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Dyslexia

This presentation includes introductory information on typical reading development, dyslexia, and SLPs' roles in treating individuals with reading deficits. Recent brain studies will be summarized. The five areas of reading as defined by the National Read
by

Andrea Handscomb

on 8 October 2011

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Transcript of Dyslexia

Dyslexia & Typical Reading Development- Brain Imaging, Criteria, & Assessment
Phono-Graphix

Lindamood Phoneme Sequencing Program (LiPS)

The Nancibell Visualizing and Verbalizing for Reading Comprehension

Wilson’s Fundations (K-3)

Read Naturally

Cueing??
Schools
Students
Provide Reading Intervention
Yes, we should.
No, we shouldn't.
Private Clinics
Other
Hospitals
Universities
Andrea Handscomb, MA, CCC-SLP
Poll
Pretest
True or False
Scope of Practice

1. An SLP cannot diagnose dyslexia.

2. Treating dyslexia is not in an SLP’s scope of practice.

3. SLPs can work on reading comprehension but should refer to a reading specialist for all other areas of reading, such as phonics.
Definition of Dyslexia

4. Dyslexia is a language-based disorder that impairs your ability to read.

5. Dyslexia is not a language-based disorder. Its etiology is rooted solely in occipital lobe (vision lobe) dysfunction.

6. An intellectual disability (mental retardation) and dyslexia can coexist.
7. ADHD and dyslexia can coexist.

8. Dyslexia = reading disorder

9. Phonics falls under phonological awareness, but phonological awareness does not fall under phonemic awareness.

10. Dyslexia is when children see letters or words backwards.
LearningObjectives
This is your brain.
This is your brain on drugs.
This is your brain in graduate school.
Angular gyrus & Wernicke’s area

Phonological analysis

Used more in early reading - decoding
Fluency

A word is stored here a few times of reading the word correctly

Rapid word recognition

Used more in later/more skilled reading
Helps analyze words slowly like the pariteo-temporal area
People with dyslexia also use areas in the right front lobe (Broca’s homologue) to read.
This data explains why some people with dyslexia learn to read but slowly.
Post-treatment fMRI Imaging (Shaywitz 2003)

Subjects received a year-long experimental reading program

Right hemisphere auxiliary pathways much less prominent

Both the anterior and posterior left hemisphere pathways more prominent

Brain repair - so individuals with dyslexia can learn to read accurately & fluently with intervention
Development of Reading & Writing (Catts & Kamhi 1999, Ehri 1991)
Early Pre-School (3-4)
Late Pre-school (4-5)
Early Kindergarten (5-5.6)
Late Kindergarten (5.6-6)
First Grade (6-7)
Second Grade (7-8)
Awareness of how sentences then words come apart

Shows interest in rhymes and alliteration

Identifies at least 10 alphabet letters (often in own name)
Divides words into syllables & 50% can count number of syllables in spoken words

Starts to separate words into phonemes & 20% can count number of phonemes in spoken words

Identifies own name & more letters
Identifies if words do/do not rhyme

Provides a rhyming word when given a simple word like cat or bake

Identifies and labels almost all upper & lowercase letters
90% can count syllables

Can identify that two spoken words with the same first phoneme or last phoneme are similar

Can label the first sound in a spoken word

70-80% can count the number of phonemes in a small word such a he

Blends phonemes into words (e.g., sh+oe)

Names all letters
Normal Progression of Reading (Shaywitz 2003)
Provides a rhyming word orally

Counts sounds in longer (three phoneme) words

Can segment sounds - e.g., say bat without the /b/

Manipulates phonemes - e.g. say cat but change the /k/ to /m/

Blends 3-phonemes to make a word

Decodes short vowels, consonants, consonant blends, & beginning consonant digraphs (sh, ch, th)

Reads aloud first grade text with accuracy & comprehension
Third Grade (8-9)
Fourth Grade & Beyond
Routinely decodes

