Introduction on Patient Monitoring and Wearable

Device Reference Designs

1
Agenda

• TI in medical

• Market trend

• Fundamentals and challenges

• Reference Designs (TIDA-01614, TIDA-010005 and etc)

2
TI Semiconductors in every medical category

Patient Medical Home

Medical Imaging Personal Care &
Monitoring & Equipment Healthcare
Fitness
Diagnostics

3
Patient Monitoring Market Trend

• The growing elderly population drives the high demand of

remote monitoring- In EU, 700B Euro spent on chronic disease per year

• Remote monitoring enhances quality of care and reduces healthcare cost

• Wearable wireless medical technology enables accurate and reliable data

in a smaller form factor: multi-modalities, longer battery, SHIP mode

• Artificial Intelligence uses analytics and big data to improve decision

making and early prevention

4
Patient Monitoring Basics

The electrocardiogram (ECG) Photoplethysmography

measure of electrical activity of the heart (PPG) is an optical
measurement of an organ’s
volume.

Arterial
volume

1 Heartbeat

5
Patient Monitoring Basics

• Pulse Transit Time (PTT) – time

interval between the R-peak of the ECG
and the max slope of the PPG
• Involves simultaneous ECG and PPG
measurements
• Systolic blood pressure (SBP) can be PTT

estimated from PTT

6
ECG vs. PPG

ECG Feature Description PPG

Electrical Measurement type Optical

Electrodes Sensor type Photodiode

Yes Can measure heart rate? Yes

Yes Diagnostic Information Yes

2 Minimum number of skin contacts 1

(Across chest) required? (Finger or wrist)

≥1 Number of ADC channels required 1

7
ECG Lead and ADC Channels Standards Electrodes Needed
IEC60601-2-51 – Diagnostics
1 Lead LA, RA
3 Lead LA, RA, LL
6 Leads LA, RA, LL
Number of ADC 12 Leads LA, RA, LL, V1-6
Number of Leads Leads Used
Channels

1 Lead I 1

3 Lead I, Lead II, Lead III 2

Lead I, Lead II, Lead III,

6 2
aVR, aVL, aVF

Lead I, Lead II, Lead III,

12 8
aVR, aVL, aVF, V1 – V6

8
ECG characteristics
Frequency domain

9
Challenges in measuring ECG

10
Challenges in Optical Bio-Sensing

§ Low power for longer battery life

§ Skin tone variation

§ Best PPG signal for Motion cancellation Algorithms

§ Performance with Glass

§ Low temperature performance

§ Ambient Light

11
Medical Sector Page on TI web

12
Medical Sensor Patches

13
Multiparameter Patient Monitor

14
Reference Design

Detailed Design
Considerations & Full
Applications Info Schematics
Comprehensive
Design Guides
Design Files
Bill
Of
Materials
TINA-TI
Boards Spice Simulation
Available for Comprehensive
Evaluation Test Results

15
TIDA-01614
Multiparameter front-end for vital signs patient monitor reference design
Features Benefits
• System measures ECG, Heart Rate, SPO2, • Single IC does both ECG ,Respiration.
Respiration rate using ADS1292R and AFE4403 and • Pace Detection
Skin temperature using TMP117 • ECG with 3 electrodes
• Circuit enables three electrode operation including right • Three temperature sensors for temperature
leg drive with good CMRR measurement
• Pace detection circuit indicates presence of pacemaker
• Supports three 0.1 Celsius accurate sensors (TMP117)
to measure the skin temperature
• Enables data transfer over isolated UART interface
• Works with 3.7V Li ion rechargeable battery
• On board memory for data logging

Applications
• Multiparameter Patient Monitor
• Medical Sensor Patches
• Pulse Oximeter
• Electrocardiogram (ECG)

16
17
Design Challenges TIDA-01614 Solves
Design Challenge 1: Design Challenge 2:
Integration of multiple modalities at optimum SNR Protection and isolation against ESD & defibrillation
levels and small form factor per IEC 60601-1-2

