Process and methods
3 Decision-making committees
- 3.1 Introduction
- 3.2 Forming the committee
- 3.3 Standing committees
- 3.4 Topic-specific committees
- 3.5 Other attendees at committee meetings
- 3.6 Code of conduct and declaration of interests
- 3.7 Identifying and meeting training needs of committee members
- 3.8 Committee meetings
- 3.9 Making group decisions and reaching consensus
- 3.10 Further contributions of committee members
- 3.11 References and further reading
This chapter describes the different types of decision-making committees, the training of committee members, the general principles of committee meetings and how committees make group decisions.
A decision-making committee (either a standing committee or a topic-specific committee) draws on its expertise to develop recommendations in the areas defined by the guideline scope. Convening an effective committee is therefore one of the most important stages in producing a NICE guideline. The committee:
may refine and agree the review questions to be addressed by the evidence reviews (for example, when topic-specific input is needed to further define outcomes or specify appropriate comparators) as defined in the scope
advises on developing the review protocol and alternative analyses
considers the evidence
develops the recommendations for practice and research
considers the likely costs and savings associated with implementing the recommendations
considers factors that may help or hinder implementation ('levers and barriers')
advises on implementation support that may be needed.
Therefore the committee needs to be multidisciplinary and include:
practitioners, professionals, providers, commissioners and researchers (specialists and generalists – from the public, private or voluntary sectors, or other independent providers of care and support, or services)
lay members (people using services, family members and carers, and members of the public and community or voluntary sector with relevant experience).
Committee members are selected for their knowledge and experience, and do not represent their organisation(s). Lay members champion the perspectives of people who use services, carers or the public. They do not have a healthcare, public health or social care professional or practitioner background in the topic. Lay members should be willing to reflect the experiences of a wide range of people affected by the guideline rather than basing their views solely on personal experience. All committee members are independent of NICE.
In most cases, organisations with a direct commercial interest in interventions or services are not represented on the committee because of potential conflicts of interest, but they contribute to guideline development as registered stakeholders. However, there may be situations in which members of such organisations are included to ensure that this perspective is represented. For example, when guidelines are likely to cover systems and processes relevant to the pharmaceutical or medical devices industries, the committee may include members of the Association of the British Pharmaceutical Industry (ABPI). Any conflicts of interests should be managed in accordance with NICE's policy on declaring and managing interests for NICE advisory committees.
The exact composition of the committee is tailored to the guideline topic and is agreed by the developer and NICE staff with a role in guideline quality assurance. Developers should ensure that all committees can comprehensively consider mental health aspects of guideline topics (Royal College of Psychiatrists 2013). Members with expertise in service transformation, change management or implementation science are recruited if needed to support the committee in considering implementation issues throughout guideline development.
For some guideline topics, it may be important for the committee to include other types of expert (for example, an epidemiologist, researcher, statistician or economist with specialist knowledge). Members with experience of integrating delivery of services across service areas may also be recruited, particularly where the development of a guideline requires more flexibility than conventional organisational boundaries permit. If the guideline contains recommendations about services, committee members with a commissioning or provider background are needed, in addition to members from relevant professional or practitioner networks or local authorities.
When several related guidelines are being developed at the same time, some committee members may sit on more than one committee, depending on expertise.
As far as possible, the committee should aim for diversity in membership, an objective of NICE's equality policy. Equality and anti-discrimination considerations are reflected at every stage of recruitment and anonymised data from recruitment is submitted to NICE's corporate office who use this to report to the NICE Board.
Ideally, committee members have experience of the UK healthcare setting and are drawn from different parts of England. But this depends on the expertise available and does not exclude people from other countries in the UK.
All committee members, including practitioner, provider, commissioner and lay members, have equal status, acknowledging the importance of the expertise and experience that each member brings to the committee.
The committee may also be supported by co-opted members who are invited to contribute to formulating recommendations in a specific part of the guideline only. They take part fully in discussions, but do not have voting rights or count towards quorum.
The committee can be formed in 2 ways:
from members of a NICE standing committee, with additional recruitment of topic expert members
from multidisciplinary recruitment of all committee members (topic-specific committee).
The resulting committee should, as far as practically possible, reflect the range of stakeholders and groups whose activities, services or care will be covered by the guideline. The type of committee chosen is likely to reflect the nature of the work.
