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BackgroundHuntington’s disease has a poor prognosis. For HD patients in the Netherlands, one way of dealing with their poor prognosis is by drawing up an advance euthanasia directive. Little is known about the perspectives of HD patients on their AED.AimTo gain insight into patients’ views on and attitudes towards their AED, and changes over time.MethodsA longitudinal qualitative interview study using 1 to 6 semi-structured interviews over a period of maximum three years. Nine HD patients who either had an AED or (...) were thinking about drawing it up participated in this study.ResultsWe identified two themes that characterize patients’ perspectives on their AEDs: general character of the AED; uncertainty around their AED. Ad The conditions that the participants described in their AED were generally not very specific for the person. Mostly they were general notions of unbearable suffering. Familiarity with HD in the family could play a role in drawing up an AED. Ad Participants generally were aware of the tentative character of their AED and could have doubts concerning their own willingness or the willingness of others in the future. Sometimes these doubts were so great, that it prevented them from drawing up an AED. However, patients did not alter their AED during the follow-up period or changed in their view or attitude on their AED.ConclusionHD patients that draw up an AED usually describe general conditions for euthanasia and recognize that these conditions may change as the disease progresses. An AED or the wish to draw one up may be a good conversation starter for conversations about goals and preferences for future care. (shrink)

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Background: In the Netherlands, people with severe cognitive deficits due to Korsakoff syndrome are generally admitted to a specialized nursing home. Professional caregivers experience that these residents are often not aware of their deficits, and consequently, their willingness to accept care is relatively low. However, these residents need permanent support when performing daily tasks due to severe cognitive deficits. The combination of objective care needs and low subjective responsiveness makes caring for people with Korsakoff syndrome a complex undertaking. It is (...) unknown how professional caregivers deal with this complex task and how they manage the associated ethical challenges. Objectives: The aim of this study was to explore the professional caregivers’ perspectives on good care for residents with Korsakoff syndrome. Methods: A qualitative study design was used. Data were collected via semi-structured interviews. The Framework Method was used for the thematic analyses of the interview data. Participants and research context: Five specialized nursing homes participated in this study. Twelve professional caregivers, including nurses, nursing assistants, and support workers, were selected based on the ability to provide rich information on the study topics and to capture a variety of demographic and professional characteristics. Ethical considerations: The institutional review board of the VU University Medical Center Amsterdam approved the research protocol. The study was conducted in accordance with the ethical principles for medical research involving human subjects. Findings: Three perspectives on good care emerged: (1) making daily life a joint effort, (2) being steadfast, and (3) treating with respect. Discussion and conclusion: Professional caregivers try to achieve responsiveness in people with Korsakoff syndrome in three different ways. These perspectives reflect fundamentally different views on the care relationship and the autonomy of the resident. By elucidating the three perspectives, we hope to promote the practitioners’ reflection on their own ideas about good care for people with Korsakoff syndrome. (shrink)

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This article revisits a reduced model of cardiac electro-physiology which was proposed to understand the genesis of unidirectional block pathology and of ectopic foci. We underline some specificities of the model from the viewpoint of dynamical systems and bifurcation theory. We point out that essentially the same properties are shared by a simpler system more accessible to analysis. With this simpler system, it becomes possible to give a new presentation of the phenomenon in a phase plane with time moving slow (...) manifolds. This presentation can be of interest both for cardiac electro-physiologists and for mathematicians. (shrink)

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The ternary xV2O5–(40 − x)Li2O–60B2O3 glass system, where x = 1, 2, 3, 4 and 6 mol%, was prepared by normal quenching. Ultrasonic velocities and attenuation were measured at room temperature using a pulse-echo technique. Various parameters, such as elastic moduli, micro-hardness, Poisson's ratio and Debye temperature, were determined from the measured densities and velocities. The composition dependence of these parameters, in addition to the glass-transition temperature, suggested that vanadium ions were incorporated into these glasses as a network modifier, resulting (...) in the reconversion of BO4 tetrahedra to BO3 triangles by the breaking of B–O–B linkages and the formation of nonbridging oxygens (NBOs). The outcome was a reduction in network connectivity and rigidity with increasing V2O5 content. The results are explained quantitatively in terms of fractal bond connectivity, average atomic volume, network dimensionality, packing density, number of network bonds per unit volume, cross-link density and atomic ring size. The Makishima and Mackenzie model appears to be valid for the studied glasses when the fate of BO4 tetrahedra and creation of NBOs are taken into account. (shrink)

