ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2017
The added value of C-reactive protein measurement in diagnosing pneumonia in primary care: a meta-analysis of individual patient data.
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Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 5 of them syntheses that pooled it.
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37citing papers in PubMed, 5 pooled it
5.7field-weighted citation impact, top 4% of its field
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
37 citing papers in PubMed, 5 syntheses or guidelines pooled it, 61 citations in OpenAlex.
- Diagnostic accuracy of point-of-care tests for acute respiratory infection: a systematic review of reviews.Health technology assessment (Winchester, England) · 2026Pooled it
- Pooled it
- Impact of point-of-care C reactive protein in ambulatory care: a systematic review and meta-analysis.BMJ open · 2019Pooled it
- Use of C-reactive protein to tailor antibiotic use: a systematic review and meta-analysis.BMJ open · 2018Pooled it
- Diagnostic value of signs, symptoms and diagnostic tests for diagnosing pneumonia in ambulant children in developed countries: a systematic review.NPJ primary care respiratory medicine · 2018Pooled it
- Trial
- Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents: cluster randomised controlled trial.BMJ (Clinical research ed.) · 2021Trial
- Antibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training: A Randomized Trial.Annals of family medicine · 2019Trial
- Assessment of Compliance with National and International Guidelines in the Empirical Management of Community-Acquired Pneumonia (CAP) in Lebanese Hospitals: A Multicenter Retrospective Cohort Study.Antibiotics (Basel, Switzerland) · 2026Article
- Association of C-reactive protein with cause, duration and severity of lower respiratory infections in primary care: a prospective cohort study.BMJ open respiratory research · 2025Article
- Development and validation of a prediction model for intrapartum fever related to chorioamnionitis in parturients undergoing epidural analgesia.Scientific reports · 2024Article
- Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes.Diagnostic and prognostic research · 2023Article
- Patient Stratification for Antibiotic Prescriptions Based on the Bound-Free Phase Detection Immunoassay of C-Reactive Protein in Serum Samples.Biosensors · 2023Article
- Development of a nomogram to estimate the risk of community-acquired pneumonia in adults with acute asthma exacerbations.The clinical respiratory journal · 2023Article
- Incorporation of biomarkers into a prediction model for paediatric radiographic pneumonia.ERJ open research · 2023Article
- Guidance on C-reactive protein point-of-care testing and complementary strategies to improve antibiotic prescribing for adults with lower respiratory tract infections in primary care.Frontiers in medicine · 2023Article
- Article
- The Role of Point-of-Care C-Reactive Protein Testing in Antibiotic Prescribing for Respiratory Tract Infections: A Survey among Swiss General Practitioners.Antibiotics (Basel, Switzerland) · 2022Article
- Prescribing antibiotics: the use of diagnostic tests in general practice. A register-based study.Scandinavian journal of primary health care · 2021Article
- What is pneumonia?Breathe (Sheffield, England) · 2021Review
Corrections and comments
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Authors and funding
18 authors at 6 institutions in 5 countries.
Margaretha C MinnaardUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands m.c.minnaard@umcutrecht.nl.
Joris A H de GrootUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Rogier M HopstakenUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Alwin SchierenbergUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Niek J de WitUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Johannes B ReitsmaUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Berna D L BroekhuizenUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Saskia F van VugtUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Arie Knuistingh NevenUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Aleida W GraffelmanUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Hasse MelbyeUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Timothy H RainerUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Johann SteurerUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Anette HolmUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Ralph GonzalesUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Geert-Jan DinantUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Alma C van de PolUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
Theo J M VerheijUniversity Medical Center Utrecht (Minnaard, de Groot, Schierenberg, de Wit, Reitsma, Broekhuizen, van Vugt, van de Pol, Verheij), Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Saltro Diagnostic Center for Primary Care (Hopstaken), Utrecht, the Netherlands; Department of Public Health and Primary Care (Knuistingh Neven, Graffelman), Leiden University Medical Center, Leiden, the Netherlands; Department of Community Medicine (Melbye), UiT the Arctic University of Norway, Tromsø, Norway; Chinese University of Hong Kong (Rainer), Hong Kong, China; Horten Centre for Patient Oriented Research and Knowledge Transfer (Steurer), University Zurich, Zurich, Switzerland; Department of Infectious Diseases (Holm), Odense University Hospital, Odense, Denmark; Division of General Internal Medicine (Gonzales), University of California, San Francisco, Calif.; Department of Family Medicine (Dinant), CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
UiT The Arctic University of Norway · NOLeiden University Medical Center · NLMaastricht University Medical Centre · NLOdense University Hospital · DKUniversity Medical Center Utrecht · NLUniversity of Zurich · CH
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundC-reactive protein (CRP) is increasingly being included in the diagnostic work-up for community-acquired pneumonia in primary care. Its added diagnostic value beyond signs and symptoms, however, remains unclear. We conducted a meta-analysis of individual patient data to quantify the added value of CRP measurement.
methodsWe included studies of the diagnostic accuracy of CRP in adult outpatients with suspected lower respiratory tract infection. We contacted authors of eligible studies for inclusion of data and for additional data as needed. The value of adding CRP measurement to a basic signs-and-symptoms prediction model was assessed. Outcome measures were improvement in discrimination between patients with and without pneumonia in primary care and improvement in risk classification, both within the individual studies and across studies.
resultsAuthors of 8 eligible studies (
interpretationAdding CRP measurement to the diagnostic work-up for suspected pneumonia in primary care improved the discrimination and risk classification of patients. However, it still left a substantial group of patients classified at intermediate risk, in which clinical decision-making remains challenging.
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