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Abstract

The perceived weaknesses of philosophical normative theories as machine ethic candidates have led some philosophers to consider combining them into some kind of a hybrid theory. This chapter develops a philosophical machine ethic which integrates “top-down” normative theories (rule-utilitarianism and prima-facie deontological ethics) and “bottom-up” (case-based reasoning) computational structure. This hybrid ethic is tested in a medical machine whose input-output function is treated as a simulacrum of professional human ethical action in clinical medicine. In six clinical medical simulations run on the proposed hybrid ethic, the output of the machine matched the respective acts of human medical professionals. Thus, the proposed machine ethic emerges as a successful model of medical ethics, and a platform for further developments.

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How does the physical growth of the fetal brain relate to pain function? Addressing this question is not just of research interest, but has profound consequences in guiding clinical use of analgesic and anesthetic intervention for in utero surgery. Adult brains appear structurally and functionally specialized for types of pain; for example, acute pain preferentially engages medial prefrontal cortical and subcortical limbic regions [1,2]. However, the question of the relationship between such specializations and pain is still controversial in the debate concerning fetal pain [3, for review]. One ‘maturational’ perspective is that brain growth and pain function co-develop through innate genetic and molecular mechanisms, and that postnatal experience merely has a role in the final ‘fine tuning’ [4,5,6,7]. Evidence concerning the differential neuroanatomical development of brain regions is used to determine a lower gestational age when particular regions likely become functional for pain. Several authors claim that maturation within subcortical brain regions enables pain function as early as 20 weeks gestation [6,7], others claim expansion of thalamocortical regions at 24 weeks is necessary and sufficient. An alternative ‘expertise’ view is that brain development and pain function involve a prolonged process of co-specialization that is shaped by postnatal experience [3,8,9,10]. Based on this approach, some authors argue that the fetal brain is not functional for pain at any gestational stage because skills such as sense of self and mind-reading learnt in postnatal life are necessary for pain [3,8,9,10].

Maturational views of functional brain development assume that brain growth and the appearance of functions are equivalent or the same thing, in the way that water and H2O are equivalent or the same thing, which implies that concerning the question of fetal pain, the sequential coming ‘on-line’ of specific brain regions during fetal development is identical with the appearance of pain function. That is, pain function numerically shares all its properties or qualities with the brain. Things with qualitative identity share properties, so things can be more or less qualitatively identical. Apples and oranges are qualitatively identical because they share the quality of being a fruit, but two apples have greater qualitative identity. Maturational views of fetal pain demand more than this, however, since they imply numerical identity. Numerical identity implies total qualitative identity, and can only hold between a thing and itself. This means that a maturational view of fetal pain makes a very strong demand about pain capacity: specific brain regions and pain function co-develop in the fetus because they are numerically identical, one and the very same thing. Pain is in the brain.

Expertise views of fetal pain challenge the core maturational commitment of brain-pain numerical identity and present philosophical arguments and data which claim instead to show the non-identity of brain-pain relationships in the fetus and the necessity of postnatal experience and learning [3,8,9,10]. A representative philosophical argument driving expertise views of fetal pain is the following: All pains are personal experiences and therefore entirely subjective; All brains are physical objects and therefore entirely objective; There is a fundamental divergence between pain and the brain. Therefore, pain cannot be numerically identical to the brain. Thus, the argument:

1. Pains are subjective.

2. Brains are objective.

Therefore, since pains and brains fundamentally diverge,

3. Pain is not numerically identical to the brain.

I will now critically examine and discuss this argument. Take the first premise: ‘pains are subjective.’ On a reasonable interpretation of its meaning, to say that ‘pains are subjective’ is to say that pains are knowable by direct personal experience. However, since brain events such as brain growth are not knowable by direct personal experience, pains cannot be one and the same thing as brain events. Here is the argument:

1. Pains are knowable to me by direct personal experience.

2. Brain events are not knowable to me by direct personal experience.

Therefore, since pains and brains fundamentally diverge,

3. My pain is not numerically identical to my brain.

Once the argument is represented in this form, it is clear that it is fallacious. This can be observed if we compare the argument with the following example:

