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How psychedelic-assisted therapy with MDMA and psilocybin works

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Investors open their minds and their wallets to the possibilities of psychedelic therapies.

Three biopharmaceutical companies that aim to manufacture psychedelic drugs for the treatment of mental disorders have gone public in the past few months: Peter Thiel supported Atai Life Sciences’ IPO in June and now has a market capitalization of $ 2.6 billion; MindMed went public in April and now has a market capitalization of more than $ 1 billion; and Compass Pathways went public in November, with a current market cap of nearly $ 1.5 billion.

Together, the three companies have more than nine psychedelic therapy drugs in their pipeline. Not to mention the work of many other private biotech and telemedicine companies like Gilgamesh Pharmaceuticals, which is supported by Y Combinator, as well as startups like Mindbloom, which already treats patients with ketamine-assisted psychotherapy. (Ketamine is not a psychedelic, but is considered a dissociative anesthetic that can distort vision, colors, sounds, self and surroundings).

All of this means that triggering mind altering drugs like MDMA could become a regular part of therapy for treating conditions like depression, post-traumatic stress disorder, addiction, chronic pain, and obsessive-compulsive disorder over the next two to five years.

This is what it could look like and what the research says.

How psychedelics work for therapy

Psychedelics are substances that change perception and mood and influence a number of cognitive processes. The classic psychedelics include MDMA, also known as “Ecstasy” or “Molly”, LSD, psilocybin or “mushrooms”, Ayahuasca and Ibogaine.

Working with therapists, research has shown that psychedelics can help treat conditions historically difficult to treat by essentially “transforming” the way “parts of the brain talk to each other,” said Jennifer Mitchell, neuroscientist and professor in the Departments of Neurology, Psychiatry, and Behavioral Sciences at the University of California San Francisco.

Researchers provide therapeutic support in the treatment room of one of the study centers for MAPS-sponsored clinical trials of MDMA-assisted therapy for PTSD.

Courtesy of MAPS.

“Psychedelics allow processing in a way that allows subjects to let go of things that previously plagued them,” she says.

As Mitchell explains, your brain goes through critical periods of learning and development at a young age, which then close as you age. Researchers believe that psychedelics “only open these closed critical periods for a tiny window of time,” she says.

“When this critical period is open again, you want to make the most of it and make this potential change as positive as possible,” she says.

For example, with psilocybin the drug is believed to increase connectivity in the brain and increase “neuroplastic states,” which are the brain’s ability to reorganize and adapt, says Dr. Stephen Ross, Associate Professor of Psychiatry at NYU Grossman School of Medicine, who has conducted clinical trials in psilocybin-assisted therapy for 16 years.

For example, a recent study from Yale University on mice found that a single dose of psilocybin caused an immediate increase in connections between neurons that lasted a month afterward.

When taking psychedelics, “parts of the brain that don’t normally talk to each other begin to communicate with each other, and it seems to reset brain patterns in some way,” he says.

What psychedelic therapy looks like: “It’s not a Burning Man”

MDMA-assisted therapy could be approved for medical use by the FDA as early as 2023, while other psychedelics, particularly psilocybin, are waiting in the wings for their turn for medical use.

If and when psychedelic assisted therapy is approved by the FDA, it will be far more complex and medical than just someone taking mushrooms for recreation in the woods.

“You don’t just get thrown in,” says Mitchell. “It’s not Burning Man or anything. It’s very thoughtful.”

First, patients need to be carefully screened to be eligible.

“It’s not for everyone,” says Dr. Corine de Boer, Chief Medical Officer at the Multidisciplinary Association for Psychedelics Studies, a nonprofit research and educational organization. For example, treatment is not suitable for people with a history of psychosis or cardiovascular problems. (And right now, psychedelics aren’t being studied in people with milder mental illnesses or people without clinically diagnosable conditions.)

For those who qualify, psychedelic assisted therapy sessions will “be a synergy between the participants, the therapist and the medication,” says de Boer.

Research-grade capsules for use in MAPS-sponsored clinical trials of MDMA-assisted therapy for PTSD.

Courtesy of MAPS.

