Entry

Inhabited Institutionalism
Callie Cleckner * and Tim Hallett

Department of Sociology, Indiana University Bloomington, Bloomington, IN 47405, USA

* Correspondence: ccleckn@iu.edu

Definition: Inhabited Institutionalism is a meso-level theoretical approach for evaluating the re-
cursive relationships among institutions, social interactions, and organizations. This theoretical
framework offers organizational scholars a multi-faceted consideration of coupling configurations
that highlight how institutional processes are maintained, challenged, and transformed without
reverting to nested yet binary arguments about individual agency and structural conditions.

Keywords: sociological theory; social interaction; organizations

1. Development of Inhabited Institutionalism

Sociologists, especially new institutionalists, lack a consistent definition of what an “in-
stitution” is; rather, the tradition often relies on vague conceptualizations [1]. Nevertheless,
organizational sociologists commonly treat institutions as “broad structures of meaning that
are taken-for-granted and organize activity” [2], p. 214. Similarly, Barley defines institutions
as “social forms or templates composted of clusters of conventions that script behavior to
varying degrees in given contexts” [3], p. 495. This conceptualization is perhaps similar
Citation: Cleckner, C.; Hallett, T. to others developed across organizational studies and economics [4,5]. However, despite
Inhabited Institutionalism. parallel definitions and plenty of literature, much new institutional scholarship treats insti-
Encyclopedia 2022, 2, 1494–1502. tutions as “reified abstractions” void of social interaction and meaning-making [2]. Instead
https://doi.org/10.3390/ of attempting to redefine institutions as the object of analysis, inhabited institutionalism
encyclopedia2030101 employs the concept of “institutional myth” to refocus empirical analyses.
Academic Editors: Sandro Serpa, Inhabited institutionalism complements the macro, anti-individualistic focus of the
Philip Hans Franses, Michael long-dominant New Institutionalism (NI), which Meyer and Rowan advanced sociolog-
McAleer, Chia-Lin Chang ically, most notably via formal structures as “myth and ceremony” [6]. In their ground-
and Raffaele Barretta breaking article, Meyer and Rowan define institutional myths as the prevailing practices
and procedures organizations adopt to maintain legitimacy, stability, and resource systems
Received: 12 July 2022
in a larger field [6]. In the macro sense, mythologies are the rationalized and impersonal
Accepted: 11 August 2022
ways in which we institutionalize rules, authority, and bureaucracy. At the local level,
Published: 16 August 2022
mythologies are the ways in which organizations ceremonially present a tight linkage
Publisher’s Note: MDPI stays neutral between formal structures and practical activity [6–8]. Institutional myths are mythic
with regard to jurisdictional claims in in the anthropological sense because they are cultural explanations for how the world
published maps and institutional affil- operates, but they are also occasionally mythic in the sense that organizational operations
iations. are inconsistent with ideal expectations [8]. New institutionalists refer to this façade of
commitment as “ceremony”—it can be simpler and even more effective to commit to the
myth verbally instead of via genuine practices. Examples of popular institutional myths
are “professionalism”, “expertise”, or “accountability,” which vary in meaning by field and
Copyright: © 2022 by the authors.
vary in adherence by organization.
Licensee MDPI, Basel, Switzerland.
Scholars have since applied myth and ceremony to observe how institutions tend
This article is an open access article
distributed under the terms and
to progressively homogenize because embedded organizations will at least ceremonially
conditions of the Creative Commons
adhere to prominent institutional myths to maintain external credibility, a process termed
Attribution (CC BY) license (https://
“institutional isomorphism” [9]. In other words, the success of organizations depends on
creativecommons.org/licenses/by/ how effectively they can secure legitimacy and resources, which means following status
4.0/). quo expectations, even if members do so only in name rather than practice for the sake of

Encyclopedia 2022, 2, 1494–1502. https://doi.org/10.3390/encyclopedia2030101 https://www.mdpi.com/journal/encyclopedia

