Publications by authors named "Geir Smedslund"

45 Publications

Effects of a mindfulness-based and acceptance-based group programme followed by physical activity for patients with fibromyalgia: a randomised controlled trial.

BMJ Open 2021 06 29;11(6):e046943. Epub 2021 Jun 29.

Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway.

Introduction: Non-pharmacological approaches are recommended as first-line treatment for patients with fibromyalgia. This randomised controlled trial investigated the effects of a multicomponent rehabilitation programme for patients with recently diagnosed fibromyalgia in primary and secondary healthcare.

Methods: Patients with widespread pain ≥3 months were referred to rheumatologists for diagnostic clarification and assessment of study eligibility. Inclusion criteria were age 20-50 years, engaged in work or studies at present or during the past 2 years, and fibromyalgia diagnosed according to the American College of Rheumatology 2010 criteria. All eligible patients participated in a short patient education programme before inclusion and randomisation. The multicomponent programme, a 10-session mindfulness-based and acceptance-based group programme followed by 12 weeks of physical activity counselling was evaluated in comparison with treatment as usual, that is, no treatment or any other treatment of their choice. The primary outcome was the Patient Global Impression of Change (PGIC). Secondary outcomes were self-reported pain, fatigue, sleep quality, psychological distress, physical activity, health-related quality of life and work ability at 12-month follow-up.

Results: In total, 170 patients were randomised, 1:1, intervention:control. Overall, the multicomponent rehabilitation programme was not more effective than treatment as usual; 13% in the intervention group and 8% in the control group reported clinically relevant improvement in PGIC (p=0.28). No statistically significant between-group differences were found in any disease-related secondary outcomes. There were significant between-group differences in patient's tendency to be mindful (p=0.016) and perceived benefits of exercise (p=0.033) in favour of the intervention group.

Conclusions: A multicomponent rehabilitation programme combining patient education with a mindfulness-based and acceptance-based group programme followed by physical activity counselling was not more effective than patient education and treatment as usual for patients with recently diagnosed fibromyalgia at 12-month follow-up.

Trial Registration Number: BMC Registry (ISRCTN96836577).
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http://dx.doi.org/10.1136/bmjopen-2020-046943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245472PMC
June 2021

The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review.

Psychiatry Res 2020 11 1;293:113441. Epub 2020 Sep 1.

Norwegian Institute of Public Health, Oslo, Norway.

The covid-19 pandemic has heavily burdened healthcare systems throughout the world. We performed a rapid systematic review to identify, assess and summarize research on the mental health impact of the covid-19 pandemic on HCWs (healthcare workers). We utilized the Norwegian Institute of Public Health's Live map of covid-19 evidence on 11 May and included 59 studies. Six reported on implementing interventions, but none reported on effects of the interventions. HCWs reported low interest in professional help, and greater reliance on social support and contact. Exposure to covid-19 was the most commonly reported correlate of mental health problems, followed by female gender, and worry about infection or about infecting others. Social support correlated with less mental health problems. HCWs reported anxiety, depression, sleep problems, and distress during the covid-19 pandemic. We assessed the certainty of the estimates of prevalence of these symptoms as very low using GRADE. Most studies did not report comparative data on mental health symptoms before the pandemic or in the general population. There seems to be a mismatch between risk factors for adverse mental health outcomes among HCWs in the current pandemic, their needs and preferences, and the individual psychopathology focus of current interventions.
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http://dx.doi.org/10.1016/j.psychres.2020.113441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462563PMC
November 2020

Mindfulness- and acceptance-based interventions for patients with fibromyalgia - A systematic review and meta-analyses.

PLoS One 2019 3;14(9):e0221897. Epub 2019 Sep 3.

Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.

Objectives: To analyze health effects of mindfulness- and acceptance-based interventions, including mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT). Additionally, we aimed to explore content and delivery components in terms of procedure, instructors, mode, length, fidelity and adherence in the included interventions.

Methods: We performed a systematic literature search in the databases MEDLINE, PsychINFO, CINAHL, EMBASE, Cochrane Central and AMED from 1990 to January 2019. We included randomized and quasi-randomized controlled trials analyzing health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia compared to no intervention, wait-list control, treatment as usual, or active interventions. MBSR combined with other treatments were included. Predefined outcomes were pain, fatigue, sleep quality, psychological distress, depression, anxiety, mindfulness, health-related quality of life and work ability. The Template for Intervention Description and Replication (TIDieR) checklist and guide was used to explore content and delivery components in the interventions. Meta-analyses were performed, and GRADE was used to assess the certainty in the evidence.

