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Development,validation and comparison of multivariable risk scores for prediction of total stroke and stroke types in Chinese adults:a prospective study of 0.5 million adults

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Stroke & Vascular Neurology 2022年第4期7卷 328-336,I0023-I0045页

作者： Matthew Chun Robert Clarke Tingting Zhu david clifton Derrick A Bennett Yiping Chen Yu Guo Pei Pei Jun Lv Canqing Yu Ling Yang Liming Li Zhengming Chen Benjamin J Cairns 无 Clinical Trial Service Unit and Epidemiological Studies Nuffield Department of Population HealthUniversity of OxfordOxfordUK Department of Engineering Science University of OxfordOxfordUK Department of Biomedical Engineering Oxford-Suzhou Centre for Advanced ResearchSuzhouChina Medical Research Council Health Research Unit Nuffield Department of Population HealthUniversity of OxfordOxfordUK CKB Project Department Fuwai Hospital Chinese Academy of Medical SciencesNational Center for Cardiovascular DiseasesBeijingChina CKB Project Department Chinese Academy of Medical SciencesBeijingChina Department of Epidemiology and Biostatistics School of Public HealthPeking UniversityBeijingChina Department of Epidemiology Peking University Center for Public Health and Epidemic Preparedness and ResponseBeijingChina On behalf of the China Kadoorie Biobank Collaborative Group

Background and purpose Low-income and middle-income countries have the greatest stroke burden,yet remain understudied.This study compared the utility of Framingham versus novel risk scores for prediction of total stroke and stroke types in Chinese adults.Methods China Kadoorie Biobank(CKB)is a prospective study of 512726 adults,aged 30-79 years,recruited from 10 areas in China in 2004-2008.By 1 January 2018,43234 incident first stroke cases(36310 ischaemic stroke(IS);8865 haemorrhagic stroke(HS))were recorded in 503842 participants with no history of stroke at baseline.We compared the predictive utility of the Framingham Stroke Risk Profile(FSRP)with novel CKB stroke risk scores and included recalibration,refitting,stratifying by study area and addition of other risk factors.Discrimination was assessed using area under the receiver operating characteristic curve(AUC)and calibration was assessed using Greenwood-Nam-D’Agostinoχ^(2) statistics.Results Incidence of total stroke varied fivefold by area in China.The FSRP had good discrimination for total stroke(AUC(95%CI);men:0.78(0.77 to 0.79),women:0.77(95%CI 0.76 to 0.78)),but poor calibration(χ^(2);men:1,825,women:3,053),substantially underestimating absolute risks.Recalibration reducedχ^(2) by>80%,but did not improve discrimination.Refitting the FSRP did not materially improve discrimination,but further improved calibration.Stratification by area improved discrimination(AUC;men:0.82(0.82 to 0.83);women:0.82(0.82 to 0.83)),but not calibration.Adding other risk factors yielded modest,but statistically significant,improvements in the AUCs.The findings for IS and HS were similar to those for total stroke.Conclusions The FSRP reliably differentiated Chinese adults with incident stroke,but substantially underestimated the absolute risks of stroke.Novel local risk prediction equations that took account of differences in stroke incidence within China enhanced risk prediction of total stroke and major stroke pathological types.

关键词： prediction income absolute

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Traumatic brain injury induced by exposure to blast overpressure via ear canal

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Neural Regeneration Research 2022年第1期17卷 115-121页

作者： Yang Ou Brad Aclifton Jinghui Li david Sandlin Na Li Li Wu Chunming Zhang Tianwen Chen Jun Huang Yue Yu Jerome Allison Fan Fan Richard JRoman James Shaffery Wu Zhou Yi Pang Hong Zhu Departmant of Otolaryngology and Head Neck Surgery Department of Neurobiology and Anatomical Sciences MD Program School of Medicine Graduate Program in Neuroscience Department of Pediatrics Department of Pharmacology and Toxicology Department of Psychiatry and Human Behavior University of Mississippi Medical CenterJacksonMSUSA Kunming Medical University KunmingYunnan ProvinceChina Department of Otolaryngology First Affiliated HospitalShanxi Medical UniversityTaiyuanShanxi ProvinceChina

