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Mide M, Arvidson E, Gordh AS. Clinical Differences of mild, Moderate, and Severe Gambling Disorder in a Sample of Treatment Seeking Pathological Gamblers in Sweden. J Gambl Stud 2023; 39:1129-1153. [PMID: 36609904 PMCID: PMC10397119 DOI: 10.1007/s10899-022-10183-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Gambling disorder (GD) is classified among the addictive disorders in the DSM-5 and the severity of the diagnosis can be specified as mild, moderate and severe. It has been seen that individuals with more severe gambling problems have a higher rate of comorbid disorders and other health problems compared to individuals with a milder clinical picture. AIMS The aim of this study was to explore clinical psychiatric differences related to the severity of disorder in treatment-seeking patients with GD. METHOD A sample of 163 patients with GD seeking treatment at an outpatient clinic was diagnosed using the SCI-GD, screened for comorbid diagnoses using the MINI, and further completed a range of self-report questionnaires measuring alcohol-, and drug-problems, symptoms of depression and anxiety, emotion regulation, cognitive distortions, and quality of life. RESULTS Greater severity was associated to more problems with alcohol and illicit drugs. Severe gamblers were more likely to gamble to "escape", and had more symptoms of depression and anxiety. Participants with moderate and severe gambling disorder had more difficulties with emotion regulation. Cognitive distortions were the same between severities. All groups had Quality-of-Life problems at a clinical level. DISCUSSION There are some distinctive differences between GD of different severities. The features shown by patients with severe GD indicates a more emotionally vulnerable group with increased symptom severity. Further knowledge about the features of GD severity levels is important for treatment planning in the clinic.
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Affiliation(s)
- Mikael Mide
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Journalvägen 5, 416 50, Gothenburg, Sweden.
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institution of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Elin Arvidson
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Journalvägen 5, 416 50, Gothenburg, Sweden
| | - Anna Söderpalm Gordh
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Journalvägen 5, 416 50, Gothenburg, Sweden
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institution of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Hsiang Tseng C, Flack M, Caudwell KM, Stevens M. Separating problem gambling behaviors and negative consequences: Examining the factor structure of the PGSI. Addict Behav 2023; 136:107496. [PMID: 36174423 DOI: 10.1016/j.addbeh.2022.107496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023]
Abstract
There is some uncertainty on how to best conceptualise and measure problem gambling and debate as to whether it is helpful to differentiate the behavioral features of problematic gambling from the negative consequences of gambling. The current study explores this issue by examining the factor structure of a commonly-used problem gambling measure, the Problem Gambling Severity Index (PGSI), as administered to respondents in the 2018 Northern Territory Gambling Prevalence and Wellbeing Survey (n = 3,740 gamblers). Confirmatory factor analyses revealed a two-factor solution offered significant improvement in fit over the one-factor model. Further, the two factors explained unique variance in the number of gambling-related harms experienced by respondents. Although the two factors were highly correlated, the current findings indicate problem gambling behaviors are related to the negative consequences of gambling, but these are not necessarily synonymous. This suggests isolating behavioral and consequential elements of gambling may have utility in public health interventions for gambling that, while concerning, falls below a clinically-significant threshold. Similarly, clinically-oriented research may benefit by measuring the behavioral features, as these components are important targets for individual-level interventions.
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Affiliation(s)
- Chen Hsiang Tseng
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory 0909, Australia
| | - Mal Flack
- Researchers in Behavioural Addictions, Alcohol, and Drugs (BAAD), College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory 0909, Australia.
| | - Kim M Caudwell
- Researchers in Behavioural Addictions, Alcohol, and Drugs (BAAD), College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory 0909, Australia.
| | - Matthew Stevens
- STRS Consultants, Darwin, Northern Territory 0800, Australia
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Rumpf HJ, Montag C. Where to put Compulsive Sexual Behavior Disorder (CSBD)? Phenomenology matters •. J Behav Addict 2022; 11:230-233. [PMID: 35895458 PMCID: PMC9295241 DOI: 10.1556/2006.2022.00039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/19/2022] Open
Abstract
In this commentary paper, it is discussed if Compulsive Sexual Behavior Disorder (CSBD) is best categorized as an Impulse Control Disorder, an Obsessive-Compulsive Disorder or in light of the overlap of characteristics with both Gaming and Gambling Disorder as an addictive behavior. The overlapping features are: loss of control over the respective excessive behavior, giving increasing priority to the excessive behavior under investigation and upholding such a behavior despite negative consequences. Besides empirical evidence regarding underlying mechanisms, phenomenology also plays an important role to correctly classify CSBD. The phenomenological aspects of CSBD clearly speak in favor of classifying CSBD under the umbrella of addictive behaviors.
