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Do not fill this in! == Electronic cigarette == {{Main|Electronic cigarette}} {{further|Safety of electronic cigarettes |Composition of electronic cigarette aerosol}} [[File:Electronic Nicotine Delivery Systems.jpg|thumb|upright=1.25|Various types of electronic cigarettes|alt=Various types of electronic cigarettes.]] <!-- Definition and Construction --> An electronic cigarette (commonly known as a '''vape''') is a handheld [[battery (electricity)|battery]]-powered [[Vaporizer (inhalation device)|vaporizer]] that simulates [[tobacco smoking|smoking]] by providing some of the behavioral aspects of smoking, including the hand-to-mouth action of smoking, but without [[combustion|combusting]] tobacco.<ref name=Caponnetto2012>{{cite journal|last1=Caponnetto|first1=Pasquale|last2=Campagna|first2=Davide|last3=Papale|first3=Gabriella|last4=Russo|first4=Cristina|last5=Polosa|first5=Riccardo|title=The emerging phenomenon of electronic cigarettes|journal=Expert Review of Respiratory Medicine|volume=6|issue=1|year=2012|pages=63–74|issn=1747-6348|doi=10.1586/ers.11.92|pmid=22283580|s2cid=207223131}}</ref> Using an e-cigarette is known as "vaping" and the user is referred to as a "vaper" or “vapist”.<ref name="Orellana-Barrios2015">{{cite journal |last1 = Orellana-Barrios |first1 = Menfil A. |last2 = Payne |first2 = Drew |last3 = Mulkey |first3 = Zachary |last4 = Nugent |first4 = Kenneth |title = Electronic cigarettes-a narrative review for clinicians |journal = The American Journal of Medicine |year = 2015 |issn = 0002-9343 |doi = 10.1016/j.amjmed.2015.01.033 |pmid = 25731134 |volume=128 |issue = 7 |pages=674–81|doi-access = free }}</ref> Instead of [[tobacco smoke|cigarette smoke]], the user inhales an [[aerosol]], commonly called [[vapor]].<ref name=Cheng2014>{{cite journal|last1=Cheng|first1=T.|title=Chemical evaluation of electronic cigarettes|journal=Tobacco Control|volume=23|issue=Supplement 2|year=2014|pages=ii11–ii17|issn=0964-4563|doi=10.1136/tobaccocontrol-2013-051482|pmc=3995255|pmid=24732157}}</ref> E-cigarettes typically have a [[heating element]] that atomizes a [[liquid solution]] called [[construction of electronic cigarettes#E-cigarette liquid|e-liquid]].<ref name=Weaver2014>{{cite journal|last1=Weaver|first1=Michael|last2=Breland|first2=Alison|last3=Spindle|first3=Tory|last4=Eissenberg|first4=Thomas|title=Electronic Cigarettes|journal=Journal of Addiction Medicine|volume=8|issue=4|year=2014|pages=234–240|issn=1932-0620|doi=10.1097/ADM.0000000000000043|pmc=4123220|pmid=25089953}}</ref> E-cigarettes are automatically activated by taking a puff;<ref name=Rahman2014>{{cite journal|last1=Rahman|first1=Muhammad|last2=Hann|first2=Nicholas|last3=Wilson|first3=Andrew|last4=Worrall-Carter|first4=Linda|title=Electronic cigarettes: patterns of use, health effects, use in smoking cessation and regulatory issues|journal=Tobacco Induced Diseases|volume=12|issue=1|year=2014|pages=21|doi=10.1186/1617-9625-12-21|pmc=4350653|pmid=25745382 |doi-access=free }}</ref> others turn on manually by pressing a button.<ref name=Orellana-Barrios2015/> Some e-cigarettes look like traditional cigarettes,<ref name=Pepper2013>{{cite journal |last1=Pepper |first1=J. K. |last2=Brewer |first2=N. T. |title=Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review |journal=Tobacco Control |volume=23 |issue=5 |year=2013 |pages=375–384 |issn=0964-4563 |doi=10.1136/tobaccocontrol-2013-051122 |pmid=24259045 |pmc=4520227}}</ref> but they come in many variations.