Lewis Blackman Paper Graded Essay Sample

The Lewis Blackman Case: Ethical motives. Law. and Implications for the Future Medical mistakes in determination devising that consequence in injury or decease are tragic and dearly-won to the households affected. There are besides negative impacts to the medical suppliers and the associated establishments ( Wu. 2000 ) . Patient safety is a basis of higher-quality wellness attention and nurses serve as a communicating nexus in all scenes which is critical in surveillance and coordination to cut down inauspicious results ( Mitchell. 2008 ) . The Lewis Blackman Case 1 of 1 point accrued

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On Thursday November 2. 2000. 15 twelvemonth old Lewis Blackman checked into Medical University of South Carolina Children’s Hospital ( MUSC ) in Charleston for elected surgery on his thorax excavatum. a inborn malformation of the anterior thorax ( Monk. 2002 ) . Due to issues with insurance coverage. a twelvemonth had elapsed since Lewis and his parents’ last assignment with the sawboness ; nevertheless. the office had non required another rating prior to his surgical day of the month ( Kumar. 2008 ) . During the pre-operative consumption procedure a nurse asked Lewis how much he weighed alternatively of executing an existent measuring ( Kumar. 2008 ) . After take a firm standing on a current value Helen discovered that his weight was 120 lbs. less than he had admitted to ( Kumar. 2008 ; Monk. 2002 ) .

While Lewis was in surgery. his household became progressively worried when the estimated surgical clip elapsed without word ( Kumar. 2008 ) . Dr. Tagge. the lead sawbones. eventually updated the household over two and a half hours subsequently saying that Lewis did good even though he had to shift the metal saloon four times for right arrangement ( Kumar. 2008 ; Monk. 2002 ) . Helen reported inquiring if Dr. Tagge had realized how much Lewis’ chest depression had deepened since he last saw him a twelvemonth ago in the office. particularly sing he did non put eyes on Lewis until he was under anesthesia the twenty-four hours of surgery ( Kumar. 2008 ) . In the recovery room. Lewis was witting and watchful with good critical marks. naming his hurting as a three out of 10 ( Monk. 2002 ) . Nurses and physicians in the recovery country charted that he had non produced any piss in his catheter despite endovenous hydration ( Kumar. 2008 ; Monk. 2002 ) . Epidural opioid analgesia was administered post-operatively for hurting control. but was supplemented every six hours by endovenous Toradol ( Ketorolac ) ( Kumar. 2008 ; Solidline Media. 2010 ) .

Following his recovery from surgery. Lewis is was sent to the children’s oncology unit related to a deficit of available beds on the surgical floor ( Monk. 2002 ) . Saturday forenoon at 9:00am. a new doctor. Dr. Hebra. assessed Lewis since Dr. Tagge had gone for the weekend ( Monk. 2002 ) . His charting included no grounds of infection and clear lung sounds with a recommendation to see acquiring out of bed ( Monk. 2002 ) . That flushing a little febrility developed and Lewis was noted to hold cold pess ; he was still besides having endovenous Toradol ( Monk. 2002 ) . Sunday. the 3rd twenty-four hours out of surgery. Lewis developed sudden terrible abdominal hurting which staff referred to as gas strivings and recommended that he walk around the ward ( Solidline Media. 2010 ) . Throughout the twenty-four hours Lewis appeared to be acquiring weaker with the following symptoms: lividness. continued hurting. perspiration. and an progressively conceited and steadfast venters ( Monk. 2002 ; Kumar. 2008 ) .

Helen repeatedly asked for an go toing doctor to measure him after her initial petition was answered by a new. first twelvemonth occupant ( Solidline Media. 2010 ) . Dr. Murray. the main occupant who arrived about 8:00pm. charted Lewis’ bosom rate as normal and noteds a likely intestinal obstruction ; nevertheless. nursing certification at the same clip recorded a bosom rate of 126 beats per minute ( Monk. 2002 ) . Subsequent bosom rates at midnight and 4:00am arewere charted as 142 and 140 beats per minute severally without documented intercession ( Monk. 2002 ) . On Monday forenoon Lewis noted that his hurting all of a sudden stopped after being really changeless and staff charted that they were unable to acquire a blood force per unit area entering in either arm or leg from 8:30-10:15am despite seeking multiple machines ( Monk. 2002 ; Solidline Media. 2010 ) .

