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Wang T, Yang L, Yang L, Liu BP, Jia CX. The relationship between psychological pain and suicidality in patients with major depressive disorder: A meta-analysis. J Affect Disord 2024; 346:115-121. [PMID: 37926158 DOI: 10.1016/j.jad.2023.10.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To systematically review the association between psychological pain and suicidality in patients with major depressive disorder (MDD). METHOD The databases of PubMed, Web of Science and PsycINFO were used to search and articles were screened for inclusion and exclusion criteria until February 2022. Two researchers independently screened the papers, extracted data, and evaluated the risk of bias of the included studies. Comprehensive Meta-Analysis software (CMA) was used for meta-analysis and the combined OR (95 % CI) values were calculated. RESULTS A total of 7 articles were included, with a sample size of 1364. The present study showed that psychological pain was a risk factor for suicidality in patients with MDD (OR = 1.322, 95 % CI:1.165-1.500). After Duval and Tweedie trim and fill to rectify potential publication bias, psychological pain was still a risk factor for suicidality in patients with MDD [OR = 1.196 (95 % CI: 1.030-1.388), P < 0.001]. Subgroup analyses showed that average age ≥ 40 [r = 0.57 (95 % CI: 0.32-0.81), P < 0.001] was moderating variable for psychological pain and suicidality. CONCLUSIONS Reducing psychological pain in MDD patients is somewhat important for preventing their suicidality, especially for the patients with advancing age.
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Affiliation(s)
- Tao Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Li Yang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lan Yang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Liu J, Dong Q, Lu X, Sun J, Zhang L, Wang M, Liu B, Ju Y, Wan P, Guo H, Zhao F, Zhang X, Zhang Y, Li L. Influence of comorbid anxiety symptoms on cognitive deficits in patients with major depressive disorder. J Affect Disord 2020; 260:91-96. [PMID: 31493645 DOI: 10.1016/j.jad.2019.08.091] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) patients with comorbid anxiety symptoms showed obvious cognitive deficits. However, it remains unclear whether comorbid anxiety symptoms will make a specific contribution to cognitive deficits in MDD. METHODS Executive function, processing speed, attention and memory were assessed in 162 MDD patients, and 142 healthy controls (HCs) by a comprehensive neuropsychological battery. 14-item Hamilton Anxiety Rating Scale (HAM-A) was used for anxiety symptoms and MDD patients with HAM-A total score >14 were classified into MDD with comorbid anxiety (MDDA) group. A multivariate analysis of covariance and regression models was conducted to evaluate the effects of anxiety symptoms on cognitive deficits. RESULTS There were no significantly differences in all 4 cognitive domains between MDD alone and MDDA patients (all p < 0.05). In MDDA subgroup, HAM-A total score contributed to executive function and memory (both p < 0.05), while HAM-A psychic symptoms contributed to all 4 domains (all p < 0.05). Moreover, after controlling for the severity of depression, either anxiety symptoms shown as HAMA total score or psychic anxiety symptoms only contributed significantly to the executive function performance. LIMITATIONS The cross-sectional design made it hard to acquire a cognitive performance trajectory accompanied by the fluctuations in anxiety symptoms. CONCLUSION Our findings suggest that there is no significant difference in cognitive performance between MDD alone and MDDA patients. However, comorbid anxiety, especially psychic anxiety may contribute to extensive cognitive deficits in MDDA patients. Notably, anxiety symptoms only independently triggered executive dysfunction when eliminating effect of the severity of depression.
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Affiliation(s)
- Jin Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Qiangli Dong
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Xiaowen Lu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Jinrong Sun
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Liang Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Mi Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Bangshan Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Yumeng Ju
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Ping Wan
- Zhumadian Psychiatric Hospital, Zhumadian, Henan 463000, China
| | - Hua Guo
- Zhumadian Psychiatric Hospital, Zhumadian, Henan 463000, China
| | - Futao Zhao
- Zhumadian Psychiatric Hospital, Zhumadian, Henan 463000, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yan Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China.
| | - Lingjiang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China.
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Fornaro M, Grunebaum MF, Burke AK, Mann JJ, Oquendo MA. Comparison of familial and non-familial suicidal behaviors among people with major depressive disorder: Testing the discriminative predicting role of high-yield clinical variables. J Psychiatr Res 2018; 102:118-122. [PMID: 29635115 DOI: 10.1016/j.jpsychires.2018.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicidal behavior in first-degree relatives of people diagnosed with major depressive disorder (MDD) increases the risk of suicidal behavior. Such an effect may be the result of genetic risk factors or environmental ones, including imitation, or both. Surprisingly few studies have examined this question and thus, there still is little known about the effect of first-degree family history of suicidal behavior on the type of suicidal behavior and profile of risk factors related to the diathesis for suicidal behavior. Even less is known about intra-familial risk transmission. METHODS Patients with MDD (n = 252) experiencing a current major depressive episode and who had a previous suicide attempt were studied. Those with and without a family history of first-degree relatives who had made a suicide attempt or died by suicide were compared across clinical and suicide-related characteristics. RESULTS Suicide attempters with (FDR+, n = 59) and without a first-degree relative with suicide attempt or suicide (FDR-, n = 193) were similar in terms of type or frequency of suicide attempts, level of lifetime aggression and impulsivity, age of onset of depression and age at first suicide attempt. LIMITATIONS Cross-Sectional study. Lack of additional external validators. CONCLUSIONS Contrary to our hypothesis and the concept of "genetic anticipation", a first-degree family history of suicide attempt or suicide in currently depressed attempters with MDD was not associated with a range of clinical and suicide-related characteristics. Longitudinal studies incorporating external validators and potential biological markers may advance this area of research.