Continues to develop short vowels, consonant blends, and consonant digraphs

Learns r-controlled vowels, vowel digraphs, and vowel diphthongs

Begins to learn how to break apart multisyllabic written words into syllables

Reads some multisyllabic real and nonsense words

Begins to read with fluency & inflection

Represents the all sounds in a word when spelling

Reads independently
Uses all vowel patterns

Uses knowledge of homophones

Decodes regular multisyllabic words

Uses knowledge of prefixes, suffixes, and root words

Reads longer fiction selections and chapter books

Summarizes main events

Correctly spells previously studied words
Reads to learn

Reads for pleasure & information
Neural Signature Differences
Overlapping Neural Areas for Language and Reading
Is dyslexia treatable?
Building the Reading Brain, Pre-K-3 Wolfe and Nevill 2004
Building the Reading Brain, Pre-K-3 Wolfe and Nevill 2004
Building the Reading Brain, Pre-K-3 Wolfe and Nevill 2004
Shaywitz 2003
http://www.readinghorizons.com/research/dyslexia/images/dyslexia_brain.gif
http://keys-to-learning.com/Reading_Writing_Spelling/Nichd_brain_img049.gif
Starts to decode unfamiliar one-syllable words - developing word attack skills

Starting to learn and apply word families

Starts to recognize common irregularly spelled words (Dolch/sight words) like have and said

Has reading vocabulary of 300-500 words

Monitors own reading & self-corrects based on letters in words & context cues

Begins to spell short, easy words
Andrea Handscomb
presented by:
Five Major Areas of Reading
National Institute of Child Health and Human Development. (2000). Report of the National Reading Panel. Teaching children to read: an evidence-based assessment of the scientific research literature on reading and its implications for reading instruction.
These areas are hierarchical
So in theory you shouldn’t work on reading comprehension until
Fluency is WNL & you shouldn’t work on fluency until
Decoding/Phonics is grade appropriate and you shouldn’t work on phonics until
The individual demonstrates phonemic awareness abilities.
You can always work on vocabulary.
Broad umbrella term that includes phonemic awareness and phonics.

Core deficit in dyslexia

Awareness of the sound structure of a language

Ability to distinguish units of speech

Involves segmentation, blending, and manipulation of phonemes and syllables

Strong link between phonological awareness and development of accurate decoding skills and reading fluency.
What is Phonological Awareness?
(Armbruster, Lehr, & Osborn 2001 - Putting Reading First)
Phonemic awareness is a subset of phonological awareness in which listeners are able to hear, identify and manipulate phonemes

/kaet/ = /k/ +/ae/ + /t/

Phonemic awareness is the basis for learning phonics.
What is Phonemic Awareness?
(Armbruster, Lehr, & Osborn 2001 - Putting Reading First)
What is Phonics?
(Armbruster, Lehr, & Osborn 2001 - Putting Reading First)
The understanding that there is a predictable relationship between phonemes and graphemes

Sound-symbol (phoneme-grapheme) relationships
Phonic Approaches
(Armbruster, Lehr, & Osborn 2001 - Putting Reading First)
Synthetic phonics
Analytic phonics
Analogy-based phonics
Phonics through spelling
Embedded phonics (bad)
Onset-rime phonics instruction
Reasons for Difficulty Acquiring Phonics
English has a less consistent orthography, and low predictability of phoneme-grapheme mapping

Same alphabet symbol can represent more than one sound

Different alphabetic symbols can represent the same sound

Different words can be pronounced in the same way

The same spelled word can be pronounced differently

Poor instruction
Fluency
http://www.readnaturally.com/pdf/METeachersManual.pdf
Monitor 50%
Intervention 10 words below 50%
Who needs fluency intervention?
Reading Comprehension
The Blimblat

Once when I was a yoder, my tomly and I were mayle in line to buy mott for the Blimbat. Finally, there was only one plam between us and the mott munt. The plam made a big ampler on me. There were eight utzs all probably ord the age of 12. You could tell tures did not have a lot of willen. Their pard weer not yanker, but tures were clean. The utzs were well-matter, all of them mayle in line, two-by-two zors their potent holding zibits. Tures were telly temering about the plums, fonts, and other yoks tures would wint that noster.
Four Volunteers
Reading Comprehension Questions - 72% decoding accuracy
Who is telling this story?

