As the only programme of its kind in the UK and Europe, this programme offers enormous benefits to students with aspirations of becoming leaders in the field of Mental Health and Substance Use (Dual Diagnosis). [8] Bipolar disorder and panic disorder have very similar rates around the world. Features of a personality disorder may overlap with a bipolar mood episode.51 It may therefore be too challenging to diagnose a personality disorder until the mood episode has been successfully treated. The News on Sunday (TNS) Pakistan's leading weekly magazine. 2001;26:341-348.31. Zullino DF, Quinche P, Hfliger T, Stigler M. Olanzapine improves social dysfunction in cluster B personality disorder. This adds to a growing body of scientific research which has found that "healthy obesity does not exist", says Professor Indranil Dasgupta, consultant nephrologist at the University Hospitals Birmingham NHS Trust, and senior author of the research paper. This will include knowledge and skills in areas such as physical assessment, homeostasis, diabetes, coronary heart disease, obesity and physical side effects of psychotropic medication. Healthcare providers calculate BMI by using weight in kilograms (kg) divided by the square of height in meters (m2). She is a successful professional living in a beautiful Yorkshire village. Read about our approach to external linking. Outside of these hours, youll be expected to do independent study where you read, listen and reflect on other learning activities. If your BMI or other medical assessments indicate that youre getting close to having obesity or if you have certain risk factors, your healthcare provider may recommend developing healthy lifestyle changes to try to prevent you from developing obesity. 2004;55:875-881.18. Students will have the opportunity to explore the subject with due regard to international perspectives. The update to the 2016 CDC Opioid Prescribing Guideline includes recommendations for managing acute, subacute, and chronic pain. 2 years part-time, Code: Strakowski SM, DelBello MP, Fleck DE, et al. So even if the person successfully loses several stone by dieting, their body remembers its baseline weight and strives to return to it. ADHD and BPD share an underlying biological mechanism (ie, common familial, genetic, or neurophysiological). Note: illness is sometimes used as a synonym of disease, but it also refers to a person's perception of their health, regardless of whether the person does or does not have a disease. She also lost eight-and-a-half stone (55kg). Currently, PWS is the leading genetic cause of morbid obesity in children, and it is associated with a number of cognitive deficits and emotional problems (Figure 10.12). [17], A review that pooled surveys of mood disorders in different countries up to 2000 found 12-month prevalence rates of 4.1% for major depressive disorder (MDD), 2% for dysthymic disorder and 0.72% for bipolar 1 disorder. New York: Marcel Dekker Inc; 1999: 1-25.Perlis RH, Miyahara S, Marangell LB, et al. 66. Clin Approaches Bipolar Disord. "What are the chairs going to be like? The miasma theory (also called the miasmatic theory) is an obsolete medical theory that held that diseasessuch as cholera, chlamydia, or the Black Deathwere caused by a miasma (, Ancient Greek for 'pollution'), a noxious form of "bad air", also known as night air.The theory held that epidemics were caused by miasma, emanating from rotting organic matter. 2003;54:317-329.67. The News on Sunday (TNS) Pakistan's leading weekly magazine. Winokur G, Coryell W, Akiskal HS, et al. Perlis RH, Miyahara S, Marangell LB, et al. Latest news from around the globe, including the nuclear arms race, migration, North Korea, Brexit and more. Should I see a behavioral counselor or psychologist with expertise in weight management? It said: "Losing weight is not easy and our world-leading obesity strategy lays out extensive action to empower people to make more informed decisions and achieve a healthier weight.". Class III obesity, formerly known as morbid obesity, is a complex chronic condition that can lead to several serious health issues. Includes news, blogs, sports, politics, fashion, life style, entertainment, feature Stroies, celebrities interviews and more. In addition, you could have health conditions that are highly associated with having class III obesity, such as Type 2 diabetes or high blood pressure, without having obesity. Half of all lifetime cases had started by age 14 and three quarters by age 24. medical a benign lump in your body or a benign disease is not cancer and morbid adjective. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Cleveland Clinics Endocrinology & Metabolism Institute is committed to providing the highest quality healthcare for patients with diabetes, endocrine and metabolic disorders, and obesity. Aripiprazole (Abilify)Carbamazepine (Carbatrol, Tegretol, others)Gabapentin (Neurontin)Lamotrigine (Lamictal)Lithium (Eskalith, Lithane, Lithobid)Olanzapine (Zyprexa)Pregabalin (Lyrica)Quetiapine (Seroquel)Risperidone (Risperdal)Topiramate (Topamax)Valproate/valproic acid (Depakote, others). Preston GA, Marchant BK, Reimherr FW, et al. But for some people living with obesity, Sarah's admission of being unhappy with her weight is at odds with their argument that it is time to reject the stigma - and the shame - and to live happily as they are. Sign up now to receive more information about studying at Middlesex University London. Perceived weight discrimination is significantly associated with a current diagnosis of mood and anxiety disorders and mental health services use. Studies on bariatric surgery results have revealed that people who undergo bariatric surgery may lose 30% to 50% of their excess weight in the first six months and 77% of excess weight 12 months or more after surgery. 66. Mental fatigue has also been shown to decrease physical performance. 1 June 2021. J Clin Psychiatry. [5] The first published figures on the 14 country surveys completed to date, indicate that, of those disorders assessed, anxiety disorders are the most common in all but 1 country (prevalence in the prior 12-month period of 2.4% to 18.2%) and mood disorders next most common in all but 2 countries (12-month prevalence of 0.8% to 9.6%), while substance disorders (0.16.4%) and impulse-control disorders (0.06.8%) were consistently less prevalent. Yatham LN, Kennedy SH, ODonovan C, et al. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. The underbanked represented 14% of U.S. households, or 18. Am J Psychiatry. Exp Clin Psychopharmacol. We do not endorse non-Cleveland Clinic products or services. Its presence confounds attempts at symptomatic and functional recovery.31, Treatment approaches. J Clin Psychiatry. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Sarah respects it, but it is not for her. Isolating a syndrome by characterizing it through a unique pathogenic process allows for diagnostic fidelity even while acknowledging overlapping phenotypes. Obesity 2009;17(11)20332039 Dementia Praecox and Paraphrenia Together With Manic-Depressive Insanity and Paranoia. If you have relevant qualifications or work experience, academic credit may be awarded towards your Middlesex University programme of study. Join Macmillan Dictionary on Twitter and Facebook for daily word facts, quizzes and language news. Most (95%) of the respondents with BPD in the National Comorbidity Survey met criteria for 3 or more lifetime psychiatric disorders.1 In a Stanley Foundation Bipolar Treatment Outcome Network study of almost 300 patients, 65% met DSM-IV criteria for at least 1 comorbid Axis I disorder.2. Simon NM, Smoller JW, Fava M, et al. But she was taken aback after her boss told her that when he first met her he remembers thinking, "You better be a bloody good sales rep, looking the way you do, trying to sell a diabetes drug". "Many people who struggle with severe obesity have a number of underlying illnesses, which are all harder to treat because of their obesity," he says. [18] Certain population subgroups, such as physicians in training, have 12-month prevalence rates as high as 21 to 43%. Class III obesity can cause side effects and complications in many parts of your body. Class III obesity is a complex disease that has several contributing factors. 2002;10:276-285.40. 2002;43:245-252.20. These medications work by affecting your brain or gastrointestinal tract: Weight-loss medications are not recommended as a single treatment for class III obesity. Have a BMI of 35 or more and are experiencing obesity-related health conditions, such as high blood pressure or diabetes. Kessler R. Comorbidity of unipolar and bipolar depression with other psychiatric disorders in a general population survey. All information these cookies collect is aggregated and therefore anonymous. Bipolar Disorder: A Clinicians Guide to Biological Treatments. Bipolar disorder (BPD) is highly prevalent and heterogeneous. "If you look at any area in your city, which is at a low level of socio-economic standing, I guarantee there's going to be more takeaways. Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children. Further information on eligibility and how to apply, Full-time students: 16,800Part-time students: 59 per credit Part-time students: 30 per dissertation, Further information on legibility and how to apply. Arch Gen Psychiatry. MacKinnon DF, Zamoiski R. Panic comorbidity with bipolar disorder: what is the manic-panic connection? dual diagnosis) with due regard to policies, research, evidenced basedpractice, and workforce development/training. Women and younger people of either gender showed more cases of disorder. 