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Specify if: With perceptual disturbances: this specifier applies in the rare instance when hal­ lucinations (usually visual or tactile) occur with intact reality testing acne hyperpigmentation treatment buy generic decadron 0.5 mg line, or auditory acne studios cheap decadron 0.5mg line, visual acne rosacea treatment buy cheap decadron 0.5mg line, or tactile illusions occur in the absence of a delirium acne emedicine 1mg decadron with mastercard. It is not permissible to code a comorbid mild alcohol use disorder with alcohol withdrawal. Diagnostic Features the essential feature of alcohol withdrawal is the presence of a characteristic withdrawal syndrome that develops within several hours to a few days after the cessation of (or re­ duction in) heavy and prolonged alcohol use (Criteria A and B). The withdrawal syn­ drome includes two or more of the symptoms reflecting autonomic hyperactivity and anxiety listed in Criterion B, along with gastrointestinal symptoms. Withdrawal symptoms cause clinically significant distress or impairment in social, oc­ cupational, or other important areas of functioning (Criterion C). The symptoms must not be attributable to another medical condition and are not better explained by another men­ tal disorder. The withdrawal symptoms typically begin when blood concentrations of alcohol decline sharply. Reflecting the relatively fast metabolism of alcohol, symptoms of alcohol withdrawal usually peak in inten­ sity during the second day of abstinence and are likely to improve markedly by the fourth or fifth day. Following acute withdrawal, however, symptoms of anxiety, insomnia, and auto­ nomic dysfunction may persist for up to 3-6 months at lower levels of intensity. Fewer than 10% of individuals who develop alcohol withdrawal will ever develop dra­ matic symptoms. Associated Features Supporting Diagnosis Although confusion and changes in consciousness are not core criteria for alcohol with­ drawal, alcohol withdrawal delirium (see "Delirium" in the chapter "Neurocognitive Dis­ orders") may occur in the context of withdrawal. As is true for any agitated, confused state, regardless of the cause, in addition to a disturbance of consciousness and cognition, with­ drawal delirium can include visual, tactile, or (rarely) auditory hallucinations (delirium tre­ mens). When alcohol withdrawal delirium develops, it is likely that a clinically relevant medical condition may be present. Prevalence It is estimated that approximately 50% of middle-class, highly functional individuals with alcohol use disorder have ever experienced a full alcohol withdrawal syndrome. Among individuals with alcohol use disorder who are hospitalized or homeless, the rate of al­ cohol withdrawal may be greater than 80%. Less than 10% of individuals in withdrawal ever demonstrate alcohol withdrawal delirium or withdrawal seizures. Development and Course Acute alcohol withdrawal occurs as an episode usually lasting 4-5 days and only after extended periods of heavy drinking. Withdrawal is relatively rare in individuals younger than 30 years, and the risk and severity increase with increasing age. The probability of developing alcohol withdrawal increases with the quantity and frequency of alcohol consumption. Most individuals with this condition are drinking daily, consuming large amounts (approximately more than eight drinks per day) for multiple days. However, there are large inter-individual differences, with enhanced risks for individuals with concurrent medical conditions, those with family histories of al­ cohol withdrawal. Diagnostic M arkers Autonomic hyperactivity in the context of moderately high but falling blood alcohol levels and a history of prolonged heavy drinking indicate a likelihood of alcohol withdrawal. Functional Consequences of Alcohol W ithdrawal Symptoms of withdrawal may serve to perpetuate drinking behaviors and contribute to relapse, resulting in persistently impaired social and occupational functioning. Symptoms requiring medically supervised detoxification result in hospital utilization and loss of work productivity. Overall, the presence of withdrawal is associated with greater func­ tional impairment and poor prognosis. The symptoms of alcohol withdrawal can also be mimicked by some medical conditions. Essential tremor, a disorder that frequently runs in families, may erroneously suggest the tremu­ lousness associated with alcohol withdrawal. Sedative, hypnotic, or anxiolytic with­ drawal produces a syndrome very similar to that of alcohol withdrawal. Comorbidity Withdrawal is more likely to occur with heavier alcohol intake, and that might be most of­ ten observed in individuals with conduct disorder and antisocial personality disorder. Withdrawal states are also more severe in older individuals, individuals who are also de­ pendent on other depressant drugs (sedative-hypnotics), and individuals who have had more alcohol withdrawal experiences in the past. O ther A lcohol-Induced Disorders the following alcohol-induced disorders are described in other chapters of the manual with disorders with which they share phenomenology (see the substance/medication-induced mental disorders in these chapters): alcohol-induced psychotic disorder ('Schizophrenia Spec­ trum and Other Psychotic Disorders"); alcohol-induced bipolar disorder ("Bipolar and Related Disorders"); alcohol-induced depressive disorder ("Depressive Disorders"); alcohol