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1.
Int J Environ Res Public Health ; 19(6)2022 03 19.
Article in English | MEDLINE | ID: covidwho-1760607

ABSTRACT

Restrictive measures due to the COVID-19 pandemic may cause problems in the physical, social, and psychological functioning of older people, resulting in increased frailty. In this cross-sectional study, we aimed to assess the prevalence and characteristics of frailty, to examine differences in perceived COVID-19-related concerns and threats between frail and non-frail people and to identify variables associated with frailty in the first wave of the COVID-19 pandemic, in Dutch older people aged ≥ 65 years. We used data from the Lifelines COVID-19 Cohort Study. The Groningen Frailty Indicator (GFI) was used, with a score ≥ 4 indicating frailty. Frailty was described per domain (i.e., physical, cognitive, social, and psychological). The association between demographic, health and lifestyle variables and frailty was determined with logistic regression analyses. Frailty was present in 13% of the 11,145 participants that completed the GFI. Most items contributing to a positive frailty score were found within the social domain, in the frail (51%) and the non-frail (59%) persons. For items related to concerns and threats, a significantly higher proportion of frail people reported being worried or feeling threatened. In conclusion, during Corona restrictions, prevalence of frailty was considerable in older people from the Northern Netherlands, with one in eight being frail. Frailty was characterized by social problems and frail people were more often worried and felt threatened by the COVID-19 pandemic.


Subject(s)
COVID-19 , Frailty , Aged , COVID-19/epidemiology , Cohort Studies , Cross-Sectional Studies , Frail Elderly/psychology , Frailty/epidemiology , Frailty/psychology , Geriatric Assessment/methods , Humans , Netherlands/epidemiology , Pandemics
2.
J Acquir Immune Defic Syndr ; 89(Suppl 1): S65-S72, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1722746

ABSTRACT

BACKGROUND: Resilience is defined as an individual's positive adaptation to stressors. The COVID-19 pandemic represents a generalized stressor which may affect differently people living with HIV (PLWH). The objective of this study was to characterize resilience in PLWH with particular regarding the identification of frailty-resilience phenotypes, which may differently affect health-related quality of life (HR-QoL). METHODS: This was an observational study of PLWH attending Modena HIV Metabolic Clinic. Frailty was assessed in 2019, before the onset of the COVID-19 pandemic by using 37-Item frailty index ranging from 0 to 1. The frailty index score was categorized as fit (<0.25) or frail (>0.25). In January 2021, PLWH were offered to complete a set of electronic questionnaires including the CD-RISC-25 for resilience and EQ-5D5L and SF-36 for HR-QoL. Resilience was defined as CD-RISC-25 score >75.7 (ranging from 0 to 100). RESULTS: Of 800 PLWH reached by mail, 575 (72%) completed the questionnaires. The median age and HIV duration were 54.5 and 24.3 years, respectively. Impaired resilience was associated with loneliness [odds ratio (OR = 2.39; 1.20 to 4.76, P < 0.001)]. Predictors for EQ-5D5L <89.7% were the phenotypes "frail/nonresilient" [OR = 5.21, 95% confidence interval (CI): 2.62 to 10.33] and "fit/nonresilient" (OR = 5.48, 95% CI: 2.8 to 10.74). Predictors for SF-36 <64.40 were the phenotypes "frail/nonresilient" (OR = 7.43, 95% CI: 2.57 to 21.22) and "fit/nonresilient" (OR = 6.27, 95% CI: 2.17 to 18.16). Both models were corrected for age, sex, HIV duration, and nadir CD4. CONCLUSIONS: Resilience characterizes the well-being of PLWH during the COVID-19 crisis. This construct is complementary to frailty in the identification of clinical phenotypes with different impacts on HR-QoL.


Subject(s)
Aging , COVID-19/psychology , Frail Elderly/psychology , Frailty/psychology , HIV Infections/psychology , Quality of Life/psychology , Resilience, Psychological , Aged , COVID-19/epidemiology , Cross-Sectional Studies , Female , HIV Infections/complications , HIV Infections/drug therapy , Humans , Male , Pandemics , SARS-CoV-2
3.
J Frailty Aging ; 11(2): 206-213, 2022.
Article in English | MEDLINE | ID: covidwho-1498010

