determined that a concept analysis of palliative care nursing (using Walker and Avant’s methodology) was needed. I believed a concept analysis was the best way to identify the antecedents of palliative care nursing competence, as well as to clearly describe the nursing behaviors that demonstrate that palliative care nursing competence is achieved.

This concept analysis is very timely considering the American Association of Colleges of Nursing’s (AACN) January 2016 release of 17 Competencies and Recommendations for Educating Undergraduate Nursing Students (CARES) for Preparing Nurses to Care for the Seriously Ill and their Families. This concept analysis fills an international knowledge gap in the theoretical understanding of palliative care nursing, which currently limits the potential for nursing education and research in this area. Establishing a clear understanding of how palliative care nursing competence is developed and translates into practice holds value for nurses who implement this important care, nursing educators who must prepare these nurses to meet the AACN competencies, and researchers investigating palliative care nursing practice.

Description, Critical Reflection and Evaluation of Transitions Theory

The current featured article is by Katja Bohner, MNSc, of Switzerland, titled  “Theory Description, Critical Reflection, and Theory Evaluation of the Transitions Theory of Meleis et al according to Chinn and Kramer (2011).” The article is available to download at no cost while it is featured, and we welcome your comments and questions here!  This is a message that Ms. Bohner sent for ANS blog

Katja Bohner


The future will ask: What did you do?

I am very glad that I have the opportunity to share some of my thoughts about my latest work.

If the future would ask me today: What did you do? I would first say in regard to this work that even though I experienced mixed feelings (e.g. excitement or insecurity) all the way long, I continued doing this work. And even though it felt “risky,” venturing into the unknown with the inherent surprises and new insights, I always felt that WHAT I am doing is worth the  effort. So, what I have learned again in this (working) process, is that finally it is about values that guide the process of navigating through the uncharted terrain of life in general and making transitions. For me, more than ever, values are what make us human beings and acting a life worth living.  So I hope that my work inspires readers to go on sharing their values by acting according to them.


Promoting Health for Hispanic Women

The current featured ANS artice addresses the challenge of cultural diversity and understanding cultural factors that influence health.  This article, titled “Evaluation of 3 Behavioral Theories for Application in Health Promotion Strategies for Hispanic Women” by Daisy S. Garcia, PhD, MSN, examines these complex issues.  The article is available to download at no cost while it is featured on the ANS website, and we invite you to read this article and return here to share your comments!  Here is

Daisy Garcia

Daisy Garcia

Dr. Garcia’s message for ANS readers about her work:

I want to thank ANS for giving me the opportunity to share this article with its readers—particularly with those who work in finding ways to enhance the health of Hispanic/Latino women living in the Unites States.

Behavior modification is key for a healthy life, free of diseases. This task can be difficult to achieve in diverse populations such as Hispanic women. There are a variety of ways in which this group of women differs. For example, independent of the number of years that Hispanic women have lived in the U.S., some women maintain strong cultural believes, while others easily acculturate and adopt new behaviors to function effectively in different environments. The obstacles that Hispanic women need to overcome to access health care are additional factors that may limit health practitioners’ ability to reach these women in order to educate and inform them about practicing healthy behaviors. Health education through health promotion programs are instruments that can successfully achieve health-enhancing behavioral change—specifically, those programs designed using a theoretical framework that suggests ways to attain positive behavior change.    

My experience working with Hispanic women and my background as an educator led me to look into health promotion strategies addressing Hispanic women as well as to identify the theories guiding these strategies so that I could incorporate them into my teachings. Through this quest, I found that information on the selection of theories suitable for developing a health strategy catering to the diverse population of Hispanic women was scarce. In this article, I analytically evaluate two of the most common behavioral theories in health promotion and a nursing theory in the context of access to U.S. health care by Hispanic women. This evaluation is completed using a practical instrument, as the purpose of this article is also to offer readers an example of theory evaluation with a less complex, yet complete and reliable theory evaluation instrument to fit health promotion strategies.