induced anxiety disorder ("Anxiety Disorders"); alcohol-induced sleep disorder ("Sleep Wake Disorders"); alcohol-induced sexual dysfunction ("Sexual Dysfunctions"); and alcohol induced major or mild neurocognitive disorder ("Neurocognitive Disorders"). For alcohol intoxication delirium and alcohol withdrawal delirium, see the criteria and discussion of de­ lirium in the chapter "Neurocognitive Disorders. However, the alcohol-induced disorder is temporary and observed after severe intoxication with and/or withdrawal from alcohol. While the symp­ toms can be identical to those of independent mental disorders. Each alcohol-induced mental disorder is listed in the relevant diagnostic section and there­ fore only a brief description is offered here. Alcohol-induced disorders must have developed in the context of severe intoxication and/or withdrawal from the substance capable of produc­ ing the mental disorder. In addition, there must be evidence that the disorder being observed is not likely to be better explained by another non-alcohol-induced mental disorder. The latter is likely to occur if the mental disorder was present before the severe intoxication or with­ drawal, or continued more than 1month after the cessation of severe intoxication and/or with­ drawal. When symptoms are observed only during a delirium, they should be considered part of the delirium and not diagnosed separately, as many sjmiptoms (including disturbances in mood, anxiety, and reality testing) are commonly seen during agitated, confused states. The al­ cohol-induced disorder must be clinically relevant, causing significant levels of distress or sig­ nificant functional impairment. Finally, there are indications that the intake of substances of abuse in the context of a preexisting mental disorder are likely to result in an intensification of the preexisting independent syndrome. However, individuals with alcohol-induced disorders are likely to also demonstrate the associated features seen with an alcohol use disorder, as listed in the subsections of this chapter. For exam­ ple, the lifetime risk for major depressive episodes in individuals with alcohol use disorder is approximately 40%, but only about one-third to one-half of these represent independent major depressive syndromes observed outside the context of intoxication. Similar rates of alcohol-induced sleep and anxiety conditions are likely, but alcohol-induced psychotic ep­ isodes are fairly rare. Development and Course Once present, the symptoms of an alcohol-induced condition are likely to remain clinically relevant as long as the individual continues to experience severe intoxication and/or with­ drawal. The alcohol-induced disorders are an important part of the differential diagnoses for the independent mental conditions. Independent schizophrenia, major depressive disor­ der, bipolar disorder, and anxiety disorders, such as panic disorder, are likely to be asso­ ciated with much longer-lasting periods of symptoms and often require longer-term medications to optimize the probability of improvement or recovery. The alcohol-induced conditions, on the other hand, are likely to be much shorter in duration and disappear within several days to 1 month after cessation of severe intoxication and/or withdrawal, even without psychotropic medications. The importance of recognizing an alcohol-induced disorder is similar to the relevance of identifying the possible role of some endocrine conditions and medication reactions be­ fore diagnosing an independent mental disorder. In light of the high prevalence of alcohol use disorders worldwide, it is important that these alcohol-induced diagnoses be consid­ ered before independent mental disorders are diagnosed. Caffeine-Related Disorders Caffeine Intoxication Caffeine Withdrawal Other Caffeine-Induced Disorders Unspecified Caffeine-Related Disorder Caffeine Intoxication Diagnostic Criteria 305. Five (or more) of the following signs or symptoms developing during, or shortly after, caffeine use: 1. Diagnostic Features Caffeine can be consumed from a number of different sources, including coffee, tea, caf feinated soda, "energy" drinks, over-the-counter analgesics and cold remedies, energy aids. Caffeine is also increasingly being used as an additive to vitamins and to food products. Some caffeine users display symptoms consistent with problem­ atic use, including tolerance and withdrawal (see "Caffeine Withdrawal" later in this chapter); the data are not available at this time to determine the clinical significance of a caffeine use disorder and its prevalence. In contrast, there is evidence that caffeine with­ drawal and caffeine intoxication are clinically significant and sufficiently prevalent. The essential feature of caffeine intoxication is recent consumption of caffeine and five or more signs or symptoms that develop during or shortly after caffeine use (Criteria A and B). Symptoms include restlessness, nervousness, excitement, insomnia, flushed face, diuresis, and gastrointestinal complaints, which can occur with low doses. Symptoms that generally appear at levels of more than 1 g/ day include muscle twitching, rambling flow of thought and speech, tachycardia or car­ diac arrhythmia, periods of inexhaustibility, and psychomotor agitation. Caffeine intoxi­ cation may not occur despite high caffeine intake because of the development of tolerance. The signs or symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion C).

