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STRESS AND ITS EFFECT ON JOB SATISFACTION

High Level of Stress in an Organization Reduces

Employee Job Satisfaction

Ahmed Z., Anum A., Mavish S., Mubeen L., Iqra H., Mudassir N.

University of Central Punjab


Part 1

Research Background and


Organization
Research Background

Stress is the psychological and physical state that results when the resources of the
individual are not sufficient to cope with the demands and pressure of the situation. Level
of job satisfaction and stress can affect both individuals and organization. Stress seems to
become even more serious at an alarming rate in many organizations. Job stress is a
recognized problem in health care workers and doctors are considered to be at particular
risk of stress and stress related psychosocial problems. If stress happens too often or lasts
too long, it can have bad effects. It can be linked to headaches, an upset stomach, back
pain, and trouble sleeping. It can weaken your immune system, making it harder to fight
off disease. If you already have a health problem, stress may make it worse. It can make
you moody, tense, or depressed. Your relationships may suffer, and you may not do well
at work.

Individuals with lower status jobs are suffering more these days due to high levels
of stress and they are prone more to high blood pressure and anxiety. Stress can
be considered to be a key determinant of job satisfaction.

Components of job stress include factors like role conflict, role ambiguity, role
overload inflexible working hours, unhealthy work environment, etc. In Pakistan,
an important segment of work professionals which is more likely to experience
stress then others are doctors.

Doctor to patient ratio is 1: 1400 in Pakistan which means that on average a


doctor has to deal with 1400 patients. This heavy burden of patients is likely to
create stress among doctors. Current security crisis in Pakistan has increased the
frequency of emergencies in hospitals. Because of these crises hospitals remain on
high alert at times and causes stress to the doctors.

Another factor which causes stress to the doctors is the attitude of the patients.
Patients quarrel at times with the doctors and doctors don’t get the actual problem
which patients are facing and this factor causes stress to the doctors.
Research Objective:

The aim of study is to find the negative relationship between stress and Job satisfaction.
According to Sherry & Rabi(1992) “Under conditions of high life stress, highly
competent individuals reported greater satisfaction with work, co-workers and
supervision, less emotional exhaustion, and less feelings of depersonalization than did
individuals who perceived themselves to be less competent.” So another purpose of the
study is to look into this perspective and see if this applies in general to the organizations
in Pakistan. “Job dissatisfaction and stress among doctors affect the quality of health
care.” (Ali, Riaz, Marie, Zafar & Nadya., 2004). The high stress level resulting from
employee intraorganizational and extraorganizational interactions is a serious problem
reducing satisfaction and motivation level.

The major stressors in an organization are intrinsic to the job, relationship


at work, career development, home/work interference, role in organization and
high work volume. They affect the individual by causing low job satisfaction,
blood pressure problems, depressed mood which in turn will effect the
organization by high absenteeism, poor quality control, high labor turnover and
thus affecting the organization adversely.

Operational Definitions:

Here are definitions of the key terms in accordance with the aim of our research:

Stress

The stress in general is psychological and physical alarm system of human body
when it corresponds to high external pressure. For an employee the stress sources may be
intra-organizational or extra-organizational. However in our study ‘stress’ means only
intra-organizational stress.

Job Dissatisfaction

By job dissatisfaction in our study, we mean the dissatisfaction resulting from stress
causing factors and which results in bad performance of the employee.

Organizational Background

Organization: ‘Services Hospital’

Origin and History:

In 1958, a separate outpatient department of Mayo Hospital, Lahore was setup for the
use of government employees. In 1960, this was converted into 55-bedded and name as
Wahdat Hospital; it had medical and surgical facilities, together with laboratory and X-
Rays unit. It was later renamed " Services Hospital ".
The bed strength was gradually increased and Services hospital was named
‘Autonomous Institution’ in 1999. The Emergency and Trauma Centre was setup in 2002
and is now being upgraded and modernized under the Chief Minister's initiative of
"Strengthening of Emergency Medical Services" (SEMS). This scheme has been
approved by the Board of Management, at a total cost of Rs. 80 million. Construction
work is being carried out by the Communication and Works Department. Equipment
worth Rs. 9.9 million is also being purchased under SEMS.

In 2003, the Government of Punjab has established a unique, self financing Services
Institute of Medical Sciences (SIMS) for undergraduate medical students and attached to
services Hospital.

