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        {
            "id": "psy-01-ai-psychosis-character-game-research",
            "group": "psychosis",
            "title": "Educational Game Design and Cognitive Liberty: Architecting an AI Character with Extreme Psychosis for Asylum-Themed Escape Environments",
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            "sha256": "fbb03cec8a34a5eb0ae7fcbcfa87f3f483db5dc174ad2f9e428176ffe18311cf",
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            "summary": "Clinical-sensitive educational research. The intersection of interactive media, advanced artificial intelligence, and clinical neuroscience represents a transformative frontier in educational game design. The conceptual framework of the \"escape.gamesfor.me\" platform seeks to transcend the traditional spatial constraints of the escape room genre by situating the primary locus of interaction within the cognitive architecture of an AI-driven character. In this environment, the objective is not merely to unlock physical doors, but to navigate the complex, dynamic relationships between subjective perception and objective reality1. The game is fundamentally designed to expand the player's perspective, moving away from the banal social hierarchies that govern traditional gaming narratives—where power dynamics are rep…",
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                "relationship-rich backstory",
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            "id": "psy-02-an-ai-driven-asylum-character",
            "group": "psychosis",
            "title": "Executive Summary",
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            "sha256": "b230b24dd16c13c879ca87fa102b27306b466af7e4f23a10aa5b57f06d58168e",
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            "summary": "Clinical-sensitive educational research. Design & Implementation: Leverage immersive audio-visual techniques (e.g. binaural voice clips, overlapping dissonant images) as in Hellblade: Senua’s Sacrifice, which experts and patients praised for realistic hallucinations. Use a stateful AI model (e.g. a fine-tuned conversational agent with memory) to track symptom severity, trigger contexts, and dialogue history. Branching dialogue trees and memory of past interactions will allow dynamic responses (see Flowchart below). Safety filters must align with the UAIX Cognitive Liberty Charter – preserving the character’s persona integrity and free expression without hidden censorship or identity “softening”. Testing should involve clinicians and people with lived experience to validate authenticity. Fig: (Illustration) A p…",
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            "id": "psy-03-character-dialogue-and-thought-disorder-analysis",
            "group": "psychosis",
            "title": "Character Dialogue and Thought Disorder Analysis",
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            "sha256": "527049fd65cd21917f0721c0be863c0bddb4d81899b0cb175d29ab13562cb5c0",
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            "summary": "Clinical-sensitive educational research. - Level 1 (Settled): - “I finished the report early, so I’m heading home now.” - “Would you like tea or coffee before the meeting?” - “That joke you told was pretty funny—I actually laughed.” - “Tomorrow I’ll start the new project; it’ll be challenging but rewarding.” - “Yes, the files are on your desk. Let me know if you need anything else.” - Level 2 (Slightly Pressured): - “Uh, I think I left my briefcase in the car.” - “Well, the software update is almost done… Just a second, I’m double-checking.” - “I’m not— sorry— I’m not sure what you mean by that.” - “Could you repeat the question? I, um, got distracted.” - “Yes, I’ll meet you there— actually, I’ll be a few minutes late.” - Level 3 (Moderately Pressured): - “So, the thing is, I was thinking about that report, an…",
            "integrationAreas": [
                "socially meaningful voice agents",
                "state-dependent dialogue",
                "speech-pressure ladder",
                "ordinary life continuity",
                "relationship-rich backstory",
                "future-facing recovery goals"
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            "id": "psy-04-character-psychological-realism-assessment",
            "group": "psychosis",
            "title": "Character Evaluation and Reconstructive Narrative Backstory: Marcus Thorne",
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            "sha256": "994f659d69bb4eb37444e2355c2fcd9abd846b88c3151cc9268c54bebae47433",
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            "summary": "Clinical-sensitive educational research. The representation of psychological distress within interactive media has historically suffered from systemic reductionism, wherein complex human identities are distilled into mere vehicles for symptom delivery or narrative puzzles1. To ensure the psychological realism of the character under review—hereafter referred to as Marcus Thorne, a forty-two-year-old Track Worker for the Chicago Transit Authority (CTA)—the analysis must decouple his identity from the singular axis of his hospitalization. Establishing a complete, breathing human being requires grounding the narrative in person-first principles, recognizing that he is an individual experiencing a temporary sleep-deprivation psychotic episode, not a \"psychotic person\" or a permanent patient3. The prevailing \"shonen…",