• Monitoring of ECG, Heart Rate, SPO2, • Using TVS0500 and series current limit
PTT, Respiration rate and Skin resistor. TVS0500 has lower clamping
temperature voltage to protect ADS1292R.
• Single Lead ECG with RLD (ADS1292R)
> Signal amplitude: 0.2mV~2mV (p-p);
> BW0.05 Hz to 2000 Hz
• Supports 3 LED and 3 Photodiodes with
ambient subtraction for SPO2 and Heart
Rate monitoring with AFE4403 • Isolated UART interface using an onboard
• Supports three 0.1 Celsius accurate MSP432P401, ISOW7842, TRS3232
sensors to measure the skin temperature
(TMP117)

18
 TIDA-01614: Multiparameter front-end reference design
ECG Analog Front End for vital signs patient monitor

Important Parameters:
• Input Bias Current
• Input Impedance
• Input Current Noise
• Input Voltage Noise
• Power Consumption
• DC/AC CMRR

19
TIDA-01614 Test Setup and Test Results

Design Specs

Test Setup

GUI Display

20
ADS1291/2
ADC specifications

• Low-noise, high input impedance front end

PGAs
• 24-bit simultaneous sampling delta-sigma ADCs
(data rates 125 SPS – 8 kSPS)
• 8 μV pk-pk noise (PGA gain = 6, BW = 150 Hz)
• CMRR: -105 dB
• Integrated Right-Leg Drive amplifier
• Integrated Lead-off detection
• Integrated respiration impedance measurement
(ADS1292R)
• Integrated test signals for verification
• Integrated low-drift ADC reference
• Integrated oscillator

21
TIDA-010005/Software-Configurable Cardiac Pacemaker Detection Module Reference Design
Features Benefits
• Programmable Thresholds for detecting rise time, • Detection of various types of pacemaker pulse provides
amplitude, duration and polarity of pace pulse the user one stop solution
• Availability of measured parameters and conditioned • Modular approach compatible with other patient
pace signal on I2C Bus for further analysis and monitoring TI Designs such as TIDA-01614
processing • Compact form factor
• Interface with TI’s ADS129X series of ECG front end • A flag signal and onboard LED are the indication of
devices presence of ‘valid’ pace signal.
• Detection of negative pulse by handling polarity of pace
pulse by software command

Applications
• Multi-parameter Patient Monitor
• Medical Sensor Patches
• Electrocardiogram (ECG)

Tools & Resources

• TIDA-010005 and Tools • Device Datasheets:
Folder ‒ INA317
• Design Guide ‒ TLV9062
• Design Files: Schematics, ‒ TLV1702
‒ DAC5578
BOM, Gerbers, Software.
‒ ADS7142

24
Design Challenges TIDA-010005 Solves
Design Challenge: Low noise, highly integrated signal path for ECG with lead-off and pace detection:
to detect amplitude, rise time, width and polarity for diagnostics with different makes of Pacemaker

• Pace signals have specific characteristics:

Amplitude: 2 mV to 700 mV
Rise Time: 10 µs to 200 µs
Pulse Duration: 100 µs to 2 ms
Polarity: +Ve or -Ve
• Major difficulty comes due to the small
amplitude, narrow-width and varying slope of
the pulse accompanied with noise consisting
of: the ECG signal itself, noise from muscle
movement due to beating of heart and
breathing, 50/60 Hz pickup from the
surroundings

25
Proposed Solution

Rise Time Measurement Scheme Pulse Duration Measurement Scheme

In order to define a ‘valid’ pace pulse, the system discriminates various signals by comparing it
to the user defined thresholds. The criteria for the same is:
• Amplitude > VAmp_th
• VRT_min < Rise Time Measure (VRT) < VRT_max
• VPT_min < Pulse Duration Measure (VPT) < VPT_max
VAmp_th, VRT_min, VRT_max, VPT_min and VPT_max comes from the DAC

26
TIDA-010005 Technical Details

Negative Pace Signal Detection - Negative Pace Pulse Undetected

Negative Pace Signal Detection Negative Pace Pulse Detected by setting the
DACs Polarity Check (CH 6) Output High