Encyclopedia 2022, 2 1495

true efficiency. For instance, many companies claim trustworthiness for self-promotion,
but one can imagine how attempting to improve profits may open avenues for distrustful
practices. Thus, even if institutions appear similar due to explicitly adopting the same
popular mythologies, on the ground practices vary. Nevertheless, adhering to dominant
mythologies in the field enables organizations to appear similar across institutions, despite
contextual differences. This process explains why most American universities promote
campus diversity or why businesses adopted more sanitation protocols during the COVID-
19 pandemic—adherence should confer more legitimacy.
Incorporating rational mythologies should allow organizations to be more legitimate,
successful, and enduring—if participants are committed to maintaining the ceremonial
structure because they are content with the technical manifestations [6]. Meaning, if a
mythology is well-received by members because it is well-implemented, the organization
should prosper. However, genuine implementation of macro mythologies can also hinder
practical activity and stimulate conflict, which is why scholars have taken a particular
interest in processes of decoupling or loose couplings [8,10].
The ways in which organizations legitimate mythologies by linking formal struc-
tures with practices is often defined as a process of coupling, with researchers describing
activities as “decoupled” or “loosely coupled” to mythologies when organizations are
only ceremonially committed to change [2,10,11]. Loose couplings may help maintain an
institution’s myth and ceremony, and therefore provide legitimacy. For example, many
organizations now purport diversity policies and programming without a sincere coupling
to systematic or cultural change [12]. Take for instance former State Farm employees
and customers accusing the organization of racial discrimination, despite the company
denying this reflects internal culture [13]. It is simple (and legitimatizing) to claim your
company is not racist but being anti-racist with insurance claims is not profitable. Scholars
have documented similar forms of decoupling or loose coupling in housing and hiring
practices—organizations claim race-neutrality, yet their outcomes remain unequal [12].
Alternatively, if recoupling occurs in which “myths become incarnate” (or go from
loosely to tightly coupled), environments may destabilize and experience conflict [7].
Consequently, tight couplings may stimulate uncertainty and conflict, which can lead to
organizational disruptions and even threaten institutional legitimacy if members perceive
imposed practices to be ineffective or insincere [7]. For example, if an organization gen-
uinely attempts to ameliorate inequalities via diversity policies, they may receive backlash
from pre-existing dominant members who perceive them as unfair [14]. On the other hand,
an attempted recoupling to diversity and equity can also instigate conflict if historically
underrepresented members find the practices unsatisfactory for opposing reasons.
Scully and Creed first used the term “inhabited institution” during a conference pre-
sentation in 1997, as they argued that people “not only inhabit this process [of institutional
diffusion], but they actually reshape (and are reshaped by) the objects and dynamics of
diffusion” [15]. Therefore, inhabited institutionalism developed through a dialogue be-
tween NI and forms of interactionist social psychology. The goal is to understand how
the macro, extra-local institutional pressures that bear on organizations are inhabited by
“people doing things together”, whether in concert or conflict [2,16]. Organizations and
institutions cannot exist without individuals propelling them in some capacity. Inhabited
Institutionalism considers the dynamics among social interactions, institutions, and orga-
nizations to examine how society operates, without reducing our analysis to individual
agents or omnipresent structures. Individuals do not create change on their own, and
structures only exist because we instill them with meaning. Thus, the interactions in the
middle are where push comes to shove.

2. New Institutionalism, Agency, and Social Interaction as the Solution

Although new institutionalism was crucial to understanding how myth and ceremony
have contributed to isomorphism, some scholars took issue with the lack of individual
agency [8]. DiMaggio (1988) criticized NI for subverting human agency, introducing the
Encyclopedia 2022, 2, FOR PEER REVIEW 3