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El impacto de las tecnologías de la información y la comunicación, TIC, ha abierto, un campo de posibilidades casi ilimitadas para comunicar y compartir la información. Entre las iniciativas creadas merece destacarse la de “OpenCourseWare (OCW)” movimiento de la iniciativa OCW-MIT, la cual proporciona un acceso libre, sencillo y coherente a los materiales docentes para educadores con carácter no lucrativo, a estudiantes y autodidactas de todo el mundo. Existen muchas razones para afirmar que la mejora del acceso libre a la (...) creación y a la comunicación de la información, es positiva para los seres humanos como en Floridi, 2002. Este artículo, recoge varios años de trabajo en la enseñanza del Álgebra y la Geometría para ingenieros. Todo esto se enmarca dentro de la tecnología de un aprendizaje invisible. Bajo este enfoque, se busca la creación de futuros relevantes aplicados a las matemáticas, fomentando la creación, ampliación y accesibilidad en un entorno informacional como en Cobo y Moravec, 2011. (shrink)

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BackgroundWith advances in sequencing technologies, increasing numbers of people are being informed about a genetic disease identified in their family. In current practice, probands are asked to inform at-risk relatives about the diagnosis. However, previous research has shown that relatives are sometimes not informed due to barriers such as family conflicts. Research on family communication in genetic diseases aims to explore the difficulties encountered in informing relatives and to identify ways to support probands in this.Main bodyResearch on family communication may (...) also reveal that participants did not inform their relatives about the risk of a serious genetic condition, even when preventive and treatment options are available. Researchers may then face a dilemma: Do they need to warn at-risk relatives about the finding? Or do they keep silent due to prior confidentiality agreements with study participants?ConclusionsWe believe that the absolute confidence promised to research participants outweighs the interests of their relatives, even though it can be claimed that relatives at risk of a genetic disease do, in principle, have a right to know information collected about their health. Not respecting confidentiality agreements could cause distrust between researchers and research participants and possibly harm the relationship between probands and relatives. Relatives' health interests can still be taken into account without jeopardizing participant trust, by considering alternative scenarios, including sharing general study findings on the barriers participants experience with their healthcare professionals and by offering participants psychosocial support for family communication. (shrink)

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The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

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We discuss our surgical philosophy concerning the subtle interplay between the size of the surgical margin taken and the resultant morbidity from ablative oncological. procedures, which is ever more evident in the treatment of head and neck malignancy. The extent of tissue resection is determined by the "trade off" between cancer control and the perioperative, functional and aesthetic morbidity and mortality of the surgery. We also discuss our dilemmas concerning recent minimally invasive endoscopic microsurgical. techniques for the trans-oral laser removal. (...) or co-ablation of aero-digestive tract tumours, which result in a minimal. surgical margin of oncological clearance. By a process of inductive argument as to the nature of the surgical margin, we consider whether the risks of taking a lesser margin with adjuvant therapy is justified by the attendant gain in reduced surgical morbidity and the possible costs in tumour control. (c) 2006 Elsevier Ltd. All rights reserved. (shrink)

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With a large number of forcibly displaced people seeking safety, the EU is facing a challenge in maintaining solidarity. Europe has seen millions of asylum seekers crossing European borders, the largest number of asylum seekers since the second world war. Endemic diseases and often failing health systems in their countries of origin, and arduous conditions during transit, raise questions around how to meet the health needs of this vulnerable population on arrival in terms of screening, vaccination, and access to timely (...) and appropriate statutory health services. This paper explores the potential role of the principle of reciprocity, defined as the disposition ‘to return good in proportion to the good we receive, and to make reparations for the harm we have done’, as a mid-level principle in infectious disease screening policies. More than half of the European countries implemented screening programmes for newly arrived asylum seekers. Screening may serve to avoid potential infectious disease risks in the receiving countries as well as help identify health needs of asylum seekers. But screening may infringe upon basic rights of those screened, thus creating an ethical dilemma. The use of the principle of reciprocity can contribute to the identification of potential improvements for current screening programmes and emphasizes the importance of certain rights into guidelines for screening. It may create a two way moral obligation, upon asylum seekers to actively participate in the programme, and upon authorities to reciprocate the asylum seekers’ participation and the benefits for the control of public health. The authors argue that the reciprocity principle leads to a stronger ethical justification of screening programmes and help achieve a balance between justifiable rights claims of the host population and the asylum seekers. The principle deserves a further and more thorough exploration of its potential use in the field of screening, migration and infectious diseases. (shrink)