<ref name=Orellana-Barrios2015/> Most versions are reusable, though some are disposable.<ref name=DropeCahn2017>{{cite journal|last1=Drope|first1=Jeffrey|last2=Cahn|first2=Zachary|last3=Kennedy|first3=Rosemary|last4=Liber|first4=Alex C.|last5=Stoklosa|first5=Michal|last6=Henson|first6=Rosemarie|last7=Douglas|first7=Clifford E.|last8=Drope|first8=Jacqui|title=Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine|journal=CA: A Cancer Journal for Clinicians|volume=67|issue=6|pages=449–471|year=2017|issn=0007-9235|doi=10.3322/caac.21413|pmid=28961314|doi-access=free}}</ref> There are first-generation,<ref name=Bhatnagar2014>{{cite journal |last1=Bhatnagar |first1=A. |last2=Whitsel |first2=L.P. |last3=Ribisl |first3=K.M. |last4=Bullen |first4=C. |last5=Chaloupka |first5=F. |last6=Piano |first6=M.R. |last7=Robertson |first7=R.M. |last8=McAuley |first8=T. |last9=Goff |first9=D. |last10=Benowitz |first10=N. |title=Electronic Cigarettes: A Policy Statement From the American Heart Association |journal=Circulation |date=August 24, 2014 |volume=130 |issue=16 |pages=1418–1436 |doi=10.1161/CIR.0000000000000107 |pmid=25156991 |pmc=7643636 |s2cid=16075813 |url=https://escholarship.org/content/qt52p2317d/qt52p2317d.pdf?t=otldep |access-date=September 2, 2019 |archive-date=March 14, 2020 |archive-url=https://web.archive.org/web/20200314040852/https://escholarship.org/content/qt52p2317d/qt52p2317d.pdf?t=otldep |url-status=live }}</ref> second-generation,<ref name=McRobbie2014>{{cite web |url=http://www.ncsct.co.uk/usr/pub/e-cigarette_briefing.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://www.ncsct.co.uk/usr/pub/e-cigarette_briefing.pdf |archive-date=2022-10-09 |url-status=live |title=Electronic cigarettes |first=Hayden |last=McRobbie |pages=1–16 |publisher=National Centre for Smoking Cessation and Training |date=2014}}</ref> third-generation,<ref name=Farsalinos2014>{{cite journal |vauthors=Farsalinos KE, Spyrou A, Tsimopoulou K, Stefopoulos C, Romagna G, Voudris V | title=Nicotine absorption from electronic cigarette use: Comparison between first and new-generation devices |journal=Scientific Reports |volume=4 |pages=4133 |year=2014 |doi=10.1038/srep04133 |pmc=3935206 |pmid=24569565| bibcode=2014NatSR...4E4133F }}</ref> and fourth-generation devices.<ref name=Farsalinos2015>{{cite web |first1=Konstantinos |last1=Farsalinos |title=Electronic cigarette evolution from the first to fourth generation and beyond |url=https://gfn.net.co/downloads/2015/Plenary%203/Konstantinos%20Farsalinos.pdf |website=gfn.net.co |page=23 |publisher=Global Forum on Nicotine |access-date=September 23, 2015 |archive-url=https://web.archive.org/web/20150708172614/http://gfn.net.co/downloads/2015/Plenary%203/Konstantinos%20Farsalinos.pdf |archive-date=July 8, 2015 }}</ref> E-liquids usually contain [[propylene glycol]], [[glycerol|glycerin]], [[nicotine]], [[Flavoring#Flavorants or flavorings|flavorings]], additives, and differing amounts of contaminants.<ref name=England2015>{{cite journal|last1=England|first1=Lucinda J.|last2=Bunnell|first2=Rebecca E.|last3=Pechacek|first3=Terry F.|last4=Tong|first4=Van T.|last5=McAfee|first5=Tim A.