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Restoring and re-storying the possibility of recovery. 恢复和重新讲述复苏的可能性。
IF 64.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1016/s2215-0366(24)00283-9
James Downs
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引用次数: 0
Clinical symptoms and psychosocial functioning in patients with schizophrenia spectrum disorders testing seropositive for anti-NMDAR antibodies: a case-control comparison with patients testing negative. 抗 NMDAR 抗体血清检测呈阳性的精神分裂症谱系障碍患者的临床症状和社会心理功能:与检测呈阴性的患者进行病例对照比较。
IF 64.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1016/s2215-0366(24)00249-9
Jurjen J Luykx,Robbert Visscher,Inge Winter-van Rossum,Patrick Waters,Lot D de Witte,W Wolfgang Fleischhacker,Bochao Danae Lin,Nini de Boer,Marte van der Horst,Ksenija Yeeles,Michael Davidson,Thomas A Pollak,Alkomiet Hasan,Belinda R Lennox
BACKGROUNDAntibodies against the N-methyl-D-aspartate receptor (NMDAR) have been described in the serum of people with schizophrenia spectrum disorders (schizophrenia). However, the prevalence and clinical relevance of these antibodies in schizophrenia is unclear. This knowledge gap includes the possibility of such antibodies being associated with a distinct clinical profile, which in turn might warrant a distinct treatment approach. We aimed to assess the seroprevalence of anti-NMDAR antibodies in schizophrenia, and compare symptoms and psychosocial functioning between patients with schizophrenia who were seropositive and seronegative for these antibodies.METHODSIn this case-control comparison, by combining new and existing studies, we included patients diagnosed with schizophrenia from four independent cohorts for whom anti-NMDAR serostatus had been assessed (or could be assessed by us) with live cell-based assays. Included cohorts were from the EULAST study (a trial conducted across 15 European countries and Israel), the OPTiMiSE study (an interventional study in Europe), and the PPiP1 and PPiP2 studies (conducted in the UK). Patients from these cohorts were analysed if they had complete Positive and Negative Syndrome Scale (PANSS) data. No participant had been diagnosed with autoimmune encephalitis or received treatment for this condition. After calculating the prevalence of serum anti-NMDAR antibodies, we examined possible differences in PANSS scores (negative, positive, and general symptom subscales, and total score) between anti-NMDAR-seropositive and anti-NMDAR-seronegative patients. Psychosocial functioning as measured by Personal Social Performance (PSP) score was also compared. All analyses were exploratory and no adjustment was done for multiple testing. People with lived experience were not involved in the conduct of this study.FINDINGSWe collected individual patient data from 1114 patients with schizophrenia across the four cohorts. The study population had a mean age of 28·6 years (SD 7·6) and comprised 382 (34·3%) women and 732 (65·7%) men, including patients of White (929 [83·4%]), Asian (54 [4·8%]), Black (68 [6·1%]), and other (62 [5·6%]) ethnicities. Overall, 41 (3·7%) participants (range 3·1-4·0% across cohorts) tested positive for serum anti-NMDAR antibodies. Lower symptom severity on the negative symptoms PANSS subscale was observed for anti-NMDAR-seropositive patients (mean score 15·8 [SD 6·4]) than for anti-NMDAR-seronegative patients (18·2 [6·8]; Cohen's d=0·36; p=0·026), as well as on the general symptoms PANSS subscale (32·9 [8·9] vs 36·1 [10·1]; d=0·33; p=0·029) and total PANSS score (65·5 [18·5] vs 72·6 [19·3]; d=0·37; p=0·013). Mean PSP score was better in anti-NMDAR-positive patients (62·0 [17·0]) than in anti-NMDAR-negative patients (53·5 [16·3]; d=0·52; p=0·014).INTERPRETATIONSerum NMDAR antibodies are present in 3-4% of patients with schizophrenia and are associated with relatively low severity of negative sympt
