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oir and atrial contraction phases, which suggest an early loss in the compensatory ability of atrial contraction with severe obesity. 2 TECHNICAL EFFICACY STAGE 3. 2 TECHNICAL EFFICACY STAGE 3.Citizenship is gaining currency in health and social care internationally as a way of making sense of the lived experiences of people with major life disruptions who face exclusion, marginalisation and discrimination, but the concept is often contested, poorly defined and understood. This paper charts the development of an empirical model of ci