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Navigational Note: - Psychosis Mild psychotic signs Moderate psychotic Severe psychotic symptoms Life-threatening Death signs (e. Navigational Note: Also think about Investigations: Creatinine increased Bladder perforation - Invasive intervention not Invasive intervention Life-threatening Death indicated indicated penalties; organ failure; urgent operative intervention indicated Definition: A disorder characterised by a rupture within the bladder wall. Navigational Note: - Bladder spasm Intervention not indicated Antispasmodics indicated Hospitalization indicated - - Definition: A dysfunction characterized by a sudden and involuntary contraction of the bladder wall. Navigational Note: - Dysuria Present - - - - Definition: A dysfunction characterised by painful urination. For grades larger than Grade 1, think about Renal and urinary problems: Bladder spasm or Cystitis noninfective; Infections and infestations: Urinary tract an infection. Glucosuria Present - - - - Definition: A disorder characterised by laboratory take a look at outcomes that indicate glucose within the urine. Navigational Note: - Hemoglobinuria Asymptomatic; clinical or - - - - diagnostic observations only; intervention not indicated Definition: A disorder characterized by laboratory take a look at results that indicate the presence of free hemoglobin within the urine. Navigational Note: - Proteinuria 1+ proteinuria; urinary Adult: 2+ and three+ proteinuria; Adult: Urinary protein >=3. Navigational Note: - Renal hemorrhage Mild signs; intervention Analgesics and hematocrit Transfusion indicated; Life-threatening Death not indicated monitoring indicated invasive intervention penalties; pressing indicated; hospitalization intervention indicated Definition: A dysfunction characterised by bleeding from the kidney. Navigational Note: - Urinary fistula - Symptomatic, invasive Invasive intervention Life-threatening Death intervention not indicated indicated penalties; urgent invasive intervention indicated Definition: A dysfunction characterised by an abnormal communication between any part of the urinary system and another organ or anatomic site. Navigational Note: - Urinary retention Urinary, suprapubic or Placement of urinary, Elective invasive intervention Life-threatening Death intermittent catheter suprapubic or intermittent indicated; substantial lack of penalties; organ failure; placement not indicated; in a position catheter placement indicated; affected kidney operate or urgent operative intervention to void with some residual medication indicated mass indicated Definition: A dysfunction characterized by accumulation of urine inside the bladder due to the inability to urinate. Navigational Note: - Urine discoloration Present - - - - Definition: A disorder characterized by a change within the colour of the urine. Navigational Note: - Azoospermia - Absence of sperm in ejaculate - - - Definition: A disorder characterized by laboratory check results that point out complete absence of spermatozoa in the semen. Navigational Note: - Breast atrophy Minimal asymmetry; minimal Moderate asymmetry; Asymmetry >1/3 of breast - - atrophy moderate atrophy volume; severe atrophy Definition: A disorder characterised by underdevelopment of the breast. Navigational Note: - Dyspareunia Mild discomfort or pain Moderate discomfort or ache Severe discomfort or pain - - associated with vaginal associated with vaginal related to vaginal penetration; discomfort penetration; discomfort or penetration; discomfort or relieved with use of vaginal ache partially relieved with pain unrelieved by vaginal lubricants or estrogen use of vaginal lubricants or lubricants or estrogen estrogen Definition: A disorder characterised by painful or difficult coitus. Navigational Note: - Ejaculation dysfunction Diminished ejaculation Anejaculation or retrograde - - - ejaculation Definition: A dysfunction characterized by problems related to ejaculation. Navigational Note: - Fallopian tube obstruction Asymptomatic; scientific or Symptomatic; elective Severe signs; invasive - - diagnostic observations only; intervention indicated intervention indicated intervention not indicated Definition: A disorder characterised by blockage of the conventional flow of the contents in the fallopian tube. Navigational Note: - Feminization acquired Mild signs; intervention Moderate symptoms; medical - - - not indicated intervention indicated Definition: A dysfunction characterized by the development of secondary female intercourse characteristics in males because of extrinsic elements. Navigational Note: - Hematosalpinx Minimal bleeding identified Moderate bleeding; medical Transfusion indicated; Life-threatening Death on imaging study or intervention indicated invasive intervention consequences; urgent laparoscopy; intervention not indicated operative intervention indicated indicated Definition: A disorder characterized by the presence of blood in a fallopian tube. Navigational Note: Also think about Reproductive system and breast disorders: Premature menopause, Amenorrhea.