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The term was coined by Herbert Spencer and used to skin care 15 days before marriage purchase 0.5mg decadron overnight delivery justify cruelty and indif symbiosis ference to skin care during pregnancy purchase decadron 1mg with visa others in Victorian society and n acne 6 year old daughter generic decadron 0.5mg without prescription. It is most commonly used to skin care gadgets order decadron 1 mg with visa describe the situation in which both species survivor guilt beneft from living together as humans ben n. A sense of remorse for the fate of people eft from having Lactobacillus in their gut who die and of failure to have done enough to which allows them to digest milk, while drink prevent their deaths in persons who have lived ing milk feeds the Lactobacillus. The term may through a life-threatening situation in which also include situations in which there is ben others did not. This is common among those eft to only one of the species involved and it is 530 symbol sympathetic nervous system either harmful or neutral to the other species symbolization and some situations in which it is harmful to n. A theory of perception that suggests that In psychoanalysis, an image which represents people in Western cultures focus more on something else, as a bear may represent a representations on paper than do people in feared father or a cigar may represent a penis. Any test that requires subjects to translate one symbol-digit test set of symbols into another, as in the symbol n. Apraxia observed in patients with anterior correct translations within a fxed time inter left hemisphere damage associated with right val is the measure of ability. Symbolic interactionism is an intellectual taneously two different motor defects: pare tradition in sociology and social psychology. Inspired by the early writings of Blumer, Sympathetic apraxia is frequently found in Cooley, and Mead, this tradition seeks to motor aphasias. The portion of the autonomic nervous sys tions these actions have for social interac tem which tends to prepare the body for action tions. Symbolic interactionism emphasizes when aroused and is opposed to the parasym negotiation and transformation of mean pathetic nervous system, which calms the ings in the social interactions through the body and prepares it for rest and digestion. From this perspective, self-knowledge sympathetic nervous system is constructed by appraising what other n. The process of encoding experience or blood fow to skeletal muscles is increased data into abstract forms in the mind or in a and epinephrine levels are raised, leading to computer program. Words and numbers are an increase in heart rate and blood sugar lev two forms of symbolic representations, and els, as well as piloerection (goose bumps). Some of these neurons also larization in the axon causes vesicles holding release acetylcholine to muscarinic metabotro chemical neurotransmitters to move to the pic receptor sites, leading to a slow response or cell wall and release their transmitter chemi even inhibition of response, depending on the cal into the cleft between the two cells. The narrow gap between an axon terminal which may be a sign of an underlying dis and the postsynaptic membrane of a dendrite ease or disorder. Anything that is taken as flled with salty water across which neurotrans an indication of something else, as a rising mitters must foat in order to propagate neu national debt may be a symptom of war. The narrow cleft between an axon terminal ing disorder or disease is produced by the and the postsynaptic membrane of a dendrite disorder or disease or a reaction to it. In flled with salty water across which neu psychoanalysis, the expression of the anxiety rotransmitters must foat in order to propa from a repressed impulse in a behavioral or gate neural impulses. In psychoanalysis, the appearance of a new brane of a neuron or muscle specialized to complaint or expression of repressed anxiety react to chemical neurotransmitters. The active process by which proteins in pre synaptic membranes remove neurotransmit synapse ter chemicals from the water in the synaptic n. The bulbous end of an axon at the junction mitters foat to propagate nerve impulses with another neuron. The process of chemical transmission of eye), mean that no two words can be perfectly an electric impulse across the water-flled gap synonymous. A brief lapse in consciousness (commonly posed by Henry Head, who suggested a four called fainting). The cause is a transient loss fold classifcation of aphasia into verbal, of cerebral oxygenation, which may result syntactic, nominal, and semantic. Syntactic from a variety of external and/or internal aphasia in general corresponds to what is usu events. Patients with of the vagus nerve, which affects parasym this type of language defect have diffculties pathetic control, slowing the heart rate and in using the