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A Special Word of Thanks….

A Special Word of Thanks….

The Governing Board wishes to express or deepest appreciation and gratitude to ASAP President Joe Kenan, M.D .for his special efforts to make the 2010 annual meeting in Los Angeles a success. In particular, we thank you for arranging the special evening events and hosting us with refreshments paid at your expense. It was great, Joe, and you have our deepest thanks.   Dean DeCrise, Greg Bunt, Sheldon Glass, Greg Barclay, Manuel Lopez-Leon, Gregg Dwyer, Chris Thompson, Adam Raff, Frances Bell &  Fabian Saleh

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From Our Members

From Our Members….

  • Thomas Wilkes, M.D. was awarded the Friends of Canada in October, 2009 for his work in securing the bid to host the 2016 IACAPAP meeting in Calgary
  • Lois T. Flaherty, M.D., past-president of ASAP and Editor of Adolescent Psychiatry, the Annals of the American Society for Adolescent Psychiatry was the recipient of the APA’s Distinguished Service Award at its recent annual meeting in New Orleans.
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From the Editor…

BY Gregory P. Barclay, M.D.

In this summer edition of our society newsletter, I am pleased to introduce a lead article written by our President-Elect, Dean DeCrise, M.D. This article relates to the implications of Megan’s Law when applied to adolescents who commit sexual offenses. This is one of several controversial issues in which ASAP is considering taking a position and for which we have reactivated our newly formed Committee for Legislative and Judicial Affairs. I asked Dean to prepare this article so that our membership have a better understanding of the Megan’s Law issue before the council takes it up at our next business meeting. For those of you who were at our 2010 annual scientific meeting in Los Angeles, Dr. DeCrise’s article summarizes his excellent presentation on the treatment of adolescent sexual offenders. And, for those of you unable to attend our meeting, please don’t despair. We have also included Dom Ferro’s  summary of  the outstanding keynote presentation given by Schonfeld Award Recipient Harold Koplewitz, M.D. as well as our usual photo gallery of presenters and ASAP members hard at work in Los Angeles.

All of this edition’s articles and book reviews have a common connection – the developing adolescent brain. With the advent of functional MRI and other imaging procedures, there is now undeniable proof of what we who work with adolescents know from clinical experience: The adolescent brain is in a state of massive change and uneven development, the result of pruning with increased white matter and diminishing gray matter through to age 24 or later. Hence, their impulsivity, emotional over-reactivity, and cognitive immaturity have clearly established origins in brain development and are only influenced to a degree by hormones and sociocultural variables. This fact alone is of enormous significance to us as an organization established to advocate for adolescents, especially with the current trends to try adolescents who commit crimes as adults, invoking the death penalty for adolescent criminals, and, as Dr. DeCrise states in his summary, applying Megan’s Law to youthful sexual offenders.

In his president’s column, Dr. Joe Kenan describes the changes in ASAP’s membership and finances over the past decade. We are also sad to note the passing of some ASAP giants, Mike Kalogerakis, James Masterson, and Everett Dulit. The challenge before us at this time is how we can grow and adapt, as a society to advocate for adolescents with mental health and substance abuse problems, to meet current reality vs. the alternative of atrophying into irrelevance. It is key for our membership to become engaged and involved. ASAP membership is now open to non-psychiatric physicians and non-physician licensed mental health professionals, as well as continuing to offer reduced-cost membership to trainees. If we each recruited one member, our society would increase to 400 members! That alone might allow us some semblance of a return to those “hey days” conferences Dr. Kenan speaks of in his president’s column and grant us more legitimacy as an advocacy organization.  It might also allow us to print and mail our newsletter once again! We all know colleagues with a passion for working with teens, so what is holding us back? Do consider asking a colleague to join, plan to attend our annual meeting in New York March 26-27, 2011, pay your dues on time, and join a committee or council (we have openings on the Governing Board and the Committee for Legislative and Judicial Affairs).

Finally, I continue to welcome any contributions to our newsletter. Please ask any residents or students interested in getting something published to contact me. Or, if you have something of your own (including poetry) to submit, or have a passion for reading and writing book reviews, drop me a line at gpbmd@aol.com.

