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  1. Article ; Online: A semi-naturalistic open-label study examining the effect of prescribed medical cannabis use on simulated driving performance.

    Manning, Brooke / Arkell, Thomas R / Hayley, Amie C / Downey, Luke A

    Journal of psychopharmacology (Oxford, England)

    2024  Volume 38, Issue 3, Page(s) 247–257

    Abstract: Background: Despite increasing medical cannabis use, research has yet to establish whether and to what extent products containing delta-9-tetrahydrocannabinol (THC) impact driving performance among patients. Stable doses of prescribed cannabinoid ... ...

    Abstract Background: Despite increasing medical cannabis use, research has yet to establish whether and to what extent products containing delta-9-tetrahydrocannabinol (THC) impact driving performance among patients. Stable doses of prescribed cannabinoid products during long-term treatment may alleviate clinical symptoms affecting cognitive and psychomotor performance.
    Aim: To examine the effects of open-label prescribed medical cannabis use on simulated driving performance among patients.
    Methods: In a semi-naturalistic laboratory study, 40 adults (55% male) aged between 23 and 80 years, consumed their own prescribed medical cannabis product. Driving performance outcomes including standard deviation of lateral position (SDLP), the standard deviation of speed (SDS), mean speed and steering variability were evaluated using the Forum8 driving simulator at baseline (pre-dosing), 2.5 h and 5 -h (post-dosing). Perceived driving effort (PDE) was self-reported after each drive. Oral fluid and whole blood samples were collected at multiple timepoints and analysed for THC via liquid chromatography-mass spectrometry.
    Results: A significant main effect of time was observed for mean speed (p = 0.014) and PDE (p = 0.020), with patients displaying modest stabilisation of vehicle control, increased adherence to speed limits and reductions in PDE post-dosing, relative to baseline. SDLP (p = 0.015) and PDE (p = 0.043) were elevated for those who consumed oil relative to flower-based products. Detectable THC concentrations were observed in oral fluid at 6-h post-dosing (range = 0-24 ng/mL).
    Conclusions: This semi-naturalistic study suggests that the consumption of medical cannabis containing THC (1.13-39.18 mg/dose) has a negligible impact on driving performance when used as prescribed.
    MeSH term(s) Adult ; Humans ; Male ; Young Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Female ; Medical Marijuana/pharmacology ; Dronabinol/pharmacology ; Hallucinogens/pharmacology ; Psychomotor Performance ; Cannabis/adverse effects ; Automobile Driving ; Marijuana Smoking/adverse effects
    Chemical Substances Medical Marijuana ; Dronabinol (7J8897W37S) ; Hallucinogens
    Language English
    Publishing date 2024-02-08
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639313-5
    ISSN 1461-7285 ; 0269-8811
    ISSN (online) 1461-7285
    ISSN 0269-8811
    DOI 10.1177/02698811241229524
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  2. Article ; Online: A systematic review of oculomotor deficits associated with acute and chronic cannabis use.

    Manning, Brooke / Downey, Luke A / Narayan, Andrea / Hayley, Amie C

    Addiction biology

    2024  Volume 29, Issue 1, Page(s) e13359

    Abstract: Driving is a critical everyday task necessitating the rapid and seamless integration of dynamic visually derived information to guide neurobehaviour. Biological markers are frequently employed to detect Δ9-tetrahydrocannabinol (THC) consumption among ... ...

