Complex interventions, such as innovation platforms, pose challenges for evaluators. A variety of methodological approaches are often required to build a more complete and comprehensive understanding of how complex interventions work. In this paper, we outline and critically appraise a methodologically pluralist evaluation of an innovation platform to strengthen primary care for Aboriginal and Torres Strait Islander Australians. In doing so, we aim to identify lessons learned from the approach taken and add to existing literature on implementing evaluations in complex settings, such as innovation platforms. The pluralist design used four evaluation approaches—developmental evaluation, principles-focused evaluation, network analysis, and framework analysis—with differing strengths and challenges. Taken together, the multiple evaluation approaches yielded a detailed description and nuanced understanding of the formation, functioning and outcomes of the innovation platform that would be difficult to achieve with any single evaluation method. While a methodologically pluralist design may place additional pressure on logistical and analytic resources available, it enables a deeper understanding of the mechanisms that underlie complex interventions.
Objective Glucose-6-phosphate dehydrogenase (G6PD) deficiency offers some protection against malaria; however, the degree of protection is poorly described and likely to vary with G6PD genotype and Plasmodium species. We present a novel approach to quantify the differential invasion rates of P. falciparum between G6PD deficient and normal red blood cells (RBCs) in an ex vivo model. A flow-cytometry based assay was developed to distinguish G6PD deficient and normal, parasitized and non-parasitized RBCs within the same sample. Venous blood collected from a G6PD heterozygous female was infected and cultured ex vivo with a laboratory strain of P. falciparum (FC27). Results Aliquots of infected blood were assayed at schizont and subsequent synchronized ring stages. At schizont stage, 84.9% of RBCs were G6PD deficient of which 0.4% were parasitized compared to 2.0% of normal RBCs. In the subsequent ring stage, 90.4% of RBCs were deficient and 0.2% of deficient and 0.9% of normal cells respectively were parasitized. The pooled Odds Ratio for a deficient RBC to be parasitized was 0.2 (95% confidence interval: 0.18–0.22, p < 0.001) compared to a normal cell. Further studies are warranted to explore preferential parasitization with different G6PD variants and Plasmodium species.
Background Disadvantage and transgenerational trauma contribute to Aboriginal and Torres Strait Islander (Indigenous) Australians being more likely to experience adverse health consequences from alcohol and other drug use than non-Indigenous peoples. Addressing these health inequities requires local monitoring of alcohol and other drug use. While culturally appropriate methods for measuring drinking patterns among Indigenous Australians have been established, no similar methods are available for measuring other drug use patterns (amount and frequency of consumption). This paper describes a protocol for creating and validating a tablet-based survey for alcohol and other drugs (“The Drug Survey App”). Methods The Drug Survey App will be co-designed with stakeholders including Indigenous Australian health professionals, addiction specialists, community leaders, and researchers. The App will allow participants to describe their drug use flexibly with an interactive, visual interface. The validity of estimated consumption patterns, and risk assessments will be tested against those made in clinical interviews conducted by Indigenous Australian health professionals. We will then trial the App as a population survey tool by using the App to determine the prevalence of substance use in two Indigenous communities. Discussion The App could empower Indigenous Australian communities to conduct independent research that informs local prevention and treatment efforts.
Background Diabetes-related foot disease (DFD) is a leading cause of the Australian disease burden. The 2011 Australian DFD guidelines were outdated. We aimed to develop methodology for systematically adapting suitable international guidelines to the Australian context to become the new Australian evidence-based guidelines for DFD. Methods We followed the Australian National Health Medical Research Council (NHMRC) guidelines for adapting guidelines. We systematically searched for all international DFD guideline records. All identified records were independently screened and assessed for eligibility. Those deemed eligible were further assessed and included if scoring at least moderate quality, suitability and currency using AGREE II and NHMRC instruments. The included international guidelines had all recommendations extracted into six sub-fields: prevention, wound classification, peripheral artery disease, infection, offloading and wound healing. Six national panels, each comprising 6–8 multidisciplinary national experts, screened all recommendations within their sub-field for acceptability and applicability in Australia using an ADAPTE form. Where panels were unsure of any acceptability and applicability items, full assessments were undertaken using a GRADE Evidence to Decision tool. Recommendations were adopted, adapted, or excluded, based on the agreement between the panel’s and international guideline’s judgements. Each panel drafted a guideline that included all their recommendations, rationale, justifications, and implementation considerations. All underwent public consultation, final revision, and approval by national peak bodies. Results We screened 182 identified records, assessed 24 full text records, and after further quality, suitability, and currency assessment, one record was deemed a suitable international guideline, the International Working Group Diabetic Foot Guidelines (IWGDF guidelines). The six panels collectively assessed 100 IWGDF recommendations, with 71 being adopted, 27 adapted, and two excluded for the Australian context. We received 47 public consultation responses with > 80% (strongly) agreeing that the guidelines should be approved, and ten national peak bodies endorsed the final six guidelines. The six guidelines and this protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/ Conclusion New Australian evidence-based guidelines for DFD have been developed for the first time in a decade by adapting suitable international guidelines. The methodology developed for adaptation may be useful for other foot-related conditions. These new guidelines will now serve as the national multidisciplinary best practice standards of DFD care in Australia.