27
Test Pacemaker Detection with TIDA-010005 & TIDA-01614

28
TIDA-01580 Wearable, Wireless, Multi-Parameter Patient Monitor
Reference Design
Features Benefits
• Simple Wearable Multi-Parameter Patient Monitor for Photo- • PPG supports 4 LEDs and 3 PDs with Digital Ambient subtraction to
plethysmography (PPG) and Electrocardiography (ECG) improve the SNR
• Provides Raw data to calculate heart-rate, Oxygen Concentration in Blood • AC and DC lead off detection helps in correct measurement of vital signs
(SpO2) and Pulse-transit Time (PTT) • Continuous Monitoring with lower operating power ensures battery life of
• Uses Single-chip Bio-sensing Front-End AFE4900 for Synchronized ECG & 30 days
PPG • Flexibility of ultra low power modes and integrated FIFO can keep MCU
• PPG (Optical heart-rate monitoring and SpO2) supports 4 LEDs and
into sleep to increase the battery operation time
3 PDs with Digital Ambient subtraction to improve the SNR
• ECG (LEAD I) signals
• Integrated ARM Cortex-M3 + 2.4GHz RF Transceiver (CC2640R2F)
supports wireless data transfer – BLE 4.2 and 5
• Operated from CR3032 (3V, 500mA Coin Cell Battery) with battery life of 30
days using highly efficient DC/DC converters
• Small form factor helps in easy adaptation to wearable applications

Target Applications
• Wireless Patient Monitor Pulse Oximeter
• Wearable Fitness & Activity Monitor ECG

Tools & Resources

• Device Datasheets:
‒ AFE4900 - CC2640R2F
‒ TPS61098 - TPS63036
‒ TPD1E10B06

29
TIDA-01580 Medical Patches
This board is connected on
bottom of the main board

This side is touching

the wrist of one hand
(ELECTRODE 1)

Other hand can be touched on PAD

on top layer of the main board.
(ELECTRODE 2)
- LAUNCHXL-CC2640R2F receives the
signals remotely and displays on
LabView GUI
- The design uses BLE 5.0 with an
advertising time = 100ms

Side View

30
Design Challenges TIDA-01580 Solves
Design Challenge #1:
Integration of multiple modalities at optimum SNR levels and small form factor

• Capturing synchronized ECG and PPG to

enable PTT and BP calculations (non-
invasive and without cuff)
• Pulse Transit Time (PTT): Time difference
between the R-peak in the ECG waveform
and the arrival of the blood pressure wave
• Simultaneous measurement of ECG and
PPG together
• Along with other variables, such as the
patient’s size, weight, age, etc., algorithms
show the correlation between PTT and
systolic blood pressure.
• Challenging to synchronize both
measurements – timing is the key!
(Powering up, clock timing, phase, drift
with temperature)
31
Design Challenges TIDA-01580 Solves
Design Challenge # 2:
BLE connectivity that does not interfere with measurement accuracy

• Signal amplitude: 0.2mV to 2mV

(p-p)
• BW : as broad as 0.05 Hz to 300
Hz (Pace detection increases
the bandwidth further)
• Reject environmental electrical
signals, such as ac mains,
security systems, and RFI to
amplify and display the ECG
signal
• Good CMRR of the signal chain
and Right-leg drive (RLD) for
CM rejection
• Differential- and common-mode
filtering, environmental shielding,
and algorithms

32
Design Challenges TIDA-01580 Solves
Design Challenge # 3:
Extending battery life to multiple days to enable portability & wearability

• Selecting the right power architecture to

enable extended battery life up to 24
hours (for rechargeable batteries) or 7
days (for primary cells)
• Powering with right buck, boost or buck-
boost device instead of directly
powering from battery (bypass modes in
DC/DC converters)
• Sleep / shutdown / standby / deep sleep
modes for radio devices like BLE, Wi-Fi
etc.
• Selection of right battery charger
(charging rate, termination current and
quiescent currents are important!)

33
SHIP mode
• By definition: Ship mode electronically
disconnects the battery from the rest of the
system to minimize power drain while the
SHIP mode
product is idle. When the consumer turns the
product on for the first time, the battery connects
to the rest of the system and stays connected
until the system decides to put itself back into
ship mode.