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Palabras claves. Métodos estadísticos, pruebas de hipótesisResumen. Se presentan de forma simple, breve y por medios de los ejemplos prácticos, los métodos estadísticos que sirven para demostrar la representatividad de una, dos o varias muestras basada en los parámetros poblacionales . Se indican la manera de reducir el tamaño del error experimental para aclarar el efecto significativo de los grupos o muestras bajo el interés . Además, se demuestran la forma de eliminar el efecto de las variables auxiliares o colaterales (...) causante del ruido o error en la estadística . También se nota el uso del modelo ANOVA Anidada para indicar la forma de segmentar la ANOVA en varias partes y de esta manera poder contestar preguntas más complejas. Finalmente, se describen e explican la forma de optimizar los recursos en la conducción de los experimentos y descubrir el efecto de la interacción entre las variables .Keywords. Hypothesis testing, statistical methods. Statistical methods that serve to represent, based upon population parameters of mean and variance, for one, tow or various samples taken from study populations are discussed. Ways to reduce the amount of experimental error in order to clarify the real effect of the treatments are demonstrated . The use of Covariance Analysis to show the pure effect of treatment free from the effect of collateral variables is also indicated. Nested ANOVA that allows division of ANOVA in several parts in order to answer complex questions is described and explained. Finally, the utility of Factorial Analysis for optimization of resource use as well as the illustration of interaction effects are noted and analyzed. (shrink)

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We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

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Conceived as a set of preliminary explorations to a future study of the problem of meaning and reference by the author, these "inquiries" clarify some questions raised by the specialists in linguistics, caution us about other questions that seem only too easily settled, and generally show, with great abundance of detail, the status of contemporary research on language. Much like Husserl's Logical Investigations, which pioneered the study of correspondences between grammar and logic-ontology, these explorations proceed in a zigzag sometimes emphasizing (...) semiotic issues ; other times tackling important syntactic and semantic problems ; and once coming close to an ontological characterization of language and of the human subject insofar as it uses language. Two features of this work are noteworthy. The first is the abundance of documentation as shown in the multitude of notes: the efforts of Ferrater Mora will spare many hours of work for those who need a guide in "the labyrinth of language." A second feature is the virtuoso performance by the author in the manipulation of, and exemplifications from, a variety of languages. Indagaciones sobre el Lenguaje certainly deserves publication in English.--A. de L. M. (shrink)

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Colorado has consistently had one of the highest rates of suicide in the United States, and El Paso County has the highest number of suicide and firearm-related suicide deaths within the state. Community-based solutions like those of the Suicide Prevention Collaborative of El Paso County may be more effective in preventing suicide as they are specific to local issues, sensitive to local culture, and informed by local data, community members, and stakeholders.

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A partir de una encuesta por correo electrónico a estudiantes de Ingeniería en el SAI de la UAMA en un contexto de enseñanza remota forzado por la pandemia, se caracteriza la gestión de la docencia, desde la visión de los estudiantes, se realiza un diagnóstico de los aspectos relacionados. Es un estudio transversal con un análisis cualitativo y descriptivo de las respuestas. La gestión docente se ve afectada por factores inherentes al proceso, así como también por factores externos. Los resultados (...) obtenidos muestran que fue impactada fuertemente al realizarse el proceso totalmente vía remota especialmente, la comunicación e interacción alumno-profesor. (shrink)