Australian vocational education and training (VET) policy makers have persistently proposed more user choice when reforming the national training system. Increasing alternatives by encouraging multiple providers to trade in regulated contestable markets remains the cornerstone of governments’ policies. However, despite policy intentions, students’ options are declining. Longitudinal quantitative jurisdiction-level statistics identify well-established trends of a reduced variety of providers, a smaller range of qualifications on offer and decreased public funding. These outcomes are occurring notwithstanding the continuous supportive policy environment for intensified competition and amplified choice. Rather than portray reduced choice as policy failure, this research makes novel use of large nationally consistent regulatory and enrolment data sets to provide evidence of successful public policy implementation that is approaching the end of the market life cycle. The results invite an exploration of issues that arise when VET markets are considered to be mature rather than unrealised aspirations. Choices provided in these fully-fledged markets that balance public and private provision are still necessary, but no longer sufficient, to meet national skills needs. It is argued that policy success is not permanent and should be revisited in light of contemporary economic alternatives to guide future VET policy making.
Worldwide, information technology now plays a substantial role in the daily life of most people, whether in the developed world or in developing countries, such as Indonesia. In this fourth most populated country in the world, information technology is widely used for everyday communications and entertainment purposes, as well as for supporting education. Using a survey of 496 students enrolled in a university in Jakarta, this paper reports on a study aimed at assessing the experiences of young Indonesian students undertaking online learning and the potential of this platform for English learning. The findings show that online activities, skills, and perceived usefulness were positively correlated with positive experiences of learning English online. In particular, the perceived usefulness of the Internet and the ability to use different functions of digital devices and applications had a stronger correlation with increased benefits of online English learning. The study generates implications for Indonesian education suggesting a review of the roles of English instructors in promoting English learning through technology, improvement in English instructors’ skills in utilizing technology in their teaching, and support of relevant stakeholders as well as the preparation of English teacher preparation programme to support pre-service teachers for teaching with technology.
Background Diabetes-related foot infections cause substantial morbidity and mortality, both globally and in Australia. There is a need for up-to-date evidence-based guidelines to ensure optimal management of patients with diabetes-related foot infections. We aimed to identify and adapt high quality international guidelines to the Australian context to become the new Australian evidence-based guideline for people with a diabetes-related foot infection. Methods Following Australian National Health and Medical Research Council (NHMRC) procedures we identified the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines as suitable for adaptation to the Australian context. Guidelines were screened, assessed and judged by an expert panel for the Australian context using the guideline adaptation frameworks ADAPTE and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Judgements led to recommendations being adopted, adapted or excluded, with additional consideration regarding their implementation, monitoring and future research for the Australian context. Clinical pathways were then developed to assist implementation. Results Of 36 original diabetes-related foot infection IWGDF sub-recommendations, 31 were adopted, four were adapted and one was excluded. Adaption was primarily undertaken due to differences or clarification of the sub-recommendations’ intended population. One sub-recommendation was excluded due to substantial differences in judgements between the panel and IWGDF and unacceptable heterogeneity of the target population. Therefore, we developed 35 evidence-based sub-recommendations for the Australian context that should guide best practice diagnosis and management of people with diabetes-related foot infection in Australia. Additionally, we incorporated these sub-recommendations into two clinical pathways to assist Australian health professionals to implement these evidence-based sub-recommendations into clinical practice. The six guidelines and the full protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/ . Conclusions A new national guideline for the diagnosis and management of people with diabetes-related foot infections were successfully developed for the Australian context. In combination with simplified clinical pathway tools they provide an evidence-based framework to ensure best management of individuals with diabetes-related foot infections across Australia and highlight considerations for implementation and monitoring.