Source: Eurostat Demo_pjan a) Starting 12 months 1991 erectile dysfunction treatment penile implants purchase 100mg avanafil with visa, b) Starting yr 1994 At the other finish of the age spectrum only Latvia and Lithuania have proven a decrease within the over 80 12 months olds, the remainder of the nations are seeing fairly marked increases (as an example Portugal, Spain and Liechtenstein all having over 90% increase on this age group). From the information obtainable from Eurostat nations similar to Cyprus, Luxembourg and Ireland are set to have big increases of their male population (above forty five%), whereas many of the Eastern European countries (and Italy) are anticipated to see their male population fall by over 20%. Current general inhabitants structure for the nations included in this report present the largest number of men are in the forty-44 12 months age band (see Fig. There remain giant variations on this pattern throughout Europe, with some countries showing fairly marked reductions in their youthful inhabitants and these are primarily from Eastern Europe with others showing a progress, for example Cyprus, Luxembourg and Ireland, which additionally show a 5 fold enhance within the over eighty age group. Source: Eurostat proj_08c2150p The adjustments within the population construction for the following 50 years could be followed in Fig. Source: Eurostat Demo_pjan This picture adjustments markedly when the age dependency ratio is calculated for these countries which have inhabitants predictions done for 2060 (Fig. Here we will see that in all the nations the variety of over sixty five yr old males far outnumber the 1-14 12 months olds as a share of the whole population. The largest reductions might be seen within the Eastern European international locations, which can add an extra burden on their rising economies. From the out there knowledge it can be seen that Ireland and Iceland have male stay delivery rates above 15 per 1,000 inhabitants as in comparison with Germany with 8 per 1000 population (Fig. The majority of those men are likely to have decrease educational attainment and to be economically inactive. However one other group is males who left house to go to college and have needed to return home through lack of ability to find work. A Flash Eurobarometer report (2007) found that the commonest purpose for young folks staying at house was as a result of an inability to afford to move out and a lack of reasonably priced housing. In contrast a further research on men and women�s timing for leaving home found a stronger affect on the dynamics within the household house and the academic level and social standing of the dad and mom had a larger affect (Blaauboer et al. Decreasing levels of parental support and being extra romantically energetic have also been found to be sturdy indicators of when a toddler might go away the house (Seiffge-Krenke, 2010). The rate of divorce over the past ten years has continued an upward development within the majority of nations across Europe, with Spain seeing the most important increase (see Fig. This has been advised as being a consequence of less close relationships between older individuals who have experienced divorce and their grownup children (Glaser et al. Men�s participation at deliveries and in toddler care 60 is a revolution in males�s behaviour, in gender relations, and in males�s relations with their kids. Among the European nations the variety of fathers who take parental depart continues to be low however contemplating the truth that cultural norms and stereotypical gender roles have existed for lots of of years, the variety of males taking an energetic parental function can also be seen as relatively excessive. Men�s collaborating on the deliveries of their kids has become typically common in a number of European countries (Madsen & Munck, 2001). The Nordic nations are in entrance of European fathers taking parental depart due to a few years of gender equality cultures and to father quotas in a number of the Nordic countries and different incentives to engage men. Around 80 p.c fathers in the Nordic international locations take parental go away (Madsen, 2009). At the identical time the majority of males desire a caring and household-pleasant improvement both in the workplace and at home (Holter, 2003).
