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Zaizar ED, Papini S, O'Connor P, Telch MJ. Impact of cannabidiol-rich hemp extract oil on reconsolidation disruption of naturalistic interoceptive aversive memory in humans: Protocol for a randomized clinical trial. Contemp Clin Trials 2022; 119:106847. [PMID: 35811050 DOI: 10.1016/j.cct.2022.106847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preclinical experiments with rodents demonstrate that cannabidiol (CBD), the non-psychotomimetic constituent of the Cannabis sativa plant, disrupts reconsolidation of aversive memories conditioned in the laboratory when administered within the memory reconsolidation window (< 6 h. post-retrieval) by indirectly activating cannabinoid type-1 (CB1) receptors in the dorsal anterior cingulate cortex (dACC). Based on these findings, we aim to test whether administration of 300 mg CBD-rich hemp extract oil following fear reactivation of an aversive interoceptive threat memory can disrupt reconsolidation of naturalistic aversive memories in humans. More specifically, naturalistic interoceptive aversive memories, a form of transdiagnostic fear memory that contributes to the pathogenesis of fear-related disorders such as panic disorder, posttraumatic stress disorder (PTSD), and illness anxiety disorder. METHODS For this proof-of-concept, placebo-controlled double-blind trial, volunteers (n = 99) reporting elevated fears of somatic sensations will be stratified on biological sex and randomized to one of three intervention arms: (a). CBD-rich oil administered within the reconsolidation window, (b) Placebo oil administered within the reconsolidation window; or (c) CBD-rich oil administered outside of the reconsolidation window. Change in emotional reactivity to a 35% CO2 challenge from baseline to two-week follow-up will serve as our primary outcome. CONCLUSION Study findings may contribute towards the development of a novel brief transdiagnostic intervention guided by reconsolidation theory for individuals prone to fear-related psychiatric disorders. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04726475.
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Affiliation(s)
- Eric D Zaizar
- Department of Psychology, The University of Texas at Austin, USA; Institute for Mental Health Research, The University of Texas at Austin, USA
| | - Santiago Papini
- Division of Research, Kaiser Permanente Northern California, USA
| | - Patrick O'Connor
- Department of Psychology, The University of Texas at Austin, USA; Institute for Neuroscience, The University of Texas at Austin, USA
| | - Michael J Telch
- Department of Psychology, The University of Texas at Austin, USA; Institute for Mental Health Research, The University of Texas at Austin, USA; Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, USA.
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2
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McKee KL. Hierarchical Biometrical Genetic Analysis of Longitudinal Dynamics. Behav Genet 2021; 51:654-664. [PMID: 33978896 DOI: 10.1007/s10519-021-10060-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 04/20/2021] [Indexed: 11/24/2022]
Abstract
For many phenotypes, individual scores are obtained as the parameter estimates of person-level models fit to intensive repeated measures from physiological sensors or experience sampling studies. Biometrical genetic analysis of such phenotypes is often done in a 2-step sequence: first the phenotypic parameters are estimated for each individual, then classical twin modeling is used to partition their variance. This study demonstrates deficiencies in accuracy and statistical power of the two-step approach to estimate genetic signals and advocates for the use of hierarchical models to overcome both problems. Simulations are used to demonstrate the benefits to accuracy and statistical power from a hierarchical modeling approach. A model of heart rate fluctuations was applied to experimental data from twin pairs recorded in independent trials. Results of the data application reveal moderate but uncorrelated heritabilities for two parameters of heart rate: oscillation frequency and damping ratio. By merging biometrical genetic analysis with process models, hierarchical mixed-effects modeling has potential to assist with discovery and extraction of novel phenotypes from within-person data and to validate theoretical models of within-person processes.
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Affiliation(s)
- Kevin L McKee
- Center for Biostatistics and Health Data Science, Virginia Tech, 1270 Hill Hollow Rd., Faber, Roanoke, VA, 22938, USA.