Management academics, as the primary researchers of business practices and the educators of future managers, play critical roles shaping corporate behaviour and industry response to global sustainability challenges. However, the competencies required to optimise sustainable management education are often lacking and further research is required. Addressing recognised gaps in the literature, this study measured student perceptions of global sustainability to better inform sustainable management education. 59 in-depth interviews with students from an Australian business and law school identified their sustainability concerns. The perceived importance of such concerns was then quantified via a survey with 383 responses. Factor analysis generated five core sustainability dimensions, comprised of 31 items, which inform a new empirically derived five-pillar model of sustainability. This model includes pillars from traditional three- and four-pillar conceptual models of sustainable development, as well as a new fifth pillar of corporate sustainability. The five pillars in order of perceived importance are social, political, economic, environmental, corporate and economic – importance varied between student types. Aligned with the United Nations 17 Sustainable Development Goals, these five pillars and associated items provide a useful planning tool to assist sustainable management educators in structuring their curricula, as well as businesses considering their sustainable corporate impacts.
Purpose The aim of this research is to examine the experience and impact of radiotherapy related fatigue in children diagnosed with solid tumours. Design and methods Children (n = 25) and parents (n = 19) participated in a semi-structured interview on the last week of radiotherapy treatment. The study sample included children who were 6 to 14 years of age, diagnosed with brain or solid tumour, and received radiotherapy as part of their treatment protocol over the period of 6 weeks. Interpretation of data was undertaken through the adoption of thematic analysis approach. Results Data revealed children's experience and response to fatigue while undergoing radiotherapy. Several recurring themes arose about their experience of fatigue/tiredness while undergoing radiotherapy. Two themes and eight sub themes, namely ‘Experience of Fatigue’ (“You feel Different in your body”, Mood and Feeling, Activity and Occurrence) and ‘Response to Fatigue’ (Rest and Sleep, Activity, Mood and Concentration and Eating Habit) were identified. Conclusions The findings illustrated significant fatigue on activity sleep, rest and mood of children undergoing radiotherapy. Practice implications Monitoring and addressing fatigue and its consequences during radiotherapy treatment are essential to improve well-being of children with cancer.
Poor farmers are particularly vulnerable to environmental stressors and often rely on traditional knowledge and grassroots creativity to help them to adapt. Such adaptation can be enhanced using other knowledge sources, but this requires greater understanding of the processes of knowledge co-production among scientists, local communities and state actors. In this study we undertook knowledge co-production on an experimental basis with two contrasting communities: smallholder farmers in Jind (Haryana) and Adi women in East Siang district (Arunachal Pradesh). We found that the Jind farmers displayed grassroots creativity in coping with salinity induced stresses to rice-wheat cropping systems, while Adi women applied their traditional knowledge of food based on namdung (Perilla ocymoides, a local plant species) to cope with climate variability that affected fermentation. Jind farmers perceived the process of knowledge co-production as moderately credible and salient, but the legitimacy of the exercise was compromised by the relatively low level of participation by state actors. The farmers rated the practical outcomes of the co-produced zero-till wheat as low to moderate for combating salinity-induce risks but as high for a community rice nursery. The knowledge co-production process was considered more credible and salient among younger Adi women than older women, and the utility of the Adi women's co-produced adaptive practices were rated as moderate to high for reducing the impacts of climate variability on namdung based foods. In both cases, an emergent property of the knowledge co-production exercise was creation of a knowledge network that has the potential to lead to ongoing enhanced adaptation to environmental change. Insights from the study could help improve knowledge co-production in similar social-ecological systems, and can be integrated with environmental change policies.