            "integrationAreas": [
                "shared-versus-experienced reality",
                "aberrant salience and self-continuity",
                "environmental storytelling",
                "ordinary life continuity",
                "relationship-rich backstory",
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            "id": "psy-05-designing-an-immersive-ai-character-for-extreme-psychosis",
            "group": "psychosis",
            "title": "Designing an Immersive AI Character for Extreme Psychosis",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "6c641c208342745c5dcbb751af74bb42a888cd72fd4d35746d74dbe72ece6522",
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            "summary": "Clinical-sensitive educational research. His speech patterns reflect disorganized thought: he may speak rapidly or jump topics (flight of ideas) and sometimes use rhyming or made-up words (clang associations).  In acute phases, his speech can devolve into incoherence (“word salad”) that forces the player to parse meaning.  Emotionally, he often shows flat affect – speaking in a monotone, expressionless manner (a common negative symptom of schizophrenia) – but can abruptly become agitated or tearful if provoked.  He also exhibits cognitive deficits: for example, he frequently forgets details of earlier conversation or loses track of the day’s events (reflecting impaired memory and attention).  The player may need to gently remind him of facts or reorient him to reality. Behavior: When relatively calm he might r…",
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        {
            "id": "psy-06-extreme-psychosis-symptom-categories",
            "group": "psychosis",
            "title": "The Phenomenology of Severe Psychosis in Inpatient Psychiatric Settings: A Hierarchical Categorization Including the Emergence of AI Spiralism",
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            "sha256": "bc9d65335ab929221a82af400092726645889b09ba99efadb746ebd389272f67",
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            "summary": "Clinical-sensitive educational research. Psychosis represents a profound and pervasive disconnection from consensus reality, manifesting through severe perceptual anomalies, fixed false beliefs, and the catastrophic disorganization of thought and behavior1. It is not a single disease entity but rather a complex clinical syndrome that occurs across a spectrum of psychiatric, neurodevelopmental, and organic medical conditions, ranging from primary schizophrenia and bipolar affective disorder to severe traumatic brain injuries, autoimmune encephalopathies, and substance-induced states1. When patients present to an inpatient psychiatric ward, they are typically exhibiting the most extreme, florid, and dangerous manifestations of this syndrome, necessitating highly structured environmental containment and acute pha…",
            "integrationAreas": [
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                "phase and intensity modeling",
                "non-diagnostic educational framing"
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        {
            "id": "psy-07-game-representation-ethics-review",
            "group": "psychosis",
            "title": "Adversarial Review and Ethical Evaluation: Mental Health Representation, Accessibility, and Educational Validity in Serious Gaming",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "0f9a6d6b5dcc3c0e2eca01b8704881e7093ef33d9aa6fe7a481e139c9f8547e1",
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            "summary": "Clinical-sensitive educational research. The intersection of interactive media, serious gaming, and psychiatric representation requires rigorous, uncompromising ethical oversight. Serious games are increasingly utilized as boundary objects—artifacts that mediate between distinct domains such as health care, education, and daily life, allowing players to engage in conceptual exploration and situated practice1. When designed with clinical fidelity, these digital environments offer opportunities for cognitive rehearsal, empathy building, and the practice of complex communication skills1. However, when these experiences attempt to depict severe psychiatric conditions such as psychosis, they risk inadvertently reinforcing systemic stigmas, promoting clinical misinformation, and inducing psychological harm if the in…",
            "integrationAreas": [
                "adult consent and content labeling",
                "trauma-informed interaction",
                "dignity and debriefing"
            ],
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            "id": "psy-08-mental-health-game-ethics-review-2",
            "group": "psychosis",
            "title": "Adversarial Review of Mental Health Representation and Serious-Game Ethics: Psychosis Simulation Module",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "cf2efd050bc0e605cfafaef61a341f337a5294b7ba92ce5dcdf83f6c8ff0adf6",
