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. 2021 Mar 19;11:6479. doi: 10.1038/s41598-021-86023-6

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Flow chart of the logic of the study: the recruitment of non-communicating persons with ID, the monitoring of their HR to identify situations that may cause pain or distress, and the resulting change in care practice or in caregivers’ understanding of the non-communicating persons with ID.