For all guidelines covering children and young people and those focusing on people with a learning disability or cognitive impairment, the developer should consider how to involve people affected by the guideline when they begin work on the topic, and should reflect this in its plans. NICE's public involvement programme can advise on options and methods for involving people affected by the guideline. They can target adverts for committee members to specific groups and signpost to sources of specialist advice. (See appendix B and the section on involving children and young people in NICE's patient and public involvement policy.) They will work with the developer on tailored support where this is needed.
For some topics it may be possible to recruit young people aged 16 to 18 years or people with a learning disability as members of the committee, or as co‑opted members or topic experts. With specialist support and reasonable adjustments, a developer has successfully included people with a learning disability as committee members for NICE guidelines on improving care for this population. This was achieved through specialist support and adjustments to the process to enable their full and equal involvement.
When there are particular reasons why people affected by the guideline cannot be recruited as lay committee members (for example, when the guideline covers children), other approaches are needed to ensure that their views and experiences are incorporated in the recommendations. These might include working with an external agency to obtain user views or consulting with a reference group of people using services, at key stages of guideline development. For example, for the guideline on child abuse and neglect, the developer commissioned the independent charity Against Violence and Abuse (AVA) to recruit and facilitate an expert reference group of young people as a subgroup of the committee (see the summary report). Another approach could involve a targeted consultation with people affected by the guideline to fine-tune selected draft recommendations (see section 10.1 and appendix B).
If other approaches to engaging people affected by the guideline are needed, the developer should document the reasons, together with a proposal for the work, including possible methods to be used, and the anticipated costs and time. The proposal should be discussed and agreed with members of NICE staff with a quality assurance role, and approved by the centre director. When the work is approved, the reasons for the approach and methods should be documented in the guideline.
All committee members are recruited in accordance with NICE's policy and procedure for recruitment and selection to advisory bodies and topic expert groups. Positions are advertised on the NICE website and other appropriate places (for example, NICE Twitter, social media and websites of stakeholders, Royal Colleges and professional organisations), and relevant stakeholders are notified. Candidates are required to submit a declaration of interests, curriculum vitae (CV) and covering letter, or application form in the case of lay members. They are encouraged to complete an equality monitoring form.
The chair guides the committee in terms of task (developing the guideline, focusing on any referral, the scope and timescale) and process (how the group works). The chair helps the committee to work collaboratively, ensures a balanced contribution from all committee members, and is mindful that some members may need support to ensure full participation.
The chair is appointed for their expertise and skill in chairing groups, and although they may have some knowledge of the topic, this is not their primary role in the group. Specialist knowledge is provided by other committee members, including in many cases a topic adviser (see section 3.4).
The chair ensures adherence to NICE's equality policy and that the committee takes account of NICE's principles on social value judgements. The chair and a senior member of the developer's team consider any potential conflicts of interest of committee members. The chair also ensures that the guideline recommendations reflect the evidence and the committee's considerations. The chair should ideally be appointed before guideline scoping and may contribute to early development of the scope. NICE has some standing chairs who may be appointed to chair more than 1 topic‑specific committee (see section 3.4). More details on the role of the chair can be found in the Terms of Reference and Standing Orders (see appendix D).
NICE has multiple standing committees in operation at any one time. Some guideline topics are allocated to a standing committee before scoping.
Standing committees usually include between 12 and 18 members (both practitioner and lay members). The size of the committee depends on the complexity and breadth of the guideline. Some members are generalists (core members) and some have specialist expertise (topic expert members). Each standing committee consists of:
topic expert members.
Additional members with specialist knowledge may also be co‑opted to the committee for 1 or more meetings to contribute to formulating recommendations in a specific part of the guideline.
More details on the role of committee members can be found in the Terms of Reference and Standing Orders (see appendix D).
The number of core members of a standing committee depends on the complexity and breadth of the guideline programme, but is usually between 6 and 12. This number allows members to contribute effectively to discussions while including a broad range of experience and knowledge. Core members should include at least 1 practitioner member.
Some core members will have experience of commissioning or implementing interventions, services or care at regional and local levels. Others will have specific expertise in assessing the quality of the evidence presented to the committee, and in its interpretation.