Effective incentive programs for farmers to conserve biodiversity on their properties are vital for sustainability. Most such programs have focussed on natural areas, like revegetating waterways, but novel agricultural habitats amplify the commitment required of farmers and the need for collaboration in the conservation process. The rice fields of Australia's Murray-Darling Basin are a key habitat for a globally endangered waterbird, the Australasian bittern, but early and sufficient ponding periods that facilitate successful breeding are inconsistent with max-imising yield per megalitre of water used. We aimed to understand farmers' willingness to undertake 'bittern-friendly' rice growing practices and their preferences for hypothetical incentive programs. Public recognition of the habitat values of their fields was a key motivation for participation, and, across the industry, we estimated that rice growers were willing to forgo an annual profit margin totalling $AU1.42 million per annum to further bittern conservation. We tested for social desirability bias, finding the inferred valuation-their nearest rice growing neighbour-was 51 % lower, but still a substantial in-kind contribution. More than half of growers did not need compensation to control foxes and cats, or to avoid herbicide use on rice bay banks, while about a third would undertake each of the other conservation actions. For financial incentives, a choice experiment showed the payment rate was important but farmers strongly preferred less demanding management requirements. The 11-day variation in ponding commencement and period was highly valued by growers, and can be crucial to bit-terns. Growers also preferred higher levels of contract flexibility, while the intensity of compliance monitoring had little impact on their choices. The preferred incentive type was to use public environmental water with no money exchanged, followed by a consumer-funded program with bittern-friendly rice products, and a standard government contract, whereas a pledge system and a tender were relatively unpopular. Bittern-friendly rice growing incentive programs should be successful if they foster custodianship, harness in-kind contributions, improve rice farming's public image, and work with growers where opportunity costs for additional water are low.
Dry eye disease (DED) is a chronic eye disease and a common complication among the world's population. Evaporation of moisture from tear film or a decrease in tear production leads to an unstable tear film which causes DED. The tear film breakup time (TBUT) test is a common clinical test used to diagnose DED. In this test, DED is diagnosed by measuring the time at which the first breakup pattern appears on the tear film. TBUT test is subjective, labour-intensive and time-consuming. These weaknesses make a computer-aided diagnosis of DED highly desirable. The existing computer-aided DED detection techniques use expensive instruments for image acquisition which may not be available in all eye clinics. Moreover, among these techniques, TBUT-based DED detection techniques are limited to finding only tear film breakup area/time and do not identify the severity of DED, which can essentially be helpful to ophthalmologists in prescribing the right treatment. Additionally, a few challenges in developing a DED detection approach are less illuminated video, constant blinking of eyes in the videos, blurred video, and lack of public datasets. This paper presents a novel TBUT-based DED detection approach that detects the presence/absence of DED from TBUT video. In addition, the proposed approach accurately identifies the severity level of DED and further categorizes it as normal, moderate or severe based on the TBUT. The proposed approach exhibits high performance in classifying TBUT frames, detecting DED, and severity grading of TBUT video with an accuracy of 83%. Also, the correlation computed between the proposed approach and the Ophthalmologist's opinion is 90%, which reflects the noteworthy contribution of our proposed approach.
Fisheries are highly complex social-ecological systems that often face ‘wicked’ problems from unsustainable resource management to climate change. Addressing these challenges requires transdisciplinary approaches that integrate perspectives across scientific disciplines and knowledge systems. Despite widespread calls for transdisciplinary fisheries research (TFR), there are still limitations in personal and institutional capacity to conduct and support this work to the highest potential. The viewpoints of early career researchers (ECRs) in this field can illuminate challenges and promote systemic change within fisheries research. This paper presents the perspectives of ECRs from across the globe, gathered through a virtual workshop held during the 2021 World Fisheries Congress, on goals, challenges, and future potential for TFR. Big picture goals for TFR were guided by principles of co-production and included (i) integrating transdisciplinary thinking at all stages of the research process, (ii) ensuring that research is inclusive and equitable, (iii) co-creating knowledge that is credible, relevant, actionable, and impactful, and (iv) consistently communicating with partners. Institutional inertia, lack of recognition of the extra time and labour required for TFR, and lack of skill development opportunities were identified as three key barriers in conducting TFR. Several critical actions were identified to help ECRs, established researchers, and institutions reach these goals. We encourage ECRs to form peer-mentorship networks to guide each other along the way. We suggest that established researchers ensure consistent mentorship while also giving space to ECR voices. Actions for institutions include retooling education programs, developing and implementing new metrics of impact, and critically examining individualism and privilege in academia. We suggest that the opportunities and actions identified here, if widely embraced now, can enable research that addresses complex challenges facing fishery systems contributing to a healthier future for fish and humans alike.