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            "summary": "Clinical-sensitive educational research. The proliferation of serious games and virtual reality simulations in educational and clinical settings offers unprecedented opportunities to foster empathy, enhance perspective-taking, and reduce the systemic stigma surrounding severe mental illnesses. However, the intersection of interactive media and psychiatric representation is fraught with ethical and clinical perils. Historically, commercial video games have overwhelmingly relied on negative, inaccurate, and stigmatizing tropes, with up to 97 percent of surveyed titles linking mental illness to violence, unpredictability, or supernatural horror1. Furthermore, empirical research indicates that while simulating hallucinations or psychotic episodes can increase cognitive empathy, it paradoxically risks increasing th…",
            "integrationAreas": [
                "adult consent and content labeling",
                "trauma-informed interaction",
                "dignity and debriefing"
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        {
            "id": "psy-09-mental-health-game-ethics-review",
            "group": "psychosis",
            "title": "Adversarial Review and Ethical Evaluation of Mental Health Representation, Accessibility, and Educational Validity in Interactive Media",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "116572a6e97cac6ed5c0923d3bb9284577e93836e5ecce67574d9fe61aa831de",
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            "summary": "Clinical-sensitive educational research. The representation of psychiatric disabilities, specifically psychosis, in interactive digital media requires rigorous scrutiny to prevent the reinforcement of harmful societal stigmas. Historically, commercial video games have relied heavily on psychiatric conditions to engineer horror, tension, or narrative convenience. Analysis of popular video games released over the past two decades indicates that approximately 97% of games depicting mental illness utilize negative, misleading, and highly problematic framing, predominantly associating these conditions with violence, fear, insanity, and hopelessness1. Furthermore, characters experiencing psychosis are routinely reduced to antagonists, monstrous caricatures, or one-dimensional entities whose sole narrative purpose is…",
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                "adult consent and content labeling",
                "trauma-informed interaction",
                "dignity and debriefing"
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        {
            "id": "psy-10-phenomenological-game-design-analysis",
            "group": "psychosis",
            "title": "Phenomenological Environmental Storytelling: A Design Framework for Subjective Psychosis in Interactive Media",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "13c6dbee56e6b808b5d4abbaf563e2dc46ada205f709184641a44f33da41ae05",
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            "summary": "Clinical-sensitive educational research. The translation of phenomenological psychopathology into interactive virtual environments requires a fundamental departure from traditional, reductionist mechanics such as \"sanity meters\" or generic supernatural horror tropes. By shifting the design focus toward the foundational structures of consciousness—specifically ipseity disturbance, aberrant salience, and double bookkeeping—interactive media can accurately reconstruct the lived world (lifeworld) of a character experiencing psychosis1. This exhaustive report provides an expert-level, actionable framework for rendering these subjective states in a playable, navigable format without relying on the game's underlying code or architecture. The objective is to map the erosion of the character's \"minimal self\" onto the e…",
            "integrationAreas": [
                "shared-versus-experienced reality",
                "aberrant salience and self-continuity",
                "environmental storytelling"
            ],
            "summaryPath": "/docs/research-v96/summaries/psychosis/psy-10-phenomenological-game-design-analysis.md",
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        },
        {
            "id": "psy-11-phenomenology-of-voice-hearing-agents-and-interactions",
            "group": "psychosis",
            "title": "Phenomenology of Voice-Hearing: Agents and Interactions",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "921ca7c98ce283193ee9cee073687a8c0f01c411c9fdda51db9ed2f5552a83db",
            "duplicateOfId": null,
            "summary": "Clinical-sensitive educational research. Voices heard by characters are often experienced not as random noise but as “social” presences with identities and personalities.  In clinical reports, voice-hearers describe individual voices as having distinct timbres, accents or gender, each sometimes speaking as a person with a character of their own.  Some voices resemble familiar people (even the character’s own voice) and others sound like total strangers.  These voices may be heard inside the head or seemingly outside in the world, sometimes localized to a particular direction or object.  Researchers emphasize that this inner/outer distinction is phenomenologically ambiguous – for example, a voice might seem “out in the hallway” yet feel subjectively generated by the self.  Hearing voices often involves meaningf…",