ABSTRACT

BACKGROUND: Despite emerging evidence about the association between social frailty and cognitive impairment, little is known about the role of executive function in this interplay, and whether the co-existence of social frailty and cognitive impairment predisposes to adverse health outcomes in healthy community-dwelling older adults. OBJECTIVES: We aim to examine independent associations between social frailty with the MMSE and FAB, and to determine if having both social frailty and cognitive impairment is associated with worse health outcomes than either or neither condition. METHODS: We studied 229 cognitively intact and functionally independent community-dwelling older adults (mean age= 67.2±7.43). Outcome measures comprise physical activity; physical performance and frailty; geriatric syndromes; life space and quality of life. We compared Chinese Mini Mental State Examination (CMMSE) and Chinese Frontal Assessment Battery (FAB) scores across the socially non-frail, socially pre-frail and socially frail. Participants were further recategorized into three subgroups (neither, either or both) based on presence of social frailty and cognitive impairment. Cognitive impairment was defined as a score below the educational adjusted cut-offs in either CMMSE or FAB. We performed logistic regression adjusted for significant covariates and mood to examine association with outcomes across the three subgroups. RESULTS: Compared with CMMSE, Chinese FAB scores significantly decreased across the social frailty spectrum (p<0.001), suggesting strong association between executive function with social frailty. We derived three subgroups relative to relationship with socially frailty and executive dysfunction: (i) Neither, N=140(61.1%), (ii) Either, N=79(34.5%), and (iii) Both, N=10(4.4%). Compared with neither or either subgroups, having both social frailty and executive dysfunction was associated with anorexia (OR=4.79, 95% CI= 1.04-22.02), near falls and falls (OR= 5.23, 95% CI= 1.10-24.90), lower life-space mobility (odds ratio, OR=9.80, 95% CI=2.07-46.31) and poorer quality of life (OR= 13.2, 95% CI= 2.38-73.4). CONCLUSION: Our results explicated the association of executive dysfunction with social frailty, and their synergistic relationship independent of mood with geriatric syndromes, decreased life space and poorer quality of life. In light of the current COVID-19 pandemic, the association between social frailty and executive dysfunction merits further study as a possible target for early intervention in relatively healthy older adults.


Subject(s)
COVID-19 , Cognitive Dysfunction , Frailty , Aged , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/psychology , Cross-Sectional Studies , Executive Function , Frail Elderly/psychology , Frailty/diagnosis , Frailty/epidemiology , Frailty/psychology , Geriatric Assessment/methods , Humans , Independent Living/psychology , Pandemics , Quality of Life/psychology , Syndrome
4.
Lit Med ; 38(2): 349-370, 2020.
Article in English | MEDLINE | ID: covidwho-1450722

ABSTRACT

This enquiry considers how the dignity of the frail elderly is objectively grounded, socially constructed, and subjectively experienced. The lives of the frail trouble public consciousness. A terror of old age, felt by young or old, is liable to form a toxic affective culture of social death. Against such threats, the dignity of the frail requires defense. However, empathy- and capacities-based approaches to dignity fail to give a compelling account of humanity's membership in shared community. By contrast, the poetry of the Psalms and New Testament puts terror to flight by articulating how dignity is found within God's steadfast, worth-bestowing love which tenderly accompanies humanity in its shared dustiness from the womb to old age and beyond. The blessed dignity these sources describe is found to be more conceptually robust and affectively compelling than an individualistic eudaimonism. Cultivating an ecology of dignity in practice is finally shown to depend on a compassion which grows from the same fertile, imaginative ground.


Subject(s)
Empathy , Fear/psychology , Frail Elderly/psychology , Respect , Social Isolation/psychology , Aged , COVID-19 , Humans , SARS-CoV-2
6.
Nurse Pract ; 46(6): 37-42, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1232226

ABSTRACT

ABSTRACT: The impact of COVID-19 on older adults may not be readily apparent. Personal protective and social distancing measures can reduce activity levels, increase feelings of isolation and loss, and result in lapsed medical care. NPs must recognize detrimental impacts on overall health and wellness and assist older adults in overcoming them.


Subject(s)
COVID-19/psychology , Disease Transmission, Infectious/prevention & control , Frail Elderly/psychology , Frail Elderly/statistics & numerical data , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Physical Distancing , Adaptation, Psychological , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Male , SARS-CoV-2 , Stress, Psychological , United States/epidemiology
7.
J Nutr Health Aging ; 25(4): 440-447, 2021.
Article in English | MEDLINE | ID: covidwho-1160647

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to abrupt restrictions of life-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. OBJECTIVE: To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. DESIGN: Multicenter prospective cohort study based on structured telephone interviews. SETTING: Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. PARTICIPANTS: 557 community-dwelling adults aged 60 years and older. MEASUREMENTS: The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of ≥ 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question «How is the COVID-19 pandemic affecting your QoL?¼, to which participants could respond «not at all¼, «to some extent¼, or «to a great extent¼. We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. RESULTS: Participants were on average 80±8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). CONCLUSION: Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.


