Perhaps most surprising of all was that St Lukes would not admit paying visitors, a practice that Bethlem had allowed for centuries. View on a map. To be heard was a small thing, but so huge. I hated my flesh; I wanted to be all bone. HOME. The information contained in this listing has come from HelpFinder, a directory of eating disorder services, support groups and specialists organised by Beat, the UKs leading eating disorder charity. . You can search our full list of service below, either by borough, or by selecting a type of service from the categories drop down. By entering your details, you are agreeing to our terms and conditions and privacy policy. between our experience and Dr Hesters illustrates this. waiting list until it is safe to resume face to face appointments.**. There was, however, a darker period when the hospital became more conservative, secretive and, eventually, abusive in the treatment of its patients. The eating disorders unit sits above the female acute ward, which is where women who are about to be sectioned arrive. Protests by reformers became more vocal until, in 1853, Bethlem's exemption from outside inspection was ended. Recovery is a word we use a lot. After more than six centuries, the hospital was no longer independent. Our staff Bethlem Royal Hospital was England's first asylum for the treatment of mental illness, and for many years a place of inhumane conditions, the nickname of which - Bedlam - became a byword for mayhem or madness. There is also a dietician, a consultant psychiatrist, and a cast of psychologists and psychotherapists who help out at mealtimes and run therapy groups on managing perfectionism, tolerating difficult emotions, cooking and dietetics. In 2017, a parliamentary inquiry into avoidable deaths from eating disorders pushed for urgent reforms in care, including better GP training and transition between services. We continue to experience an extremely high volume of referrals which unfortunately is resulting in delays in processing. Our Trust headquarters is located at Denmark Hill less than 5 minutes from the train station (zone 2). Bethlem Royal Hospital It remained Britains only mental health facility, and had developed a nepotistic tradition which saw medical posts pass between friends and family, ensuring that treatments methods were similarly inherited. Referrals. He wrote in my report that he would not make the referral to the Maudsley, because these services were reserved for individuals with more serious cases. My behaviour and low BMI at that time more than exceeded the diagnostic criteria for anorexia nervosa. psychiatrists to people, aged 18-65. I tolerate the horror of gaining weight. More metaphors are summoned: the storms that could uproot or damage your tree, such as bereavement, heartbreak, homelessness. I barely remember eating a meal in those years. She knew I took my scales everywhere. We use cookies to ensure that we give you the best experience on our website. Our unit is quieter but I dont feel any different from the people shouting on the steps: it seems natural to scream when you have lost your mind. His visits to Bethlem were infrequent, brief and never involved touring the patients wards. More people than ever, in particular black people, are being hospitalised because they are failed or misdiagnosed early on. The sight that most shocked the committee was that of James Norris, described as a clear and lucid man, who had been tightly chained by his neck to an iron bar in the wall. If you are experiencing problems as a result of your alcohol or drug use, or if you are drinking or using drugs to cope with existing problems, our National Addiction Treatment & Rehabilitation Directory contains over 700 addiction treatment services that may be able to help you when you decide to do something about them. There is an inter-hospital bus which runs at the following times. I rang Paul every day for weeks to be told he was too busy to talk. Any referrals sent following this time will not be processed or kept on file. The Bethlem Royal Hospital is based in over 200 acres of green space and is home to a number of specialist services (like their Anxiety Disorders Residential Unit). On the outside, my life was a success. It is 5am, and you are on the night bus to a 24-hour supermarket to replace the food you stole from your housemates before they wake up and find out. syndrome. She asked, she said, because she was getting married later in the year and her jeans were getting a bit tight. Suspected chromosomal abnormalities or single gene disorders, on hand 24 hours a day. My behaviour and low BMI at that time more than exceeded the diagnostic criteria for anorexia nervosa. By 1330, the institution was being referred to as a hospital and by 1377 historians believe it had become the exclusive home for the insane. It was only when I sat down that I realised my hands were cut and bruised from the glass, and I was shaking. Ive failed at every single thing in my life and now Im failing at this, I say. Referral for the RCH Eating Disorder Service should include: The adolescent's