    Abstract Driving is a critical everyday task necessitating the rapid and seamless integration of dynamic visually derived information to guide neurobehaviour. Biological markers are frequently employed to detect Δ9-tetrahydrocannabinol (THC) consumption among drivers during roadside tests, despite not necessarily indicating impairment. Characterising THC-specific alterations to oculomotor behaviour may offer a more sensitive measure for indexing drug-related impairment, necessitating discrimination between acute THC effects, chronic use and potential tolerance effects. The present review aims to synthesise current evidence on the acute and chronic effects of THC on driving-relevant oculomotor behaviour. The review was prospectively registered (10.17605/OSF.IO/A4H9W), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines informed reporting standards. Overall, 20 included articles comprising 12 experimental acute dosing trials, 5 cross-sectional chronic use studies and 3 roadside epidemiological studies examined the effects of cannabis/THC on oculomotor parameters including saccadic activity gaze behaviour, nystagmus, smooth pursuit and eyelid/blink characteristics. Acute THC consumption selectively impacts oculomotor control, notably increasing saccadic latency and inaccuracy and impairing inhibitory control. Chronic cannabis users, especially those with early age of use onset, display enduring oculomotor deficits that affect visual scanning efficiency. The presence of eyelid tremors appears to be a reliable indicator of cannabis consumption while remaining distinct from direct impairment associated with visual attention and motor control. Cannabis selectively influences oculomotor activity relevant to driving, highlighting the role of cannabinoid systems in these processes. Defining cannabis/THC-specific changes in oculomotor control may enhance the precision of roadside impairment assessments and vehicle safety systems to detect drug-related impairment and assess driving fitness.
    MeSH term(s) Cannabis ; Dronabinol ; Cross-Sectional Studies ; Cannabinoids ; Cannabinoid Receptor Agonists
    Chemical Substances Dronabinol (7J8897W37S) ; Cannabinoids ; Cannabinoid Receptor Agonists
    Language English
    Publishing date 2024-01-12
    Publishing country United States
    Document type Systematic Review ; Journal Article ; Review
    ZDB-ID 1324314-7
    ISSN 1369-1600 ; 1355-6215
    ISSN (online) 1369-1600
    ISSN 1355-6215
    DOI 10.1111/adb.13359
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  3. Article ; Online: Prescription medication use and crash risk: taking responsibility for a new global challenge.

    Downey, Luke A / Hayley, Amie C

    The Lancet. Public health

    2021  Volume 6, Issue 6, Page(s) e349–e350

    MeSH term(s) Accidents, Traffic ; Case-Control Studies ; Humans ; Prescription Drugs ; Prescriptions
    Chemical Substances Prescription Drugs
    Language English
    Publishing date 2021-04-20
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Comment
    ISSN 2468-2667
    ISSN (online) 2468-2667
    DOI 10.1016/S2468-2667(21)00045-1
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  4. Article ; Online: Driving Impairment Following Vaporization of Cannabis.

    Downey, Luke A / Hayley, Amie C

    JAMA

    2021  Volume 325, Issue 12, Page(s) 1225

    MeSH term(s) Automobile Driving ; Cannabidiol ; Cannabis/adverse effects ; Dronabinol ; Marijuana Smoking ; Volatilization
    Chemical Substances Cannabidiol (19GBJ60SN5) ; Dronabinol (7J8897W37S)
    Language English
    Publishing date 2021-03-23
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2021.0451
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  5. Article ; Online: Cannabidiol for moderate-severe insomnia: a randomized controlled pilot trial of 150 mg of nightly dosing.

    Narayan, Andrea J / Downey, Luke A / Rose, Sarah / Di Natale, Lauren / Hayley, Amie C

    Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

    2024  Volume 20, Issue 5, Page(s) 753–763

    Abstract: Study objectives: Low-dose cannabidiol (CBD) has become readily available in numerous countries; however, little consensus exists on its efficacy as a sleep aid. This trial explored the efficacy of 150 mg of CBD (n = 15) compared with placebo (n = 15) ... ...

    Abstract Study objectives: Low-dose cannabidiol (CBD) has become readily available in numerous countries; however, little consensus exists on its efficacy as a sleep aid. This trial explored the efficacy of 150 mg of CBD (n = 15) compared with placebo (n = 15) as a sleep aid in primary insomnia. CBD supplementation was hypothesized to decrease insomnia symptoms and improve aspects of psychological health, relative to placebo.
    Methods: Using a randomized, placebo-controlled, parallel design featuring a single-blind placebo run-in week followed by a 2-week double-blind randomized dosing phase, participants consumed the assigned treatment sublingually 60 minutes before bed nightly. Wrist-actigraphy and sleep diaries measured daily sleep. Sleep quality, sleep effort, and well-being were measured weekly over 4 in-laboratory visits. Insomnia severity and trait anxiety were measured at screening and study conclusion.
    Results: Insomnia severity, self-reported sleep-onset latency, sleep efficiency, and wake after sleep onset did not differ between treatments throughout the trial (all
    Conclusions: Nightly supplementation of 150 mg CBD was similar to placebo regarding most sleep outcomes while sustaining greater well-being, suggesting more prominent psychological effects. Additional controlled trials examining varying treatment periods and doses are crucial.
    Clinical trial registration: Registry: Australian New Zealand Clinical Trials Registry; Name: Cannabidiol (CBD) treatment for insomnia; URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000070932; Identifier: ACTRN12620000070932.
    Citation: Narayan AJ, Downey LA, Rose S, Di Natale L, Hayley AC. Cannabidiol for moderate-severe insomnia: a randomized controlled pilot trial of 150 mg of nightly dosing.
    MeSH term(s) Humans ; Sleep Initiation and Maintenance Disorders/drug therapy ; Cannabidiol/administration & dosage ; Cannabidiol/therapeutic use ; Male ; Female ; Pilot Projects ; Double-Blind Method ; Adult ; Middle Aged ; Single-Blind Method ; Treatment Outcome ; Actigraphy ; Severity of Illness Index
    Chemical Substances Cannabidiol (19GBJ60SN5)
    Language English
    Publishing date 2024-01-04
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2397213-0
    ISSN 1550-9397 ; 1550-9389
    ISSN (online) 1550-9397
    ISSN 1550-9389
    DOI 10.5664/jcsm.10998
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  6. Article ; Online: A randomised, placebo-controlled, double blind, crossover trial on the effect of a 20:1 cannabidiol: Δ9-tetrahydrocannabinol medical cannabis product on neurocognition, attention, and mood.

