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Gasquoine PG. Self-reported anterograde memory loss in older persons that is not validated on neuropsychological assessment: Considerations for a dissociative diagnosis. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-6. [PMID: 38615907 DOI: 10.1080/23279095.2024.2341801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
The past decade has witnessed amplified public awareness of age-related dementias. This has resulted in a dramatic rise in the number of older persons referred to memory clinics with a primary complaint of self-reported memory loss without an antecedent neurological event (e.g., stroke) who produce neuropsychological test profiles that lack evidence of such impairment. Since the latter part of the 19th century, a confusing array of changing terminology, criteria, and perceived causation have been ascribed to patients with unverified medical symptoms to implicate psychological causation. Such terms are often misperceived by laypersons as reflecting character flaws or malingering. Of import for clinical neuropsychologists, the 11th edition of the International Classification of Diseases added cognitive to symptoms eligible for a diagnosis of the modern formulation, dissociative neurological symptom disorder. One dissociative option for referrals with self-reported neurocognitive symptoms not validated on neuropsychological testing is functional memory disorder, conceived as a psychological disorder where emotional distress is plausibly related to the perceived memory loss but is of less severity than would warrant a major depressive or anxiety diagnosis. If evidence of psychological distress or behavioral impairment is not present the referral likely reflects the increased public awareness of age-related dementias interacting with the high base rate of self-perceived memory loss in the general population. In such cases, a dissociative diagnosis should be avoided as there is evidence of neither a medical nor a psychological disorder. A summary statement of not dementia or similar is likely sufficient to help the patient.
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Affiliation(s)
- Philip Gerard Gasquoine
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, TX, USA
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Tsuda S, Toya J, Ito K. Collaborative Care Models of Primary Care Clinics for People with Early-Stage Dementia: A Cross-Sectional Survey of Primary Care Physicians in Japan. Int J Integr Care 2024; 24:21. [PMID: 38855029 PMCID: PMC11160391 DOI: 10.5334/ijic.7726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives This study explored collaboration models between primary care physicians (PCPs) and care managers (CMs) and assessed each model's potential in meeting the support needs of individuals with early-stage dementia. Methods In 2022, a cross-sectional survey was conducted among the PCPs in Tokyo. The data regarding the participant and clinic characteristics and daily practices for individuals with early-stage dementia were collected. The clinical collaborative practice was classified using a latent class analysis; comparisons were made between the identified classes based on 14 items in seven domains of support. Results Two collaborative and one stand-alone models were identified. The former varied in the professionals' roles, with one led by PCPs and the other by CMs. We named them PCP-led, CM-led, and stand-alone models, accounting for 46.4%, 32.8%, and 20.6% of the clinics, respectively. The PCP-led clinics were significantly more likely to provide support than the stand-alone ones across five domains: cognitive function, care planning, carers' support, information, and social health. The CM-led model clinics generally fell between those of the other two models. Conclusion Different leadership styles exist in the PCP-CM collaborations in care delivery for people with early-stage dementia. This collaboration offers distinct advantages for clinics in addressing their needs.
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Affiliation(s)
- Shuji Tsuda
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo 173-0015, Japan
| | - Junichiro Toya
- Sakurashinmachi Urban Clinic, 3-21-1-2F Shinmachi, Setagaya, Tokyo 154-0014, Japan
| | - Kae Ito
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo 173-0015, Japan
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Rühl J, Brinkmann ST, Schaufler D, Gräßel E, Walker BB, Kolominsky-Rabas P. [Travel time to memory clinics in Bavaria: A geographical analyses within the framework of digiDEM Bayern]. DAS GESUNDHEITSWESEN 2024; 86:263-273. [PMID: 38579731 PMCID: PMC11003252 DOI: 10.1055/a-2233-6168] [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] [Indexed: 04/07/2024]
Abstract
BACKGROUND Memory clinics can contribute significantly to a qualified diagnosis of dementia. Since the accessibility of medical facilities is an important predictor for their utilisation, the aim of this study was to determine the accessibility of memory clinics for persons with dementia in Bavaria. METHODS We used a Geographic Information System (GIS) to determine travel times to the nearest memory clinic for all Bavarian municipalities based on OpenStreetMap road network data. RESULTS The majority of the modelled persons with dementia in Bavaria (40%; n = 93,950) live in communities with an average travel time of 20 to 40 minutes to the nearest memory clinic. Almost 7,000 (3%) require more than one hour. Especially persons from rural communities have to travel significantly longer distances than people from urban areas. CONCLUSION In view of demographic developments, there is an urgent need for memory clinics to be accessible throughout the country for all persons with dementia, regardless of where they live. The systematic development of memory clinics in areas with long travel times or the establishment of mobile diagnostic services could help to improve dementia care.
