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Journal ArticleDOI

Constructing constructs for psychopathology: the NIMH research domain criteria.

01 Aug 2013-Journal of Abnormal Psychology (J Abnorm Psychol)-Vol. 122, Iss: 3, pp 928-937
TL;DR: A description of the impetus for the U.S. National Institute of Mental Health's (NIMH) Research Domain Criteria (RDoC) initiative is described and an update of progress on that initiative to date is provided.
Abstract: As a commentary for the special section on Reconceptualizing the Classification of Mental Disorders, this article begins with a description of the impetus for the U.S. National Institute of Mental Health's (NIMH) Research Domain Criteria (RDoC) initiative and provides an update of progress on that initiative to date. The commentary then engages the articles in this special section, beginning with a response to Berenbaum's concern that the RDoC approach to sorting constructs across multiple units of analysis espouses a de facto biological fundamentalism. This leads us to delineate the relationship between RDoC and the NIMH priorities relevant to this initiative. The commentary then considers how Patrick's iterative "construct-network" method can be applied to RDoC construct validation, highlighting several aspects that are particularly useful. One aspect of this work involves determining subject inclusion and exclusion criteria that provide an appropriate range of variance. Finally, this commentary considers the Bilder group's article, explicating the ways in which multilevel models can foster development of hypotheses and informatics approaches needed for further RDoC progress.
Citations
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Journal ArticleDOI
TL;DR: The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies and provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response.
Abstract: The reliability and validity of traditional taxonomies are limited by arbitrary boundaries between psychopathology and normality, often unclear boundaries between disorders, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. These taxonomies went beyond evidence available on the structure of psychopathology and were shaped by a variety of other considerations, which may explain the aforementioned shortcomings. The Hierarchical Taxonomy Of Psychopathology (HiTOP) model has emerged as a research effort to address these problems. It constructs psychopathological syndromes and their components/subtypes based on the observed covariation of symptoms, grouping related symptoms together and thus reducing heterogeneity. It also combines co-occurring syndromes into spectra, thereby mapping out comorbidity. Moreover, it characterizes these phenomena dimensionally, which addresses boundary problems and diagnostic instability. Here, we review the development of the HiTOP and the relevant evidence. The new classification already covers most forms of psychopathology. Dimensional measures have been developed to assess many of the identified components, syndromes, and spectra. Several domains of this model are ready for clinical and research applications. The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies. It also provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response. This can greatly improve the utility of the diagnosis of mental disorders. The new classification remains a work in progress. However, it is developing rapidly and is poised to advance mental health research and care significantly as the relevant science matures. (PsycINFO Database Record

1,635 citations


Cites background from "Constructing constructs for psychop..."

  • ...However, the RDoC framework is concerned with basic biological processes (e.g., neural circuits) as much as with pathological behavior, and seeks to link animal and human research, thus largely focusing on constructs that apply across species (Cuthbert & Kozak, 2013)....

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Journal ArticleDOI
TL;DR: A meta-analysis aimed at determining the polysomnographic characteristics of several mental disorders found sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders, and comorbidity was associated with enhanced REM sleep pressure.
Abstract: Investigating sleep in mental disorders has the potential to reveal both disorder-specific and transdiagnostic psychophysiological mechanisms. This meta-analysis aimed at determining the polysomnographic (PSG) characteristics of several mental disorders. Relevant studies were searched through standard strategies. Controlled PSG studies evaluating sleep in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, attention-deficit-hyperactivity disorder (ADHD), and schizophrenia were included. PSG variables of sleep continuity, depth, and architecture, as well as rapid-eye movement (REM) sleep were considered. Calculations were performed with the "Comprehensive Meta-Analysis" and "R" software. Using random effects modeling, for each disorder and each variable, a separate meta-analysis was conducted if at least 3 studies were available for calculation of effect sizes as standardized means (Hedges' g). Sources of variability, that is, sex, age, and mental disorders comorbidity, were evaluated in subgroup analyses. Sleep alterations were evidenced in all disorders, with the exception of ADHD and seasonal affective disorders. Sleep continuity problems were observed in most mental disorders. Sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders. Comorbidity was associated with enhanced REM sleep pressure and more inhibition of sleep depth. No sleep parameter was exclusively altered in 1 condition; however, no 2 conditions shared the same PSG profile. Sleep continuity disturbances imply a transdiagnostic imbalance in the arousal system likely representing a basic dimension of mental health. Sleep depth and REM variables might play a key role in psychiatric comorbidity processes. Constellations of sleep alterations may define distinct disorders better than alterations in 1 single variable. (PsycINFO Database Record