A randomized, multicenter, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the remedy of alcohol dependence. Efficacy and security of naltrexone and acamprosate in the remedy of alcohol dependence: A systematic review. The efficacy of acamprosate and naltrexone in the therapy of alcohol dependence: a relative advantages analysis of randomized managed trials. Naltrexone for the therapy of alcoholism: a meta-analysis of randomized controlled trials. Opioid antagonists within the treatment of alcohol dependence: scientific efficacy and prevention of relapse. Efficacy and tolerability of lengthy-appearing injectable naltrexone for alcohol dependence: a randomized controlled trial. Predicting remedy response to naltrexone: the affect of craving and household history. Clinical predictors of response to naltrexone in alcoholic patients: who advantages most from therapy with naltrexone? Pharmacological enhancement of naltrexone remedy for opioid dependence: a evaluation. Acamprosate: a evaluate of its use within the maintenance of abstinence in sufferers with alcohol dependence. Acamprosate for therapy of alcohol dependence: mechanisms, efficacy, and medical utility. Predictors of acamprosate efficacy: outcomes from a pooled analysis of seven European trials including 1,485 alcohol-dependent patients. Effect of oral acamprosate on abstinence in sufferers with alcohol dependence in a double-blind, placebo-controlled trial: the function of affected person motivation. The efficacy of acamprosate in the upkeep of abstinence in alcohol-dependent individuals: outcomes of a meta-evaluation. Opioid detoxification and naltrexone induction methods: Recommendations for medical apply. Naltrexone: Extended-launch injectable suspension for therapy of alcoholism dependence. Department of Justice, Drug Enforcement Agency, Office of Diversion Control Web Site. Two-yr expertise with buprenorphine/naloxone (Suboxone) for upkeep therapy of opioid dependence within a private follow setting. Aim: To present an outline and suggestions concerning endocrinologic control of sexual want and arousal and erection and their disturbances. Methods: Medical literature was reviewed by the subcommittee of the International Consultation of Sexual Medicine, followed by extensive internal dialogue, after which public presentation and discussion with different specialists.
Loss of variation is indicative for autonomic less dependable erectile dysfunction market order avanafil 50mg visa, because they concurrently measure neuropathy, presuming absence of confounding fac-- a sequence of events or reactions involving receptors, tors similar to cardiac arrhythmia, nicotine, or caffeine small ibers, and target organs. Confounding components use earlier than testing, treatment (especially antihyper-- similar to treatment, caffeine, temperature, hypo- tensives), hypo, or hypervolemia, and dysfunction of and hypervolemia, psychological mood, and receptor or baroreceptors or target organs [a hundred and fifty]. Basic questions relating to the signal and parasympathetic nerve methods, as within the pelvic recorded, and the way to interpret it, are still unresolved. Moreover, Thus, despite some clinical use this take a look at should be re-- efferent autonomic function tests contain the evalu-- garded as experimental [152-159]. Radioisotopic penography assesses standardised, therefore reproducibility, validity and the speed of washout of a radioisotope from the penis comparability of test outcomes between laboratories following pharmacotesting or visual erotic stimula-- are dificult. Clinical indications are lumbar used and accepted take a look at in urology was given a disc disorders, pelvic anatomical lesions, pelvic sur-- score of 2B on the proof obtainable, and was gery and so on[one hundred forty four]. It must be noted that these tion velocity along the sensory pathways from the four widely used checks may be carried out alone, or genital region to the sensory cerebral cortex [147]. Improvements Thermal threshold measurements yield data on in diagnostic accuracy or reliability with mixed the conductance of small sensory nerve ibres and testing has not been systematically investigated due to this fact could relect indirectly the function of the overall, and accordingly was not reviewed by this penile efferent (motoric) nerve ibers. The scale should have at minimum Finally, latest proposals have been made for rou-- an proof-based score of Grade B or C for consid-- tine use of Endothelial Dysfunction testing, both eration in scientific or analysis settings. Several of the by way of forearm occlusion strategies or easy ofice scales and questionnaires the committee reviewed recording methods (EndoPat) for assessing endo-- are able to meet this commonplace. Whenever potential, the temporal affiliation or causal relationship between the signs should C. Therefore the usage of self-administered primarily based; and (iii) psychometric validation studies in symptom scales has turn into essential in clinical re-- both patient and non-patient groups [164]. Typically, search in sexual drugs, and has been applied ex-- no less than two quantitative validation studies are re-- tensively in on a regular basis scientific follow in lots of settings. For query-- tionnaires are essential in sexual drugs not solely naires that are designed to function diagnostic 50 Comittee 06. In widespread with all psychometric and validated, self-report measures of sexual satis-- scales or instruments, the two fundamental and nec-- faction or quality of life (e. Reliability satisfaction and others are directed at psychosocial refers to the consistency or replicability of information, with outcomes of therapy (e. It is reliability �coeficients� serving as formal indicators necessary to make distinctions between the concep-- of measurement consistency. These have to be re-- tual focus or theoretical rationale for each of these ported with every scale or questionnaire, and will consequence measures, along with the psychometric include both check-retest and inter-merchandise reliabilities. These Each of these aspects of reliability may be deter-- measures differ additionally in the diploma to which they mined using commonplace psychometric measures (e. Unlike reliabil-- phrases of: (i) the conceptual focus of the measure; ity, which is established through a speciic, rigor-- (ii) qualitative and quantitative psychometrics; (iii) ously prescribed sequence of statistical exercises, the extent of clinical use; (iv) overall suggestions. Nunnally cent guidelines have emphasized the necessity for these [163] has likened the validation course of to �..
