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Vera Cruz G, Aboujaoude E, Liberacka-Dwojak M, Wiłkość-Dębczyńska M, Rochat L, Khan R, Khazaal Y. How much online pornography is too much? A comparison of two theoretically distinct assessment scales. Arch Public Health 2024; 82:79. [PMID: 38816773 PMCID: PMC11137999 DOI: 10.1186/s13690-024-01294-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/15/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Online pornography use, an ever more common activity, has raised myriad psychosocial and clinical concerns. While there is a need to screen for and measure its problematic dimension, there is a debate about the adequacy of existing assessment tools. OBJECTIVE The study compares two instruments for measuring pathological online pornography use (POPU) that are based on different theoretical frameworks-one in line with DSM-5 criteria and the six-component addiction model and one in line with ICD-11 criteria. METHODS An international sample of 1,823 adults (Mean age = 31.66, SD = 6.74) answered an online questionnaire that included the Short Version of the Problematic Pornography Consumption Scale (PPCS-6) and the Assessment of Criteria for Specific Internet-Use Disorders (ACSID-11). Factorial, correlational, and network analyses were conducted on the data. RESULTS Both tools adequately screened for online "addictive" behavior, but the ACSID-11 was superior in assessing the degree of clinical risk. CONCLUSION Depending on the specific aim of the assessment (screening vs. clinical diagnostics), both online pornography measurement tools may be useful.
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Affiliation(s)
- Germano Vera Cruz
- Department of Psychology, CRP-CPO, University of Picardie Jules Verne, Amiens, France.
| | - Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Program in Internet, Health and Society, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | | | | | - Lucien Rochat
- Department of Mental Health and Psychiatry, Specialized Facility in Behavioral Addiction ReConnecte, University Hospitals of Geneva, Geneva, Switzerland
| | - Riaz Khan
- Department of Mental Health and Psychiatry, Frontier Medical College Abbottabad, Bahria University Islamabad, Islamabad, Pakistan
| | - Yasser Khazaal
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
- Research Centre, University Institute of Mental Health at Montreal and Department of Psychiatry and Addiction Montreal University, Montreal, Canada.
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2
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Ince C, Fontenelle LF, Carter A, Albertella L, Tiego J, Chamberlain SR, Rotaru K. Clarifying and extending our understanding of problematic pornography use through descriptions of the lived experience. Sci Rep 2023; 13:18193. [PMID: 37875697 PMCID: PMC10598215 DOI: 10.1038/s41598-023-45459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023] Open
Abstract
Problematic pornography use (PPU) is a complex and growing area of research. However, knowledge of the PPU lived experience is limited. To address this gap, we conducted an online qualitative study with 67 individuals who self-identified as having problematic pornography use (76% male; Mage = 24.70 years, SD = 8.54). Results indicated several dimensions that have not been fully explored in the literature. These included various mental and physical complaints following periods of heavy pornography use, sexual functioning deficits with real partners, and a subjectively altered state of sexual arousal while using pornography. Moreover, we expanded on current knowledge regarding the inner conflict associated with PPU and clarified the ways that users can progress to increasingly intensified patterns of pornography use, such as tolerance/escalation and pornographic binges. Our study highlights the complex and nuanced nature of PPU and provides suggestions for future research and clinical practice.
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Affiliation(s)
- Campbell Ince
- School of Psychological Sciences, Monash University, 770 Blackburn Rd, Clayton, VIC, 3168, Australia.
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.
