Matthew Leonard Maciejewski, PhD


Professor in Medicine
Department / Division:
Medicine / General Internal Medicine
Address:
Hock Plaza 2424 Erwin Road
Durhajm, NC 27705
Office Telephone:
(919) 286-6936
Training:
  • PhD, University of Minnesota, Twin Cities, 1998
Representative Publications:
  • Maciejewski, ML; Harman, JS. Patient satisfaction associated with lower emergency department use but more hospitalisations and higher costs and mortality. Evidence-Based Medicine. 2013;18:e10.  Abstract
  • Butler, MG; Farley, JF; Sleath, BL; Murray, MD; Maciejewski, ML. Medicare part D information seeking: the role of recognition of need and patient activation. Research in Social and Administrative Pharmacy. 2012;8:433-442.  Abstract
  • Farley, JF; Wansink, D; Lindquist, JH; Parker, JC; Maciejewski, ML. Medication adherence changes following value-based insurance design. American Journal of Managed Care. 2012;18:265-274.  Abstract
  • Hall, RK; Wang, V; Jackson, GL; Hammill, BG; Maciejewski, ML; Yano, EM; Svetkey, LP; Patel, UD. Implementation of automated reporting of estimated glomerular filtration rate among Veterans Affairs laboratories: a retrospective study. BMC Medical Informatics and Decision Making. 2012;12:69.  Abstract
  • Hansen, RA; Maciejewski, M; Yu-Isenberg, K; Farley, JF. Adherence to antipsychotics and cardiometabolic medication: association with health care utilization and costs. Psychiatric Services. 2012;63:920-928.  Abstract
  • Liu, CF; Bryson, CL; Burgess, JF; Sharp, N; Perkins, M; Maciejewski, ML. Use of outpatient care in VA and Medicare among disability-eligible and age-eligible veteran patients. BMC Health Services Research. 2012;12:51.  Abstract
  • Maciejewski, ML; Liu, CF; Kavee, AL; Olsen, MK. How price responsive is the demand for specialty care?. Health Economics. 2012;21:902-912.  Abstract
  • Maciejewski, ML; Livingston, EH; Smith, VA; Kahwati, LC; Henderson, WG; Arterburn, DE. Health expenditures among high-risk patients after gastric bypass and matched controls. Archives of Surgery. 2012;147:633-640.  Abstract
  • Taber, DR; Stevens, J; Poole, C; Maciejewski, ML; Evenson, KR; Ward, DS. State disparities in time trends of adolescent body mass index percentile and weight-related behaviors in the United States. Journal of Community Health. 2012;37:242-252.  Abstract
  • Voils, CI; Chang, Y; Crandell, J; Leeman, J; Sandelowski, M; Maciejewski, ML. Informing the dosing of interventions in randomized trials. Contemporary Clinical Trials. 2012;33:1225-1230.  Abstract
  • Voils, CI; Coffman, CJ; Edelman, D; Maciejewski, ML; Grubber, JM; Sadeghpour, A; Cho, A; McKenzie, J; Blanpain, F; Scheuner, M; Sandelowski, M; Gallagher, MP; Ginsburg, GS; Yancy, WS. Examining the impact of genetic testing for type 2 diabetes on health behaviors: study protocol for a randomized controlled trial. Trials. 2012;13:121.  Abstract
  • Voils, CI; Maciejewski, ML; Hoyle, RH; Reeve, BB; Gallagher, P; Bryson, CL; Yancy, WS. Initial validation of a self-report measure of the extent of and reasons for medication nonadherence. Medical Care. 2012;50:1013-1019.  Abstract
  • Wong, ES; Piette, JD; Liu, CF; Perkins, M; Maciejewski, ML; Jackson, GL; Blough, DK; Fihn, SD; Au, DH; Bryson, CL. Measures of adherence to oral hypoglycemic agents at the primary care clinic level: the role of risk adjustment. Medical Care. 2012;50:591-598.  Abstract
  • Bell, JF; Zimmerman, FJ; Arterburn, DE; Maciejewski, ML. Health-care expenditures of overweight and obese males and females in the medical expenditures panel survey by age cohort. Obesity. 2011;19:228-232.  Abstract