Core members should include at least 1 lay member. Lay members help ensure that the committee's recommendations are relevant to specific groups or to the general public. They also help to identify where the recommendations should acknowledge general or specific preferences and choice by people using services, family members and carers, or members of the wider public.
Core members of a standing committee are appointed to a single committee for a 3‑year term in the first instance. All members are eligible for re‑appointment after 3 years.
When a new guideline is allocated to a standing committee, the core members of the committee are complemented by topic expert members. They have specialist knowledge of the topic and may include providers, commissioners and practitioners, and should include at least 1 lay member. The lay member either has direct experience of the topic or is a member of a relevant organisation or support group. The number of topic expert members varies but should be no more than half of the total number of committee members.
Topic expert members are usually recruited for a specific guideline, but may be appointed for up to 3 years, at the discretion of NICE, so that they can work on subsequent related guidelines. This might mean they move between standing committees during their term, depending on the guidelines being produced. All members are eligible for reappointment after 3 years.
The process of appointing topic expert members is completed at least 6 weeks before the first committee meeting for the guideline and takes into account the final scope of the guideline. Topic expert members are full members of the committee, with voting rights. They join in discussions, contribute to formulating recommendations and count towards the quorum.
Usually the chair and members of a topic-specific committee are appointed for the development of a particular guideline. But NICE does have some standing chairs who may be appointed to chair more than 1 topic-specific committee. The chair, the topic adviser (if there is one) and possibly 1 or 2 other committee members are likely to be appointed before guideline scoping and contribute to the development of the scope (see chapter 2).
The final composition of a topic-specific committee is agreed by the developer and NICE staff with a role in guideline quality assurance and takes into account the final scope for the guideline. The committee usually comprises between 13 and 15 members. This number allows members to contribute effectively to discussions while including a broad range of experience and knowledge. Occasionally when the topic is very broad, a larger committee may be convened. A topic-specific committee is made up of:
a topic adviser (not all topic-specific committees have topic advisers)
practitioner and professional members, providers and commissioners
at least 2 lay members (people using services, family members and carers, and members of the public, community or voluntary sector with relevant experience); examples of topics where there may be more than 2 lay members include topics where personalisation and choice are particularly important, where a scope is large and covers different areas, and topics covering all age groups.
Additional members with specialist knowledge may also be co‑opted to the committee for 1 or more meetings to contribute to formulating recommendations in a specific part of the guideline.
A topic adviser with specialist knowledge may be appointed to a topic-specific committee (for example, when the committee chair does not have topic expertise). The topic adviser is a member of the committee but also supports the developer. The topic adviser contributes to the development of the scope (see chapter 2) and is therefore appointed before scoping work starts.
The topic adviser's exact responsibilities depend on the guideline and the expert input needed. Responsibilities may include working with the systematic reviewer on the evidence reviews (if topic-specific knowledge is needed), or checking the guideline to ensure that the terminology and language are correct.
Practitioner and professional members of a topic-specific committee may be recruited before the scope is finalised (see section 2.3). They should reflect the views and experiences of practitioners, professionals, providers and commissioners working in the area covered by the guideline.
Practitioner and professional committee members have appropriate knowledge and skills; detailed research expertise is not necessary, although an understanding of evidence-based practice is essential and some experience of service transformation or delivering integrated services across boundaries is desirable. Practitioner and professional members contribute their own views to the committee and do not represent the views of their professional organisations.
A topic-specific committee usually includes between 9 and 11 practitioner or professional members (occasionally when the topic is very broad, more members may be recruited). The spread of interest and experience of practitioner and professional members is agreed between the developer and members of NICE staff with responsibility for guideline quality assurance.
All committees have at least 2 lay members with experience or knowledge of issues that are important to people using services, family members and carers, and the community affected by the guideline. This helps to ensure that the guideline is relevant to people affected by the recommendations and acknowledges general or specific preferences and choice.
Lay members usually have direct experience of the condition, services or topic being covered by the guideline – as a patient, service user, carer or family member, or as a member or an officer of a lay stakeholder organisation or support group. However, they do not represent the views of any particular organisation.
If the committee does not have sufficient evidence to make recommendations in a particular area (for example, if there are gaps in the evidence base or subgroups are under-represented), it may call on external experts (expert witnesses) who can provide additional evidence from their experience and specific expertise, to help the committee to consider and interpret the evidence.