Size:

Initially the organizations size was limited to 55 bed and today after expansion the size
has increased to 1096 beds plus the Trauma and Emergency Department. There are 33
departments comprising more than 250 doctors.

Location:

Services Hospital, Jail Road, Lahore, Punjab, Pakistan

Charter:

Approval for research has been granted by House Officer, General Surgery, Dr. Amir
Zaheer Shakoori. MBBS, part 1.

Relation with Other Organizations:

Services Hospital has been initially associated with Allama Iqbal Medical College in
1977, then with Postgraduate Medical Institution (PMGI) in 1995. Today it is associated
with SIMS Services Institute of Medical Sciences.

Since it is a government organization, the relations with other hospitals is not


competitive in nature. However the doctors still feel a sense of competition among their
hospitals Services also refers patients to other hospital like Mayo Hospital and Vice
versa. So they don’t compete for getting all the patients, rather share the burden in
emergency situations.
Resources and Financial Position:

The government allocates annual budget of the Services hospital. The budget of
services is the part of the 2% of the total government’s budget for a fiscal year. In
addition to this the government provides project based funds to the hospital. E.g. in 2002
the chief minister allocated Rs.80 million for "Strengthening of Emergency Medical
Services" (SEMS). Equipment worth Rs.9.9 million is also being purchased under SEMS.
As per Chief Minister's initiative, the emergency staff is receiving an additional
allowance equivalent to 50% of their basic pay. The financial position of the government
hospital is therefore stable.

Inclusion and Exclusion Criteria for Respondants:

Inclusion Criteria

• The age of doctor is between 22 and 30.


• The doctor has at least worked for 2 months at services hospital.
• The doctor is in a good socio-economical condition.
• Family of doctor is not primarily dependant on his or her income.

Exclusion Criteria

• The doctor is a patient of stress induced disease.

- He/she is going through a family or personal dispute during the time of survey.

• The doctor has a poor background.


• The doctor is also working under another hospital or doing multiple jobs.
Part 2

Literature Review
Literature Review

The purpose of Nazanin’s (1999) the study was to determine whether there is a causal
relationship between stress and job satisfaction. Stress management is very significant
issue these days. Various techniques are suggested to reduce stress. A pre test was
conducted on a sample of 11 employees. Then they were divided and one group was
made to use stress management techniques and the other one did not. Then post tests
were conducted to see the effects. “Although other researchers have shown a strong
correlation between stress level and job satisfaction, a causal relationship has not been
discussed. The purpose of this study was to determine whether or not a causal
relationship exists. The results, though not statistically significant, did support a
directional change in stress level: stress levels were reduced with stress management
techniques”. (Discussion section para. 1).

Eva et. Al (2000) carried out the study to measure prevalence of burnout, job
satisfaction and job stress and to understand the relation between consideration of
alternative work situations and burnout, psychological morbidity, job satisfaction and job
stress among medical oncology personnel. “There has been growing concern about
anecdotal reports of burnout, high levels of stress and staff leaving or decreasing their
work hours. However, no research has systematically determined whether there is
evidence to support or refute these reports.” (Background section para. 1). A
questionnaire used and designed by Ramirez and associates was used to measure job
stress and satisfaction. In the responses received majority said that the stress sources were
factors like high work volume, inadequate staffing, feeling under pressure to make
deadlines and having hoe life disrupted because of long working hours.

Dowell, Westcott, McLeod, Hamilton (2000) conducted the study “To assess job
satisfaction, job-related stress and psychological morbidity among New Zealand
physicians, surgeons and community pharmacists and provide a comparison with New
Zealand general practitioners (GPs)”. (AIM section para. 1). General Health
questionnaire and job satisfaction by the Warr Cook Wall scale were distributed among
1041 doctors practitioners and others. “Job satisfaction varied according to gender, the
relative amount of time spent in public practice and the perceived ill effects of work on
health. Pharmacists had the highest number of cases with significant scores on the GHQ-
12 scale, with physicians and surgeons scoring similar to GPs.” (Result section). The
groups were generally satisfied with their jobs except the pharmacists were less satisfied.