Introduction Financial incentive schemes have been commonly used by the hearing aid industry as a way of encouraging device sales. These schemes can lead to a conflict of interest as the hearing device dispenser is torn between personal reward over the best interests of their client. This conflict of interest has the potential for the dispenser to develop “moral distress”, a negative state of mind when an individual’s ethical values contrast with those of the employing organization. The purpose of this study was to investigate if there was a relationship between financial incentives and moral distress in Australian audiologists and audiometrists. Methods An online survey was distributed to all members of Audiology Australia and the Australian College of Audiology via email. Participants rated their perceived moral distress from 0 to 10 on the Moral Distress Thermometer and answered four questions about financial incentives in their respective workplace. Results A total of 65 participants, 42 females and 23 males, completed the online survey. A quarter of participants rated their moral distress corresponding to levels of uncomfortable or above. A statistically significant association was found between financial incentives, sales target setting, and higher perceived moral distress in participants. Conclusions For our sample, the implementation of financial incentives created ethical challenges for practicing audiologists and audiometrists. Modifications to employee rewards programs as well as a regulation of device sales are recommended.
Reversing large-scale habitat degradation and deforestation goes beyond what can be achieved by site-level ecological restoration and a landscape ecology perspective is fundamental. Here we assess the relative importance of tree cover and its configuration on forest-dependent birds and late-successional tree seedlings in restoration sites in southern Costa Rica. The abundance and species richness of birds increased in landscapes with more corridors, higher tree cover, and lower levels of fragmentation, highlighting the importance of riparian corridors for connectivity, and continuous tree cover as suitable habitat. Landscape variables affected abundance and species richness of seedlings similarly, but effects were weaker, possibly because seedlings face establishment limitation in addition to dispersal limitation. Moreover, the scale of landscape effects on seedlings was small, likely because proximal individual trees can significantly influence recruitment in restoration plots. Results underscore the importance of incorporating landscape-level metrics to restoration projects, as knowing the extent, and how the landscape may affect restoration outcomes can help to infer what kind of species will arrive to restoration plots.
The complex feature characteristics and low contrast of cancer lesions, a high degree of inter-class resemblance between malignant and benign lesions, and the presence of various artifacts including hairs make automated melanoma recognition in dermoscopy images quite challenging. To date, various computer-aided solutions have been proposed to identify and classify skin cancer. In this paper, a deep learning model with a shallow architecture is proposed to classify the lesions into benign and malignant. To achieve effective training while limiting overfitting problems due to limited training data, image preprocessing and data augmentation processes are introduced. After this, the ‘box blur’ down-scaling method is employed, which adds efficiency to our study by reducing the overall training time and space complexity significantly. Our proposed shallow convolutional neural network (SCNN_12) model is trained and evaluated on the Kaggle skin cancer data ISIC archive which was augmented to 16485 images by implementing different augmentation techniques. The model was able to achieve an accuracy of 98.87% with optimizer Adam and a learning rate of 0.001. In this regard, parameter and hyper-parameters of the model are determined by performing ablation studies. To assert no occurrence of overfitting, experiments are carried out exploring k-fold cross-validation and different dataset split ratios. Furthermore, to affirm the robustness the model is evaluated on noisy data to examine the performance when the image quality gets corrupted.This research corroborates that effective training for medical image analysis, addressing training time and space complexity, is possible even with a lightweighted network using a limited amount of training data.
The COVID-19 pandemic represents the most significant global challenge in a generation. Based on extant data from previous pandemics, demographic, occupational, and psychological factors have been linked to distress and for some vulnerable members of society. COVID-19 has added to the layers of grief and distress of existing trauma. Evidence-based frameworks exist to guide our individual and collective response to reduce the trauma associated with the experience of a pandemic. Pandemic and post-pandemic measures to ameliorate impacts require a multi-disciplined approach, central to which is community connectedness, resilience, and access to support. We advocate for the acceptance and broader application of Dadirri, a healing practice held by the Ngan'gikurunggurr and Ngen'giwumirri Aboriginal people of the Daly River region in the Northern Territory, Australia. This modality engages therapeutic phases that are comparable with other practiced trauma therapies. The demonstrated therapeutic outcomes from Dadirri can be attained through an individualistic or in a relational engagement context. This practice is accessible to all ages, is non-specific to gender and is suitable for people constrained in their mobility or limited by resources, pertinent in pandemic affected settings.