背景在精神分裂症谱系障碍(精神分裂症)患者的血清中发现了针对N-甲基-D-天冬氨酸受体(NMDAR)的抗体。然而,这些抗体在精神分裂症中的流行程度和临床意义尚不清楚。这一知识空白包括这些抗体可能与不同的临床特征相关,从而可能需要不同的治疗方法。我们的目的是评估抗 NMDAR 抗体在精神分裂症中的血清流行率,并比较血清阳性和血清阴性精神分裂症患者的症状和社会心理功能。方法在这次病例对照比较中,我们结合了新的和现有的研究,纳入了来自四个独立队列的精神分裂症患者,这些患者的抗 NMDAR 血清状态已通过活细胞检测进行了评估(或我们可以进行评估)。纳入的队列来自 EULAST 研究(一项在 15 个欧洲国家和以色列进行的试验)、OPTiMiSE 研究(一项在欧洲进行的干预性研究)以及 PPiP1 和 PPiP2 研究(在英国进行)。如果这些队列中的患者有完整的阳性和阴性综合征量表(PANSS)数据,则对其进行分析。没有参与者被诊断患有自身免疫性脑炎或接受过相关治疗。在计算血清中抗 NMDAR 抗体的流行率后,我们研究了抗 NMDAR 血清阳性患者与抗 NMDAR 血清阴性患者在 PANSS 评分(阴性、阳性、一般症状分量表和总分)上可能存在的差异。此外,还比较了以个人社会表现(PSP)评分衡量的心理社会功能。所有分析均为探索性分析,未进行多重检验调整。我们收集了四个队列中 1114 名精神分裂症患者的个人数据。研究对象的平均年龄为 28-6 岁(SD 7-6),其中女性 382 人(34-3%),男性 732 人(65-7%),包括白人(929 [83-4%])、亚裔(54 [4-8%])、黑人(68 [6-1%])和其他种族(62 [5-6%])患者。总体而言,41 名参与者(3-7%)(各组群的范围为 3-1-4-0%)的血清抗 NMDAR 抗体检测呈阳性。在阴性症状 PANSS 分量表中,抗 NMDAR 血清阳性患者的症状严重程度(平均分 15-8 [SD 6-4])低于抗 NMDAR 阴性患者(18-2 [6-8];科恩氏 d=0-36;p=0-026),以及一般症状 PANSS 分量表(32-9 [8-9] vs 36-1 [10-1];d=0-33;p=0-029)和 PANSS 总分(65-5 [18-5] vs 72-6 [19-3];d=0-37;p=0-013)。抗 NMDAR 阳性患者的 PSP 平均得分(62-0 [17-0])优于抗 NMDAR 阴性患者(53-5 [16-3];d=0-52;p=0-014)。因此,尽管研究结果有待在其他地区的队列中复制,但血清中的抗 NMDAR 抗体可能与不同形式的精神病有关。这些发现可为未来的预后和干预研究提供参考,这些研究将探讨抗NMDAR抗体是否与特定病程或治疗反应有关。
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引用次数: 0
Conversion practice recall and mental health symptoms in sexual and gender minority adults in the USA: a cross-sectional study 美国性少数群体和性别少数群体成年人的转化实践回忆与心理健康症状:一项横断面研究
IF 64.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-30 DOI: 10.1016/s2215-0366(24)00251-7
Nguyen K Tran, Elle Lett, Barbara Cassese, Carl G Streed, David J Kinitz, Shalonda Ingram, Karalin Sprague, Zubin Dastur, Micah E Lubensky, Annesa Flentje, Juno Obedin-Maliver, Mitchell R Lunn
<h3>Background</h3>Conversion practices are associated with psychological morbidity, yet few studies have evaluated differences between efforts to change gender identity, sexual orientation, or both. We aimed to examine the individual and joint association of conversion practice recall targeted at gender identity or sexual orientation, or both, with current mental health symptoms among sexual and gender minority people.<h3>Methods</h3>This cross-sectional study used data from The PRIDE Study, a US-based, online, prospective cohort study of sexual and gender minority adults who were recruited through social media, digital advertisements, and sexual and gender minority community-based events and organisations. For this analysis, we included participants who completed a lifetime questionnaire in 2019–20 and a subsequent annual questionnaire in 2020–21 without missing outcome data. All questionnaires were in English. The exposure was lifetime recall of conversion practice targeting gender identity alone, sexual orientation alone, or both (versus no conversion practice). Mental health outcomes were continuous measures: Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item (depression) scale, Post-Traumatic Stress Disorder Checklist 6-item scale, and Suicide Behaviors Questionnaire–Revised scale. We used linear regression to analyse the associations of conversion practice recall and mental health symptoms, controlling for demographic and childhood factors and stratified between cisgender and transgender and gender diverse groups. Sensitivity analyses evaluated the potential impact of unmeasured confounding. Analyses were conducted in R. We included people with related lived experience in the design and implementation of this study.