  • Burgess, JF; Maciejewski, ML; Bryson, CL; Chapko, M; Fortney, JC; Perkins, M; Sharp, ND; Liu, CF. Importance of health system context for evaluating utilization patterns across systems. Health Economics. 2011;20:239-251.  Abstract
  • Chew, RB; Bryson, CL; Au, DH; Maciejewski, ML; Bradley, KA. Are smoking and alcohol misuse associated with subsequent hospitalizations for ambulatory care sensitive conditions?. Journal of Behavioral Health Services and Research. 2011;38:3-15.  Abstract
  • Dowd, B; Maciejewski, ML; O'Connor, H; Riley, G; Geng, Y. Health plan enrollment and mortality in the Medicare program. Health Economics. 2011;20:645-659.  Abstract
  • Farley, JF; Wang, CC; Hansen, RA; Voils, CI; Maciejewski, ML. Continuity of antipsychotic medication management for Medicaid patients with schizophrenia. Psychiatric Services. 2011;62:747-752.  Abstract
  • Fortney, JC; Maciejewski, ML; Tripathi, SP; Deen, TL; Pyne, JM. A budget impact analysis of telemedicine-based collaborative care for depression. Medical Care. 2011;49:872-880.  Abstract
  • Harris, BD; Hanson, C; Christy, C; Adams, T; Banks, A; Willis, TS; Maciejewski, ML. Strict hand hygiene and other practices shortened stays and cut costs and mortality in a pediatric intensive care unit. Health Affairs. 2011;30:1751-1761.  Abstract
  • Kennedy, JJ; Maciejewski, M; Liu, D; Blodgett, E. Cost-related nonadherence in the Medicare program: the impact of Part D. Medical Care. 2011;49:522-526.  Abstract
  • Li, YF; Wong, ES; Sales, AE; Sharp, ND; Needleman, J; Maciejewski, ML; Lowy, E; Alt-White, AC; Liu, CF. Nurse staffing and patient care costs in acute inpatient nursing units. Medical Care. 2011;49:708-715.  Abstract
  • Liu, CF; Manning, WG; Burgess, JF; Hebert, PL; Bryson, CL; Fortney, J; Perkins, M; Sharp, ND; Maciejewski, ML. Reliance on Veterans Affairs outpatient care by Medicare-eligible veterans. Medical Care. 2011;49:911-917.  Abstract
  • Maciejewski, ML; Livingston, EH; Smith, VA; Kavee, AL; Kahwati, LC; Henderson, WG; Arterburn, DE. Survival among high-risk patients after bariatric surgery. JAMA: Journal of the American Medical Association. 2011;305:2419-2426.  Abstract
  • Maciejewski, ML; Wang, V; Grabowski, DC; Lin, PJ. Early evidence on the quality of care provided by special needs plans. Medical Care. 2011;49:891-896.  Abstract
  • Maciejewski, ML; Weaver, EM; Hebert, PL. Synonyms in health services research methodology. Medical Care Research and Review. 2011;68:156-176.  Abstract
  • Roblin, DW; Maciejewski, ML. Repeat experience with the doughnut hole in Medicare Part D: when the doughnut hole becomes a tunnel. Medical Care. 2011;49:436-442.  Abstract
  • Taber, DR; Stevens, J; Evenson, KR; Ward, DS; Poole, C; Maciejewski, ML; Murray, DM; Brownson, RC. State policies targeting junk food in schools: racial/ethnic differences in the effect of policy change on soda consumption. American Journal of Public Health. 2011;101:1769-1775.  Abstract
  • Voils, CI; Hoyle, RH; Thorpe, CT; Maciejewski, ML; Yancy, WS. Improving the measurement of self-reported medication nonadherence. Journal of Clinical Epidemiology. 2011;64:250-254.  Abstract
  • Wang, V; Lee, SY; Patel, UD; Maciejewski, ML; Ricketts, TC. Longitudinal analysis of market factors associated with provision of peritoneal dialysis services. Medical Care Research and Review. 2011;68:537-558.  Abstract
  • Wang, V; Liu, CF; Bryson, CL; Sharp, ND; Maciejewski, ML. Does medication adherence following a copayment increase differ by disease burden?. Health Services Research. 2011;46:1963-1985.  Abstract