Producing Environments of Care

The current featured ANS article is titled “A Practice Theory Approach to Understanding the Interdependency of Nursing Practice and the Environment: Implications for Nurse-Led Care Delivery Models” by Miriam Bender, PhD, RN and Martha S. Feldman, PhD.  The article is available for free download while it is featured on the ANS web site.  Dr. Bender has shared this story of how this work evolved, and the importance of networks in the evolution of theoretical ideas:

This article is the product of more than two years’ immersion in a multi-disciplinary practice theory reading group created by Martha S. Feldman at the University of California, Irvine (UCI). Martha is an organization theorist best known for her work on organizational routines, and routine dynamics

Dr. Miriam Bender

Dr. Miriam Bender

in particular.

In 2012, I was working on my doctoral research, which focused (and still does) on a care delivery model that integrates a new nursing role, the clinical nurse leader. I wanted to understand the mechanisms by which this reorganization and implementation of nursing care delivery produced documented improvements in care quality and outcomes.

I chanced upon Martha’s and Brian T. Pentland’s article Organizational Routines As A Unit Of Analysis (2005) via an exploratory Google Scholar search. Fascinated, I found and read more of her articles, which opened my eyes to a theoretical lens and body of work on organization dynamics that I felt could be leveraged to better understand and explain the complexity of multi-disciplinary healthcare delivery.

I gathered my courage to contact Martha (with a supportive push from Dr. Ann M. Mayo, one of my outstanding doctoral committee members), and she very graciously met with me and even invited me to join the practice theory reading group, which had its first meeting January 2013. The reading

Dr. Martha Feldman

Dr. Martha Feldman

group includes nursing, social ecology, business, education, informatics, and many other interdisciplinary scholars who meet every month for a couple of hours to engage with practice theory and empirical research that uses a practice theory lens.

As I am learning, practice theory offers a new way of understanding and explaining social phenomena such as contemporary organizing, which is increasingly understood to be complex, dynamic and distributed. A philosophical premise of practice theory is that there are no boundaries separating subject and object, mind and body, or structure and action, but rather they only exist in a recursive relationship of mutual constitution. Mutual constitution means social orders (structures, institutions, routines, etc.) cannot be conceived without understanding the role of actions in producing them, and similarly, human actions should be understood as always already configured by structural conditions. This continuous co-production of action and structure in practice means neither is static or stable, but rather they are continuously refreshed, adapted or perpetuated.

The more I became immersed in this strange new world of mutual constitution, the more I began to think about nursing practice in relation to the spaces where nurses practice. Current theory and research on nurse practice environments focus on the ‘things’ necessary to create environments that nurses then populate and practice within. Bad environments make nursing practice difficult, good environments make nursing practice easy. Partial or thwarted nursing practice negatively influences patient health outcomes, while fully engaged nursing practice positively influences patient health outcomes.

I slowly began to realize that in this conceptualization, no meaning is ascribed to nursing practice contributing to the environment where all this occurs. Using a practice lens, I began to understand that nurses, along with patients and everyone else on the healthcare team, through their practices, are always meaningfully constituting their environments of care and conditions for practice. There is in fact no externally defined environment that nurses and others populate and act within, but rather the environment is embedded in their activities.

Once that became clear to me, I made another realization; there is currently no proposition explicitly linking nursing practice and the environment in the nursing metaparadigm, which I believe has led conceptually and methodologically to nursing knowledge that is also preconfigured and separate. In other words, because we have not linked nursing practice and the environment theoretically, we have not considered the ways they are linked empirically and have instead studied them in isolation from each other.

Once that became clear to me, I felt challenged to address this theoretical gap as a first step towards creating awareness of nurses’ critical role in shaping environments through their practices. Hence the published article, which argues that a refined conceptualization of the interdependency of nursing practice and environment is necessary to identify, theorize and promote nursing practices that are beneficial to the environment of care as part of an explicitly proposed domain of nursing knowledge and practice.

The significance of a focus on the mutual constitution of nursing practice and environment is that it enables the conceptualization and development of holistic models of care that better integrate the dynamics of practice and the conditions for health into the organization of healthcare delivery. Implications include healthcare practice patterns that patients, nurses and the multi-professional healthcare team consider healing and health promoting.