Out of SHIP mode

• Existing TI collaterals:
– Implementing Ship Mode Using the
TPS22915B Load Switch
– Don’t let your battery drain on the shelf –
use ship mode
– Ship mode reference design (TIDA-
00556)
Example circuit
using load switch
Low-voltage switchers
• For battery operated patches, a buck-boost and/or a boost is required. Few proposed
devices are:
TPS63802 TPS63030 TPS63036 TPS61022 TPS61099 TPS61291 LMR61428
Vin (Min ) (V ) 1.3 1.8 1.8
Vin (Min ) (V ) 0.5 0.7 0.9 1.2
Vin (Max ) (V ) 5.5 5.5 5.5
Vout (Min ) (V ) 1.8 1.2 1.2 Vin (Max ) (V ) 5.5 5.5 5 14
Vout (Max ) (V ) 5 5.5 5.5 Vout (Min ) (V ) 2.2 1.8 2.5 1.24
Iout (Max ) (A ) 2 0.5 0.5 Vout (Max ) (V ) 5.5 5.5 3.3 14
Rating Catalog Catalog Catalog
Switch current limit (Typ ) (A ) 8 1 1 2.85
Buck-Boost
Topology Buck-Boost Buck-Boost Regulated outputs (# ) 1 1 1 1
Buck/Boost
Type Converter Converter Converter Switching frequency (Min ) (kHz ) 1000 2300 300
Switching frequency (Min ) (kHz ) 2500 2200 2200 Switching frequency (Max ) (kHz ) 1000 3000 2300 2000
Switching frequency (Max ) (kHz ) 2500 2600 2600
Iq (Typ ) (mA ) 0.027 0.0008 0.005 0.1
Iq (Typ ) (mA ) 0.011 0.025 0.025
Enable Enable Enable Enable
Light Load Efficiency Frequency Synchronization Frequency Synchronization Light Load Efficiency
Load Disconnect Light Load Efficiency Light Load Efficiency Load Disconnect
Features Power Good Load Disconnect Load Disconnect Features Synchronous Rectification Bypass Mode Enable
Pre-Bias Start-Up
Pre-Bias Start-Up Synchronous Rectification Synchronous Rectification
Synchronous Rectification UVLO Fixed UVLO Fixed
Synchronous Rectification
UVLO Fixed UVLO Fixed
Switch current limit (Typ ) (A ) 4.5 1 1 Duty cycle (Max ) (% ) 97 90 90 70
Duty cycle (Max ) (% ) 100 100 100
Operating temperature range (C ) -40 to 125 -40 to 85 -40 to 85
Package Group VSON-HR | 10 SON | 10 DSBGA | 8
 Full system | Multi-parameter patient monitor +
wireless sensors

Nurse’s Station /
Doctor’s Office

36
Why TI SimpleLink™ for Multi-parameter patient monitor +
sensor patch?
Low Power Ease of use Secure Small size

§ BLE SoC with § CC3135/CC3235 § FIPS 140-Level 1 § BAW: First crystal-less

integrated Ultra low Wi-Fi modules validation wireless BLE SoC
Power Sensor § 5GHz Wi-Fi to 12% area savings in
Controller § Offload CPU
reliably connect to reference design
bandwidth – HW
§ Wi-Fi low power IoT hospital network crypto accelerators § Tiny BLE SoC:
§ Best-in-class § BLE multi-role CC2640R2F
§ Secure boot 2.7mmx2.7mm DSBGA
standby current support
up to 32 simultaneous
connections

37
 Invest once, reuse effortlessly
100% code reuse

• Learn more about SimpleLink code portability

• SimpleLink Medical Resources

Common software
38
TIDA-010029
Wearable, 16-phase multi-sensor SpO2 and heart rate monitor (HRM) reference design with Bluetooth® 5

Features Benefits
• Provides raw data to calculate heart rate, SpO2, and other related • PPG supports 4 LEDs and 4 PDs with Automatic Ambient
parameters subtraction to improve the SNR
• Uses single-chip, bio-sensing, front-end AFE4420 device for PPG
• Continuous Monitoring with lower operating power ensures
measurement
battery life of 100 hours for continuous operation
• Enables signal acquisition of up to 16 phases and multi-
wavelength measurements with the flexible allocation of LEDs • Flexibility of ultra low power modes and integrated FIFO can
and photodiodes in each phase keep MCU into sleep to increase the battery operation time
• Integrated Arm® Cortex®-M3 and 2.4-GHz RF transceiver • Small form factor helps in easy adaptation to wearable
(CC2640R2F) supports wireless data transfer through Bluetooth® applications
low energy 4.2 and 5.0

Applications
• Pulse Oximeter
• Wearable Fitness and Activity Monitor
• Multiparameter Patient Monitor
• Medical Sensor Patches

Tools & Resources

• TIDA-010029 and/or Tools • Device Datasheets:

‒ AFE4420
Folder
‒ CC2640R2F
• Design Guide ‒ TPS63036
• Design Files: Schematics, ‒ TPS61099
BOM, Gerbers, Software, etc. ‒ TPD1E10B06

39
Design Challenges TIDA-010029 Solves
Design Challenge # 1:
Integration of multiple modalities at optimum SNR levels and small form factor

• Provides raw data to calculate heart rate,

SpO2, and other related parameters
• Supports 4 LEDs and 4 PDs with improved
the SNR
• External Light sources can disturb the
receive signal (Smart automatic ambient
light suppressing technologies – integrated
into the device)
• Standard pulse oximetry uses Red and IR
lights. The additional green and orange
wavelengths can distinguish to the
absorption of deoxyhemoglobin (RHb) and
oxyhemoglobin (HbO2).
• Physiology of the Human body (Skin tone
and body Location determines use case,
Transmissive vs reflective oximetry)
Source: An applicable approach for extracting human heart rate and oxygen saturation during physical movements using a multi-
wavelength illumination optoelectronic sensor system (Link)

40
Design Challenges TIDA-010029 Solves
Design Challenge # 2:
BLE connectivity that does not interfere with measurement accuracy

• Supports wireless data transfer through

Bluetooth® low energy 4.2 and 5.0 with
CC2642R
• CM chokes placed at the PD inputs to
reduce noise effects on very sensitive
signals coming from photo diodes
• Layout Optimization for AFE and BLE to
minimize interface while maintain the
measurement accuracy
• AFE4420 and CC2640R2F placed on
different layers with GND layer in between
for shielding
• Split ground for RF and AFE sections
• STAR grounding at the negative terminal
of the battery

41
TIDA-010029 board details

42
TIDA-010043: Efficient, high-current, linear LED driver reference design for SpO2 and
other medical applications
Features Benefits
• Higher efficiency by providing headroom control to optimally
• Built-in self-calibration and look-up table for headroom
drive LED
• Diagnostics (LED open, LED short, LED disconnect) and
control
protection mechanism for fault by disconnecting the supply • Dynamic adjustment of the LED supply voltage, to achieve
using e-fuse optimal efficiency at the programmed current levels
• Wide operating input range from 1.8 V to 5.5 V to support all
battery type inputs
• Programmable range selection for LED current (from 100 mA
to 1.5 A)
• Compatible with AFE44xx series EVMs (tested with AFE4403
EVM) for driving LEDs
• Tested with MSP430G2553 LAUNCHPAD™ and two on-
board LEDs (green and red)
Target Applications
Pulse oximeter Multiparameter patient
monitor
Endoscope Surgical equipment
Tools & Resources

Device datasheets:
• TPS63802 TPS2595
• CSD13306W CSD13202Q2
• TMUX1119 TLV7021
• OPA333
OPA365

43
Design Challenges TIDA-010043 solves
Design Challenge: Accurate SpO2 measurement across varying photodiode placements, wavelengths and body
physiologies through optimizing LED driving circuit and photo-diode signal chain at low power

• External Light sources are disturbing the

receive signal (Smart ambient light
suppressing technologies – integrated into
the device)
• Physiology of the Human body (Skin tone and
body Location determines use case,
Transmissive vs reflective oximetry)
• Optical Signal Path (Define optimal Photo
Diode size & LED wavelengths, use multiple
sensors and PDs, optimum in PD / LED
spacing)

44
TIDA-010043 Technical Details – flowchart
These are number of steps for calibration
These are course and fine levels for setting
the PWM to set the LED supply voltage
(Each step in calibration has to go through
course and fine level adjustment)

Check FET_SAT to confirm if the step is

over and to go to next step in calibration

45
TIDA-010043 Technical Details – Calibration
No. of steps
15 for calibration
(before calibration) 11 12 13 14
10
4.7V 8 9
5 6 7
Software steps for 4
1 2 3
calibration (the
current through (after calibration)
LED will increase
by 100mA for
2.8V
each step)
Each calibration step has
course and fine levels for
setting the LED supply voltage
TPS63802 Vout
(LED Supply
Voltage)

FET_SAT signal
(used for sensing
if the LED current
is gone out of
linear region)

