Cited by 161Attention Deficit Hyperactivity DisorderChild and Adolescent Psychosocial and Emotional DevelopmentBehavioral and Psychological Studies

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Effects of ethnicity on treatment attendance, stimulant response/dose, and 14-month outcome in ADHD

Arnold, L. Eugene, Elliott, Michael, Sachs, Larry, Bird, Hector, Kraemer, Helena C., Wells, Karen C., Abikoff, Howard B., Comarda, Anne, Conners, C. Keith, Elliott, Glen R., Greenhill, Laurence L., Hechtman, Lily, Hinshaw, Stephen P., Hoza, Betsy, Jensen, Peter S., March, John S., Newcorn, Jeffrey H., Pelham, William E., Severe, Joanne B., Swanson, James M., Vitiello, Benedetto, Wigal, Timothy·2003·Journal of Consulting and Clinical Psychology

DOI 10.1037/0022-006x.71.4.713

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Abstract

From the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder--a randomized clinical trial of 579 children ages 7-9 years receiving 14 months of medication management, behavioral treatment, combination, or community care--the authors matched each African American and Latino participant with randomly selected Caucasian participants of same sex, treatment group, and site. Although Caucasian children were significantly less symptomatic than African American and Latino children on some ratings, response to treatment did not differ significantly by ethnicity after controlling for public assistance. Ethnic minority families cooperated with and benefited significantly from combination (multimodal) treatment (d = 0.36, compared with medication). This incremental gain withstood statistical control for mother's education, single-parent status, and public assistance. Treatment for lower socioeconomic status minority children, especially if comorbid, should combine medication and behavioral treatment.

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BackgroundInfluential
Considering cultural diversity in the management of ADHD in Hispanic patients.
Rothe, E. M. (2005) · PubMed Central · Cited by 40
Individual differences in attention deficit hyperactivity disorder symptoms and associated executive dysfunction and traits: Sex, ethnicity, and family income.
Martel, M. M. (2013) · American Journal of Orthopsychiatry · doi:10.1111/ajop.12034 · Cited by 40
“This is in line with ADHD treatment outcome work that found that SES moderated treatment effects, but ethnicity did not (Arnold et al., 2003; Rieppi et al., 2002).”
Result
Daily Behavior Report Cards with and without Home-Based Consequences: Improving Classroom Behavior in Low Income, African American Children with ADHD
Jurbergs, N., Palcic, J. L., & Kelley, M. L. (2010) · Child & Family Behavior Therapy · doi:10.1080/07317107.2010.500501 · Cited by 37
“Furthermore, large multi-site comparisons of stimulant medication and behavioral interventions found an incremental effect for behavioral interventions over medication in ethnic minority children that was not found for Caucasian participants, highlighting the need for research with low SES, minority samples (Arnold et…”
Background
Psychosocial treatments for attention-deficit/hyperactivity disorder
Knight, L. A., Rooney, M., & Chronis-Tuscano, A. (2008) · Current Psychiatry Reports · doi:10.1007/s11920-008-0066-6 · Cited by 35
Youth Perceptions of Attention-Deficit/Hyperactivity Disorder and Barriers to Treatment
Walker-Noack, L., Corkum, P. V., Elik, N., & Fearon, I. (2013) · Canadian Journal of School Psychology · doi:10.1177/0829573513491232 · Cited by 35
“Several studies show that demographic variables, such as ethnicity, gender, and socioeconomic status may be indirectly linked to nonadherence (Arnold et al., 2003; Power, Russell, Soffer, Blom-Hoffman, & Grim, 2002).”