This has been a long, long journey that really is only just beginning. Over the last few years I have transitioned from doctoral student to assistant professor at UCI, which allows me to continue my engagement in this incredibly generative cross-disciplinary practice theory forum that Martha initiated and which continues to flourish. I am grateful to Martha and all participants of the reading group, who challenge me to further explore practice and the duality of structure and action in relation to nursing and healthcare delivery, and to better understand how healthcare practice patterns are produced, reinforced and/or adapted, and how they generate both expected and unexpected outcomes and the conditions for further practice.








Health Change Trajectory Model

The discipline of nursing now has a growing and rich body of theoretical models that provide useful perspectives from which we can build practices addressing some of the most pervasive health challenges we and our patients face.  These models also facilitate the design and implementation of research projects that add to the evidence required for effective outcomes of practice.  Our current featured article is an example!  The title is “The Health Change Trajectory Model: An Integrated Model of Health Change” by Deborah Christensen, BSN, RN.  Here is a message Ms. Christensen has prepared for the ANS blog:

Health change appraisal is unique to each individual with dynamic changes across the lifespan. To promote understanding of evolution and change in health care appraisal, I developed the Health Change Trajectory Model by

Deborah Christensen

Deborah Christensen

integrating concepts from uncertainty in illness and illness trajectory theories. The integrated model is applicable to any change in health, not just the occurrence of chronic illness.

Nurses are the key health care providers who assist others in understanding and coping with health changes. Placing the experience of health change in a trajectory framework offers a new and creative perspective for nurses as they assist patients and families with positive adaptation to changes in health throughout the life course. Conceptualizing the nurse as health change management partner emphasizes the nurse and patient/client partnership with patients clearly in charge of shaping their health management trajectory.

Studies from uncertainty in illness theory indicate that there are phases when uncertainty can be perceived as an opportunity rather than a threat. For example, in several types of cancer there are periods of remission (comeback phase) interrupted by disease progression (acute or downward phase). Through genomic research and the development of targeted and immunotherapies, patients may have several different treatment options that can be perceived as opportunities. Further, the experience of decreased energy in the absence of illness can be perceived as a threat or as an opportunity for positive changes in physical activity and nutrition. How is uncertainty perceived in these situations? How can uncertainty as opportunity be supported? I believe that in answering these questions, nursing interventions can be developed to help patients move toward adaptation and a balanced perceptual shift from threat to opportunity in uncertainty, thus, optimizing their health change trajectory. The Heath Change Trajectory Model provides the theoretical framework for exploration of all perceived health changes, not just those specific to chronic illness, as unique opportunities for a more optimistic view of health change.

This article will be featured on the ANS web site for the next couple of weeks and will be available at no charge while it is featured!  So please visit the web site to get your copy, and come back to this blog and share your feedback and ideas!  We would be delighted to hear from you!

Informed Advocacy: An Emancipatory Nursing Perspective

The current ANS featured article is titled “Informed Advocacy: Rural, Remote, and Northern Nursing Praxis.”  In this article, the authors, Karen MacKinnon, PhD, RN; Pertice Moffitt, PhD, RN present present a synthesis of their combined research about nursing practices in Western and Northern Canada. They compared the stories of rural Canadian public health nurses with feminist and critical theoreticalnurse-advocate3_300 perspectives in order to discern evidence of informed advocacy as emancipatory nursing practice. In their conclusion they describe the elements of informed advocacy:

 . . . we learned that the informed advocacy work of rural, remote, and northern nurses includes the following dimensions: (1) ensuring that people’s concerns are heard  (by listening with intention and responding with action), (2) contextualizing practices  (by making visible or using information about the contexts of people’s lives to inform health care decision making), (3) safeguarding  (by ensuring that people remained safe), and (4) addressing systematic health inequities  (by mobilizing local resources and by providing leadership at the health system or health policy level).

We welcome your ideas and responses!  While this article is featured, it is available for free download, so visit the ANS web site now, read the article, and come back here to share your comments!