Results: The search identified 4430 records, of which nine original trials were included. The vast majority of the participants were women. The analyses showed small to moderate effects in favor of mindfulness- and acceptance-based interventions compared to controls in pain (SMD -0.46 [95% CI -0.75, -0.17]), depression (SMD -0.49 [95% CI -0.85, -0.12]), anxiety (SMD -0.37 [95% CI -0.71, -0.02]), mindfulness (SMD -0.40 [-0.69, -0.11]), sleep quality (SMD -0.33 [-0.70, 0.04]) and health-related quality of life (SMD -0.74 [95% CI -2.02, 0.54]) at end of treatment. The effects are uncertain due to individual study limitations, inconsistent results and imprecision.

Conclusion: Health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia are promising but uncertain. Future trials should consider investigating whether strategies to improve adherence and fidelity of mindfulness- and acceptance-based interventions can improve health outcomes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221897PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719827PMC
March 2020

G. Smedslund and C. Stoltenberg respond.

Tidsskr Nor Laegeforen 2018 11 26;138(19). Epub 2018 Nov 26.

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http://dx.doi.org/10.4045/tidsskr.18.0870DOI Listing
November 2018

What do we know about the long-term effects of antipsychotic drugs?

Tidsskr Nor Laegeforen 2018 10 15;138(16). Epub 2018 Oct 15.

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http://dx.doi.org/10.4045/tidsskr.18.0729DOI Listing
October 2018

Evidence of reduced parasympathetic autonomic regulation in inflammatory joint disease: A meta-analyses study.

Semin Arthritis Rheum 2018 08 5;48(1):134-140. Epub 2017 Dec 5.

Department of Rheumatology, National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.

Background: Rheumatoid arthritis (RA) and spondyloarthritis (SpA) are inflammatory joint disorders (IJD) with increased risk of cardiovascular disease (CVD). Autonomic dysfunction (AD) is a risk factor for CVD, and parasympathetic AD is linked to key features of IJD such as inflammation, physical inactivity and pain. Heart-rate variability (HRV) is a marker of cardiac AD. The study objective was to compare parasympathetic cardiac AD, measured by HRV, between patients with IJD and healthy controls, using meta-analysis methodology, and to examine the impact of inflammation, physical inactivity and pain on HRV in IJD.

Methods: Medline, Embase and Amed were searched. Inclusion criteria were adult case-control studies published in English or a Scandinavian language, presenting HRV data in IJD. Two measures of HRV and 3 from the Ewing protocol were selected: square root of mean squared difference of successive R-R intervals (RMSSD), high frequency (HF), Ewing protocol; standing (E-S), breathing (E-B) and Valsalva (E-V). Patients with RA, SpA and healthy controls were compared separately using random-effects meta-analyses of standardized mean differences (SMD).

Results: In all, 35 papers were eligible for inclusion. For RMSSD the pooled SMD (95% CI) RA vs. controls was -0.90 (-1.35 to -0.44), for SpA vs. controls; -0.34 (-0.73 to 0.06). For HF pooled SMD RA vs. controls was -0.78 (-0.99 to -0.57), for SpA vs. controls; -0.04 (-0.22 to 0.13). All Ewing parameters were significantly lower in cases, except for E-V which was comparable between cases and controls in patients with RA.

Conclusion: Patients with IJD have cardiac parasympathetic AD which is related to inflammation.
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http://dx.doi.org/10.1016/j.semarthrit.2017.11.010DOI Listing
August 2018

Exercise for Hand Osteoarthritis: A Cochrane Systematic Review.

J Rheumatol 2017 Dec 15;44(12):1850-1858. Epub 2017 Oct 15.

From the National Advisory Unit on Rehabilitation in Rheumatology, and the Department of Rheumatology, Diakonhjemmet Hospital; Norwegian Institute of Public Health; University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics, Oslo, Norway.

Objective: To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with hand osteoarthritis (OA).

Methods: Systematic review using Cochrane Collaboration methodology. Six electronic databases were searched up until September 2015.

Inclusion Criteria: randomized or controlled clinical trials comparing therapeutic exercise versus no exercise, or comparing different exercise programs.

Main Outcomes: hand pain, hand function, finger joint stiffness, quality of life, adverse events, and withdrawals because of adverse effects. Risk of bias and quality of the evidence were assessed.