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Book Review Corner…

Gregory P. Barclay, M.D., Newsletter Editor

Editor’s note: In this edition, I am pleased to summarize 3 books I have recently read. They all relate to a common theme, which is how our increasing understanding of neuroscience helps us to understand and re-define the process of psychotherapy. As professionals with particular interests in adolescents, it is essential that we have a thorough and updated education in neuroscience, since what we are learning about the adolescent brain has enormous impact on how we conduct treatment and what we should expect from patients at an individual level. Moreover, as a society, our growing understanding of the adolescent brain moves us into the forefront of highly charged societal issues, including the controversies of trying adolescents who commit violent crimes as adults, invocation of the death penalty for adjudicated delinquents, and as Dr. DeCrise explains in his article, the requirement that youthful sexual offenders be placed on public monitoring.

The Behavioral Neuroscience of Adolescence, by Linda Spear, Ph.D. (2009, New York, Norton Professional Books), 368 pgs, hardcover. $40 US.

This book was presumably written for professionals without advanced training in neurosciences as well as those with more formal training and experience in the area. Even though I was in the latter group, I found myself challenged as I attempted to recall the basics of neuroanatomy and neurophysiology I learned 30 years ago as a medical student and later on during my residency in psychiatry. As a professional with that knowledge, I found Dr. Spear’s book to be a refreshing and comprehensive review of our current understanding of the teen brain. However, I would doubt that other professionals without advanced training in neurosciences would be able to grasp or fully comprehend the subjects as presented. For psychiatrists who work with adolescents, though, this book is one definitely to purchase and read, as the information it contains influences our expectations and approaches to adolescents in our daily work with them.

The book is divided into two sections. The first reviews overall brain structure, function, and development as influenced by evolutionary, genetic, hormonal, neural, and sociocultural factors. The interaction of these produce distinctly adolescent behaviors and thought processes that are reviewed in the book’s second section. Those later chapters include detailed reviewed of the neurodevelopmental basis of adolescent risk taking, social behavior, and cognitive capacities, as well as the basis for emergence of psychological and drug abuse disorders during adolescence.

This book is an excellent resource for any professional who works with adolescents.  I found the use of bullets and italicized first sentences of paragraphs to be especially helpful for doing a quick read and review.

What Freud Didn’t Know - A Three-Step Practice for Emotional Well-Being through Neuroscience and Psychology, by Timothy B. Stokes, Ph.D. (2009, Rutgers University Press), 210 pgs., hardcover, $24.95 US

Although this book is intended for the lay person who struggles with emotional regulation problems, I found it to be a very useful book from my perspective as a treating provider. As its title suggests, Timothy Stokes reviews how Freud’s fundamental concepts of the Id, Ego, and Superego now are best understood as corresponding to brain regions of varying degrees of connectivity and maturity. He develops the concept of “Amygdala Scripts” and reviews how powerful emotional experiences are stored instantaneously in the amygdale and subsequently “hijack the neocortex”. This process  is at the root of what maintains negative and distorted cognitions and compensatory maladaptive behavior, and therefore “mastering” the amygdale scripts is the core of his 3-step practice.

The 3-step practice is essentially a self-help style simplification of what is accomplished in Eye Movement Desensitization and Reprocessing (EMDR) and Dialectical Behavior Therapy. Dr. Stokes provides guidance on how to first establish an enhanced state of mindfulness so as to allow for access to deeply buried Amygdala scripts. Consequently, it is possible to develop enhanced insight to facilitate the mastering those scripts and attaining the third step, which is belief change. Throughout the book, there are examples and exercises designed for the motivated lay person to accomplish meaningful change. Dr. Stokes makes it clear, however, that many individuals with these problems require a much higher level of treatment delivered by a trained professional.

This book is useful to have on your shelf to share with a highly motivated and intelligent patient with emotional regulation problems, as it may assist them before committing to an extensive course of EMDR or DBT. It is also a good reference for patients already participating in psychotherapy.

Changing Minds in Therapy – Emotion, Attachment, Trauma, & Neurobiology, by Margaret Wilkinson (2010, New York, Norton Professional Books), 248 pgs., hardcover, $32 US.

