出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2013/02/11 10:09:54」(JST)
Suicide | |
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Classification and external resources | |
The Suicide by Édouard Manet 1877–1881 |
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ICD-10 | X60–X84 |
ICD-9 | E950 |
MedlinePlus | 001554 |
eMedicine | article/288598 |
MeSH | F01.145.126.980.875 |
Suicide (Latin suicidium, from sui caedere, "to kill oneself") is the act of intentionally causing one's own death. Suicide is often committed out of despair, the cause of which is frequently attributed to a mental disorder such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse.[1] Stress factors such as financial difficulties or troubles with interpersonal relationships often play a role. Efforts to prevent suicide include limiting access to firearms, treating mental illness and drug misuse, and improving economic development.
The most commonly used method varies by country and is partly related to availability. Common methods include: hanging, pesticide poisoning, and firearms. Over one million people die by suicide every year, making it the 10th leading cause of death worldwide.[1] Rates are higher in men than in women, with males three to four times more likely to kill themselves than females.[2] There are an estimated 10 to 20 million non-fatal attempted suicides every year.[3] Attempts are more common in the young and females.
Views on suicide have been influenced by broad existential themes such as religion, honor, and the meaning of life. The Abrahamic religions traditionally consider suicide an offense towards God due to the belief in the sanctity of life. It is often regarded as a serious crime in modern Western thought. In ancient Greek and Roman culture suicide was not seen as automatically immoral and during the samurai era in Japan, seppuku was respected as a means of atonement for failure or as a form of protest. Sati, a now outlawed Hindu funeral practice, expected the widow to immolate herself on her husband's funeral pyre, either willingly or under pressure from the family and society.[4] In the 20th and 21st centuries, suicide in the form of self-immolation has been used as a medium of protest, and kamikaze and suicide bombings have been used as a military or terrorist tactic.
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Suicide also known as completed suicide is the "act of taking one's own life".[5] Attempted suicide or non fatal suicidal behavior is self injury with the desire to end ones life that does not result in death.[6] Assisted suicide is when one individual helps another bring about their own death indirectly via providing either advice or the means to the end.[7] This is in contrast to euthanasia where another person takes a more active role in bringing about a persons death.[7] Suicidal ideations are thoughts of endings ones life.[6]
Factors that affect the risk of suicide include psychiatric disorders, drug misuse, psychological states, cultural, family and social situations, and genetics.[9] mental illness is one of the primary causes[10][11] and frequently co-exists with substance misuse.[12] Other risks include availability of a means to commit the act, family history of suicide, and traumatic brain injury.[13] For example suicide rates have been found to be greater in households with firearms than those without them.[14] Socio-economic factors such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts.[15] About 15–40% of people leave a suicide note.[16] Genetics appears to account for between 38% and 55% of suicidal behaviors.[17]
Mental disorders are often present at the time of suicide with estimates from 27%[18] to more than 90%.[19] Of those who have been admitted to a psychiatric unit there life time risk of completed suicide is about 8.6%.[19] Major depression may be present in half of suicides and increases the risk 20 fold.[20] Other conditions implicated include schizophrenia (14%), personality disorders (14%),[21] bipolar disorder,[20] and posttraumatic stress disorder.[19] About 5% of people with schizophrenia die of suicide.[22] Eating disorders are another high risk condition.[23]
A history of previous suicide attempts is the greatest predictor of eventual completion of suicide.[19] Approximately 20% of suicides have had a previous attempt and of those who have attempted suicide 1% complete suicide within a year[19] and more than 5% commit suicide after 10 years.[23] While acts of self-harm are not seen as suicide attempts, the presence of self-injurious behavior is related to increased suicide risk.[24]
In approximately 80% of completed suicides the individuals has seen a physician within the year before their death,[25] including 45% within the prior month.[26] Approximately 25–40% of those who completed suicide had contact with mental health services in the prior year.[18][25]
Substance abuse is the second most common risk factor for suicide after major depression and bipolar disorder.[27] Both chronic substance misuse as well as acute intoxication are associated.[12][28] When combined with personal grief, such as bereavement, the risk is further increased.[28] Additionally substance misuse is associated with mental health disorders.[12]
Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they commit suicide[29] with alcoholism present in between 15% and 61% of cases.[12] Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide[30] with this link being primarily related to distilled spirit use rather than total alcohol use.[12] About 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by suicide.[30] Alcoholics who attempt suicide are usually male, older, and have tried to commit suicide in the past.[12] Between 3 and 35% of deaths among those who use heroin are due to suicide (approximately 14 fold greater than those who do not use).[31]
The misuse of cocaine and methamphetamines has a high correlation with suicide.[12][32] In those who use cocaine the risk is greatest during the withdrawal phase.[33] Those who used inhalants are also at significant risk with around 20% attempting suicide at some point and more than 65% considering it.[12] Smoking cigarettes is associated with the risk of suicide.[34] There is little evidence as to why this association exists; however it has been hypothesized that those who are predisposed to smoke are also predisposed to suicide, that smoking causes health problems which subsequently make people want to end their life, and that smoking affects brain chemistry causing a propensity for suicide.[34] Cannibis however does not appear to independently increase the risk.[12]
Problem gambling is associated with increased suicidal ideation and attempts compared to the general population.[35] Between 12 and 24% pathological gamblers attempt suicide.[36] The rate of suicide among their wives is three times greater than that of the general population.[36] Other factors that increase the risk in problem gamblers include mental illness, alcohol and drug misuse.[37]
There is an association between suicidality and physical health problems including:[23] chronic pain,[38] traumatic brain injury,[39] cancer,[40] those on hemodialysis, HIV, systemic lupus erythematosus, among others.[23] The diagnosis of cancer approximately doubles the subsequent risk of suicide.[40] The prevalence of increased suicidality persisted after adjusting for depressive illness and alcohol abuse. In people with more than one medical condition the risk was particularly high, suggesting a need for increased screening for suicidality in general medical settings.
Sleep disturbances such as insomnia[41] and sleep apnea are risk factors for depression and suicide. In some instances the sleep disturbances may be a risk factor independent of depression.[42] A number of other medical conditions may present with symptoms similar to mood disorders including: hypothyroidism, Alzheimer's, brain tumors, systemic lupus erythematosus, and adverse effects from a number of medications (such as beta blockers and steroids).[19]
A number of psychological states increase the risk of suicide including: hopelessness, loss of pleasure in life, depression and anxiousness.[20] A poor ability to solve problems, the loss of abilities one used to have, and poor impulse control also play a role.[20][43] In older adults the perception of being a burden to others is important.[44][44]
Recent life stresses such as a loss of a family member or friend, loss of a job, or social isolation (such as living alone) increases risk.[20] Those who have never married are also at greater risk.[19] Being religious may reduce ones risk of suicide.[45] This has been attributed to the negative stance many religions take against suicide and to the greater connectedness religion may give.[45]
Some may commit suicide to escape bullying or prejudice.[46] A history of childhood sexual abuse[47] and time spent in foster care are also risk factors.[48] Sexual abuse is believed to contribute to about 20% of the overall risk.[17]
An evolutionary explanation for suicide is that it may improve inclusive fitness. This may occur if the person committing suicide cannot have more children and takes resources away from relatives by staying alive. An objection is that deaths by healthy adolescents likely does not increase inclusive fitness. Adaptation to a very different ancestral environment may be maladaptive in the current one.[43][49]
Poverty is associated with the risk of suicide.[50] Controlling for income and individual characteristics, individual suicide risk rises with others’ income.[51] Over 200,000 debt-ridden farmers in India have committed suicide since 1997.[52]
The media, which includes the internet, plays an important role.[9] How it presents depiction of suicide may have a negative effect with high volume, prominent, repetitive coverage that glorifies or romanticizes suicide having the most impact.[53] When detailed description of how to commit suicide by a specific means are portrayed, this method of suicide may increase in the population as a whole.[54]