morphosyntactic rules of the decreasing the availability of oxygen to the language and apraxia of speech. Also, a parasympathetic rebound from associated with damage in the left posterior sympathetic activity in the abdominal viscera frontal lobe, the brain area named Broca’s area (a vaso-vagal phenomenon) may produce (Brodmann’s area 44). Extreme temperature, emotional stress, or hypoglycemia may also induce syn syntactic processing cope. Syntactic processing, or parsing, is the pro mized by lying down fat or by sitting with the cess of recovering syntactic structure from head between the knees. Linguistic sig the acupressure point for fainting, pressure nals – written, acoustic, or gestural – are frst applied between the upper lip and nostrils, decoded into a string of linearly ordered lexi may also prevent or minimize syncope. The syntactic processor must deter use of an ammonia inhalant capsule may mine the hierarchical relations between these revive a person who is fainting or has just lexical items. A sensory experience resulting from stimu grounded on limitations imposed by the cog lation of a different body part or a different nitive architecture, including working mem sense from the one experienced by the sub ory limitations. In such sentences, the initial analysis built by the syntactic processor (here, taking raced to synonym be the main verb of the sentence) turns out n. Two words with similar or identical mean to be incorrect (raced is really the participle of ings are synonyms. For example, volume and an omitted verb in a reduced relative clause; tome are synonyms for the word book; student cf. Garden path sentences are diffcult to pro Arguably, details of the origins of words, cess because their correct structure violates a as well as their additional senses. Syntax is the component of a language’s producing stimuli, which leads to acquisition grammar that licenses sentence structure, by of a competing response (relaxation) in the means of a set of principles that generate the presence of the anxiety-producing object, set of well-formed sentences in that language. Instead, syntactic relation computer programming, such as C++, which ships are hierarchical: the two adjacent words enables simulation of concurrent processes dates Beatrice are related in a way that Augustine including communication between the dates are not. First, system justi cation theory by the application of phrase structure rules, n. Societies differ in the manner and extent the syntax generates basic sentence struc of differentiation between groups and the tures consisting of a subject (noun phrase) forms of inequality that prevail. Social institu and a predicate (verb phrase), as well as any tions and hierarchies are maintained in part obligatory heads. System justifcation refers to the social direct object noun phrases or prepositional psychological tendency to defend, justify, and phrases). Second, basic sentence structures uphold aspects of the social status quo, even are combined by the syntax to create complex if it was arrived at arbitrarily or if a different sentences containing subordinate clauses, system would better meet people’s interests. This goal is a powerful ciples which license the movement of constitu determinant of thoughts, feelings, and behav ents within sentences, to obtain constructions iors, because it satisfes several social and psy such as questions (Who does Augustine date From the perspective of the disadvantaged, synthetic language justifying the system perpetuates their own n. An artifcial language such as those deprivation and therefore works against used in computer programs, as opposed to their personal and collective interests. People natural languages, which have evolved in and system justify because attaining this goal are spoken by persons of particular cultures. In linguistics, a language which tends to anxiety, guilt, dissonance, discomfort, and express multiple meanings with a single word, uncertainty that result from being part of as opposed to isolating languages, in which an unequal and possibly unjust system. The there is a single meaning per word although net result of system justifcation is social and in practice languages vary along a continuum political acquiescence. A therapeutic procedure used to lessen processes into component parts which can be phobic and other anxious reactions involving modeled by a computer program, as is com learning relaxation techniques followed by mon in cognitive psychology. A supercomputer that comprises 1,100 ily therapy, and group dynamics in which Apple Power Mac G5 computers, which was the functions and patterns of interaction the frst supercomputer to achieve a speed of of the parts are the focus of analysis and 10 terafops, in 2003. A prohibition against ple without verbal, obvious, or overt efforts at particular behaviors, things, or persons based transferring the information, as in reaching on religious