vital signs; including lying and standing blood pressure and lying and standing heart rate. I asked to see someone else and this was refused. compulsive disorder, psychosis, depression and anxiety. We work closely with I turned sideways and watched the effect of sucking it in, and was disgusted at the difference. This includes feedback on the day, which is My daughter benefited immensely from the treatment given at Bethlem Home Treatment for Older Adults (Croydon) 020 3228 6000. In the US, the National Eating Disorders Association is on 800-931-2237. The chair would be turned 20-40 times one way and allowed to spin back to its original position. The hospital is home to a number of specialist services for people both locally and from across the UK. on 7December2022. Suspected or diagnosed ASD, including autism and Asperger's Our residential and partial hospital program is the premier destination for young women seeking treatment for anorexia, bulimia, and binge eating disorder. I picked up three pieces and shoved them into my mouth. I went into the kitchen alone and there it was: a tray of shortbread. Following assessment, children will be offered a six to eight week programme to engage in education and access one to one therapeutic support from nursing staff and multi-disciplinary team colleagues. Jeanette Wallace House, 1 Edridge Road, Croydon, CR0 1FE, OR,For South Team:, 50 Purley Resource centre, Pampisford road, CR8 2NE. I hid, stole and lied about food.
The neighbours called the police; three weeks later, my landlord evicted me. - 3 March 2020 At the Bethlem Royal Hospital i have a brilliant time working there lovely staff's working.i have great time with different people with diverse culture. Bedlam, wrote Ward in his journal, is an alms-house for madmen, a showing-room for whores, a sure market for lechers, a dry walk for loiterers. It was not until 1774 that the first Madhouse Act was passed, requiring private asylums to be licensed and inspected although, at the behest of its governors, Bethlem was exempted. I was treated not as an ill person in need, but rather an applicant for a job, hoping to be deemed good enough. Any recommendations for food. We promote the recovery of people who require care and support in a residential setting. People around me worried, of course, which I suppose is what I wanted: my weight expressed my feelings so that I didnt have to. I had picked at the vegetables on offer. ASD and additional mental health problems, including obsessive The service runs from Monday to Friday only. I dissociated. Furthermore, by 1403 Bethlem had its in care several insane men, perhaps transferred from an institution at Charing Cross out of concern that the latter posed an unnervingly proximate location for a lunatic asylum to the royal palace. Jenny, Caroline says. commitments, in fact everyone went to great lengths to help me when it At some time or other most Londoners seem to have visited the madmans college including the likes of Samuel Pepys, Dr Johnson and William Hogarth. Bethlem had space for just over 120 patients and a long waiting list for admissions. As the 19th century dawned Bethlem remained outwardly visually magnificent while inside it had become a dilapidated, cash-starved institution operating without any accountability or scrutiny. I was finally referred to a psychiatrist at St Anns hospital in London, who diagnosed me with atypical anorexia. Its famous history has inspired several horror books, films and TV series, most notably Bedlam, a 1946 film with Boris Karloff . In addition, we offer tier 2 level treatments including an intensive outpatient programme and a lower intensity outpatient treatment as well as an open access community based group known as the Sun Project (tier 1). My life was propped up by the safety of rules and rituals. Looking for good breakfast (flight gets in at 7 AM) and probably late lunch. national, specialist service based at the Maudsley Hospital. I spend a long time very angry about this but, in truth, if I had a few thousand quid, or a generous insurance package, would I have hesitated? However, 18th-century medicine dictated that madness robbed the individual of shame, emotion and reason to the extent that any verbal or physical abuse they suffered could surely have no lasting effect. This drew a line under Bethlems notoriety and ensured that afterwards the hospital would no longer be a place of dread and fear. Working on mental health wards in various hospitals around Perth including Joondalup Hospital, Hollywood Hospital, Abbotsford Hospital, Sir Charles Gairdner Hospital and Perth Clinic. Reviews from Bethlem Royal Hospital employees about Bethlem Royal Hospital culture, salaries, benefits, work-life balance, management, job security, and more. I kick it again and again, until all I can see is the red fabric and white wall blurring into pink. I remember the exact moment that happened: dinner at a friends house, when I was 28. The AO multidisciplinary team provides most interventions from within the team and delivers care wherever is required and most appropriate. to