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Affiliation(s)
- Jana Rühl
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisziplinäres
Zentrum für Health Technology Assessment (HTA) und Public Health (IZPH),
Erlangen, Germany
| | - Sebastian T. Brinkmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für
Geographie, Erlangen, Germany
| | - Dominik Schaufler
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für
Geographie, Erlangen, Germany
| | - Elmar Gräßel
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische und
Psychotherapeutische Klinik, Universitätsklinikum Erlangen,
Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen,
Germany
| | - Blake Byron Walker
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für
Geographie, Erlangen, Germany
| | - Peter Kolominsky-Rabas
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisziplinäres
Zentrum für Health Technology Assessment (HTA) und Public Health (IZPH),
Erlangen, Germany
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Giaquinto F, Lorenzini P, Salvi E, Carnevale G, Vaccaro R, Matascioli F, Corbo M, Locuratolo N, Vanacore N, Bacigalupo I. The Profile of the Italian Centers for Cognitive Disorders and Dementia in the Context of New Drugs in Alzheimer's Disease. J Alzheimers Dis 2024; 101:509-524. [PMID: 39213073 DOI: 10.3233/jad-240594] [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] [Indexed: 09/04/2024]
Abstract
Background The wait for the upcoming disease-modifying therapies (DMT) for Alzheimer's disease in Europe is raising questions about the preparedness of national healthcare systems to conduct accurate diagnoses and effective prescriptions. In this article, we focus on the current situation in Italy. Objective The primary goal is to propose a profile of the Italian Centers for Cognitive Disorders and Dementias (CCDDs) that could be taken into consideration by regional and autonomous provincial authorities when deciding on the prescribing centers for DMT. Methods Based on responses to a national survey on CCDDs in Italy, we identified the CCDDs that meet the requirements for effective prescription: 1) Multidisciplinary team; 2) Minimum Core Test for the neuropsychological assessment; 3) PET, CSF, and Brain MRI assessments. Univariate and multivariate comparisons were conducted between CCDDs that met the criteria and the others. Results Only 10.4% of CCDDs met the requirements for effective DMT prescription, mainly located in Northern Italy. They are also characterized by longer opening hours, a higher number of professionals, a university location, and a higher frequency of conducting genetic tests, and could potentially result in prescribing centers. Conclusions The findings suggest that the Italian national healthcare system may benefit from further enhancements to facilitate the effective prescription of DMTs. This could involve initiatives to reduce fragmentation, ensure adequate resources and equipment, and secure sufficient funding to support this aspect of healthcare delivery.
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Affiliation(s)
- Francesco Giaquinto
- Department of Human and Social Sciences, University of Salento, Lecce, Italy
| | - Patrizia Lorenzini
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Emanuela Salvi
- National Center for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Giulia Carnevale
- Italian National Institute of Health FONDEM Study Group, Rome, Italy
| | - Roberta Vaccaro
- Italian National Institute of Health FONDEM Study Group, Rome, Italy
- Scientific cultural workshops, Cognitive Therapy Centre (CTC), Como, Italy
| | - Fabio Matascioli
- Italian National Institute of Health FONDEM Study Group, Rome, Italy
- TAM Onlus, Social Cooperative, Naples, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa Cura Igea, Milan, Italy
| | - Nicoletta Locuratolo
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Ilaria Bacigalupo
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
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Pacas Fronza G, Byrne G, Appadurai K, Pachana N, Dissanayaka NNW. Anxiety Symptoms in Australian Memory Clinic Attendees with Cognitive Impairment: Differences Between Self-, Carer-, and Clinician-Report Measures. Clin Gerontol 2024; 47:215-223. [PMID: 37409742 DOI: 10.1080/07317115.2023.2231940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVES To identify the prevalence of anxiety symptoms using a variety of instruments in an Australian memory clinic sample. METHODS This is an exploratory cross-sectional study using a purposive consecutive series sample of 163 individuals and their carers who attended a Brisbane, Australia, memory clinic in 2012-2015. Descriptive statistics and correlation analyses were performed to explore different approaches to measuring anxiety in the sample, using clinician-rated, self-report and carer-report measures. RESULTS The mean age of participants was 78 years, nearly 53% were females. Over 70% of participants with mild cognitive impairment (MCI) and dementia (n = 163) experienced mild to moderate anxiety per a clinician-rated measure (HAM-A), which moderately correlated with carer-report anxiety (IQAD; rs =.59, p < .001). Only weak correlations of these measures with self-report anxiety (GAI) were detected. CONCLUSIONS Mild to moderate anxiety symptoms were frequent in memory clinic attendees diagnosed with MCI or dementia using the HAM-A, suggesting experiences of subclinical anxiety symptoms. CLINICAL IMPLICATIONS Self- as well as carer-report screening tools should be used in memory clinics in addition to routinely administered neuropsychiatric assessments to support early identification of anxiety symptoms and mapping of available post-diagnostic care pathways for people diagnosed with cognitive impairment.