This book is designed as a resource for therapists who conduct long term therapy with patients with trauma histories and/or disturbed early attachments. Dr. Wilkinson explores the dynamics of brain-mind change in therapy utilizing current research. She describes the neural basis of attachment, attunement, and affect regulation and how their development is influenced by our earliest attachments. Disruption of this process leads to observed changes in the orbitofrontal cortex where those experiences are initially encoded and consequently dictate how we experience emotion and relationships later in life. Dr. Wilkinson skillfully demonstrates with case examples how problems with attachment and attunement lead to clinical problems seen in the therapist’s office and how proper attunement by the therapist is central to the repair process.

Dr. Wilkinson’s book is divided into two sections. The first introduces the reader to the neurobiology of attachment, attunement, and affect regulation. In particular, she emphasizes how the right brain matures earlier than the left, and therefore how disruptions in attachment and attunement occurring at a very early age leave their residua in the right limbic structures, the Amygdala in particular. Since the ability to form memories with a verbal narrative occurs later and generally involves the left hippocampus, patients with early trauma experience right brain-mediated emotions in relationships that they neither understand nor can regulate unless therapeutic work is done to enable the left brain to neutralize the right. Dr. Wilkinson’s approach is a more traditional one in which she utilizes the therapeutic relationship itself over the course of time as the medium through which the repair process occurs. In this respect, she differs from the more contemporary therapies yet the general principles, e.g. harnessing the right limbic system with the left prefrontal cortex remains the same.

I found this to be a fascinating book because I have a particular clinical interest in adoption and attachment-related disturbances. In that respect, this is a good book for clinicians with similar interests who desire a deeper understanding of the neurobiology involved.

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In Memoriam

BY Lois T. Flaherty, M.D.

James F. Masterson, M.D.

James F. Masterson died at the age of 84 on April 12 in Greenwich Connecticut from complications of pneumonia. He was a psychiatrist and psychoanalyst who was one of the founders of ASAP and was Past-President of the New York SAP. He often spoke at our meetings and contributed to the Annals. He was a Schonfeld Award winner in 2001. He was well known as an expert on narcissism and borderline personality disorder, and described manifestations of these conditions throughout the life cycle, including in adolescence.  He was among the first, along with Heinz Kohut and Otto Kernberg, to apply object relations theory to the understanding and treatment of personality disorders, maintaining that these disorders had their roots in infancy and early mother-child relationships. Dr. Masterson believed that these disorders crucially involve the conflict between a person’s two “selves”: the false self, who the very young child constructs to please the mother, and the true self.

An article in Wikipedia (http://en.wikipedia.org/wiki/James_F._Masterson ) states:

In 1993 Masterson proposed two categories for pathological narcissism, exhibitionist and closet. Both fail to adequately develop an age- and phase- appropriate self because of defects in the quality of psychological nurturing provided, usually by the mother. The exhibitionist narcissist is the one described in DSM-IV and differs from the closet narcissist in several important ways.

The closet narcissist is more likely to be described as having a deflated, inadequate self perception and greater awareness of emptiness within. The exhibitionist narcissist would be described as having an inflated, grandiose self perception with little or no conscious awareness of the emptiness within. Such a person would assume that this condition was normal and that others were just like them.

The closet narcissist seeks constant approval from others and appears similar to the borderline in the need to please others. The exhibitionist narcissist seeks perfect admiration all the time from others.

In 1977 Masterson established The Masterson Institute for Psychoanalytic Psychotherapy in New York. The institute offers psychoanalytic training at its headquarters in Manhattan, its West Coast branch in San Francisco and, via the Internet, locations around the world. He was long associated with the Payne Whitney Clinic, where he headed the adolescent program, and at his death he was clinical professor emeritus of psychiatry at Weill Medical College of Cornell University.

Dr. Masterson, authored many books, including “The Psychiatric Dilemma of Adolescence” (Little, Brown, 1967).

The New York Times obituary on April 18 noted. “Dr. Masterson became so well known as an expert on narcissism that he sometimes attracted patients for whom only a high-profile therapist would do — in other words, narcissists. In the 1980s, after The New York Times cited him as an authority on the disorder, he received a dozen calls from people wanting treatment.