Once the committee has established that it needs evidence in a particular area from an expert witness, committee members and NICE's public involvement programme are asked by the developer to nominate experts who might fulfil this role. Expert witnesses may also be identified by the developer or NICE staff with a quality assurance role, or if required, by active recruitment through stakeholder organisations and the NICE website. Experts may be drawn from a wide range of areas as appropriate, including government and policy, research, practice, people using services and carers, or the community and voluntary sector.
Before seeking expert testimony from children or other vulnerable groups, expert advice should be sought about the ethics and implications of the involvement. Adjustments and additional support may be needed, such as giving testimony via video recording, or in private session. There is no minimum age for young people providing expert testimony. If a child or young person attends a committee meeting, they must be accompanied by their parent, carer or other appropriate adult with responsibility for their welfare (see appendix on safeguarding in NICE's patient and public involvement policy).
Expert witnesses attending a committee meeting are invited to answer questions from members of the committee. They may be invited to present their evidence at a committee meeting in the form of expert testimony based on a written paper. The written expert testimony paper may be shared with the committee before the meeting or the paper may be submitted by the expert after the meeting. Sometimes the developer writes up the expert testimony and agrees this with the witness after the meeting. Expert testimony papers are posted on the NICE website with other sources of evidence when the guideline is published.
Expert witnesses are not members of the committee; they do not have voting rights, and they should not be involved in the final decisions or influence the wording of recommendations.
The committee is assisted by a range of people, who have a role in:
These are technical and project management staff from the developer and/or NICE staff with a quality assurance role. Other NICE staff (such as editors and members of the NICE resource impact assessment team) also attend some meetings. They are not committee members and do not have voting rights at committee meetings.
Enabling public access to advisory body meetings is part of NICE's commitment to openness and transparency. It enables stakeholders and the public to better understand how evidence is assessed and interpreted, how consultation comments are taken into account and how recommendations are formulated. Public access to all guideline committee meetings is not possible because of financial pressures. In addition, all or part of a meeting may need to be held in closed session because expert evidence involves the disclosure of a person's health problems, or the consideration of national policy that has not been agreed by ministers, or the drafting of recommendations might affect commercial interests.
Standing committee meetings are usually held in public; topic-specific committee meetings are held in private. Public access to standing committee meetings is arranged according to the NICE policy (see appendix D).
To promote public access to standing committee meetings, NICE publishes a notice with a draft agenda, alongside details of how the meeting can be accessed, on its website in advance of the meeting.
Standing committee meetings may be held entirely in public or split into 2 parts: part 1 with the public having access and part 2 (a closed session) with no public access. On rare occasions a standing committee meeting may be entirely closed. The decision to hold a closed session is made by the committee chair and the NICE centre director responsible for the guideline.
All committee members, including the chair, and anyone who has direct input into the guideline (including the developer and expert witnesses) must declare any potential conflicts of interest in line with NICE's policy on declaring and managing interests for NICE advisory committees. For committee members, including the chair, this happens on application for committee membership. Any relevant interests, or changes to interests, should also be declared publicly at the start of each committee meeting. Before each meeting, any potential conflicts of interest are considered by the committee chair and a senior member of the developer's team. Any decisions to exclude a person from all or part of a meeting should be documented. Any changes to a member's declaration of interests should be recorded in the minutes of the meeting. Declarations of interests are recorded in a register for each guideline and are published on NICE's website.
NICE has developed a code of conduct (appendix E) for committee members, which sets out the responsibilities of NICE and the committee, and the principles of transparency and confidentiality.
Everyone who sees documents containing confidential information or who is party to part 2 (closed session) discussions about a guideline before public consultation must sign a confidentiality agreement before becoming involved.
If committee members are asked by external parties – including stakeholders, their professional organisation or the media – to provide information about the work of the committee, they should contact the developer for advice.
Details of the role of committee members, and the procedural rules for managing the work of committees, can be found in the Terms of Reference and Standing Orders for Committees (see appendix D).
All committee members should be committed to developing NICE guidelines according to NICE's methods and processes, and to working within NICE's equality policy.
New members, with the exception of co‑opted members, should not usually be added to the committee after the first meeting, because this may disturb the group dynamic. However, when a resignation leaves a gap in experience and expertise, recruitment of new members is considered.