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Affiliation(s)
- Gabriela Pacas Fronza
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Gerard Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Australia
- Academy of Psychiatry, School of Medicine, The University of Queensland, Herston, Australia
| | - Kana Appadurai
- Geriatric and Rehabilitation Services, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Nancy Pachana
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Australia
| | - Nadeeka N W Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Australia
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Australia
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Pena‐Garcia A, Richards R, Richards M, Campbell C, Mosley H, Asper J, Eliacin J, Polsinelli A, Apostolova L, Hendrie H, Tackett A, Elliott C, Van Heiden S, Gao S, Saykin A, Wang S. Accelerating diversity in Alzheimer's disease research by partnering with a community advisory board. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12400. [PMID: 37256164 PMCID: PMC10225742 DOI: 10.1002/trc2.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 06/01/2023]
Abstract
Introduction Community advisory boards (CABs) and researcher partnerships present a promising opportunity to accelerate enrollment of underrepresented groups (URGs). We outline the framework for how the CAB and researchers at the Indiana Alzheimer's Disease Research Center (IADRC) partnered to accelerate URG participation in AD neuroimaging research. Methods CAB and the IADRC researchers partnered to increase the CAB's impact on URG study enrollment through community and research interactions. Community interactions included the CAB collaboratively building a network of URG focused community organizations and collaborating with those URG-focused organizations to host IADRC outreach and recruitment events. Research interactions included direct impact (CAB members referring themselves or close contacts as participants) and strategic impact, mainly by the CAB working with researchers to develop and refine URG focused outreach and recruitment strategies for IADRC and affiliated studies to increase URG representation. We created a database infrastructure to measure how these interactions impacted URG study enrollment. Results Out of the 354 URG research referrals made to the IADRC between October 2019 and December 2022, 267 referrals were directly referred by the CAB (N = 36) or from community events in which CAB members organized and/or volunteered at (N = 231). Out of these 267 referrals, 34 were enrolled in IADRC and 2 were enrolled in Indiana University Longitudinal Early Onset AD Study (IU LEADS). Of note, both studies require the prospective participants to be willing to do MRI and PET scans. As of December 2022, 30 out of the 34 enrolled participants have received a consensus diagnosis; the majority were cognitively normal (64.7%), with the remainder having mild cognitive impairment (17.6%) or early-stage AD (2.9%). Discussion The IADRC CAB-researcher partnership had a measurable impact on the enrollment of African American/Black adults in AD neuroimaging studies. Future studies will need to test whether this conceptual model works for other sites and for other URGs.