Khuwaja, Qureshi, Andrades, Fatmi, Khuwaja (2002) studied the comparison of job
satisfaction and stress among male and female doctors at teaching hospitals. The study is
very significant since “job dissatisfaction and stress among doctors affect the quality of
health care” (Background section para. 1) The ten most frequently identified workplace
characteristics, by selected doctors, relating to job satisfaction were included in a five
point Likert Scale format questionnaire. Out of 270 postal surveys 189 responses were
received out of which 182 were found complete for analysis. “Majority (68%) of the
doctors were not satisfied with their jobs, females more than males (males 65% and
females 72%; p = > 0.05)” (Results section para. 2). The mean stress score was 3.32
which were mainly affecting their personal lives as it was deteriorating their physical and
mental health. Thus majority of doctors are suffering from high levels of stress and job
dissatisfaction in teaching hospitals of Karachi and these results in poor health care
performance and negative impact on health of an individual.

The study of Mario (2002) was conducted to see the relation between job satisfaction
and high stress at work. The findings of a previous research, that Italian workers in an
organization were satisfied with their job but complained about high stress level at work
were to be proved in this study. Democratici di Sinistra (DS) survey was conducted.
Internal factors like internal bureaucracy and pressure of management demands,
differences in occupational status, job insecurity and Poor economic reward, lack of
opportunity to participate in work organization, and difficulty in maintaining a good
work-life balance were main sources of stress for both male and female workers.
“Companies have not updated their organization and human resource policies to meet the
new competitive environment, which may partly explain Italy’s current economic
decline.” (Commentary section para. 2).

Monson, Walker, Sharp, Sharma (2008) studied the high stress and its influence of
burnout and morbidity. A booklet of questionnaire was sent to all the doctors containing
questions relating cancer-related and specialty-specific work load, job satisfaction and
socio-demographics. It also included the General Health Questionnaire (GHQ). 77% of
the surgeons stated they would retire as soon as possible. Thisa was because they were
burned out and suffering morbidity. “Work satisfaction was negatively correlated with
psychiatric morbidity and all three burnout scales.” (pg. 574). “Levels of psychiatric
morbidity, burnout and work dissatisfaction are worryingly high in colorectal and
vascular surgeons and are likely to impact adversely on patient satisfaction and service
quality.” (pg. 576).

Jamal (2008) in his study examined the relation between stress at work job satisfaction,
burnout and health problems. Job stress is considered as one of the most serious
occupational hazards of modern time in industrialized countries; it is also increasing the
work-stress cost of the organizations. Job stress and its effects had been empirically
tested only in developed countries and not in developing countries like Pakistan and
Malaysia. “Bivariate multiple regression and hierarchical multiple regression analyses
were used to test the nature of the relationship between the measures of job stress and the
dependent variables.” (Abstract Section para. 1). The overall relation between job stress
and dependant variables was linear and job satisfaction was found to be negatively
proportional.

According to Sehlen, et al. (2009) “The impetus for the study was to analyze factors
for stress and job satisfaction of cancer care workers within the context of different
radiotherapy departments in Germany and Austria.” (Background section, para. 4). The
increase in complexity of cases and available treatment options especially the radiation
oncology treatment has become more complex than before. 8 universities and 3 general
hospitals were given 42 item FBAS format questionnaire to fill. 534 complete responses
were collected. “Nurses and physicians showed the highest levels of job stress (mean
FBAS total score 2.2 and 2.1, respectively” (Results section, para 1). “Increasing
evidence suggests that physician distress can lead to erosion of physician compassion,
patient compliance and the quality of care physicians deliver.” (Discussion section,
para.4). “Current workplace environments have a negative impact on stress levels and the
satisfaction of radiotherapy staff.” (Conclusion section, para 1)

“Looking at the ways in which an organization can create stress for employees, how
much it is costing industry and what can be done to minimize the adverse effects.” (pg.
146). The stress causes harmful effects to individual and his or her organization
adversely. “The cost is widespread: it includes the expense of days lost to illness, lost
opportunities and, more recently, a massive increase in claims for worker compensation
based on stress at work.” (pg. 147) In order to deal with stress to reduce it managers must
be able to identify them accurately. Recognition of possible sources of management
stress will help minimizing its negative impact.(pg. 148). Stress from work overload, role
ambiguity, role conflict, relationship at work, job security, climate and work/home
interference can cause job dissatisfaction, absenteeism, low motivation, depressed mood
and many other problems to individual and eventually to organization.