Background
College Readiness: Differences Between First-Year Undergraduates With and Without ADHD
Canu, W. H., Stevens, A. E., Ranson, L. M., Lefler, E. K., LaCount, P. A., Serrano, J. W., Willcutt, E. G., & Hartung, C. M. (2020) · Journal of Learning Disabilities · doi:10.1177/0022219420972693 · Cited by 43
“For instance, research suggests that African American and Hispanic children who have ADHD can be perceived as more symptomatic than their White counterparts (Arnold et al., 2003; Hinojosa et al., 2012; Martel, 2013), and yet racial minority groups have been shown to have lower rates of diagnosis and treatment (Miller…”
Background
Attention-Deficit/Hyperactivity Disorder and Telemental Health
Palmer, N. B., Myers, K., Stoep, A. V., McCarty, C. A., Geyer, J. R., & DeSalvo, A. (2010) · Current Psychiatry Reports · doi:10.1007/s11920-010-0132-8 · Cited by 33
“As Hispanic children with ADHD have been underrepresented in prior studies and clinical practice, and as ethnicity seems to affect adherence to protocol and outcomes [44], Hispanic youth will comprise 30% of this study population.”
Background
The impact of individual and methodological factors in the variability of response to methylphenidate in ADHD pharmacogenetic studies from four different continents
Polanczyk, G. V., Faraone, S. V., Bau, C. H. D., Victor, M. M., Becker, K., Pelz, R., Buitelaar, J. K., Franke, B., Kooij, J. J. S., van der Meulen, E., et al. (2008) · American Journal of Medical Genetics Part B Neuropsychiatric Genetics · doi:10.1002/ajmg.b.30855 · Cited by 32
“These findings are in the same direction of those from the National Institute of Mental Health Multimodal Treatment Study of ADHD (MTA), which detected a substantial and clinically similar response to MPH between African Americans, Latinos, and Caucasians [Arnold et al., 2003].”
Result
Comorbid Symptomatology Moderates Response to Risperidone, Stimulant, and Parent Training in Children with Severe Aggression, Disruptive Behavior Disorder, and Attention-Deficit/Hyperactivity Disorder
Farmer, C., Brown, N. V., Gadow, K. D., Arnold, L. E., Kolko, D., Findling, R. L., Molina, B. S. G., Buchan-Page, K. A., Rice, R. R., Bangalore, S. S., et al. (2015) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2014.0109 · Cited by 31
Attention-Deficit/Hyperactivity Disorder in African American Youth
Bailey, R. K., Ali, S., Jabeen, S., Akpudo, H., Avenido, J., Bailey, T., Lyons, J., & Whitehead, A. A. (2010) · Current Psychiatry Reports · doi:10.1007/s11920-010-0144-4 · Cited by 30
“36 compared with medication), even after controlling for maternal education, single-parent status, and use of public assistance [14].”
ADHD and manic symptoms: Diagnostic and treatment implications
Galanter, C. A., Pagar, D., Davies, M., Li, W., Carlson, G. A., Abikoff, H., Arnold, L. E., Bukstein, O. G., Pelham, W. E., Elliott, G. R., et al. (2005) · Clinical Neuroscience Research · doi:10.1016/j.cnr.2005.09.008 · Cited by 29
Identifying, Evaluating, Diagnosing, and Treating ADHD in Minority Youth
Hervey-Jumper, H., Douyon, K., Falcone, T., & Franco, K. N. (2007) · Journal of Attention Disorders · doi:10.1177/1087054707311054 · Cited by 31
“Multimodality treatment using both psychotherapy and medication is clearly the best for African American children with ADHD (Arnold et al., 2003).”
Background
Satisfaction with treatment for attention-deficit/hyperactivity disorder.