1. Ibuprofen is known by me to relieve pain.

2. Iso-butyl-propanoic-phenolic acid is not known by me to relieve pain.

Therefore, since ibuprofen and iso-butyl-propanoic-phenolic acid fundamentally diverge,

3. Ibuprofen cannot be identical to iso-butyl-propanoic-phenolic acid.

The premises in the example are true, but the conclusion is known to be false. The argument is fallacious because its core assumption – ‘fundamental divergence’ – is mistaken: it mistakenly assumes that a thing must be known by somebody somewhere. But the property ‘being known by somebody’ is not a necessary feature of anything, much less a property that might establish its identity or non-identity with something otherwise known. The truth of the premises may be due to nothing else but my ignorance of what turns out to be identical with what. This point entails that ‘being known by somebody’ is not a necessary feature of pain that might explain its identity or non-identity with the brain. The non-identity of fetal brain development and pain function cannot be established by this argument.

The argument needs to produce independent evidence for the idea of ‘fundamental divergence’, since it is not self-evident. To illustrate this point, consider the argument for pain-brain numerical identity that personal pain would have no influence on mammalian behaviour were it not numerically identical with brain events [11]. This apparently simple argument wasn’t established until fairly recently because a crucial premise was not available. This is the premise that physical effects like pain are determined by prior physical causes. This is an empirical premise, and one which scientific theories of pain didn’t take to be fully evidenced until the middle and late twentieth century [12, for review]. It is this evidential shift, and not the apparently obvious, which is responsible for the argument’s persuasive power. It remains to be seen if stronger evidence for pain-brain identity in the fetus is forthcoming.

Of course, the failure of this particular argument to establish its conclusion does not thereby abolish the expertise perspective and self-guarantee its opposite, the maturational perspective, or even prove that the two perspectives are mutually exclusive. Rather, what the failure of the argument shows is that apparently obvious logic is sometimes a poor guide to reality. Whether pain-brain identity is true or false is impossible to tell simply by arguing personal appearances.

References

[1] Apkarian AV, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain 2011; 152(3 Suppl): S49–S64.

[2] Wager TD, Atlas LY, Lindquist MA, Roy M, Woo CW, Kross E. An fMRI-based neurologic signature of physical pain. New England Journal of Medicine 2013; 368(15): 1388–1397.

[3] Derbyshire SWG, Raja A. On the development of painful experience. Journal of Consciousness Studies 2011; 18: 9–10.

[4] Anand KJ, Hickey PR. Pain and its effects in the human neonate and fetus. New England Journal of Medicine 1987; 317(21): 1321–1329.

[5] Anand KJ. Consciousness, cortical function, and pain perception in nonverbal humans. Behavioral and Brain Sciences 2007; 30(1): 82–83.

[6] Lowery CL, Hardman MP, Manning N, Clancy B, Whit Hall R, Anand KJS. Neurodevelopmental changes of fetal pain. Seminars in Perinatology 2007; 31(5): 275–282.

[7] Brusseau RR, Mashour GA. Subcortical consciousness: Implications for fetal anesthesia and analgesia. Behavioral and Brain Sciences 2007; 30(01): 86–87.

[8] Derbyshire SWG. Controversy: Can fetuses feel pain? BMJ: British Medical Journal 2006; 332(7546): 909–912.

[9] Derbyshire SWG. Fetal analgesia: where are we now? Future Neurology 2012; 7(4): 367–369.

[10] Szawarski Z. Do fetuses feel pain? Probably no pain in the absence of “self”. BMJ: British Medical Journal 1996; 313(7060): 796–797.

[11] Papineau D. Thinking about consciousness. Oxford: Oxford University Press; 2002.

[12] Perl ER. Pain mechanisms: a commentary on concepts and issues. Progress in Neurobiology 2011; 94(1): 20–38.