Duane (2004) in his book studied the effects of stress on managers, staff and those in
operation positions to see its effect on health and productivity. “Stress at work exerts a
dramatic effect on employee health and productivity.”(pg. 453). The stress levels of large
organization’s employees were measured after the company had gone under a sweeping
organizational change. The employees were 2000 in number. “The most striking finding
is that managers showed a very low incidence of stress reactions compared to those in
staff and operations positions.” (pg. 447). Stress can be dealt with elimination of work
overload, provision of social support, emotional climate control etc.
Part 3

Research Methodology
Theoretical Framework:

According to the literature review and the interview from some doctors at the hospital we
concluded the following theoretical frame work:

Figure giving the Independent variables affecting the Stress.

Figure giving the Independent variables


affecting the Stress

There are other factors as well which affect stress and satisfaction level but for our
research we chose the above variables only.

Research Design:

How important do you think standardized test scores are to a fifth-grader's education (circle one number):
Not very Extremely
important important
1 2 3 4 5

The research will be a ‘closed-ended survey’ because this type of survey requires
lesser resources and gives quantitative and easily measureable results. The survey will be
a ‘Likert Scale’ method. This is because when we want to know feelings of our subject
we use ‘Likert Scale’ method.

Population:

The population selected for the research was composed of doctors of three departments
of Services hospital i.e. Medicine, Gynae and Surgery. The population size is 113
doctors.

Sample
The sample was taken of 30 doctors out of the total population of these
departments. Ten doctors from each department were selected for survey.

Sampling Technique:

We used ‘quota sampling’ to select the respondents according to own ratio of


gender and designation.

Response Received:

Out of the 30 surveys that were distributed 25 were complete responses. The rest
five were either incomplete or they were misplaced by respondents.

Interferences:

There was minimal interference by the researchers since the questionnaires were
dropped off at the site and collected later. Filing instructions were given on the
front page for the respondents to follow.
Part 3

Data Analysis and


Interpretations

Introduction to Data Analysis:


The data collected from 25 respondents was analyzed via SPSS statistics data editor. We
used various tables and analysis techniques like ANOVA, Correlation and Cross
tabulation to analyze various categorical and quantitative data in the research. The
application of various methods is given in figure below:

Results and Interpretations:

We take value of alpha= 0.05

Gender and Stress:

Ho: The stress experienced by doctors is same for different doctors of different genders.

H1: The stress experienced by doctors is different for different doctors of different
genders.

ANOVA
Stress
Sum of Squares df Mean Square F Sig.
Between Groups 44.518 1 44.518 1.425 .245
Within Groups 718.442 23 31.237
Total 762.960 24

p= 0.245

The value of p is above the value of alpha therefore Ho will be accepted that the level of
stress does not vary due to gender differences among the doctors in the hospitals.

Stress and Departments:

Ho: Stress level is same in all departments.


H1: Stress level is different in different departments.

ANOVA
Stress
Sum of Squares df Mean Square F Sig.
Between Groups 122.471 2 61.236 2.103 .146
Within Groups 640.489 22 29.113
Total 762.960 24

p = 0.146

Since value of p is greater than alpha the Ho will be accepted and thus there is no
significant difference in the stress level experienced by the doctors belonging to different
departments. Thus the stress level is almost same in medicine, gynae and surgery of
Services hospital.

Stress and Designation:

Ho: The stress level is different for various designations of doctors.

H1: The stress level is same for various designations of doctors.

ANOVA
Stress
Sum of Squares df Mean Square F Sig.
Between Groups 91.853 2 45.926 1.506 .244
Within Groups 671.107 22 30.505
Total 762.960 24

p= 0.244

The level of stress is thus same for all designations. One reason for this could be the
unspecified tasks of all the doctors at the hospital and the high percentage of patients in
general and emergency.
Satisfaction & Gender:

Ho: The satisfaction level is same for both males and females doctors.

H1: The satisfaction level is different for male and female doctors.

ANOVA
Satisfaction
Sum of Squares df Mean Square F Sig.
Between Groups 9.083 1 9.083 1.171 .290
Within Groups 178.357 23 7.755
Total 187.440 24

p= 0.290

Since the value of p is greater then alpha thus the satisfaction level does not vary with the
gender of the doctors, it is rather dependant on other factors like salary, motivation etc.