<h3>Findings</h3>Of 6601 participants who completed the lifetime questionnaire in 2019–20, 4440 completed the subsequent annual questionnaire in 2020 or 2021, and 4426 did not have missing outcome data. Of the 4426 included participants, 4073 (92·0%) identified as White (either alone or in combination with other ethnoracial options), 460 (10·4%) identified with multiple ethnoracial identities, and 1923 (43·4%) were transgender and gender diverse. Participants' age ranged from 18 years to 84 years (median 31·7 years, IQR 25·5–44·1). 149 (3·4%) participants reported sexual orientation-related conversion practice alone, 43 (1·0%) reported gender identity-related conversion practice alone, and 42 (1·0%) reported both. Recalling both forms of conversion practice was most strongly associated with greater post-traumatic stress disorder (PTSD; β 2·84, 95% CI 0·94–4·74) and suicidality (2·14, 0·95–3·32) symptoms. Recall of only sexual orientation-related conversion practice was associated with greater symptoms of PTSD (1·10, 0·22–1·98). Recall of gender identity-related conversion practice alone was most strongly associated with greater depressive symptoms (3·24, 1·03–5·46). Only associations for suicidality d
背景转换行为与心理发病率有关,但很少有研究对改变性别认同、性取向或两者的努力之间的差异进行评估。我们旨在研究针对性别认同或性取向或两者的转换行为回忆与性少数群体和性别少数群体当前心理健康症状的个体和联合关联。方法这项横断面研究使用了 "PRIDE研究 "的数据,该研究是一项基于美国的在线前瞻性队列研究,研究对象是通过社交媒体、数字广告以及性少数群体和性别少数群体社区活动和组织招募的性少数群体和性别少数群体成年人。在本次分析中,我们纳入了在 2019-20 年完成终生问卷调查的参与者,以及在 2020-21 年完成后续年度问卷调查且未遗漏结果数据的参与者。所有问卷均使用英语。调查对象在一生中回忆过仅针对性别认同、仅针对性取向或两者兼有的转换行为(相对于没有转换行为)。心理健康结果为连续测量:广泛性焦虑症 7 项量表、患者健康问卷 9 项(抑郁)量表、创伤后应激障碍清单 6 项量表和自杀行为问卷修订版量表。我们使用线性回归分析了转换实践回忆与心理健康症状之间的关联,同时控制了人口统计学和童年因素,并对顺性别群体、跨性别群体和性别多元化群体进行了分层。敏感性分析评估了未测量混杂因素的潜在影响。我们让有相关生活经验的人参与了本研究的设计和实施。研究结果在 2019-20 年完成终生问卷调查的 6601 名参与者中,有 4440 人在 2020 年或 2021 年完成了随后的年度问卷调查,有 4426 人没有缺失结果数据。在这 4426 名参与者中,有 4073 人(92-0%)被认定为白人(单独或与其他人种选项结合),460 人(10-4%)被认定为多重人种,1923 人(43-4%)是变性人和性别多元化者。参与者的年龄从 18 岁到 84 岁不等(中位数为 31-7 岁,IQR 为 25-5-44-1)。149(3-4%)名参与者仅报告了与性取向相关的转化实践,43(1-0%)名参与者仅报告了与性别认同相关的转化实践,42(1-0%)名参与者报告了两种形式的转化实践。回忆起这两种形式的皈依实践与创伤后应激障碍(PTSD;β 2-84, 95% CI 0-94-4-74)和自杀(2-14, 0-95-3-32)症状的加重有最密切的关系。只有回忆起与性取向相关的皈依实践,才会出现更多的创伤后应激障碍症状(1-10,0-22-1-98)。仅忆及与性别认同相关的皈依实践与抑郁症状加重的关系最为密切(3-24,1-03-5-46)。只有自杀倾向的相关性在顺性别者、跨性别者和性别多元化者之间存在差异,尽管后者总体上表现出更高的心理健康症状。在敏感性分析中,研究结果对潜在的未测量混杂因素具有适度的稳健性。这些研究结果支持禁止转换行为的呼吁,因为转换行为是心理健康的结构性决定因素。
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引用次数: 0
Conversion practices: looking back and moving forwards 转换实践:回顾过去,展望未来
IF 64.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-30 DOI: 10.1016/s2215-0366(24)00311-0
Jack Drescher
No Abstract
无摘要
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引用次数: 0
Suicidality should be considered for inclusion in the diagnostic criteria for PMDD. 应考虑将自杀纳入 PMDD 的诊断标准。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-19 DOI: 10.1016/S2215-0366(24)00288-8
Jennifer L Gordon, Sneha Chenji, Arianna Di Florio, Liisa Hantsoo, Sandi MacDonald, Jessica R Peters, Jaclyn M Ross, Katja Schmalenberger, Tory A Eisenlohr-Moul
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引用次数: 0
Optimising psychiatric care through pain management. 通过疼痛管理优化精神病护理。
IF 64.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-17 DOI: 10.1016/s2215-0366(24)00278-5
Nilson N Mendes Neto,Jessika M Mendes
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引用次数: 0
Competency-based training and supervision: development of the WHO-UNICEF Ensuring Quality in Psychosocial and Mental Health Care (EQUIP) initiative. 以能力为基础的培训和监督:世界卫生组织-联合国儿童基金会确保社会心理和精神保健质量(EQUIP)倡议的发展。
IF 64.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-06 DOI: 10.1016/s2215-0366(24)00183-4
Brandon A Kohrt,Gloria A Pedersen,Alison Schafer,Kenneth Carswell,Fiamma Rupp,Mark J D Jordans,Elise West,Josephine Akellot,Pamela Y Collins,Carmen Contreras,Jerome T Galea,Frezgi Gebrekristos,Muthoni Mathai,Kristina Metz,Naser Morina,Mwamba Mwila Mwenge,Frederik Steen,Ann Willhoite,Mark van Ommeren,James Underhill,