Subject(s)
COVID-19/psychology , Frail Elderly/psychology , Frailty/psychology , Geriatric Assessment/statistics & numerical data , Quality of Life/psychology , Aged , Aged, 80 and over , Anxiety/psychology , Brazil , Cross-Sectional Studies , Depression/psychology , Fatigue/psychology , Female , Humans , Independent Living , Interviews as Topic , Loneliness/psychology , Male , Middle Aged , Physical Distancing , Prospective Studies , SARS-CoV-2
8.
Aging Clin Exp Res ; 32(7): 1189-1194, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1139406

ABSTRACT

The early stages of the COVID-19 pandemic have focused on containing SARS-CoV-2 infection and identifying treatment strategies. While controlling this communicable disease is of utmost importance, the long-term effect on individuals with non-communicable diseases (NCD) is significant. Although certain NCDs appear to increase the severity of COVID-19 and mortality risk, SARS-CoV-2 infection in survivors with NCDs may also affect the progression of their pre-existing clinical conditions. Infection containment measures will have substantial short- and long-term consequences; social distancing and quarantine restrictions will reduce physical activity and increase other unhealthy lifestyles, thus increasing NCD risk factors and worsening clinical symptoms. Vitamin D levels might decrease and there might be a rise in mental health disorders. Many countries have made changes to routine management of NCD patients, e.g., cancelling non-urgent outpatient visits, which will have important implications for NCD management, diagnosis of new-onset NCDs, medication adherence, and NCD progression. We may have opportunities to learn from this unprecedented crisis on how to leverage healthcare technologies and improve procedures to optimize healthcare service provision. This article discusses how the COVID-19 outbreak and related infection control measures could hit the most frail individuals, worsening the condition of NCD patients, while further jeopardizing the sustainability of the healthcare systems. We suggest ways to define an integrated strategy that could involve both public institutional entities and the private sector to safeguard frail individuals and mitigate the impact of the outbreak.


Subject(s)
Coronavirus Infections/complications , Frail Elderly/psychology , Frailty/complications , Healthy Aging , Noncommunicable Diseases/epidemiology , Pneumonia, Viral/complications , Aged , Betacoronavirus , COVID-19 , Chronic Disease/epidemiology , Coronavirus Infections/mortality , Coronavirus Infections/prevention & control , Delivery of Health Care , Disease Outbreaks , Disease Progression , Europe/epidemiology , Frailty/psychology , Humans , Infection Control , Loneliness , Pandemics/prevention & control , Pneumonia, Viral/mortality , Pneumonia, Viral/prevention & control , Prevalence , Quarantine , SARS-CoV-2
9.
Clin Interv Aging ; 16: 415-429, 2021.
Article in English | MEDLINE | ID: covidwho-1127887

ABSTRACT

PURPOSE: Older persons have been identified as a vulnerable population with respect to the novel coronavirus outbreak, COVID-19. Aiming to "flatten the curve" a strict Movement Control Order (MCO) was implemented in Malaysia. Older adults with cognitive frailty are prone to physical, cognitive and psychosocial decline. This study aims to compare physical activity patterns, psychological wellbeing and coping strategies of older persons with cognitive frailty in the "WE-RISE" trial (intervention versus control) throughout this period. MATERIALS AND METHODS: This study was conducted as a sub-analysis of the ongoing "WE-RISE" randomized controlled trial. This study included 42 community-dwelling older adults, aged 60 years and above, with cognitive frailty, stratified into intervention (n=21) and control (n=21) groups who are receiving a multi-domain intervention and usual care, respectively, within the Klang Valley, Malaysia. Phone call interviews were conducted during the MCO period. Physical activity patterns were assessed using International Physical Activity Questionnaire (IPAQ) and Functional Activities Questionnaire (FAQ). Psychological wellbeing was assessed using Flourishing Scale (FS) and General Health Questionnaire (GHQ-12), while the Brief Coping Orientation to Problems Experienced (COPE) assessed coping strategies. Data were analysed descriptively and with independent samples t-test. RESULTS: The WE-RISE intervention group had significantly higher levels of estimated resting energy expenditure (MET) for "walking activity" (I:µ=1723.1±780.7;C:µ=537.4±581.9)(p<0.001), "moderate activity" (I:µ=1422.8±1215.1;C:µ=405.7±746.9)(p=0.002) and "total physical activity" (I: µ=3625.9±3399.3;C:µ=994.6±1193.9)(p=0.002). The intervention group was also significantly more independent in functional activities (µ=1.76±1.73) as compared to the control group (µ=5.57±8.31) (p<0.05). Moreover, significant higher self-perception of living a meaningful life and feeling respected (p<0.05) was demonstrated in regard to psychological well-being in the intervention group. Regarding coping strategies, the intervention group relied significantly on the domains of religion (I:µ=6.43±0.99;C:µ=6.09±1.09)(p<0.05) and planning (I:µ=4.81±0.75; C:µ=4.04±1.28)(p<0.05) whilst the control group relied on humour (C:µ=3.14±1.19; I:µ=2.38±0.74)(p<0.05). CONCLUSION: Participants of the WE-RISE intervention group were more physically active, functionally independent and had higher self-perceived social-psychological prosperity regarding living a meaningful life and feeling respected; whilst both groups relied on positive coping strategies during the MCO. These results indicate that it is vital to ensure older persons with cognitive frailty remain physically active and preserve their psychosocial wellbeing to be more resilient in preventing further decline during a crisis such as the COVID-19 pandemic.