At midday. while staff were holding trouble trying to pull blood. Lewis became unresponsive. Helen called for aid and Dr. Murray arrived to the room ( Monk. 2002 ) . A codification was called and the on-call doctor. Dr. Adamson. arrived and later attempted to revive Lewis for an hr before naming a clip of decease at 1:23pm ( Kumar. 2008 ; Monk. 2002 ) . An necropsy subsequently revealed that Lewis Blackman died from internal hemorrhage caused by a pierced ulcer with stopping point to three litres of blood and digestive fluid in
his venters ( Monk. 2002 ) . Ethical motives and Relation to Nursing 1. 75 of 2 points accrued

The nurse has a moral duty to make good and avoid injury to the patient ( Westrick & A ; Dempski. 2009 ) . While non knowing or direct. the nurses caring for Lewis Blackman failed to continue certain facets of their criterions of attention and responsibility which resulted in his continued diminution in heath and eventual death. Inadequate weekend staffing may hold played a portion. but the liberty of Lewis’ female parent was removed when true information was withheld. or non decently disclosed. by both wellness attention suppliers and nursing staff ( Westrick & A ; Dempski. 2009 ) . The Institute of Medicine ( IOM ) ( 2004 ) studies that among healthcare suppliers. nurses are most likely to both prevent and place complications hence triping appropriate responses in a timely mode. This is frequently referred to as “rescuing” the patient from complications ( IOM. 2004 ) . Unfortunately in this instance. nursing attention fails to run into appropriate criterions of attention.

The nurses caring for Lewis Blackman fell abruptly in several ways including: unequal appraisal of the patient. unequal preparation for the assignment. and unequal communicating ( Westrick & A ; Dempski. 2009. p. 23 ) . Most of these countries are related to failures in the nurses’ independent legal responsibility to the patient to do an accurate. thorough appraisal. If concern or impairment in status is noted. nurses have to exert this independent responsibility to look into and use the chain-of-command when the nurse moderately believes injury will ensue by following orders ( American Nurses Association [ ANA ] . 2001 ; Westrick & A ; Dempski. 2009 ) . The nurses caring for Lewis should hold known the physicians’ orders and program were incongruent did non fit up with their appraisals. the patient’s ailments. or and his mother’s concerns.

The patient suffered injury from their inactivity and they placed themselves at hazard of being held apt under this responsibility ( Westrick & A ; Dempski. 2009 ) . In add-on. while non qualified to decide differences sing diagnosing or intervention. nurses have a responsibility to be a patient advocator and to cognize self-limitations ( Hanks. 2008 ; Hewitt. 2002 ) . Westrick & A ; Dempski ( 2009 ) note that the “standard of attention does non alter for an inexperient nurse” ( p. 25 ) . if the oncology nurses caring for Lewis were non comfy caring for him they should hold taken stairss to avoid injury such as an assignment alteration or supervisor counsel ( ANA. 2001 ) .

Finally. co-occuring with the responsibility to the patient for a proper appraisal. it is a nursing duty to pass on efficaciously. Failing to advise the doctor of alterations in patient’s status. unequal certification. or failure to use the chain-of-command in state of affairss where hurt may happen are all facets of unequal communicating ( Westrick & A ; Dempski. 2009 ) . Another outstanding issue is a complete failure of these nurses to rede their nursing supervisor of the unequal doctor response when there was concern for the patient’s status. Documentation was charted observing terrible changes in his status. but the responses were non equal or incongruent with his demands ( Solidline Media. 2010 ) .

Legal Issues and Relation to Nursing 1 of 1 point accrued
The Legal Information Institute ( 2014 ) defines moralss as the interaction among persons and the nature of responsibilities that people owe themselves or one another. Though the jurisprudence will often stand for ethical rules. jurisprudence and moralss are non ever in understanding ( Legal Information Institute. 2014 ) . Public jurisprudence is defined as the sum sum of regulations and ordinances by which society is governed and it is non restricted to merely codifying societal norms ( Legal Information Institute. 2014 ; Westrick. 2014 ) . This translates into extremely detailed. enforceable codifications of behavior found within the wellness attention system that consequence judgements sing behavior of wellness professionals during judicial proceeding ( Legal Information Institute. 2014 ) . Failure to carry through the behavior directed by professional moralss will normally ensue in countenances. or even ejection. from the wellness profession ( Legal Information Institute. 2014 ) .