  • Bosworth, HB; Almirall, D; Weiner, BJ; Maciejewski, M; Kaufman, MA; Powers, BJ; Oddone, EZ; Lee, SY; Damush, TM; Smith, V; Olsen, MK; Anderson, D; Roumie, CL; Rakley, S; Del Monte, PS; Bowen, ME; Kravetz, JD; Jackson, GL. The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295). Implementation Science. 2010;5:54.  Abstract
  • Cadmus, L; Patrick, MB; Maciejewski, ML; Topolski, T; Belza, B; Patrick, DL. Community-based aquatic exercise and quality of life in persons with osteoarthritis. Medicine and Science in Sports and Exercise. 2010;42:8-15.  Abstract
  • Chen, SY; Hansen, RA; Farley, JF; Gaynes, BN; Morrissey, JP; Maciejewski, ML. Follow-up visits by provider specialty for patients with major depressive disorder initiating antidepressant treatment. Psychiatric Services. 2010;61:81-85.  Abstract
  • Chen, SY; Hansen, RA; Gaynes, BN; Farley, JF; Morrissey, JP; Maciejewski, ML. Guideline-concordant antidepressant use among patients with major depressive disorder. General Hospital Psychiatry. 2010;32:360-367.  Abstract
  • Hansen, RA; Chen, SY; Gaynes, BN; Maciejewski, ML. Relationship of pharmaceutical promotion to antidepressant switching and adherence: a retrospective cohort study. Psychiatric Services. 2010;61:1232-1238.  Abstract
  • Hansen, RA; Farley, JF; Droege, M; Maciejewski, ML. A retrospective cohort study of economic outcomes and adherence to monotherapy with metformin, pioglitazone, or a sulfonylurea among patients with type 2 diabetes mellitus in the United States from 2003 to 2005. Clinical Therapeutics: the international peer-reviewed journal of drug therapy. 2010;32:1308-1319.  Abstract
  • Lin, PJ; Kaufer, DI; Maciejewski, ML; Ganguly, R; Paul, JE; Biddle, AK. An examination of Alzheimer's disease case definitions using Medicare claims and survey data. Alzheimer's and Dementia. 2010;6:334-341.  Abstract
  • Lin, PJ; Maciejewski, ML; Paul, JE; Biddle, AK. Risk adjustment for Medicare beneficiaries with Alzheimer's disease and related dementias. American Journal of Managed Care. 2010;16:191-198.  Abstract
  • Liu, CF; Chapko, M; Bryson, CL; Burgess, JF; Fortney, JC; Perkins, M; Sharp, ND; Maciejewski, ML. Use of outpatient care in Veterans Health Administration and Medicare among veterans receiving primary care in community-based and hospital outpatient clinics. Health Services Research. 2010;45:1268-1286.  Abstract
  • Maciejewski, ML; Bryson, CL; Perkins, M; Blough, DK; Cunningham, FE; Fortney, JC; Krein, SL; Stroupe, KT; Sharp, ND; Liu, CF. Increasing copayments and adherence to diabetes, hypertension, and hyperlipidemic medications. American Journal of Managed Care. 2010;16:e20-e34.  Abstract
  • Maciejewski, ML; Farley, JF; Hansen, RA; Wei, D; Harman, JS. Part D plan enrollment by uninsured medicare beneficiaries. Medical Care. 2010;48:183-186.  Abstract
  • Maciejewski, ML; Farley, JF; Parker, J; Wansink, D. Copayment reductions generate greater medication adherence in targeted patients. Health Affairs. 2010;29:2002-2008.  Abstract
  • Maciejewski, ML; Livingston, EH; Kahwati, LC; Henderson, WG; Kavee, AL; Arterburn, DE. Discontinuation of diabetes and lipid-lowering medications after bariatric surgery at Veterans Affairs medical centers. Surgery for Obesity and Related Diseases. 2010;6:601-607.  Abstract
  • Maciejewski, ML; Smith, VA; Livingston, EH; Kavee, AL; Kahwati, LC; Henderson, WG; Arterburn, DE. Health care utilization and expenditure changes associated with bariatric surgery. Medical Care. 2010;48:989-998.  Abstract
  • Pyne, JM; Fortney, JC; Tripathi, SP; Maciejewski, ML; Edlund, MJ; Williams, DK. Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression. Archives of General Psychiatry. 2010;67:812-821.  Abstract