Caring as Emancipatory Nursing Praxis

The new featured article in the current ANS issue challenges readers to examine values and believes that form a foundation for nursing as caring within complex technical and economically driven systems. The article, titled “Caring as Emancipatory Nursing Praxis: The Theory of Relational Caring Complexity,” is authored by Marilyn A. Ray, PhD, RN, CTN-A, FAAN and Marian C. Turkel, PhD, RN, NEA-BC, FAAN.  They have each provided interesting background about their work, and insight in to how their ideas have emerged:

From Dr. Ray:

My journey focusing on the study of human caring in complex hospital cultures began in 1969 as an MSN student in nursing and anthropology where I conducted an ethnography of a hospital. My interest in the study of nursing as a “small” culture and health care/hospital organizations as “small” cultures led to seeking a Master of Arts in Cultural Anthropology, and a PhD in

Dr. Marilyn Ray

Dr. Marilyn Ray

Transcultural Nursing where, within my dissertation, grounded theories of nursing as transcultural caring were discovered. The substantive theory of Differential Caring unfolded showing how the dominant environmental context of different hospital units influenced the meaning of caring, such as, the interrelationship between technology and caring in an Intensive Care Unit, economics and caring in Administration, and spiritual-ethical caring in the Oncology Unit. Analysis and insight led to the discovery of the formal theory of Bureaucratic Caring (rendering the paradox of human caring in complex organizations which continues today). Subsequent research on the technology and economics of caring, exposure to Rogerian unitary science and the emerging field of complexity science/s through teaching philosophical inquiry, caring science, qualitative research methods, and conducting research with the late Dr. Alice Davidson continued to open my mind to the significance of human-environment integrality. Over the past 20 years accomplishing funded research with Dr. Marian Turkel on economic caring within many public, military, and private complex healthcare systems exposed more of how the contextual dimensions of economics, political, legal and technological phenomena enlightened our understanding of contemporary practice, and how the research illuminated the discovery of the Theory of Relational Caring Complexity. This theory deepened our commitment to seeking understanding of human rights, social justice and social caring ethics as emancipatory praxis in complex systems and prompted us to share this content.

As a doctoral student of Dr. Madeleine Leininger, my classmates and I received the gift of exploring “caring as the essence of nursing.” As a former faculty member of the University of Colorado College of Nursing (and now as a Professor Emeritus at Florida Atlantic University), I have had the opportunity of sharing ideas of and learning about, and researching caring science, ethics, unitary science, complexity sciences, and the feminist ideal of peace power with Drs. Jean Watson, Sally Gadow, Marlaine Smith, Peggy Chinn, the late Alice Davidson, and many other professionals. This knowledge has directed and continues to direct the discipline of nursing. At the same time, as an officer in the United States Air Force Reserve, Nurse Corps, I was aware of how these ideals needed to be embedded in local and global cultures, including not only the military, but also, the Transcultural Nursing Society, World Health Organization and United Nations. I am a charter member of the International Association for Human Caring and have been committed to co-creating awareness of caring science and art, respect for human dignity, cooperation, and reasoned dialogue to lay the foundation for a sustained commitment to human rights and social justice. These actions hopefully will lead to peaceful coexistence among all people and a world without war. Nurses have the obligation to be examples of human caring–to seek ethical caring knowledge, promote moral mindfulness, give voice to the voiceless, cultivate humanity, understand transcultural nursing and social/cultural contexts, and exercise ethical judgment and evaluation to facilitate the creation of peaceful communities of caring worldwide.

From Dr. Turkel:

Like my co-author and colleague, I am committed to the advancement of the scholarship of caring science and complexity science. My professional career trajectory is grounded in the philosophical tenets of caring being essential to the disciplinary foundation of nursing and the theoretical concepts of caring and complexity serving as a framework for professional nursing