Too busy to accept new patients, Dr. Masterson referred the callers to his associates. As The Times reported in 1988, not a single one made an appointment.” <http://www.nytimes.com/2010/04/19/us/19masterson.html>.

Dr. Masterson is survived by his wife, Patricia, whom he married in 1949; two sons, Jim and Richard; a brother, Richard; a sister, Joan Masterson; and three grandchildren. We will miss him.

Michael G. Kalogerakis, M.D.

Lois Flaherty, M.D. and Shelley Doctors

Dr. Michael G. Kalogerakis, 83, died suddenly on March 14 while on vacation in Florida. A psychiatrist and psychoanalyst, he was Past-President of the American Society of Adolescent Psychiatry (1978-1979) and winner of the Schonfeld Award. He also served two terms as President of the International Society for Adolescent Psychiatry and Psychology. He was a beloved friend, colleague and mentor to many in both organizations.

In addition, Mike, a long-time New Yorker, was the former Associate Commissioner for Children and Youth, at the New York State Office of Mental Health.  As Clinical Professor of Psychiatry at NYU School of Medicine, and the former Director of Adolescent Services at Bellevue Psychiatric Hospital, he trained a generation of young psychiatrists, stimulating in many a passion for the study of adolescence and the pursuit of lifelong careers as adolescent psychotherapists.

Mike served as a Board member for 25 years for the Citizen’s Committee for Children of New York, the oldest child advocacy organization in the U.S., and was President of the Kenworthy-Swift Foundation.  Michael worked tirelessly on task forces and committees of the American Psychiatric Association and the American Society for Adolescent Psychiatry, as well as on various advisory committees, in his ceaseless efforts to improve services to violent and/or delinquent adolescents who came to the attention to the juvenile justice system.  Dr. Kalogerakis wrote over thirty book chapters and articles and was the editor of The Handbook of Psychiatric Practice in the Juvenile Court, published by the American Psychiatric Press, Washington, D.C., in 1992.

His dedication to adolescents influenced countless individuals and organizations locally, nationally, and internationally.  Mike’s infectious enthusiasm won him friends wherever he went.  It didn’t take long before he was able to speak to new friends in their own language–Spanish, Portuguese, French, Greek, and others we’re certain he would have modestly asked us to omit from mention.  Dan Offer, writing in the New York Times online guestbook for Mike, expressed the feelings of many in saying, “I had the privilege of knowing Mike as a colleague and friend for at least 40 years. We shared joint interests in adolescent psychiatry and I considered him one of the wisest and most vivacious persons that I have ever known. We would always meet at the national meetings, have coffee or lunch and share experiences, opinions, and yes, of course, jokes. I will miss him.” Mike is survived by his wife Kay and his two sons, Alexi and George and their families. Alexi is a child and adolescent psychiatrist practices in New York; George is a New York Times reporter who chronicled trips with his father, including a 2007 family cruise off the coast of Turkey to celebrate Mike’s 80th birthday in (Three Generations on One Tiny Ship < http://travel.nytimes.com/2009/09/06/travel/06personal.html>).
Everett Dulit, M.D.

Everett Dulit, M.D. a long time member of ASAP passed away on June 2, 2010.   He had been ill for some time but died at home in his bed and surrounded in his last weeks by his wife, children, extended family, and friends.

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From Our Members

From our members…

  • Daniel Offer M.D. retired from Northwestern University Medical School as Professor of Psychiatry and Behavioral Sciences on September 21, 2008. He became Professor Emeritus at Northwestern’s commencement on June 19. 2009.
  • V. Cox, M.D. is still “considering retiring”.
  • Charles L. Ragan, II, M.D., MBA, CPE was made a Fellow of the American Academy of Psychoanalysis and Dynamic Psychiatry in April 2005, and a Diplomate (Certified Physician Executive) of the American College of Physician Executives in October, 2007. He earned his MBA at Southern Methodist University if May, 2001.
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About Parental Alienation and DSM-V?