544 citations

Journal ArticleDOI
TL;DR: A number of theoretical and methodological issues that can arise in connection with the nature of RDoC constructs are highlighted: subjectivism and heterophenomenology, desynchrony and theoretical neutrality among units of analysis, theoretical reductionism, endophenotypes, biomarkers, neural circuits, construct "grain size," and analytic challenges.
Abstract: This article describes the National Institute of Mental Health's Research Domain Criteria (RDoC) initiative. The description includes background, rationale, goals, and the way the initiative has been developed and organized. The central RDoC concepts are summarized and the current matrix of constructs that have been vetted by workshops of extramural scientists is depicted. A number of theoretical and methodological issues that can arise in connection with the nature of RDoC constructs are highlighted: subjectivism and heterophenomenology, desynchrony and theoretical neutrality among units of analysis, theoretical reductionism, endophenotypes, biomarkers, neural circuits, construct “grain size,” and analytic challenges. The importance of linking RDoC constructs to psychiatric clinical problems is discussed. Some pragmatics of incorporating RDoC concepts into applications for NIMH research funding are considered, including sampling design.

473 citations

Journal ArticleDOI
01 Mar 2016-eLife
TL;DR: Using large-scale online assessment of psychiatric symptoms and neurocognitive performance in two independent general-population samples, it was found that deficits in goal-directed control were most strongly associated with a symptom dimension comprising compulsive behavior and intrusive thought.
Abstract: Prominent theories suggest that compulsive behaviors, characteristic of obsessive-compulsive disorder and addiction, are driven by shared deficits in goal-directed control, which confers vulnerability for developing rigid habits. However, recent studies have shown that deficient goal-directed control accompanies several disorders, including those without an obvious compulsive element. Reasoning that this lack of clinical specificity might reflect broader issues with psychiatric diagnostic categories, we investigated whether a dimensional approach would better delineate the clinical manifestations of goal-directed deficits. Using large-scale online assessment of psychiatric symptoms and neurocognitive performance in two independent general-population samples, we found that deficits in goal-directed control were most strongly associated with a symptom dimension comprising compulsive behavior and intrusive thought. This association was highly specific when compared to other non-compulsive aspects of psychopathology. These data showcase a powerful new methodology and highlight the potential of a dimensional, biologically-grounded approach to psychiatry research.

375 citations

Journal ArticleDOI
TL;DR: This causal taxonomy implies the need for changes in strategies for studying the etiology, psychobiology, prevention, and treatment of psychopathology, and provides a novel framework for understanding the heterogeneity of each first-order dimension.
Abstract: We propose a taxonomy of psychopathology based on patterns of shared causal influences identified in a review of multivariate behavior genetic studies that distinguish genetic and environmental influences that are either common to multiple dimensions of psychopathology or unique to each dimension. At the phenotypic level, first-order dimensions are defined by correlations among symptoms; correlations among first-order dimensions similarly define higher-order domains (e.g., internalizing or externalizing psychopathology). We hypothesize that the robust phenotypic correlations among first-order dimensions reflect a hierarchy of increasingly specific etiologic influences. Some nonspecific etiologic factors increase risk for all first-order dimensions of psychopathology to varying degrees through a general factor of psychopathology. Other nonspecific etiologic factors increase risk only for all first-order dimensions within a more specific higher-order domain. Furthermore, each first-order dimension has its own unique causal influences. Genetic and environmental influences common to family members tend to be nonspecific, whereas environmental influences unique to each individual are more dimension-specific. We posit that these causal influences on psychopathology are moderated by sex and developmental processes. This causal taxonomy also provides a novel framework for understanding the heterogeneity of each first-order dimension: Different persons exhibiting similar symptoms may be influenced by different combinations of etiologic influences from each of the 3 levels of the etiologic hierarchy. Furthermore, we relate the proposed causal taxonomy to transdimensional psychobiological processes, which also impact the heterogeneity of each psychopathology dimension. This causal taxonomy implies the need for changes in strategies for studying the etiology, psychobiology, prevention, and treatment of psychopathology. (PsycINFO Database Record

311 citations


Cites background or result from "Constructing constructs for psychop..."

  • ...[PubMed: 16769298] Huang YY, Kotov R, de Girolamo G, Preti A, Angermeyer M, Benjet C, … Kessler RC. DSM-IV personality disorders in the WHO World Mental Health Surveys....

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  • ...A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript Institute of Mental Health (Cuthbert & Kozak, 2013; Insel et al., 2010; Sanislow et al., 2010)....