The University of Tokyo Center for Philosophy, Uehiro Research Division,
Philosophy of Disability & Co-existence Project (UTCP/PhDC):

3rd International Conference ‘Phenomenology of Pain’

20140104_poster_ver4

There is broad agreement among researchers that the minimal necessary neural pathways for pain are in the human fetus by 24 weeks gestation [1, for review]. However, some argue that the fetus can feel pain earlier than 24 weeks because pain can be enabled by subcortical brain structures [2,3,4,5]. Other researchers argue that the fetus cannot feel pain at any stage of gestation because the fetus is sustained in a state of unconsciousness [6]. Finally, others argue that the fetus cannot feel pain at any stage because the fetus lacks the conceptual postnatal development necessary for pain [7,8,9]. If a behavioral and neural reaction to a noxious stimulus is considered sufficient for pain then pain is possible from 24 weeks and probably much earlier. If a conceptual subjectivity is considered necessary for pain, however, then pain is not possible at any gestational age. According to [1], much of the disagreement concerning fetal pain rests on the understanding of key terms such as ‘wakefulness’, ‘conscious’ and ‘pain’.

A motivation for thinking conceptual subjectivity is necessary for pain is the idea that subjective experiences such as pain cannot be reduced to or identified with the objective features of the brain [7,8,9]. All pains are personal experiences and therefore entirely subjective; all brain states are physical events and therefore entirely objective. There is a fundamental divergence between pain and the brain. Thus, pain cannot be in the brain. The basic argument:

1. Pain experiences are subjective.

2. Brain events are objective.

Therefore, since pain experiences and brain events fundamentally diverge,

3. Pain experiences are not identical to brain events.

Is this a good argument? Let’s examine its first premise – ‘pain experiences are subjective.’ On a reasonable interpretation of its meaning, to state that ‘pain experiences are subjective’ is to state that pain experiences are knowable by introspection. However, since brain events are not knowable by introspection, pain experiences cannot be identical to brain events. Here is the argument:

1. Pain experiences are knowable to me by introspection.

2. Brain events are not knowable to me by introspection.

Therefore, since pain experiences and brain events fundamentally diverge,

3. My pain experiences are not identical to any of my brain events.

Once the argument is represented in this form, it is clear that it is fallacious. This can be clearly observed if we compare the argument with the following example:

1. Ibuprofen is known to me to relieve pain.

2. Iso-butyl-propanoic-phenolic acid is not known by me to relieve pain.

Therefore, since ibuprofen and iso-butyl-propanoic-phenolic acid fundamentally diverge,

3. Ibuprofen cannot be identical to iso-butyl-propanoic-phenolic acid.

The premises in the example are true, but the conclusion is known to be false. The argument is fallacious because the core idea of the argument – ‘fundamental divergence’ – makes an erroneous assumption; namely, it assumes that a thing must be known by somebody. But the property ‘being known by somebody’ is not a necessary feature of any thing, much less a property that might establish its identity or non-identity with some thing otherwise known. The truth of the premises may be due to nothing else but my ignorance of what turns out to be identical with what. These considerations challenge the assumed epistemology in the conceptual subjectivity view of pain.

They also challenge the related claim made by proponents of conceptual subjectivity that any description of a pain given in objective scientific terms will necessarily always exclude the personal experience of that pain [7,8,9]. The argument made here is by now familiar: since descriptions of pain in personal subjective terms are different from scientific descriptions of pain, it follows that a pain and its private subjectivity cannot be identical with a brain event and its public objectivity. Only persons can feel pain – brain cells and protein channels can’t. Clearly, the argument begs the issue in question: whether or not the subjective features of a pain I personally experience are identical with some objective features of my brain that might be discovered by neuroscience is precisely the question at issue [10,11].

Besides, in order to understand a scientific explanation of pain, neuroscience does not require of a person that he both understands the explanation and feels pain as a condition of understanding. Neuroscience aims to explain pain, that is its main purpose. Too much is demanded of neuroscience if, in addition to formulating an explanation of pain, it is meant to re-create pain in somebody as a requirement of understanding [10,11]. This expectation is therefore much too strong.

References

[1] Derbyshire SWG, Raja A. (2011). On the development of painful experience.Journal of Consciousness Studies18, 9–10.

[2] Anand KJ, Hickey PR. (1987). Pain and its effects in the human neonate and fetus. New England Journal of Medicine, 317(21), 1321–1329.

[3] Anand KJ. (2007). Consciousness, cortical function, and pain perception in nonverbal humans. Behavioral and Brain Sciences30(1), 82–83.

[4] Lowery CL, Hardman MP, Manning N, Clancy B, Whit Hall R, Anand KJS. (2007). Neurodevelopmental changes of fetal pain. In Seminars in perinatology, 31(5), 275–282.