| | - Leonardo F Fontenelle
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
| | - Adrian Carter
- School of Psychological Sciences, Monash University, 770 Blackburn Rd, Clayton, VIC, 3168, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Lucy Albertella
- School of Psychological Sciences, Monash University, 770 Blackburn Rd, Clayton, VIC, 3168, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Jeggan Tiego
- School of Psychological Sciences, Monash University, 770 Blackburn Rd, Clayton, VIC, 3168, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Monash Biomedical Imaging, Monash University, Clayton, Australia
| | - Samuel R Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Kristian Rotaru
- School of Psychological Sciences, Monash University, 770 Blackburn Rd, Clayton, VIC, 3168, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Monash Business School, Monash University, Clayton, Australia
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3
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Müller SM, Antons S. Decision making and executive functions in problematic pornography use. Front Psychiatry 2023; 14:1191297. [PMID: 37564242 PMCID: PMC10411905 DOI: 10.3389/fpsyt.2023.1191297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Previous research on cognitive functions in Compulsive Sexual Behavior Disorder (CSBD) and problematic pornography use (PPU) reported inconsistent findings and mostly included sexual pictures in the used tasks. The role of general executive functions and cognitive competences (without the presence of appetitive stimuli) in the context of PPU is largely unexplored. Methods This study investigated differences between individuals with high versus low problem severity of PPU regarding decision making and executive functions. The sample of the laboratory study consisted of N = 102 male adults. Besides measures of trait impulsivity, we used standard neuropsychological tests (Trail Making Test and three-back working memory task) and an intertemporal risky choice paradigm, the Cards & Lottery Task (CLT). Results The results show heightened impulsivity (urgency and deficits in perseverance) in individuals with high PPU, but no differences regarding performance in the CLT and executive function tasks. Discussion The findings indicate that PPU might be associated with impulsive behavior when experiencing strong emotions (urgency) and deficient cognitive performance especially in the presence of sexual stimuli but not in general.
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Affiliation(s)
- Silke M. Müller
- Department of General Psychology, Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
| | - Stephanie Antons
- Department of General Psychology, Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
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4
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Su Y, Zheng L, Zheng Y. Pornography Use and Mental Health Problems in the Chinese Population: Examining the Pornography Problems Due to Moral Incongruence Model. JOURNAL OF SEX RESEARCH 2023:1-12. [PMID: 37074351 DOI: 10.1080/00224499.2023.2201255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Pornography has become increasingly prevalent worldwide with the development of the Internet, and considerable research on the effects of pornography use has emerged. Based on existing research and the Pornography Problems Due to Moral Incongruence (PPMI) model, we examined problematic pornography use (PPU) as a mediator and moral disapproval of pornography use as a moderator in the links between pornography use frequency and mental health problems in a Chinese sample (N = 833). Our results support the completely mediated effect of PPU (ab = 0.16) and the moderated effect of moral disapproval of pornography use on the association between pornography use frequency and PPU. Pornography use frequency was strongly associated with PPU when participants experienced high moral incongruence (MI), and the indirect effect of PPU was weaker (ab = 0.13) at the lower level of moderator (-1 SD), and stronger (ab = 0.23) at the higher level of moderator (+1 SD). However, the direct effect of MI on mental health problems was not supported. This study advances our understanding of the internal mechanism between pornography use and mental health and extends the PPMI model to the Chinese cultural context (characterized as low religiosity and sexually conservative). The findings confirm the cross-cultural consistency of the PPMI model in China and highlight another important source of MI besides religiosity: cultural characteristics.
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Affiliation(s)
- Yanchen Su
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University
| | - Lijun Zheng
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University
| | - Yong Zheng
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University
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Indulging in Smartphones in Times of Stress: A Moderated Mediation Model of Experiential Avoidance and Trait Mindfulness. Behav Sci (Basel) 2022; 12:bs12120485. [PMID: 36546968 PMCID: PMC9774252 DOI: 10.3390/bs12120485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
Although previous studies have shown that perceived stress is positively related to problematic smartphone use, knowledge of mediating and moderating mechanisms underpinning this relationship is quite limited. In this study, we explored whether experiential avoidance mediated the relationship between perceived stress and problematic smartphone use and whether trait mindfulness moderated this mediating process. A total of 763 Chinese college students completed the measures of perceived stress, experiential avoidance, problematic smartphone use, and trait mindfulness. The results indicate that perceived stress was positively related to problematic smartphone use and this relation was partially mediated by experiential avoidance. Furthermore, moderated mediation analysis showed that trait mindfulness moderated the linkage between perceived stress and problematic smartphone use via experiential avoidance. This link became weaker for college students with higher levels of trait mindfulness. The results highlight the value of identifying the underlying mechanisms between perceived stress and college students' problematic smartphone use.