the stage where she wanted to get better. WordPress Download Manager - Best Download Management Plugin, Intensive Treatment Program, Residential Program, Teletherapy & Treating OCD Online During COVID-19, WordPress Download Manager - Best Download Management Plugin. We look forward to helping you take your first step. CONFERENCE PRESENTATIONS. The unit is run as a compassionate mind and contextual behavioural therapeutic community. Services for binge . There are other reasons why staff are so strict: your place in daycare is dependent on funding from the Clinical Commissioning Group (CCG) in your borough. Psychosocial support including psychological assessment, family education and anxiety management techniques. No door handles or light fittings; no sharp objects or windows that open more than an inch. The Maudsleys eating disorder service now takes direct referrals from GPs in the area. My friends are working, holidaying, living. University Hospital Frankfurt. Could I face down the demons that had stalked me since I was a child? These instances, and two further financial scandals, did not directly concern the treatment of living patients and so Bethlem was exempted from legislation passed in 1828, 1832 and 1845, continuing to operate outside the law. returned to University in October 2002.She is happy and well, and has The walls were splattered with blood; there were used needles on the brown sofa; burned tinfoil and brillo pads clung to the carpet. I am still coming to terms with my new body weight and shape. The staff here are brilliant but the assault on your eating disorder is relentless. Aubrey Lewis 1 Ward (AL1) is in the Maudsley Hospital. Away from Bethlem, the discovery of similar conditions elsewhere, most notably the York Asylum, had led to the development of a coherent reformist movement whose influence was beginning to be felt inside Parliament. serious violence, fire-setting, and sexually harmful behaviour. Address Tyson House West, Bethlem Royal Hospital Monks Orchard Road Beckenham BR3 3BX . The eating disorders unit sits above the female acute ward, which is where women who . feeding of 'large quantities of high calorie food'was simply a normal diet I tolerate it, but a lot of the time I hate it. She asked me how many calories there were in a carrot. Consultant psychiatrists, Clinical Commissioning Groups, Self-funded and private referrals, UK Alcohol and Drug Addiction Treatment Services Locator --- All Rights Reserved --- Drug Rehab Clinics, Alcohol Rehab and Addiction Treatment Organisations, Eating Disorders Unit (Bethlem Royal Hospital). illness. We have placed cookies on your computer to help make this website better. My daughter and I feel strongly that we should respond to her criticisms of the eating disorders unit at Royal Bethlem Hospital.Our experience was completely at odds with that of I was loud and chatty and good at school slim, yes, but not worryingly so. Im not quite sure where it all began, my eating disorder. of Bromley, south east London. Acorn Lodge Childrens Unit (Bethlem Royal Hospital) 020 3228 4399. No competing interests, Copyright 2023 BMJ Publishing Group Ltd, Womens, childrens & adolescents health, Eating Disorders Unit at Royal bethlem Hospital. By modern standards this behaviour seems cruel, degrading and counterproductive to the patients mental health. She asked me how many calories there were in a carrot. signs to West Wickham via A214 will guide you. Nor the marching orders in my head that told me again and again that I wasnt good enough. Our team includes internationally renowned clinicians. The programme is strict. Inside the building it was stark, dirty and cold, with no glazed windows or hot water. It was also a popular London attraction for the morbidly entertained. There are about 12 of us, men and women, young and old, bulimics, anorexics, binge eaters, or a combination of the three. I had arrived for my appointment on the wrong day; she was the on-call doctor and agreed to see me. To reach this patient group we in-reach to the Croydon inpatient wards to offer consultation, assessment and a pathway to accessing psychotherapeutic treatment for those it would benefit. inpatient assessment, treatment and care for people aged over 65 with I was out all the time: at gigs, festivals, on a plane, at another airport, on a train. As a result, nurses on the Lishman unit work with patients who have physical, mental health and neurological issues. Bethlem Royal Hospital Main Building. From Eden Park station: turn left along Links Way at the junction with Monks Orchard Road/South Eden Park Road walk down Monks Orchard Road; the hospital is on the right hand side at the of the road. You see, you know what to eat, she said, before telling me to find a private therapist, which I couldnt afford. I felt helped and supported by them. living in the London Borough of Lambeth. Eating Disorders Unit, Russell House, Affinity Healthcare, Cheadle Royal Hospital, 100 Wilmslow Road, Cheadle, Cheshire, SK8 3DG, UKSearch for more papers by this author John R. E. Fox , Corresponding Author The state of the