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Affiliation(s)
- Michele Fornaro
- New York State Psychiatric Institute, Columbia University, NY, USA.
| | | | - Ainsley K Burke
- New York State Psychiatric Institute, Columbia University, NY, USA.
| | - J John Mann
- New York State Psychiatric Institute, Columbia University, NY, USA.
| | - Maria A Oquendo
- New York State Psychiatric Institute, Columbia University, NY, USA.
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Müller HHO, Moeller S, Lücke C, Lam AP, Braun N, Philipsen A. Vagus Nerve Stimulation (VNS) and Other Augmentation Strategies for Therapy-Resistant Depression (TRD): Review of the Evidence and Clinical Advice for Use. Front Neurosci 2018; 12:239. [PMID: 29692707 PMCID: PMC5902793 DOI: 10.3389/fnins.2018.00239] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/27/2018] [Indexed: 12/21/2022] Open
Abstract
In addition to electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS) is one of the approved neurostimulation tools for treatment of major depression. VNS is particularly used in therapy-resistant depression (TRD) and exhibits antidepressive and augmentative effects. In long-term treatment, up to two-thirds of patients respond. This mini-review provides a comprehensive overview of augmentation pharmacotherapy and neurostimulation-based treatment strategies, with a special focus on VNS in TRD, and provides practical clinical advice for how to select TRD patients for add-on neurostimulation treatment strategies.
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Affiliation(s)
- Helge H O Müller
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Bonn, Bonn, Germany
| | - Sebastian Moeller
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Caroline Lücke
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Bonn, Bonn, Germany
| | - Alexandra P Lam
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Bonn, Bonn, Germany.,Department of Psychiatry and Psychotherapy, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Bonn, Bonn, Germany
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Paraschakis A, Michopoulos I, Christodoulou C, Koutsaftis F, Lykouras L, Douzenis A. A 2-year psychological autopsy study of completed suicides in the athens greater area, Greece. Psychiatry Investig 2015; 12:212-7. [PMID: 25866522 PMCID: PMC4390592 DOI: 10.4306/pi.2015.12.2.212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/16/2014] [Accepted: 06/16/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To study the characteristics of a sample of suicide victims from the Athens Greater Area using the psychological autopsy method for the first time in Greece. METHODS We studied all recorded cases of completed suicide for the 2-year time period November 2007-October 2009 collecting data from the victims' forensic records as well as from the completion of a psychological autopsy questionnaire. RESULTS 335 persons were recorded as suicide victims. We contacted relatives of 256 victims interviewing those of 248 of them (96.9%). The differences regarding sex, marital and employment status between our sample and the general population were statistically significant (p<0.001). The male/female ratio was 3:1. Comparatively more victims were divorced, separated or single and a greater proportion were pensioners or unemployed. 26.0% of the victims had history of prior attempts (64.4% once, 20.3% twice and 15.3% more times). 42.6% were taking psychiatric medication-significantly more women than men according to blood tests; 14.2% had been hospitalized in a psychiatric clinic the year prior to their death. 84.8% have deceased at the place of suicide and 15.2% died in the hospital; 80.3% died indoors and 19.7% outdoors. Men died primarily by hanging or shooting by a firearm while women preferred jumping from height instead (p<0.001). As many as 48.8% had expressed their intention to die to their relatives; 26.6% left a suicide note. CONCLUSION Our study has shown that the psychological autopsy method is applicable and widely accepted yielding results comparable to the international literature. Specific parameters associated with suicide have been studied for the first time in Greece.
