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Exam 2 study guide

by: Natalie Notetaker

Exam 2 study guide 502

Natalie Notetaker


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About this Document

Cover chapters 5-7
Dr. Keen
Study Guide
50 ?




Popular in PTSD

Popular in Psychology (PSYC)

This 7 page Study Guide was uploaded by Natalie Notetaker on Saturday October 8, 2016. The Study Guide belongs to 502 at University of South Carolina Upstate taught by Dr. Keen in Fall 2016. Since its upload, it has received 4 views. For similar materials see PTSD in Psychology (PSYC) at University of South Carolina Upstate.


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Date Created: 10/08/16
1 Chapter 5 Risk factors • Pre- trauma -Stuff people bring with them when the trauma happens • Pre-trauma – you are whatever sex you are, age you are… • Then stuff that happens during the trauma is peri-trauma – what kind of trauma, was it one time, over the course of years, how severe is the trauma Pre-trauma • variables Demographic (pre- Age trauma) status • Age is weird variable that is the least consistent – in general we see older age people are less affected but research is murky – this is not so simple because there are many variables that can be confounded with that • Because we look at folks that have been victim of crime – likely have lots of people with different ages – is it the age they are now? Is it the age they were when the trauma happened? How many years have passed since trauma? Maybe people are coming at this idea of age from diff perspectives? Ex- person in study now who was victim of crime 1 year ago compared to another that was victim from 10 years agao – makes a big difference • Research found if youe xperienced when younger, you experience more trauma – when you are older • Older people have more wisdom and as things come to pass, they might handle it better because they have experieces • Younger people might be involved in riskier behaviors which allows them to have higher rates of trauma Race • RACE – when looking at global perspective – lot of research is conducted in the US so hard to catch the global picture • We don’t see too mnay diff with race – there’s some here and there (ex Asians following rape or Hawaii) • We see differences seems to be more because of the trauma itself, the type of trauma, how much trauma has been experienced • Research shows Hispanic in vietnam had more Ptsd but minority soldiers were more on the front line so that might be why or maybe they were in service longer • It’s the exposure to the trauma, not the race or age GENDER • Type of trauma women experience compared to men might play a part • Not a lot of research on men with sexual assault – and men who are raped are not volunteering research studies • Even when we look at same kind of trauma – women experience PTSD and other things more than men (same with depression) • Men – more with substance abuse Other pre-trauma • Family environment, family psychiatric illness, whether someone has experienced childhood traumas, prior life events, variables prior trauma • Inoculating effects – idea not about trauma itself but you have 2 people that have gone through same trauma – one of the people had more challenges in their life before the trauma – they tend to have a less chance of developing PTSD – the fewer life events you’ve had, if you experience trauma, you have greater chance of PTSD • However, prior trauma does not inoculate you to ptsd • Look at notes • Ex – older folks – might have this effect that protects them – more experience, wisdom and opportunity to deal with negative events in their life • Negative life events are like a vaccine • You have some events where life sucks (small doses – divorce,…) – later on, something happens where life sucks but you are better able to deal with it when hit with something harder • When you have prior traumatic experiences with more trauma on top of that – makes you more vulnerable to negative effects of future trauma • That was the problem with Janoff-Bulman’s theory – doesn’t predict that – doesn’t work that way • Once you have had trauma – it bumps you out of the inoculating effect – people who have experienced trauma, inoculating effect doesn’t apply at all • So if person has no big life experiences and then experiences a trauma – they are greater risk of developing PTSD/depression/substance abuse • If person has life experiences that are a little hard, then experience trauma – they are less risk of developing PTSD/depression/substance abuse Acquaintanceship • General population (public perception) feels that stranger rape is worse than familiar with person rape • Husband/boyfriend raping wife/girlfriend – hasn’t always been considered rape – legally it was impossible to be raped by …ts/dbed32b2067e4784bbae48f12df900c8/studyguide.test2.docx 10/8/16, 10▯14 AM Page 1 of 7 your spouse • Look at it in criminal situation – two court cases – guy jumping out of bushes or husband rapes wife – stranger gets a worse sentence • Also more common to be raped by an acquaintance • Victims reactions in this – if you know who your attacker is, you are less likely to report or delay reporting – you are less likely to