Every adolescent psychiatrist should know about and thoroughly understand the condition of “mental alienation”.  A large group of mental health and legal professionals have submitted formal proposals to include parental alienation in DSM-V and ICD-11.  ASAP member, William Bernet, M.D., has organized this international effort.  Dr. Bernet says  “Our definition of parental alienation is:  a mental condition to which a child – usually one whose parents are engaged in a high-conflict divorce – allies himself or herself strongly with one parent (the preferred parent) and rejects a relationship with the other parent (the alienated parent) without legitimate justification.  There is nothing controversial about this definition.  Almost everyone who evaluates, treats, or conducts research on children of divorced parents agrees that parental alienation – as the concept is defined in our proposal – really exists and is a serious problem.”

You will soon be able to read the proposals regarding parental alienation. Look for: Parental Alienation Disorder and DSM-V, American Journal of Family Therapy, 2010, in press.  Also, for more information, contact william.bernet@vanderbilt.edu

or Joe Kenan, M.D.

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Did you know?

by Gregory Barclay

…That the ASAP Council on Topical Studies has been reactivated?

Joe Kenan, M.D is the Chair

This council addresses controversial issues in the field of adolescent psychiatry with the intention of assisting the governing board in making a position statement. Among the issues currently being considered is:

  • The Graham & Sullivan vs. Florida Supreme Court case relating to adolescent competency to stand trial as an adult
  • The psychological impact on children when adopted by LGBT couples

Are you interested in contributing to ASAP in a meaningful way? Have you ever wanted to be a part of big policy decisions? Please consider volunteering to participate in this council. Councils typically meet annually at the March ASAP Scientific Meeting. Accordingly,next year’s new council will convene during our annual meeting in Los Angeles, March 6-7, 2010. If you are interested, please contact Frances Bell at (972) 613-0985 or via email: adpsych@aol.com.

Gregory P. Barclay, M.D.

Editor

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Hello Hollywood

Jim Gilfoil, M.D.

Hey, aren’t you glad we’re not at the beach in Santa Monica or downtown with all that culture?  No, we’re in the “real LA”–Hollywood.  No more of that ersatz stuff, just the real deal.  This is the place that, according to Harvey Weinstein, when referring to freeing Roman Polanski, “has the best moral compass because we have compassion.”  And modesty too.  Well, hopefully we won’t run into him.  We will be staying at a chic boutique hotel, Le Petit, where “bohemianism is a way of life,” at least according to the website.  Hey, I’m in.  And, we will, of course, be dining out with the stars per usual.  Here are my best bets.

What may well be the hottest table in town hadn’t opened at the time I wrote this article, but Thomas Keller’s Bouchon Beverly Hills promises to be intimate with only 17,000 Sq. ft. (!) of indoor and outdoor space and hopefully elegant with a  $12M price tag.  You know it’ll be good, with his so far successful formula—let’s just hope it’s more bistroy and not totally impossible to get in.  We’ll see.  One to avoid, however, is XIV unless you’re totally into the scene instead of the food.  Nobody in LA would be like that.  It’s a seriously overwrought and overpriced disaster from another celebrity chef, Michael Mina.  Unless you’re a true masochist with very deep pockets, don’t go.

Several exciting new restaurants have opened in LA since we were there three years ago.  You may recall Jose Andres from DC and his restaurants Jaleo, Café Atlántico, and Minibar. His The Bazaar has been getting well-deserved rave reviews:   Esquire magazine just selected it their Restaurant of the Year.  As you would expect, it’s all about tapas in this Phillipe Starck designed space.  There is plenty of showbiz with that liquid nitrogen thing going with the drinks, and the menu is wonderfully inventive, without being precious or overwrought—enough to woo the most jaded taste buds.  Try the foie gras lollipop or the “Philly cheese steak” or any of the other fabulous creations.  A must!