Exposure to explosive shockwave often leads to blast-induced traumatic brain injury in military and civilian populations.Unprotected ears are most often damaged following exposure to blasts.Although there is an association between tympanic membrane perforation and TBI in blast exposure victims,little is known about how and to what extent blast energy is transmitted to the central nervous system via the external ear canal.The present study investigated whether exposure to blasts directed through the ear canal causes brain injury in LongEvans rats.Animals were exposed to a single blast(0–30 pounds per square inch(psi))through the ear canal,and brain injury was evaluated by histological and behavioral outcomes at multiple time-points.Blast exposure not only caused tympanic membrane perforation but also produced substantial neuropathological changes in the brain,including increased expression of c-Fos,induction of a profound chronic neuroinflammatory response,and apoptosis of neurons.The blast-induced injury was not limited only to the brainstem most proximal to the source of the blast,but also affected the forebrain including the hippocampus,amygdala and the habenula,which are all involved in cognitive functions.Indeed,the animals exhibited long-term neurological deficits,including signs of anxiety in open field tests 2 months following blast exposure,and impaired learning and memory in an 8-arm maze 12 months following blast exposure.These results suggest that the unprotected ear canal provides a locus for blast waves to cause TBI.This study was approved by the Institutional Animal Care and Use Committee at the University of Mississippi Medical Center(Animal protocol#0932 E,approval date:September 30,2016 and 0932 F,approval date:September 27,2019).

关键词： anxiety blast ear ear protection learning memory microglia neuroinflammation neuron rat traumatic brain injury

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购买和维护一套领先的分动器的技巧

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非开挖技术 2008年第6期25卷 14-15页

作者： david clifton 胡波（译）

本文简要介绍了水平定向钻进施工中的分动器结构原理，以及在优选及维护分动器需要注意的几个技术问题。

关键词：非开挖分动器优选

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A Dual-radiolabel Marker Quantifies Decrease in HT29 Xenograft Hypoxia Induced by Mild Temperature Hyperthermia

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2012年第2期1卷 32-39页

作者： Mutian Zhang Xiao-Feng Li Makiko Suehiro Zhihong Zhao david Gagne John Pizzonia Zhigang Zhang Gloria Li C. clifton Ling John L. Humm Department of Epidemiology & Biostatistics Memorial Sloan-Kettering Cancer Center New York USA Department of Medical Physics Memorial Sloan-Kettering Cancer Center New York USA Department of Radiation Oncology Memorial Sloan-Kettering Cancer Center New York USA Department of Radiation Oncology University of Nebraska Medical Center Omaha USA Life Sciences Group FUJIFILM Medical Systems USA Inc. Woodbridge USA Munroe-Meyer Institute University of Nebraska Medical Center Omaha USA

Purpose: In this project, we developed novel methods to quantify changes in tumor hypoxia following a mild tempera-ture hyperthermia (MTH) treatment in rat HT29 human colon adenocarcinoma xenograft. Materials and Methods: An exogenous hypoxia marker (IAZGP) was labeled with two radioisotopes of iodine (131I and 123I, respectively) to form two distinct tracers. The two tracers were injected into HT29-bearing nude rats 4-hour before and immediately following 41.5℃, 45-minute mild hyperthermia treatment. The distributions of the two hypoxia tracers were obtained by performing digital autoradiography on tumor sections, and image processing resulted in quantitative information at 50 μm pixel size. Results: Following the hyperthermia treatment, there was a remarkable decrease in hypoxia tracer binding. The average whole tumor hypoxia tracer targeted fraction in five animals changed from 30.3% ± 9.7% to 13.0% ± 5.3% after the hyperthermia treatment (P = 0.001). Detailed pixelby-pixel analysis of the image data revealed a decline in hypoxia tracer uptake after hyperthermia in most regions. However, there was concomitant emergence of some new regions of hypoxia identified by increased tracer uptake. In the control group, the overall hypoxia tracer targeted fraction remained almost constant, with some hypoxic tracer redistribution (putative acute hypoxia) observed. Conclusion: Reoxygenation occurred in the rat HT29 xenograft following MTH treatment. This was evident with preponderance of decreased hypoxia specific tracer uptake on tumor sections. Our methodology might be a useful tool in hypoxia study.