Before any medication is administered, doctors meet the patient to discuss what might happen to them – for example a traumatic event or painful memories from childhood, or, in the case of a terminally ill patient, they can check how the disease has affected them Has affected life.

The sessions in which the patient takes psychedelic medication can be quite labor-intensive and long (around eight hours), says Mitchell. A single dose of MDMA will work for six hours and half a dose will be given approximately 90 minutes after the session begins.

To provide patients with a comfortable travel environment, providers set up a room that resembles a living room or bedroom and give patients an eye mask and a playlist of soothing music before taking the medication. Patients are invited to “go inside” and reflect on the issues they discussed in the preparatory sessions.

“Whatever comes up for them is what medicine is based on their own history and [brain] Circuit, “says Mitchell.

Patients can talk about the issues that arise, and the therapists are there to help them accept and listen to any ideas that come to the surface rather than asking questions. “As you can imagine, there are a lot of emotions,” says Mitchell.

Patients are conscious and can comfortably eat, drink, and use the toilet, but are accompanied by two staff members when they stand or walk, Mitchell explains.

The next day there is an “integration session” in which the therapists talk to the patient and help him understand what he has experienced. The patient could return to the reasons why they did the treatments in the first place and, for example, discuss what they felt or saw during the experience.

Mitchell says an important transformation occurs when people take psychedelics in this clinical setting. “It’s amazing how much lighter and freer people seem to be after the first session,” she says.

In fact, in a recent MDMA study, depression was relieved or significantly reduced after three doses given about a month apart.

It is to be expected that these treatments will be covered by the health insurance at some point. Obtaining insurance to cover treatment also depends on the compounds being moved from their current classification as List I Medicines under the Controlled Substances Act. (Experts believe MDMA could be postponed in the next two years.)

Of course, the treatment carries risks. Psychedelic therapy is not recommended for people with psychotic disorders and people with high blood pressure. Outside of a clinical trial, many psychedelics, such as psilocybin and MDMA, are classified as Schedule I drugs under the Controlled Substances Act.

But “in the next three to five years psychiatry will change profoundly” with psychedelic-assisted therapy, says Ross.

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‘Anomie in post-Covid world reason for more urban suicides’ | Nagpur News

