Peer Review History

Original SubmissionJune 15, 2022
Decision Letter - Laurent Mourot, Editor

PONE-D-22-16539Associations of habitual physical activity and carotid-femoral pulse wave velocity; a systematic review and meta-analysis of observational studies.PLOS ONE

Dear Dr. Lear,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses all the points raised during the review process.Please submit your revised manuscript by Oct 29 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Laurent Mourot

Section Editor

PLOS ONE

Journal Requirements:

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3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The introduction begins with information about the problem of cardiovascular disease (CVD), especially its impact on the public health system. Then the protective effects of exercise, recommendations, and the inverse relationship between CVD and exercise. The third paragraph showed information about other cardiovascular risk factors but that do not alter the inverse relationship between exercise and CVD. However, the sequence of ideas in the fourth and fifth paragraph is confusing. Information about vascular health appears, then about exercise and then the different methods of vascular outcome measurement. It would be interesting to organize the ideas in paragraphs 4 and 5 for a better understanding of the study's problem.

In line 165 “Authors were contacted to obtain this information if not reported in the paper (N=14)”, Does the number refer to the authors contacted or to the number of information not obtained?

In line 176. “In eight studies30 33-40 univariate” the number of the references does not correspond to the information described.

In line 206. “Five studies34 44-46 included a group” revise the number of references.

In line 214. 16 measured hPA via self-report questionnaire or interview.27 30 34-36 38-40 42 43 46 48 50 56-58

In figure 1, if we consider all the excluded reports from the reports assessed for eligibility, 13 studies remain. Probably one study fell into more than one exclusion criterion. It would be clearer to describe this information in the results.

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

**********

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While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Revision 1

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

Author response: Thank you. We have been through the PLoS ONE style requirements and have made edits to ensure it meets the required standard.

2. We note that you have included the phrase “data not shown” in your manuscript. Unfortunately, this does not meet our data sharing requirements. PLOS does not permit references to inaccessible data. We require that authors provide all relevant data within the paper, Supporting Information files, or in an acceptable, public repository. Please add a citation to support this phrase or upload the data that corresponds with these findings to a stable repository (such as Figshare or Dryad) and provide and URLs, DOIs, or accession numbers that may be used to access these data. Or, if the data are not a core part of the research being presented in your study, we ask that you remove the phrase that refers to these data.

Author Response: No data has been removed, rather 3 new supplementary files have now been added to the manuscript.

3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information

Author Response: We have now added a “supporting information” section at end of manuscript with associated captions.

Comments to the Author

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The introduction begins with information about the problem of cardiovascular disease (CVD), especially its impact on the public health system. Then the protective effects of exercise, recommendations, and the inverse relationship between CVD and exercise. The third paragraph showed information about other cardiovascular risk factors but that do not alter the inverse relationship between exercise and CVD. However, the sequence of ideas in the fourth and fifth paragraph is confusing. Information about vascular health appears, then about exercise and then the different methods of vascular outcome measurement. It would be interesting to organize the ideas in paragraphs 4 and 5 for a better understanding of the study's problem.

Author response: Thank you for this comment, we welcome the opportunity to clarify this section. To improve the flow of the latter part of the introduction and clarify the rationale for the review we have made a number of edits and have moved the discussion of vascular function and its assessment to earlier in the piece. This is now followed by discussion of evidence for associations between structured exercise and vascular function, and the evidence gaps which this review addresses, namely the lack of clarity regarding associations between habitual physical activity and arterial stiffness and the limitations of existing reviews.

In line 165 “Authors were contacted to obtain this information if not reported in the paper (N=14)”, Does the number refer to the authors contacted or to the number of information not obtained?

Author response: Thank you, we appreciate the opportunity to clarify. The text has now been edited to read: “We contacted the corresponding authors of 14 studies to request any information required for meta-analysis that was not reported in their papers."

The resultant information not obtained from contacting Authors and therefore necessitating manual conversion is then detailed in the following bullet points 1-3, together with citations of the individual studies.

In line 176. “In eight studies30 33-40 univariate” the number of the references does not correspond to the information described.

Author response: Thank-you for pointing out this error. These references have been checked and the extra reference (30) removed.

In line 206. “Five studies34 44-46 included a group” revise the number of references.

Author response: Thank-you for pointing out this error. There were only four studies included a subset of participants with disease. These are specified correctly. The text has been edited to describe the “four” rather than ‘five’ studies.

In line 214. 16 measured hPA via self-report questionnaire or interview.27 30 34-36 38-40 42 43 46 48 50 56-58.

Author Response: These references have been double checked and are indeed correct. No changes have been made.

In figure 1, if we consider all the excluded reports from the reports assessed for eligibility, 13 studies remain. Probably one study fell into more than one exclusion criterion. It would be clearer to describe this information in the results.

Author response: This is correct, we appreciate the opportunity to clarify. Several studies were excluded based on them meeting more than one exclusion criteria. This has been addressed by the addition of “(not mutually exclusive)” within figure 1 for clarity.

Additionally, this information has now been added in full in lines 206-212 (clean manuscript file, or lines 218-225 in track changes manuscript file) as follows: “Database searches yielded 8149 studies of which 180 full-texts were screened for eligibility. 151 studies were excluded for the following reasons: Investigating clinical population without healthy control group (N=21), Measuring exercise only with no measurement of habitual PA (N=50), alternative measurement of vascular function without cfPWV (N=51), insufficient data reported (N=37) and the inadequate categorization of participants restricting analysis (N=8). Note, a number of studies were excluded for meeting more than one of these exclusion criteria. A PRISMA flow diagram is presented in Fig 1.”