  • Taber, DR; Meischke, H; Maciejewski, ML. Testing social cognitive mechanisms of exercise in college students. American Journal of Health Behavior. 2010;34:156-165.  Abstract
  • Takahashi, TA; Maciejewski, ML; Bradley, K. US hospitalizations and costs for illicit drug users with soft tissue infections. Journal of Behavioral Health Services and Research. 2010;37:508-518.  Abstract
  • Yancy, WS; Maciejewski, ML; Schulman, KA. Animal, vegetable, or ... clinical trial?. Annals of Internal Medicine. 2010;153:337-339.  Abstract
  • Arterburn, D; Livingston, EH; Schifftner, T; Kahwati, LC; Henderson, WG; Maciejewski, ML. Predictors of long-term mortality after bariatric surgery performed in Veterans Affairs medical centers. Archives of Surgery. 2009;144:914-920.  Abstract
  • Chapko, MK; Liu, CF; Perkins, M; Li, YF; Fortney, JC; Maciejewski, ML. Equivalence of two healthcare costing methods: bottom-up and top-down. Health Economics. 2009;18:1188-1201.  Abstract
  • Gao, SK; Fitzpatrick, AL; Psaty, B; Jiang, R; Post, W; Cutler, J; Maciejewski, ML. Suboptimal nutritional intake for hypertension control in 4 ethnic groups. Archives of Internal Medicine. 2009;169:702-707.  Abstract
  • Lin, PJ; Biddle, AK; Ganguly, R; Kaufer, DI; Maciejewski, ML. The concentration and persistence of health care expenditures and prescription drug expenditures in Medicare beneficiaries with Alzheimer disease and related dementias. Medical Care. 2009;47:1174-1179.  Abstract
  • Liu, CF; Sharp, ND; Sales, AE; Lowy, E; Maciejewski, ML; Needleman, J; Li, YF. Line authority for nurse staffing and costs for acute inpatient care. Inquiry: the Journal of Health Care Organization Provision and Financing. 2009;46:339-351.  Abstract
  • Maciejewski, ML; Birken, S; Perkins, M; Burgess, JF; Sharp, N; Liu, CF. Medicare managed care enrollment by disability-eligible and age-eligible veterans. Medical Care. 2009;47:1180-1185.  Abstract
  • Maciejewski, ML; Chen, SY; Au, DH. Adult asthma disease management: an analysis of studies, approaches, outcomes, and methods. Respiratory Care: a monthly science journal. 2009;54:878-886.  Abstract
  • Maciejewski, ML; Liu, CF; Fihn, SD. Performance of comorbidity, risk adjustment, and functional status measures in expenditure prediction for patients with diabetes. Diabetes Care. 2009;32:75-80.  Abstract
  • Powers, BJ; King, JL; Ali, R; Alkon, A; Bowlby, L; Edelman, D; Gentry, P; Grubber, JM; Koropchak, C; Maciejewski, ML; McCant, F; McKoy, G; Newell, M; Oddone, EZ; Olsen, MK; Rose, CM; Trujillo, G; Bosworth, HB. The Cholesterol, Hypertension, and Glucose Education (CHANGE) study for African Americans with diabetes: study design and methodology. American Heart Journal. 2009;158:342-348.  Abstract
  • Prela, CM; Baumgardner, GA; Reiber, GE; McFarland, LV; Maynard, C; Anderson, N; Maciejewski, M. Challenges in merging Medicaid and Medicare databases to obtain healthcare costs for dual-eligible beneficiaries: using diabetes as an example. PharmacoEconomics. 2009;27:167-177.  Abstract
  • Thorpe, CT; Bryson, CL; Maciejewski, ML; Bosworth, HB. Medication acquisition and self-reported adherence in veterans with hypertension. Medical Care. 2009;47:474-481.  Abstract
  • Yancy, WS; Almirall, D; Maciejewski, ML; Kolotkin, RL; McDuffie, JR; Westman, EC. Effects of two weight-loss diets on health-related quality of life. Quality of Life Research. 2009;18:281-289.  Abstract
  • Zhang, B; Wright, AA; Huskamp, HA; Nilsson, ME; Maciejewski, ML; Earle, CC; Block, SD; Maciejewski, PK; Prigerson, HG. Health care costs in the last week of life: associations with end-of-life conversations. Archives of Internal Medicine. 2009;169:480-488.  Abstract