Laws Governing Care of Lewis Blackman 1. 75 of 2 points accrued Analysis of the Lewis Blackman instance reveals that several Torahs sing responsibilities to the patient were non followed. Unfortunately. this breach resulted in the decease of a kid and a life changing crisis for his household. Laws regulating Lewis’ attention include: safe medicine disposal. patient safety. accurate certification. and coverage ( Westrick & A ; Dempski. 2009 ) . These Torahs apply straight to nurses and other trained professionals in the infirmary scenes as outlined by the province boards for nursing and medical specialty ( Westrick. 2014 ) . Failure to follow any of these may take to a malpractice action claim. disciplinary action. or condemnable indictment action ( Westrick & A ; Dempski. 2009 ) . An of import rule of medicine disposal and patient safety is to oppugn any orders that may represent a serious hazard to the patient ( Westrick. 2014 ) . Under province and federal Torahs. schemes such as standardised handoff communications. direct bedside patient unit of ammunitions at displacement alteration. and a non-punitive coverage system of mistakes or near-misses are required as steps to increase patient safety and cut down mistakes ( Westrick. 2014 ) .

Healthcare professionals working in a infirmary puting have a legal responsibility of attention noted by the National Council of State Boards of Nursing ( NCSBN ) and their several province regulation boards. Failure to deliverance. or non reacting in a timely mode to serious complications or alterations in patient status. may ensue in legal actions ( Westrick. 2014 ) . The providersThe suppliers caring for Lewis had a legal responsibility to document supply their nonsubjective appraisal certification including his response to their intercessions ( Westrick. 2014 ) . Accredited suppliers should non include subjective remarks and premises about the patient or household in certification. but dismissing Helen’s subjective position may hold constituted an mistake in professional judgement ( Solidline Media. 2010 ) . State Law 2 of 2 points accrued

Licensure for health care installations and wellness professionals. every bit good as Torahs finding health care and medical malpractice. are mostly regulated on a province degree ( American Nephrology Nurses Association [ ANNA ] . 2014 ) . The accredited forces who cared for Lewis are besides held accountable for their actions based on professional guidelines ( ANNA. 2014 ) . Nurses are accountable under the American Nurses Association ( ANA ) Scope and Standards of Practice. the ANA Code of Ethics. and their state’s nurse pattern act ( Westrick & A ; Dempski. 2009 ) . In add-on. health care suppliers must follow policies and processs outlined by their employer. For illustration. the Montana Code Annotated ( MCA ) and the Administrative Rules of Montana ( ARM ) set out demands and outlooks of both nurses and health care installations. Nurses shall “collaborate with other members of the wellness squad to supply optimal client attention. ” and “consult with nurses and other wellness squad members and do referrals as necessary” ( Administrative Rules of Montana [ ARM ] 24. 159. 1205 ) .

Sing the behavior of nurses the ARM ( 24. 159. 2301 ) provinces: Unprofessional behavior is determined by the board to intend behaviour ( Acts of the Apostless. skips. cognition. and patterns ) which fails to conform to the recognized criterions of the nursing profession and which could endanger the wellness and public assistance of the people and shall include. but non be limited to. the undermentioned: ( a ) weakness to use appropriate judgement in administrating safe nursing pattern based upon the degree of nursing for which the person is licensed ; ( B ) neglecting to exert proficient competency in transporting out nursing attention ; ( degree Celsius ) neglecting to follow policies or processs defined in the pattern state of affairs to safeguard patient attention. Nurses in the Blackman instance did non look to measure the patient adequately. utilize good judgement. or consult and collaborate with physicians to step in in a timely mode in order to guarantee optimal attention ( ARM 24. 159. 1205 ) . These failures could can be construed as carelessness on the portion of the nurse. Other members of the wellness attention squad. such as the physicians or occupants involved in his attention. are accountable in a comparable manner. Federal Law 2 of 2 points accrued

In the US. infirmaries must adhere to many federal ordinances in order to remain in conformity. The Center for Medicare and Medicaid Services ( CMS ) Regional Office and the Department of Health and Human Services ( DHHS ) run study bureaus in each province that follow guidelines laid out in the CMS State Operations Manual ( Center for Medicare and Medicaid Services [ CMS ] . 2013 ) . These guidelines are specific and address any installation failures to adhere to the Medicaid Conditions of Participation ( CoPs ) and Conditions of Coverage ( CfCs ) ( CMS. 2013 ; Department of Health and Human Services [ DHHS ] . 2012 ) . After the province study bureau determines how all whether demands are met. a Statement of Deficiencies signifier is submitted and the installation responds within which allows 10 calendar yearss of reception with for the installation to react with a Plan of Correction ( PoC ) to turn to any defects ( CMS. 2013 ) .