2004; 65:1106-1113.11. After her own struggle with obesity, Sarah is hoping for something better for her daughter. 2004;19:369-386.4. However, there are several other factors that contribute to how much food we eat, the type of food we eat and how our body uses that energy. The Department of Health and Social Care described it as "one of the most significant challenges we face today". A BMI of 30 or above is linked to a higher risk of T2D for white people. Frankenburg FR, Zanarini MC. Mental illness can be of biological (e.g., anatomical, chemical, or genetic) or psychological (e.g., trauma or conflict) origin. These cookies may also be used for advertising purposes by these third parties. Bipolar Disord. Obesity prevalence among children and adolescents is still too high. [23] A US survey that incidentally screened for personality disorder found an overall rate of 14.79%. 2003;73:123-131.9. The underbanked represented 14% of U.S. households, or 18. Report Faults Agencys Food Unit for Leaderless Dysfunction. The miasma theory (also called the miasmatic theory) is an obsolete medical theory that held that diseasessuch as cholera, chlamydia, or the Black Deathwere caused by a miasma (, Ancient Greek for 'pollution'), a noxious form of "bad air", also known as night air.The theory held that epidemics were caused by miasma, emanating from rotting organic matter. This may reflect the limited nature of the clinical evidence in this field.68,69 The cost of diagnostic and therapeutic uncertainty, however, is calculated through the high cost of chronicity, with elevated rates of suicide, legal and interpersonal difficulties, and repeated hospitalizations. The module aims to develop the students knowledge and understanding of current evidence-based interventions for service users with mental health and substance use. Currently, PWS is the leading genetic cause of morbid obesity in children, and it is associated with a number of cognitive deficits and emotional problems (Figure 10.12). 65. The focus will include physiology as applied to nursing and a range of skills required in facilitating safe physical care for mental health service users. 2003;54:216-226. Experts used the tools during the systematic evidence review process to update existing clinical guidelines, such as those on cholesterol, blood pressure, and obesity. Analogous to models in medicine (eg, cardiovascular disease), BPD incorporates psychiatric and medical comorbidities (Table) whose simultaneous treatment is equally pressing to the core mood disturbance.3 Checks and balances must be used to address the distressing comorbid condition (eg, anxiety) whose treatment with an SSRI or serotonin norepinephrine reuptake inhibitor (SNRI) may catalyze a round of mood cycling in an otherwise stable patient; a greater degree of protection via mood stabilizers may be warranted in such an individual to reduce this possibility. That it's a choice," she says. It can be daunting and overwhelming to try to lose weight and change lifestyle habits. The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. ADHD is treated with psychostimulants that trigger the onset of childhood BPD. Studies from GP records in the UK showed that the annual chance of achieving normal weight in people with morbid obesity is one-in-700 to one-in-1,000. The 39-year-old mum has a Body Mass Index, or BMI, of over 40, which means she is medically classified as having "severe obesity" and is overweight enough for her health to be at risk. Obesity 2009;17(11)20332039 Approximately one in ten met criteria within a 12-month period. F.D.A. Given that Sarah's weight problems are mainly down to genetics, she does not know how that will impact her two-year-old daughter Emily. dual diagnosis) with due regard to policies, research, evidenced based practice, and workforce development/training. 2003;73:87-98.55. Start: [15], A 2005 review of 27 studies have found that 27% of adult Europeans is or has been affected by at least one mental disorder in the past 12 months. Am J Psychiatry. Comorbid anxiety in bipolar disorder: does it have an independent effect on suicidality? Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. McElroy SL, Altshuler LL, Suppes T, et al. Recommendation 1: NIMH staff should draft a policy for the National Advisory Mental Health Councils consideration that provides for the sharing of genetic materials (i.e., DNA, diagnostic data, and genotypes) collected through NIMHs grants and cooperative agreements after a 12- to 18-month proprietary period. Scientists have found that people's genetic background means their weight changes differently, even if they eat the same amount of calories. Mental fatigue is a temporary inability to maintain optimal cognitive performance. Their findings are outlined in the following reports: Different types of behavioral and psychological therapies that can help treat obesity include: When healthy lifestyle changes are not enough, your healthcare provider may recommend treating obesity with FDA-approved medications. [9][10], However, these are widely believed to be underestimates, due to poor diagnosis (especially in countries without affordable access to mental health services) and low reporting rates, in part because of the predominant use of self-report data, rather than semi-structured instruments such as the Structured Clinical Interview for DSM-IV (SCID); actual lifetime prevalence rates for mental disorders are estimated to be between 65% and 85%. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Visit ourEnglish language requirements page for a full list of accepted tests and qualifications. Obesity as a correlate of outcome in patients with bipolar I disorder. 2008;10:67-78.19. Specialist health professionals say it is time for obesity to be regarded as an illness caused by genetics, biology and how we live today. This module is designed to develop students understanding of a range of advanced inquiry methodologies appropriate for practitioners, in order to design a real work based project that has clear objectives related to their own professional development or the development of practice in their settings. Second-generation antipsychotic agents, including quetiapine and aripiprazole, reduced drug use and craving in small open-label studies.41,42, Treatment of comorbid BPD and SUD invariably requires an integrated approach that focuses on both disorders simultaneously, and incorporates both psychotherapy and pharmacotherapy. Creating and Analyzing Large, Well-documented Samples. "Public perception hasn't quite understood that it's a real illness," says bariatric weight loss surgeon Shaw Somers. The purpose of this module is to critically explore issues influencing the approach to the care of individuals coping with co-morbid mental health and substance use conditions (i.e. Although patients need to make permanent lifestyle changes after surgery to avoid putting weight back on, it can also lead to hormone changes that can reduce appetite. The CDC has found that obesity is the single strongest risk factor for severe COVID-19 illness. Hatzenbuehler ML, Keyes KM, Hasin DS. Removed fallow time between household members from dental appendix. The BMI scale is not always accurate, so healthcare providers may use other tests and tools to assess obesity, such as measuring waist circumference. JAMA. A related figure not given in other studies (known as lifetime morbid risk), reported to be an accurate statement of how many people would theoretically develop schizophrenia at any point in life regardless of time of assessment, was found to be "about seven to eight individuals per 1,000" (0.7/0.8%). The News on Sunday (TNS) Pakistan's leading weekly magazine. "There is a postcode-related issue here where some people will not have services available. "I do look at some of the body positive community and kind of envy their self-love. This module is a culmination of a student's Masters study and provides the opportunity to synthesise professional and academic learning. Goldstein BI, Levitt AJ. A review that pooled surveys of mood disorders in different countries up to 2000 found 12-month prevalence rates of 4.1% for major depressive disorder (MDD), 2% for dysthymic disorder and 0.72% for bipolar 1 disorder.The average lifetime prevalence found was 6.7% for MDD (with a relatively low lifetime prevalence rate in higher-quality studies, compared to the rates typically 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Class III Obesity (Formerly Known as Morbid Obesity). These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. [citation needed][8], Previous widely cited large-scale surveys in the US were the Epidemiological Catchment Area (ECA) survey and subsequent National Comorbidity Survey (NCS). A history of substance abuse complicates remission from acute mania in bipolar disorder. September 2023, Around 6,000 people each year in England go ahead with an operation to help reduce their weight and improve their health dramatically. Despite what she now knows about obesity, Sarah still wants to be slimmer. Those who have a checking or savings account, but also use financial alternatives like check cashing services are considered underbanked. A substantial minority (23%) met criteria for more than two disorders. mortal adjective. California focuses on mental illness to reduce homelessness. Psychiatric and medical comorbidities of bipolar disorder. Addict Behav. Like all medications, they have different side effects, and some should not be taken if you have certain conditions or are taking certain