2. New Institutionalism, Agency, and Social Interaction as the Solution

Encyclopedia 2022, 2 Although new institutionalism was crucial to understanding how myth and cere- 1496
mony have contributed to isomorphism, some scholars took issue with the lack of indi-
vidual agency [8]. DiMaggio (1988) criticized NI for subverting human agency, introduc-
ing the concept of “institutional entrepreneurs” [17], whereas others used “institutional
concept of “institutional entrepreneurs” [17], whereas others used “institutional work” to
work” to tackle this concern [8]. Nevertheless, this conceptualization of the agentic insti-
tackle this concern [8]. Nevertheless, this conceptualization of the agentic institutional
tutional entrepreneur or institutional work more generally still creates a binary rather
entrepreneur or institutional work more generally still creates a binary rather than a holistic
than
view aofholistic
humanview of human
behavior. behavior.
Individual actorsIndividual
become the actors
bottombecome the bottom
line—the line—the
case is either one
case is either one of personal agency or cultural dopes [8]. Rather, social interactions
of personal agency or cultural dopes [8]. Rather, social interactions should be the object of
should be the object of our analysis.
our analysis.
Moreover,
Moreover, institutional
institutional theorists
theorists have
have relied
relied on
on aa “nested”
“nested” approach:
approach: conceptualizing
conceptualizing
individuals as nested inside organizations which are nested inside
individuals as nested inside organizations which are nested inside institutions institutions (Figure
(Figure 1)
1) [8].
[8]. However, inhabited institutionalism proposes that the full products of
However, inhabited institutionalism proposes that the full products of social interactionssocial interac-
tions are more
are more important
important than than the individual
the individual ingredients
ingredients [7]. [7].
How How people
people act act in conjunc-
in conjunction
tion with their environment is far more empirically valuable than pinpointing
with their environment is far more empirically valuable than pinpointing the effects the effects
of the
of the environment
environment or individual
or individual agencyagency in isolation.
in isolation.

Figure 1.
Figure Nested theoretical
1. Nested theoretical approach,
approach, adapted
adapted [8].
[8].

2.1. Including Social Interaction

2.1. Including Social Interaction
Institutions are inhabited by individual actors, but it is among their social interactions
withInstitutions
others that arewe inhabited by individual
find organizational actors,
variety. but it isinhabited
Further, among their social interactions
institutionalism does
with others that we find organizational variety. Further, inhabited
not require us to examine social interactions in isolation; rather, they are examined institutionalism does
in
not require
relation us to examine
to institutional social interactions
mythologies in isolation;
and organizational rather, they
constraints [8].are examined
Adapting in re-
Blumer’s
lation to institutional
three famous premises, mythologies and organizational
inhabited institutionalism constraints
presupposes that[8]. Adapting
people Blumer’s
in organizations
three
(1) actfamous
towardpremises, inhabited
institutional institutionalism
mythologies based on the presupposes
meanings they thathave
people in organiza-
to them. (2) The
tions (1) act toward institutional mythologies based on the meanings
meanings of mythologies are developed via social interaction, and (3) these meanings they have to them.
are
(2) The meanings of mythologies are developed via social interaction, and
modified through an interpretive process [18]. Inhabited Institutionalism expects the people (3) these mean-
ings
withinareorganizations
modified through to haveanvaried
interpretive process [18].
understandings Inhabited
of myths ratherInstitutionalism
than assumingexpects
formal
the people within organizations to have varied understandings
structures are homogenously implemented and understood across organizations. of myths ratherMoreover,
than as-
suming formal structures
the expectations of socialare homogenously
interaction create implemented and understood
additional constraints on how across organ-
individuals
izations. Moreover,
should behave, the expectations
but they can also createof semi-autonomous
social interaction spaces
create additional constraints
of opportunity that mighton
how
not beindividuals should behave,
visible in isolation [19,20].but theyspaces
These can also
arecreate
wheresemi-autonomous
“agency” may flourishspacesdespite
of op-
portunity that might
organizational not be visible
and institutional in isolation [19,20]. These spaces are where “agency”
forces.
may flourish despite organizational
Thus, social interactions are best and institutional
understood in forces.
relation to local organizational con-
Thus,
straints andsocial interactions
broader are best
institutional understood Focusing
mythologies. in relationon to this
localtriumvirate
organizational con-
of social
straints and broader
interactions, institutional
institutional mythologies.
mythologies, Focusing on inhabited
and the organization, this triumvirate of social
institutionalism
considers the full range of “couplings” that comprise an organization. NI primarily con-
siders the loose coupling between institutional mythologies and organizational practices
(i.e., myth and ceremony), whereas scholars in the inhabited tradition document a range
of coupling configurations including re-couplings (a change from loose to tight), tight
couplings, loose couplings, and complex combinations [7,21–24]. Across empirical cases,
 Encyclopedia 2022, 2 1497

inhabited institutionalism seeks to understand the variety of coupling configurations in

play because they provide insights to the distribution of opportunities and resources as
well as the social construction of reality more generally [25].