In respect to the Lewis Blackman instance. MUSC has potency for mistake in non run intoing CoPs related to safe attention. One of the ailments expressed by Lewis’s female parent was related to the deficiency of an adequate informed consent procedure and the deficiency of response to petitions for intervention when her kid was in hurt ( Solidline Media. 2010 ) . An illustration of a A proviso that could be the topic of this MUSC lack related to patient’s rights provinces: The patient or his or her representative ( as allowed under State jurisprudence ) has the right to do informed determinations sing his or her attention. The patient’s rights include being informed of his or her wellness position. being involved in attention planning and intervention. and being able to bespeak or decline intervention. ( Condition of engagement: Patient’s rights. 2012 ) Federal demands for infirmaries are besides regulated through recognizing organic structures such as the Joint Commission. a CMS approved independent. non-profit enfranchisement and recognizing organisation ( Zhani. 2014 ) .

The Joint Commission ( 2014 ) evaluates wellness service suppliers based on CMS guidelines along with reportable quality. result. safety. and answerability steps. This appraisal is besides based on the Specification Manual for National Hospital Inpatient Quality Measures and the Specification Manual for Joint Commission National Quality Core Measures ( The Joint Commission. 2014 ) . The inadvertences in the Blackman instance could be grounds of a breach of patient safety. a dislocation of communicating. and a deficiency of follow-through on the portion of the infirmary and its staff ( Solidline Media. 2010 ) . The accreditation of the infirmary is placed at hazard due to the potentially negligent Acts of the Apostless antecedently outlined in this instance. Components of Medical Malpractice 2 of 2 points accrued

In order to be found apt for medical malpractice. four specific elements must be apparent including: an established responsibility. comprehensiveness of this responsibility. causings. and amendss ( Bailey. 2013 ) . The tribunal must foremost find if there is an established responsibility to the patient ( Bailey. 2013 ) . Normally. a responsibility of attention is set Forth in the physician-patient relationship and can be established when a patient seeks aid from a doctor and the physician agrees to handle the patient ( Bailey. 2013 ; Sanbar. Gibofsky. Firestone. & A ; LeBlang. 1995 ) . This relationship can be established through an express or implied contract. trust. or payment ( Bailey. 2013. p. 114 ) . In the instance of Lewis Blackman. responsibility was established when Lewis and his parents sought attention for his thorax excavatum and consented for a surgical fix ( Solidline Media. 2010 ) .

The following component of a carelessness claim must demo breach of this established responsibility by showing that the medical supplier did non give supply the appropriate criterion of attention ( Bailey. 2013 ) . Standard of attention does non hold a unvarying theoretical account and varies. but it may be measured from province Torahs and national organisations such as the Joint Commission ( Janes. 2011 ) . There are criterions which a sawbones such as Lewis’
doctor must continue. every bit good as criterions for nursing staff and infirmaries. It. and it appears as if a breach of professional criterion of attention is apparent within this instance. Finally. the patient must turn out set up that the provider’s breach of responsibility caused otherwise evitable amendss or hurt for which the patient should have compensation ( Sanbar et al. . 1995 ) . Lewis’ unexpected decease was the consequence of a pierced duodenal ulcer. bleeding. and circulative prostration ( Solidline Media. 2010 ) .