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İmam Mâlik (ö. 179/795) ve öğrencilerinin fıkhi faaliyetleri sonucu ortaya çıkan Mâlikî Mezhebi kendi içinde gerek coğrafik gerekse de metodolojik nedenlere bağlı olarak Mısır, Kayravân, Medîne, Endülüs ve Irak gibi farklı ekollere ayrılmıştır. Her ekolün kendine göre geleneği, bu geleneğin tesis ve teşekkülünde etkili olan isimler ve ilim halkaları söz konusudur. Kayravân ekolünün tesis edilmesinde ve temellerinin atılmasında öne çıkan birçok Malikî fakîhi bulunmaktadır. Genel olarak Mâlikî Mezhebi’nin tamamında ön plandaki isim olan Sahnûn b. Saîd (ö. 240/854) esasen Kayravân ekolünün (...) temsilcisidir ve telif ettiği el-Müdevvenetü’l-kübrâ da ekolün temel başvuru kaynağıdır. Ekol içinde yapılan telif çalışmaları daha ziyade el-Müdevvene merkezli olmuş, metin üzerinde birçok şerh kaleme alınmıştır. Makalenin konusu olan Ebü’l-Hasan el-Lahmî (ö. 478/1085) ve öğrencileri ise bu ekolün teşekkül sürecinde etkili olmuşlardır. Lahmî’nin ilmi birikimini kaleme aldığı et-Tabsira isimli eser de el-Müdevvene üzerine yapılmış şerhlerden biridir. Bu çalışmada Lahmî’nin hayatı, ilmi şahsiyeti, telifleri ve Kayravân Mâlikî ekolünün teşekkül sürecindeki yeri incelenecektir. (shrink)

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Gilbert Romeyer Dherbey, qui avait succédé à Pierre Aubenque à la chaire de philosophie antique de Paris IV, et qui a su maintenir très haut le rayonnement international du Centre de recherches sur la pensée antique, plus familièrement appelé Centre Léon Robin, n'est pas seulement un aristotélisant subtil et exigeant. Il a toujours refusé une pure érudition qui oublierait de se relier à une pensée philosophique. Et par là même, peut-être, il déborde le cadre strictement universitaire de la spécialisation, d'abord, (...) non seulement à l'intérieur du domaine grec, avec notamment son approche des présocratiques, mais surtout comme éditeur et interprète reconnu de Maine de Biran, et aussi par son goût de la littérature, que trahit une élégance stylistique heureusement toujours féconde. C'est pour rendre hommage au professeur et à l'homme, que nous nous sommes réunis à Lyon, au printemps 2008, autour de lui, son propre professeur de khâgne, M Gourinat, son camarade de toujours, J-F Marquet, ex-collègue de Paris IV, le maître des études hégéliennes qu'est B Bourgeois, les collègues, les amis, les anciens élèves, que sont B Saint Girons, M Protopapas, A-G Wersinger, A Devarieux, J-J Duhot, J-F Mattéi, J Frère, M Rashed, A Villani, F Baghdassarian. (shrink)

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RESUMEN: Este trabajo tiene como finalidad destacar la contribución específica de H.L.A. Hart sobre el problema del positivismo jurídico. A juicio del autor, el tratamiento que Hart dio a la polémica entre positivismo jurídico y Derecho Natural estuvo marcada por dos extremos aparentemente contradictorios. Por una parte, se abocó a clarificar las diversas tesis que anidan tras la etiqueta “positivismo jurídico”, así como las posiciones que suelen referirse como tales. Al hacerlo abrió el camino para mostrar en qué sentido no (...) resulta ilógico defender algunas tesis asociadas al mismo o negar otras. Por otra parte, y si bien no asumió una posición que afirmase la conexión necesaria entre Derecho y moral, se ocupó también de mostrar en qué sentido tal conexión existe y es importante. Con dicho objetivo, en el primer apartado se ofrece una reconstrucción detallada sobre el tratamiento que Hart hizo sobre el problema del positivismo jurídico. En el segundo se expone el tratamiento del autor sobre el iusnaturalismo, con la intención de comprender el lugar preciso e implicaciones de su conocida tesis del “contenido mínimo Derecho Natural”. En la tercera parte se aborda la teoría elaborada por Hart sobre el positivismo jurídico, esto es, el “positivismo jurídico hartiano” y las tesis por él defendidas. Importante aquí será su posición respecto a la posibilidad de que la regla de reconocimiento pueda incorporar criterios materiales para la identificación jurídica que nos introduce en una nueva etapa de la nunca acabada polémica. ABSTRACT: The aim of this work is to address H.L.A. Hart’s contribution to the problem of legal positivism. According to the author, Hart’s approach to the controversy of Natural Law/Legal Positivism was characterized by two apparently opposing ends. On the one hand, he clarified the label “Legal Positivism” as well as other approaches that are usually referred as such. In doing so, he paved the way to show in which sense it is not illogical to defend some theses associated with it and in which sense it is not. On the other hand, despite he did not take a stand for the necessary connection between Law and Morals, he did show in what sense such connection may exist and why it is important. To this end, section one offers a detailed reconstruction of Hart’s approach to the problem of legal positivism. In section two the author’s approach to Natural Law is explained so that his well-known thesis of “The Minimum Content of Natural Law”, and what it implies, is properly understood. Section three is devoted to Hart’s theory of Legal Positivism that is “Hartian Legal Positivism”, where his main claims are presented. Hart’s claim on the possibility for the rule of recognition to incorporate material criteria for legal identification or legal validity is particular relevant because it introduces us to a new stage of the never-ending controversy. PALABRAS CLAVE: H.L.A. Hart, positivismo jurídico, teorías de derecho natural, positivismo jurídico incluyenteKEYWORDS: H.L.A. Hart, legal positivism, natural law theories, inclusive legal positivism. (shrink)