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3
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Snyder A, Sheridan C, Tanner A, Bickart K, Sullan M, Craske M, Choe M, Babikian T, Giza C, Asarnow R. Cardiorespiratory Functioning in Youth with Persistent Post-Concussion Symptoms: A Pilot Study. J Clin Med 2021; 10:561. [PMID: 33546148 PMCID: PMC7913264 DOI: 10.3390/jcm10040561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 12/15/2022] Open
Abstract
Dysregulation of the autonomic nervous system (ANS) may play an important role in the development and maintenance of persistent post-concussive symptoms (PPCS). Post-injury breathing dysfunction, which is influenced by the ANS, has not been well-studied in youth. This study evaluated cardiorespiratory functioning at baseline in youth patients with PPCS and examined the relationship of cardiorespiratory variables with neurobehavioral outcomes. Participants were between the ages of 13-25 in two groups: (1) Patients with PPCS (concussion within the past 2-16 months; n = 13) and (2) non-injured controls (n = 12). Capnometry was used to obtain end-tidal CO2 (EtCO2), oxygen saturation (SaO2), respiration rate (RR), and pulse rate (PR) at seated rest. PPCS participants exhibited a reduced mean value of EtCO2 in exhaled breath (M = 36.3 mmHg, SD = 2.86 mmHg) and an altered inter-correlation between EtCO2 and RR compared to controls. Neurobehavioral outcomes including depression, severity of self-reported concussion symptoms, cognitive catastrophizing, and psychomotor processing speed were correlated with cardiorespiratory variables when the groups were combined. Overall, results from this study suggest that breathing dynamics may be altered in youth with PPCS and that cardiorespiratory outcomes could be related to a dimension of neurobehavioral outcomes associated with poorer recovery from concussion.
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Affiliation(s)
- Aliyah Snyder
- Department of Psychiatry, University of California, Los Angeles, CA 90095, USA; (T.B.); (R.A.)
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA 90095, USA; (C.S.); (K.B.); (M.C.); (C.G.)
| | - Christopher Sheridan
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA 90095, USA; (C.S.); (K.B.); (M.C.); (C.G.)
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Alexandra Tanner
- Department of Psychology, University of California, Los Angeles, CA 90095, USA; (A.T.); (M.C.)
| | - Kevin Bickart
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA 90095, USA; (C.S.); (K.B.); (M.C.); (C.G.)
- Departments of Neurology and Neuropsychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Molly Sullan
- Department of Psychiatry, Psychology Service, University of California, San Diego, CA 92093, USA;
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Michelle Craske
- Department of Psychology, University of California, Los Angeles, CA 90095, USA; (A.T.); (M.C.)
| | - Meeryo Choe
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA 90095, USA; (C.S.); (K.B.); (M.C.); (C.G.)
- UCLA Mattel Children’s Hospital, Los Angeles, CA 90095, USA
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Talin Babikian
- Department of Psychiatry, University of California, Los Angeles, CA 90095, USA; (T.B.); (R.A.)
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA 90095, USA; (C.S.); (K.B.); (M.C.); (C.G.)
| | - Christopher Giza
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA 90095, USA; (C.S.); (K.B.); (M.C.); (C.G.)
- UCLA Mattel Children’s Hospital, Los Angeles, CA 90095, USA
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Robert Asarnow
- Department of Psychiatry, University of California, Los Angeles, CA 90095, USA; (T.B.); (R.A.)
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA 90095, USA; (C.S.); (K.B.); (M.C.); (C.G.)
- Department of Psychology, University of California, Los Angeles, CA 90095, USA; (A.T.); (M.C.)
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4
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Robinaugh DJ, Ward MJ, Toner ER, Brown ML, Losiewicz OM, Bui E, Orr SP. Assessing vulnerability to panic: a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder. Gen Psychiatr 2020; 32:e100140. [PMID: 31922089 PMCID: PMC6936969 DOI: 10.1136/gpsych-2019-100140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background Cognitive–behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived threat. In a recently developed computational model formalising these theories of panic attacks, it was observed that the response to a simulated perturbation to arousal provided a strong indicator of vulnerability to panic attacks and panic disorder. In this review, we evaluate whether this observation is borne out in the empirical literature that has examined responses to biological challenge (eg, CO2 inhalation) and their relation to subsequent panic attacks and panic disorder. Method We searched PubMed, Web of Science and PsycINFO using keywords denoting provocation agents (eg, sodium lactate) and procedures (eg, infusion) combined with keywords relevant to panic disorder (eg, panic). Articles were eligible if they used response to a biological challenge paradigm to prospectively predict panic attacks or panic disorder. Results We identified four eligible studies. Pooled effect sizes suggest that there is biological challenge response has a moderate prospective association with subsequent panic attacks, but no prospective relationship with panic disorder. Conclusions These findings provide support for the prediction derived from cognitive–behavioural theories and some preliminary evidence that response to a biological challenge may have clinical utility as a marker of vulnerability to panic attacks pending further research and development. Trial registration number 135908.