or moral grounds although some an unspoken agreement. Information possessed by a person or other the property of Madam Pele, who will cause organism of which the possessor is not aware misfortune for anyone who removes them. Term originated by the 17th-century philoso tactical self-enhancement pher John Locke. The idea that people of different cultures is born with its mind/brain a total blank slate, all self-enhance but choose to do so in differ upon which is written its life experience. Skinner’s mid-20th-century description of the tactile receptor mind/brain as a “black box” which receives the n. Any of the nerve endings having receptors conditioning and reinforcements of an individ located in the skin, including those for pres ual’s life. This position postulates that nurture, sure, texture, vibration, temperature, and not nature. Of or relating to the sense of touch or nature and nurture are inextricably interwo contact with the skin.

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The severity of mood symptoms in psychosis has prognostic value and guides treatment skin care equipment wholesale buy decadron 1mg with visa. There is growing evidence that schizoaffective disorder is not a distinct nosological category skin care 11 year olds safe decadron 1 mg. Thus acne clothing purchase decadron 0.5mg on line, dimensional assessments of depres­ sion and mania for all psychotic disorders alert clinicians to skin care industry buy decadron 1mg fast delivery mood pathology and the need to treat where appropriate. Many individuals with psychotic disorders have impairments in a range of cognitive domains that predict functional status. Clinical neuropsychological as­ sessment can help guide diagnosis and treatment, but brief assessments without formal neuropsychological assessment can provide useful information that can be sufficient for diagnostic purposes. Formal neuropsychological testing, when conducted, should be ad­ ministered and scored by personnel trained in the use of testing instruments. If a formal neuropsychological assessment is not conducted, the clinician should use the best avail­ able information to make a judgment. Schizotypal (Personality) Disorder Criteria and text for schizotypal personality disorder can be found in the chapter "Person­ ality Disorders. Note: Hallucinations, if present, are not prominent and are related to the delusional theme. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods. The disturbance is not attributable to the physiological effects of a substance or an­ other medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder. Specify whether: Erotomanie type: this subtype applies when the central theme of the delusion is that another person is in love with the individual. Grandiose type: this subtype applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery. Jeaious type: this subtype applies when the central theme of the individual’s delusion is that his or her spouse or lover is unfaithful. Persecutory type: this subtype applies when the central theme of the delusion in­ volves the individual’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals. Somatic type: this subtype applies when the central theme of the delusion involves bodily functions or sensations. Unspecified type: this subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types. Specify if: With bizarre content: Delusions are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences. Specify if: the following course specifiers are only to be used after a 1-year duration of the disorder: First episode, currently in acute episode: First manifestation of the disorder meet­ ing the defining diagnostic symptom and time criteria. First episode, currently in partial remission: Partial remission is a time period dur­ ing which an improvement after a previous episode is maintained and in which the de­ fining criteria of the disorder are only partially fulfilled. Subtypes In erotomanie type, the central theme of the delusion is that another person is in love with the individual. In grandiose type, the central theme of the de­ lusion is the conviction of having some great talent or insight or of having made some im­ portant discovery. Less commonly, the individual may have the delusion of having a special relationship with a prominent individual or of being a prominent person (in which case the actual individual may be regarded as an impostor). In jealous type, the central theme of the delusion is that of an un­ faithful partner. This belief is arrived at without due cause and is based on incorrect infer­ ences supported by small bits of "evidence". The individual with the delusion usually confronts the spouse or lover and attempts to intervene in the imagined infidelity. The affected individual may engage in repeated attempts to obtain satisfaction by legal or legislative action. Indi­ viduals with persecutory delusions are often resentful and angry and may