关键词： Digital Autoradiography IAZGP Imaging Plate Mild Temperature Hyperthermia Tumor Hypoxi

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Population assessment and habitat associations of the Visayan Hornbill(Penelopides panini)in Northwest Panay,Philippines

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Avian Research 2021年第4期12卷 612-622页

作者： Holly Isabelle Mynott david Charles Lee Rhea Aranas Santillan Christian Jürgen Schwarz Benjamin Tacud Arcel Dryden Fernandez Daphne Kerhoas Bristol Zoological Society Bristol Zoo GardensCollege RoadCliftonBristol BS83HAUK School of Applied Sciences University of South WalesAlfred Russel Wallace BuildingUpper Glyntaff CampusPontypridd CF374BBUK PhilinCon L.A.Dioso Memorial Public LibraryIloilo-Antique Road5712 PandanPhilippines PhilinCon Germany Ruhr-Universität BochumUniversitätsstraße 150ND 1/3144801 BochumGermany

Background:Seven out of ten hornbill species in the Philippines are threatened with extinction.Among these is the endangered Visayan Hornbill(Penelopides panini),found on the islands of Panay and Negros.Threatened by habitat loss and hunting,its population size is thought to have declined from 1800 individuals 20 years ago to less than 1000.However,a recent study on Negros estimated 3564 individuals across three core forest blocks.This study aims to quantify the Visayan Hornbill population size in and around the Northwest Panay Peninsula Natural Park(NWPPNP)on Panay,the largest contiguous low-elevation forest landscape remaining across its range,and its broad habitat associations across a gradient of environmental degradation.Methods:Hornbills were surveyed using 10-min distance sampling point counts(n=367)along transects(average length 1.1 km).Environmental variables were recorded along transects,while habitat was classified into primary forest,secondary forest,plantation,or open habitat.Distance software was used to estimate population densities stratified by habitat,with the overall population estimate taken as a mean of habitat density estimates weighted by habitat area.Using generalized linear mixed models,hornbill occurrence was modelled using combinations of nine environmental variables as main and two-way fixed effects.Results:Surveys covered 204.4 km^(2) of the 374.8 km^(2) Northwest Panay Peninsula.Hornbills were not recorded in plantations or open habitats.Hornbill density was significantly higher in primary forest(17.8 individuals/km~2±26.9%CV)than in secondary forest(3.7 individuals/km^(2)±33.2%CV;z=15.212,P<0.001).The overall population estimate for the NWPPNP and environs is 2109 individuals,and 2673 individuals for the entire Northwest Panay Peninsula.Hornbill presence was best explained by a model including distance from the Park boundary alongside five interaction effects and transect as a random effect.Distance,and the interaction between distance and medium-sized trees were significant predict

关键词： Distance sampling Endangered species GLMM Hornbill Point count Population size Protected area

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Development of a Functional Assessment of Chronic Illness Therapy item library and primary symptom list for the assessment of patient-reported adverse events associated with immune checkpoint modulators

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Journal of Cancer Metastasis and Treatment 2020年第1期6卷 74-87页