Subject(s)
Adaptation, Psychological , COVID-19/epidemiology , Exercise , Frail Elderly/psychology , Frailty/psychology , Aged , Aged, 80 and over , Cognition , Energy Metabolism , Female , Frailty/epidemiology , Humans , Independent Living , Interviews as Topic , Longitudinal Studies , Malaysia , Male , Middle Aged , Pandemics , SARS-CoV-2
10.
Front Public Health ; 8: 609695, 2020.
Article in English | MEDLINE | ID: covidwho-1058476

ABSTRACT

The coronavirus disease 2019 (COVID-19) is affecting the population disproportionately and is continuously widening the health gap among the population. Based on some recent studies on COVID-19 and the older population, the various cascades toward health inequity have been projected. This study highlights how the COVID-19 is met by health inequity triggers, such as global trade inequality, ageist social regulations, and the existing social inequity. While those triggers are applicable to all the populations, there seems to be specific amplifiers for health inequity among the older populations. In particular, six types of amplifiers have been identified: (1) expansion of riskscape, (2) reduction of social ties, (3) uncertainty of future, (4) losing trust in institutions, (5) coping with new knowledge, and (6) straining on public spending. While the fundamental mitigating responses to health inequity among the older population is tackling existing inequalities, this study may help to shed light on emerging vulnerabilities among the older population to alleviate far-reaching consequences of COVID-19 of the identified inequity amplifiers.


Subject(s)
Ageism/psychology , Ageism/statistics & numerical data , COVID-19/epidemiology , COVID-19/psychology , Frail Elderly/psychology , Frail Elderly/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Male , SARS-CoV-2 , Socioeconomic Factors
11.
J Immunol Res ; 2020: 8375096, 2020.
Article in English | MEDLINE | ID: covidwho-949232

ABSTRACT

Recently, the novel coronavirus epidemic occurred in China and spread worldwide to become a global pandemic. COVID-19 is a fatal viral infection causing death, particularly in aged individuals, due to impaired immunity. To date, no intervention is available to prevent COVID-19 and its manifestations. Physical exercise training generally has health benefits, and it assists in the prevention of several chronic diseases. Therefore, this review is aimed at exploring the role of physical exercise training in the face of COVID-19 in older adults and elderly individuals. From this point of view, this review suggests that physical exercise training plays a key role in promoting immune system regulation, delaying immunity dysfunction, reducing circulatory inflammation markers, and preventing sarcopenia and thus could prevent the risk of acquiring COVID-19 infection and reduce the complications of recommended self-isolation in older adults and elderly individuals. Additionally, immunity biomarkers were optimistically demonstrated in older adults following physical exercise training, thereby reducing mortality and morbidity rates. Finally, in accordance with recommendations to stay home and perform self-isolation to prevent the spread of COVID-19, all populations are strongly recommended to practice regular home exercise training at home to promote immune system functioning.


Subject(s)
Exercise/physiology , Exercise/psychology , Psychosocial Functioning , Aged , Aged, 80 and over , COVID-19/prevention & control , Frail Elderly/psychology , Humans , Immunity, Cellular/immunology , Patient Isolation , Psychosocial Deprivation , SARS-CoV-2 , Sarcopenia/prevention & control
12.
BMJ Open ; 10(9): e040569, 2020 09 29.
Article in English | MEDLINE | ID: covidwho-809101