  • Ackermann, RT; Williams, B; Nguyen, HQ; Berke, EM; Maciejewski, ML; LoGerfo, JP. Healthcare cost differences with participation in a community-based group physical activity benefit for medicare managed care health plan members. Journal of the American Geriatrics Society. 2008;56:1459-1465.  Abstract
  • Liu, CF; Chapko, MK; Perkins, MW; Fortney, J; Maciejewski, ML. The impact of contract primary care on health care expenditures and quality of care. Medical Care Research and Review. 2008;65:300-314.  Abstract
  • Nguyen, HQ; Ackermann, RT; Maciejewski, M; Berke, E; Patrick, M; Williams, B; LoGerfo, JP. Managed-Medicare health club benefit and reduced health care costs among older adults. Preventing Chronic Diseases: Public health research, practice, and policy. 2008;5:A14.  Abstract
  • Nguyen, HQ; Maciejewski, ML; Gao, S; Lin, E; Williams, B; Logerfo, JP. Health care use and costs associated with use of a health club membership benefit in older adults with diabetes. Diabetes Care. 2008;31:1562-1567.  Abstract
  • Maciejewski, ML; Perkins, M; Li, YF; Chapko, M; Fortney, JC; Liu, CF. Utilization and expenditures of veterans obtaining primary care in community clinics and VA medical centers: an observational cohort study. BMC Health Services Research. 2007;7:56.  Abstract
  • Nguyen, HQ; Ackermann, RT; Berke, EM; Cheadle, A; Williams, B; Lin, E; Maciejewski, ML; LoGerfo, JP. Impact of a managed-Medicare physical activity benefit on health care utilization and costs in older adults with diabetes. Diabetes Care. 2007;30:43-48.  Abstract
  • Berke, EM; Ackermann, RT; Lin, EH; Diehr, PH; Maciejewski, ML; Williams, B; Patrick, MB; LoGerfo, JP. Distance as a barrier to using a fitness-program benefit for managed Medicare enrollees. Journal of Aging and Physical Activity. 2006;14:313-324.  Abstract
  • Penrod, JD; Deb, P; Luhrs, C; Dellenbaugh, C; Zhu, CW; Hochman, T; Maciejewski, ML; Granieri, E; Morrison, RS. Cost and utilization outcomes of patients receiving hospital-based palliative care consultation. Journal of Palliative Medicine. 2006;9:855-860.  Abstract
  • Rejeski, WJ; Lang, W; Neiberg, RH; Van Dorsten, B; Foster, GD; Maciejewski, ML; Rubin, R; Williamson, DF; Look AHEAD Research Group. Correlates of health-related quality of life in overweight and obese adults with type 2 diabetes. Obesity. 2006;14:870-883.  Abstract
  • Arterburn, DE; Maciejewski, ML; Tsevat, J. Impact of morbid obesity on medical expenditures in adults. International Journal of Obesity. 2005;29:334-339.  Abstract
  • Atherly, A; Hebert, PL; Maciejewski, ML. An analysis of disenrollment from Medicare managed care plans by Medicare beneficiaries with diabetes. Medical Care. 2005;43:500-506.  Abstract
  • Fortney, JC; Maciejewski, ML; Warren, JJ; Burgess, JF. Does improving geographic access to VA primary care services impact patients' patterns of utilization and costs?. Inquiry: the Journal of Health Care Organization Provision and Financing. 2005;42:29-42.  Abstract
  • Fortney, JC; Steffick, DE; Burgess, JF; Maciejewski, ML; Petersen, LA. Are primary care services a substitute or complement for specialty and inpatient services?. Health Services Research. 2005;40:1422-1442.  Abstract
  • Liu, CF; Maciejewski, ML; Sales, AE. Changes in characteristics of veterans using the VHA health care system between 1996 and 1999. Health Research Policy and Systems. 2005;3:5.  Abstract
  • Maciejewski, ML; Liu, CF; Derleth, A; McDonell, M; Anderson, S; Fihn, SD. The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures. Health Services Research. 2005;40:887-904.  Abstract