Next on my list is Rivera in downtown LA.  Chef John Rivera Sedlar, who had the wonderful Abiquiu in Santa Monica a few years back (remember the restaurant scene in the movie Get Shorty), has done it again.  Dubbed by LA Times restaurant critic Irene Virbila, “one of the most exciting restaurants to debut in LA in the last few years,” and also picked in Esquire as one of the best new restaurants in the country, Rivera is a pan-Latin marvel.  Don’t be put off by dishes like “dog’s snout salsa,” or all the chilies, for Sedlar doesn’t overdo the heat.  He helps you appreciate the complexities in Latin, mainly Mexican, cuisines.  Virbila says his take on duck confit has “to be the best in town right now.”  Throw in great margaritas, terrific tequila-based cocktails, and outstanding wines from Spain, Portugal, and South America, and I’m there.  I will have a designated driver though.

If I’m going to do French this trip, it’ll be at RH at the Andaz in the Andaz West Hollywood Hotel on Sunset Strip.  Sebastian Archambault does a masterful job of updating the cooking of southwest France—think Dordogne and foie gras.  He’s got great terrines, outstanding duck confit, a poached egg with mushrooms, foie gras, and truffles on top, and a burger with foie gras and mushrooms.  Needless to say, if you don’t like foie gras, don’t go.  That just leaves more for the rest of us.  By the way, for you untouchables, Andaz means “personal style” in Hindi.  Can’t think of a better name for the LA scene.

Two other possibilities are restaurants that have reinvented themselves—Bastide and Wilshire.  Bastide is on its fourth chef, and it’s finally gotten the attitude makeover it needed.  The food was always good, the setting is magical, but, whoa, that arrogance.  It made the French seem humble.  Anyway, they alienated so many over the years, that they had to come back to reality, and they have with a bang.  New chef Paul Shoemaker, of Providence fame, is cooking up a storm with French-Asian creations paired with some of the best wines in town.  Chef Andrew Kirschner has transformed Wilshire from a hip bar scene place into a serious dining room to be reckoned with.  He showcases the best of California cuisine today, so consider it.

What about old and not so old favorites?  Well, Cut, Wolfgang Puck’s ode to steak, is still going strong, as is Spago.  Pizzeria Mozza and Osteria Mozza need to be on your short list too.  If you’ve been hiding in those caves somewhere in Afghanistan, maybe you don’t know of these two, but Nancy Silverton, a well-known bakemeister, and Mario Batali have combined to wow the unwowables in LA with the greatest pizza this side of Naples and other terrific Italian fare.  I’ve always found Batali’s food to be just a touch inconsistent, but try one or both if you can just to prove me wrong.  Providence is still superb, as is Suzanne Goin’s—daughter of former APA president Marcia—Lucques. So, that ought to keep you busy, just make sure your wattage is up to it.  See you in Tinsel town!

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What happened to The American Board of Adolescent Psychiatry?

Gregory P. Barclay, M.D., Editor

On August 1, 2009, The American Board of Adolescent Psychiatry (ABAP) ceased to exist as an independent organization, the result of a planned merger with The American Society of Adolescent Psychiatry (ASAP). ASAP has assumed full responsibility for the re-certification process for all of the current ABAP Diplomates. In addition, the day to day administrative procedures, staff and offices remain unchanged since heretofore they were handled by Francis Bell, ASAP’s Executive Director. In particular, records and certification will continue to be maintained with the same integrity as in the past.

A new Council on Certification in Adolescent Psychiatry has been developed, and the former ABAP functions will be assumed by this new council. Accordingly, Richard Ratner, M.D. has assumed the duties of Chair of the Council on Certification in Adolescent Psychiatry.

In addition to maintaining the certification status for existing Diplomates, the Council on Certification in Adolescent Psychiatry is committed to developing a new certification exam.  The Council will be working on this task in the months ahead and is seeking input from ASAP members and ABAP Diplomates in its development. If you are interested in assisting us with this process, please contact Frances Bell.

We are happy to see this merger finally come to pass, as it allows for the process of Certification in Adolescent Psychiatry to continue under the sponsorship of the only national organization devoted exclusively to Adolescent Psychiatry. We invite all ABAP Diplomates who currently are not members of ASAP to join at this time.  In addition to the many individual benefits of membership, a strong ASAP will help strengthen our identities and the value of our certifications as adolescent psychiatrists in difficult times.  Prospective members may check our websitewww.adolpsych.org, or contact Frances Bell at (972) 613-0985 for a copy of the most recent Newsletter and a membership application.

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