|title=Nicotine and the Developing Human|journal=American Journal of Preventive Medicine|year=2015|volume=49|issue=2|pages=286–93|issn=0749-3797|doi=10.1016/j.amepre.2015.01.015|pmc=4594223|pmid=25794473}}</ref> E-liquids are also sold without propylene glycol,<ref name=Kacker2014>{{cite journal |last1=Oh |first1=Anne Y. |last2=Kacker |first2=Ashutosh |s2cid=10560264 |title=Do electronic cigarettes impart a lower potential disease burden than conventional tobacco cigarettes?: Review on e-cigarette vapor versus tobacco smoke |journal=The Laryngoscope |date=December 2014 |volume=124 |issue=12 |pages=2702–2706 |doi=10.1002/lary.24750 |pmid=25302452|doi-access=free }}</ref> nicotine,<ref name=LeducQuoix2016>{{cite journal|last1=Leduc|first1=Charlotte|last2=Quoix|first2=Elisabeth|title=Is there a role for e-cigarettes in smoking cessation?|journal=Therapeutic Advances in Respiratory Disease|volume=10|issue=2|year=2016|pages=130–135|issn=1753-4658|doi=10.1177/1753465815621233|pmid=26668136|pmc=5933562}}</ref> or flavors.{{sfn|Wilder|2016|p=82}} <!-- Health effects, Safety, and Addiction and dependence --> The benefits and the [[safety of electronic cigarettes|health risks of e-cigarettes]] are uncertain.<ref name=EbbertAgunwamba2015>{{cite journal|last1=Ebbert|first1=Jon O.|last2=Agunwamba|first2=Amenah A.|last3=Rutten|first3=Lila J.|title=Counseling Patients on the Use of Electronic Cigarettes|journal=Mayo Clinic Proceedings|volume=90|issue=1|year=2015|pages=128–134|issn=0025-6196|doi=10.1016/j.mayocp.2014.11.004|pmid=25572196|doi-access=free}}</ref><ref name=Siu2015>{{cite journal |last1=Siu |first1=A.L. |title=Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement. |journal=Annals of Internal Medicine |date=September 22, 2015 |pmid=26389730 |doi=10.7326/M15-2023 |volume=163 |issue=8 |pages=622–34|doi-access=free }}</ref><ref name=Harrell2014>{{cite journal |last1=Harrell |first1=P.T. |last2=Simmons |first2=V.N. |last3=Correa |first3=J.B. |last4=Padhya |first4=T.A. |last5=Brandon |first5=T.H. |title=Electronic Nicotine Delivery Systems ("E-cigarettes"): Review of Safety and Smoking Cessation Efficacy.|journal=Otolaryngology–Head and Neck Surgery |date= June 4, 2014 |pmid=24898072 |doi=10.1177/0194599814536847 |volume=151 |issue=3 |pages=381–393 |pmc=4376316}}</ref> There is moderate-certainty evidence that e-cigarettes with nicotine may help people quit smoking when compared with e-cigarettes without nicotine and nicotine replacement therapy.<ref name="Hartmann-Boyce CD010216">{{Cite journal |last1=Hartmann-Boyce |first1=Jamie |last2=McRobbie |first2=Hayden |last3=Butler |first3=Ailsa R. |last4=Lindson |first4=Nicola |last5=Bullen |first5=Chris |last6=Begh |first6=Rachna |last7=Theodoulou |first7=Annika |last8=Notley |first8=Caitlin |last9=Rigotti |first9=Nancy A. |last10=Turner |first10=Tari |last11=Fanshawe |first11=Thomas R. |date=September 14, 2021 |title=Electronic cigarettes for smoking cessation |url= |journal=The Cochrane Database of Systematic Reviews |volume=9 |issue=6 |pages=CD010216 |doi=10.1002/14651858.CD010216.pub6 |issn=1469-493X |pmc=8438601 |pmid=34519354}}</ref> However, other studies have not supported the finding that e-cigarettes are proven to be more effective than [[smoking cessation]] medicine.<ref name=McDonough2015>{{cite journal|last1=McDonough|first1=Mike|title=Update on medicines for smoking cessation|journal=Australian Prescriber|volume=38|issue=4|year=2015|pages=106–111|issn=0312-8008|doi=10.18773/austprescr.2015.038|pmc=4653977|pmid=26648633}}</ref> There is concern with the possibility that non-smokers and children may start nicotine use with e-cigarettes at a rate higher than anticipated than if they were never created.