This trigger of suicide contagion or copycat suicide is known as the Werther effect, named after the protagonist in Goethe's The Sorrows of Young Werther who committed suicide.[55] This risk is greater in adolescents who may romanticize death.[56] It appears that while news media has a significant effect, that of the entertainment media is equivocal.[57] The opposite of the Werther effect is the proposed Papageno effect in which coverage of effective coping mechanisms, may have a protective effects. The term is based upon a character in Mozart’s opera The Magic Flute who fearing the loss of a loved one was going to commit suicide until friends help him out.[55] When media follows appropriate reporting guidelines the risk of suicides can be decreased.[53] Getting buy in from industry however can be difficult especially in the long term.[53]
Rational suicide is the reasoned taking of ones own life.[58] Some however feel that suicide is never logical.[58] When someone ends there life to benefit others this is known as altruistic suicide.[59] An example of this is an elder ending their life to leave greater amounts of food for the younger people in the community.[59] A suicide attack is a political action where an attacker perpetrates violence against others which they understand will results in their own death.[60] Murder–suicide is an act of homicide followed within a week by suicide of the person who carried out the act.[61] Mass suicides are often performed under social pressure where members give up autonomy to a leader.[62] Mass suicides can take place with as few as two people, often referred to as a suicide pact.[63]
In extenuating situations where continuing to live would be intolerable, some people use suicide as a means of escape.[64] Some inmates in Nazi concentration camps are known to have killed themselves by deliberately touching the electrified fences.[65]
The leading method of suicide varies between countries. The leading methods in different regions include hanging, pesticide poisoning, and firearms.[66] These differences are believed to be in part due to availability of the different methods.[54] A review of 56 countries found that hanging was the most common method in most of the countries,[67] accounting for 53% of the male suicides and 39% of the female suicides.[68] Worldwide 30% of suicides are from pesticides. The use of this method however varies markedly from 4% in Europe to more than 50% in the Pacific region.[69] It is also common in Latin America due to easy access within the farming populations.[54] In many countries, drug overdoses account for approximately 60% of suicides among women and 30% among men.[70] Jumping to ones death is common in both Hong Kong and Singapore at 50% and 80% respectively.[54] Many are unplanned and occur during an acute period of ambivalence.[54] The death rate varies by method: firearms 80-90%, drowning 65-80%, hanging 60-85%, car exhaust 40-60%, jumping 35-60%, charcoal burning 40-50%, pesticides 6-75%, medication overdose 1.5-4%.[54] The most common attempted methods of suicide differ from the most common successful methods with up to 85% of attempts via drug overdose in the developed world.[23]
In the United States 57% of suicides involve the use of firearms with this method being somewhat more common in men than women.[19] The next most common cause was hanging in males and self poisoning in females.[19] Together they comprised about 40% of U.S. suicides. Other methods of suicide include blunt force trauma (jumping from a building or bridge, self-defenestrating, stepping in front of a train, or car collision, for example). Exsanguination or bloodletting (slitting one's wrist or throat), intentional drowning, self-immolation, electrocution, and intentional starvation are other suicide methods. Individuals may also intentionally provoke another person into administering lethal action against them, as in suicide by cop.[71]
There is no known unifying underlying pathophysiology for either suicide or depression.[19] It is however believed to result from an interplay of behavioral, socio-environmental and psychiatric factors.[54]
Low levels of brain-derived neurotrophic factor (BDNF) are both directly associated with suicide[72] and indirectly associated through its role in major depression, post-traumatic stress disorder, schizophrenia and obsessive-compulsive disorder.[73] Post-mortem studies have found reduced levels of BDNF in the hippocampus and prefrontal cortex, in those with and without psychiatric conditions.[74] Serotonin, a brain neurotransmitter, is believed to be low in those who commit suicide. This is partly based on evidence of increased levels of 5-HT2A receptors found after death.[75] Other evidence includes reduced levels of a breakdown product of serotonin, 5-hydroxyindoleacetic acid, in the cerebral spinal fluid.[76] Direct evidence is however hard to gather.[75] Epigenetics, the study of changes in genetic expression in response to environmental factors which do not alter the underlying DNA, is also believed to play a role in determining suicide risk.[77]
Suicide prevention is a term used for the collective efforts to reduce the incidence of suicide through preventive measures.