Satisfaction & Departments:

H1: The satisfaction level of different departments varies accordingly.

Ho: The satisfaction level of different departments is the same and does not vary
accordingly.

ANOVA
Satisfaction
Sum of Squares df Mean Square F Sig.
Between Groups 15.040 2 7.520 .960 .398
Within Groups 172.400 22 7.836
Total 187.440 24
p= 0.398

Satisfaction & Designation:

H1: The satisfaction level is different among different designations of doctors.

Ho: The satisfaction level does not vary with different designations of doctors.
ANOVA
Satisfaction
Sum of Squares df Mean Square F Sig.
Between Groups 9.011 2 4.506 .556 .582
Within Groups 178.429 22 8.110
Total 187.440 24

P= 0.582

The H1 will be rejected and thus the level of designation has no effect on satisfaction of
the doctors.

Experience and Stress:

Correlations
Years in hospital Stress
Years in hospital Pearson Correlation 1 -.317
Sig. (2-tailed) .122
N 25 25
Stress Pearson Correlation -.317 1
Sig. (2-tailed) .122
N 25 25

The results show that stress is highly negatively correlated with the experience of doctors
i.e. the number of years spent by the doctors at the hospital.

Cross Tabulation:

Department of the respondent * No one has to do other's duties Cross tabulation


No one has to do other's duties Total
strongly disagree not agree strongly
disagree sure agree
Department of the Medicine Count 0 6 2 1 0 9
respondent % within Department of the .0% 66.7% 22.2% 11.1% .0% 100.0%
respondent
surgery Count 1 4 0 4 1 10
% within Department of the 10.0% 40.0% .0% 40.0% 10.0% 100.0%
respondent
gynae Count 1 1 2 2 0 6
% within Department of the 16.7% 16.7% 33.3% 33.3% .0% 100.0%
respondent
Total Count 2 11 4 7 1 25
% within Department of the 8.0% 44.0% 16.0% 28.0% 4.0% 100.0%
respondent

Department of the respondent * Duties are fixed Cross tabulation


Duties are fixed Total
strongly disagree not sure agree strongly
disagree agree
Department of the Medicine Count 2 3 2 1 1 9
respondent % within Department of the 22.2% 33.3% 22.2% 11.1% 11.1% 100.0%
respondent
surgery Count 1 3 0 4 2 10
% within Department of the 10.0% 30.0% .0% 40.0% 20.0% 100.0%
respondent
gynae Count 1 1 1 2 1 6
% within Department of the 16.7% 16.7% 16.7% 33.3% 16.7% 100.0%
respondent
Total Count 4 7 3 7 4 25
% within Department of the 16.0% 28.0% 12.0% 28.0% 16.0% 100.0%
respondent

Designation of the respondents * Salary Cross tabulation


Salary Total
strongly Disagree agree strongly
disagree agree
Designation of the House Count 5 1 6 0 12
respondants officer % within Designation of the 41.7% 8.3% 50.0% .0% 100.0%
respondents
Medical Count 4 3 0 0 7
officer % within Designation of the 57.1% 42.9% .0% .0% 100.0%
respondants
Registrar Count 3 2 0 1 6
% within Designation of the 50.0% 33.3% .0% 16.7% 100.0%
respondants
Total Count 12 6 6 1 25
% within Designation of the 48.0% 24.0% 24.0% 4.0% 100.0%
respondants

Designation of the respondants * Incentives Crosstabulation


Incentives Total
strongly disagree not agree
disagree sure
Designation of the House officer Count 10 2 0 0 12
respondants % within Designation of the 83.3% 16.7% .0% .0% 100.0%
respondants
Medical Count 5 1 1 0 7
officer % within Designation of the 71.4% 14.3% 14.3% .0% 100.0%
respondants
Registrar Count 4 1 0 1 6
% within Designation of the 66.7% 16.7% .0% 16.7% 100.0%
respondants
Total Count 19 4 1 1 25
% within Designation of the 76.0% 16.0% 4.0% 4.0% 100.0%
respondants