{{sfn|WHO|2014|p=6}} Following the possibility of [[nicotine addiction]] from e-cigarette use, there is concern children may start smoking cigarettes.{{sfn|WHO|2014|p=6}} Youth who use e-cigarettes are more likely to go on to smoke cigarettes.<ref name=SGUSFactSheet2016>{{cite web|url=https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Fact_Sheet_508.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Fact_Sheet_508.pdf |archive-date=2022-10-09 |url-status=live|title=E-Cigarette Use Among Youth and Young Adults A Report of the Surgeon General: Fact Sheet|publisher=Surgeon General of the United States|year=2016}}{{PD-notice}}</ref><ref>{{cite book |author1=((National Academies of Sciences, Engineering, and Medicine)) |author2=((Health and Medicine Division)) |author3=((Board on Population Health and Public Health Practice)) |author4=((Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems)) |editor-first1=Kathleen |editor-first2=Leslie Y |editor-first3=David L |editor-last1=Stratton |editor-last2=Kwan |editor-last3=Eaton |title=Public Health Consequences of E-Cigarettes |date=23 January 2018 |doi=10.17226/24952 |pmid=29894118 |isbn=978-0-309-46834-3 |url=https://www.nap.edu/resource/24952/012318ecigaretteHighlights.pdf |archive-url=https://web.archive.org/web/20180127094412/https://www.nap.edu/resource/24952/012318ecigaretteHighlights.pdf |archive-date=2018-01-27 |url-status=live}}</ref> Their part in [[tobacco harm reduction]] is unclear,<ref name=Drummond2014>{{cite journal |last1=Drummond |first1=M.B. |last2=Upson |first2=D |title=Electronic cigarettes: Potential harms and benefits |journal=Annals of the American Thoracic Society |date=February 2014 |volume=11 |issue=2 |pages=236–42 |doi=10.1513/annalsats.201311-391fr |pmid=24575993|pmc=5469426 }}</ref> while another review found they appear to have the potential to lower tobacco-related death and disease.<ref name=Cahn2011>{{cite journal |last1= M. |first1=Z. |last2=Siegel |title=Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes? |journal=Journal of Public Health Policy |date=February 2011 |volume=32 |issue=1 |pages=16–31 |pmid=21150942 |doi= 10.1057/jphp.2010.41 |first2= M|doi-access=free }}</ref> Regulated US [[Food and Drug Administration]] [[nicotine replacement products]] may be safer than e-cigarettes,<ref name=Drummond2014/> but e-cigarettes are generally seen as safer than combusted [[tobacco products]].<ref name=KnorstBenedetto2014>{{cite journal|last1=Knorst|first1=Marli Maria|last2=Benedetto|first2=Igor Gorski|last3=Hoffmeister|first3=Mariana Costa|last4=Gazzana|first4=Marcelo Basso|title=The electronic cigarette: the new cigarette of the 21st century?|journal=Jornal Brasileiro de Pneumologia|volume=40|issue=5|year=2014|pages=564–572|issn=1806-3713|doi=10.1590/S1806-37132014000500013|pmc=4263338|pmid=25410845}}</ref><ref name=Burstyn2014>{{cite journal|last1=Burstyn|first1=Igor|title=Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks|journal=BMC Public Health|volume=14|issue=1|date=January 9, 2014|pages=18|issn=1471-2458|doi=10.1186/1471-2458-14-18|pmc=3937158|pmid=24406205 |doi-access=free }}</ref> It is estimated their safety risk to users is similar to that of [[smokeless tobacco]].<ref name=Caponnetto2013>{{cite journal |title=Electronic cigarette: a possible substitute for cigarette dependence |journal=Monaldi Archives for Chest Disease |date=March 2013 |author1=Caponnetto P. |author2=Russo C. |author3=Bruno C.M. |author4=Alamo A. |author5=Amaradio M.D. |author6=Polosa R. |volume=79 |issue=1 |pages=12–19 |pmid=23741941 |doi=10.4081/monaldi.2013.104|doi-access=free }}</ref> The long-term effects of e-cigarette use are unknown.