Bukstein, O. G. (2004) · PubMed · Cited by 28
Multimodal treatment for childhood attention-deficit/hyperactivity disorder
Kaiser, N. M., Hoza, B., & Hurt, E. A. (2008) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.8.10.1573 · Cited by 28
Packages of Care for Attention-Deficit Hyperactivity Disorder in Low- and Middle-Income Countries
Flisher, A. J., Sorsdahl, K. R., Hatherill, S., & Chehil, S. (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000235 · Cited by 27
“disorders [42–44] or psychosocial stressors [45,46] did benefit”
Background
OROS-methylphenidate or placebo for adult smokers with attention deficit hyperactivity disorder: Racial/ethnic differences☆
Covey, L. S., Hu, M., Winhusen, T. M., Weissman, J. D., Berlin, I., & Nunes, E. V. (2010) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2010.02.002 · Cited by 27
“A trial of 579 children with ADHD found similar benefit of methylphenidate for whites and non-whites (Arnold et al., 2003); however, no prior study has reported ethnic differences in treatment outcome among adults with ADHD.”
Background
Deficits in diagnosis, treatment and continuity of care in African-American children and adolescents with ADHD.
Hervey-Jumper, H., Douyon, K., & Franco, K. N. (2006) · PubMed Central · Cited by 26
Collaborative care for the treatment of Hispanic children diagnosed with attention-deficit hyperactivity disorder
Myers, K., Stoep, A. V., Thompson, K., Zhou, C., & Unützer, J. (2010) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2010.08.004 · Cited by 25
“to decreased attendance at appointments and lower stimulant doses [8–11].”
Background
Ethnicity as a Moderator of Treatment Effects on Parent—Child Interaction for Children With ADHD
Jones, H. A., Epstein, J. N., Hinshaw, S. P., Owens, E. B., Chi, T. C., Arnold, L. E., Hoza, B., & Wells, K. C. (2009) · Journal of Attention Disorders · doi:10.1177/1087054709332158 · Cited by 24
“Given the findings from (a) Arnold et al. (2003), indicating that Comb was more effective for ethnic minority children than for Caucasian children in reducing reported ADHD symptoms, and (b) Wells et al. (2006), showing treatment-related changes on observed PCIs, we examined whether there were any…”
Influential
Attendance and Engagement in Parent Training Predict Child Behavioral Outcomes in Children Pharmacologically Treated for Attention-Deficit/Hyperactivity Disorder and Severe Aggression
Joseph, H. M., Farmer, C., Kipp, H., Kolko, D. J., Aman, M. G., McGinley, J. J., Arnold, L. E., Gadow, K. D., Findling, R. L., & Molina, B. S. G. (2018) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2018.0119 · Cited by 23
“In another study with more frequent PT (35 sessions) and additional behavioral treatments, the Multimodal Treatment Study of ADHD, ethnic/racial minorities benefited more from adding behavioral treatment to medication than did nonHispanic whites (Arnold et al. 2003).”
Background
The Incredible Years® Programs for ADHD in Young Children: A Critical Review of the Evidence
Murray, D. W., Lawrence, J. R., & LaForett, D. R. (2017) · Journal of Emotional and Behavioral Disorders · doi:10.1177/1063426617717740 · Cited by 26
“Although IY research has found little evidence of differential outcome for minority groups (Reid, Webster-Stratton, & Beauchaine, 2001), other studies of ADHD behavioral treatment with ethnic minorities have found better response for African American and Hispanic subgroups (Arnold et al., 2003).”
Methylphenidate Improves Aspects of Executive Function in African American Children With ADHD
Hazel-Fernandez, L. A., Klorman, R., Wallace, J. M., & Cook, S. R. (2006) · Journal of Attention Disorders · doi:10.1177/1087054705284243 · Cited by 23
“These results support previous reports that African American children respond similarly to stimulant medications as their more widely studied Caucasian counterparts do (Arnold et al., 2003).”
BackgroundResult
Drug Class Review on Pharmacologic Treatments for ADHD
McDonagh, M. S., Peterson, K., & Thakurta, S. (2005) · Cited by 21
The Effects of Stimulant Medication and Training on Sports Competence Among Children With ADHD
Altszuler, A. R., Morrow, A. S., Merrill, B. M., Hammer, S. N., Macphee, F. L., Gnagy, E. M., Greiner, A. R., Coxe, S. J., Raiker, J. S., Coles, E. K., et al. (2017) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2016.1270829 · Cited by 20
“…treatment to date (the MTA study; Richters et al., 1995), Hispanic youth responded no differently to behavioral or pharmacological treatments than did Caucasian youth (Arnold et al., 2003), increasing the likelihood that current results will replicate in samples of different ethnic/racial makeup.”