Attachments
Attachment
Submitted filename: Response to Reviewers.docx
Decision Letter - Laurent Mourot, Editor

PONE-D-22-16539R1Associations of habitual physical activity and carotid-femoral pulse wave velocity; a systematic review and meta-analysis of observational studies.PLOS ONE

Dear Dr. Lear,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Important limitations still persist, especially specifying how physical activity (PA) was measured and if it has an importance in the link between PA and pulse wave velocity, and what is the effect of duration/intensity/total work on this link / these links. The difference/concordance with the litterature is also of importance. This is at the heart of the manuscript and should be taken into account in your answers. Please submit your revised manuscript by Dec 01 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Laurent Mourot

Section Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for taking my considerations into account. I still have some questions for the authors.

The purpose of this present review is to clarify the associations between habitual physical activity and arterial stiffness, responding to the limits of a previous review. This information appears in the introduction and there is nothing further. It would be interesting to have an approach on both studies, the previous review and the current one in the discussion.

If I understand correctly, data adjusted for age, sex, BMI and BP were used. However, the units of measurement of physical activity are extremely variable. In the authors' opinion, is it possible that the association between habitual physical activity and PWV was not evident from these differences? Perhaps trying to classify the studies according to the amount of physical activity and/or intensity would reveal a stronger association. Explore more the information of the lines 388-393.

In the discussion between the lines the authors cite physical training. The comparison cited between the results of this review and previous studies of physical training needs to be approached with caution. First, because of the limitations cited above regarding self-reporting of physical activity. Second, because this is not the initial purpose of this review. Finally, because the results of this review are not the effects of interventional studies of physical training. However, exploring why the results are consistent across studies despite differences in modalities may be interesting and may help answer my previous question.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Revision 2

We thank the editor and reviewer for taking the time to read our manuscript and for their useful and constructive comments. Please find our responses below.

1) The purpose of this present review is to clarify the associations between habitual physical activity and arterial stiffness, responding to the limits of a previous review. This information appears in the introduction and there is nothing further. It would be interesting to have an approach on both studies, the previous review and the current one in the discussion.

Author Response: Thank you for this comment, we agree that it is useful to compare the results from the present review with that of the previous review, on which we are providing an update. The text in the first paragraph of the discussion has now been amended to compare the results from our own pooled analyses with that of the previous review.

2) If I understand correctly, data adjusted for age, sex, BMI and BP were used. However, the units of measurement of physical activity are extremely variable. In the authors' opinion, is it possible that the association between habitual physical activity and PWV was not evident from these differences? Perhaps trying to classify the studies according to the amount of physical activity and/or intensity would reveal a stronger association. Explore more the information of the lines 388-393.

Author Response: Thank you for your comment. We agree that the measurement units of habitual physical activity (hPA) were very variable within included studies. It is for this reason that we converted all association results to partial r or standardised beta – by doing this we are instead reporting the association between per standard deviation change in hPA, rather than in absolute units (of which are variable). This allowed us to make direct comparisons across different studies that have measured and reported hPA in different ways.

The amount of physical activity and the intensity of physical activity was considered when completing our analyses. A subgroup analysis was completed on studies reporting associations with total PA and compared to those reporting associations with MVPA (figure 3 in the manuscript). However unfortunately it was not possible to complete separate pooled analysis for associations with light intensity activity due to the limited number of studies reporting this association (N=6) and the lack of data available from these six studies meaning it was not possible to convert the available association statistics to partial r / standardised beta for comparison across studies.

Similarly, we decided it would not be appropriate to complete a subgroup analysis, or meta-regression on the average level of PA completed by the cohort within each study due to the limited number of included studies that reported average PA level (N=9 out of 18) and the differing units of PA measurement reported within these 9 studies.

3) In the discussion between the lines the authors cite physical training. The comparison cited between the results of this review and previous studies of physical training needs to be approached with caution. First, because of the limitations cited above regarding self-reporting of physical activity. Second, because this is not the initial purpose of this review. Finally, because the results of this review are not the effects of interventional studies of physical training. However, exploring why the results are consistent across studies despite differences in modalities may be interesting and may help answer my previous question.

Author Response: We thank you for your comment and agree it is not useful to compare the results from the present review to those of previous meta-analyses on exercise training interventions. This text has now been edited to remove reference of training intervention studies and instead provide a detailed comparison with that of the previous systematic review on habitual PA and cfPWV.

Attachments
Attachment
Submitted filename: response to reviewers.docx
Decision Letter - Laurent Mourot, Editor

Associations of habitual physical activity and carotid-femoral pulse wave velocity; a systematic review and meta-analysis of observational studies.

PONE-D-22-16539R2

Dear Dr. Lear,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Laurent Mourot

Section Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The study is relevant and the method followed the PRISMA recommendations. The statistical analysis is robust and takes into account factors that influence the main measurement variable. The suggestions made were accepted and the necessary changes were made.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Daniele Peres

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Formally Accepted
Acceptance Letter - Laurent Mourot, Editor

PONE-D-22-16539R2

Associations of habitual physical activity and carotid-femoral pulse wave velocity; a systematic review and meta-analysis of observational studies.

Dear Dr. Lear:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr Laurent Mourot

Section Editor

PLOS ONE

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