Dr. Marian Turkel

Dr. Marian Turkel

practice. My journey into caring as a substantive area of study within the discipline unfolded when I entered graduate school at Florida Atlantic University (FAU) in 1989. It was a wonderful time to be at the university as our Dean, Dr. Anne Boykin was integrating caring into the curriculum and Dr. Leininger and Dr. Watson came to university sponsored conferences. I became very involved with the International Association for Human Caring (IAHC) and met Dr. Ray who was our eminent scholar. My favorite story is that I knew she was important, not sure what an eminent scholar was, and did not know if I was allowed to talk with her. She taught nursing leadership and we formed an instant personal and professional relationship as we had shared values related to caring in complex systems. As a nurse leader, I was always challenged by the paradox between caring and economics within complex systems and the social injustice that registered nurses often face in the real world of hospital nursing practice. My master’s thesis was A Journey into Caring as Experienced by Nurse Managers. Managers shared their frustration of trying to care when economics ruled decision making. My doctoral dissertation, Struggling to Find a Balance examined the paradox between caring and economics from the perspective of patients, nurses, and administrators.I was on faculty at Florida Atlantic University and the sentinel qualitative and quantitative research that Dr. Ray and I completed validated that caring was explicitly linked to improved patient and nurse outcomes and hospital system economic outcomes.

My life journey took a turn and my husband and I relocated to Chicago and then Philadelphia. I made an intentional decision to return to practice and began my journey into “praxis” (informed practice). I went back into the hospital setting but with a new lens, using research, evidence-based practice and caring theory to inform and transform practice. I continued my involvement with the IAHC, re-connected with Dr. Watson and became involved with the Watson Caring Science Institute (WCSI). As faculty within WCSI, I work with hospitals to create caring healing environments for employees, patients, and families by integrating caring theory into the practice setting. My scholarship is now focusing on leadership framed in caring science where intention setting, caring , love, peace, and values ground the practice of leadership. I just ended my IAHC Presidency May 2014 with a conference in Kyoto, Japan sponsored by IAHC and Kobe University. The conference theme was the Universality of Caring with over 781 Registered nurses from 20 countries and regions in attendance. On a personal note, I am moving back to Florida in July and returning to Holy Cross Hospital where I used to work and met my husband. My vision is to co- create a very innovative Service-Academic Partnership with Florida Atlantic University College of Nursing. In caring and peace, Marian

Visit the ANS web site to see this wonderful article – you can download it at no cost while it is featured!  Then return here to share your comments and ideas!

Developing a Frailty Framework for Vulnerable Populations

The featured article from the current issue of ANS is titled “Development of a Frailty Framework Among Vulnerable Populations,” authored by Benissa E. Salem, PhD, MSN, RN; Adeline Nyamathi, PhD, ANP, FAAN; Linda R. Phillips, PhD, RN, FAAN, FGSA; Janet C. Mentes, PhD, APRN, BC, FGSA; and Catherine Sarkisian, MD, MSPH; Mary-Lynn Brecht, PhD.  Recognizing that nursing is at the forefront of care for most vulnerable populations, they collaborated in developing a wholistic framework that can be used to guide research with these very difficult-to-reach groups of people.  Dr. Salem shared this message about their work:



Mary-Lynn Brecht, Janet C. Mentes, Adey Nyamathi, Benissa E. Salem, Catherine Sarkisian and Linda Phillips.

We are so pleased that our article has been selected to be featured in this current issue of ANS.  I have been so blessed to work with my dissertation chair, Dr. Nyamathi, along with my committee members, Drs. Phillips, Mentes, Brecht and Sarkisian in the development of this manuscript.  Further, I have been privileged to consult with Drs. Gobbens and Morley regarding the model. The framework has been inspired by several disciplines (nursing, gerontology/geriatrics and vulnerable populations), along with those who are homeless. Frailty itself is a construct which is challenging to disentangle. When working with vulnerable populations, specifically, homeless populations, it is imperative to understand unique antecedents which may influence frailty and outcomes. Drawing upon the literature focused upon homelessness, discussion with experts, and based upon experience and discussion among coauthors, the model guides possible antecedents, along with frailty, and the outcomes.  Future models related to this construct should assess nursing intervention components and the potential for frailty to be a dynamic, rather than a static state. Further, application of the model and refinement related to other vulnerable populations are all areas of future work.

While this article is featured, you can download it at no cost.  We hope you will do so, and return here to offer your ideas and responses to this very important work.

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