Aim Marine vertebrates play key functional roles on reef ecosystems. Despite their phylogenetic distance, different vertebrate lineages could play similar functions on reefs, which has been overlooked by current research on marine functional biogeography. We provide the first comprehensive assessment of the functional structure and inventory of ecosystem functions delivered by 224 vertebrates—marine mammals, sea turtles, sharks, rays and bony fish—in Atlantic Ocean reefs. Location Atlantic Ocean reefs. Methods We compiled six species-level traits and investigated geographical patterns of functional richness (FRic), functional uniqueness (FUn) and specialization (FSpe) in 83 assemblages. Additionally, we simulate the effects of marine vertebrate species’ extinction on functional diversity metrics. Results Sharks, rays and bony fish species had the highest overlap in functional space (30.94%), while turtles overlapped mainly with bony fishes (1.76%). The functional structure of vertebrate assemblages is not homogeneous across the Atlantic. While functional richness peaks in the Caribbean (a “functional hotspot”), this region depicts low-to-intermediate functional uniqueness and functional specialization levels. Despite the large proportion of threatened top predator species (53.1%), mainly large-bodied sharks, it is the loss of mesopredator species that will severely impact (up to 94% of functional loss) the functional space of vertebrate assemblages in Atlantic Ocean reefs. Main conclusions Our study reveals that functional richness patterns of vertebrate assemblages differ across Atlantic Ocean reefs. Despite the low values of functional uniqueness and specialization in some reef assemblages, reef functioning can still be compromised due to species’ extinctions. The impact of mesopredators’ loss over the functional structure of vertebrate assemblages is worrisome since this group holds a considerable proportion of threatened species (20.1%) and is next in line considering the anthropogenic impacts over high trophic level species.
Multimedia Communications of Internet of Vehicles (IoV) uses WLAN, NFC and Fifth Generation networks. At the same time, in multimedia communications in healthcare, IoV's essential task is optimizing the quality of experience (QoE) via regulating wireless links between cars. In addition, the artificial intelligence (AI) method has revolutionized IoV's environment in total, and portable wireless devices have become highly essential to end consumers in their various activities for transferring multimedia material into IoV systems. Most consumers face their irritated and not-so-sufficient view of the performance, QoE. When the service delivery is not pleasurable, most customers can stop, and the market can eventually devalue the overall performance of a product, organization, or system as a whole. This article initially offers two new algorithms called Energy-aware QoE Optimization Algorithm (EQOA) and Queue aware QoE Optimization Algorithm (QQOA) and contrasts their results with Baseline. This article provides an alternative approach to these problems. Secondly, it presents a system for multimodal communication. Thirdly, multimedia IoV transmission through mobile devices offers the QoE Optimization Model. The experimental findings show that the proposed methods maximize QoE by delighting end-users service of mobile devices to levels greater than Baseline reference. Therefore, the suggested algorithms surpass the Baseline such that during multimedia transmission, they can be regarded as promising contenders for IoV implementations.
Modern designs of solar still desalination technology are reported to tackle the cost and energy issues. However, the low productivity of this technology is the main challenge that inhibits its commercialization uses. In this study, a triangular solar still (TrSS) integrated with an external PVC pipe solar heater and an internal separated condenser is designed for the first time to enhance water desalination under Malaysian climate conditions. The daily water production of active still was 24% higher than that of passive one. The temperatures of water and ambient air, relative humidity inside the still and the intensity of solar radiation affect the daily distillate output of both stills. Besides, a few strong relationships were developed between the intensity of solar radiation and water productivity, between the daily average ambient temperature and water productivity, and between the daily average water temperature and water productivity. The desalinated water cost per liter is estimated and is reasonable. Finally, the water quality tests of raw seawater and product water were performed and analyzed. A significant improvement in the desalinated water quality is realized when compared with raw seawater quality. The product water was considered as safe drinkable water while comparing its quality with the World Health Organization (WHO) standards.
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