    Manning, Brooke / Hayley, Amie C / Catchlove, Sarah / Stough, Con / Downey, Luke A

    European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology

    2024  Volume 82, Page(s) 35–43

    Abstract: As cannabinoid-based medications gain popularity in the treatment of refractory medical conditions, it is crucial to examine the neurocognitive effects of commonly prescribed products to ensure associated safety profiles. The present study aims to ... ...

    Abstract As cannabinoid-based medications gain popularity in the treatment of refractory medical conditions, it is crucial to examine the neurocognitive effects of commonly prescribed products to ensure associated safety profiles. The present study aims to investigate the acute effects of a standard 1 mL sublingual dose of CannEpil®, a medicinal cannabis oil containing 100 mg cannabidiol (CBD) and 5 mg Δ9-tetrahydrocannabinol (THC) on neurocognition, attention, and mood. A randomised, double-blind, placebo-controlled, within-subjects design assessed 31 healthy participants (16 female, 15 male), aged between 21 and 58 years, over a two-week experimental protocol. Neurocognitive performance outcomes were assessed using the Cambridge Neuropsychological Test Automated Battery, with the Profile of Mood States questionnaire, and the Bond-Lader Visual Analogue Scale used to assess subjective state and mood. CannEpil increased Total Errors in Spatial Span and Correct Latency (median) in Pattern Recognition Memory, while also increasing Efficiency Score (lower score indicates greater efficiency) relative to placebo (all p < .05). Subjective Contentedness (p < .01) and Amicability (p < .05) were also increased at around 2.5 h post dosing, relative to placebo. Drowsiness or sedative effect was reported by 23 % of participants between three to six hours post CannEpil administration. Plasma concentrations of CBD, THC, and their metabolites were not significantly correlated with any observed alterations in neurocognition, subjective state, or adverse event occurrence. An acute dose of CannEpil impairs select aspects of visuospatial working memory and delayed pattern recognition, while largely preserving mood states among healthy individuals. Intermittent reports of drowsiness and sedation underscore the inter-individual variability of medicinal cannabis effects on subjective state. (ANZCTR; ACTRN12619000932167; https://www.anzctr.org.au).
    MeSH term(s) Humans ; Male ; Double-Blind Method ; Female ; Adult ; Dronabinol/administration & dosage ; Dronabinol/pharmacology ; Dronabinol/blood ; Cannabidiol/pharmacology ; Cannabidiol/administration & dosage ; Affect/drug effects ; Cross-Over Studies ; Young Adult ; Middle Aged ; Attention/drug effects ; Cognition/drug effects ; Medical Marijuana/administration & dosage ; Medical Marijuana/pharmacology ; Neuropsychological Tests
    Chemical Substances Dronabinol (7J8897W37S) ; Cannabidiol (19GBJ60SN5) ; Medical Marijuana
    Language English
    Publishing date 2024-03-14
    Publishing country Netherlands
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 1082947-7
    ISSN 1873-7862 ; 0924-977X
    ISSN (online) 1873-7862
    ISSN 0924-977X
    DOI 10.1016/j.euroneuro.2024.02.002
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  7. Article ; Online: Assessment of Medical Cannabis and Health-Related Quality of Life.

    Arkell, Thomas R / Downey, Luke A / Hayley, Amie C / Roth, Sebastian

    JAMA network open

    2023  Volume 6, Issue 5, Page(s) e2312522

    Abstract: Importance: The use of cannabis as a medicine is becoming increasingly prevalent. Given the diverse range of conditions being treated with medical cannabis, as well as the vast array of products and dose forms available, clinical evidence incorporating ... ...