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  • ...Transdimensional Dispositions and the Causal Heterogeneity of Psychopathology There are fundamental similarities between the present causal taxonomy and key tenets of the NIMH RDoC initiative (Cuthbert & Kozak, 2013; Insel et al., 2010; Sanislow et al., 2010)....

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  • ...[PubMed: 10883720] Bijl RV, Ravelli A, van Zessen G. Prevalence of psychiatric disorder in the general population: Results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS)....

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  • ...Functional disability and quality of life decrements in mental disorders: Results from the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH)....

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References
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Journal ArticleDOI
TL;DR: An issue concerning the criteria for tic disorders is highlighted, and how this might affect classification of dyskinesias in psychotic spectrum disorders.
Abstract: Given the recent attention to movement abnormalities in psychosis spectrum disorders (e.g., prodromal/high-risk syndromes, schizophrenia) (Mittal et al., 2008; Pappa and Dazzan, 2009), and an ongoing discussion pertaining to revisions of the Diagnostic and Statistical Manuel of Mental Disorders (DSM) for the upcoming 5th edition, we would like to take this opportunity to highlight an issue concerning the criteria for tic disorders, and how this might affect classification of dyskinesias in psychotic spectrum disorders. Rapid, non-rhythmic, abnormal movements can appear in psychosis spectrum disorders, as well as in a host of commonly co-occurring conditions, including Tourette’s Syndrome and Transient Tic Disorder (Kerbeshian et al., 2009). Confusion can arise when it becomes necessary to determine whether an observed movement (e.g., a sudden head jerk) represents a spontaneous dyskinesia (i.e., spontaneous transient chorea, athetosis, dystonia, ballismus involving muscle groups of the arms, legs, trunk, face, and/or neck) or a tic (i.e., stereotypic or patterned movements defined by the relationship to voluntary movement, acute and chronic time course, and sensory urges). Indeed, dyskinetic movements such as dystonia (i.e., sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions) closely resemble tics in a patterned appearance, and may only be visually discernable by attending to timing differences (Gilbert, 2006). When turning to the current DSM-IV TR for clarification, the description reads: “Tic Disorders must be distinguished from other types of abnormal movements that may accompany general medical conditions (e.g., Huntington’s disease, stroke, Lesch-Nyhan syndrome, Wilson’s disease, Sydenham’s chorea, multiple sclerosis, postviral encephalitis, head injury) and from abnormal movements that are due to the direct effects of a substance (e.g., a neuroleptic medication)”. However, as it is written, it is unclear if psychosis falls under one such exclusionary medical disorder. The “direct effects of a substance” criteria, referencing neuroleptic medications, further contributes to the uncertainty around this issue. As a result, ruling-out or differentiating tics in psychosis spectrum disorders is at best, a murky endeavor. Historically, the advent of antipsychotic medication in the 1950s has contributed to the confusion about movement signs in psychiatric populations. Because neuroleptic medications produce characteristic movement disorder in some patients (i.e. extrapyramidal side effects), drug-induced movement disturbances have been the focus of research attention in psychotic disorders. However, accumulating data have documented that spontaneous dyskinesias, including choreoathetodic movements, can occur in medication naive adults with schizophrenia spectrum disorders (Pappa and Dazzan, 2009), as well as healthy first-degree relatives of chronically ill schizophrenia patients (McCreadie et al., 2003). Taken together, this suggests that movement abnormalities may reflect pathogenic processes underlying some psychotic disorders (Mittal et al., 2008; Pappa and Dazzan, 2009). More specifically, because spontaneous hyperkinetic movements are believed to reflect abnormal striatal dopamine activity (DeLong and Wichmann, 2007), and dysfunction in this same circuit is also proposed to contribute to psychosis, it is possible that spontaneous dyskinesias serve as an outward manifestation of circuit dysfunction underlying some schizophrenia-spectrum symptoms (Walker, 1994). Further, because these movements precede the clinical onset of psychotic symptoms, sometimes occurring in early childhood (Walker, 1994), and may steadily increase during adolescence among populations at high-risk for schizophrenia (Mittal et al., 2008), observable dyskinesias could reflect a susceptibility that later interacts with environmental and neurodevelopmental factors, in the genesis of psychosis. In adolescents who meet criteria for a prodromal syndrome (i.e., the period preceding formal onset of psychotic disorders characterized by subtle attenuated positive symptoms coupled with a decline in functioning), there is sometimes a history of childhood conditions which are also characterized by suppressible tics or tic like movements (Niendam et al., 2009). On the other hand, differentiating between tics and dyskinesias has also complicated research on childhood disorders such as Tourette syndrome (Kompoliti and Goetz, 1998; Gilbert, 2006). We propose consideration of more explicit and operationalized criteria for differentiating tics and dyskinesias, based on empirically derived understanding of neural mechanisms. Further, revisions of the DSM should allow for the possibility that movement abnormalities might reflect neuropathologic processes underlying the etiology of psychosis for a subgroup of patients. Psychotic disorders might also be included among the medical disorders that are considered a rule-out for tics. Related to this, the reliability of movement assessment needs to be improved, and this may require more training for mental health professionals in movement symptoms. Although standardized assessment of movement and neurological abnormalities is common in research settings, it has been proposed that an examination of neuromotor signs should figure in the assessment of any patient, and be as much a part of the patient assessment as the mental state examination (Picchioni and Dazzan, 2009). To this end it is important for researchers and clinicians to be aware of differentiating characteristics for these two classes of abnormal movement. For example, tics tend to be more complex than myoclonic twitches, and less flowing than choreoathetodic movements (Kompoliti and Goetz, 1998). Patients with tics often describe a sensory premonition or urge to perform a tic, and the ability to postpone tics at the cost of rising inner tension (Gilbert, 2006). For example, one study showed that patients with tic disorders could accurately distinguish tics from other movement abnormalities based on the subjective experience of some voluntary control of tics (Lang, 1991). Another differentiating factor derives from the relationship of the movement in question to other voluntary movements. Tics in one body area rarely occur during purposeful and voluntary movements in that same body area whereas dyskinesia are often exacerbated by voluntary movement (Gilbert, 2006). Finally, it is noteworthy that tics wax and wane in frequency and intensity and migrate in location over time, often becoming more complex and peaking between the ages of 9 and 14 years (Gilbert, 2006). In the case of dyskinesias among youth at-risk for psychosis, there is evidence that the movements tend to increase in severity and frequency as the individual approaches the mean age of conversion to schizophrenia spectrum disorders (Mittal et al., 2008). As revisions to the DSM are currently underway in preparation for the new edition (DSM V), we encourage greater attention to the important, though often subtle, distinctions among subtypes of movement abnormalities and their association with psychiatric syndromes.