What made an impression on the yoder?

Where did the yoder see the plam?

Why did the plam make an impression on the yoder?

When did the yoder see the plam?
Reading Comprehension Questions - 80% decoding accuracy
Who is telling this story?

What made an impression on the yoder?

Where did the yoder see the plam?

Why did the plam make an impression on the yoder?

When did the yoder see the plam?
The Circus

Once when I was a teenager, my tomly and I were standing in line to buy mott for the circus. Finally, there was only one plam between us and the mott counter. This plam made a big impression on me. There were eight utzs, all probably under the age of 12. You could tell they did not have a lot of money. Their clothes were not expensive, but they were clean. The utzs were well-behaved, all of them standing in line, two-by-two behind their parents holding hands. They were excitedly jabbering about the clowns, fonts, and other acts they would see that night.
Reading Comprehension Questions - 93% decoding accuracy
Who is telling this story?

What made an impression on the teenager?

Where did the teenager see the plam?

Why did the plam make an impression on the teenager?

When did the teenager see the plam?
The Circus
Once when I was a teenager, my boyfriend and I were standing in line to buy tickets for the circus. Finally, there was only one family between us and the ticket counter. This family made a big impression on me. There were eight children, all probably under the age of 12. You could tell they did not have a lot of money. Their clothes were not expensive, but they were clean. The children were well-behaved, all of them standing in line, two-by-two behind their parents holding hands. They were excitedly jabbering about the clowns, fonts, and other acts they would see that night.
Reading Comprehension Questions - 100% accuracy
Who is telling this story?

What made an impression on the teenager?

Where did the teenager see the family?

Why did the family make an impression on the teenager?

When did the teenager see the family?
Levels Decoding Aloud Comprehension
Independent 96-100% 90-100%
Instructional 90-95% 70-89%
Frustration ≤90% ≤70%
Dyslexia - What is this?
Common Theories on the Etiology of Dyslexia
Phonological Theory**

Rapid Auditory Processing Theory

Visual Theory (does not refute phonological component)

Cerebellar Theory*

Magnocellular Theory* (attempts to unify all the above theories)

Perceptual Visual-Noise Exclusion Theory
What is dyslexia?
International Dyslexia Association (IAD) Definition
(research committee of the IDA, Lyon et al. 2003)
Language-based learning disability- more on this

Cluster of symptoms, resulting in difficulties with specific language skills, particularly reading.

Also difficulty with spelling, writing, and pronouncing words.

Lifelong disorder: but it’s impact can change

A specific learning disability that is neurobiological in origin.

Difficulties with accurate and or fluent word recognition

Difficulties with decoding

Difficulties with spelling (encoding)
What does that mean?
Difficulty sounding out written words
Decoding
Cat = /k/ + /ae/ + /t/

Difficulty pulling out each sound in the word when spelling
Encoding
/k/ + /ae/ + /t/ = cat

Slow readers
Either due to decoding difficulty
Or slow word retrieval
Cat = cat
What is dyslexia?
(research committee of the IDA, Lyon et al. 2003)
Difficulties typically result from deficits in the PHONOLOGICAL components of language that is often UNEXPECTED in RELATION to OTHER COGNITIVE ABILITIES and the provisions of effective classroom instruction
What does this mean?
(Lyon, Shaywitz, & Shaywitz 2003)
Underlying difficulty is in PHONOLOGICAL processing

The hallmark characteristics are

Difficulty reading words

Discrepancy between ability and achievement (IQ test results vs. education achievement test results)
- I.e., it’s a learning disability

Not due to an intellectual disability - normal intelligence

Not due to poor school instruction
Some of the Major Types of Dyslexia
Note that there are other categorizations of dyslexia, such auditory dyslexia, visual dyslexia, etc. The classifying of dyslexia like its etiology are disputed.
Difficulty with non-word reading.