Diseases
Moreover, the ventral and female) heterosexual topics to relatively striatum was discovered to be the principle region related to brief 4s-shows of erotic (nude people sexual pleasure throughout groups and stimuli [51]. In between sexual depth, common emotional arousal, not one of the apriori deined areas did ladies have and valence. This suggests of refined experimental designs to get nearer that in heterosexual women the amygdala, and to the heart of sexual arousal. It is fascinating that similar sexual behavioral Sexual arousal has a definite quality, which ought to output, i. Likewise, a large in men this historic system is extra tuned in the direction of vary of duties activate the anterior cingulate cortex, sexual cues. These activations consciously, reliably activated the male amygdala are hallmarks of visually-induced emotional states, [54]. The the extrastriate visual areas, the inferior parietal distinction between erotic and impartial pictures resulted lobule, the anterior cingulate cortex, and the ventral in a big cluster of activation within the extrastriate striatum. However, only the ventral striatum could be visual areas and the inferior parietal lobule, as well convincingly linked to female sexual arousal [51,52]. Blue voxels indi-- cate signiicant regions for the conjunction of the contrasts [bodily>non-bodily-emotional pictures] and [non-bodily- emotional>non-bodily neutral footage] at p<zero. Activa-- tion distinction for the couples stimuli versus ixation (a�c) and the couples stimuli versus neutral contrast (d�f) (P < 0. The proper hemi-- sphere is on the right of the coronal photographs and bottom of the axial images. Right, axial view (z = �16) of the identical distinction, displaying extra right cerebellar ctivation. Right, axial view (z = �20) of the same cont- trast, exhibiting primarily left-sided amygdala activation. An overview of the experimental tasks that A main concern is that seemingly reverse emotional had been carried out is given in igure 8. Recent neuroimaging studies in men point out that this location may not be correct, and that the Georgiadis et al. They included 12 healthy heterosexual positioned in the inferior parietal lobule, serves a spread volunteers whose male companions manually carried out of higher stage sensory modalities [60,sixty one]. The location of the section relative to the midline is indi-- cated in the backside right cor-- ner of every part (negative worth for x, left hemisphere). Bar graphs in the prime right nook of each part indi-- cate how the response within the centre of signiicant mind clusters various in the course of the 4 situations. This aver-- age signal change for every parameter relative to the imply normalised activition over all scans is expressed as a proportion. With permission from [fifty six] [sixty two,63], or non-erotic stimulation of the penis [59,64]. Clinical indings hedonic experience, because it becomes activated with of temporal lobe lesions causing hypersexuality growing satiation and subjective pleasantness, [67], and temporal lobe epilepsy-associated sexual and deactivated with emotions of satiety [78,seventy nine]. This swap in amygdala levels signiicantly decide sexual behavioral exercise may be crucial for sexual encounters to take end result.