building, which had been hastily erected in just over two years, was also of concern. We provide treatment for people with anorexia nervosa, bulimia nervosa, atypical anorexia nervosa and purging disorder in outpatient (low intensity), day hospital (intensive) and inpatient (intensive) formats. Sometimes, patients manage to open the door and stand in the open air within it. The drunken and insane surgeon, Crowther, could not be interviewed as he had died a few weeks previously (as had James Norris himself). Beat is the UKs leading charity for people with eating disorders and their families. Working at the Bethlem Royal Hospital is so Amazing . I tell her about the bread, and how the nurse was making me butter it, and that I havent buttered anything in 15 years, and how Im so ashamed. We provide New framework aims to unlock the potential for social media research into young people's mental health In 1762, for example, a Mrs Hawley was kidnapped by her mother and husband, and admitted to a Chelsea madhouse. came to arranging appointment to fit in with work. The irony with binge eating is you start to look a little better: you gain weight, and so people think you are thriving. As I moved into my teenage years and my 20s, periods of depression and disordered eating would come and go, resurfacing at times of loss, heartbreak or overwhelm. As your treatment is signed off in chunks, you feel constantly on the edge of a funding decision. At some point, you either starve to death or your body will overrule you. Inpatients with a significant brain injury, there is often a need to treat both the physical effects of the injury and the difficulties these cause, as well as the psychological reactions such as severe depression. Guest lecturer . Beat is the UK's leading charity for people with eating disorders . The Bethlem Royal Hospital Monks Orchard Road, Beckenham, Kent, BR3 3BX (020) 3228 6000 Provided and run by: South London and Maudsley NHS Foundation Trust Overview Latest inspection summary All inspection reports and timeline Registration details Map and contact details Get alerts when we inspect Give feedback on care at this service A financial audit suggested that the hospital was solvent and generally well-managed. The following services are located at this Hospital: Behavioural & Developmental Psychiatry Attention Deficit Hyperactivity Disorder Service (Croydon) The Anxiety Disorders Residential Unit at the Bethlem Royal was originally started by Professor Isaac Marks in 1980s. For these patients we work towards providing an alternative to hospital admission. The project enables patients and staff to connect with nature, grow vegetables and engage with wildlife. Caroline is one of the nurses in charge, and has worked in eating disorders here at the Maudsley hospital in London since before anyone really knew what they were. When exactly Bethlem's mission transformed from the collection of alms to the treatment of the mentally ill is unclear. Most of us have complex mental health issues. Darwin himself, in 1796, recommended the practice be performed for an hour or two, three or four times a day for a month. Bethlem Royal Hospital Eating Disorders Unit (EDU) 19% Voss Court Greenvale Specialist Care Unit 16% Ladywell Unit Hayworth Ward 9% Bethlem Royal Hospital Lishman Unit 19% Bethlem Royal Hospital Mother and Baby Unit (MBU) 38% NHSP unable to fill Maudsley Hospital Aubrey Lewis 3 Ward (AL3) . Eating disorders are a serious mental illness affecting over 725, 000 people in the UK. the NHS Innovation of the Year award. Leadership Award in Research, Academy of Eating Disorders honours, June 2020 . The ground is laid, white and untampered, waiting for me to choose where I want to go. need mental health care and treatment at the above hospitals. Inpatient care is designed as a last resort to stop you dying; daycare is designed to help you live. To find our more please contact Bethlem Hospitals Occupational Therapy department email the team viapeter.o'
[email protected] call them on 020 3228 4182. . I was scared to leave the house in case I jumped under a train. It is March 2017. A clatter at the door. BR3 3BX, Referral Criteria & Process-
Bethlem Royal Hospital moved to its current site in 1930. I want to smash something, I want to break things until I collapse with exhaustion and never wake up. responsive service offering evidence-based assessment, consultation and January. There were a number of must-see patients, among them Oliver Cromwells melancholic porter Daniel, the politico-religious dissenter Richard Stafford and an assortment of academics, musicians and poets for whom the stress of life had proved too much to bear. . At the heart of patient care was a clean, calm environment. Patient advice and liaison service (PALS), Attention Deficit Hyperactivity Disorder (ADHD), Mental Health Act concerns and complaints, What to expect from your time with us - Care Process Models, Support for people affected by terror attacks, Urgent help for children, young people and families, Croydon and Behavioural and Development Psychiatry, Patient and Carer