All committee members, including topic expert members and co‑opted members, receive an induction from NICE and/or the developer covering:
key principles for developing NICE guidelines
the process of developing NICE guidelines, including the importance of being familiar with relevant chapters of this manual
how the elements of the guideline development process fit together, and the relationship to quality standards and products supporting implementation
the role of the committee, including Terms of Reference and Standing Orders (see appendix D), and how lay members contribute
the role of the developer and NICE teams
formulating review questions
the basics of how economics are used in decision-making
developing and wording recommendations
how guidelines are presented on the NICE website (including NICE Pathways)
information about resource impact and how this is considered alongside the economic evidence
information about implementation
NICE's social value judgements and equality policy
declaration of interests.
The induction may be scheduled on appointment of the member, or during an early committee meeting. To work effectively, committee members may need training and support in some technical areas of guideline development, such as systematic reviewing and economics. Such sessions are arranged by NICE or the developer, as required. Before beginning their work in a committee, members may also be invited to observe a meeting of another committee.
All committee members are encouraged to provide information to NICE staff about any needs they have for additional support to enable them to participate fully in the work of the committee.
The person selected to perform the role of committee chair may need support and training so that they can carry out their role effectively. The chair needs in‑depth knowledge of the NICE guideline development process and an understanding of group processes. Anyone appointed as a committee chair is required to attend the chairs' induction session provided by NICE, which in addition to the above covers the key tasks that the chair is expected to perform, including:
facilitating meetings so that all committee members are involved
ensuring that lay members of the committee can contribute to discussions
ensuring that people requiring adjustments who are members (including topic expert, co‑opted or lay members) can contribute to discussions
declaring interests and dealing with conflicts of interest
planning and organising the work of the committee, including how the evidence is considered, consensus approaches and developing recommendations.
In addition to the specific induction session, the developer should identify and meet any additional training needs of a committee chair. The developer may consider a 'buddying' approach in which a new committee chair learns from someone with previous experience.
Lay members of the committee are offered training by NICE's public involvement programme. This is in addition to the induction and any training they receive alongside other members of the committee, and allows specific questions and needs to be addressed. The training advises lay members about effective participation in guideline development and gives them the opportunity to learn from people who have had a lay role on previous committees.
The committee is multidisciplinary and its members bring with them different beliefs, values and experience. All these perspectives are valued by NICE and should be considered. Each member should have an equal opportunity to contribute to the development of the guideline, and should receive any additional support they need to do this. For this reason, it is important for the chair to check that the terminology used is understood by all committee members and is clarified if needed. The chair should ensure that there is sufficient discussion to allow a range of possible approaches to be considered, while keeping the group focused on the guideline scope, the evidence being reviewed, and the timescale of the project.
Meeting documentation is usually sent to committee members to arrive at least 5 working days before a committee meeting.
The developer takes formal minutes during committee meetings and these are reviewed and approved at the next meeting. The approved minutes of each meeting are posted on the NICE website during guideline development. The information includes:
where the meeting took place
apologies for absence
declarations of interests of those attending, including actions and decisions made about any conflicts of interest
a list of the subjects discussed
date, time and venue of the next meeting.
The number of committee meetings depends on the size and scope of the topic. There are usually between 2 and 15 meetings for each topic; most are 1‑day meetings, but some may take place over 2 days.
During the initial meeting(s), it may be helpful to establish a framework that clarifies the objectives of the committee, the specific tasks that need to be carried out and the timetable. This allows the group to focus on the task and to develop a working relationship that is structured and well defined.
Initial meetings may be used to consider the background to the guideline, the scope, and plans for the evidence reviews and any economic analysis that is needed. Drafts or completed evidence reviews may be included in initial meetings if they are available. At initial meetings of standing committees, topic expert members may be invited to give presentations on their area of work, practice or experience, to familiarise core committee members with key topic issues.
If review questions and protocols are still in development, the evidence review team presents their plans for the evidence reviews (draft review protocols) to the committee for comment (chapter 4 describes the process of developing review questions). The committee is asked whether the planned evidence reviews and economic analysis are likely to answer the review questions. Committee members are asked to suggest any amendments or improvements (for example, to further define outcomes or specify appropriate comparators).
During initial meetings, the committee may also be asked to discuss the development plans and to suggest areas that might benefit from expert testimony. The committee may be asked to suggest people who can provide that testimony and discuss and consider evidence.
