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Lim S, Athilingam P, Lahiri M, Cheung PPM, He HG, Lopez V. A Web-Based Patient Empowerment to Medication Adherence Program for Patients With Rheumatoid Arthritis: Feasibility Randomized Controlled Trial. JMIR Form Res 2023; 7:e48079. [PMID: 37930758 PMCID: PMC10660247 DOI: 10.2196/48079] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Living with a chronic illness such as rheumatoid arthritis (RA) requires medications and therapies, as well as long-term follow-up with multidisciplinary clinical teams. Patient involvement in the shared decision-making process on medication regimens is an important element in promoting medication adherence. Literature review and needs assessment showed the viability of technology-based interventions to equip patients with knowledge about chronic illness and competencies to improve their adherence to medications. Thus, a web-based intervention was developed to empower patients living with RA to adhere to their disease-modifying antirheumatic drugs (DMARDs) medication regimen. OBJECTIVE This study aims to discuss the intervention mapping process in the design of a web-based intervention that supports patient empowerment to medication adherence and to evaluate its feasibility among patients living with RA. METHODS The theory-based Patient Empowerment to Medication Adherence Programme (PE2MAP) for patients with RA was built upon the Zimmerman Psychological Empowerment framework, a web-based program launched through the Udemy website. PE2MAP was developed using a 6-step intervention mapping process: (1) needs assessment, (2) program objectives, (3) conceptual framework to guide the intervention, (4) program plan, (5) adoption, and (6) evaluation involving multidisciplinary health care professionals (HCPs) and a multimedia team. PE2MAP is designed as a 4-week web-based intervention program with a complementary RA handbook. A feasibility randomized controlled trial was completed on 30 participants from the intervention group who are actively taking DMARD medication for RA to test the acceptability and feasibility of the PE2MAP. RESULTS The mean age and disease duration of the 30 participants were 52.63 and 8.50 years, respectively. The feasibility data showed 87% (n=26) completed the 4-week web-based PE2MAP intervention, 57% (n=17) completed all 100% of the contents, and 27% (n=8) completed 96% to 74% of the contents, indicating the overall feasibility of the intervention. As a whole, 96% (n=24) of the participants found the information on managing the side effects of medications, keeping fit, managing flare-ups, and monitoring joint swelling/pain/stiffness as the most useful contents of the intervention. In addition, 88% (n=23) and 92% (n=24) agreed that the intervention improved their adherence to medications and management of their side effects, including confidence in communicating with their health care team, respectively. The dos and do nots of traditional Chinese medicine were found by 96% (n=25) to be useful. Goal setting was rated as the least useful skill by 6 (23.1%) of the participants. CONCLUSIONS The web-based PE2MAP intervention was found to be acceptable, feasible, and effective as a web-based tool to empower patients with RA to manage and adhere to their DMARD medications. Further well-designed randomized controlled trials are warranted to explore the effectiveness of this intervention in the management of patients with RA.
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Affiliation(s)
- Siriwan Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Manjari Lahiri
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter Pak Moon Cheung
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Violeta Lopez
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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Eigl ES, Hauser T, Topalidis PI, Schabus M. On the Efficacy of a CBT-I-Based Online Program for Sleep Problems: A Randomized Controlled Trial. Clocks Sleep 2023; 5:590-603. [PMID: 37873840 PMCID: PMC10594462 DOI: 10.3390/clockssleep5040039] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
There is an urgent need for easily accessible treatment options for sleep problems to reduce the current treatment gap in receiving cognitive behavioral therapy for insomnia (CBT-I). Using a randomized controlled trial, we evaluated the efficacy of a CBT-I-based online program on sleep. Fifty-three volunteers (21-71 years; MAge = 44.6 ± 12.5; 27 female) suffering from impaired sleep were randomly allocated either to the experimental group (EG, n = 27) or to an active control group (CG, n = 26). The EG participated in a 6-week CBT-I-based online program, while the CG received psychoeducation and sleep hygiene instructions. Sleep was assessed both objectively via ambulatory polysomnography (PSG) as well as subjectively via questionnaires at three time points (baseline, pre- and post-intervention). A one-month follow-up assessment was performed using questionnaires. The EG showed small but reliable improvements from pre- to post-intervention in PSG-derived wake after sleep onset (from 58.6 min to 42.5 min; p < 0.05) and sleep efficiency (from 86.0% to 89.2%; p < 0.05). Furthermore, subjective sleep quality (assessed via Pittsburgh Sleep Quality Index) improved significantly during intervention (p = 0.011) and follow-up (p = 0.015) in the EG alone. The Insomnia Severity Index decreased from pre- to post-intervention in both groups (EG: p = 0.003, CG: p = 0.008), while it further improved during follow-up (p = 0.035) in the EG alone. We show that a CBT-I-based online program can improve sleep not only subjectively but also objectively and can be a viable alternative when face-to-face interventions are not available.