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Dr. Abhishek Somani, Professor, Department of Psychiatry, Indira Gandhi Government Medical College and Hospital, invokes the concept of “anomie” by French sociologist Emile Durkheim to explain the state of despair and hopelessness that many face after rounds of limitations and Go through isolation. An increasing sense of dejection is a very strong indicator of suicidal intent, adds a widespread sense of fear about the unpredictability of the disease, economic problems due to lockdown, an increase in alcohol and other substance use, resulting health problems, and verbal and physical violence added home. All of these are an important mix in leading a person to suicidal intent. In an interview with TOI, Dr. Somani, who is also the past president of the Psychiatric Society of Nagpur, elaborates on this burning issue.
Excerpts …
Q. What are your general observations on the upward trend in suicides?
A. The social fabric is getting weaker. The earlier concepts of shared families and extended families are now seen in fewer and fewer cases. That important safety net is now missing. With the world at your fingertips with the Internet, a Pandora’s box has been opened. So you are not only influenced by what is good, but also by things that are not so good. The Blue Whale game is a good example. The internet also draws attention to the lack of sophistication in one’s life. And since everyone publishes photos of the best time ever, a doubt creeps in: “Why am I not as happy as you are? Maybe I’m a failure. People got through the pandemic without any significant increase in suicide gestures in the immediate period. But the stress of the pandemic and its social, economic and personal effects will increase mental health problems in the long run, and we will see an increase unless urgent action is taken to alleviate these problems.
Q. Has the lockdown and Covid phase increased suicidality?
A. Surprisingly not. There was an immediate period of escalation in anxiety and depression as the pandemic level began to decline, but the incidence of self-harm and committed suicide was lower than expected. We can speculate that maybe everyone was in trouble together, so people drew strength from misery.
Q. Why are middle class people and even the financially secure people at the end of their lives?
A. Overall, the suicide rate tends towards cities. Large cities account for nearly 25% of suicide deaths in urban areas, according to NCRB 2019 data. The same data suggests that over 90% of suicides are committed by people from the lower social classes, but common sense suggests that it can be disgusting to have suicides reported by those who are better at hiding a shameful death .
Q. How do you justify this underreporting claim?
A. The French sociologist Emile Durkheim’s concept of “anomie” comes to mind. Anomie is a state of society in which generally accepted values ​​and meanings lose their acceptance, but new values ​​(with common consensus) have yet to be developed. People at risk develop a sense of senselessness and emotional emptiness. This feeling of helplessness and hopelessness is a strong indicator of suicidal intent. Financial stability is by no means a protection against psychological stress. Peace of mind emerges from feeling satisfied with everything one has. So money doesn’t do much to prevent suicide, but it definitely helps to hide it. Anomie can develop in the post-covid world where normal interactions and communication have become a risky activity. So putting on a mask and maintaining physical distance are not a natural part of our behavior.
Q. Are you suggesting that the mask and physical distancing need to go at some point?
A. We cannot maintain physical distance for life. You can see that people don’t put on their masks. Few of those who are very cautious or paranoid about Covid still adhere to the norms. Quiet, everyone has left. This is a kind of anomie that happens when normal social rules are given up or broken but nothing else could be picked up. This created a “I don’t know what to do” feeling. The normal structure of life is disturbed and there is no alternative. The mind cannot exist in an ambivalence. This ambivalence causes fear and fear has suicide as one of the results. You have to take sides, yes or no. There is a lot of indecision due to Covid. You don’t know when the pandemic will end, who will survive if you get infected.
Q. Is the pandemic the only cause of mental health problems?
A. All of the previous factors related to suicide have been accelerated by the stress caused by Covid and Lockdown. 33% of suicides are due to family problems, 17% to illness, 6% to addiction and 10% to money problems. Each of these factors increased during the lockdown. Some families have grown closer, but domestic violence has increased dramatically as any police officer will tell you. Alcohol consumption has risen sharply. Covid’s hospital stay has severely impacted the family’s savings. So overall, the pandemic has accelerated the fire of the mental health problems that people will face over the next few years. An increase in mental disorders would increase the number of episodes of self harm, unless we can make people aware of the importance of seeking help in a timely manner.
Q. What are the early signs and indicators of mental illness?
A. A noticeable change in a person’s behavior over a period of typically 2 weeks or more. He / she becomes more moody, loses interest in ordinary activities, appears withdrawn or aloof, sloppy looking, suddenly crying or flying in anger, talking about how better it would be if he / she wasn’t around, etc. But it requires a really keen eye to see that we often give a long rope to those who have recently suffered a traumatic event. We consider this part of normal sadness. Conversations about dying are not. The number of violent and homicidal offenses is increasing significantly, which can also be seen in the context of the lockdown-associated anomie, in which social rules and values ​​lose importance.
Q What are the solutions?
A. Prevention is easier said than done. It will take years of effort to create mental health professionals capable of meeting India’s tremendous needs. There are currently fewer than 10,000 psychiatrists in India, the overwhelming majority of whom serve urban areas. In the meantime, a sustained campaign in the media to highlight symptoms of mental illness, support and recognition from well-known personalities and simple things like a break from ambition, changes in a more balanced lifestyle, and sustainable life goals will help.

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She fought to save her child from an eating disorder. Now, she combats the misconceptions.

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Nine years ago, JD Ouellette almost lost her then 17-year-old daughter Kinsey to an almost fatal anorexia nervosa. Kinsey has since recovered, but her mother is still in the trenches helping other parents and children in San Diego teach the tools and strategies they need to win their own battle against eating disorders.

According to the National Eating Disorders Association, EDs will affect approximately 20 million women and 10 million men in America during their lifetime. These conditions include anorexia and bulimia nervosa, as well as binge eating and eating disorders that restrict avoidance. They can affect people of any age, ethnicity, and socio-economic group. They can occur in children as early as 7 years of age and are particularly common in women between the ages of 15 and 24. Unfortunately, only about 10 percent of people with eating disorders are ever treated.