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Se presenta una aplicación desarrollada en Visual Basic para Microsoft Excel 2010 con el propósito de ofrecer una herramienta que ayude al profesorado en las labores de calificación de pruebas de evaluación continua a lo largo de un curso en conjunción con la plataforma Moodle. Se describe también su aplicación a una asignatura concreta.

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En este trabajo se ofrece un bosquejo biográfico de H. L. A. Hart así como una reconstrucción del contexto cultural y filosófico en el que forjó su pensamiento. En la primera parte se proporcionan los datos más relevantes de su biografía, entre los que destaca su participación en los servicios de inteligencia durante la Segunda Guerra Mundial. Posteriormente, el trabajo incursiona en el panorama filosófico británico de principios del siglo XX, durante la llamada revuelta anti-idealista, que es donde se ubican (...) los orígenes de la moderna filosofía analítica. Es allí donde encontramos los antecedentes del método filosófico de Hart; concretamente, en la corriente de la filosofía del lenguaje ordinario encabezada por J. L. Austin. El autor concluye con una serie de testimonios del propio Hart donde se evidencia lo anterior y plantea algunos temas para futuras investigaciones. (shrink)

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Al-Ḥurūf al-Muqaṭṭaʿa, which are at the beginnings of the 29 sūrahs of the Qurʾān and consist of 14 letters, have been a subject of curiosity since the time of the Successors. About al-Ḥurūf al-Muqaṭṭaʿa, as they appear with a non-existent usage in Arabic language - at least within our knowledge of the language so far - more than twenty interpretations have been made. Islamic scholars who thought that they could not understand these letters, have included them in the category of (...) Mutashābihāt, which has been beyond our limit of comprehension and have treated these letters as they were, without interpretation. These letters, which are included in the research field of linguistics, indeed have caused a problem of coherence since they have been under the same heading with the transcendental subjects of Mutashābihāt such as the attributes of God, knowledge of the future, Heaven, Hell, Angels. On the one hand, this problem has forced the commentators to interpret al-Ḥurūf al-Muqaṭṭaʿa out of their usual way which cannot be explained comparing their general interpretation styles. On the other hand, these letters have taken their place among the indispensable subjects of Orientalist Qur'anic studies that highlight their mysterious qualities. (shrink)

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Makalede, İbn-i Kemâl’in “Risâletun fî Beyâni’l-Uslûbi’l-Hakîm” adlı risalesinde “el-üslûbu’lhakîm” belâğî sanatını incelemesi ele alınmıştır. es-Sekkâkî’nin isim babası olduğu söz konusu sanatın tanımı, örnekleri ve özellikle Kur’ân’daki yansımaları eserin genel konularıdır. es-Sekkâkî’nin tanımıyla sunduğu bazı örnekler arasında tam bir uygunluk olmadığına dikkatleri çeken müellif, konuyu daha doğru bir zemine oturtabilmek için öncelikle mevcut tanımı ıslah etmeye gayret etmiştir. es-Sekkâkî’nin örneklerini her iki bakış açısıyla tartışan Kemâl Paşazâde, yeni örnekler sunarak ilgili sanatın anlaşılmasına önemli katkılarda bulunmuştur. Ayrıca müellifin, âyetlerin daha doğru anlaşılması (...) için metin ve bağlam sentezlemesinin nasıl yapılacağına dair uygulama örnekleri tefsir açısından kıymetli veriler taşımaktadır. (shrink)

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