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Affiliation(s)
- Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Meredith J Ward
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emma R Toner
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mackenzie L Brown
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Olivia M Losiewicz
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Grillon C, Robinson OJ, Cornwell B, Ernst M. Modeling anxiety in healthy humans: a key intermediate bridge between basic and clinical sciences. Neuropsychopharmacology 2019; 44:1999-2010. [PMID: 31226707 PMCID: PMC6897969 DOI: 10.1038/s41386-019-0445-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 12/11/2022]
Abstract
Animal models of anxiety disorders are important for elucidating neurobiological defense mechanisms. However, animal models are limited when it comes to understanding the more complex processes of anxiety that are unique to humans (e.g., worry) and to screen new treatments. In this review, we outline how the Experimental Psychopathology approach, based on experimental models of anxiety in healthy subjects, can mitigate these limitations and complement research in animals. Experimental psychopathology can bridge basic research in animals and clinical studies, as well as guide and constrain hypotheses about the nature of psychopathology, treatment mechanisms, and treatment targets. This review begins with a brief review of the strengths and limitations of animal models before discussing the need for human models of anxiety, which are especially necessary to probe higher-order cognitive processes. This can be accomplished by combining anxiety-induction procedures with tasks that probe clinically relevant processes to identify neurocircuits that are potentially altered by anxiety. The review then discusses the validity of experimental psychopathology and introduces a methodological approach consisting of five steps: (1) select anxiety-relevant cognitive or behavioral operations and associated tasks, (2) identify the underlying neurocircuits supporting these operations in healthy controls, 3) examine the impact of experimental anxiety on the targeted operations in healthy controls, (4) utilize findings from step 3 to generate hypotheses about neurocircuit dysfunction in anxious patients, and 5) evaluate treatment mechanisms and screen novel treatments. This is followed by two concrete illustrations of this approach and suggestions for future studies.
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Affiliation(s)
- Christian Grillon
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA.
| | - Oliver J Robinson
- University College London, Institute of Cognitive Neuroscience, London, UK
| | - Brian Cornwell
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Monique Ernst
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
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6
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Rappaport LM, Sheerin C, Carney DM, Towbin KE, Leibenluft E, Pine DS, Brotman MA, Roberson-Nay R, Hettema JM. Clinical Correlates of Carbon Dioxide Hypersensitivity in Children. J Am Acad Child Adolesc Psychiatry 2017; 56:1089-1096.e1. [PMID: 29173743 PMCID: PMC5762134 DOI: 10.1016/j.jaac.2017.09.423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/16/2017] [Accepted: 09/19/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Hypersensitivity to carbon dioxide (CO2)-enriched air may be a promising risk marker for anxiety disorders. Among adult and adolescent samples, heterogeneity in distress response to the CO2 challenge task indexes 3 underlying classes of individuals, which distinguish between sustained and acute threat response as markers for internalizing disorders, broadly, and anxiety disorders, specifically. The present study examines latent classes in children's response to the CO2 challenge task to clarify the association of CO2 hypersensitivity with anxiety and internalizing symptomatology in childhood. METHOD Healthy children from a community twin sample (N = 538; age 9-13 years) rated anxious distress every 2 minutes while breathing air enriched to 7.5% CO2 for 8 minutes. Latent growth mixture modeling evaluated potential classes of individuals with characteristic trajectories of distress during the task to clarify the association with internalizing disorder symptoms and related traits (e.g., anxiety sensitivity, irritability). RESULTS Although all participants reported increased distress during the task, interindividual heterogeneity in distress indexed 3 underlying classes: a consistently low class ("low"), a consistently high class ("high"), and participants who demonstrated markedly increased acute distress ("acute"). Compared to the low class, the high class reported greater internalizing psychopathology, whereas membership in the acute class was associated with experiencing a panic-like event during the task. CONCLUSION As in older individuals, 3 distinct trajectories emerged to capture interindividual heterogeneity in children's distress during the CO2 challenge task. These classes were distinguished by clinical validators that reinforce the association of CO2 hypersensitivity and internalizing disorder phenotypes in children.