turn them in because the person doesn’t want to betray that person even though they betrayed you – true with kids who were abused as well – they are still attached • Sexual abuse situation – if kids reveal – they tend to recant – especially young kids because it just came out and then they see it hurts the family and they try to take it back (ex – there dad in jail) • Despite general public perception is stranger rape is worse – the reality is they are not different from acquaintance – they are both just as horrible – there’s no difference except for the reporting – acquaintance ship rate might mess with self- esteem worse • Stranger rape – might have behavior self blame • Acquaintance – more likely to have characterological blame – what kind of person am I to let that person do that? What is wrong with me that attracts that type of man? • Ex – kid stole from me – how did I raise a child that could do this? Peri-trauma variables Peri-trauma Peri-trauma variables – happened during the trauma, type of trauma, level of exposure to the trauma, acquaintanceship status, variables safety, mental defeat, peritraumatic dissociation Prior trauma Childhood trauma become PTSD – could a person have a delyed reaction – it may be that when the person was a child,they didn’t really have the frame of reference of what was happening to them, they didn’t have cognitive functioning to deal with it but then they get older and they can process it – or intimacy as an adult, triggers happen and the trauma becomes present again (VAM/SAM – they have a situationally setup memory) Peri-traumatic Peritraumatic dissociation – memory for it is like swiss cheese (you have gist of what happened but you don’t have the whole dissociation memory of the event) – • Ex – suspected child had been sexually abused but when talking to child – kept bringing up 100 acre woods – Winnie the Pooh – could be possible that child dissociated to happy place (such as 100 acre woods) – memories can come back later on - just not accessible at that moment • Guy that was gang-raped – couldn’t remember sequence of events, the timing of the event – but he remembered smells, and other things • The dissociation can make it worse for a person to where they feel anxious over having holes in their memory – could worsen/ptsd Combat exposure • Length of time can cause trouble • Level = would mean how severe • Frequency = how often (length of time in combat, in country, number of deployments, number of combat related experiences) • Level/severity – lots of people served in Vietnam – cook on a big base – didn’t see combat, still stressful – could hear bombing, sirens – mild severity • Person in infantry – engaged in regular hand to hand combat, more severe • In Vietnam in particular – minorities were more likely frontline infantry • But length of time could fit into that as well – folks were drafted did one stint and that was it but there were others that multiple deployments because they decided to stay in • Some veterans were enlisted – if you enlisted before draft – you had little bit control over what you did – could choose branch of service, your military occupational specialty (job) Natural disaster • Even severe disaster, people reactions are a bit lower trauma • We have this sense that it was just a natural disaster, it’s God maybe, out of our hands • More personal the trauma, the more effect it has on us Threat index • Crime and severity of threat • All levels of crime – threat from physical assault without weapon is less than physical assault with weapon Mental defeat • Giving up, loss of autonomy • Loss of sense of self, loss of identity, how you fit into the world, how does life make sense, how does life have importance, sense that there is nothing you can do about it • Learned helplessness factors in – it’s not just this • Mental defeat is all of this – not just one part • What kinds of trauma would have a hand in this? …ts/dbed32b2067e4784bbae48f12df900c8/studyguide.test2.docx 10/8/16, 10▯14 AM Page 2 of 7 • Probably sexual assault, domestic violence, child maltreatment (severe physical/neglect, sexual abuse), captivity/held hostage • Ex – kid chained to the porch and forced to wear dead chicken around their neck, married couple – woman was a dss worker/superviser – think it was a foster kid (guy was nurse; child had cuts and guy would stitch the kid) • Bastard out of Carolina – mom picked the guy over the child • Combat – because of all of the loss, Vietnam veterans – felt there was no purpose to what they were doing: taking a hill then leaving it; then taking it again • Stockholms syndrome – doesn’t fit because there is a little loss of autonomy but it’s different from mental defeat; it is when someone is kidnapped and then start aligning with their captors (brainwashing), they help their captor keep them – ex – police come, you (the victim) answers the door and says everything is fine – ex – Patty Hearst – niece kidnapped by liberation army and over time she was working with them with robbing banks and committing crimes – when she was caught, she claimed Stockholm syndrome – it’s possible that person can be traumatized by being separated by the captor because you identify with the captor • Treatment