Considering that psychoanalysis interact with each other in successful sexually intimate methods, and that can traditionally take a few years, refraining from any sexual actions most sexual issues end result from an absence of schooling or misconceptions while undergoing therapy may be notably difcult for shoppers to about sexuality. Social psychology analysis that was being carried out in the Nineteen Seventies Post-psychoanalytic contributions to sex therapy had demonstrated that perspective, feelings, and habits are all intently linked and that a change in any certainly one of these is more likely to initiate a change Kinsey exposed the various sexual actions of �regular� men in the others [16]. Terefore, by altering the habits related to (1948) and girls (1953), in a time where there was no organic typical sexual encounters, people may develop more positive understanding of sexual urges or physiological processes concerned in attitudes towards sexual experiences. Te laboratory-based research of Masters efort to alter a consumer�s perspective or �sexual worth system�; a change and Johnson that burgeoned within the late 1960�s, complimented Kinsey�s in attitude is seen as a by-product of the change in behavior [16]. Researchers corresponding to Kinsey, and Masters and mixture of these brief and solution-centered methods was most Johnson got down to study the sexual habits of typical folks, however efective [5,19]. Terefore, it soon turned clear that there was a must defne most efective psychotherapy of this time. One of the most commonly used behavioral methods in intercourse By the 1970�s the Sexual Revolution was in full swing, bringing with remedy is that of systematic desensitization. In this system, the it a surge of clientele who were keen to enhance and even good their sexual relationships [thirteen]. Many believed that sexual gratifcation was therapist and client work together, creating a list of hysteria scary out there to all people if only they sought course to realize the sexual experiences. Te client is led right into a relaxed state using deep about the way to enrich their sexual lives [1]. Te 1970�s turned a time for muscle relaxation or pharmaceutical treatment, and the stimuli are then the development and fourishing of many forms of sex therapy. Te bond Conceptualization of sexual disorder: Afer establishing the between these responses is then weakened and the anxious response parts of the �normal� sexual response cycle, Masters and Johnson associated with sexual stimuli is finally extinguished [20]. Typically laid the muse for modern intercourse therapy with the publication of their book Human Sexual Inadequacy [15]. Te use of imaginal emphasis on cognitive and behavioral approaches to psychotherapy publicity somewhat than in vivo publicity can really be extra efective, that proved to be of much shorter therapeutic length than conventional as a result of imaginal exposure is performed in the therapist�s ofce underneath analytic approaches [8,13]. Emphasis was placed on the non-organic his or her supervision, whereas in vivo exposure happens within the residence, in factors current in the development of sexual dysfunction. Furthermore, the act of receiving instructions from the Common sexual dysfunctions have been classifed based on deviations therapist frees the client from any negative ideas or moral judgments from the �regular� sexual response cycle [14] and included erectile that they may have toward themselves [22]. Instead, the person is dysfunction, untimely ejaculation, pain related to intercourse considered as being a �good� and compliant patient. Te improvement of sexual issues was presupposed to intercourse, he may be instructed to have interaction only in sensual activities occur as a result of sexual encounters are regarded as anxiety provoking that don�t require an erection. While anxiety addressed in psychoanalysis originated instructions, his anxiety is alleviated. Masters and apply, which is ofen employed at the side of other behavioral Johnson thought of the underlying trigger of one�s nervousness as largely methods. Tis was a elementary change from Terefore, the patient is able to be taught that sensual experiences may be the traditional psychoanalytic orientations which viewed humans gratifying with out the fixed pressure to �perform�.
Smoking shortens that smoking interferes with the effectiveness of sure life way over most other threat factors for early mortal- therapies for rheumatoid arthritis (Chapter 10). Smoking cessation by forty years of age reduces that loss reproductive results are now discovered to be attributable to roughly ninety%. However, reduc- the embryo implants in the Fallopian tube or elsewhere ing the number of cigarettes smoked per day is way much less outdoors the uterus. Ectopic being pregnant may be very rarely a sur- efficient than quitting completely for avoiding the dangers of vivable condition for the fetus and is a probably fatal untimely death from all smoking-related causes of death. This report fnds that mater- Much of this 50th anniversary Surgeon General�s nal smoking throughout early pregnancy is causal for orofa- report is devoted to inspecting proof on the myriad cial clefts in infants, and proof suggests that smoking well being effects, avoidable diseases, and all-trigger mortal- might be related to certain other start defects. The macula is probably the most sensitive a part of the retina and is the a part of the eye that provides sharp vision. The evidence is suffcient to deduce that nicotine acti- not seem for 20 or extra years after smoking cessation. The proof is suffcient to deduce that nicotine