Globally, there has not been a standardised approach to ensure that the growing number of people who are not licensed clinicians but are delivering psychological interventions and mental health services have the competencies to deliver those interventions and services safely. Therefore, WHO and UNICEF developed Ensuring Quality in Psychosocial and Mental Health Care (EQUIP). EQUIP is a free resource with a digital platform that can be used to guide competency assessment. We describe EQUIP's 5-year development (2018-23) and the rationale supporting its contents and use. Development phases included establishing consensus for competency-based strategies; selecting foundational competencies; evaluating feasibility of assessments, role plays, and technology; piloting EQUIP when training non-specialists; and public dissemination and ongoing adaptations to increase scalability. From the public launch in March, 2022, through to March, 2024, EQUIP's digital platform has been used in 794 training programmes in 36 countries with 3760 trainees resulting in 10 001 competency assessments.
在全球范围内,还没有一种标准化的方法来确保越来越多没有执业资格但正在提供心理干预和心理健康服务的人员具备安全提供这些干预和服务的能力。因此,世卫组织和联合国儿童基金会开发了 "确保社会心理和心理健康护理质量"(EQUIP)。EQUIP 是一个免费资源,拥有一个数字平台,可用于指导能力评估。我们介绍了 EQUIP 的 5 年发展历程(2018-23 年)以及支持其内容和使用的理由。开发阶段包括就基于能力的策略达成共识;选择基础能力;评估评估、角色扮演和技术的可行性;在培训非专业人员时试用 EQUIP;以及公开传播和不断调整以提高可扩展性。从 2022 年 3 月公开发布到 2024 年 3 月,EQUIP 数字平台已在 36 个国家的 794 个培训项目中使用,受训人员达 3760 人,完成了 10 001 项能力评估。
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引用次数: 0
Cognitive and psychiatric symptom trajectories 2-3 years after hospital admission for COVID-19: a longitudinal, prospective cohort study in the UK. 因 COVID-19 入院 2-3 年后的认知和精神症状轨迹:英国的一项纵向前瞻性队列研究。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-01 Epub Date: 2024-07-31 DOI: 10.1016/S2215-0366(24)00214-1
Maxime Taquet, Zuzanna Skorniewska, Thomas De Deyn, Adam Hampshire, William R Trender, Peter J Hellyer, James D Chalmers, Ling-Pei Ho, Alex Horsley, Michael Marks, Krisnah Poinasamy, Betty Raman, Olivia C Leavy, Matthew Richardson, Omer Elneima, Hamish J C McAuley, Aarti Shikotra, Amisha Singapuri, Marco Sereno, Ruth M Saunders, Victoria C Harris, Natalie Rogers, Linzy Houchen-Wolloff, Neil J Greening, Parisa Mansoori, Ewen M Harrison, Annemarie B Docherty, Nazir I Lone, Jennifer Quint, Christopher E Brightling, Louise V Wain, Rachael A Evans, John R Geddes, Paul J Harrison

Background: COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning.

Methods: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK. In the C-Fog study, a subset of PHOSP-COVID participants who consented to be recontacted for other research were invited to complete a computerised cognitive assessment and clinical scales between 2 years and 3 years after hospital admission. Participants completed eight cognitive tasks, covering eight cognitive domains, from the Cognitron battery, in addition to the 9-item Patient Health Questionnaire for depression, the Generalised Anxiety Disorder 7-item scale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the 20-item Cognitive Change Index (CCI-20) questionnaire to assess subjective cognitive decline. We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2-3 years, and whether symptoms at 2-3 years were predicted by earlier aspects of COVID-19 illness. Participants completed an occupation change questionnaire to establish whether their occupation or working status had changed and, if so, why. We assessed which symptoms at 2-3 years were associated with occupation change. People with lived experience were involved in the study.