Reducing access to certain methods, such as firearms or toxins reduces the risk.[78][54] Other measures include reducing access to charcoal and barriers on bridges and subway platforms.[54] Treatment of drug and alcohol addiction, depression, and those who have attempted suicide in the past may also be effective.[78] Some have proposed reducing access to alcohol as a preventative strategy (such as reducing the number of bars).[12] Although crisis hotlines are common there is little evidence to support or refute their effectiveness.[79][80] In young adults who have recently thought about suicide, cognitive behavioral therapy appears to improve outcomes.[81] Economic development through its ability to reduce poverty may be able to decrease suicide rates.[50] Efforts to increase social connection especially in elderly males may be effective.[82]
There is little data on the effects of screening the general population on the ultimate rate of suicide.[83] As there is a high rate of people who test positive via these tool that are not at risk of suicide there are concerns that screening may significantly increase mental health care resource utilization.[84] Assessing those at high risk however is recommended.[19] Asking about suicidality does not appear to increase the risk.[19]
In those with mental health problems a number of treatments may reduce the risk of suicide. Those who are actively suicidal may be admitted to psychiatric care either voluntarily or involuntarily.[19] Possessions that may be used to harm oneself are typically removed.[23] Some clinicians get patients to signsuicide prevention contracts where they agree to not harm themselves if released.[19] Evidence however does not support a significant effect from this practice.[19] If a person is at low risk out-patient mental health treatment may be arranged.[23]
There is tentative evidence that psychotherapy, specifically, dialectical behaviour therapy reduces suicidality in adolescents[85] as well as those with borderline personality disorder.[86] Evidence however has not found a decrease in completed suicides.[85]
There is controversy around the benefit versus harm of antidepressants.[9] While they appear to decrease suicidality in older persons they may increase suicidality in young persons.[19] Lithium appears effective at lowering the risk in those with bipolar disorder and unipolar depression to nearly the same levels as the general population.[87][88]
Approximately 1 in 200 people end their life by suicide.[19] Globally, as of 2008/2009, suicide is the tenth leading cause of death[1] with about 800,000 people dying annually, giving a mortality rate of 11.6 per 100,000 persons per year.[90] Rates of suicide have increased by 60% from the 1960s to 2012,[78] with these increases seen primarily in the developing world.[1] For every suicide that results in death there are between 10 and 40 attempted suicides.[19]
Suicide rates differ significantly between countries and over time.[90] As of 2008 rates per 100,000 where: Australia 8.6, Canada 11.1, China 12.7, India 23.2, United Kingdom 7.6, United States 11.4.[91] It is ranked as the 10th leading cause of death in the United States in 2009 at about 36,000 cases a year.[92] And about 650,000 people are seen in the emergency department yearly there due to attempting suicide.[19] Lithuania, Japan and Hungary has the highest rates.[90]
In the Western world, males die three times more often by means of suicide than do females, although females attempt suicide four times more often.[19] This has been attributed to males using more lethal means to end their lives.[93] This different is even more pronounced in those over the age of 65 with ten fold more males committing suicide than females.[93] China has one of the highest female suicide rates in the world and it is higher than that of men.[94]
In many countries the rate of suicide is highest in the middle aged[95] or elderly.[54] In the United States it is greatest in caucasian men older than 80 years even though younger people more frequently attempt suicide.[19] It is the second most common cause of death in adolescents[9] and in young males is second only to accidental death.[95] In young males in the developed world it is the cause of nearly 30% of mortality.[95] In the developing world rates are equivalent but it makes up a smaller proportion of overall deaths due to higher rates of trauma.[95]
As suicide was a crime in various countries, including in England and Wales which decriminalized it in 1961, the word "commit" has traditionally been used in reference. Organisations such as the BBC and the Samaritans have stopped using this term because of its negative connotation. "Attempt" suicide or other phrases are preferred.[96] The Guardian and The Observer also avoid the phrase, preferring the use of "killed him or herself".[97]
In some jurisdictions, an act or incomplete act of suicide is considered to be a crime. More commonly, a surviving party who assisted in the suicide attempt can face criminal charges.