2.2. Coupling Configurations

Coupling configurations are a contrast to the “nested” approaches in dominant in-
stitutional theory, as represented in the adapted Figure 1 [8]. Social life is more multi-
dimensional than this imagery suggests. Figure 2 depicts a more comprehensive approach
through the imagery of linked spheres or “coupling configurations” developed in inhab-
ited institutionalism [8]. Figure 2 represents a fairly loosely coupled configuration, the
model presumed by NI, with the important inclusion of social interaction [8]. Again, this
is because individuals cannot create change with purely their own volition—change is
an inherently interactive process. Returning to a previous example, most universities
subscribe to the myth of diversity in some capacity. However, this commitment is often
only loosely coupled to social interactions and campus organizations at predominately
white institutions [12,26]. In fact, some research suggests white students benefit the most
from “diverse” interactions in higher education compared to other races/ethnicities [27,28].
Despite limited meaningful engagement, there are times when the diversity myth is tightly
coupled to one’s social interactions—say for instance, someone asks a black student “are
you on a diversity scholarship?” The coupling between social interaction and the insti-
tutional myth dramatically tightens. The way this hypothetical university implements
opedia 2022, 2, FOR PEER REVIEW “diversity and equity” might be loosely coupled to this student’s experience 5 in general,
but occasionally it becomes tightly coupled in their interactions with others who bring the
myth to the foreground.

Figure
Figure 2. Depicts 2. Depicts
the linked the (i.e.,
spheres linked spheresconfigurations),
coupling (i.e., coupling configurations),
adapted [8]. adapted [8].
Therefore, it is important to note coupling configurations can be complex and quickly
2.2.1. Loose Coupling Configurations
changing. Nevertheless, this is the primary strength of the framework—scholars can
The purpose of arranging
highlight moments these
andthree levelsthat
examples of analysis in this
contribute format
to much is to social
larger show how
processes without
the factors can be separate yet still exert varied force on one another. The less “force” or
authority an organization or institution has over social interactions, the more loosely cou-
pled the configuration is. For instance, No Child Left Behind was introduced to improve
testing outcomes in the US, yet in turn, the policy exacerbated inequalities in education
rather than providing a safety net as the name (i.e., myth) suggests [29]. A looser coupling
Encyclopedia 2022, 2 1498

reverting to the agency versus structure dichotomy. The following subsections detail
the differences between tight and loose coupling configurations as well as examples of
mixed situations.

2.2.1. Loose Coupling Configurations

The purpose of arranging these three levels of analysis in this format is to show how
the factors can be separate yet still exert varied force on one another. The less “force”
or authority an organization or institution has over social interactions, the more loosely
coupled the configuration is. For instance, No Child Left Behind was introduced to improve
testing outcomes in the US, yet in turn, the policy exacerbated inequalities in education
rather than providing a safety net as the name (i.e., myth) suggests [29]. A looser coupling
to the accountability myth means a school has greater flexibility in maintaining standard-
ized outcomes, perhaps because it is a state with easier than average tests or excessive
cheating [30,31]. If the state administers extremely easy exams, the accountability myth is
loosely coupled to organizations (K-12 schools) and social interactions (teaching) because it
is not a major concern to the individuals in this context. The accountability myth does not
have a strong influence on how educators, administrators, and students must behave. This
example could be represented by Figure 2.

2.2.2. Tight Coupling Configurations

Tight coupling configurations occur when an institutional myth, organizational prac-
tice, or social interaction are strongly influenced by one another. Figure 3a represents a
slightly tighter configuration, as compared to Figure 2, whereas Figure 3b represents a very
tightly coupled configuration. Tight coupling configurations mean two (or more) entities
have a meaningful relationship between them in a situation. For instance, in American
higher education, SAT scores were once believed to be the best determinant for college
admissions and future academic success, despite SAT scores being poor predictors of stu-
dent outcomes and being culturally biased [32]. The SAT myth was tightly coupled to6
Encyclopedia 2022, 2, FOR PEER REVIEW
how universities and colleges operated for decades and in turn, how students behaved,
because whether or not one believed SAT scores predicted academic propensity, we treated
it as such. Now that colleges and universities have begun to move away from requiring
standardized test scores, we can conceptualize a university with a test-optional policy like
standardized test scores, we can conceptualize a university with a test-optional policy
Figure 3a—standardized test scores can still affect whether you gain admission to a uni-
like Figure 3a—standardized test scores can still affect whether you gain admission to
aversity, but there
university, is more
but there is opportunity space compared
more opportunity to a university
space compared that nearly
to a university thatrequires
nearly
high standardized test scores for admission (Figure 3b).
requires high standardized test scores for admission (Figure 3b).