作者： Kimberly A.Webster Mary L.O’Connor Aaron R.Hansen Sheetal Kircher Heather S.L.Jim Adam P.Dicker Monika Janda Kari Ala-leppilampi clifton O.Bingham III Josephine Feliciano Norah Lynn Henry Laurie E.Steffen McLouth david Cella Department of Medical Social Sciences Northwestern University Feinberg School of MedicineChicagoIL 60611USA Princess Margaret Cancer Center University Health NetworkToronto M5G 1Z5Canada Robert H Lurie Comprehensive Cancer Center Northwestern UniversityChicagoIL 60611USA Department of Health Outcomes and Behavior Moffitt Cancer CenterTampaFL 33612USA Department of Radiation Oncology Sidney Kimmel Medical College and Cancer Center at Thomas Jefferson UniversityPhiladelphiaPA 19107USA Centre for Health Services Research The University of QueenslandQLD 4102Australia Applied Health Research Centre Li Ka Shing Knowledge InstituteSt Michael’s HospitalToronto M5B 1W8Canada Divisions of Rheumatology and Allergy and Clinical Immunology Johns Hopkins UniversityBaltimoreMD 21224USA Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center BaltimoreMD 21231USA University of Michigan Rogel Cancer Center Ann ArborMI 48109USA Department of Behavioral Science Center for Health Equity Transformation and Markey Cancer CenterUniversity of Kentucky College of MedicineLexingtonKY 40536USA

Aim:To develop a comprehensive item library of patient-reported,immunotherapy-related adverse events(irAEs)that draws from and expands on the Functional Assessment of Chronic Illness Therapy(FACIT)Measurement System.Methods:Literature review and iterative expert input.Based on a literature review of irAEs,we developed a framework of immunotherapy classes and their associated symptoms.Clinical experts then reviewed iterations of symptom summaries and item maps linked to the immunotherapy framework.Experts provided content review and feedback was shared across experts until consensus was reached.The iterative process facilitated creation of a Primary Symptom List associated with immune checkpoint modulators(ICMs),drawn from the larger set of symptoms.Existing FACIT items were mapped to the symptom list,and new items were written as needed to create the item library.Results:The full item library of irAEs is comprised of 239 items,covering 142 unique symptoms across 75 inflammatory reactions/immune conditions.A subset of 66 items comprises a Primary Symptom List considered most common/relevant to ICM treatment.This includes gastrointestinal,skin,pulmonary,neurologic,musculoskeletal,and multiple miscellaneous and constitutional symptoms.Conclusion:The FACIT Immunotherapy Item Library is a compilation of 239 self-report items that capture the wide range of AEs experienced by people receiving immune treatments.A subset of 66 items comprises a Primary Symptom List meant for ICM therapy.Use of items selected from this library is encouraged in clinical research and clinical practice evaluation.

关键词： Immunotherapy immune checkpoint modulators quality of life immune-related adverse events patient reported outcomes cancer oncology

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Treatment-Plan Comparison of Three Advanced Radiation Treatment Modalities for Fractionated Stereotactic Radiotherapy to the Head and Neck

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2019年第2期8卷 106-120页

作者： He Wang James N. Yang Xiaodong Zhang Jing Li Steven J. Frank Zhongxiang Zhao Dershan Luo Xiaorong Zhu Congjun Wang Samuel Tung Adam S. Garden david I. Rosenthal clifton david Fuller Gary Brandon Gunn Amol J. Ghia Jay P. Reddy Shaan M. Raza Franco De Monte Mark S. Chambers Paul D. Brown Shirley Su Jack Phan Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX USA Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston TX USA Department of Neurosurgery The University of Texas MD Anderson Cancer Center Houston TX USA Department of Oncologic Dentistry Prosthodontics Thoracic/Head &Neck Surgery The University of Texas MD Anderson Cancer Center Houston TX USA Department of Radiation Oncology The Mayo Clinic Rochester MN USA