Designation of the respondents * Supportive seniors Cross tabulation


Supportive seniors Total
strongly disagree not sure agree strongly
disagree agree
Designation of the House officer Count 2 0 0 8 2 12
respondents % within Designation of the 16.7% .0% .0% 66.7% 16.7% 100.0%
respondents
Medical Count 0 1 3 3 0 7
officer % within Designation of the .0% 14.3% 42.9% 42.9% .0% 100.0%
respondents
Registrar Count 0 0 2 3 1 6
% within Designation of the .0% .0% 33.3% 50.0% 16.7% 100.0%
respondents
Total Count 2 1 5 14 3 25
% within Designation of the 8.0% 4.0% 20.0% 56.0% 12.0% 100.0%
respondants

Department of the respondent * Patients are cooperative Cross tabulation


Patients are cooperative Total
strongly disagree not sure agree
disagree
Department of the Medicine Count 0 6 3 0 9
respondent % within Department of the .0% 66.7% 33.3% .0% 100.0%
respondent
surgery Count 1 5 1 3 10
% within Department of the 10.0% 50.0% 10.0% 30.0% 100.0%
respondent
gynae Count 3 3 0 0 6
% within Department of the 50.0% 50.0% .0% .0% 100.0%
respondent
Total Count 4 14 4 3 25
% within Department of the 16.0% 56.0% 16.0% 12.0% 100.0%
respondent

Department of the respondent * Emergencies Cross tabulation


Emergencies Total
disagree not sure agree strongly agree
Department of the respondent Medicine Count 0 0 1 8 9
% within Department of the respondent .0% .0% 11.1% 88.9% 100.0%
surgery Count 1 1 5 3 10
% within Department of the respondent 10.0% 10.0% 50.0% 30.0% 100.0%
gynae Count 1 0 3 2 6
% within Department of the respondent 16.7% .0% 50.0% 33.3% 100.0%
Total Count 2 1 9 13 25
% within Department of the respondent 8.0% 4.0% 36.0% 52.0% 100.0%

Interpretations of Correlations:

• 44% of the respondent doctors agree that they have to do the tasks of other
doctors on their departments.
• On the question of duties given to the doctors the response is mix 28% agree with
fixed duties while 28% also disagree with it.
• 48% of the respondents say that they are not satisfied with the salary being given
according to their posts.
• Majority doctors say that they are not being given any sort of incentive by the
hospital which is a crucial point with regard to satisfaction of doctors.
• 56% doctors agree that their superiors are supportive which is good for motivation
and satisfaction of the doctors.
• The doctors highly responded in disagreement when asked about the level of
cooperation of patients.
• 52% doctors say that the level of emergencies is increasing. The main reason for
this would be the increasing accidental rates.

Frequencies

Statistics
Stress Satisfaction
N Valid 25 25
Missing 0 0
Mean 40.0400 12.3200

The highest score of stress in Questionnaire = 65

The lowest score of stress in Questionnaire = 13

Score of stress in result = 40.04


Comment: Therefore the mean level of stress is high in the hospital in all the three
departments.

The highest score of satisfaction in Questionnaire = 25

The lowest score of satisfaction in questionnaire = 5

The score of satisfaction in result = 12.32

Comment: The mean level of satisfaction is closer lowest limit of satisfaction therefore
the overall satisfaction of doctors in the hospital is low.

Part 4

Conclusion
Conclusions:

From the above results and interpretations we see that when the stress level is high which
is 40.04 but the stress level is not very low (12.03). Thus we can conclude that the effect
of stress on satisfaction is negative, but the effect is not very prominent.

However the results above do support the general statement and hypothesis that high
stress effects the satisfaction of employees in an organization but only to a limited
extent.

• The level of stress & satisfaction is not affected by the designation, department
and gender of doctors. They depend on other factors like salary, patients
quarreling, improper job design etc.
• The doctors’ greatest stress causing source would be the patients’ and their
attendants constant quarreling and no cooperation with the doctors. The patients
being illiterate most of the time do not know how to manage and follow rules and
procedures without questioning. So doctors have to guide them in every small
detail.

• Incentives are almost extinct with the doctors. This affects the satisfaction and
thus reduces motivation to work. The doctors are not given transport or bonuses
as incentives.

• Majority of our respondents had an experience of less than a year and they
allowed higher level of stress as compared to the doctors with 2 to 3 years of
experience. Thus we can conclude that greater the experiences lesser is the stress
level due to increase in ability to handle situations smartly and efficiently.

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