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Soraya S, Rashedi V, Saeidi M, Hashemi P, Hadi F, Ahmadkhaniha H, Shalbafan M. Comparison of Online Sexual Activity Among Iranian Individuals With and Without Substance Use Disorder: A Case-Control Study. Front Psychiatry 2022; 13:889528. [PMID: 35935427 PMCID: PMC9353021 DOI: 10.3389/fpsyt.2022.889528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022] Open
Abstract
The most important practical concerns in addiction medicine are the non-substance addiction and related addictive behaviors among individuals with substance use disorder. On the other hand, technological advances, and easy access have increased the frequency of online sexual activities (OSAs) as one of these behaviors. This study aimed to compare the prevalence of OSAs, based on the Internet Sex Screening Test (ISST) scores, among 60 patients with substance use disorder referred to Iran Psychiatric Hospital and 60 non-dependent individuals. The results showed significant negative correlations between the ISST scores and age, age at the onset of substance use, and substance use duration. There was a significant difference between the ISST scores of the case and control groups (P = 0.001). Patients who start using substances at an early age and have a great duration of substance use are more likely to engage in other addictive behaviors such as OSAs. Therefore, it is critical to consider OSAs and other addictive behaviors in patients with substance use disorder to provide better care for this vulnerable community.
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Affiliation(s)
- Shiva Soraya
- Research Center for Addiction and Risky Behaviors, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- Iranian Research Center on Aging, Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahdieh Saeidi
- Research Center for Addiction and Risky Behaviors, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pooria Hashemi
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hadi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Ahmadkhaniha
- Research Center for Addiction and Risky Behaviors, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shalbafan
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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7
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Blinka L, Ševčíková A, Dreier M, Škařupová K, Wölfling K. Online Sex Addiction: A Qualitative Analysis of Symptoms in Treatment-Seeking Men. Front Psychiatry 2022; 13:907549. [PMID: 35873234 PMCID: PMC9302710 DOI: 10.3389/fpsyt.2022.907549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Problematic sexual internet use has been attracting increasing research attention in recent years. However, there is a paucity of qualitative studies about how this problem manifests on a daily basis in the clinical population and whether the phenomenon should fall within the hypersexual, compulsive-impulsive, or addictive spectrums of disorders. METHODS Twenty-three semi-structured interviews, including AICA-C clinical interviews, were conducted with men who were in treatment for problematic internet sex use (aged 22-53; Mage = 35.82). The interview structure focused on the patterns of sexual behavior in question, their development, the manifestation of symptoms, and other associated psychosocial problems. A thematic analysis was applied as the main analytical strategy. RESULTS Typical problematic patterns included pornography use and cybersex, together with continuous masturbation for several hours several times a week. This pattern emerged relatively early in young adulthood and became persistent for years. The majority of participants fulfilled the criteria for behavioral addiction (as defined, e.g., by the components model of addiction), with loss of control and preoccupation being the most pronounced and withdrawal symptoms being the least. Together with the onset of erectile dysfunction, negative consequences were reported as being slowly built up over years and typically in the form of deep life dissatisfaction, regret, and feelings of unfulfilled potential. DISCUSSION AND CONCLUSION The Addiction model is relevant for describing the difficulties in treatment-seeking men who suffer from problematic sexual internet use. However, the manifestations of the additional criteria are nuanced. In the case of negative consequences, their onset might be very slow and not easily reflected. While there was evidence of several forms of tolerance, potential withdrawal symptoms in online sex addiction need further attention to be verified.