Purpose: Fractionated stereotactic radiosurgery (FSRS) can be given with at least three modalities: Gamma Knife, with the noninvasive frameless extend system (GKE);linear accelerator-based volumetric modulated arc therapy (VMAT);and intensity-modulated proton therapy (IMPT). We extracted treatment plans for patients who had received FSRS with GKE for recurrent skull base or intracranial tumors, created corresponding plans for VMAT and IMPT, and compared the quality of the three sets of plans. Methods and materials: Plans were extracted for 9 patients with recurrent malignant skull-base tumors (n = 6) or large intracranial tumors (n = 3) who had received FSRS with GKE (median dose 24 Gy in 3 fractions) in 2013 through 2015. Plans for VMAT were generated with a TrueBeam STx LINAC machine using 6-MV photons, and plans for IMPT were generated with multi-field optimization. The optimized VMAT and IMPT plans were normalized to achieve the best possible target coverage while meeting the same dose-volume constraints on organs at risk (OARs) as the GKE plans. Plans were evaluated on the basis of target coverage, conformity index, homogeneity index, gradient index, and treatment efficiency. Results: The median target volume was 10.2 cm3 (range 1.9 - 33.8 cm3). The VMAT and IMPT plans met all OAR constraints, and target coverage and conformity were comparable among all plans. VMAT and IMPT plans showed significantly better target uniformity and treatment delivery efficiency (P P Conclusion: FSRS for skull base and large intracranial lesions delivered by VMAT and IMPT can achieve comparable target coverage, conformity, and sparing of critical structure as the GKE while providing superior target uniformity and treatment delivery efficiency. The GKE had superior high-dose gradients outside the target and thus better protected surrounding normal structures.

关键词： Gamma Knife Extend System Stereotactic Radiosurgery Volumetric Modulated Arc Therapy Intensity-Modulated Proton Therapy Spot Scanning Proton Therapy

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乳清蛋白对于2型糖尿病患者胃排空速率,血糖水平及肠促胰素分泌的影响

乳清蛋白对于2型糖尿病患者胃排空速率,血糖水平及肠促胰素分泌的...

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中华医学会第十一次全国内分泌学学术会议

作者：麻静 david R Jesudason Antonietta Russo,Julie E Stevens Jennifer Keogh Judith M Wishart Karen L Jones Peter M clifton Michael Horowitz Christopher K Rayner 上海市仁济医院 Centre of Clinical Research Excellence in Nutritional Physiology Interventions and OutcomesUniversity of AdelaideAdelaideAustralia Endocrine & Metabolic Unit Royal Adelaide HospitalAdelaideAustralia

目的:进食高碳水化合物之前,单次给予2型糖尿病患者少量的乳清蛋白可减慢胃排空速率,刺激肠促胰素分泌从而降低餐后血糖水平。然而长期乳清蛋白摄入是否会造成小肠对于胃排空速率的反馈抑制及肠促胰素的分泌发生适应性的改变尚不清楚。...

目的:进食高碳水化合物之前,单次给予2型糖尿病患者少量的乳清蛋白可减慢胃排空速率,刺激肠促胰素分泌从而降低餐后血糖水平。然而长期乳清蛋白摄入是否会造成小肠对于胃排空速率的反馈抑制及肠促胰素的分泌发生适应性的改变尚不清楚。此项研究目的在于评价2型糖尿病患者口服小量乳清蛋白4周对于胃排空速率,血糖水平及肠促胰素的分泌的影响。

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The Cellulolytic Bacteria <i>R. albus</i>for Improving the Efficiency of Microbial Fuel Cell

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Journal of Sustainable Bioenergy Systems 2018年第2期8卷 36-46页

作者： Rebecca Chung Diane J. Moon Yoo Na Chang david S. Chung Taekwon Kong Justin Kim Centreville High School Clifton VA USA The Gwinnett School of Mathematics Science and Technology Lawrenceville GA USA Korean Minjok Leadership Academy Gangwon-do Korea School of Arts and Sciences Brown University Providence RI USA Department of Chemistry College of Arts & Sciences Washington University St. Louis MO USA School of Art & Sciences University of Pennsylvania Philadelphia PA USA