  • Maciejewski, ML; Patrick, DL; Williamson, DF. A structured review of randomized controlled trials of weight loss showed little improvement in health-related quality of life. Journal of Clinical Epidemiology. 2005;58:568-578.  Abstract
  • McFall, M; Tackett, J; Maciejewski, ML; Richardson, RD; Hunt, SC; Roberts, L. Predicting costs of Veterans Affairs health care in Gulf War veterans with medically unexplained physical symptoms. Military Medicine: international journal of AMSUS. 2005;170:70-75.  Abstract
  • Maciejewski, ML; Dowd, B; O'Connor, H. Multiple prior years of health expenditures and Medicare health plan choice. International Journal of Health Care Finance and Economics. 2004;4:247-261.  Abstract
  • Maciejewski, ML; Maynard, C. Diabetes-related utilization and costs for inpatient and outpatient services in the Veterans Administration. Diabetes Care. 2004;27 Suppl 2:B69-B73.  Abstract
  • Maciejewski, ML; Reiber, GE; Smith, DG; Wallace, C; Hayes, S; Boyko, EJ. Effectiveness of diabetic therapeutic footwear in preventing reulceration. Diabetes Care. 2004;27:1774-1782.  Abstract
  • Chan, L; Beaver, S; Maclehose, RF; Jha, A; Maciejewski, M; Doctor, JN. Disability and health care costs in the Medicare population. Archives of Physical Medicine and Rehabilitation. 2002;83:1196-1201.  Abstract
  • Chapko, MK; Borowsky, SJ; Fortney, JC; Hedeen, AN; Hoegle, M; Maciejewski, ML; VanDeusen Lukas, C. Evaluation of the Department of Veterans Affairs community-based outpatient clinics. Medical Care. 2002;40:555-560.  Abstract
  • Fortney, JC; Borowsky, SJ; Hedeen, AN; Maciejewski, ML; Chapko, MK. VA community-based outpatient clinics: access and utilization performance measures. Medical Care. 2002;40:561-569.  Abstract
  • Maciejewski, ML; Chapko, MK; Hedeen, AN; Fortney, JC. VA community-based outpatient clinics: cost performance measures. Medical Care. 2002;40:587-595.  Abstract
  • Maciejewski, ML; Diehr, P; Smith, MA; Hebert, P. Common methodological terms in health services research and their synonyms [correction of symptoms]. Medical Care. 2002;40:477-484.  Abstract
  • Reiber, GE; Smith, DG; Wallace, C; Sullivan, K; Hayes, S; Vath, C; Maciejewski, ML; Yu, O; Heagerty, PJ; LeMaster, J. Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial. JAMA: Journal of the American Medical Association. 2002;287:2552-2558.  Abstract
  • Reiber, GE; Smith, DG; Wallace, CM; Vath, CA; Sullivan, K; Hayes, S; Yu, O; Martin, D; Maciejewski, M. Footwear used by individuals with diabetes and a history of foot ulcer. Journal of Rehabilitation Research and Development. 2002;39:615-622.  Abstract
  • Call, KT; Dowd, BE; Feldman, R; Lurie, N; McBean, MA; Maciejewski, M. Disenrollment from Medicare HMOs. American Journal of Managed Care. 2001;7:37-51.  Abstract
  • Feldman, R; Dowd, BE; Maciejewski, M. A demand-side view of risk adjustment. Inquiry: the Journal of Health Care Organization Provision and Financing. 2001;38:280-289.  Abstract
  • Maciejewski, ML; Dowd, B; Call, KT; Feldman, R. Comparing mortality and time until death for medicare HMO and FFS beneficiaries. Health Services Research. 2001;35:1245-1265.  Abstract
  • Call, KT; Dowd, B; Feldman, R; Maciejewski, M. Selection experiences in Medicare HMOs: pre-enrollment expenditures. Health Care Financing Review. 1999;20:197-209.  Abstract
  • Kane, RL; Maciejewski, M; Finch, M. The relationship of patient satisfaction with care and clinical outcomes. Medical Care. 1997;35:714-730.  Abstract
  • Maciejewski, ML; Dowd, BE; Feldman, R. How do states buy health insurance for their own employees?. Managed care quarterly. 1997;5:11-19.  Abstract
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