67,017 citations

Journal ArticleDOI
TL;DR: In this paper, it was shown that people are sometimes unaware of the existence of a stimulus that influenced a response, unaware of its existence, and unaware that the stimulus has affected the response.
Abstract: Evidence is reviewed which suggests that there may be little or no direct introspective access to higher order cognitive processes. Subjects are sometimes (a) unaware of the existence of a stimulus that importantly influenced a response, (b) unaware of the existence of the response, and (c) unaware that the stimulus has affected the response. It is proposed that when people attempt to report on their cognitive processes, that is, on the processes mediating the effects of a stimulus on a response, they do not do so on the basis of any true introspection. Instead, their reports are based on a priori, implicit causal theories, or judgments about the extent to which a particular stimulus is a plausible cause of a given response. This suggests that though people may not be able to observe directly their cognitive processes, they will sometimes be able to report accurately about them. Accurate reports will occur when influential stimuli are salient and are plausible causes of the responses they produce, and will not occur when stimuli are not salient or are not plausible causes.

10,186 citations


"Constructing constructs for psychop..." refers background in this paper

  • ...Notwithstanding oft-cited limitations of self-report measures (Nisbett & Wilson, 1977), such measures are not necessarily less valid or less useful than measures in other domains (Haeffel & Howard, 2010)....

