Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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On Aug 2018

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"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : LC01 - LC05 Full Version

Identification of Factors Affecting Patient Safety in the Emergency Department: A Retrospective Study

Published: March 1, 2022 | DOI:
Mashael Althobaiti, Ahmad Joman Alghamdi, Mohammed Almalki, Ahmed S Alkarani, Sultan Alamri

1. Nursing Specialist, Department of Nursing, Children Hospital, Taif, Makkah, Saudi Arabia. 2. Assistant Professor, Department of Radiological Sciences, Taif University, Taif, Makkah, Saudi Arabia. 3. Assistant Professor, Department of Nursing, Taif University, Taif, Makkah, Saudi Arabia. 4. Assistant Professor, Department of Nursing, Taif University, Taif, Makkah, Saudi Arabia. 5. Assistant Professor, Department of Radiological Sciences, Taif University, Taif, Makkah, Saudi Arabia.

Correspondence Address :
Dr. Sultan Alamri,
Assistant Professor, Department of Radiological Sciences, Taif University, Taif, Makkah, Saudi Arabia.


Introduction: Emergency Departments (EDs) have been described as complex, dynamic and at high risk for medical errors. Factors affecting the risk of medical error in the ED are related to communication, triage and medication management and upto 3% of all medical errors in hospitals take place in the ED.

Aim: To identify the factors affecting patients’ safety in the EDs of two major hospitals in Taif city based on Occurrence Variance Reporting (OVR).

Materials and Methods: The present study was a cross-sectional retrospective study which was conducted from January 2018 to October 2020 at King Abdul-Aziz Specialist Hospital (KAASH) and from October 2018 to October 2020 at King Faisal Medical Complex (KFMC) in Taif city, Makkah, Saudi Arabia. The OVR data included six variables including category of OVR, name of hospital, year of OVR, type of report, who made the OVR and action taken by the hospitals, and was analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS).

Results: This study found that 3,632 OVR reports were collected. Nearly two-thirds of all OVRs were associated with nursing care management issues, followed by identification/document/consent issues (9.4%), medical equipment issues (5.5%), housekeeping issues (0.2%) and laundry service (0.1%) representing the lowest frequency of OVR. Unsafe conditions accounted for 75.17% (2,730) of all OVR reports and only 24.83% (902) were incident reports. Staff nurses reported a majority of reports (89.5%), with 10.5% of OVRs reported by other healthcare workers. The primary actions taken by the hospitals in response to these reports were detection (72.3%) and prevention (17.4%), while only 10.3% was corrected.

Conclusion: Patient safety is the primary challenge faced by healthcare providers at hospitals. Thus, OVR is a very important tool in order to avoid errors and limit harms ensuring healthcare quality and safety delivery.


Medical error, Occurrence variance reporting, Risk

The EDs provide immediate access to medical care. However, there is a risk of exposure to medical error caused by mistakes made by healthcare providers. These unintended adverse events can lead to poor outcomes including disability, or even death (1). The number of patients who utilised the ED in Saudi Arabia from 2011 to 2015 was estimated to be 102.2 million (2). Medical actions in the ED can be non urgent or urgent in nature. Incomplete information on the patient’s condition may lead to the provision of unnecessary or inappropriate interventions. In contrast, hospitals that have instituted constant rounds have demonstrated higher levels of refinement and optimisation of their medical care (3).

The World Health Organisation (WHO) defines patient safety as “the absence of preventable harm to a patient during the process of healthcare” and established global norms, and evidence-based policies to guarantee excellence in patient’s safety (4). In the United States 100,000 patients lost their lives due to medical errors every year (5). The term “medical error” is widely used in patient safety literature to describe a failure that occurs in the processes of healthcare but does not necessarily include harm (6). The OVR is essential for ensuring patient and staff safety, quality of care, and risk management. Occurrence reports are used to report events that may have risk management considerations and may require further follow-up by other departments (7). A successful OVR system is one in which 100% of the outcomes of incidents are reported to the risk manager as the purpose of OVR is to provide complete facts regarding any incidents (8). Therefore, this study aimed to identify the factors affecting patient safety in the EDs based on an assessment of OVRs at KAASH and KFMC in Taif city, Saudi Arabia.

Material and Methods

A cross-sectional retrospective study was conducted from January 2018-October 2020 at KAASH and from October 2018-October 2020 at KFMC in Taif city. The analysis of the study was done from December 2020-January 2021. The proposal for this study was approved by the Directorate of Health Affairs-Taif (IRB Registration Number with KACST, KSA: HAP-02-T-067, approval number 424 on 10/9/2020).