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Affiliation(s)
- Lance M. Rappaport
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond
| | - Christina Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond
| | - Dever M. Carney
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond
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7
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Rappaport LM, Sheerin C, Savage JE, Hettema JM, Roberson-Nay R. Clinical characteristics of latent classes of CO 2 hypersensitivity in adolescents and young adults. Behav Res Ther 2017; 93:95-103. [PMID: 28395158 DOI: 10.1016/j.brat.2017.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/22/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
Although breathing CO2-enriched air reliably increases anxiety, there is debate concerning the nature and specificity of CO2 hypersensitivity to panic risk and panic disorder versus anxiety disorders and related traits broadly, particularly among adolescents and emerging adults. The present study sought to clarify the association of CO2 hypersensitivity with internalizing conditions and symptoms among adolescents and young adults. Participants (N = 628) self-reported anxiety levels every 2 min while breathing air enriched to 7.5% CO2 for 8 min. Growth mixture models were used to examine the structure of anxiety trajectories during the task and the association of each trajectory with dimensional and diagnostic assessments of internalizing disorders. Three distinct trajectories emerged: overall low (low), overall high (high), and acutely increased anxiety (acute). Compared to the low class, the acute class reported elevated neuroticism, anxiety sensitivity, and stress whereas the high class reported elevated anxiety symptoms, depression symptoms, neuroticism, anxiety sensitivity, and increased likelihood of an anxiety disorder diagnosis. Moreover, the acute and high classes reported experiencing a panic-like event at a higher rate than the low class while participants in the high class terminated the task prematurely at a higher rate. The present study clarifies the nature of response to CO2 challenge. Three distinct response profiles emerged, which clarifies the manifestation of CO2 hypersensitivity in anxiety disorders with strong, though not unique, associations with panic-relevant traits.
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Affiliation(s)
- Lance M Rappaport
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, 800 E Leigh Street, Suite 101, Richmond, VA, USA.
| | - Christina Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, 800 E Leigh Street, Suite 101, Richmond, VA, USA.
| | - Jeanne E Savage
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, 800 E Leigh Street, Suite 101, Richmond, VA, USA.
| | - John M Hettema
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, 800 E Leigh Street, Suite 101, Richmond, VA, USA.
| | - Roxann Roberson-Nay
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, 800 E Leigh Street, Suite 101, Richmond, VA, USA.
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Temporal stability of multiple response systems to 7.5% carbon dioxide challenge. Biol Psychol 2017; 124:111-118. [PMID: 28163046 DOI: 10.1016/j.biopsycho.2017.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 01/18/2017] [Accepted: 01/31/2017] [Indexed: 12/21/2022]
Abstract
Self-reported anxiety, and potentially physiological response, to maintained inhalation of carbon dioxide (CO2) enriched air shows promise as a putative marker of panic reactivity and vulnerability. Temporal stability of response systems during low-dose, steady-state CO2 breathing challenge is lacking. Outcomes on multiple levels were measured two times, one week apart, in 93 individuals. Stability was highest during the CO2 breathing phase compared to pre-CO2 and recovery phases, with anxiety ratings, respiratory rate, skin conductance level, and heart rate demonstrating good to excellent temporal stability (ICCs≥0.71). Cognitive symptoms tied to panic were somewhat less stable (ICC=0.58) than physical symptoms (ICC=0.74) during CO2 breathing. Escape/avoidance behaviors and DSM-5 panic attacks were not stable. Large effect sizes between task phases also were observed. Overall, results suggest good-excellent levels of temporal stability for multiple outcomes during respiratory stimulation via 7.5% CO2.
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Beadel JR, Mathews A, Teachman BA. Cognitive Bias Modification to Enhance Resilience to a Panic Challenge. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9791-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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