46
TIDA-010043 Technical Details – block diagram

Calibration
loop

47
TIDA-01624 Bluetooth-Enabled High Accuracy Skin Temperature
Measurement Flex PCB Patch
Features Benefits
• High Accuracy, Low Power Temperature Sensor • Low power consumption and long battery life
• BLE 4.2 and 5 enabled microcontroller • Extremely long shelf life (3+ Years)
• Thin-Film Flexible Battery Power, enabling entirely • Small, Flexible Form Factor
flexible design • Connects to Smart Device
• Integrated PCB antenna • Zero-Calibration to ±0.1°C Accuracy
• Temperature updates every second

Applications
• Medical Sensor Patches
• Multiparameter Patient Monitors
• Smart Patches
Skin
Tools & Resources Temperatur
e
• TIDA-01624 and/or Tools • Device Datasheets: TMP117
Folder ‒ TMP117 I2C
• Design Guide ‒ CC2640R2F
• Design Files: Schematics, BLE MCU
BOM, Gerbers, Software, etc. CC2640R2F
TMP117x
Ultra-High Accuracy Digital Temp Sensor with integrated non-volatile memory
Features Benefits
Accuracy Ultra-high Accuracy
• Meets ASTM E1112 & ISO medical standards:
Accuracy • 0.1°C acc. range 35.8°C to 42°C
TI Part Accuracy (°C) Full Range • No calibration needed; NIST Traceable
Integrated Non-volatile memory
TMP117M ±0.1oC @ (30oC to 45oC) ±0.2oC @ (0oC to 85oC) • Store configuration even after losing power
±0.1oC @ (-20oC to ±0.3oC @ (-55oC to • 64 Bits of general purpose scratch pad memory
TMP117 50oC) 150oC) Low Power Consumption
TMP117N ±0.2 C @ (-40 C to
o o ±0.3 C @ (-55oC to
o • 3.5uA Average Iq @ 1Hz; serial bus inactive
100oC) 150oC) • 150nA Shutdown Iq; serial bus inactive
Digital feature & I2C Interface:
• 16-bit Resolution (0.0078°C) • Programmable Temperature Alert & Offset value
• Minimum PSRR: 1LSB = 7.8 m°C/V • Soft Device Rest
Integrated EEPROM Smallest Package: 6 PIN, QFN & CSP

Low power consumption

• 140uA Iq during conversion
• 3.5uA Average Iq @ 1Hz
• 150nA Shutdown Iq
• 1.8V – 5.5V
Digital feature: Automatic offset NVM/ Soft Reset
Interface: Single wire
Packaging
• 6pin WSON (2 x 2) mm
• 6pin WCSP (1.6 x 1) mm

Applications
• Gas Meter • Wearables
• Medical • Instrumentation & Test
• Cold Chain • Thermocouple – Reference
TIDA-010040 / Alarm tone generator reference design

Features Benefits
• Provides a solution that can be used for producing auditory • Timing parameters are all adjustable via firmware
alarms described in the IEC60601-1-8 medical specification. • Minimal code-space used allows for low-cost MSP430
• Capable of outputting low, medium, and high priority alarms with • Booster pack design makes for easy setup
software-adjustable rise/fall time, pulse duration, pulse spacing,
and burst spacing
• Can output 8 different alarm melodies as described in the
IEC60601-1-8 spec.
Target Applications
• Coincidence Detector confirms if speaker is actually making • Multiparameter Patient Monitor Infusion Pump
correct sound • Dialysis Machine AED Surgery Equipment

50
Key Design Challenge: Technical details
IEC60601-1-8 based medical alarm tone generation & coincidence detection

• Provides a solution that can be used for producing auditory

alarms described in the IEC60601-1-8 medical specification.

• With a Low cost microcontroller and some external

hardware, Analog Burst patterns are created. The Rise
and Fall times, the Amplitude ,width and Frequency of
these Bursts are all programmable.

• The Alarm made by the circuit when attached to a Patient

monitor might be indicative of a Medical condition such as
a Heart attack. Therefore it is very important that the Alarm
itself has some kind of monitoring of its operation.

A microphone is Placed close to the speaker and it monitors

the sounds made by the Alarm. If the Actual sound received
by the microphone is not the same as the sound intended by
the circuit an error flag is raised. This is called Coincidence
detection
Coincidence
Detection

51
TIDA-010040 – Coincidence Detection

52
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