Ouellette, a 57-year-old mother of four from Scripps Ranch, said parents may not be able to spot the signs due to widespread myth and outdated information online. New research over the past 20 years has dramatically changed scientists’ knowledge of these diseases and their treatments, Ouellette said that sharing this new information with families can save lives.

“What I’m telling parents is to trust their Spidey sense,” Ouellette said, referring to Spider-Man’s oversensitivity to danger. “If you feel like something is wrong, especially after reading it in the Union-Tribune, get a review right away.”

JD Oullette stands outside the UC San Diego Health Eating Disorders Center in La Jolla.

(Ariana Drehsler / The San Diego Union-Tribune)

In 2012, Kinsey Ouellette underwent treatment at the UC San Diego Eating Disorders Center for Treatment and Research in La Jolla, widely recognized as one of the leading eating disorder research organizations in the country. JD Ouellette said she was so grateful for her daughter’s recovery that she volunteered to look after other parents of children starting treatment. When the university where she worked as an administrative specialist was closed in 2018, she devoted herself entirely to her new calling.

Today she runs her own coaching service for parents and patients with eating disorders; serves as a parenting mentor on the University of California Center’s Parents Advisory Board at San Diego; is the mentor for EQUIP, a 2-year program for the treatment of fully virtual eating disorders in San Diego; is a co-founder of the International Eating Disorders Family Support Network and the World Eating Disorders Action Day; and is a former board member for Families Empowered and Supporting Treatment of Eating Disorders (FEAST).

Ouellette said that most Americans, and a surprising number of pediatricians, fail to realize that eating disorders is not a personal “choice” but an inherited, genetic, neurobiological disorder. Although they can be triggered by social or environmental factors (such as bodyshaming or the media promotion of thin body types), they should be understood as complex medical and psychiatric diseases.

“One of the greatest things I’ve learned is that everything I thought I knew about EDs was just plain wrong,” she said. “I was a teacher with a master’s degree and was wrong.”

Decades ago, traditional treatment for young people with severe eating disorders was removing them – or a “parental ectomy,” as Ouellette calls it – because parents were seen as the cause of the problem. Now, according to Ouellette, research has shown that the most effective method is called family-based treatment, where a patient’s family is part of the trained “team” that guides the patient to physical and emotional health at home.

“No family causes an eating disorder, but every family needs to change to fight an eating disorder,” said Ouellette. “Think of it this way: your family’s operating software does not have an ED control patch, so you need to update your software to the version that combats ED.”

Ouellette said teens with these disorders share temperamental traits in common. They are often great students and high performing athletes and artists who work hard, are internally motivated, and used to practicing perfectly.

“These are very valuable skills, but once you develop ED, the same discipline applies. There is a light and a dark side to these skills, ”she said.

That was the case with Kinsey, who was a top student and high school athlete. After graduation, she and a few friends decided to “re-model” a “healthy diet” to avoid the “new 15” pounds that students often put on in their freshman year of college, but within two months of starting the makeover, Kinseys became Health so precarious that her family urged her to seek treatment at UC San Diego.

“Some people burn slowly, but it was a long way from the cliff. It was amazing, ”said Ouellette. “She has said many times in the years since that if we hadn’t intervened, she would have been dead within a few months.”

“Think about your disorder as a person. If your child screams, yells, throws objects, refuses to eat, negotiates meals, whatever it is, you are not witnessing or interacting with your actual child. You are face to face with the personification of their disorder. “

Kinsey, the daughter of JD Oullette, as she wrote in an essay about her eating disorder

Ouellette said family-based treatment works, but it’s not easy. Marriages can break up and parent-child relationships can be permanently broken without the support of a comprehensive treatment program like the one at UC San Diego, Rady Children’s Hospital in San Diego, or EQUIP.

“If a plate of food is like a plate of snakes and spiders for a child, they will behave appropriately, and that’s hard for anyone,” Ouellette said. “It’s really easy for parents to feel like you are against their child, but in reality, it is you against the eating disorder your child is controlling.”

In an essay, Kinsey wrote about her battle with anorexia for FEAST, she said that children affected by an eating disorder will say and do almost anything if they believe their parents are in the way of their weight goal.