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Affiliation(s)
- Esther-Sevil Eigl
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
| | - Theresa Hauser
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
| | - Pavlos I. Topalidis
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
| | - Manuel Schabus
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
- Centre for Cognitive Neuroscience Salzburg (CCNS), Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
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Bielinski LL, Wälchli G, Nissen C, Berger T, Moggi F. Does an Internet-Based Emotion Regulation Intervention Provide Added Value for Acute Psychiatric Inpatient Care? Protocol for a Randomized Controlled Pilot Trial. JMIR Res Protoc 2023; 12:e47656. [PMID: 37432724 PMCID: PMC10369307 DOI: 10.2196/47656] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND There is a lack of studies on internet-based interventions in inpatient settings. This is especially true for studies of internet-based interventions in acute psychiatric inpatient care. Internet-based interventions in this specific setting may provide benefits such as patient empowerment and overall improved treatment outcomes. However, there may also be specific barriers to their implementation that are unique due to the complexity of acute psychiatric inpatient care. OBJECTIVE The aim of this study is to examine the feasibility and preliminary evidence for effectiveness of a web-based emotion regulation intervention provided as an add-on to acute psychiatric inpatient care. METHODS The goal is to randomly allocate 60 patients with a range of different diagnoses in a 1:1 ratio to either treatment as usual (TAU), which consists of acute psychiatric inpatient treatment, or to the intervention group, which will receive TAU plus access to a web-based intervention that focuses on reduction of emotion regulation difficulties and improvement of emotion regulation skills. The primary outcome is symptom severity, assessed with the short form of the Brief Symptom Inventory at baseline, after 4 weeks, after 8 weeks, and at hospital discharge. Secondary outcomes include 2 emotion regulation parameters, intervention use, usability, patient satisfaction, and reasons for patient loss to follow-up. RESULTS Participant recruitment started in August 2021 and as of March 2023 was ongoing. First publication of study results is expected in 2024. CONCLUSIONS This study protocol describes a study that intends to examine a web-based emotion regulation intervention in acute psychiatric inpatient care. The study will provide information on the feasibility of the intervention and possible effects on symptom severity and emotion regulation. The results will provide new insights on blended treatment, in this case the combination of a web-based intervention and face-to-face psychiatric treatment, in an understudied patient group and setting. TRIAL REGISTRATION ClinicalTrials.gov NCT04990674; https://clinicaltrials.gov/ct2/show/NCT04990674. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47656.
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Affiliation(s)
- Laura Luisa Bielinski
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Gwendolyn Wälchli
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- Division of Psychiatric Specialties, Geneva University Hospitals, Geneva, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Kayser J, Wang X, Wu Z, Dimoji A, Xiang X. Layperson-Facilitated Internet-Delivered Cognitive Behavioral Therapy for Homebound Older Adults With Depression: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e44210. [PMID: 36811937 PMCID: PMC9996421 DOI: 10.2196/44210] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Depression in older adults has serious biological, psychological, and social consequences. Homebound older adults experience a high burden of depression and significant barriers to accessing mental health treatments. Few interventions to address their specific needs have been developed. Existing treatment modalities can be challenging to scale up, are not tailored to unique population concerns, and require significant staffing support. Technology-assisted, layperson-facilitated psychotherapy has the potential to overcome these challenges. OBJECTIVE The aim of this study is to assess the efficacy of a layperson-facilitated internet-delivered cognitive behavioral therapy program tailored for homebound older adults. The novel intervention, Empower@Home, was developed based on user-centered design principles and partnerships between researchers, social service agencies, care recipients, and other stakeholders serving low-income homebound older adults. METHODS This 2-arm, 20-week pilot randomized controlled trial (RCT) with a waitlist control crossover design aims to enroll 70 community-dwelling older adults with elevated depressive symptoms. The treatment group will receive the 10-week intervention immediately, whereas the waitlist control group will cross over and receive the intervention after 10 weeks. This pilot is part of a multiphase project involving a single-group feasibility study (completed in December 2022). This project consists of a pilot RCT (described in this protocol) and an implementation feasibility study running in parallel with the pilot RCT. The primary clinical outcome of the pilot is the change in depressive symptoms after the intervention and at the 20-week postrandomization follow-up. Additional outcomes include acceptability, adherence, and changes in anxiety, social isolation, and quality of life. RESULTS Institutional review board approval was obtained for the proposed trial in April 2022. Recruitment for the pilot RCT began in January 2023 and is anticipated to end in September 2023. On completion of the pilot trial, we will examine the preliminary efficacy of the intervention on depression symptoms and other secondary clinical outcomes in an intention-to-treat analysis. CONCLUSIONS Although web-based cognitive behavioral therapy programs are available, most programs have low adherence and very few are tailored for older adults. Our intervention addresses this gap. Older adults, particularly those with mobility difficulties and multiple chronic health conditions, could benefit from internet-based psychotherapy. This approach can serve a pressing need in society while being cost-effective, scalable, and convenient. This pilot RCT builds on a completed single-group feasibility study by determining the preliminary effects of the intervention compared with a control condition. The findings will provide a foundation for a future fully-powered randomized controlled efficacy trial. If our intervention is found to be effective, implications extend to other digital mental health interventions and populations with physical disabilities and access restrictions who face persistent disparities in mental health. TRIAL REGISTRATION ClinicalTrials.gov NCT05593276; https://clinicaltrials.gov/ct2/show/NCT05593276. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/44210.