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Affiliation(s)
- Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany,Corresponding author. E-mail:
| | - Christian Montag
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Draps M, Sescousse G, Potenza MN, Marchewka A, Duda A, Lew-Starowicz M, Kopera M, Jakubczyk A, Wojnar M, Gola M. Gray Matter Volume Differences in Impulse Control and Addictive Disorders-An Evidence From a Sample of Heterosexual Males. J Sex Med 2020; 17:1761-9. [PMID: 32690426 DOI: 10.1016/j.jsxm.2020.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/16/2020] [Accepted: 05/10/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUNDS The classification of addictions and impulse control disorders is changing as reflected in the 11th version of International Classification of Disorders (WHO, 2018). However, studies focusing on direct comparison of structural brain differences in behavioral and substance addictions are limited. AIM Here, we contrast gray matter volumes (GMVs) across groups of individuals with compulsive sexual behavior disorder (CSBD), gambling disorder (GD), and alcohol use disorder (AUD) with those with none of these disorders (healthy controls participants; HCs). METHODS Voxel-based morphometry was used to study brain structure, and severities of addiction symptoms were assessed with questionnaires. To identify brain regions related to severities of addictions, correlations between questionnaire scores and GMVs were computed. MAIN OUTCOME We collected magnetic resonance imaging (GMVs) data from 26 patients with CSBD, 26 patients with GD, 21 patients with AUD, and 25 HC participants (all heterosexual males; age: 24-60; mean = 34.5, standard deviation = 6.48). RESULTS Affected individuals (CSBD, GD, AUD) compared with HC participants showed smaller GMVs in the left frontal pole, specifically in the orbitofrontal cortex. The most pronounced differences were observed in the GD and AUD groups, and the least in the CSBD group. In addition, a negative correlation was found between GMVs and disorder severity in the CSBD group. Higher severity of CSBD symptoms was correlated with decreased GMVs in the right anterior cingulate gyrus. CLINICAL IMPLICATIONS Our findings suggest similarities between CSBD and addictions. STRENGHS AND LIMITIATIONS This study is the first showing smaller GMVs in 3 clinical groups of CSBD, GD, and AUD. But the study was limited only to heterosexual men. Longitudinal studies should examine the extent to which ventral prefrontal decrements in volume may represent preexisting vulnerability factors or whether they may develop with disorder progression. CONCLUSIONS Our research extends prior findings in substance use disorders of lower GMVs in prefrontal cortical volumes among 3 clinical groups of patients with specific impulse control (CSBD) and behavioral (GD) and substance (AUD) addictive disorders. The negative correlation between CSBD symptoms and GMV of right anterior cingulate gyrus suggests a link with clinical symptomatology. Draps M, Sescousse G, Potenza MN, et al. Gray Matter Volume Differences in Impulse Control and Addictive Disorders-An Evidence From a Sample of Heterosexual Males. J Sex Med 2020;17:1761-1769.
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Grubbs JB, Chapman H. Predicting Gambling Situations: The Roles of Impulsivity, Substance Use, and Post-Traumatic Stress. Subst Abuse 2019; 13:1178221819852641. [PMID: 31258327 PMCID: PMC6591666 DOI: 10.1177/1178221819852641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/02/2019] [Indexed: 12/04/2022]
Abstract
Gambling disorder and symptoms of post-traumatic stress are highly comorbid.
Numerous studies suggest that the presence of one (either disordered gambling or
post-traumatic stress) substantially increases the odds of later developing the
other. However, little is known about the etiological links between these two
domains or the nuances of the comorbidity. Past research has suggested that
symptoms of post-traumatic stress might be related to unique motivations for and
beliefs about gambling. The present work sought to examine whether or not
symptoms of post-traumatic stress might also be related to specific situational
vulnerabilities to gambling behaviors. Using a large cross-sectional sample of
Internet-using adults in the United States who were primarily recreational
gamblers (N = 743; 46% men, Mage = 36.0, SD = 11.1),
as well as an inpatient sample of US Armed Forces veterans seeking treatment for
gambling disorder (N = 332, 80% men, Mage = 53.5,
SD = 11.5), the present work tested whether or not symptoms of post-traumatic
stress were uniquely related to a variety of gambling situations. Results in
both samples revealed that even when controlling for potentially confounding
variables (eg, substance use and trait impulsivity), symptoms of post-traumatic
stress were uniquely related to gambling in response to negative affect,
gambling in response to social pressure, and gambling due to a need for
excitement. These findings are consistent with recent work suggesting that
individuals with post-traumatic stress symptoms are more likely to engage in
gambling behaviors for unique reasons that differ from gamblers without such
symptoms.