resort to vio­ lence against those they believe are hurting them. In somatic type, the central theme of the delusion involves bodily functions or sensations. Most common is the belief that the individual emits a foul odor; that there is an in­ festation of insects on or in the skin; that there is an internal parasite; that certain parts of the body are misshapen or ugly; or that parts of the body are not functioning. Diagnostic Features the essential feature of delusional disorder is the presence of one or more delusions that persist for at least 1 month (Criterion A). A diagnosis of delusional disorder is not given if the individual has ever had a symptom presentation that met Criterion A for schizophre­ nia (Criterion B). Apart from the direct impact of the delusions, impairments in psychoso­ cial functioning may be more circumscribed than those seen in other psychotic disorders such as schizophrenia, and behavior is not obviously bizarre or odd (Criterion C). If mood episodes occur concurrently with the delusions, the total duration of these mood episodes is brief relative to the total duration of the delusional periods (Criterion D). The delusions are not attributable to the physiological effects of a substance. Associated Features Supporting Diagnosis Social, marital, or work problems can result from the delusional beliefs of delusional dis­ order. Individuals with delusional disorder may be able to factually describe that others view their beliefs as irrational but are unable to accept this themselves. Many individuals develop irritable or dysphoric mood, which can usually be understood as a reaction to their delusional beliefs. Anger and violent behavior can occur with persecutory, jealous, and erotomanie types. Prevaience the lifetime prevalence of delusional disorder has been estimated at around 0. Delusional disorder, jealous type, is probably more common in males than in females, but there are no major gender differences in the overall frequency of delusional disorder. Deveiopment and Course On average, global function is generally better than that observed in schizophrenia. Al­ though the diagnosis is generally stable, a proportion of individuals go on to develop schizophrenia. Delusional disorder has a significant familial relationship with both schizophrenia and schizotypal personality disorder. Although it can occur in younger age groups, the condition may be more prevalent in older individuals. Functional Consequences of Delusional Disorder the functional impairment is usually more circumscribed than that seen with other psy­ chotic disorders, although in some cases, the impairment may be substantial and include poor occupational functioning and social isolation. When poor psychosocial functioning is present, delusional beliefs themselves often play a significant role. A common character­ istic of individuals with delusional disorder is the apparent normality of their behavior and appearance when their delusional ideas are not being discussed or acted on. If an individual with obsessive-compul­ sive disorder is completely convinced that his or her obsessive-compulsive disorder beliefs are true, then the diagnosis of obsessive-compulsive disorder, with absent insight/delu­ sional beliefs specifier, should be given rather than a diagnosis of delusional disorder. Similarly, if an individual with body dysmorphic disorder is completely convinced that his or her body dysmorphic disorder beliefs are true, then the diagnosis of body dysmor­ phic disorder, with absent insight/delusional beliefs specifier, should be given rather than a diagnosis of delusional disorder. Delirium, major neurocognitive disorder, psychotic disorder due to another medical con­ dition, and substance/medication-induced psychotic disorder. Individuals with these disorders may present with symptoms that suggest delusional disorder. For example, sim­ ple persecutory delusions in the context of major neurocognitive disorder would be di­ agnosed as major neurocognitive disorder, with behavioral disturbance. A substance/ medication-induced psychotic disorder cross-sectionally may be identical in symptom­ atology to delusional disorder but can be distinguished by the chronological relationship of substance use to the onset and remission of the delusional beliefs. Delusional disorder can be distinguished from schizophrenia and schizophreniform disorder by the absence of the other character­ istic symptoms of the active phase of schizophrenia. These disorders may be distinguished from delusional disorder by the temporal relationship between the mood disturbance and the delusions and by the severity of the mood symptoms. If delusions oc­ cur exclusively during mood episodes, the diagnosis is depressive or bipolar disorder with psychotic features. Mood symptoms that meet full criteria for a mood episode can be su­ perimposed on delusional disorder.

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