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Affiliation(s)
- Jay Kayser
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Xu Wang
- Computer Science and Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Zhenke Wu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Asha Dimoji
- College of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI, United States
| | - Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
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Lin M, Phipps M, Yilmaz Y, Nash CJ, Gisondi MA, Chan TM. A Fork in the Road for Emergency Medicine and Critical Care Blogs and Podcasts: Cross-sectional Study. JMIR Med Educ 2022; 8:e39946. [PMID: 36306167 PMCID: PMC9652734 DOI: 10.2196/39946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/02/2022] [Accepted: 10/12/2022] [Indexed: 05/21/2023]
Abstract
BACKGROUND Free open-access meducation (FOAM) refers to open-access, web-based learning resources in medicine. It includes all formats of digital products, including blogs and podcasts. The number of FOAM blog and podcast sites in emergency medicine and critical care increased dramatically from 2002 to 2013, and physicians began to rely on the availability of these resources. The current landscape of these FOAM sites is unknown. OBJECTIVE This study aims to (1) estimate the current number of active, open-access blogs and podcasts in emergency medicine and critical care and (2) describe observed and anticipated trends in the FOAM movement using the Theory of Disruptive Innovation by Christensen as a theoretical framework. METHODS The authors used multiple resources and sampling strategies to identify active, open-access blogs and podcasts between April 25, 2022, and May 8, 2022, and classified these websites as blogs, podcasts, or blogs+podcasts. For each category, they reported the following outcome measures using descriptive statistics: age, funding, affiliations, and team composition. Based on these findings, the authors projected trends in the number of active sites using a positivist paradigm and the Theory of Disruptive Innovation as a theoretical framework. RESULTS The authors identified 109 emergency medicine and critical care websites, which comprised 45.9% (n=50) blogs, 22.9% (n=25) podcasts, and 31.2% (n=34) blogs+podcasts. Ages ranged from 0 to 18 years; 27.5% (n=30) sold products, 18.3% (n=20) used advertisements, 44.0% (n=48) had institutional funding, and 27.5% (n=30) had no affiliation or external funding sources. Team sizes ranged from 1 (n=26, 23.9%) to ≥5 (n=60, 55%) individuals. CONCLUSIONS There was a sharp decline in the number of emergency medicine and critical care blogs and podcasts in the last decade, dropping 40.4% since 2013. The initial growth of FOAM and its subsequent downturn align with principles in the Theory of Disruptive Innovation by Christensen. These findings have important implications for the field of medical education.