medications. All modules are delivered through distance learning. Ultimately it means there's no support for them," says Stuart Flint, a director of Obesity UK, and associate professor in psychology at the University of Leeds. Talk to your healthcare provider and/or a registered dietician about setting healthy and obtainable goals. Across the road from his house, he remembers the parade of shops once having a greengrocer's and a butcher's - now eight of the 20 shops are fast-food outlets. Fertility and Sterility is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. Well use technology to enhance all of your learning and give you access to online resources to use in your own time. California focuses on mental illness to reduce homelessness. Management for class III obesity may include: Certain lifestyle changes can help you manage obesity, improve your overall health and/or lose weight, including: Your healthcare provider may recommend enrolling in individual or group behavioral weight-loss programs to help treat obesity. Too many weight management programmes for those living with obesity begin with "moving more and eating less", which in reality is a prevention for obesity, not a cure. J Am Acad Child Adolesc Psychiatry. Kupfer DJ. 2003;37:187-192.15. Headache. Its important to remember that changing lifestyle habits takes time and patience. An adult may be considered to have class III obesity if they meet one of the following criteria: The BMI scale isn't always accurate for certain populations, and healthcare providers use a different scale to determine obesity in children. Approximately 9% of adults in the United States had class III obesity from 2017 to 2018. These rates are much higher than the rate of 10% to 20%, respectively, in patients without the SUD comorbidity and the highest rate within any psychiatric disorder.25, Reflecting findings from other studies, the most common SUD appears to be alcohol abuse and dependence.26,27 Research from the Stanley Foundation Bipolar Network found that the lifetime prevalence rate of alcohol abuse or dependence was 49% for bipolar men and 29% for bipolar women. 2006;67 (suppl 1):5-7.10. 1 June 2021. At the time, it made her feel "brilliant". The work has just been published in the American Journal of Kidney Disease and involved studying 4.5 million patient records from GPs in the UK over 20 years. NOTE: Empty data cells represent counts between 1-9 that have been suppressed in accordance with NCHS confidentiality standards. Forging the pathophysiological links between specific medical illnesses and BPD, including the use of clinical biomarkers to help refine the understanding of bipolar subtypes, may help clarify the pathophysiology of BPD itself. Figure 10.12 Eugenia Martnez Vallejo, depicted in this 1680 painting, may have had Prader-Willi syndrome. McIntyre RS, Konarski JZ, Yatham LN. 1990;264:2511-2518.26. Research shows that some people who have obesity and take prescription weight management medications lose 10% or more of their starting weight. 2003;54:216-226. Hum Psychopharmacol. Figure 10.12 Eugenia Martnez Vallejo, depicted in this 1680 painting, may have had Prader-Willi syndrome. Obsessive-compulsive disorder is two to three times as common in Latin America, Africa, and Europe as in Asia and Oceania. 2006;8:677-685.30. If we have insufficient numbers of students interested in an optional module, or there are staffing changes which affect the teaching, it may not be offered. she possesses a variant of the FTO gene, which is associated with weight gain and increases the risk of obesity, she has a mutation of the MC4 receptor which causes obesity, England: 28% of adults are obese (Health Survey for England 2019), Wales: 25% of adults are obese (National Survey for Wales 2019-20), Scotland: 29% of adults are obese (Scottish Health Survey 2019), Northern Ireland: 25% of adults are obese (Health Survey Northern Ireland 2018-19), gastric band - placed around the stomach, making you feel fuller sooner, gastric bypass - top part of your stomach is joined to the small intestine, so you feel fuller sooner, absorb fewer calories from food and your metabolism improves, sleeve gastrectomy - part of stomach removed so you cannot eat as much, and feel fuller sooner. In the spring of 2020, we, the members of the editorial board of the American Journal of Surgery, committed to using our collective voices to publicly address and call for action against racism and social injustices in our society. Sarah has lived with obesity her entire adult life. [22], Studies of the prevalence of personality disorders (PDs) have been fewer and smaller-scale, but a broader Norwegian survey found a similar overall prevalence of almost 1 in 7 (13.4%), based on meeting personality criteria over the prior five-year period. People from these backgrounds often dont show signs of a large waist circumference even though they may have unhealthy amounts of fat deep in their abdomens and may be diagnosed with obesity. It can impair the affected person's ability to work or study and can harm interpersonal relationships. Brady KT, Sonne SC, Malcolm RJ, et al. Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. Figure 10.12 Eugenia Martnez Vallejo, depicted in this 1680 painting, may have had Prader-Willi syndrome. National Institute of Mental Health (NIMH) Depression; Mood Disorders; Overweight and obesity. We aim to model a wide range of teaching strategies and approaches on the course which you can adapt to your own setting. Treatment for class III obesity is very individualized. The tools were specific to certain study designs and tested for potential flaws in study methods or implementation. Jed says that he recently signed a petition to try to prevent another takeaway from opening. New research adds to growing scientific opinion that "healthy obesity" does not exist. Katon WJ. Dr Tahrani says that Semaglutide was approved in the US very recently, and could lead to 15-to-17% weight loss. Psychologist Dr Denise Ratcliffe says that many people accept the narrative that they are to blame for their obesity. A BMI of 26 or above is linked to a higher risk of T2D for people of Arabic descent. Its increasing complexity is often caused by the presence of comorbid conditions, which have become the rule rather than the exception. 2008;69:1267-1275.24. Evidence-Based ReferencesKessler R. Comorbidity of unipolar and bipolar depression with other psychiatric disorders in a general population survey. It is also going to legislate to end the promotion of foods high in fat, sugar and salt. Unfortunately, there are few controlled data on the pharmacotherapeutic management of comorbid SUD and BPD. 2008;6:20-28.47. Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and may not represent all deaths that occurred in that period. Both the genetic and psychological components of obesity can be amplified when there is easy access to fatty, sugar-laden foods, which are available cheaply and conveniently. Childhood obesity is a serious problem in the United States, putting children and adolescents at risk for poor health. And the evidence for cost-effectiveness and health improvement are clear, from many studies around the world. Dr Sagman is staff psychiatrist, Toronto East General Hospital, Toronto, and associate vice-president, clinical research, Eli Lilly Canada Inc, and Dr Tohen is Distinguished Lilly Scholar for Neurosciences, Lilly Research Laboratories, Indianapolis. Students will be facilitated to develop their own leadership role within their chosen profession, and to explore and evaluate their own leadership style. Healthcare providers diagnose class III obesity in part by determining a persons body mass index (BMI). 2008; 10:117-128.70. The following course-related costs are included in the fees: As an undergraduate alumnus continuing postgraduate studies at Middlesex, you are eligible for an alumni bursary worth 20% off your fees. WHO International Consortium in Psychiatric Epidemiology", "The World Health Report 2001 Mental Health: New Understanding, New Hope", "Mental Health Care in the Developing World", The World Mental Health Survey Initiative, "Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys", "Global burden of obsessive-compulsive disorder in the year 2000", "Global burden of schizophrenia in the year 2000", "Global burden of bipolar disorder in the year 2000", "Global burden of panic disorder in the year 2000", "Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication", "Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication", The Numbers Count: Mental Disorders in America, "Size and burden of mental disorders in Europe--a critical review and appraisal of 27 studies", "Prevalence and incidence studies of anxiety disorders: a systematic review of the literature", "Prevalence and incidence studies of mood disorders: a systematic review of the literature", "Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis", "Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis", "Prevalence of Burnout Among Physicians: A Systematic Review", "A systematic review of the prevalence of schizophrenia", "The prevalence of personality disorders in a community sample", Prevalence of Mental Illness in the United States: Data Sources and Estimates, https://en.wikipedia.org/w/index.php?title=Prevalence_of_mental_disorders&oldid=1089456148, All articles with vague or ambiguous time, Articles with unsourced statements from April 2010, Creative Commons Attribution-ShareAlike License 3.0, This page was last edited on 23 May 2022, at 22:25. 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