“Think about your disorder as a person,” wrote Kinsey. “If your child is screaming, yelling, throwing objects, refusing to eat, negotiating meals, whatever it is, you are not experiencing or dealing with your actual child. They face the personification of their disorder. That hatred comes from a losing eating disorder. So remember that the more hate you feel, the better you work. “

Treatment and recovery outcomes vary, but Ouellette said that in most cases, aggressive treatment can resolve the disorder in three to four months, but it can take one to three years to achieve full recovery. Relapses are common. Some studies show a relapse rate of 36 percent in anorexic patients and 35 percent in bulimic patients.

Ouellette said she advises parents who are having difficulty treating their child to focus on the end goal and stay on track.

“It is important that you approach this with compassion, consistency, and with the knowledge that whatever you do is protection, even if it feels like punishment or seems filtered,” she said. “Feeding our children and monitoring exercise and other behaviors in order to achieve and maintain their optimal physical and mental health is our right and responsibility as parents.”

Common warning signs of an eating disorder

  • Sudden weight loss or weight gain
  • Eating disorders, such as skipping breakfast or lunch habitually
  • Take part in fasting challenges or keep track of everything you eat in a day
  • Sudden change in mood or socializing habits
  • Self-esteem problems related to body image
  • Decision for vegans or vegetarians
  • Anxiety or depression
  • Exercise compulsion
  • Eating rituals (such as over-chewing or not touching food)
  • Girls experience irregular menstruation or a break in menstruation
  • Boys with focus on bodybuilding and body fat
  • Dizziness or fainting
  • Stomach cramps or acid reflux
  • Sleep disorder
  • Cuts and calluses on the top of the finger joints (from vomiting)
  • Yellow skin (eaten from too many carrots)
  • Difficulty concentrating
  • Dry skin and hair

– Source: National Association for Eating Disorders

Self-care tips for parents of a child with an eating disorder

  • Learn psychoeducation, which is a therapeutic intervention for patients and family members to understand and manage illness.
  • Work with providers to equip them with the same skills that you are teaching your child.
  • In order to avoid conflict, both parents should remain on the same side when treating their child.
  • Divide up the responsibilities in your family, ideally so that the father can take on a more active role.
  • Engage in bonding activities with your child in treatment.
  • Do guided meditation for at least five minutes a day.
  • Learn to play a musical instrument.
  • Go outside and take a walk.
  • Avoid activities that cause stress.

– Source: JD Ouellette

Resources:

National Association for Eating Disorders – nationaleatingdisorders.org
Families supports and supports the treatment of eating disorders (FEAST): fest-ed.org
UC San Diego Center for Treatment and Research for Eating Disorders – eatdisorders.ucsd.edu
Rady Children’s Hospital-San Diego Eating Disorders Treatment Unit – rchsd.org
EQUIP virtual family-based treatment program – equip.health
Parent and patient coaching by JD Ouellette: jdouellette.com

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How insulin resistance can lead to depression

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Stanford Medicine scientists have found that insulin resistance can increase the risk of developing major depressive disorder. The results of the study were published in the American Journal of Psychiatry. “If you are insulin resistant, your risk of developing major depressive disorder is twice that of someone who is not insulin resistant, even if you’ve never experienced depression before,” said Natalie Rasgon, MD, PhD, Professor of Psychiatry and Behavioral Sciences.

The WHO estimates that almost 5% of adults suffer from depression. Symptoms include incessant sadness, despair, sluggishness, trouble sleeping, and loss of appetite.

Also read: How I recognized OCD and what impact it had on my life

Some factors that contribute to this deeply debilitating disease – such as childhood trauma, the loss of a loved one, or the stress of the COVID-19 pandemic – we cannot prevent. But insulin resistance is preventable: it can be reduced or eliminated through diet, exercise and, if necessary, medication.

Rasgon shares lead authorship of the study with Brenda Penninx, MD, PhD, Professor of Psychiatric Epidemiology at the Medical Center of the University of Amsterdam. The study’s lead author is Kathleen Watson, PhD, a postdoctoral fellow in Rasgon’s group.