In this instance: failure to see the wrongness of continued Toradol disposal. failure to order simple lab trials that would hold detected blood loss. and failure to pass on Lewis’ deteriorating status to the go toing sawbones all appear to lend to his ill-timed decease. In ____ province. the jurisprudence states that when harmed. amendss such as fiscal compensation are warranted. As celebrated above. all four elements of medical liability can be established in the Lewis Blackman instance. Lewis’ household and MUSC agreed on an out of tribunal colony of did settle out of tribunal for $ 950. 000 before registering a case ( Center for Justice and Democracy. 2014 ) . The Blackman household is utilizing this money for scholarships and to fund patient safety enterprises in South Carolina ( Center for Justice and Democracy. 2014 ) . Ultimately. this calamity has become a conduit for alteration and helps to advance a safe and merely civilization within health care. Execution of Safe and Just Culture

The study To Err is Human released in 1999 by the Institute of Medicine highlighted the dismaying rates of medical mistakes and sounded a call to action to turn to the manner we deal with mistakes ( Westrick. 2014 ) . In the yesteryear. a civilization of incrimination focused on single answerability with small thought given to analysis of the factors taking up to the mistake ( Westrick. 2014 ) . This blasted civilization strains distrust when people blame each other to avoid being disciplined. ensuing in a deficiency of advanced thoughts and personal enterprise because people do non desire to put on the line being incorrect ( Khatri. Brown. & A ; Hicks. 2009 ) . In fact. this civilization has been blamed for unacceptable high rates of medical mistakes ( Khatri et al. . 2009 ) . In a merely civilization environment the focal point is on placing and turn toing the issues that lead persons to pattern insecure behaviours every bit good as keeping single answerability ( Miranda. Samuel. & A ; Olexa. 2013 ) .

Alternatively of an environment ruled by single incrimination. a merely civilization supports unfastened duologue to ease safer patterns ( Khatri et al. . 2009 ) . In the instance of Lewis Blackman. it is apparent that communicating was an issue on many degrees and the rules of merely civilization were non at work ( Solidline Media. 2010 ) . In a blasted civilization. medical occupants are loath to oppugn go toing doctors and nurses are hesitating to dispute either one in respects to their several attention program or orders ( Khatri et al. . 2009 ) . Lack of unfastened duologue among staff at MUSC perpetuated the belief that appraisals of Lewis enduring from “gas” were right ( Solidline Media. 2010 ) . Khatri. Brown. and Hicks ( 2009 ) depict a civilization of “psychological safety” . Possibly if this environment was fostered at MUSC the nurses who had concerns would hold questioned the predominating appraisal of Lewis and. in fact. saved his life. Furthermore. merely civilizations look at system issues and may hold addressed the insecure pattern of puting paediatric surgical patients on the oncology floor ; admittance to this unit contributed to before it caused the type of injury evident in the Lewis Blackmans instance.

Medication disposal is another system that can profit from a merely safety civilization. If early warning systems had been in topographic point alarming suppliers to the jeopardies of medicines. such as giving Toradol to patients with low urine end product. possibly Lewis would non hold continued to have this medicine that caused him such dangerous injury. Just civilization recognizes the complexness of mistakes and encourages patient safety by taking a systematic attack to error bar ( Westrick. 2014 ) . Another cardinal component of merely civilization is in its desire to handle near-misses with the same degree of examination that existent mistakes receive. Within the blasted civilization. mistakes doing no injury are frequently ignored or dismissed which enables the mistakes to go on once more and finally consequences in injury that could hold been prevented ( Burhans. Chastain. & A ; George. 2012 ) . Alternatively. error revelation systems seek to better quality through instruction and integrating of all relevant parties in the health care system including patients and their households ( Liang. 2002 ) .

Doctors should be educated about the systems nature of mistake and patients besides must be informed about what they can lend to a safe bringing environment ( Liang. 2002 ) . Patients should be equal spouses in the bringing of attention and be equipped to talk up when they see errors or jobs with their attention ( Liang. 2002 ) . If there had been an mistake revelation system within MUSC that clearly outlined patient and households rights and duties. Helen may hold had entree to the aid she needed for Lewis. Furthermore. when the establishment realized mistakes occurred that resulted in a child decease. effectual policies around error revelation should hold involved the household in the procedure of probe and declaration ( Liang. 2002 ) . At the beginning. an apology would hold validated the hurting and agony of the household and may hold reduced the hazard of judicial proceeding. if the household had been allowed to vent and be heard ( Liang. 2002 ) . The Lewis Blackman narrative is full of illustrations of a system that failed to maintain him safe.