Background
Culturally adapting parent training for Latino youth with ADHD: Development and pilot.
Gerdes, A. C., Kapke, T. L., Lawton, K. E., Grace, M. A., & Hurtado, G. (2015) · Journal of Latina/o Psychology · doi:10.1037/lat0000037 · Cited by 20
“Although Latino families had similar treatment outcomes as European American families after controlling for socioeconomic factors (Arnold et al., 2003), the Latino families who participated in the MTA likely are not representative of all Latino families in the United States.”
Background
Latino Versus Caucasian Response to Atomoxetine in Attention-Deficit/Hyperactivity Disorder
Tamayo, J., Pumariega, A., Rothe, E., Kelsey, D., Allen, A., Velez-Borras, J., Williams, D., Anderson, S., & Durell, T. M. (2008) · Journal of child and adolescent psychopharmacology · doi:10.1089/cap.2006.0132 · Cited by 15
Early Intervention for Young Children With Attention Deficit Hyperactivity Disorder: Prediction of Academic and Behavioral Outcomes
DuPaul, G. J., Kern, L., Caskie, G. I. L., & Volpe, R. J. (2015) · School Psychology Review · doi:10.17105/spr44-1.3-20 · Cited by 18
“lies (Arnold et al., 2003).”
Systematic Review and Meta-Analysis: Reporting and Representation of Race/Ethnicity in 310 Randomized Controlled Trials of Attention-Deficit/Hyperactivity Disorder Medications
Riccioni, A., Raduà, J., Ashaye, F. O., Solmi, M., & Cortese, S. (2023) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2023.09.544 · Cited by 19
Effects of Open-Label Atomoxetine on African-American and Caucasian Pediatric Outpatients with Attention-Deficit/Hyperactivity Disorder
Durell, T. M., Pumariega, A. J., Rothe, E. M., Tamayo, J. M., Baron, D. A., & Williams, D. W. (2009) · Annals of Clinical Psychiatry · doi:10.1177/104012370902100104 · Cited by 19
Use of Treatment Services for Attention-Deficit/Hyperactivity Disorder in Latino Children
Eiraldi, R. B., & Diaz, Y. (2010) · Current Psychiatry Reports · doi:10.1007/s11920-010-0139-1 · Cited by 21
“Given that medication titration was partially based on parent ratings of child behavior and side effects, these results suggest that Latino parents may have reported fewer positive effects or more side effects of medication as medication doses increased [ 12 ].”