[5] Merker B. (2007). Consciousness without a cerebral cortex, a challenge
for neuroscience and medicine. Target article with peer commentary and author’s response. Behavioral and Brain Sciences, 30, 63–134.

[6] Mellor DJ, Diesch TJ, Gunn AJ, Bennet L. (2005). The importance of ‘awareness’ for understanding fetal pain. Brain research reviews49(3), 455-471.

[7] Derbyshire SWG. (2012). Fetal analgesia: where are we now? Future Neurology7(4), 367-369.

[8] Derbyshire SWG. (2006). Controversy: Can fetuses feel pain? BMJ: British Medical Journal332(7546), 909.

[9] Szawarski Z. (1996). Do fetuses feel pain? Probably no pain in the absence of “self”. BMJ: British Medical Journal313(7060), 796–797. 

[10] Churchland PS. (2002). Brain-wise: V: Studies in Neurophilosophy. MIT press.

[11] van Rysewyk S. (2013). Pain is Mechanism. PhD Dissertation, University of Tasmania.

Call for Chapters: ‘Pain Experience and Neuroscience’, Edited Collection, 2014 

You are warmly invited to submit your research chapter for possible inclusion in an edited collection entitled ‘Pain Experience and Neuroscience’. The collection editor is Dr. Simon van Rysewyk. The target publication date is December 2014. Target publisher: MIT Press.

According to the International Association of the Study of Pain, pain is ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage’. Nociceptor activity induced by a noxious stimulus is not pain even though pain most typically has a peripheral physical cause. Pain is always personal. Many laboratory and clinical studies support the IASP pain definition, and it is widely endorsed in the international pain community. Not all pain is associated with tissue damage (stomach and head ache). Pains present in countless varieties associated with different sensations, imbued with different meanings and strong emotions and cognitions. Pain can have intense, complex features that need to be explained. The discovery of how such varied dimensions of pain experience relate to each other and to the pain-related neural pathways, neurotransmitters, and integrative centers of the brain that support them is a major scientific challenge in the study of pain. How can it be done?

The way to meet this challenge is to integrate knowledge from current models of pain with knowledge and insights from neuroscience, psychology, and humanities. A history of experiential pain investigations does exist. For example, early in the twentieth century, Sir Henry Head, William Landau and George H. Bishop conducted psychophysical studies on qualitative differences between ‘first pain’ and ‘second pain’ and neurophysiological studies on the relationship of these pain sub-types to brain activity. Later, temporal differences between first and second pain were explained in terms of central temporal summation in psychophysiological studies by Donald D. Price and others and Roland Staud. These integrative studies use well-known psychophysical scaling methods (e.g., ratio scales) or, the ‘experiential-phenomenological method’, in studies by Price and colleagues. Other experiential methods that form productive research programs should be considered to model pain experience, such as descriptive experience sampling (DES) (to analyze very brief episodes of experience in natural settings) developed by Russell T. Hurlburt and his colleagues, or the explication interview method to analyze the fine grain of chronic experiences, exemplified in the works of Francisco Varella, Claire Petitmengin, and Pierre Vermersch.

Without a detailed experiential analysis of the qualities of pain, or the qualitative differences between pain sub-types, it is extremely challenging to establish a detailed examination of the neural systems that support such features. Experiential analyses are also essential for the advancement of psychological pain theory and clinical practice. The aim of this edited collection is to contribute towards integrating pain psychology and neuroscience with the humanities in the study of pain.

Target audiences of ‘Pain Experience and Neuroscience’

The expected target audiences of ‘Pain Experience and Neuroscience’ are scientists, researchers, authors, and practitioners currently active in pain science, including the neurosciences and clinical neurosciences, psychology, and the humanities. The target audience will also include various stakeholders, like academic scientists and humanists, research institutes, and individuals interested in pain, including pain patients, their families and significant others, and the huge audience in the public sector comprising health service providers, government agencies, ministries, education institutions, social service providers and other types of government, commercial and not-for-profit agencies.

Intent to submit your chapter

Please indicate your intention to submit a manuscript to Simon with the title of the chapter, and author(s). He will approach a publisher once he has accepted 25 intents to submit.