would be hard because you feel there is nothing that can be done Safety • If you have a safety appraisal that is higher, the outcome tends to be worse • Ex – you think you are safe in your home and a trauma happens in your home, it’s worse (the reaction to the event is worse then if you were in a dark alley) • More of a betrayal of your sense of self and safety • Acquaintanceship status – you feel safe with someone you know and trust; could be a betrayal • Maybe you feel safe telling your mother you were raped, negative reaction from mom – makes it worse • Safety appraisal is more about location but other things can apply like safety with people • Read the book “The Room” • Chapter 6: resilience Coping • The way we cope with daily stressors isn’t necessarily a helpful way to cope with trauma • Ex – really hard day (hectic, stressed), you go home and have a drink – no big deal – wake up next morning, it’s a new day • Ex – you have a trauma and you drink, you may drink more – you wake up next morning and it’s not a new day, you still experienced the trauma • We use coping as if it’s a good thing – there are good and bad ways to cope – drinking is a way of coping (not effective) • Drinking doesn’t help you figure out how to deal with it – helps you avoid – • Avoidance is ok with little stuff but with trauma reactions – that’s a symptom of the disorder – can be more harmful then helpful • Folks with ptsd/trauma experiences, if you give them instructions to not think about something, when the task is done, they think about it even more – called thought suppression – they are told not to think about it, then they rebound (it comes flooding back) • Coping (graph with • Diagram in book (approach/avoidance graph in notes) – this idea that there are two dimensions to coping quadrants) • We can cope in the approach (you are going towards the issue; doing something active) or avoidance (you are moving away from the issue; not handling it) • Ex of approach – therapy/getting help, talking to friend/family member, actively do something to handle the situation, admitting to yourself that you have a problem • Ex of avoidance – any behavior/activity that prevents you from thinking about it (similar to thought suppression) – distract yourself with tv…or drink/do drugs • The other dimension is emotion or problem focused • Problem focused (behavior focused) – something with actions = exercise, meditation, journaling, going for a drive/clearing your head, talk to other person if you have a problem with them = idea is you are trying to resolve the issue so very solution focused • Emotion focused – something to do with affect, mood, regulating it, not regulating it, paying attention to it or ignoring it = accept/acknowledge there is a problem with yourself (or resign yourself to there is a problem); crying, being angry (frustrated), wallowing, grieving (just sitting there with your emotions), • This is all on dimensions – you will not be on one extreme or the other – some are somewhere in the middle • Trauma specific examples = • There are problem focused approach = therapy, going to police to report rape • Problem focused avoidance = drinking, drugs, “sweep it under the rug” • Emotion focused approach = crying (a good cleansing sad cry helps you deal with the issue; or helps you processing the emotion) • Emotion focused avoidance = displacing (you yell at someone when you are really mad at something else); wallowing/stewing/pity party (feeling sorry for yourself) …ts/dbed32b2067e4784bbae48f12df900c8/studyguide.test2.docx 10/8/16, 10▯14 AM Page 3 of 7 • Generally the upper quadrant have a better coping (the approach coping tends to be more resilient) • Denial may work for day to day stuff; but that type of coping in trauma, it’s more of a risk factor • Resiliency is about how you deal with it after experiencing the trauma • 16% people are resilient Timing on treatment • Critical incident stess debriefing – for first responders – research suggest doing this debriefing too soon can be more after trauma harmful rather than helpful for some people • There is no magic number on when to help • Some people can’t process in that formalized way • Men and women both use avoidance to the same extent; men more likely to avoid with drugs and alcohol • Women avoid by not talking about it • Borderline personality disorder – can individuals with borderline manage their emotions eventually or not? • Dialectical behavior therapy – that is exactly designed to do this • Mindfulness, • Specifically designed for trauma experiencing borderline personality disorder Compartmentalize Attempting to avoid can be detrimental; compartmentalize? Is that avoiding or coping • Compartmentalization – put it away in a box – some people are really good at doing that and can be effective; especially if it’s day to day • With trauma, they try to compartmentalize – it might work for a while but not forever – the box is only so big and stuff will leak out of the box • Some people are really good at compartmentalizing – Dr. Keen uses this as self-care – when hearing the traumatic stuff from people, she’s able to leave it at work • Ex – had a patient with awful trauma history – she was in hospital a lot for self-harm – that was a situation when Dr. Keen worried over the weekend about her whether she might kill herself • If compartmentalizing is not something you are good at, and you are in trauma type work, you must find other forms of self-care Cognitions • Assimilation – “I’m going to vote for this political candidate and there is nothing you can say about it that will change my mind” – this isn’t hurtful necessarily because it’s not trauma – when you don’t adjust your schema; • Accommodation – when you change your schema, that’s accommodation Learned helplessness theory – • Martin Selegman and the dogs – the dogs get shocked on one side of the room and some can jump to the other side; with some dogs, the wall is too tall to jump…over time they won’t try and even with a shorter wall, they will not jump or even try – because they learned to be helpless • Has been applied to domestic violence issues, learning disabilities • Because they learned that they can’t • Has been applied to attribution theory in humans • We make attributions and if they internal (it’s my fault, all about me), stable (it’s always my fault; all bad all the time), global (it happens to be my fault in all situations) • Idea is for people to help/intervene to change this way of thinking is to try to help these people to become a universal helplessness • Idea that these situations are uncontrollable for everyone across all situatons • This is not unique to one person; we all could have something bad happen to us at anytime in any situation For people with internal, stable, global – they need more of the universal Hindsight Hindsight bias bias/justification • “I should’ve known” distortion/wrongdoing • There’s no way you know on Sunday evening what you know on Monday morning distortion • Ex = tv show (this is what you should if this happens) – if you are kidnapped and put in trunk of car, car stops and person chases you with gun – tells the people to escape and run in a zigzag pattern – what if you are that person who forgot to run in a zigzag and then later someone asks you “why didn’t you run in a zigzag” • Problematic way of thinking – I shoulda did this, I shoulda did that • These can lead people to feel guilt, the shame come about; these ideas will continue after the trauma Social support Social support • The actual social support that people have or don’t have • If you are lacking social support – • There is bad social support – where people in your lives do more harm than good …ts/dbed32b2067e4784bbae48f12df900c8/studyguide.test2.docx 10/8/16, 10▯14 AM Page 4 of 7 • Child that is sexually abused whose mother doesn’t believe the child • Or someone telling you “can’t you get over it” • Trauma can result in the loss of support – ex = natural disaster/combat/motor vehicle – other lives can be lost • It could be loss of support because – it’s difficult to interact with a person that has experienced trauma – • Trauma survivors might push their support away • Or sometimes support people might drop away • Many challenges in social support • There is also perceived social support – there has been research done on depression/mental health issues/people in general – perceived social support might be better than your actual support • It’s what you think about your own social support – it your perception is positive, it doesn’t really matter, what you think is important • If your perception is negative, it doesn’t really matter, what you think about the social support is important • Ex = you may have family that really care about you, but if you think their motives aren’t pure or that you’ve always been the scapegoat in the family (regardless of it justified or not), you will perceive them as not being supportive • Ex = you are really rich, your support seems to care about you but it’s superficial but you perceive them as supportive Cognitive appraisals How can cognitive appraisals effect the person effect on a person • Ex = sexual assault – woman/man has been sexually assaulted and they tell loved one – woman might hear “well you must have done something to deserve it” or man “men can’t be raped” • That is that person’s cognitive appraisal that turns into lack of support • They are directly connected Chapter 7 EMDR • Eye movement desensitization and reprocessing • Came about in 1990’s (becoming known) – it met with lots of controversy • Idea behind is that you are supposed to watch a moving target (like metronome or therapist finger/wand) and person follows it with their eyes • When this was first introduced, the idea was the lateral eye movements while thinking/processing the traumatic event is supposed to be therapeutic • There was huge controversy – supporters said it worked and anti said it doesn’t do anything and if it does anything, it doesn’t do anything beyond what cognitive behavioral therapy does because there are cbt techniques in addition to the eye movement • Researchers tried to test with just lateral eye movements – found that does nothing by itself • Francine Shapiro – had to pay $1000’s of dollars to learn the treatment – and some found it not working and then she said there was a part two and that’s why It didn’t work • It has become more popular recently (students/others wanted to