    Abstract Importance: The use of cannabis as a medicine is becoming increasingly prevalent. Given the diverse range of conditions being treated with medical cannabis, as well as the vast array of products and dose forms available, clinical evidence incorporating patient-reported outcomes may help determine safety and efficacy.
    Objective: To assess whether patients using medical cannabis report improvements in health-related quality of life over time.
    Design, setting, and participants: This retrospective case series study was conducted at a network of specialist medical clinics (Emerald Clinics) located across Australia. Participants were patients who received treatment for any indication at any point between December 2018 and May 2022. Patients were followed up every mean (SD) 44.6 (30.1) days. Data for up to 15 follow-ups were reported. Statistical analysis was conducted from August to September 2022.
    Exposure: Medical cannabis. Product types and cannabinoid content varied over time in accordance with the treating physician's clinical judgement.
    Main outcomes and measures: The main outcome measure was health-related quality of life as assessed using the 36-Item Short Form Health Survey (SF-36) questionnaire.
    Results: In this case series of 3148 patients, 1688 (53.6%) were female; 820 (30.2%) were employed; and the mean (SD) age was 55.9 (18.7) years at baseline before treatment. Chronic noncancer pain was the most common indication for treatment (68.6% [2160 of 3148]), followed by cancer pain (6.0% [190 of 3148]), insomnia (4.8% [152 of 3148]), and anxiety (4.2% [132 of 3148]). After commencing treatment with medical cannabis, patients reported significant improvements relative to baseline on all 8 domains of the SF-36, and these improvements were mostly sustained over time. After controlling for potential confounders in a regression model, treatment with medical cannabis was associated with an improvement of 6.60 (95% CI, 4.57-8.63) points to 18.31 (95% CI, 15.86-20.77) points in SF-36 scores, depending on the domain (all P < .001). Effect sizes (Cohen d) ranged from 0.21 to 0.72. A total of 2919 adverse events were reported, including 2 that were considered serious.
    Conclusions and relevance: In this case series study, patients using medical cannabis reported improvements in health-related quality of life, which were mostly sustained over time. Adverse events were rarely serious but common, highlighting the need for caution with prescribing medical cannabis.
    MeSH term(s) Humans ; Female ; Middle Aged ; Male ; Medical Marijuana/therapeutic use ; Quality of Life ; Analgesics, Opioid ; Retrospective Studies ; Chronic Pain ; Cannabis ; Cannabinoid Receptor Agonists ; Hallucinogens
    Chemical Substances Medical Marijuana ; Analgesics, Opioid ; Cannabinoid Receptor Agonists ; Hallucinogens
    Language English
    Publishing date 2023-05-01
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2023.12522
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  8. Article ; Online: Acute neurocognitive and subjective effects of oral methamphetamine with low doses of alcohol: A randomised controlled trial.

    Hayley, Amie C / Shiferaw, Brook / Rositano, Joanna / Downey, Luke A

    Journal of psychopharmacology (Oxford, England)

    2023  Volume 37, Issue 9, Page(s) 928–936

    Abstract: Background: Methamphetamine is often recreationally co-consumed with alcohol due to desirable off-target effects; however, the acute neurocognitive and subjective consequences of combined use are unclear.: Methods: In a randomised, placebo-controlled, ...

    Abstract Background: Methamphetamine is often recreationally co-consumed with alcohol due to desirable off-target effects; however, the acute neurocognitive and subjective consequences of combined use are unclear.
    Methods: In a randomised, placebo-controlled, counterbalanced, cross-over study design, the effects of acute oral methamphetamine (0.42 mg/kg) were assessed with and without low doses of alcohol (target 0.04% blood-alcohol concentration, BAC) on subjective intoxication, alertness, physiological outcomes and neurocognition during the ascending and descending phases of the BAC curve. Sixteen healthy adults (mean age = 30.4 years, SD ± 4.4, 67% male) completed four experimental sessions over 4 weeks involving a one-week washout period.
    Results: Cardiovascular measures [heart rate (beats/minute), blood pressure (mmHg)] were predictably elevated following methamphetamine, but unaffected by combined alcohol use. Methamphetamine and alcohol produce divergent effects on subjective alertness and sedation across time, yet their combination produced predominantly sustained stimulative effects independent of the biphasic alcohol curve. At a peak BAC of 0.029%, alcohol alone impaired performance across most functional neurocognitive domains relative to placebo and methamphetamine only, and the addition of methamphetamine attenuated these effects. Methamphetamine alone produced isolated improvement in psychomotor speed consistent with peak drug effects.
    Conclusion: Methamphetamine combined with alcohol does not substantially alter the physiological or metabolic profile compared to either drug alone. Strong stimulative effects of methamphetamine appear to mask the biphasic sedative and performance effects of low doses of alcohol, which may underlie motivations for co-consumption in recreational settings and increase propensity for harm.
    MeSH term(s) Adult ; Humans ; Male ; Female ; Methamphetamine/adverse effects ; Cross-Over Studies ; Ethanol/adverse effects ; Alcohol Drinking ; Attention ; Double-Blind Method
    Chemical Substances Methamphetamine (44RAL3456C) ; Ethanol (3K9958V90M)
    Language English
    Publishing date 2023-06-14
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639313-5
    ISSN 1461-7285 ; 0269-8811
    ISSN (online) 1461-7285
    ISSN 0269-8811
    DOI 10.1177/02698811231179805
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  9. Article ; Online: A Semi-Naturalistic, Open-Label Trial Examining the Effect of Prescribed Medical Cannabis on Neurocognitive Performance.