BackgroundResult
Prediction of Placebo Response in 2 Clinical Trials of Lisdexamfetamine Dimesylate for the Treatment of ADHD
Waxmonsky, J. G., Waschbusch, D. A., Glatt, S. J., & Faraone, S. V. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10m05979pur · Cited by 18
Feasibility, Acceptability, and Preliminary Outcomes of a Culturally Adapted Evidence-Based Treatment for Latino Youth With ADHD
Gerdes, A. C., Kapke, T. L., Grace, M. A., & Castro, A. (2019) · Journal of Attention Disorders · doi:10.1177/1087054718821729 · Cited by 18
“…functioning in youth with ADHD from predominantly European American families, as well as Latino families more oriented to U.S. mainstream culture (Arnold et al., 2003; Gerdes, Haack, & Schneider, 2012; Pelham & Fabiano, 2008); however, no published research has examined its effectiveness with…”
Influential
Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder
assessment, I. A. M. H., (inattention, T. C. S. S. F. A. B. S. A. Q. R. T. M. S. D. O. A., impulsivity, the, A. H. A. A. W. S. S. C. I. T. S. Q. S. B. A. R. O. T. N. O. T. C. C. R. S. O. S. Q. C., symptoms of ADHD can also be included in clinic/office registration materials to be completed by parents before visits or in the waiting room before the evaluation. If a parent reports that the patient suffers from any symptoms of ADHD that induce impairment or if the patient scores in the clinical range for ADHD symptoms on a rating scale, & indicated., T. A. F. E. F. A. A. S. O. I. T. N. R. I. (2008) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/foc.6.3.foc401 · Cited by 18
Getting to First Base: Promoting Engagement in Family–School Intervention for Children with ADHD in Urban, Primary Care Practice
Power, T. J., Hughes, C. L., Helwig, J. R., Nissley-Tsiopinis, J., Mautone, J. A., & Lavin, H. J. (2010) · School Mental Health · doi:10.1007/s12310-010-9029-2 · Cited by 21
The Impact of Social Determinants of Health on the Efficacy of School-Based Interventions for Adolescents with ADHD
Green, C. D., Dvorsky, M. R., Langberg, J. M., Jones, H. A., & Floyd, A. L. (2020) · School Mental Health · doi:10.1007/s12310-020-09367-w · Cited by 20
“Findings revealed a significant difference in teacher-rated ADHD symptoms between Black and matched White participants, with Black participants rated as more symptomatic post-intervention (Arnold et al., 2003).”
BackgroundInfluential
Cultural Competence in Therapy with African Americans
Jones, E. O., Huey, S. J., & Rubenson, M. P. (2018) · Springer eBooks · doi:10.1007/978-3-319-78997-2_22 · Cited by 17
“Age Group Representative EBTs ADHD Youth Behavioral treatment + stimulant medication (Arnold et al., 2003) Anxiety-Related Problems Youth Group CBT (Ginsburg & Drake, 2002) Adult Panic Control Therapy (Carter et al., 2003) Antisocial Behavior Youth MST (Borduin et al., 1995) Depression Youth…”
SLC6A3 polymorphism and response to methylphenidate in children with ADHD: A systematic review and meta‐analysis
Soleimani, R., Salehi, Z., Soltanipour, S., Hasandokht, T., & Jalali‌, M. M. (2017) · American Journal of Medical Genetics Part B Neuropsychiatric Genetics · doi:10.1002/ajmg.b.32613 · Cited by 15
“These findings are consistent with those of previous studies (Arnold et al., 2003; Polanczyk et al., 2008) that rejected the significant effect of ethnicity on response to MPH.”
Result
Differences in ADHD medication usage patterns in children and adolescents from different cultural backgrounds in the Netherlands
van den Ban, E. F., Souverein, P. C., van Engeland, H., Swaab, H., Egberts, T. C. G., & Heerdink, E. R. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1068-4 · Cited by 15
“Differences in prescription rate or cost do not seem to be associated with differences in effectiveness of ADHD medication, since there is evidence that ADHD medication is as effective in Caucasian as in Afro American of Latin-American children or adolescents [41, 42].”
Research Methods in Clinical Psychology
Kendall, P. C., & Comer, J. S. (2014) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780199328710.013.027 · Cited by 13
Understanding parental locus of control in Latino parents: Examination of cultural influences and help-seeking intentions for childhood ADHD.