be trained in it) • It’s on list of evidence based research – • It could just be increasing awareness (mindfulness) • Ex = seeking safety – dealt with people with dual diagnosis – trauma mixed with substance abuse; one of the guys went into hospital, he came back demonstrating to the group one of the treatments – thought field therapy (tapping) – you have these pressure points in body – things like this come up often Biological Treatment • Medication • There is no ptsd medicine – you have anti depressive, anti anxiety • Typically person will be on a cocktail of meds • Ptsd usually has sleep issues, depression, anxiety – so will be on those to help • Anti anxiety is addictive – • Meds are not a cookie cutter, one size fits all • There are so many meds out there with diff positive and negative side effects and many people are different reactions to the meds • As far as meds, we don’t have anything better – there is a chance that anxiety meds become addictive but there is also chance that person will cope just fine • Ex = when dr. keen worked at va, saw patients once a week – they would see their psychiatrists for 15 min every 6 monthsand they are the one that manages their meds • Medications have their purpose but they should be done in concert with therapy – the meds are just a bandaid – injury is still there underneath – therapy helps with the healing – gives people the tools they need • Meds are easier and not as stigmatizing as going to psychologist • Ssri’s are not permanent – they prevent the reuptake of the neurotransmitters in the synaptic cleft – keeps the neurotransmitters active for a longer time – prevent it from being metabolized …ts/dbed32b2067e4784bbae48f12df900c8/studyguide.test2.docx 10/8/16, 10▯14 AM Page 5 of 7 • People with lower levels of serotonin – doesn’t increase serotonin, just slows down metabolizing process • If someone is unable to sleep, or so depressed/anxious to even engage in therapy – that is when a psychologist sends the person to a psychiatrist • When engaging in trauma therapy, part of it is exposure (re-experiencing through story, narrative) – if you are on meds that block the feeling you should be having, that wont help either • Ex – guy that had been gangraped – he was on valium – he realized that exposure therapy wasn’t working, so he stopped taking valium before the therapy • Exposure therapy – you need the arousal symptoms because the exposure will help to decrease the physiological symptoms • Propranolol – controversial – touted as medication that helps people forget (not really what it does) • Prescribed for people with ptsd to help forget trauma – it actually helps to break the connection between the memory and the emotion – you still remember what happened but you don’t have same emotional connection to the those memories • Some say it should be prescribed shortly after trauma, but there are some a little longer after the trauma • It interacts with norepinephrine – it doesn’t change hippocampal/amygdala structure but it changes the functioning • Was a heart med first, but now ptsd, performance anxiety – helps modulate the emotion Definitions • Psychologist – do not prescribe meds (although there are some states that allow psychologist to do so) • Psychiatrist – they are md and can prescribe meds • Psy D degree – more focused on clinical training • Psy PHD – more focused on research • Ex – woman had borderline/physical pain/substance abuse/ptsd – she was forced into therapy because she got caught filling multiple pain meds (in recovery for substance abuse problems) – she had psychiatrist through va and was on benzodiazapene – she saw dr. keen and was horribly stressed and she wanted her benzo increased – dr. keen tried to help her with non medicated ways of dealing – psychiatrist was not going to up her meds but ended up doing it – there was tons of emotion from woman, you could feel her stress – dr keen couldn’t prescribe and thankful she wasn’t psychiatrist Psychodynamic • Idea with psychoanalytic therapy – focused on early childhood experiences, focused on inner psychic conflict, the therapy personal distress of yourself • Transference – the patient projects/transferring your emotions onto the therapist • Counter-transference – therapist does that to patient • Therapy- is about the relationship in the room, it’s an indication of how you relate to people in your life • You treat your therapist the way you might treat your mother • The therapist may treat/view the patient as their child/parent • That relationship is important, it’s not ignored, it’s addressed in the room and used in therapy • Ex = patient sold by parents in sex ring, rallied clinical team to help him – that is psychodynamic idea – in therapy, would talk to him about what it means to have the whole team help with your recovery and how does that relate to the trauma you experienced Critical distress • Crisis intervention immediately after trauma for firs-responders that are exposed to trauma on a regular basis (can be therapy done in group setting) • There’s mixed research on whether this is effective or not • Some research shows that it makes it worse – this has been highlighted – shouldn’t blanket use this on everyone • If people don’t need