    Arkell, Thomas R / Manning, Brooke / Downey, Luke A / Hayley, Amie C

    CNS drugs

    2023  Volume 37, Issue 11, Page(s) 981–992

    Abstract: Background and objectives: Medical cannabis use is increasing in Australia and other jurisdictions, yet little is known about the effects of medical cannabis on cognitive function. Findings from studies of non-medical ('recreational') cannabis may not ... ...

    Abstract Background and objectives: Medical cannabis use is increasing in Australia and other jurisdictions, yet little is known about the effects of medical cannabis on cognitive function. Findings from studies of non-medical ('recreational') cannabis may not be applicable to patients using prescribed medical cannabis to manage a health condition.
    Methods: In this semi-naturalistic, open-label trial, patients with various health conditions attended a single laboratory session in which they self-administered a standard dose of prescribed medical cannabis as per instructions on the pharmacy label. We assessed cognitive performance using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and Druid application (app) prior to and following (CANTAB: + 3 h; Druid: + 3 and 5.5 h) medical cannabis self-administration. We also assessed subjective drug effects prior to and following (1, 2 and 4 h) medical cannabis self-administration using a range of 0-10 cm visual analogue scales ('stoned', 'sedated', 'relaxed', 'comfortable', 'anxious' and 'confident'). Data were analyzed using linear fixed-effect models.
    Results: Participants (N = 40; 22 females) were prescribed a range of products including orally administered oils (n = 23) and flower for vaporization (n = 17). Participants had a mean (standard deviation [SD]) age of 41.38 (12.66) years and had been using medical cannabis for a mean (SD) of 10.18 (8.73) months. Chronic non-cancer pain was the most common indication for medical cannabis use (n = 20), followed by sleep disorder (n = 18) and anxiety (n = 11). The mean (SD) delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) dose administered by participants was 9.61 (8.52) mg/9.15 (10.11) mg among those using an oil, and 37.00 (24.53) mg/0.38 (1.58) mg among those who vaporized flower, respectively. Participants' performance improved over time on the CANTAB Multitasking Test and Rapid Visual Information Processing test (both p-values <0.001). All other changes in cognitive performance measures over time were non-significant (p > 0.05). Vaporization of flower was associated with significantly stronger subjective feelings of 'stoned' and 'sedated' relative to oils (both p < 0.001).
    Conclusions: These findings suggest that prescribed medical cannabis may have minimal acute impact on cognitive function among patients with chronic health conditions, although larger and controlled trials are needed.
    MeSH term(s) Adult ; Female ; Humans ; Analgesics, Opioid ; Chronic Pain ; Dronabinol/pharmacology ; Dronabinol/therapeutic use ; Marijuana Smoking/psychology ; Medical Marijuana/adverse effects ; Oils
    Chemical Substances Analgesics, Opioid ; Dronabinol (7J8897W37S) ; Medical Marijuana ; Oils
    Language English
    Publishing date 2023-11-09
    Publishing country New Zealand
    Document type Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1203800-3
    ISSN 1179-1934 ; 1172-7047
    ISSN (online) 1179-1934
    ISSN 1172-7047
    DOI 10.1007/s40263-023-01046-z
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  10. Article ; Online: Legalization of Psychedelic Substances.

    Downey, Luke A / Sarris, Jerome / Perkins, Daniel

    JAMA

    2022  Volume 326, Issue 23, Page(s) 2434–2435

    MeSH term(s) Hallucinogens
    Chemical Substances Hallucinogens
    Language English
    Publishing date 2022-01-06
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2021.19372
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