(a) A more tightly coupled configuration (b) Very tightly coupled configuration
Figure 3.
Figure 3. (a)
(A)represents
representsaatighter
tightercoupling
coupling configuration
configuration compared
compared to
to Figure
Figure 2,
2, and
and (b)
(B) is
is an
an even
even
more tightly coupled configuration, adapted [8].
more tightly coupled configuration, adapted [8].

2.2.3. Complicating Coupling Configurations

Coupling configurations are not always entirely loose or tight. In other words, the
relationships between two entities might be tight, while they are loosely connected to the
third and vice versa (two loose, one tight). Organizations have policies, rules, and regula-
tions that are created to perpetuate institutional myths such as professionalism, meritoc-
Encyclopedia 2022, 2 1499

2.2.3. Complicating Coupling Configurations

Coupling configurations are not always entirely loose or tight. In other words, the
relationships between two entities might be tight, while they are loosely connected to
the third and vice versa (two loose, one tight). Organizations have policies, rules, and
regulations that are created to perpetuate institutional myths such as professionalism,
Encyclopedia 2022, 2, FOR PEER REVIEW 7
meritocracy, or colorblindness [33]. However, how members of the organization behave is
not always in accordance with organizational constraints or cultural ideals. For instance,
food workers have strict guidelines for kitchen safety and sanitation. Most consumers hope
and the way they interact with and treat others. Thus, tight versus loose linkages are value
restaurants are always tightly connected to this ideal in theory and practice (Figure 3b).
free descriptors of social life. Whether a coupling should be loose or tight is not for sociol-
Regardless, there are plenty of instances where social interactions are loosely coupled to
ogists to decide. We are simply evaluating the magnitude to which it exists empirically.
organizational and institutional commitments to safety and sanitation. Take for instance
Whether that is the way things ought to be is up to readers and those operating and expe-
a restaurant employee telling a new line cook he does not have to wear gloves and a
riencing the forces we discuss.
hairnet if there is a rush. Now, the coupling configuration looks like Figure 4 in which the
Critics may question the utility of this perspective because it may seem vague, ab-
sanitation rules are still tightly coupled to the myth, yet the social interactions are only
stract, or empirically limited. However, if we use the perspective for a comparative anal-
loosely aligned. There is more flexibility in the way the restaurant employees can behave
ysis, the benefits become clear. For instance, scholars are interested in how American
in this type of configuration.
teachers approach education
By incorporating differently
an interactionist despite inhabited
approach, similar training [7,23,33].
institutional If a can
scholars school
showis
tightly coupled
the complex, to a myth
situational such
yet as colorblindness,
constantly teachers
connected factors in are
anygoing
givento have a more
scenario. diffi-
This offers
cult time teaching students in a race-conscious manner [33]. Whereas if another
endless conceptual models across domains of social life. While this may appear daunting, nearby
(but
theseperhaps
modelsless
pointwell-funded) school
to how broader is loosely
social coupled
processes to theThe
operate. same mythpieces
puzzle due to(i.e.,
different
data)
constraints,
must be found and organized before we can put together the full picture. Then, the more
teachers have more flexibility and freedom to teach in a way they find most
equitable
prominent[33].
and This shows how
apt examples canthe local ameaning
provide snapshotand culture
of how the in an organization
much can in-
broader phenomena
fluence outcomes
of interest function.even if it might appear systematically similar to others in the field.

Figure 4.
Figure Institutionaland
4. Institutional andorganizational
organizational tight
tight coupling,
coupling, loosely
loosely coupled
coupled to social
to social interactions,
interactions,
adapted [8].