ABSTRACT

INTRODUCTION: This protocol describes an observational study which set out to assess whether frailty and/or multimorbidity correlates with short-term and medium-term outcomes in patients diagnosed with COVID-19 in a European, multicentre setting. METHODS AND ANALYSIS: Over a 3-month period we aim to recruit a minimum of 500 patients across 10 hospital sites, collecting baseline data including: patient demographics; presence of comorbidities; relevant blood tests on admission; prescription of ACE inhibitors/angiotensin receptor blockers/non-steroidal anti-inflammatory drugs/immunosuppressants; smoking status; Clinical Frailty Score (CFS); length of hospital stay; mortality and readmission. All patients receiving inpatient hospital care >18 years who receive a diagnosis of COVID-19 are eligible for inclusion. Long-term follow-up at 6 and 12 months is planned. This will assess frailty, quality of life and medical complications.Our primary analysis will be short-term and long-term mortality by CFS, adjusted for age (18-64, 65-80 and >80) and gender. We will carry out a secondary analysis of the primary outcome by including additional clinical mediators which are determined statistically important using a likelihood ratio test. All analyses will be presented as crude and adjusted HR and OR with associated 95% CIs and p values. ETHICS AND DISSEMINATION: This study has been registered, reviewed and approved by the following: Health Research Authority (20/HRA1898); Ethics Committee of Hospital Policlinico Modena, Italy (369/2020/OSS/AOUMO); Health and Care Research Permissions Service, Wales; and NHS Research Scotland Permissions Co-ordinating Centre, Scotland. All participating units obtained approval from their local Research and Development department consistent with the guidance from their relevant national organisation.Data will be reported as a whole cohort. This project will be submitted for presentation at a national or international surgical and geriatric conference. Manuscript(s) will be prepared following the close of the project.


Subject(s)
Coronavirus Infections , Frail Elderly , Frailty , Multimorbidity , Pandemics , Pneumonia, Viral , Public Health/methods , Quality of Life , Adult , Aged , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Correlation of Data , Europe/epidemiology , Female , Frail Elderly/psychology , Frail Elderly/statistics & numerical data , Frailty/diagnosis , Frailty/epidemiology , Geriatric Assessment/methods , Hospitalization/statistics & numerical data , Humans , Male , Multicenter Studies as Topic , Observational Studies as Topic , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , SARS-CoV-2 , Survival Analysis
13.
JMIR Mhealth Uhealth ; 8(9): e21845, 2020 09 18.
Article in English | MEDLINE | ID: covidwho-781815

ABSTRACT

BACKGROUND: Technological communication methods such as telephone calls and video calls can help prevent social isolation and loneliness in frail older adults during confinement. OBJECTIVE: Our objectives were to determine which virtual communication method (ie, telephone call or video call) was preferred by confined older hospital patients and nursing home residents and the variables influencing this preference. METHODS: The TOVID (Telephony Or Videophony for Isolated elDerly) study was a cross-sectional study that was designed to examine the preference between telephone calls and video calls among frail older adults who were either hospitalized in a geriatric acute care unit or institutionalized in a long-term care and nursing home during the COVID-19 confinement period. RESULTS: A total of 132 older people were surveyed between March 25 and May 11, 2020 (mean age 88.2 years, SD 6.2); 79 (59.8%) were women. Patients hospitalized in the geriatric acute care unit were more able to establish communication independently than residents institutionalized in the long-term care and nursing home (P=.03) and were more satisfied with their communication experiences (P=.02). Overall, older people tended to favor telephone calls (73/132, 55.3%) over video calls (59/132, 44.7%); however, their satisfaction degree was similar regardless of the chosen method (P=.1), with no effect of age (P=.97) or gender (P=.2). In the geriatric acute care unit, the satisfaction degrees were similar for telephone calls (40/41, 98%) and video calls (33/38, 87%) in older patients (P=.10). Conversely, in the long-term care and nursing home, residents were more satisfied with the use of video calls to communicate with their relatives (14/15, 93%) versus the use of telephone calls (6/12, 50%; P=.02). CONCLUSIONS: Older people confined to health care settings were able to complete telephone calls more independently than video calls, and they tended to use telephone calls more often than video calls. The satisfaction degrees were similar with both modalities and even greater with video calls among long-term care and nursing home residents when they were given assistance to establish communication. TRIAL REGISTRATION: ClinicalTrials.gov NCT04333849: https://www.clinicaltrials.gov/ct2/show/NCT04333849.


Subject(s)
Consumer Behavior/statistics & numerical data , Coronavirus Infections/prevention & control , Frail Elderly/psychology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Social Isolation , Telephone , Videoconferencing , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Female , Frail Elderly/statistics & numerical data , Hospitalization , Humans , Loneliness , Male , Nursing Homes , Pneumonia, Viral/epidemiology
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