Results: Seven trials were included in the review, and up to 5 trials (n = 381) were included in the pooled analyses with data from postintervention. Compared to no exercise, low-quality evidence indicated that exercise may improve hand pain [5 trials, standardized mean difference (SMD) -0.27, 95% CI -0.47 to -0.07], hand function (4 trials, SMD -0.28, 95% CI -0.58 to 0.02), and finger joint stiffness (4 trials, SMD -0.36, 95% CI -0.58 to -0.15) in people with hand OA. Quality of life was evaluated by 1 study (113 participants) showing very low-quality evidence for no difference. Three studies reported on adverse events, which were very few and not severe.

Conclusion: Pooled results from 5 studies with low risk of bias showed low-quality evidence for small to moderate beneficial effects of exercise on hand pain, function, and finger joint stiffness postintervention. Estimated effect sizes were small, and whether they represent a clinically important change may be debated.
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http://dx.doi.org/10.3899/jrheum.170424DOI Listing
December 2017

Effect of cardiorespiratory and strength exercises on disease activity in patients with inflammatory rheumatic diseases: a systematic review and meta-analysis.

Br J Sports Med 2017 Jul 28;51(14):1065-1072. Epub 2017 Apr 28.

Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway.

Objective: To investigate the effects of cardiorespiratory and strength exercises on disease activity for patients with inflammatory rheumatic diseases (IRDs).

Design: A systematic review with meta-analysis registered at PROSPERO (CRD42015020004).

Participants: Patients with IRDs.

Data Sources: The databases MEDLINE, AMED, Embase and CINAHL were searched from inception up to April 2016.

Eligibility Criteria For Selecting Studies: Trials were included if they were randomised controlled trials of adults with IRDs, comparing the effect of cardiorespiratory and strength exercises with usual care on disease activity and followed the American College of Sports Medicine's exercise recommendations. The primary outcome was disease activity in terms of inflammation, joint damage and symptoms.

Data Synthesis: Data were pooled in a random-effect model for all outcomes, and standardised mean differences (SMDs) were calculated. The quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation approach.

Results: Twenty-six trials with a total of 1286 participants were included. There was high to moderate quality evidence, for a small beneficial effect on disease activity scores (0.19 (95% CI 0.05 to 0.33), p<0.01) and joint damage (SMD 0.27 (95% CI 0.07 to 0.46), p<0.01). Furthermore, moderate quality evidence for a small beneficial effect on erythrocyte sedimentation rate (SMD 0.20 (95% CI 0.0 to 0.39), p=0.04) and for no effect on C reactive protein (SMD -0.14 (95% CI -0.37 to 0.08), p=0.21). Beneficial effects were also seen for symptoms.

Conclusions: The results of this review suggest beneficial effects of exercises on inflammation, joint damage and symptoms in patients with IRDs.
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http://dx.doi.org/10.1136/bjsports-2016-097149DOI Listing
July 2017

Exercise for hand osteoarthritis.

Cochrane Database Syst Rev 2017 01 31;1:CD010388. Epub 2017 Jan 31.

National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Boks 23 Vinderen, Oslo, Oslo, Norway, 0319.

Background: Hand osteoarthritis (OA) is a prevalent joint disease that may lead to pain, stiffness and problems in performing hand-related activities of daily living. Currently, no cure for OA is known, and non-pharmacological modalities are recommended as first-line care. A positive effect of exercise in hip and knee OA has been documented, but the effect of exercise on hand OA remains uncertain.

Objectives: To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with hand OA. Main outcomes are hand pain and hand function.

Search Methods: We searched six electronic databases up until September 2015.

Selection Criteria: All randomised and controlled clinical trials comparing therapeutic exercise versus no exercise or comparing different exercise programmes.

Data Collection And Analysis: Two review authors independently selected trials, extracted data, assessed risk of bias and assessed the quality of the body of evidence using the GRADE approach. Outcomes consisted of both continuous (hand pain, physical function, finger joint stiffness and quality of life) and dichotomous outcomes (proportions of adverse events and withdrawals).