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Affiliation(s)
| | - Ioannis Michopoulos
- 2nd Department of Psychiatry, Athens University Medical School, "Attikon" General Hospital, Athens, Greece
| | - Christos Christodoulou
- 2nd Department of Psychiatry, Athens University Medical School, "Attikon" General Hospital, Athens, Greece
| | | | - Lefteris Lykouras
- 2nd Department of Psychiatry, Athens University Medical School, "Attikon" General Hospital, Athens, Greece
| | - Athanassios Douzenis
- 2nd Department of Psychiatry, Athens University Medical School, "Attikon" General Hospital, Athens, Greece
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Chistiakov DA, Kekelidze ZI, Chekhonin VP. Endophenotypes as a measure of suicidality. J Appl Genet 2012; 53:389-413. [DOI: 10.1007/s13353-012-0113-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/13/2012] [Accepted: 08/15/2012] [Indexed: 01/07/2023]
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7
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Affiliation(s)
- Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rush AJ, Warden D, Wisniewski SR, Fava M, Trivedi MH, Gaynes BN, Nierenberg AA. STAR*D: revising conventional wisdom. CNS Drugs 2009; 23:627-47. [PMID: 19594193 DOI: 10.2165/00023210-200923080-00001] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study used a series of sequenced, randomized treatment trials following a first and, if needed, subsequent treatment steps to define the tolerability and effectiveness of various options in both acute and longer term treatment. Adult outpatients (n=4041) with nonpsychotic major depressive disorder, substantial chronic and recurrent depression, and co-morbid psychiatric and general medical conditions were enrolled in 41 representative primary and specialty care settings. About one-third of participants remitted in first step treatment with citalopram, 50% of these within 6 weeks. Poorer outcomes were associated with minority status, socioeconomic disadvantage, more axis I and III co-morbid disorders, lower function and quality of life, and anxious and melancholic features. In step 2 medication switch, there were no significant differences in remission among within-class, out-of-class or dual-action agents: sertraline (27%), bupropion-sustained release (26%) and venlafaxine-extended release (25%). In step 2 medication augmentation of citalopram, there was no significant difference in remission between bupropion-sustained release (39%) and buspirone (33%), although participants using bupropion-sustained release had greater symptom reduction and better tolerability. There were no significant differences in remission in step 2 between cognitive therapy and medication treatment in either the switch (31% vs 27%) or augmentation (31% vs 33%) strategies, although participants in cognitive therapy augmentation had a longer time to remission than those in medication augmentation (55 vs 40 days). In step 3, there were no differences in remission between a switch to mirtazapine (8%) or nortriptyline (12%), or between augmentation with lithium (13%) or T(3) (triiodothyronine, liothyronine) [25%], although more participants discontinued lithium due to adverse effects than discontinued T(3). In the fourth step, there was no difference in remission between tranylcypromine (14%) or venlafaxine-extended release plus mirtazapine (16%), although the combination treatment had fewer adverse effects and had the advantages of not requiring a washout period or diet restrictions. Participants requiring more than two well delivered treatments may be characterized as treatment resistant given the substantially lower remission rates after that point. Treatment resistance was associated with more concurrent axis I or III co-morbid conditions, socioeconomic disadvantage, chronicity and melancholic or anxious features. However, if participants remained in treatment for up to four steps, about 67% reached remission. Times to remission were not substantially longer for later treatment steps. The importance of reaching remission is highlighted by the lower relapse rates in naturalistic follow-up for participants entering in remission compared with those entering with response but not remission (step 1: 34% vs 59%; step 2: 47% vs 68%; step 3: 42% vs 76%; step 4: 50% vs 83%). Clinical decision making based on the itemized measurement of symptoms and adverse effects at each treatment visit was feasible in STAR*D's real world settings and resulted in adequate dosages and durations of treatment that generally exceeded those typically found in practice settings. Although switch and augmentation strategies could not be directly compared due to the equipoise stratified randomized design, the higher remission rates at step 2 with medication augmentation are intriguing and merit further study.
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Affiliation(s)
- A John Rush
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Lizardi D, Sher L, Sullivan GM, Stanley B, Burke A, Oquendo MA. Association between familial suicidal behavior and frequency of attempts among depressed suicide attempters. Acta Psychiatr Scand 2009; 119:406-10. [PMID: 19367777 PMCID: PMC3804892 DOI: 10.1111/j.1600-0447.2009.01365.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Only a few studies have examined whether a family history of suicide influences the severity of suicidal acts and the results have been inconsistent. The current study aimed to examine whether a family history of suicidal acts predicts severity of suicide attempts. METHOD 190 suicide attempters aged 18-75 years with a lifetime history of major depression were assessed for first-degree family history of suicidality and severity of suicide attempts (number and lethality of prior suicide attempts and age at first attempt). RESULTS Regression analyses indicate that a positive family history of suicidal behaviors predicts a greater number of suicide attempts. Reasons for living predict number and lethality of prior attempts. CONCLUSION It is critical to assess for family history of suicidal behavior when treating depressed suicide attempters as it may serve as an indicator of the risk of repeat suicide attempt and as a guide for treatment.
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Affiliation(s)
- D. Lizardi
- School of Social Work, Columbia University, New York, NY, USA
| | - L. Sher
- Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - G. M. Sullivan
- Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - B. Stanley
- Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - A. Burke
- Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - M. A. Oquendo
- Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
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