In Brazil, assisting a minor in a suicide attempt earns double the penalty and not considered as homicide. In Italy and Canada, encouraging or causing another to commit suicide is also a criminal offense. In Singapore, assisting in the suicide of a mentally handicapped person is a capital offense. In India, abetting a suicide attempt of a minor or a mentally challenged person can result in a maximum one-year prison term with a possible fine.[98]
In Germany, the following laws apply to cases of suicide:[99]
Switzerland has recently taken steps to legalize assisted suicide for the chronically mentally ill. The high court in Lausanne, in a 2006 ruling, granted an anonymous individual with longstanding psychiatric difficulties the right to end his own life. At least one leading American bioethicist, Jacob Appel of Brown University, has argued that the American medical community ought to condone suicide in certain individuals with mental illness.[100]
In the United States, suicide in some states consider it an unwritten "common law crime" as stated in Blackstone's Commentaries. Physician-assisted suicide is legal in the states of Oregon (ORS 127.800–995[101]) and Washington.[102]
In the Australian state of Victoria, suicide itself is no longer a crime. However, a survivor of a suicide pact can be charged with manslaughter. Also, it is a crime to counsel, incite, or aid and abet another in attempting to commit suicide, and the law explicitly allows any person to use "such force as may reasonably be necessary" to prevent another from committing suicide. This explicitly makes physician-assisted suicide illegal.
In most forms of Christianity, suicide is considered a sin, based mainly on the writings of influential Christian thinkers of the Middle Ages, such as St. Augustine and St. Thomas Aquinas; but suicide was not considered a sin under the Byzantine Christian code of Justinian, for instance.[103][104] In Catholic doctrine, the argument is based on the commandment "Thou shalt not kill" (made applicable under the New Covenant by Jesus in Matthew 19:18), as well as the idea that life is a gift given by God which should not be spurned, and that suicide is against the "natural order" and thus interferes with God's master plan for the world.[105] However, it is believed that mental illness or grave fear of suffering diminishes the responsibility of the one completing suicide.[106] Counter-arguments include the following: that the sixth commandment is more accurately translated as "thou shalt not murder", not necessarily applying to the self; that God has given free will to humans; that taking one's own life no more violates God's Law than does curing a disease; and that a number of suicides by followers of God are recorded in the Bible with no dire condemnation.[107]
Judaism focuses on the importance of valuing this life, and as such, suicide is tantamount to denying God's goodness in the world. Despite this, under extreme circumstances when there has seemed no choice but to either be killed or forced to betray their religion, Jews have committed individual suicide or mass suicide (see Masada, First French persecution of the Jews, and York Castle for examples) and as a grim reminder there is even a prayer in the Jewish liturgy for "when the knife is at the throat", for those dying "to sanctify God's Name" (see Martyrdom). These acts have received mixed responses by Jewish authorities, regarded both as examples of heroic martyrdom, while others state that it was wrong for them to take their own lives in anticipation of martyrdom.[108]
Suicide is not allowed in Islam.[109]
In Hinduism, suicide is generally frowned upon and is considered equally sinful as murdering another in contemporary Hindu society. Hindu Scriptures state that one who commits suicide will become part of the spirit world, wandering earth until the time one would have otherwise died, had one not committed suicide.[110] However, Hinduism accept a man's right to end one's life through the non-violent practice of fasting to death, termed Prayopavesa.[111] But Prayopavesa is strictly restricted to people who have no desire or ambition left, and no responsibilities remaining in this life.[111] Jainism has a similar practice named Santhara. Sati, or self-immolation by widows was prevalent in Hindu society during the Middle Ages.