Main Results: We included seven studies in the review. Most studies were free from selection and reporting bias, but one study was available only as a congress abstract. It was not possible to blind participants to treatment allocation, and although most studies reported blinded outcome assessors, some outcomes (pain, function, stiffness and quality of life) were self-reported. The results may be vulnerable to performance and detection bias owing to unblinded participants and self-reported outcomes. Two studies with high drop-out rates may be vulnerable to attrition bias. We downgraded the overall quality of the body of evidence to low owing to potential detection bias (lack of blinding of participants on self-reported outcomes) and imprecision (studies were few, the number of participants was limited and confidence intervals were wide for the outcomes pain, function and joint stiffness). For quality of life, adverse events and withdrawals due to adverse events, we further downgraded the overall quality of the body of evidence to very low because studies were very few and confidence intervals were very wide.Low-quality evidence from five trials (381 participants) indicated that exercise reduced hand pain (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.47 to -0.07) post intervention. The absolute reduction in pain for the exercise group, compared with the control group, was 5% (1% to 9%) on a 0 to 10 point scale. Pain was estimated to be 3.9 points on this scale (0 = no pain) in the control group, and exercise reduced pain by 0.5 points (95% CI 0.1 to 0.9; number needed to treat for an additional beneficial outcome (NNTB) 9).Four studies (369 participants) indicated that exercise improved hand function (SMD -0.28, 95% CI -0.58 to 0.02) post intervention. The absolute improvement in function noted in the exercise group, compared with the control group, was 6% (0.4% worsening to 13% improvement). Function was estimated at 14.5 points on a 0 to 36 point scale (0 = no physical disability) in the control group, and exercise improved function by 2.2 points (95% CI -0.2 to 4.6; NNTB 9).One study (113 participants) evaluated quality of life, and the effect of exercise on quality of life is currently uncertain (mean difference (MD) 0.30, 95% CI -3.72 to 4.32). The absolute improvement in quality of life for the exercise group, compared with the control group, was 0.3% (4% worsening to 4% improvement). Quality of life was 50.4 points on a 0 to 100 point scale (100 = maximum quality of life) in the control group, and the mean score in the exercise group was 0.3 points higher (3.5 points lower to 4.1 points higher).Four studies (369 participants) indicated that exercise reduced finger joint stiffness (SMD -0.36, 95% CI -0.58 to -0.15) post intervention. The absolute reduction in finger joint stiffness for the exercise group, compared with the control group, was 7% (3% to 10%). Finger joint stiffness was estimated at 4.5 points on a 0 to 10 point scale (0 = no stiffness) in the control group, and exercise improved stiffness by 0.7 points (95% CI 0.3 to 1.0; NNTB 7).Three studies reported intervention-related adverse events and withdrawals due to adverse events. The few reported adverse events consisted of increased finger joint inflammation and hand pain. Low-quality evidence from the three studies showed an increased likelihood of adverse events (risk ratio (RR) 4.55, 95% CI 0.53 to 39.31) and of withdrawals due to adverse events in the exercise group compared with the control group (RR 2.88, 95% CI 0.30 to 27.18), but the effect is uncertain and further research may change the estimates.Included studies did not measure radiographic joint structure changes. Two studies provided six-month follow-up data (220 participants), and one (102 participants) provided 12-month follow-up data. The positive effect of exercise on pain, function and joint stiffness was not sustained at medium- and long-term follow-up.The exercise intervention varied largely in terms of dosage, content and number of supervised sessions. Participants were instructed to exercise two to three times a week in four studies, daily in two studies and three to four times daily in another study. Exercise interventions in all seven studies aimed to improve muscle strength and joint stability or function, but the numbers and types of exercises varied largely across studies. Four studies reported adherence to the exercise programme; in three studies, this was self-reported. Self-reported adherence to the recommended frequency of exercise sessions ranged between 78% and 94%. In the fourth study, 67% fulfilled at least 16 of the 18 scheduled exercise sessions.

Authors' Conclusions: When we pooled results from five studies, we found low-quality evidence showing small beneficial effects of exercise on hand pain, function and finger joint stiffness. Estimated effect sizes were small, and whether they represent a clinically important change may be debated. One study reported quality of life, and the effect is uncertain. Three studies reported on adverse events, which were very few and were not severe.
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http://dx.doi.org/10.1002/14651858.CD010388.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464796PMC
January 2017

Quality of Community-Based Osteoarthritis Care: A Systematic Review and Meta-Analysis.

Arthritis Care Res (Hoboken) 2016 10 16;68(10):1443-52. Epub 2016 Sep 16.

Norwegian Institute of Public Health, Oslo, Norway.

Objective: To evaluate the state of quality of care for osteoarthritis (OA) by summarizing studies that have assessed the care provided to patients.