Please feel free to contact Simon if you have any questions or concerns. Many thanks!

IMPORTANT DATES:

Intent to Submit: December 31, 2013
Full Version: May 31, 2014
Decision Date: July 31, 2014
Final Version: August 31, 2014 

Editor 

Dr. Simon van Rysewyk

Post-Doctoral Fellow, Graduate Institute of Medical Humanities, Taipei Medical University, 250 Wu-Hsing Street, Xin-yi District, Taipei City, Taiwan 110.

email: vanrysewyk@tmu.edu.tw

mobile: +886 916 608 88

Email: vanrysewyk@tmu.edu.tw
http://simonvanrysewyk@wordpress.com
http://utas.academia.edu/SimonvanRysewyk

Variations in response to pain have been reported in clinical settings (e.g., Bates et al. 1996; Cherkin et al. 1994; Jensen et al. 1986; Unruh, 1996; Wormslev et al. 1994). Patients with similar types and degrees of wounds vary from showing no pain to showing severe and disabling pain. Many chronic pain patients show disabling chronic pain despite showing no observable wound. Other patients show severe wounds but do not show pain. Why is it that two persons with identical lesions do not show the same pain or no pain at all? Why are all pain patients unique?

I propose that mind-brain identity theory may offer an answer to this difficult question. There are two main versions of identity theory: type and token identity. A sample type identical property is to identify “Being in pain” (X) with “Being the operation of the nervous-endocrine-immune mechanism” (Y) (i.e., X iff Y) (Chapman et al. 2008; van Rysewyk, 2013). For any person in pain the nervous-endocrine-immune mechanism (NEIM) must be active, and when NEIM is active in a person, he or she is in pain. Thus, type identity theory strongly limits the pattern of covariation across persons. According to token identity theory, for a person in mental state X at time t, X is identical to some neurophysiological state Y. However, in the same person at time t1, the same mental state X may be identical to a different neurophysiological state Y2. Token identity theory doesn’t limit the pattern of covariation across persons; it only claims that, at any given time, some mind-brain identity must be true.

In response to the topic question, I propose a hybrid version of identity theory – ‘type-token mind-brain identity theory’. Accordingly, for every person, there is a type identity between a mental state X and some neurophysiological state Y. So, when I am in pain, I am in NEIM state Y (and vice versa), but this NEIM state Y may be quite different across persons. Type-token identity theory therefore proposes a type identity model at the level of every person (i.e., it may vary across persons). A type-token identity theory implies that group-level type identities (i.e., type-type) cannot fully explain the pattern of covariation in pain responses across persons. Measuring changes of a pattern of psychological and neurophysiological indicators over time may then support a unidimensional model of chronic pain for each pain patient. Thus, being in chronic pain for me is identical with a specific pattern of NEIM activity (Chapman et al. 2008; van Rysewyk, 2013), but for a different patient, the same state of pain may be identical to a different pattern of NEIM activity. In preventing and alleviating chronic pain, it is therefore essential to best fit the intervention to the type-token pain identity profile of the patient.

References

Bates, M. S., Edwards, W. T., & Anderson, K. O. (1993). Ethnocultural influences on variation in chronic pain perception. Pain, 52(1), 101-112.

Chapman, C. R., Tuckett, R. P., & Song, C. W. (2008). Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. Journal of Pain 9: 122-145.

Cherkin, D. C., Deyo, R. A., Wheeler, K., & Ciol, M. A. (1994). Physician variation in diagnostic testing for low back pain. Who you see is what you get. Arthritis & Rheumatism, 37(1), 15-22.

Jensen, M. P., Karoly, P., & Braver, S. (1986). The measurement of clinical pain intensity: a comparison of six methods. Pain, 27(1), 117-126.

Unruh, A. M. (1996). Gender variations in clinical pain experience. Pain, 65(2), 123-167.

van Rysewyk, S. (2013). Pain is Mechanism. Unpublished PhD Thesis. University of Tasmania.

Wormslev, M., Juul, A. M., Marques, B., Minck, H., Bentzen, L., & Hansen, T. M. (1994). Clinical examination of pelvic insufficiency during pregnancy: an evaluation of the interobserver variation, the relation between clinical signs and pain and the relation between clinical signs and physical disability. Scandinavian journal of rheumatology, 23(2), 96-102.