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Affiliation(s)
- Lukas Blinka
- Institute for Research on Children, Youth, and Family, Faculty of Social Studies, Masaryk University, Brno, Czechia
| | - Anna Ševčíková
- Institute for Research on Children, Youth, and Family, Faculty of Social Studies, Masaryk University, Brno, Czechia
| | - Michael Dreier
- Outpatient Clinic for Behavioral Addictions, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katerina Škařupová
- Institute for Research on Children, Youth, and Family, Faculty of Social Studies, Masaryk University, Brno, Czechia
| | - Klaus Wölfling
- Outpatient Clinic for Behavioral Addictions, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Musetti A, Gori A, Alessandra A, Topino E, Terrone G, Plazzi G, Cacioppo M, Franceschini C. The Interplay Between Problematic Online Pornography Use, Psychological Stress, Emotion Dysregulation and Insomnia Symptoms During the COVID-19 Pandemic: A Mediation Analysis. Nat Sci Sleep 2022; 14:83-92. [PMID: 35082545 PMCID: PMC8786338 DOI: 10.2147/nss.s348242] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Although a link between problematic online pornographic use (POPU) and insomnia symptoms has been established, psychological and psychopathological mechanisms underlying this relationship are still not clear. Psychological stress and emotion dysregulation have been pointed out as relevant in the development and maintenance of insomnia. This study aims to explore the associations between POPU, psychological stress, emotion dysregulation and insomnia symptoms and to understand the mediating role of psychological stress and emotion dysregulation in the relationship between POPU and insomnia symptoms. PARTICIPANTS AND METHODS A sample of 776 Italian adults aged 19-48 years (51.4% female; M age = 28.49; SD = 7.33) completed questionnaires regarding demographics, COVID-19-related variables, POPU, psychological stress, emotion dysregulation, and insomnia symptoms. RESULTS After controlling for demographic covariates and COVID-19-related variables, multiple mediation model showed that higher psychological stress and emotion dysregulation fully mediated the link between POPU and insomnia. CONCLUSION The findings underscore the significance of the negative consequences of POPU and underline the importance of working on this and its effects on psychological stress and emotion dysregulation to limit insomnia.
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Affiliation(s)
- Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy
| | - Alessio Gori
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Eleonora Topino
- Department of Human Sciences, Lumsa University of Rome, Rome, Italy
| | - Grazia Terrone
- Department of History, Cultural Heritage, Education and Society, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,IRCCS Institute of Neurological Sciences of Bologna (ISNB), Bologna, Italy
| | - Marco Cacioppo
- Department of Human Sciences, Lumsa University of Rome, Rome, Italy
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Courtice EL, Shaughnessy K, Blom K, Asrat Y, Daneback K, Döring N, Grov C, Byers ES. Young Adults' Qualitative Self-Reports of Their Outcomes of Online Sexual Activities. Eur J Investig Health Psychol Educ 2021; 11:303-320. [PMID: 34708815 PMCID: PMC8314359 DOI: 10.3390/ejihpe11020023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/16/2022] Open
Abstract
Online sexual activities (OSA) refer to Internet-based activities, behaviours, and materials that are sexual in nature. Many young adults engage in OSA, but report doing so infrequently. Most OSA outcome research has focused on negative effects of only some types of OSA (e.g., viewing pornography online). The goal of this study was to enhance knowledge on the range of OSA outcomes by qualitatively exploring young adults' self-reported negative and positive outcomes from OSA experiences generally. University/College students from Canada (n = 246), Germany (n = 411), Sweden (n = 299), and the USA (n = 123) completed an online survey that included open-ended questions about "one of the most positive/negative effects that engaging in online sexual activities has had on your life". More participants provided positive outcome responses than negative outcome responses. Qualitative analysis of the responses suggested a wide range of positive and negative outcome content that fit into seven bi-polar, higher-order themes: No Outcomes, Relationship Outcomes, Sexual Experience, Emotional Outcomes, Knowledge, Personal Outcomes, and Security. We found no variations in themes or their respective codes across the four countries. The findings suggests that researchers, educators, health care and psychology providers need to include multiple dimensions of positive and negative, personal and interpersonal, sexual and non-sexual OSA outcomes in their work.
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Affiliation(s)
| | - Krystelle Shaughnessy
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Correspondence: ; Tel.: +613-562-5800 (ext. 8701)
| | - Kristin Blom
- Department of Social Work, University of Gothenburg, 405 30 Göteborg, Sweden; (K.B.); (K.D.)
| | - Yodit Asrat
- Department of Psychology, Trent University, Peterborough, ON K9J 7B8, Canada;
| | - Kristian Daneback
- Department of Social Work, University of Gothenburg, 405 30 Göteborg, Sweden; (K.B.); (K.D.)
| | - Nicola Döring
- Institute of Media and Communication Science, Ilmenau University of Technology, Ehrenbergstraße 29, 98693 Ilmenau, Germany;
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY 10027, USA;
| | - E. Sandra Byers
- Department of Psychology, University of New Brunswick, Fredericton, NB E3B 5A3, Canada;
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