expo- Prostate Cancer certain throughout fetal improvement, a critical window for 1. The proof is suggestive of no causal relationship brain improvement, has lasting antagonistic penalties between smoking and the risk of incident prostate for mind improvement. The evidence is suggestive of a higher danger of demise adversely affects maternal and fetal well being dur- from prostate most cancers in smokers than in nonsmokers. The evidence is suggestive that nicotine exposure much less-properly-differentiated cancer in people who smoke than in during adolescence, a crucial window for mind devel- nonsmokers, and�impartial of stage and histo- opment, might have lasting adverse consequences for logic grade�the next threat of illness progression. The proof is inadequate to deduce the presence or absence of a causal relationship between publicity to 1. The proof is suggestive but not suffcient to infer Chapter 6: Cancer a causal relationship between tobacco smoke and breast most cancers. The evidence is suggestive however not suffcient to infer of developing adenocarcinoma of the lung from ciga- a causal relationship between lively smoking and rette smoking has elevated for the reason that Nineteen Sixties. The evidence is suggestive but not suffcient to infer a increased threat of adenocarcinoma of the lung in causal relationship between exposure to secondhand smokers outcomes from adjustments in the design and com- tobacco smoke and breast most cancers. In cancer patients and survivors, the proof is suf- carcinoma follows the pattern of declining smoking fcient to infer a causal relationship between cigarette prevalence. In most cancers patients and survivors, the proof is suf- ship between smoking and hepatocellular carcinoma. The evidence is suffcient to infer a causal relation- ship between smoking and colorectal adenomatous polyps and colorectal most cancers. In cancer patients and survivors, the evidence is sug- Tuberculosis gestive but not suffcient to infer a causal relation- 1. The evidence is suffcient to infer a causal relation- ship between cigarette smoking and (1) the risk of ship between smoking and an elevated danger of Myco- recurrence, (2) poorer response to remedy, and (3) bacterium tuberculosis disease. The proof is suffcient to deduce a causal relationship between smoking and mortality due to tuberculosis. The evidence is suggestive of a causal relationship Chronic Obstructive Pulmonary Disease between smoking and the danger of recurrent tubercu- losis disease.
The line ought to correspond with the corona, just below the head of the penis (Fig. Some uncircumcised males have a really lax foreskin, which is partially retracted in the resting place. Surgical procedures for adults and adolescents Chapter 5-15 Male circumcision underneath native anaesthesia Version 3. Surgical procedures for adults and adolescents Chapter 5-16 Male circumcision underneath local anaesthesia Version three. All three methods produce an excellent lengthy-term outcome, however require different levels of skill. The sleeve method produces an excellent end result, however requires the highest level of surgical ability. In scientific trials it has been proven to provide constantly good results with low complication charges. At present, devices similar to those used for paediatric circumcision (see Chapter 6) are either not obtainable or not suitable for adult circumcision. It can be utilized in clinics with restricted sources, and it can be carried out without an assistant. Grasp the foreskin on the three o�clock and 9 o�clock positions with two artery forceps. Place these forceps on the pure apex of the foreskin, in such a method as to put equal rigidity on the inside and outdoors surfaces of the foreskin. Put enough rigidity on the foreskin to drag the previously made mark to simply beyond the glans. Taking care not to catch the glans, apply a long straight forceps across the foreskin, just proximal to the mark, with the lengthy axis of the forceps going from the 6 o�clock to the 12 o�clock place (taking the frenulum as the 6 o�clock position). Surgical procedures for adults and adolescents Chapter 5-17 Male circumcision under local anaesthesia Version 3. Using a scalpel, reduce away the foreskin flush with the outer aspect of the forceps. The forceps protects the glans from injury, but nonetheless, particular care is required at this stage. Take care to catch the blood vessels as precisely as possible and with minimal adjacent tissue. When dealing with bleeding in the frenular space or on the underside of the penis, care have to be taken to not injure the urethra. Surgical procedures for adults and adolescents Chapter 5-18 Male circumcision underneath native anaesthesia Version 3. Surgical procedures for adults and adolescents Chapter 5-19 Male circumcision underneath native anaesthesia Version three.
Treslott, 34 years: These cells are present in high density in the epithelium of the inner foreskin, and are close to the floor because the layer of 18, 19 keratin is thin.
Khabir, 26 years: The distinction between the charges of improved erection in participants allocated to trimix plus sodium bicarbonate versus trimix alone was not statistically vital (78.
Zuben, 22 years: Acamprosate is supplied as identified particular traits that might 7 predict which patients would profit most from enteric-coated 333 mg tablets.
Amul, 60 years: A examine by Wilson et al (1999) assessed system survival before and after the November 1992 design modification; estimates of proportions of devices freed from mechanical failure at five years had been seventy five.
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