<ref name="Hartmann-Boyce CD010216"/><ref name=BradyDeLaRosa2019>{{cite journal|last1=Brady|first1=Benjamin R.|last2=De La Rosa|first2=Jennifer S.|last3=Nair|first3=Uma S.|last4=Leischow|first4=Scott J.|title=Electronic Cigarette Policy Recommendations: A Scoping Review|journal=American Journal of Health Behavior|volume=43|issue=1|year=2019|pages=88–104|issn=1087-3244|doi=10.5993/AJHB.43.1.8|pmid=30522569|s2cid=54566712 }}</ref><ref name=BalsBoyd2019>{{cite journal|last1=Bals|first1=Robert|last2=Boyd|first2=Jeanette|last3=Esposito|first3=Susanna|last4=Foronjy|first4=Robert|last5=Hiemstra|first5=Pieter S.|last6=Jiménez-Ruiz|first6=Carlos A.|last7=Katsaounou|first7=Paraskevi|last8=Lindberg|first8=Anne|last9=Metz|first9=Carlos|last10=Schober|first10=Wolfgang|last11=Spira|first11=Avrum|last12=Blasi|first12=Francesco|title=Electronic cigarettes: a task force report from the European Respiratory Society|journal=European Respiratory Journal|volume=53|issue=2|year=2019|pages=1801151|issn=0903-1936|doi=10.1183/13993003.01151-2018|pmid=30464018|doi-access=free}}</ref> The risk from [[serious adverse event]]s was reported in 2016 to be low.<ref name=PaleyEchalier2016>{{cite journal|last1=Paley|first1=Grace L.|last2=Echalier|first2=Elizabeth|last3=Eck|first3=Thomas W.|last4=Hong|first4=Augustine R.|last5=Farooq|first5=Asim V.|last6=Gregory|first6=Darren G.|last7=Lubniewski|first7=Anthony J.|title=Corneoscleral Laceration and Ocular Burns Caused by Electronic Cigarette Explosions|journal=Cornea|volume=35|issue=7|year=2016|pages=1015–1018|issn=0277-3740|doi=10.1097/ICO.0000000000000881|pmc=4900417|pmid=27191672}}</ref> Less serious [[adverse effect]]s include abdominal pain, headache, blurry vision,<ref name=BrelandSpindle2014>{{cite journal|last1=Breland|first1=Alison B.|last2=Spindle|first2=Tory|last3=Weaver|first3=Michael|last4=Eissenberg|first4=Thomas|title=Science and Electronic Cigarettes|journal=Journal of Addiction Medicine|volume=8|issue=4|year=2014|pages=223–233|issn=1932-0620|doi=10.1097/ADM.0000000000000049|pmc=4122311|pmid=25089952}}</ref> throat and mouth irritation, vomiting, nausea, and coughing.<ref name=Grana2014/> Nicotine itself is associated with some health harms.<ref name=Edgar2013>{{cite web|url=https://www.webmd.com/smoking-cessation/news/20131112/e-cigarettes-cdc#1|title=E-Cigarettes: Expert Q&A With the CDC|last=Edgar|first=Julie|website=[[WebMD]]|date=November 12, 2013|access-date=September 7, 2019|archive-date=April 9, 2022|archive-url=https://web.archive.org/web/20220409055819/https://www.webmd.com/smoking-cessation/news/20131112/e-cigarettes-cdc#1|url-status=live}}</ref> In 2019 and 2020, an [[2019–20 vaping lung illness outbreak|outbreak of severe lung illness throughout the US was linked to the use of vaping products]]<ref name=CDC2020>{{cite web|url=https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html|title=Outbreak of Lung Illness Associated with Using E-cigarette Products|publisher=Centers for Disease Control and Prevention|date=January 28, 2020|access-date=September 8, 2019|archive-date=April 12, 2021|archive-url=https://web.archive.org/web/20210412020842/https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html|url-status=live}}{{PD-notice}}</ref> <!