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Affiliation(s)
- Michelle Lin
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Mina Phipps
- Department of Emergency Medicine, Stanford University, Stanford, CA, United States
| | - Yusuf Yilmaz
- Education Research, Innovation, and Theory Program, McMaster University, Hamilton, ON, Canada
- Department of Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Christopher J Nash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Michael A Gisondi
- Precision Education and Assessment Research Lab, Department of Emergency Medicine, Stanford University, Stanford, CA, United States
| | - Teresa M Chan
- Education Research, Innovation, and Theory Program, McMaster University, Hamilton, ON, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Zaslavsky O, Kaneshiro J, Chu F, Teng A, Domoto-Reilly K, Chen AT. Virtual Intervention for Caregivers of Persons With Lewy Body Dementia: Pilot Quasi-Experimental Single-Arm Study. JMIR Form Res 2022; 6:e37108. [PMID: 35904843 PMCID: PMC9377445 DOI: 10.2196/37108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Compared to other types of dementia, family caregivers of people with Lewy body dementia (LBD) report higher stress levels and more severe depressive symptoms. Although several digital support interventions for caregivers of persons with dementia exist, few target LBD specifically or leverage a fully remote and asynchronous approach suitable for pandemic circumstances. OBJECTIVE We performed a pilot evaluation of a digital intervention designed to help caregivers of people with LBD address challenges they have experienced, with the end goal of reducing psychological distress in this population. METHODS We recruited 15 family caregivers of people with LBD to participate in the quasi-experimental, single-arm, mixed methods study titled Virtual Online Communities for Aging Life Experience-Lewy Body Dementia (VOCALE-LBD). The study offers an 8-week web-based intervention that uses a digital discussion platform and involves moderation, peer-to-peer support, didactic training, and problem-solving skill enactment. RESULTS Participants' baseline characteristics were the following: mean age 66 (SD 8) years; 14 of 15 (93%) of them were female; all (15/15, 100%) were White; and 8 (53%) of them had at least a postgraduate degree. Throughout the intervention, participants engaged in weekly web-based discussions, generating a total of 434 posts (average 4 posts per week). Attrition was 20% (3/15). Upon study exit, participants showed the following average improvements: 3.0 (SD 6.0) in depression, 8.3 (SD 16.7) in burden, 2.9 (SD 6.8) in stress, and 0.3 (SD 0.8) in loneliness. When looking at the proportion of participants with clinically significant improvement versus those with a worsening of ≥0.5 SD for each outcome, we observed net improvements of 50% (6/12), 33% (4/12), 25% (3/12), and 25% (3/12) in depression, loneliness, burden, and stress, respectively. In terms of the benefits of participation, participants reported that participation helped them "a great deal" to (1) improve their understanding of LBD (9/12, 75%), (2) gain confidence in dealing with difficult behaviors of the care recipient (6/12, 50%), and (3) improve in one's abilities to provide care to the care recipient (4/12, 33%). CONCLUSIONS The study generated promising feasibility and preliminary efficacy data for a low-cost, web-based intervention designed for caregivers of persons with LBD. Though the study was not powered for significance, we observed nominal average and net improvements in important psychological outcomes. Moreover, many caregivers reported that study participation helped them better understand the disease, feel more confident in dealing with difficult behaviors of the care recipient, and improve their ability to care for the care recipient. If validated in future studies, the intervention could be an accessible, on-demand resource for caregivers, enabling them to engage in moderated remote discussions with peers at their own convenience in terms of location, time of the day, and frequency.
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Affiliation(s)
| | | | - Frances Chu
- University of Washington, Seattle, WA, United States
| | - Andrew Teng
- University of Washington, Seattle, WA, United States
| | | | - Annie T Chen
- University of Washington, Seattle, WA, United States
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Zhou J, Wang D, Schlegel V, Zempleni J. Development of an internet based system for modeling biotin metabolism using Bayesian networks. Comput Methods Programs Biomed 2011; 104:254-9. [PMID: 21356565 PMCID: PMC3132571 DOI: 10.1016/j.cmpb.2011.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 02/04/2011] [Indexed: 05/30/2023]
Abstract
Biotin is an essential water-soluble vitamin crucial for maintaining normal body functions. The importance of biotin for human health has been under-appreciated but there is plenty of opportunity for future research with great importance for human health. Currently, carrying out predictions of biotin metabolism involves tedious manual manipulations. In this paper, we report the development of BiotinNet, an internet based program that uses Bayesian networks to integrate published data on various aspects of biotin metabolism. Users can provide a combination of values on the levels of biotin related metabolites to obtain the predictions on other metabolites that are not specified. As an inherent feature of Bayesian networks, the uncertainty of the prediction is also quantified and reported to the user. This program enables convenient in silico experiments regarding biotin metabolism, which can help researchers design future experiments while new data can be continuously incorporated.
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Affiliation(s)
- Jinglei Zhou
- Department of Statistics, University of Nebraska-Lincoln, Lincoln, NE 68583, USA
| | - Dong Wang
- Department of Statistics, University of Nebraska-Lincoln, Lincoln, NE 68583, USA, Tel: +1 4024724921 fax: +1 4024720736
| | - Vicki Schlegel
- Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, NE 68583, USA
| | - Janos Zempleni
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA
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