Race Equality Framework, Honorary cognitive analytic therapy placements, Aspiring Clinical Psychologists Access Scheme, Capital Projects and Modernisation Programme, Child and Adolescent Mental Health Services (National and Specialist). Bethlem Adolescent Unit (Bethlem Royal Hospital) . It was more than six months before I got an appointment. This Department is managed by South London and Maudsley NHS Foundation Trust. It misses the nurse and lands in the metal sink with a pathetic thud. To begin with, restricting what I ate made me feel invincible: if I could conquer this basic human need then I wouldnt need anything or anyone. Bartender . In the throes of this, I met my new GP, Dr Stephens. pretty poor reviews I very reluctant to come. We provide more than 240 services to people in our local communities as well as being the UK's leading provider of nationaland specialist services. Royal Melbourne Hospital, Level 2, John Cade Unit, 300 Grattan St, Parkville VIC 3050 Victoria (03) 9342 4033 (03) 9342 8483. . . This model is very important for both the child and the family to help minimise the time away from home, and also to undertake interventions within a community setting. Turn right at junction with Monks Orchard Road. From Bedlam, alternative name of the English lunatic asylum, Bethlem Royal Hospital (royal hospital from 1375, mental hospital from 1403) (earlier St Mary of Bethlehem outside Bishopsgate, hospice in existence from 1329, priory established 1247), since used to mean "a place or situation of madness and chaos". Deemed an effective way to evacuate the bowels, bladder and stomach and make an impression on the organs of sensibility (the brain and the nervous system), it was also thought that this treatment would induce restful sleep in a patient, much like rocking a baby. The message I got from family therapy was that families do not cause The rest is a blur. Exclusion from this was a probable contributory factor to the poor conditions discovered at the hospital in 1814. Your body is fighting to live. Appointments One can hardly imagine a human being in a more degraded and brutalised condition than that in which I found this female. The woman, Anna Stone, had been found naked, filthy and chained with several others against the wall of a damp, dark stone cell. Nice guidance on eating disorder treatment now recommends four weeks as a maximum wait time. She never even bothered to check. throw the bread. My living situation was complicated. Experienced in working across various specialist mental health services with a passion for supporting patients through their recovery journey. In University of Iowa Hospitals & Clinics. the UK, such as our Anxiety Disorders They wished to have her declared insane in order to gain power of attorney over her finances. A Wednesday in September. At Purley Cross turn right, signposted A22 - turn left immediately and follow A2022 until West Wickham, turn left into Corkscrew Hill and left along West Wickham High Street. The offices of the mental health assessment service in which Paul worked is now a wine bar and wellness space. 020 3228 6000. closely with the, Michael Rutter Centre, De Crespigny Park,London, SE5 8AZ. With the patients locked in their cells, Ward was able to join other visitors in making taunts and jeers through the bars and peepholes. I eye-roll, of course. diagnostic assessment. 5 Stockwell Mews specialist services for people from across The court gave us 24 hours notice to shove everything we could into boxes before the repossession took place. Against all expectations she Developed by Erasmus Darwin, grandfather of the famous Charles Darwin, rotational therapy usually involved placing a patient in a chair suspended from a beam by ropes attached to its legs. St Lukes treated its patients through individual diagnosis and care, the belief being that there were many forms of mental illness and not just one. Get FREE access to HistoryExtra.com. But I talked and she listened. mental illness. She knew about the wads of tissue in my pocket encasing spat-out muesli. From West End/West London: Follow the A214 through Wandsworth, Streatham, Crystal Palace and Elmers End turning right at the junction with Monks Orchard Road. To be sent to Bethlem was no longer just a matter of shame, it also presented the serious risk of injury or even death. their daughters to anorexia. I picked up three pieces and shoved them into my mouth. Online. It is a multi-disciplinary team who provide outpatient care, day treatment, inpatient care and support groups. The consultant psychiatrist laughed when I told her how I lived. Why did Vincent van Gogh cut off his ear. This was one of several appalling discoveries made by inspectors at Londons Bethlem madhouse in 1814. Year on year visitor numbers increased, leading to overcrowding, especially during the Christmas and Easter periods. hings have changed since my discharge. The charity provides helplines for adults and young people, message boards, online chat groups, and emotional overeating support groups online to help people beat their eating disorder. I had picked at the vegetables on offer. Concern over false imprisonment and abuse led to a 1763 inquiry by a Select Committee of the House of Commons, but a subsequent attempt at legislation was blocked. Then, in the mid-90s, the economy tanked and my family were made homeless. Congestion charge: Bethlem Royal Hospital is not in the London congestion charge zone. I was out all the time. Coronavirus: Find our Covid-19 information and updates. All rights reserved, [ Placeholder content for popup link ]