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Journal ArticleDOI

7,863 citations


"Constructing constructs for psychop..." refers background in this paper

  • ...Classification can then proceed from accurate observations to some rationale, such as formal similarity or association in nature, for defining categories. Arguably, thoughts and feelings are not observable, and so must be inferred (for a contrasting view, see Dretske, 1999, 2000). Traditionally, great weight has been accorded in psychopathology to self-reports of thoughts and feelings, and such reported experiences have often been considered as “primary” phenomena to be explained. An alternative view (e.g., Kozak & Miller, 1982; Miller & Kozak, 1993) to this subjectivism is that self-reported experiences have the logical status of fallible hypotheses about function. That is to say that experiential claims constitute a kind of “folk” psychology of the self that, as such, should be neither assumed veridical nor simply discounted. (For a similar but more developed account see Daniel Dennett’s “heterophenomenology” in Consciousness Explained, 1991.) In citing Kozak and Miller’s article, Berenbaum might seem to acknowledge their agnostic view of the veridicality of reports of experience, but his interest in classifying thoughts and feelings leaves ambiguity about his own position. From the RDoC perspective, one would seek neither to explain nor classify selfreported thoughts or feelings, but rather, one might use the selfreports to inform hypotheses about psychobiological mechanisms (constructs) that in turn would be subject to convergent validation, via multiple levels of analysis, to explain some narrowly defined problem behavior. Ultimately, if the RDoC initiative proves successful, psychobiological mechanisms might usurp the telltale role of self-reported experiences in a renovated diagnostic system. A problem with this tidy formulation of reports of experiences as fallible hypotheses about function arises if self-report is the only available indicator of a clinical problem, such as a putative delusion, hallucination, or feeling of shame, or if self-report data provide resolution that is simply unavailable from other indicators. Subjective interpretations, regardless of their fallibility, can contribute to a subject’s functioning, and self-report is often the most efficient way, if not the only way, to discover these interpretations. In other words, meaning matters, and the language of self-report can code nuances of meaning with fine resolution. Mostly, it is not self-reports themselves (observable behavior) that are psychiatric problems, but rather, the unobservable thoughts or feelings to which they are supposed to refer, and any related ill-motivated behavior. If one does not adopt an expedient working assumption of the veridicality of self-reports, and there are no available converging measures from different levels of analysis, then one forsakes capacity to study various important problems. Although the RDoC approach provides no elegant solution to this puzzle, in pure form, it would nonetheless avoid taking self-reports as veridical. However, unless or until more resolved construct ascertainment becomes available, the study of certain kinds of psychiatric clinical problems will continue to require expedient but scientifically awkward presumptions about the referents of self-reports. In sum, however, Berenbaum is right in supposing that research that relies exclusively on self-report data would fall outside of RDoC approach. The fact that RDoC constructs necessarily involve biological measures should not be taken to imply that self-report measures alone have no validity or utility. Notwithstanding oft-cited limitations of self-report measures (Nisbett & Wilson, 1977), such measures are not necessarily less valid or less useful than measures in other domains (Haeffel & Howard, 2010). In fact, they have routinely been found more useful for predicting psychiatric problems (e.g., Chapman, Chapman, & Raulin, 1976; Haeffel et al., 2008; Kwapil, 1998) than any available biological measure. Furthermore, the predictive utility of self-reports need not depend upon presumed veridicality. In other words, subjective perception of a situation can sometimes be a better predictor of a person’s functioning in that situation than objective measurement of the situation itself (Cotton, 1980). The explanatory role of self-reports in psychopathology is reminiscent of Dennett’s (1978) construal of the role of intentional constructs in psychological explanation....

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  • ...Research in psychopathology has increasingly identified problems with the current diagnostic system, as embodied in the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000) and the mental and behavioral disorders section of the International Classification of Diseases (ICD; World Health Organization, 2007). The structure of these systems was developed during the 1970s to deal with a troubling lack of reliability in assigning diagnoses, which threatened the credibility of psychiatry as a medical specialty. The product arrived in the form of the DSM–III (1980), which threw out most of the old system based on psychodynamic assumptions about etiology....

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  • ...Research in psychopathology has increasingly identified problems with the current diagnostic system, as embodied in the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000) and the mental and behavioral disorders section of the International Classification of Diseases (ICD; World Health Organization, 2007)....

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Journal ArticleDOI

5,173 citations


"Constructing constructs for psychop..." refers background or methods in this paper

  • ...For Berenbaum, a crucial issue is the view that “the RDoC framework conceptualized mental illnesses as brain disorders” (Insel et al., 2010, p. 749)....

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  • ...Detailed descriptions of the process and structure of the RDoC project are available elsewhere so need not be covered here in detail (e.g., Insel et al., 2010; Sanislow et al., 2010; Morris & Cuthbert, 2012)....

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Journal ArticleDOI
TL;DR: A meta-analysis of a liability spectrum model of comorbidity is presented, in which specific mental disorders are understood as manifestations of latent liability factors that explain comorbridity by virtue of their impact on multiple disorders.
Abstract: Comorbidity has presented a persistent puzzle for psychopathology research. We review recent literature indicating that the puzzle of comorbidity is being solved by research fitting explicit quantitative models to data on comorbidity. We present a meta-analysis of a liability spectrum model of comorbidity, in which specific mental disorders are understood as manifestations of latent liability factors that explain comorbidity by virtue of their impact on multiple disorders. Nosological, structural, etiological, and psychological aspects of this liability spectrum approach to understanding comorbidity are discussed.

1,010 citations


"Constructing constructs for psychop..." refers background in this paper

  • ...…that affect relationships between systems—for example, the correlation of “fear” and “distress” disorders in structural models of internalizing (e.g., Krueger & Markon, 2006), or recent reports of neuroplasticity resulting from interactions between prefrontal cortex and mesolimbic dopamine…...

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