The current study has been undertaken to examine the beneficial effect in the power output of a microbial fuel cell (MFC) by adding cellulolytic bacteria Ruminococcus albus (R. albus) into the anodic chamber. Mediator-less H-type MFCs were set up where the anode chamber contained anaerobic digester microorganisms as inocula on finely ground pine tree (Avicel) at 2% (w/v) and the cathode chamber of 10mM phosphate buffered saline conductive solution, both separated by a cation exchange membrane. The functioning of the MFCs for generation of electrical power and the amounts of gaseous byproducts was monitored over a 9-day period. The addition of cellulolytic bacteria caused an increase of average power density from 7.9 m W/m2 to19.5 m W/m2, about 245% increase over a 9-day period. For both groups of MFCs;with R. albus and the control, the head space gases collected were methane and CO2. While the methane: CO2 ratios were found unchanged at 1.7:1 throughout the 9 days of operation, the total gas production increased from 248 mL to 319 mL due to the presence of R. albus addition. This study confirms that whereas the biocatalytic activity of anode microbial population determines the energy production, the addition of external cellulolytic bacteria into anode microbial population can improve and extend the biomass utilization.

关键词： Microbial Fuel Cell (MFC) Cellulolytic Bacteria Microorganism R. albus

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2010年类风湿关节炎分类标准——美国风湿病学会和欧洲抗风湿病联盟的联合倡议

2010年类风湿关节炎分类标准——美国风湿病学会和欧洲抗风湿病联...

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贵州省医学会风湿病学分会第四届学术年会

作者： Daniel Aletaha Tuhina Neogi Alan J Silman Julia Funovits david T Felson clifton O Bingham Ⅲ Neal S Birnbaum Gerd R Burmester Vivian P Bykerk Marc D Cohen Bernard Combe Karen H Costenbader Maxime Dougados Paul Emery Gianfranco Ferraccioli Johanna MW Hazes Kathryn Hobbs Tom WJ Huizinga Arthur Kavanaugh Jonathan Kay Tore K Kvien Timothy Laing Philip Mease Henri A Menard Larry W Moreland Raymond L Naden Theodore Pincus Josef S Smolen Ewa Stanislawska-Biernat Deborah Symmons Paul P Tak Katherine S Upchurch Jiri Vencovsky Frederick Wolfe Gillian Hawker 季兰岚邓雪蓉赵明田真张卓莉 Medical University of Vienna ViennaAustria Boston University School of Medicine BostonMassachusettsUSA

目的 :在早期类风湿关节炎(rheumatoid arthritis,RA)的诊断中,1987年美国风湿病学会(AmericanCollege of Rheumatology,ACR;旧称AmericanRheumatism Association,ARA)的诊断标准因为缺乏敏感度而受到质疑。本研究的目的是建立新的RA分类标准。方法 :由ACR和欧洲抗风湿病联盟(EuropeanLeague Against Rheumatism,EULAR)共同组成的工作小组,分三个阶段建立RA新的分类标准。研究的目标人群是初发的未分化关节炎患者,主要研究目的是寻找能够预测这些病人发展为RA的危险因素,并将RA疾病特点定义为持续性和/或侵蚀性关节炎。结果 :在新的分类标准中,确诊RA至少需要一个关节有明确的滑膜炎表现,除外其他可能导致滑膜炎症的疾病,同时以下四项评分的总分≥6分(最高10分):受累关节的数量和部位(0-5分)、血清学自身抗体异常(0-3分)、急性期反应物升高(0-1分)和症状持续时间(共分两级;0-1分)。结论 :既往诊断RA比较依赖骨破坏这一RA晚期表现,而新的分类标准着重于疾病早期表现而不是晚期特点,将疾病特点重新定义为持续性和/或侵蚀性滑膜炎。这一新标准的推出将再次强调了RA早期诊断的必要性以及早期有效治疗对于预防或减少不良后遗症的发生具有重要意义。

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