-- E-liquid and aerosol --> E-cigarettes create vapor made of fine and [[ultrafine particle]]s of [[particulates|particulate matter]],<ref name=Grana2014/> which have been found to contain propylene glycol, glycerin, nicotine, flavors, small amounts of [[toxicant]]s,<ref name=Grana2014/> [[carcinogen]]s,<ref name=Hajek2014>{{cite journal|last1=Hajek|first1=P|last2=Etter|first2=JF|last3=Benowitz|first3=N|last4=Eissenberg|first4=T|last5=McRobbie|first5=H|title=Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit.|url=http://tobonline.com/Media/Default/Article/Addiction-%20Hajek%2014.pdf |archive-url=https://web.archive.org/web/20141205205447/http://tobonline.com/Media/Default/Article/Addiction-%20Hajek%2014.pdf |archive-date=2014-12-05 |url-status=live|journal=Addiction|date=July 31, 2014|pmid=25078252|doi=10.1111/add.12659|volume=109|issue=11|pages=1801–10|pmc=4487785}}</ref> and [[heavy metals]], as well as metal [[nanoparticle]]s, and other substances.<ref name=Grana2014/> Its [[composition of electronic cigarette aerosol|exact composition varies across and within manufacturers]], and depends on the contents of the liquid, the physical and electrical design of the device, and user behavior, among other factors.<ref name=Cheng2014/> E-cigarette vapor potentially contains harmful chemicals not found in tobacco smoke.<ref name=Hildick-SmithPesko2015>{{cite journal|last1=Hildick-Smith|first1=Gordon J.|last2=Pesko|first2=Michael F.|last3=Shearer|first3=Lee|last4=Hughes|first4=Jenna M.|last5=Chang|first5=Jane|last6=Loughlin|first6=Gerald M.|last7=Ipp|first7=Lisa S.|title=A Practitioner's Guide to Electronic Cigarettes in the Adolescent Population|journal=Journal of Adolescent Health|year=2015|issn=1054-139X|doi=10.1016/j.jadohealth.2015.07.020|pmid=26422289|volume=57|issue=6|pages=574–9|doi-access=free}}</ref> E-cigarette vapor contains fewer toxic chemicals,<ref name=Grana2014>{{cite journal|last=Grana|first=R|author2=Benowitz, N|author3=Glantz, SA|title=E-cigarettes: a scientific review.|journal=Circulation|date=May 13, 2014|volume=129|issue=19|pages=1972–86|doi=10.1161/circulationaha.114.007667|pmc=4018182|pmid=24821826}}</ref> and lower concentrations of potential toxic chemicals than cigarette smoke.<ref name="FernándezBallbè2015">{{cite journal|last1=Fernández|first1=Esteve|last2=Ballbè|first2=Montse|last3=Sureda|first3=Xisca|last4=Fu|first4=Marcela|last5=Saltó|first5=Esteve|last6=Martínez-Sánchez|first6=Jose M.|title=Particulate Matter from Electronic Cigarettes and Conventional Cigarettes: a Systematic Review and Observational Study|journal=Current Environmental Health Reports|volume=2|issue=4|pages=423–9|year=2015|issn=2196-5412|doi=10.1007/s40572-015-0072-x|pmid=26452675|doi-access=free}}</ref> The vapor is probably much less harmful to users and bystanders than cigarette smoke,<ref name=Hajek2014/> although concern exists that the exhaled vapor may be inhaled by non-users, particularly indoors.<ref name=Rom2014>{{cite journal|last1=Rom|first1=Oren|last2=Pecorelli|first2=Alessandra|last3=Valacchi|first3=Giuseppe|last4=Reznick|first4=Abraham Z.|title=Are E-cigarettes a safe and good alternative to cigarette smoking?|journal=Annals of the New York Academy of Sciences|volume=1340|issue=1|year=2014|pages=65–74|issn=0077-8923|bibcode=2015NYASA1340...65R|doi=10.1111/nyas.12609|pmid=25557889|s2cid=26187171}}</ref> Summary: Please note that all contributions to Christianpedia may be edited, altered, or removed by other contributors. 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