Data were collected from the quality management and patient safety departments at both hospitals using a checklist of the monthly OVRs between October 2020 and December 2020. The OVR data included six variables: category of OVR [Appendix A], name of hospital, year of OVR (including 2018, 2019, and 2020), type of report including incident, near miss, and unsafe condition [Appendix B], who made the OVR (including nurses and other healthcare workers), and action taken by the hospitals (including correction, detection, and prevention).

Statistical Analysis

After reviewing and coding the collected data, it was analysed using IBM SPSS Statistics for Windows, version 24.0 (IBM Corp., Armonk, N.Y., USA). Descriptive statistics such as frequency and percentage were used for qualitative variables and the Chi-square test was used to compare dependent and independent variables.


During the study period, 3,632 OVR reports were collected. Nearly two-thirds of all OVRs were associated with nursing care management issues, followed by ID/document/consent issues (9.4%) and medical equipment issues (5.5%). Housekeeping (0.2%) and laundry service (0.1%) issues represented the lowest proportion of OVRs (Table/Fig 1). Unsafe conditions accounted for 75.17% of these reports (2730), while only 24.83% were incident reports (902). Only four reports were in the near miss category, which represented a negligible value, so these reports were added to the unsafe condition reports (Table/Fig 2). Staff nurses reported the majority of OVRs (n=3251, 89.5%) and the remaining reports were by other healthcare workers (n=381, 10.5%). The primary action taken in response to these reports was detection (n=2626, 72.3%), followed by prevention (n=633, 17.4%) and correction (n=373, 10.3%).

There were differences in OVR reporting between KAASH and KFMC from 2018 to 2020. In 2018, of the total 1,337 reports that were conducted, including both unsafe conditions and incidents, 1,235 reports were from KAASH, while only 102 reports were from KFMC. In 2019, 1,683 reports were conducted including both unsafe conditions and incidents, with 1,063 reports occurring at KAASH and 620 reports occurring at KFMC. In 2020, a total of only 612 reports were conducted including both unsafe conditions and incidents, 388 of which occurred at KAASH and 224 of which occurred at KFMC (Table/Fig 2).

The number of OVR reports conducted differed between hospitals during the study period. Of the total of 3,632 reports conducted in both hospitals from 2018 to 2020, 2,686 (73.9%) were conducted at KAASH, while only 946 (26.1%) were conducted at KFMC. There was a statistically significant difference (p-value <0.001) between hospitals in the number of OVR reports (Table/Fig 3).


This study aimed to identify the factors affecting patient safety in the EDs at KAASH and KFMC based on their OVRs. It was determined that 3,632 OVR reports were conducted during the study period. A similar Saudi study conducted in Riyadh found that a total of 2,362 OVRs were reported to the quality management department in 2020 alone (9). The number of OVRs reported at the Taif hospitals included in the present study was significantly lower. This indicates increased OVR reporting in the Riyadh hospitals. A possible explanation for this might be the application of effective educational programmes in Riyadh hospitals that increased the general awareness of staff with the OVR database and its importance to the hospital, staff, and patient safety (9). Another possible explanation is that hospital policies have been modified, leading to a non-punitive culture surrounding medical errors (10).

There were 21 OVR categories found, all of them affecting patient safety in the ED to a varying degree. The most common OVR type was nursing care management issues (60.4%), followed by ID\document\consent issues (9.4%). Housekeeping issues (0.2%) and laundry service (0.1%) represented the least frequent OVR types. A study performed in Turkey in 2020 found that the types and percentage of errors in the ED varied. For example, procedural errors accounted for 38% of all errors, medication errors for 16%, documentation errors for 13%, and communication for 12% (11). This study, in contrast, found that procedural and medication errors each accounted for only 0.4% of all errors, with documentation errors accounting for 9.4% and communication errors accounting for 1.4%. Moreover, it has been shown that up to 90% of nurses can expose to violence (security-related issue) (12). In the present study, all security-related issues accounted for only 2.8%. This indicates that the factors affecting patient safety in the ED are different from one country to another. In agreement with the present study, in which issues relating to nursing care management accounted for the majority of OVRs reported (n=2194), a previous Saudi study performed at Al Qassim at King Saud Hospital in 2014 demonstrated that the majority of OVR types were due to nursing care management (n=389) (7).