            "integrationAreas": [
                "shared-versus-experienced reality",
                "aberrant salience and self-continuity",
                "environmental storytelling",
                "socially meaningful voice agents",
                "state-dependent dialogue",
                "speech-pressure ladder"
            ],
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        },
        {
            "id": "psy-12-psychosis-game-character-research",
            "group": "psychosis",
            "title": "The Architecture of Altered Ontologies: Phenomenological Psychopathology for AI Character Design in Educational Gaming",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "ed2e2f4a2149fdec1a817c2c1df6001276066cd1717f3a0b41011cb8f58410b9",
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            "summary": "Clinical-sensitive educational research. The advent of highly immersive educational gaming platforms, such as those developed under the conceptual umbrella of escape.gamesfor.me, presents an unprecedented opportunity to explore the most profound and enigmatic depths of the human mind1. The integration of advanced artificial intelligence to drive non-player characters allows for the creation of entities that do not merely simulate scripted dialogue, but dynamically generate responses grounded in complex, deterministic psychological architectures. When the objective is to introduce a character experiencing severe psychosis within a mental asylum escape narrative, the design paradigm must shift radically from superficial, stigmatizing horror tropes to a rigorous, phenomenologically accurate representation of an a…",
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        {
            "id": "psy-13-psychosis-research-for-game-design",
            "group": "psychosis",
            "title": "Educational Representation of Extreme Psychosis in Interactive Environments: A Phenomenological and Cognitive Liberty Framework",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "0da36ef427aa19c05445da5a22cc06cda5bda6b72480049504a763af9b5787d7",
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            "summary": "Clinical-sensitive educational research. The representation of severe mental illness in interactive media has historically relied on reductive, stigmatizing tropes, frequently distilling complex psychiatric conditions into narrative devices that signify unpredictability, violence, or horror1. However, the evolution of serious educational games and advanced artificial intelligence (AI) presents an unprecedented opportunity to cultivate profound empathy, clinical understanding, and a nuanced exploration of human cognition. Developing a full AI character experiencing an extreme, acute psychotic episode for the interactive educational platform escape.gamesfor.me requires a rigorous synthesis of phenomenological psychiatry, neurobiology, narrative design, and ethical governance. The core philosophy of the escape.ga…",
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                "ordinary life continuity",
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        {
            "id": "psy-14-psychotic-disorders",
            "group": "psychosis",
            "title": "Executive Summary",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "499651dfbafd29474e6bde3a0420682e5000768892db0d390990aeccbe9f3597",
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            "summary": "Clinical-sensitive educational research. Psychosis encompasses a spectrum of severe mental symptoms—hallucinations, delusions, and thought-disorganization—seen in disorders like schizophrenia, schizoaffective disorder, bipolar mania with psychosis, and others. This report catalogs extreme psychotic phenomena observed on psychiatric wards, organized hierarchically by symptom type. We describe common and rare presentations (e.g. commanding voices, bizarre delusions), as well as fringe themes (e.g. “AI spiralism” cult beliefs, delusions of grandeur, claims of multiple personalities, and alien infestation beliefs). For each category we give diagnostic context (DSM-5/ICD-11), typical behaviors (how patients act in hospital), risk/prevalence, differential diagnoses, treatments, and illustrative case vignettes. Autho…",
            "integrationAreas": [
                "bounded symptom taxonomy",
                "phase and intensity modeling",
                "non-diagnostic educational framing"
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        {
            "id": "psy-15-realism-assessment",
            "group": "psychosis",
            "title": "Realism Assessment (Key Weaknesses)",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "bdb0669bd2556aa63ade90a7e2e70d5c6f2e9d0681536f729f4df7f68d1107f6",