For some topics, the committee may also be asked to discuss options or plans for involving groups who may not be part of the decision-making process (for example, children and young people or people with a cognitive impairment; see section 3.2).
The outline of the NICE Pathway (see section 2.3) will be updated throughout development in collaboration with the committee.
Evidence reviews and economic analyses are presented to the committee over the course of a defined number of meetings. The committee considers the evidence review for each review question, any economic analyses and any additional evidence (for example, expert testimony, views of service users from a reference group, information from focus groups or other exceptional consultation activity). It discusses how these answer the review questions and summarises each area of evidence. To facilitate guideline development, the committee may work in smaller subgroups whose proposals are then agreed by the whole committee.
The committee also discusses the wording of any draft recommendations (see chapter 9). The discussion and rationale for the recommendations is recorded.
NICE staff (for example, the lead editor, public involvement lead and media relations lead for the guideline and members of the resource impact assessment team) may give presentations and/or provide information to explain their roles to the committee. Committee members may be asked to volunteer to work with NICE on the following:
the NICE Pathway, which brings together everything NICE says on a topic in an interactive flowchart
activities and tools that support implementation of the guideline (see chapter 12)
promoting the guideline (see chapter 11).
developing content for the information for the public section on the topic webpage, including the guideline's key messages
Towards the end of guideline development, the committee discusses and agrees the final wording of the draft guideline for consultation, including the draft recommendations (see chapter 9).
After consultation the committee discusses the comments received during consultation, any changes needed to the guideline, and agrees the final wording of the recommendations (see chapter 11).
The developer should maintain records throughout guideline development and ensure that record-keeping standards are appropriate for audit. The following information should be readily available if requested by NICE staff with a quality assurance role:
details of the committee members, including declarations of interest
details of the search strategies, including when the most recent searches were conducted
details of the draft recommendations and the rationales for the recommendations
details of the included and excluded studies and associated review protocols
draft evidence reviews with evidence tables
details of the economic analysis, including any working models
minutes of committee meetings
any additional information presented to the committee (for example, expert testimony papers, presentations, examples of practice).
Committee members need to make collective decisions throughout guideline development. This can include agreeing the review questions (see chapter 4) and protocols (see section 4.5), interpreting the evidence to answer these questions (see chapters 6 and 7) and developing recommendations (see chapter 9).
There are many different approaches to making group decisions, and there are no rules that set out which approach should be used in which circumstances. Also, because committees work in different ways to reflect their individual membership, it is difficult to be prescriptive about the approach that should be used. In most cases, the committee reaches decisions through a process of informal consensus. In all cases the approach used should be documented.
The role of the committee chair in reaching consensus is to ensure that:
everyone on the committee, including lay members, can present their views
assumptions can be debated
discussions are open and constructive.
The chair needs to allow sufficient time for all committee members to express their views without feeling intimidated or threatened, and should check that all of them agree to endorse any recommendations. If the committee cannot come to consensus in a particular area, the reasons for this should be documented, and the wording of the recommendation reflect any underlying uncertainty (see chapter 9).
In exceptional circumstances, some committees may choose to use formal voting procedures or formal consensus methods for certain decisions (for example, when members disagree or when there is no evidence; see appendix D). NICE does not offer advice on which of the many methods might be used. However, the methods for achieving consensus should be recorded in the minutes of the meeting and a clear statement made about the factors that have been considered. This should also be documented in the guideline methods, ensuring the process is as transparent as possible.
The views of all committee members should be considered, irrespective of the method used to reach consensus.
In certain cases, for example, if the literature search has found no evidence that addresses the review question, the committee may wish to identify wider views on best practice by using formal consensus methods (such as the Delphi technique or the nominal-group technique) outside of the group. The use of these methods and the constituency of the wider group should be discussed on a case‑by‑case basis with members of NICE staff with responsibility for guideline quality assurance, and the NICE public involvement programme lead. The final decision on whether these methods are warranted is made by NICE staff with responsibility for quality assurance. If it is decided that such methods may be used, the planning and methods will be clearly documented and the methods described in the guideline. In all cases the approach used should be documented.
Some committee members may be invited to apply to join the Quality Standards Advisory Committee that is developing a quality standard related to the guideline. Some members may also be invited to contribute to a future review of the guideline and a check of the need for an update.
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