A civilization of incrimination that focuses on one person will non turn to the alterations that need to be made to the system. A merely civilization creates the hope that mistakes can be reduced through equal engagement and committedness by every member of the health care squad to consistently measure bringing of attention ( Liang. 2002 ) . A thorough mistake revelation system can capture mistakes when they are close girls. non tragic deceases. and can authorise patients to be equal spouses in the procedure ( Liang. 2002 ) . Lessons learned from the Lewis Blackman instance and application of a merely civilization environment to medical pattern has the possible to do healthcare bringing processes safer. Recommendations for Change in Advanced Nursing Roles 1 of 2 points accrued

The end of any health care bringing system is to supply safe and comprehensive patient attention. Harmonizing to Mason. Leavitt. & A ; Chaffee ( 2012 ) nurses are good positioned to reform health care in ways that promote increased public wellness and cut down health care costs ( p. 10 ) . Nurses. particularly advanced pattern nurses. must germinate in their functions in order to supply high-quality. patient centered attention and to implement techniques that facilitate necessary alterations within their establishment. Transforming attention at the bedside is a technique that empowers nurses to originate betterments in four chief classs including: safe and dependable attention. verve and teamwork. patient-centered attention. and value-added attention processes ( Mason. Leavitt. & A ; Chaffee. 2012 ) . Similar to a merely civilization model. this modern-day plan is an built-in portion of a nursing attempt that focuses on betterment of infirmary work environments in an attempt to better nurse satisfaction and finally the quality of patient attention ( Mason. et Al. . 2012 ) .

The work atmosphere improves as staff deliver attention in safer. better runing systems where the civilization encourages quality and safety over penalty and incrimination ( ANA. 2010 ) . Nurse practicians. and other advanced nurses. already integrate evidence-based pattern with caring. compassion. and intuition to supply quality attention ( ANA Nursing Standards. 2003 ) . Their function as patient advocator will now assist to take barriers. facilitates faced in accomplishing optimum health care and aids in the development of bringing environments focused on patient safety and a merely civilization ( ANA Position Statement. 2010 ; Mason et Al. . 2012 ) .

In add-on. integrating engineering into the art of lovingness will let nurses to be resourceful and antiphonal to challenges of the complex wellness attention system ( ANA Nursing Standards. 2003 ) . Continued larning. engagement in civic activities. rank and support of professional associations. corporate bargaining. and workplace protagonism will beef up single pattern every bit good ( ANA Nursing Standards. 2003 ) . The happenings of medical errors should be viewed as chance to larn and better nursing attempts as advanced practicians. Decisions 1 of 1 point accrued

Healthcare professionals have to be persevering and punctilious when caring for every person. They are trusted to make good and avoid injury ( Westrick & A ; Dempski. 2009 ) . Medical mistakes caused by hapless clinical determination devising or negligent actions can do important harm to patients. households. and establishments every bit good as the medical suppliers themselves ( Wu. 2000 ) . The Lewis Blackman instance is an unfortunate illustration of a critical dislocation within the health care bringing system that resulted in the decease of a promising young person ( Kumar. 2008 ) . Failures among the MUSC medical providers’ established ethical and legal responsibilities of attention culminated to fulfill all four makings for malpractice liability ( Sanbar et al. . 1995 ; Westrick & A ; Dempski. 2009 ) . Following through in state of affairss where there is concern for the patient’s best involvement will assist to avoid any via media on patient safety. This non merely prevents carelessness. malpractice. and disciplinary or condemnable action. but besides hurt or serious inauspicious results ( Westrick & A ; Dempski. 2009 ) .

State and Federal Torahs support schemes to avoid mistakes and better patient safety through standardized handoff communications. direct patient rounds at displacement alteration. and a non-punitive coverage system of mistakes or near-misses ( CMS. 2013 ; The Joint Commission. 2014 ) . Continuing nursing instruction. patient protagonism. and set uping better describing systems with a focal point on patient-centered attention can all aid to better wellness results. “By advancing system betterments over single penalty. a Just Culture in health care does much to better patient safety. cut down mistakes. and give nurses and other wellness attention workers a major interest in the betterment process” ( ANA Position Statement. 2010. p. 7 ) . This civilization of patient safety addresses the spreads in traditional health care bringing systems and works better with nurses’ critical thought accomplishments and procedure ( ANA Position Statement. 2010 ) . Advanced pattern nurses are good placed to assist ease a merely civilization environment and to recommend for improved safety steps ( Mason et al. . 2012 ) .


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