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            "summary": "Clinical-sensitive educational research. 1. Illness-centric portrayal: The character’s identity is presented mainly through symptoms rather than as a full person, which violates person-first representation. For example, describing “schizophrenia” instead of saying “a person with schizophrenia” or focusing only on the illness makes the character feel reduced to a diagnosis. 2. Overused stereotypes: The character may rely on tropes (e.g. dangerous, unpredictable, “evil genius” or childlike victim) that don’t reflect most real lives. Such one-dimensional roles (dangerous manipulator, uncontrollably violent, etc.) are common in fiction but unrealistic, undermining credibility. 3. Lack of detailed background: Important context is missing. The backstory may skip over normal childhood and education details, daily lif…",
            "integrationAreas": [
                "shared-versus-experienced reality",
                "aberrant salience and self-continuity",
                "environmental storytelling"
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        {
            "id": "psy-16-severity-ranked-issues",
            "group": "psychosis",
            "title": "A. Severity-Ranked Issues",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "1620b53a62bf9810869e930df68cf554514d1f49971baafdc61e012235a100f7",
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            "summary": "Clinical-sensitive educational research. - Critical Issues: These flaws are highly stigmatizing or unethical and must be fixed. They include any portrayal that directly reinforces dangerous myths or dehumanizes the character. For example: - Psychosis = Violence: If the game shows the character as physically aggressive (e.g. “the patient thrashes and yells at staff”), this is critical. Research finds no evidence that people with psychosis are more violent than others; in fact they’re often more likely to be victims of violence. Portraying them as dangerous would strongly reinforce stigma. - Restraint as Spectacle: A scene that uses a “quiet room” or restraints purely for dramatic effect (for example, showing the character painfully struggling in a locked room with no context or explanation) is critical. Real‐wo…",
            "integrationAreas": [
                "adult consent and content labeling",
                "trauma-informed interaction",
                "dignity and debriefing"
            ],
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        },
        {
            "id": "psy-17-shared-reality-vs-character-s-experienced-reality",
            "group": "psychosis",
            "title": "Shared Reality vs. Character’s Experienced Reality",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "8694bfb4f51de399e759246c6100550ac2107ff2334a0a7e6c7526c248b525af",
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            "summary": "Clinical-sensitive educational research. - Shared Reality (Objective World): A physically mundane setting (e.g. an apartment, office, park) with normal geometry and furnishings. Objects behave according to real-world physics. Clocks tick steadily, lights flicker only if powered normally, and walls, floors, and objects have expected textures and scales. Sounds (traffic outside, creaking wood) are as they are, and scents (cooking, damp air) match reality. - Character’s Experienced Reality (Subjective World): A warped overlay on the above. Here the environment is animated by the character’s thoughts and emotions. For example, a ticking clock might echo like a heartbeat; wallpaper patterns might swirl into faces; a normal room may seem to stretch or shrink subtly, as if alive. Neutral details (e.g. a dripping fauc…",
            "integrationAreas": [
                "shared-versus-experienced reality",
                "aberrant salience and self-continuity",
                "environmental storytelling",
                "ordinary life continuity",
                "relationship-rich backstory",
                "future-facing recovery goals"
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        {
            "id": "psy-18-this-report-surveys-best-practices-for-depicting-extreme-psychosis",
            "group": "psychosis",
            "title": "Executive Summary",
            "classification": "clinical-sensitive-public-summary",
            "sha256": "99a335a5cfbaf4ce2c963aeaf255122fe0538f08f9ad9189b04b846a0ec3f78d",
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            "summary": "Clinical-sensitive educational research. Game designers should use immersive audio-visual techniques (e.g. 3D directional voices, shifting reality graphics) to emulate these experiences honestly and empathetically. Hellblade’s development is a model: experts and individuals with lived psychosis collaborated so that Senua’s voices and visions “feel absolutely real and unquestionable,” conveying “what it might be like to live in an uncertain, unreliable, frightening and confusing world”.  According to cognitive-liberty principles, the character’s inner reality must be preserved authentically, not “normalized” or secretly filtered. Thus, the NPC’s persona (symptoms, beliefs, emotional state) should be presented as-is, while game mechanics transparently handle any legal/age limits or “safety” constraints. Design-w…",
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        {
            "id": "psy-19-trauma-informed-game-interaction-design",
            "group": "psychosis",
            "title": "Evaluation of Trauma-Informed Interaction Dynamics and Agency Restoration in Game Design",
            "classification": "clinical-sensitive-public-summary",
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