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Affiliation(s)
- Joshua B Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Heather Chapman
- Gambling Treatment Program, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
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Maremmani AGI, Gazzarrini D, Fiorin A, Cingano V, Bellio G, Perugi G, Maremmani I. Psychopathology of addiction: Can the SCL90-based five-dimensional structure differentiate Heroin Use Disorder from a non-substance-related addictive disorder such as Gambling Disorder? Ann Gen Psychiatry 2018; 17:3. [PMID: 29371875 PMCID: PMC5769351 DOI: 10.1186/s12991-018-0173-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/03/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In the Gambling Disorder (GD), there is no exogenous drug administration that acts as the central core of the traditional meaning of addiction. A specific psychopathology of Substance Use Disorders has been proposed recently. In a sample of Heroin Use Disorder (HUD) patients entering opioid agonist treatment, it became possible to identify a group of 5 mutually exclusive psychiatric dimensions: Worthlessness-Being trapped (W-BT), Somatic Symptoms (SS), Sensitivity-Psychoticism (SP), Panic Anxiety (PA) and Violence-Suicide (VS). The specificity of these dimensions was suggested by the absence of their correlations with treatment choice, active substance use, psychiatric comorbidity and the principal substance of abuse and by the opportunity, through their use, of fully discriminating HUD from Major Depression patients and, partially, from obese non-psychiatric patients. To further support this specificity in the present study, we tested the feasibility of discriminating HUD patients from those affected by a non-substance-related addictive behaviour, such as GD. In this way, we also investigated the psychopathological peculiarities of GD patients. METHODS We compared the severity and frequency of each of the five aspects found by us, in 972 (83.5% males; mean age 30.12 ± 6.6) HUD and 110 (50% males; average age 30.12 ± 6.6) GD patients at univariate (T test; Chi square) and multivariate (discriminant analysis and logistic regression) level. RESULTS HUD patients showed higher general psychopathology indexes than GD patients. The severity of all five psychopathological dimensions was significantly greater in HUD patients. Discriminant analysis revealed that SS and VS severity were able to discriminate between HUD (higher severity) and GD patients (lower severity), whereas PA and SP could not. W-BT severity was negatively correlated with SS and VS; GD patients were distinguished by low scores for SS and VS low scores associated with high ones for W-BT. Psychopathological subtypes characterized by SS and VS symptomatology were better represented in HUD patients, whereas PA symptomatology was more frequent in GD individuals. No differences were observed regarding the W-BT and SP dimensions. At multivariate level, the one prominent characteristic of HUD patients was the presence of SS (OR = 5.43) as a prominent qualification for psychopathological status. CONCLUSIONS Apart from the lower severity of all psychopathological dimensions, only the lower frequency of SS typology seems to be the prominent factor in GD patients. The SCL90-defined structure of opioid addiction seems to be useful even in non-substance-related addictive disorders, as in the case of GD patients, further supporting the possible existence of a psychopathology specific to addiction.