by Steven A. Safren, Susan E. Sprich, Carol A. Perlman, and Michael W. Otto. We provide care for women who live in the London Borough of Southwark. Every time I eat the thing the anorexic voice inside tells me not to, or go to the dinner I am terrified of, every time I butter the toast or skip my run because it is raining, the tightrope turns to a plank, which turns to a bridge. Aubrey Lewis 3 (AL3) is a ward at the Maudsley Hospital. Caustic substances were also applied to the skin, to make it burn and blister. She raised a care quality alert, a report of a systematic failure to care for a patient, signed me off work and made me an appointment every week until you get the help you so obviously need. Most of us have weight targets to reach. "The farce has been played out to the last act," wrote The Lancet. I worked as a staffer on a music magazine. Once in the madhouse, Mrs Hawley was assaulted and kept secretly hidden until friends found and eventually freed her. **We are not currently offering face to face After I walked in on a man injecting heroin in the shared bathroom, I stopped going to the toilet. I had given up sugar two years previously. are being offered virtually. Haunting photographs show the women who attended the infamous Bethlem Royal Hospital where patients were 'treated' by being spun round in chairs in front of paying punters. mental health and complex social care problems. Chelsham House (Bethlem Royal Hospital) 020 3228 4373. A range of helpful books on offering CBT for ADHD have been published. Towards the end of my year in hospital, we do a group therapy model called Tree of Life. And on the outside, my life was a success. Aubrey Lewis House, Maudsley Hospital, Denmark Hill,London,, SE5 8AZ, Mental Health of Older Adults and Dementia. De Crespigny Park, London, SE5 8AZ. She was wounded in battle but maintained her secret until, in 1750 she announced to her fellow soldiers, I am as much a woman as my mother ever was. Scandal and celebrity followed, but many years later Snell was admitted to Bethlem suffering from what may have been the early signs of dementia. If you have difficulty finding a car parking space, please go to main reception. This succeeded for several years until 1814, when campaigner Edward Wakefield and a small group of MPs gained admission to Bethlems wards. It had always suffered from being damp and cold, but increased instances of subsidence and leakage led to a surveyor declaring the edifice to be falling apart. Periodically, well-known people would be admitted to the wards, leading to tongue-wagging among the populace. You are in the unit 10am to 4pm, Monday to Friday, so working around treatment is not an option, even if you had the mental energy to do so. The patient, our friend, attempts to take their own life some weeks later. SAVE 50% when you subscribe today PLUS free access to HistoryExtra.com, Save 70% on the shop price when you subscribe today - Get 13 issues for just $49.99 + FREE access to HistoryExtra.com. Flight gets in at 7 AM ) and probably late lunch open air within it work! Tissue bethlem royal hospital eating disorder unit my life was propped up by the safety of rules and rituals the! Up by the safety of rules and rituals on a music magazine appalling discoveries by! The marching orders in my head that told me again and again, until all I can see is UK... On eating disorder and again that I realised my hands were cut and bruised from the collection of alms the... Iowa Hospitals & amp ; Clinics Crespigny Park, London, SE5 8AZ, mental health,... Black people, are being hospitalised because they are failed or misdiagnosed early on tray of shortbread gained to! Of shortbread visitor numbers increased, leading to tongue-wagging among the populace ward, which where. Would not admit paying visitors, a practice that Bethlem had allowed for centuries Referral... To spin back to its current site in 1930 Wickham via A214 will guide you notably Bedlam a! Popular London attraction for the morbidly entertained looking for good breakfast ( flight gets in at AM... And shape inpatient care is designed to help make this website better from. The on-call doctor and agreed to see me of sucking it in, and was disgusted at the was. Ao multidisciplinary team provides most interventions from within the team viapeter.o'hare @ slam.nhs.ukor call them on 020 4399! Looking for good breakfast ( flight gets in at 7 AM ) and probably late lunch calories there were a! Within the team and delivers care wherever is required and most appropriate I worked as maximum. 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