Findings: 2469 PHOSP-COVID participants were invited to participate in the C-Fog study, and 475 participants (191 [40·2%] females and 284 [59·8%] males; mean age 58·26 [SD 11·13] years) who were discharged from one of 83 hospitals provided data at the 2-3-year follow-up. Participants had worse cognitive scores than would be expected on the basis of their sociodemographic characteristics across all cognitive domains tested (average score 0·71 SD below the mean [IQR 0·16-1·04]; p<0·0001). Most participants reported at least mild depression (263 [74·5%] of 353), anxiety (189 [53·5%] of 353), fatigue (220 [62·3%] of 353), or subjective cognitive decline (184 [52·1%] of 353), and more than a fifth reported severe depression (79 [22·4%] of 353), fatigue (87 [24·6%] of 353), or subjective cognitive decline (88 [24·9%] of 353). Depression, anxiety, and fatigue were worse at 2-3 years than at 6 months or 12 months, with evidence of both worsening of existing symptoms and emergence of new symptoms. Symptoms at 2-3 years were not predicted by the severity of acute COVID-19 illness, but were strongly predicted by the degree of recovery

背景:众所周知,COVID-19 与疾病急性期后认知和精神疾病风险的增加有关。我们旨在评估这些症状是否会在 COVID-19 住院一年后出现或持续存在,确定 COVID-19 疾病的哪些早期症状可预测长期症状,并确定这些症状与职业功能的关系:COVID-19住院后研究(PHOSP-COVID)是一项前瞻性纵向队列研究,研究对象是在英国参与研究的国民健康服务医院中因临床诊断为COVID-19而住院的成年人(年龄≥18岁)。在C-Fog研究中,PHOSP-COVID参与者中同意因其他研究而再次联系的一部分人受邀在入院后2年至3年间完成计算机化认知评估和临床量表。除了 9 项抑郁患者健康问卷、7 项广泛焦虑症量表、慢性疾病治疗疲劳功能评估量表和 20 项认知变化指数 (CCI-20) 问卷外,参与者还完成了 Cognitron 电池中涵盖 8 个认知领域的 8 项认知任务,以评估主观认知能力的下降。我们评估了症状的绝对风险在 6 个月、12 个月和 2-3 年的随访期间是如何演变的,以及 2-3 年后的症状是否会受到 COVID-19 早期疾病的影响。参与者填写了一份职业变化问卷,以确定他们的职业或工作状态是否发生了变化,如果发生了变化,原因是什么。我们评估了 2-3 年后哪些症状与职业变化有关。研究结果:2469 名 PHOSP-COVID 参与者受邀参加了 C-Fog 研究,其中 475 名参与者(191 名 [40-2%] 女性和 284 名 [59-8%] 男性;平均年龄 58-26 [SD 11-13] 岁)从 83 家医院之一出院,并提供了 2-3 年的随访数据。在所有测试的认知领域中,参与者的认知得分低于根据其社会人口学特征所预期的得分(平均得分低于平均值 0-71 SD [IQR 0-16-1-04];p解释:入院后的头 2-3 年中,精神和认知症状似乎会增加,这既是由于 6 个月时已有症状的恶化,也是由于新症状的出现。新症状主要出现在 6 个月时已有其他症状的患者身上。因此,及早发现和处理症状可能是防止日后出现复杂综合征的有效策略。职业改变很常见,主要与客观和主观认知障碍有关。因此,需要采取干预措施来促进认知能力的恢复或预防认知能力的下降,以限制 COVID-19 对功能和经济的影响:国家健康与护理研究所牛津健康生物医学研究中心、沃尔夫森基金会、MQ心理健康研究中心、英国医学研究中心研究与创新部、国家健康与护理研究所。
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引用次数: 0
Neuropsychiatric and work outcomes after COVID-19 hospitalisation. COVID-19 住院后的神经精神和工作结果。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-01 Epub Date: 2024-07-31 DOI: 10.1016/S2215-0366(24)00250-5
Tracy D Vannorsdall, Esther S Oh, Ann M Parker
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引用次数: 0
Integrated mental health care could improve treatment of older hospital inpatients with complex health needs. 综合心理保健可以改善对有复杂健康需求的老年住院病人的治疗。
IF 30.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI: 10.1016/S2215-0366(24)00246-3
Wolfgang Söllner
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引用次数: 0
期刊
Lancet Psychiatry
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