It is also important
2.3. Guidelines to note
for an Inhabited that tight and loose couplings themselves are value neutral.
Approach
There is no “correct” way for a coupling configuration to exist in the abstract because it is
In their foundational article, Hallett and Ventresca propose three “signposts” for the
context dependent. There are instances where an organization might want to be loosely
inhabited institutions approach: (1) acknowledging the embeddedness of institutions and
coupled or even decoupled from a myth, say something sinister like white supremacy
interactions, (2) an emphasis on meanings (both locally and broadly), and (3) a skeptical,
or eugenics, and there are instances where they might attempt to be tightly coupled to
inquiring attitude [2]. These three tenets broadly guide scholars in this tradition—main-
a myth like diversity and inclusion. On the other hand, an organization may be tightly
taining a critical view on how intertwining institutions, organizations, and social interac-
coupled to the myth of white supremacy, take the extreme example of Neo-Nazis. Members
tion influence social outcomes is key to both understanding social life and potentially im-
are content with a tight coupling between their organization, white supremacy, and the
proving it. Coupling configurations provide empirical leverage, but it is important to re-
member their theoretical conceptualization, which is based on combining the principles
of social interactionism with the macro ideas in new institutionalism. While some may
argue the perspective is a “kitchen-sink” approach, social life is a combination of multiple,
changing intertwined factors with varied salience across one’s experiences. Rather than
Encyclopedia 2022, 2 1500

way they interact with and treat others. Thus, tight versus loose linkages are value free
descriptors of social life. Whether a coupling should be loose or tight is not for sociologists
to decide. We are simply evaluating the magnitude to which it exists empirically. Whether
that is the way things ought to be is up to readers and those operating and experiencing the
forces we discuss.
Critics may question the utility of this perspective because it may seem vague, abstract,
or empirically limited. However, if we use the perspective for a comparative analysis,
the benefits become clear. For instance, scholars are interested in how American teachers
approach education differently despite similar training [7,23,33]. If a school is tightly
coupled to a myth such as colorblindness, teachers are going to have a more difficult time
teaching students in a race-conscious manner [33]. Whereas if another nearby (but perhaps
less well-funded) school is loosely coupled to the same myth due to different constraints,
teachers have more flexibility and freedom to teach in a way they find more equitable [33].
This shows how the local meaning and culture in an organization can influence outcomes
even if it might appear systematically similar to others in the field.

2.3. Guidelines for an Inhabited Approach

In their foundational article, Hallett and Ventresca propose three “signposts” for the
inhabited institutions approach: (1) acknowledging the embeddedness of institutions and
interactions, (2) an emphasis on meanings (both locally and broadly), and (3) a skeptical, in-
quiring attitude [2]. These three tenets broadly guide scholars in this tradition—maintaining
a critical view on how intertwining institutions, organizations, and social interaction influ-
ence social outcomes is key to both understanding social life and potentially improving
it. Coupling configurations provide empirical leverage, but it is important to remember
their theoretical conceptualization, which is based on combining the principles of social
interactionism with the macro ideas in new institutionalism. While some may argue the
perspective is a “kitchen-sink” approach, social life is a combination of multiple, changing
intertwined factors with varied salience across one’s experiences. Rather than forcing our
arguments into one element, we should be developing ways to simultaneously and sys-
tematically evaluate each of these moving pieces. Although sociologists prefer to organize
analyses by level, the micro, meso, and macro are in constant flux with one another.

3. The Future of Inhabited Institutionalism

Sociologists are increasingly identifying how organizations maintain and challenge
axes of difference, including race/ethnicity, gender, sexuality, social class, and other posi-
tions of power and privilege [12,27,34–37]. Inhabited institutionalism offers a comprehen-
sive framework for observing and analyzing these dynamic, multi-dimensional processes
across organizations. Social life is complicated; thus, we need complex models to envi-
sion how phenomena occur across situations and contexts. Researchers should continue
to adopt this framework so that we can collaboratively elucidate social constructions of
race/ethnicity, gender, sexuality, and more without relying on the false dichotomy of
structure versus agency.
The inhabited viewpoint remedies debates about how the world operates broadly
because it simultaneously incorporates all avenues for change. It is not enough to claim
“systems” or “structures” determine life chances and experiences, nor is it enough to argue
everyone has equal opportunities in America based on their individual merits. We must
show how it is the case that certain identities and statuses can generally be privileged over
others despite success stories. Inhabited Institutionalism helps reveal this gray area that
truly colors life experiences.

Author Contributions: Conceptualization, T.H. and C.C.; writing—original draft preparation, C.C.;
writing—review and editing, T.H. All authors have read and agreed to the published version of
the manuscript.
Funding: This research received no external funding.
Encyclopedia 2022, 2 1501

Institutional Review Board Statement: Not applicable.

Informed Consent Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest.

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