it, then they have it, makes them focus on something more than they needed to • Not everyone needs to process everything • Good compartmentalizer – don’t need to dredge it up to deal with it • Initial idea was one session and known as wonder cure – but now extended in 4 sessions or more Cognitive behavioral • Most research has been done here therapy • In general, found to be a therapeutic strategy • Idea is there is cognitive component and behavioral componenet • Cognitive addresses the thoughts – are you having thoughts of shame, self-blame, sense of loss? Different for each person and different for each trauma • Combat/natural disaster – might be more about loss • Rape – might be more blame and shame • Resick – cognitive processing therapy – form of cbt but focuses more on cognitive than behavioral (ex – gangraped patient, used this therapy) • Behavioral piece – exposure therapy – more gradual systematic desensitization • With exposure, you can have imaginative or in vivo (live) – makes sense for woman who won’t go to parking garage – can’t have your trauma again but can expose yourself to things that were associated with the trauma • Make list of things that cause the anxiety – then do each of the things • In vivo – doing it in live …ts/dbed32b2067e4784bbae48f12df900c8/studyguide.test2.docx 10/8/16, 10▯14 AM Page 6 of 7 • Imaginative – creating a story and reliving it in that way • The idea is to break the connection between anxiety and the thing itself (helps with anxiety symptoms like heart rate, sweating…) • Desensitization helps with triggers (because that’s when you are avoiding); triggers happen because you avoid but you can’t always avoid – desensitization will help triggers have less power • Ex – patient with grilling meat – you can’t avoid that forever, when the trigger happens because you didn’t figure out a way to cope – by confronting, you can handle triggers better • Research shows that cbt - Most effective in most situations and has longer lasting effects (6mths; yr later – they still have benefit from it) • Stress and inoculating therapies – similar to cbt Socratic style • Socratic style – supposedly Socrates had this style of not giving answers but turning questions around to more questions • It’s infuriating but it’s more helpful • Process of figuring out the answer is a learning tool • In therapy, it’s good if person figures things out for themselves • “why do you think it’s important?” “what do you think you should do?” • Helping patient come to their own realizations • This is common and popular – helps the person more – Acceptance therapy • First wave of psychotherapy – behavior therapies (exposure/desensitization) • Second wave of psychotherapy – traditional cognitive therapy, combo of cognitive/behavioral • Third wave of psychotherapy (where we are now) – moves away from the cognitive piece acceptance therapies - moving away from cognitive piece – cognitive therapy is criticized as being harsh because the premise is you need to change the way you think –some people think that that is wrong “how you think is how you think and to tell people how to think is like a slap in the face” – cognitive says you need to get rid of your guilt and shame • now the thought is it’s ok to feel the guilt and shame – no need to change them but accept them Acceptance commitment therapy • ACT – acceptance commitment therapy – more behavioral than traditional cognitive/behavioral – but not strictly behavioral – there is cognitive but it’s different in that you are accepting your thoughts, not changing the way you think – accept the guilt and shame because it’s ok and then move on • Stephen Hayes developed ACT – thoughts are just thoughts, they don’t have to rule your behavior, but they are your thoughts – has lots of strategies like analogies… that help you see that your thoughts are ok, given what you have gone through, it’s appropriate that you would have that thought, you don’t have to act on that thought or let it govern your behavior • Ex – patient with substance problem – his thoughts/cravings were about using – he thought he had to give into it – so therapy was around where he didn’t have to give into it and use Dialectical behavioral therapy • Dialectical behavioral therapy – (Marsha Linahan) mindfulness, interpersonal affectiveness, distress tolerance – • mindfulness – paying attention to what’s going on in the moment – living your life in a way where you pay attention to what’s going on in the moment – helps with avoidance • distress tolerance – to be able to tolerate distress –acceptance comes in – life is not about trying to forget distress, you have negative emotions and it’s ok to have negative emotions – then try to manage the emotions as they come – it’s not realistic to say you won’t be sad or anxious again, trying to forget it can make it worse • interpersonal effectiveness – about interactions with people – people with borderline personality disorder that have intense stressed social relationships – helps to combat that • Changing your thoughts but not in a way of getting rid of them - …ts/dbed32b2067e4784bbae48f12df900c8/studyguide.test2.docx 10/8/16, 10▯14 AM Page 7 of 7


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