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Affiliation(s)
- Alex Pena‐Garcia
- Marian University College of Osteopathic MedicineIndianapolisIndianaUSA
| | - Ralph Richards
- Indiana University Alzheimer's Disease Research Center Community Advisory BoardIndiana University School of MedicineIndianapolisIndianaUSA
| | - Mollie Richards
- Indiana University Alzheimer's Disease Research Center Community Advisory BoardIndiana University School of MedicineIndianapolisIndianaUSA
| | - Christopher Campbell
- Indiana University Alzheimer's Disease Research Center Community Advisory BoardIndiana University School of MedicineIndianapolisIndianaUSA
| | - Hank Mosley
- Indiana University Alzheimer's Disease Research Center Community Advisory BoardIndiana University School of MedicineIndianapolisIndianaUSA
| | - Joseph Asper
- Marian University College of Osteopathic MedicineIndianapolisIndianaUSA
| | - Johanne Eliacin
- Department of Internal General MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- VA HSR&D Center for Health Information and CommunicationRoudebush VA Medical CenterIndianapolisIndianaUSA
| | - Angelina Polsinelli
- Indiana University Alzheimer's Disease Research Center Community Advisory BoardIndiana University School of MedicineIndianapolisIndianaUSA
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Liana Apostolova
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Hugh Hendrie
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Andrew Tackett
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
| | - Caprice Elliott
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of RadiologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Sarah Van Heiden
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of RadiologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Sujuan Gao
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of BiostatisticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Andrew Saykin
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of RadiologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Sophia Wang
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
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Low LF, Gresham M, Phillipson L. Further development needed: models of post-diagnostic support for people with dementia. Curr Opin Psychiatry 2023; 36:104-111. [PMID: 36705009 DOI: 10.1097/yco.0000000000000848] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW There is increasing recognition of a service gap immediately after diagnosis for people with dementia and carers. This narrative review of models of post-diagnostic support focuses on recent developments and offers suggestions for future development. We present the current evidence for these models and consider the service components they provide against the recommendations of clinical guidelines and principles underpinning ideal post-diagnostic support. RECENT FINDINGS Models of post-diagnostic support include a short-term support worker, ongoing support worker, centre-based support, primary care management, and specialist dementia clinics. Of these, specialist dementia clinics that include ongoing support workers provide most components of an ideal and timely post-diagnostic support framework, but may be more costly to implement universally. The greatest research evidence is for the benefits of long-term support models, specifically case management, though this does not necessarily include medical care or nonpharmacological interventions. There is sparce evidence for the benefits of short-term support worker models such as dementia advisers for people with dementia and carers. SUMMARY Further development is needed to create whole-system models of dementia support which meet the needs of people with dementia and their carers, are timely, accessible and equitable, and can be implemented universally.
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Affiliation(s)
- Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney
| | - Meredith Gresham
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney
| | - Lyn Phillipson
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
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Liu C, Yang H, Jiao Y, Liu Y, Chang J, Ji Y. Preferences of people with mild cognitive impairment for physical activity interventions in China: protocol for a discrete choice experiment study. BMJ Open 2022; 12:e064153. [PMID: 36241356 PMCID: PMC9577920 DOI: 10.1136/bmjopen-2022-064153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Exercise interventions are important non-pharmacological interventions for patients with mild cognitive impairment (MCI), but patients with MCI have poor compliance and there is no consistent strategy for exercise interventions. Understanding the needs and preferences of MCI patients allows for the development of effective and acceptable exercise intervention programmes that achieve the goals of patient-centred care. This study uses a discrete choice experiment (DCE) to measure and quantify MCI patients' preferences for exercise interventions, and aims at (1) identifying and exploring which elements of exercise intervention programmes are essential for MCI patients; (2) measuring MCI patients' preferences for exercise interventions and summarising relevant characteristics that may influence preference choices and (3) determining whether these preferences vary by participant characteristics and classifying the population types based on the sociodemographic characteristics of the participants. METHODS AND ANALYSIS A DCE will be conducted to explore MCI patients' preferences for exercise interventions. We conducted a systematic literature review and extensive qualitative work to select the best attributes to develop the design of DCE. A partial factorial survey design was generated through an orthogonal experimental design. We will conduct a questionnaire survey in one city each in the eastern (Nanjing), western (Xining), southern (Zhuhai) and northern (Beijing) parts of China and reach the planned sample size (n=278). Final data will be analysed using a mixed logit model and a latent class model. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of Nanjing Medical University (2021-666). All participants will be required to provide informed consent. Our findings will be disseminated and shared with interested patient groups and the general public through online blogs, policy briefs, national and international conferences and peer-reviewed journals.
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Affiliation(s)
- Chang Liu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Hong Yang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yuchen Jiao
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yunyue Liu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jing Chang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yan Ji
- School of Nursing, Nanjing Medical University, Nanjing, China
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