Call for Chapters: Machine Medical Ethics, Edited Collection

You are warmly invited to submit your research chapter for possible inclusion in an edited collection entitled Machine Medical Ethics. Target publication date: 2014.

The new field of Artificial Intelligence called Machine Ethics is concerned with ensuring that the behaviour of machines towards human users and other machines is ethical. This unique edited collection aims to provide an interdisciplinary platform for researchers in this field to present new research and developments in Machine Medical Ethics. Areas of interest for this edited collection include, but are not limited to, the following topics:

Foundational Concepts

What is medical ethics?

What is machine medical ethics?

What are the consequences of creating or not creating ethical medical machines?

Can medical machines be autonomous?

Ought medical machines to operate autonomously, or under (complete or partial) human physician control?

Theories of Machine Medical Ethics

What theories of machine medical ethics are most theoretically plausible and most empirically supported?

Ought machine medical ethics be rule-based (top-down), case- based (bottom-up), or a hybrid view of both top-down and bottom-up?

Is an interdisciplinary approach suited to designing a machine medical ethical theory? (e.g., collaboration between philosophy, psychology, AI, computational neuroscience…)

Medical Machine Training

What does ethical training for medical machines consist in: ethical principles, ethical theories, or ethical skills? Is a hybrid approach best?

What training regimes currently tested and/or used are most successful?

Can ethically trained medical machines become unethical?

Can a medical machine learn empathy (caring) and skills relevant to the patient-physician relationship?

Can a medical machine learn to give an apology for a medical error?

Ought medical machines to be trained to detect and respond to patient embarrassment and/or issues of patient privacy? What social norms are relevant for training?

Ought medical machines to be trained to show sensitivity to gender, cultural and age-differences?

Ought machines to teach medicine and medical ethics to human medical students?

Patient-Machine-Physician Relationship

What role ought imitation or mimicry to play in the patient-machine-physician relationship?

What role ought empathy or caring to play in the patient-machine-physician relationship?

What skills are necessary to maintain a good patient-machine-physician relationship?

Ought medical machines be able to detect patient fakery and malingering?

Under what conditions ought medical machines to operate with a nurse?

In what circumstances should a machine physician consult with human or other machine physicians regarding patient assessment or diagnosis?

Medical Machine Physical Appearance

Is there a correlation between physical appearance and physician trustworthiness?

Ought medical machines to appear human or non-human?

Is a highly plastic human-like face essential to medical machines? Or, is a static face sufficient?

What specific morphological facial features ought medical machines to have?

Ought medical machines to be gendered or androgynous?

Ought medical machines to possess a human-like body with mobile limbs?

What vocal characteristics ought medical machines to have?

As a new field, the target audiences are expected to be from the scientists, researchers, and practitioners working in the field of machine ethics and medical ethics. The target audience will also include various stakeholders, like academics, research institutes, and individuals interested in this field, and the huge audience in the public sector comprising health service providers, government agencies, ministries, education institutions, social service providers and other types of government, commercial and not-for-profit agencies.

Please indicate your intention to submit your full paper by email to the editor who emails you with the title of the paper, authors, and abstract. The full manuscript, as PDF file, should be emailed to that same editor by the deadline indicated below. Authoring guidelines will be mailed to you after we receive your letter of intent.

Please feel free to contact the editors, Simon van Rysewyk or Dr. Matthijs Pontier, if you have any questions or concerns. Many thanks!

IMPORTANT DATES:

Intent to Submit: June 10, 2013

Full Version: October 20, 2013

Decision Date: November 10, 2013

Final Version: December 31, 2013

Editors:

Simon van Rysewyk

School of Humanities
University of Tasmania
Private Bag 41
Hobart
Tasmania 7001
Australia

Email: simonvanrysewyk@utas.edu.au

Dr. Matthijs Pontier

Post-Doctoral Researcher
The Centre for Advanced Media Research (CAMeRA)
Vrije Universiteit Amsterdam
Buitenveldertselaan 3
1081 HV Amsterdam
The Netherlands

Email: matthijspon@gmail.com

Chemical Brain Preservation: How to Live “Forever” – A Personal View.

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