A number of questions are raised within the philosophy of suicide, included what constitutes suicide, whether or not suicide can be a rational choice, and the moral permissibility of suicide.[112] Philosophical arguments in regard to whether or not suicide can be morally acceptable range from strong opposition, (viewing suicide as unethical and immoral), through to perceptions of suicide as a sacrosanct right for anyone (even a young and healthy person) who believes they have rationally and conscientiously come to the decision to end their own lives. Opponents to suicide include Christian philosophers such as Augustine of Hippo and Thomas Aquinas,[112] Immanuel Kant[113] and, arguably, John Stuart Mill – Mill's focus on the importance of liberty and autonomy meant that he rejected choices which would prevent a person from making future autonomous decisions.[114] Others view suicide as a legitimate matter of personal choice. Supporters of this position maintain that no one should be forced to suffer against their will, particularly from conditions such as incurable disease, mental illness, and old age that have no possibility of improvement. They reject the belief that suicide is always irrational, arguing instead that it can be a valid last resort for those enduring major pain or trauma.[115] A stronger stance would argue that people should be allowed to autonomously choose to die regardless of whether they are suffering. Notable supporters of this school of thought include Scottish empiricist David Hume[112] and American bioethicist Jacob Appel.[100][116]
Some landmarks have become known for high levels of suicide attempts.[117] These include San Francisco's Golden Gate Bridge, Japan's Aokigahara Forest,[118], England's Beachy Head,[117] and Toronto's Bloor Street Viaduct.[119]
As of 2010 the Golden Gate Bridge has had more than 1,300 commit suicide by jumping since its construction in 1937.[120] Many locations where suicide is common have constructed barriers to prevent it.[121] This includes the Luminous Veil in Toronto,[119] and barriers at the Eiffel Tower in Paris and Empire State Building in New York.[121] As of 2011 a barrier is being constructed for the Golden Gate Bridge.[122] They appear to be generally very effective.[122]
Advocacy of suicide has occurred in many cultures and subcultures. The Japanese military during World War II encouraged and glorified kamikaze attacks, and Japanese society as a whole has been described as suicide "tolerant"[124] (see Suicide in Japan).
Web searches for information on suicide are likely to return sites that encourage, and even facilitate, suicide attempts.[125] There is some concern that such sites may push the suicidal over the edge.[126] Some people form suicide pacts with people they meet online.[127] Becker writes, "Suicidal adolescent visitors risk losing their doubts and fears about committing suicide. Risk factors include peer pressure to commit suicide and appointments for joint suicides. Furthermore, some chat rooms celebrate chatters who committed suicide."[128]
"Suicide" has been observed in salmonella seeking to overcome competing bacteria by triggering an immune system response against them.[129] Suicidal defences by workers are also noted in a Brazilian ant Forelius pusillus where a small group of ants leaves the security of the nest after sealing the entrance from the outside each evening.[130]
Pea aphids, when threatened by a ladybug, can explode themselves, scattering and protecting their brethren and sometimes even killing the lady bug.[131] Some species of termites have soldiers that explode, covering their enemies with sticky goo.[132][133]
There have been anecdotal reports of dogs, horses, and dolphins committing suicide, but with little conclusive evidence.[134] There has been little scientific study of animal suicide.[135]
An example of mass suicide is the 1978 "Jonestown" cult suicide, in which 918 members of the Peoples Temple, an American cult led by Jim Jones, ended their lives by drinking grape Flavor Aid laced with cyanide.[136][137][138] Over 10,000 Japanese civilians committed suicide in the last days of the Battle of Saipanin 1944, some jumping from "Suicide Cliff" and "Banzai Cliff".[139]
Suicide is sometimes committed as an act of defiance or political protest such as the suicide of Mohamed Bouaziziin Tunisia whose treatment at the hands of the authorities led to a revolt that overthrew the ruling regime and touched off the Arab Spring. During the sectarian strife in Northern Ireland known as "The Troubles" a hunger strike was launched by the provisional IRA, demanding that their prisoners be reclassified as prisoners of war rather than as terrorists. The infamous 1981 hunger strikes, led by Bobby Sands, resulted in 10 deaths. The cause of death was recorded as "starvation, self-imposed" rather than suicide by the coroner; this was modified to simply "starvation" on the death certificates after protest from the dead striker's families.[140]
Dutiful suicide is an act of fatal self violence at one's own hands done in the belief that it will secure a greater good, rather than to escape harsh or impossible conditions. It can be voluntary, to relieve some dishonor or punishment, or imposed by threats of death or reprisals on one's family or reputation as in the forced suicide of German general Erwin Rommel during World War II. He was found to have foreknowledge of the July 20 Plot on Hitler's life and was threatened with public trial, execution, and reprisals on his family unless he took his own life.[141] It is a traditional practice in some cultures, such as the heavily ritualized Japanese custom of seppuku.
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リンク元 | 「suicidal」 |
関連記事 | 「kill」「killing」 |
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