Methods: A systematic review of community-based observational studies of actual clinical practice treating people with OA compared with quality indicators (QIs) was performed. Four databases were searched from January 2000 to November 2015. Two reviewers independently determined study eligibility, assessed risk of bias, and extracted study data. The outcome was adherence to the QIs (pass rate). The overall pass rate (the total number of indicators passed divided by the total number of indicators for which the patients were eligible) was extracted from each study. When at least 50% of the studies had comparable individual QIs, the data were pooled with proportion meta-analyses.

Results: Fifteen studies comprising 16,103 patients were included, and the median overall pass rate across studies was 41% (range 22-65%). The pooled pass rates for individual QIs were "referral to orthopedic surgeon if no response to other therapy": 59.4% (95% confidence interval [95% CI] 47.5-70.3); "paracetamol or acetaminophen first drug used": 46.0% (95% CI 26.6-66.7); "assessed for pain and/or function": 45.5% (95% CI 33.9-57.6); "referral or recommendation to exercise": 38.7% (28.9-49.5); "offered education and self-management": 35.4% (95% CI 27.8-44.0); and "informed about potential risks if NSAIDs prescribed": 34.1% (95% CI 24.7-44.9).

Conclusion: There is room for improvement in community-based OA care.
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http://dx.doi.org/10.1002/acr.22891DOI Listing
October 2016

Design and effects of supportive followup interventions in clinical care of patients with rheumatic diseases: a systematic review with meta-analysis.

Arthritis Care Res (Hoboken) 2015 Feb;67(2):240-54

Diakonhjemmet Hospital and University of Oslo, Oslo, Norway.

Objective: To describe the design and determine the clinical effects of supportive followup interventions delivered after or alongside nonsurgical treatment or rehabilitation of patients with rheumatic diseases.

Methods: We performed a systematic review of randomized controlled trials searching the Ovid Medline, Embase, Cinahl, AMED, PsychINFO, and Cochrane Library databases. Trials evaluating the effects of interventions designed to enhance and/or prolong the effects of rheumatic treatment or rehabilitation were included. Data on pain, depression, and physical function were pooled in separate meta-analyses, including analyses made to calculate short-term (0-2 months) and long-term (5-6 months after followup intervention) effects. Risk of bias was assessed by 2 independent reviewers.

Results: The searches generated 3,231 citations, of which 11 original trials were included. The results demonstrated a great variety in the design of followup interventions. We found moderate quality evidence for small effects on self-reported physical function, with standardized mean differences of -0.15 (95% confidence interval [95% CI] -0.30, 0.00; P = 0.05) at short term, and -0.18 (95% CI -0.37, 0.00; P = 0.05) at long-term followup. Moderate quality evidence showed no effect of supportive followup interventions on short-term depression. Low quality evidence showed no significant effects on short-term pain, and very low quality evidence showed no significant effects on long-term pain and depression.

Conclusion: Currently there is no clear evidence concerning what constitutes an optimal design of supportive followup interventions. There is evidence that supportive followup can improve physical function in patients with rheumatic diseases, whereas no significant effects were found for pain and depression.
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http://dx.doi.org/10.1002/acr.22407DOI Listing
February 2015

Measurement properties of instruments assessing self-efficacy in patients with rheumatic diseases.

Rheumatology (Oxford) 2014 Jul 18;53(7):1161-71. Epub 2013 Nov 18.

National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Norwegian Knowledge Centre for the Health Services, Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Norwegian Knowledge Centre for the Health Services, Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.

The measurement properties of instruments assessing self-efficacy (SE) in patients with rheumatic diseases were reviewed. The consensus-based standards for the selection of health measurement instruments (COSMIN) checklist was applied following systematic searches of seven electronic databases from 1989 to December 2011. Fifteen articles met the inclusion criteria that included the arthritis SE scales (ASES), generalized SE scale (GSES), joint protection SE scale (JP-SES), Marcus & Resnick SE exercise behaviour (SEEB) instruments, and RA SE scale (RASE). The ASES and RASE have undergone more than one evaluation. There was little formal evaluation of content validity for the instruments. Evidence for the RASE suggests that it is not unidimensional. The JP-SES and SEEB were evaluated using modern psychometric methods. The instruments require further evaluation before application. The quality of the evidence for the ASES and RASE is generally poor. The generic focus of the GSES limits its relevance. The JP-SES and SEEB have only undergone one evaluation and that relating to the latter was narrow in scope. Future studies should address these methodological weaknesses.
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http://dx.doi.org/10.1093/rheumatology/ket374DOI Listing
July 2014
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