Studies have confirmed that at least 1 in 3 of us walk around with insulin resistance – often without knowing it. The condition is not caused by an inadequate ability of the pancreas to secrete insulin into the bloodstream, as is the case with type 1 diabetes, but rather by the decreased ability of cells throughout the body to obey this hormone’s command.

The job of insulin is to tell our cells that it is time for them to process the glucose that floods our blood from our food intake, its production in our liver, or both. Every cell in the body uses glucose as fuel, and each of these cells has receptors on their surface that, when bound to insulin, signal the cell to take in the precious source of energy.

But an increasing proportion of the world’s population is insulin resistant for a variety of reasons, including their insulin receptors that don’t bind properly to insulin, excessive caloric intake, sedentary lifestyle, stress, and lack of sleep. Eventually, their blood sugar levels become chronically high.

Once these levels stay above a certain threshold, the diagnosis is type 2 diabetes, a treatable but incurable disease that can lead to cardiovascular and cerebrovascular disease, neuropathy, kidney disease, limb amputation, and other unhealthy outcomes.

Associations between insulin resistance and several mental disorders have already been established. For example, about 40 percent of patients who suffer from mood disorders have been shown to be insulin resistant, Rasgon said. But these assessments are based on cross-sectional studies – snapshots of populations at a single point in time.

The question of whether one event was the cause or the result of the other – or whether both were the results of a different causal factor – is best clarified by longitudinal studies that people can typically track over years or even decades to determine which event occurred first.

Also Read: How Reflection Can Accelerate Growth

As part of a cross-institutional collaboration within the Rasgon research network, founded in 2015, the scientists received data from an ongoing longitudinal study in which more than 3,000 participants were closely observed in order to get to know the causes and consequences of depression: the Dutch study on depression and anxiety.

Rasgon is Stanford’s lead investigator and Penninx is the lead investigator. “The Dutch study, with its meticulous monitoring of a large test population for nine years and still growing, presented us with a great opportunity,” said Watson.

The Stanford team analyzed data from 601 men and women who served as controls for the Dutch study. At the time of their enrollment, they had never suffered from depression or anxiety. Their median age was 41 years. The team measured three proxies of insulin resistance: fasting blood sugar levels, waist circumference, and the ratio of circulating triglyceride levels to that of circulating high-density lipoprotein – or HDL, known as “good” cholesterol.

They examined the data to see if those who were diagnosed with insulin resistance were at an increased nine-year risk of developing major depressive disorder. The answer to all three measures was yes: they found that a moderate increase in insulin resistance, as measured by the triglyceride-to-HDL ratio, was associated with an 89 percent increase in new cases of major depressive disorders.

Similarly, every two-inch increase in belly fat was associated with an 11 percent higher rate of depression, and an increase in fasting plasma glucose of 18 milligrams per deciliter of blood was associated with a 37 percent higher rate of depression. “Some subjects were already insulin resistant at the start of the study – there was no way of knowing when they first became insulin resistant,” said Watson. “We wanted to be more specific about how quickly the connection started,” added Watson.

The researchers therefore limited the next phase of their analysis to the approximately 400 test subjects who not only had never experienced significant depression, but also showed no signs of insulin resistance at the start of the study. However, within the first two years of the study, nearly 100 of these participants became insulin resistant. The researchers compared the likelihood of this group of developing major depressive disorder within the next seven years with that of participants who had not become insulin resistant after two years.

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While the number of participants was too small to determine statistical significance for waist circumference and triglyceride-to-HDL ratio, the fasting glucose results were not only statistically significant – meaning they were not incidental – but Also clinically meaningful – that is, important enough to worry: Those who developed prediabetes within the first two years of the study were at 2.66 times the risk of major depression after the nine-year follow-up up compared to those who received normal fasting glucose test results. had the two year point.

Bottom line: Insulin resistance is a strong risk factor for serious problems, including not only type 2 diabetes but also depression. “It is time providers took into account the metabolic status of patients with mood disorders and vice versa by assessing mood in patients with metabolic disorders such as obesity and high blood pressure,” said Rasgon. “To prevent depression, doctors should check their patients’ insulin sensitivity. These tests are readily available in laboratories around the world and they are inexpensive. In the end, we can curb the development of lifelong debilitating diseases, ”concluded Rasgon.

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