In assessing the medical staff who report OVR events, the current study indicated that the majority of these reports (89.5%) were conducted by staff nurses, with only 10.5% conducted by other healthcare workers. This difference may be explained in part by the fact that there are a large number of nurses working in the hospital compared to other clinicians. In addition, reporting any incidents or medical errors is one of the important roles given to nurses. A study conducted in 2017 by the University of Cape Town found that doctors and nurses were largely unaware of the hospital’s error reporting system. This was attributed to inadequacies within the organisation, as the participants were willing to report incidents if perceived barriers were removed. This suggested an urgent need for an effective error reporting system to be implemented in the local setting and for appropriate awareness training and educational interventions to improve clinician knowledge of the system (13). A report in 2012 at King Khalid University showed that nursing staff reported about 63% of total OVR reports (9). The present study also found that nurses contribute to the majority of all OVR reports.

A previous study has revealed that fear is a key factor in not reporting medical errors (14) as they may fear punishment, legal action, or loss of employment. In addition, a lack of feedback from the quality or patient safety departments can contribute to a lack of reporting. Other barriers to reporting include personal characteristics, workload or staff shortages, nursing leadership problems, blame, lack of knowledge or skills, lack of clarity, or non compliance with policy and safety culture (15),(16). Furthermore, a study conducted in 2020 that aimed to identify major barriers to the provision of patient safety by nurses in the ED found that violent acts against ED staff constituted the main barrier to reporting (17).

The main goal of preventative action is to prevent harm, while corrective actions aim to reduce the occurrence of such errors, and detection action aim to discover the cause of potential harm to create early solution. This finding supports the effectiveness of OVR in hospitals but also demonstrates that hospital managers should devote more attention to preventing medical errors which would be beneficial to both patients and staff. A study in Saudi Arabia completed in 2014 mentioned that corrective action should be taken if the OVR information and analysis indicates that a patient was affected (7). A study conducted in 2014 discussed medical errors and suggested strategies for preventing medication errors in the ED, which included developing a safe, non-punitive approach to handling these errors (18).

Finally, the total number of reports conducted at KAASH accounted for 73.9% of all reports, while only 26.1% of all reports were conducted at KFMC. This result may indicate an improved OVR culture amongst workers at KAASH. As for the small number of reports in KFMC, there are two possible explanations. First, the Quality and Patient Safety departments at KFMC were not merged until the final quarter of 2018, which may have contributed to a reduction in the percentage of OVR reports. Second, KFMC was selected as the primary centre for Coronavirus Disease-2019 cases in the city of Taif, and consequently fewer reports were conducted during the pandemic period.


The time period considered for data collection from the two hospitals were different which may have affected the number of OVRs collected from the two hospitals.


This study aimed to identify the factors affecting patient safety in the EDs based on an assessment of OVRs. This study states that OVR is critical for achieving patient and staff safety, improving quality of care and reducing medical errors or incidents. The study found that the OVR system in the included hospitals was effective to some extent and found 21 factors that affect patient safety in the ED to different degrees. These findings highlight the need for increased awareness amongst medical staff, particularly nurses, regarding the importance of reporting all incidents.

Therefore, the study suggests that it is essential that senior management at study hospitals consider the major issues affecting the OVR system and minimise medical errors and their adverse impact on patients, staff, and hospital image. Also, hospitals should encourage the development of quality improvement plans as applicable. It is essential to provide continuous monitoring and gathering of data for analysis (monthly and quarterly) for continuous assessment. Moreover, there is a need to encourage performance by providing continuous education, rewards and commendations for the highest-reporting department. Further in-depth studies are needed to provide practical procedures to prevent or reduce the patient safety incidents.


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Albarrak AI, Almansour AS, Alzahrani AA, Almalki AH, Alshehri AA, Mohammed R. Assessment of patient safety challenges and electronic Occurrence Variance Reporting (e-OVR) barriers facing physicians and nurses in the emergency department: A cross sectional study. BMC Emerg Med. 2020;20(1):01-08. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2022/52095.16062

Date of Submission: Aug 24, 2021
Date of Peer Review: Nov 30, 2021
Date of Acceptance: Dec 30, 2021
Date of Publishing: Mar 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Aug 25, 2021
• Manual Googling: Dec 28, 2021
• iThenticate Software: Jan 18, 2022 (7%)

ETYMOLOGY: Author Origin

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