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Affiliation(s)
- Angelo G I Maremmani
- Department of Psychiatry, North-Western Tuscany Region Local Health Unit, Versilian Zone, Viareggio, Italy.,Association for the Application of Neuroscientific Knowledge To Social Aims (AU-CNS), Pietrasanta, Italy.,G. De Lisio Institute of Behavioural Sciences, Pisa, Italy
| | | | - Amelia Fiorin
- Drug Addiction Unit, Castelfranco Veneto, Treviso, Italy
| | | | | | - Giulio Perugi
- G. De Lisio Institute of Behavioural Sciences, Pisa, Italy.,5Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Icro Maremmani
- Association for the Application of Neuroscientific Knowledge To Social Aims (AU-CNS), Pietrasanta, Italy.,G. De Lisio Institute of Behavioural Sciences, Pisa, Italy.,6Vincent P. Dole Dual Diagnosis Unit, Department of Specialty Medicine, Santa Chiara University Hospital, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
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Merkouris SS, Rodda SN, Austin D, Lubman DI, Harvey P, Battersby M, Cunningham J, Lavis T, Smith D, Dowling NA. GAMBLINGLESS: FOR LIFE study protocol: a pragmatic randomised trial of an online cognitive-behavioural programme for disordered gambling. BMJ Open 2017; 7:e014226. [PMID: 28235970 PMCID: PMC5337748 DOI: 10.1136/bmjopen-2016-014226] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The prevalence of disordered gambling worldwide has been estimated at 2.3%. Only a small minority of disordered gamblers seek specialist face-to-face treatment, and so a need for alternative treatment delivery models that capitalise on advances in communication technology, and use self-directed activity that can complement existing services has been identified. As such, the primary aim of this study is to evaluate an online self-directed cognitive-behavioural programme for disordered gambling (GamblingLess: For Life). METHODS AND ANALYSIS The study will be a 2-arm, parallel group, pragmatic randomised trial. Participants will be randomly allocated to a pure self-directed (PSD) or guided self-directed (GSD) intervention. Participants in both groups will be asked to work through the 4 modules of the GamblingLess programme over 8 weeks. Participants in the GSD intervention will also receive weekly emails of guidance and support from a gambling counsellor. A total of 200 participants will be recruited. Participants will be eligible if they reside in Australia, are aged 18 years and over, have access to the internet, have adequate knowledge of the English language, are seeking help for their own gambling problems and are willing to take part in the intervention and associated assessments. Assessments will be conducted at preintervention, and at 2, 3 and 12 months from preintervention. The primary outcome is gambling severity, assessed using the Gambling Symptom Assessment Scale. Secondary outcomes include gambling frequency, gambling expenditure, psychological distress, quality of life and additional help-seeking. Qualitative interviews will also be conducted with a subsample of participants and the Guides (counsellors). ETHICS AND DISSEMINATION The study has been approved by the Deakin University Human Research and Eastern Health Human Research Ethics Committees. Findings will be disseminated via report, peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12615000864527; results.
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Affiliation(s)
- S S Merkouris
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - S N Rodda
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Turning Point, Eastern Health, Fitzroy, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Auckland University of Technology, Auckland, New Zealand
| | - D Austin
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - D I Lubman
- Turning Point, Eastern Health, Fitzroy, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - P Harvey
- School of Medicine, Flinders University, Adelaide, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - M Battersby
- School of Medicine, Flinders University, Adelaide, Australia
| | - J Cunningham
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Research School of Population Health, Australian National University, Canberra, Australia
| | - T Lavis
- School of Medicine, Flinders University, Adelaide, Australia
| | - D Smith
- School of Medicine, Flinders University, Adelaide, Australia
| | - N A Dowling
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia
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Müller KW, Dreier M, Beutel ME, Wölfling K. Is Sensation Seeking a correlate of excessive behaviors and behavioral addictions? A detailed examination of patients with Gambling Disorder and Internet Addiction. Psychiatry Res 2016; 242:319-325. [PMID: 27322843 DOI: 10.1016/j.psychres.2016.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 06/02/2016] [Accepted: 06/05/2016] [Indexed: 01/14/2023]
Abstract
Sensation Seeking has repeatedly been related to substance use. Also, its role as a correlate of Gambling Disorder has been discussed although research has led to heterogeneous results. Likewise, first studies on Internet Addiction have indicated increased Sensation Seeking, to some extent contradicting clinical impression of patients suffering from internet addiction. We assessed Sensation Seeking in a clinical sample of n=251 patients with Gambling Disorder, n=243 patients with internet addiction, n=103 clients with excessive but not addictive internet use, and n=142 healthy controls. The clinical groups were further sub-divided according to the preferred type of addictive behavior (slot-machine gambling vs. high arousal gambling activities and internet gaming disorder vs. other internet-related addictive behaviors). Decreased scores in some subscales of Sensation Seeking were found among male patients compared to healthy controls with no differences between patients with Gambling Disorder and Internet Addiction. The type of preferred gambling or online activity was not related to differences in Sensation Seeking. Previous findings indicating only small associations between Sensation Seeking and Gambling Disorder were confirmed. Regarding Internet Addiction our results contradict findings from non-clinical samples. Sensation Seeking might be relevant in initiating contact to the health care system.
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Affiliation(s)
- K W Müller
- Department of Psychosomatic Medicine and Psychotherapy, Outpatient Clinic for Behavioural Addictions, University Medical Centre, Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
| | - M Dreier
- Department of Psychosomatic Medicine and Psychotherapy, Outpatient Clinic for Behavioural Addictions, University Medical Centre, Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
| | - M E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, Outpatient Clinic for Behavioural Addictions, University Medical Centre, Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
| | - K Wölfling
- Department of Psychosomatic Medicine and Psychotherapy, Outpatient Clinic for Behavioural Addictions, University Medical Centre, Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
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