Lawton, K. E., Kapke, T. L., & Gerdes, A. C. (2015) · Cultural Diversity & Ethnic Minority Psychology · doi:10.1037/cdp0000022 · Cited by 15
Report of the Working Group on Psychotropic Medications for Children and Adolescents: Psychopharmacological, Psychosocial, and Combined Interventions for Childhood Disorders: Evidence Base, Contextual Factors, and Future Directions
APA Working Group on Psychoactive Medications for Children and Adolescents (2006) · PsycEXTRA Dataset · doi:10.1037/e539722009-001 · Cited by 14
Culturally Adapted Pharmacotherapy and the Integrative Formulation
Malik, M. A., Lake, J., Lawson, W. B., & Joshi, S. V. (2010) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2010.08.003 · Cited by 12
Low-income African American Male Youth with ADHD Symptoms in the United States: Recommendations for Clinical Mental Health Counselors
Tucker, C., & Dixon, A. L. (2009) · Journal of Mental Health Counseling · doi:10.17744/mehc.31.4.j451mx7135887238 · Cited by 13
Cognitive markers for efficacy of neurofeedback for attention-deficit hyperactivity disorder – personalized medicine using computational psychiatry in a randomized clinical trial
Ging-Jehli, N. R., KRAEMER, H. C., Arnold, L. E., Roley‐Roberts, M. E., & DeBeus, R. J. (2023) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2023.2206637 · Cited by 11
Empirical Evaluation of the Generalizability of the Sample from the Multimodal Treatment Study for ADHD
Stevens, J. H., Kelleher, K. J., Greenhouse, J. B., Chen, G., Xiang, H., Kaizar, E. E., Jensen, P. S., & Arnold, L. E. (2006) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-006-0097-4 · Cited by 10

Authors: Arnold, L. E., Elliott, M., Sachs, L., Bird, H., Kraemer, H. C., Wells, K. C., Abikoff, H. B., Comarda, A., Conners, C. K., Elliott, G. R., Greenhill, L. L., Hechtman, L., Hinshaw, S. P., Hoza, B., Jensen, P. S., March, J. S., Newcorn, J. H., Pelham, W. E., Severe, J. B., Swanson, J. M., Vitiello, B., & Wigal, T.
Affiliations: The Ohio State University (US)
Stanford University (US)
Duke University (US)
NYU Langone Health (US)
University of California, San Francisco (US)
Columbia University (US)
McGill University (CA)
University of California, Berkeley (US)
Purdue University West Lafayette (US)
Mount Sinai Hospital (US)
University at Buffalo, State University of New York (US)
National Institute of Mental Health (US)
University of California, Irvine (US)
ORCID: Arnold, L. Eugene
Elliott, Michael
Kraemer, Helena C.
Abikoff, Howard B.
Elliott, Glen R.
Greenhill, Laurence L.
Hechtman, Lily
Hinshaw, Stephen P.
Hoza, Betsy
Jensen, Peter S.
Newcorn, Jeffrey H.
Pelham, William E.
Swanson, James M.
Vitiello, Benedetto
Venue: Journal of Consulting and Clinical Psychology
Publisher: American Psychological Association (APA)
Published: 2003-08
Volume: 71
Issue: 4
Pages: 713-727
ISSN: 0022-006X (ISSN-L)
1939-2117
DOI: 10.1037/0022-006x.71.4.713
OpenAlex: W2010108781
Cited by: 159
References: 38
Citations by year: 2026: 1 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 1 · 2020: 5 · 2019: 7 · 2018: 7 · 2017: 4 · 2016: 8 · 2015: 11 · 2014: 12 · 2013: 8 · 2012: 3
FWCI: 7.14
Type: journal article
Language: en
Open access: closed
Locations: Journal of Consulting and Clinical Psychology (publishedVersion)
PubMed (publishedVersion)
Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
Funders: National Institute of Mental Health (U01 MH50447, U01MH50461, U01MH50440, U01MH050467, U01MH50454, U01MH050447, U01MH050440, U01MH050453, U01MH50467, U01MH050461, U01MH50453, U01MH050454)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
Keywords: attention deficit hyperactivity disorder, ethnicity, African American children, Latino children, treatment attendance, stimulant medication response, dosage, multimodal therapy, social assistance, socioeconomic status, comorbidities, children
MeSH terms: Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Double-Blind Method, Ethnicity, Female, Humans, Male, Methylphenidate, Patient Compliance, Attention Deficit and Disruptive Behavior Disorders

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Effects of ethnicity on treatment attendance, stimulant response/dose, and 14-month outcome in ADHD

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