E.g., mana (mama) and aufo (auto)
Horwitz, Rumsey, Donohue (1998), Pugh et al. (2000), Simos et al. (2000a, 2000b), Shaywitz 2003
Developmental phonological dyslexia
Developmental surface dyslexia
Castles and Coltheart 1993, Patterson, Marshall, Coltheart 1985
Difficulty in reading irregular/sight words

E.g., where, bin, do, you, etc.
Double deficit dyslexia
Wolf & Bowers 2002
Phonological deficits and deficits in rapid automatic naming (RAN)
Secondary Consequence
(research committee of the IDA, Lyon et al., 2003)
Reading comprehension

Reduced reading experience

These can result in

- Impeded vocabulary growth

- Reduced background/general knowledge
The following disorders can either coexist with dyslexia or

Someone these disorders can be misdiagnosed with dyslexia (vice-versa)
Comorbid Disorders
ADHD - very common

CAPD

Language Disorder - very common
Visual disorders
Prevalence of Dyslexia
5 to 15 percent of Americans
- 14.5 to 43.5 million children and adults

Although more boys are identified, it is believed that the prevalence is similar in males and females

Familial/hereditary link
- Parent with a dyslexia has about a 23-65% chance of
having a child with dyslexia
- Sibling of a child with dyslexia has about a 27-49% chance
- Pennington & Gilger, 1996; Scarborough, 1998
Some Disorders That Impact Reading
Intellectual disability

ADHD (can co-exist though)

Social-emotional disorders (can co-exist though)

SLI: can’t comprehend oral language = can’t comprehend written language/poor vocab (can co-exist though)

CAS (can co-exist though)

Physical disability

Other contributors
- Exposure factors
- Poor memory
How can you tell if a child has dyslexia and a comorbid disorder or if they have just have a disorder that’s causing them to have difficulty with reading?
That’s a separate discussion that we don’t have time for today.

It’s also a tough question for which we don’t have a great answer.

Team approach - including SLP, educator, parent, child, & psychologist

Sometimes need to see if reading problem goes away when other disorder is treated.
Poor Reader Subgroups
(Catts, Hogan, & Adolf 2005 and Catts, Hogan & Fey 2003)
In a nutshell
Dyslexia = (developmental) reading disorder
Reading disorder = Dyslexia & Dyslexia = Reading Disorder
Can have other deficits/disorders that cause difficulty with reading but that doesn’t mean you have a dyslexia or a reading disorder.

However dyslexia can exist with other disorders.
Who Assesses Dyslexia?
Generally a psychologist - why?
According to the definition of dyslexia there must be a discrepancy between your word recognition and IQ
Although this model is criticized:
SLP cannot specifically diagnose dyslexia but you may be the first person to assess the child and may need to make referrals.
Psychologist may have diagnosed a child with dyslexia and send him/her to you to assess language/specific skill areas needed for reading. It’s your responsibility to take that diagnosis into consideration when preparing your test protocol.
So, we are part of the team.
Also you may have a child with dyslexia on your caseload and want additional information regarding the child’s skills in order to treat him/her.
More on our role as SLPs later.
Assessment Considerations
Need to assess both listening comprehension and word recognition to determine the underlying deficit

Want to figure out the lowest area of deficit (of the five) as your treatment should target that area first.
Case History Considerations & Early Signs of Dyslexia
Family history of language or reading impairment

Difficulty learning the letter names and sounds

Speech sound reversal errors - “pheletone” for telephone

Idiosyncratic speech substitutions

Also difficulties pronouncing “r” and “l” and confusing acoustically similar sounds (m/n, d/g, etc.)
Reversing letters when writing: typical until 2nd grade

Common error on multisyllabic words - “pasketi” for spaghetti
Not Early Signs of Dyslexia
Listening Comprehension Tests
Written Language Tests
Phonological/Phonemic Awareness Tests
Phonics/Decoding Tests
Vocabulary Tests
Reading Comprehension
Multiple Areas
Running Record
Informal
Assessments
All of your typical comprehensive language assessments

CASL, CELF-4, TLC-2, TLC-A, TACL-3

CELF-4: Understanding Spoken Paragraphs, RAN, Working Memory
Oral and Written Language Scales (OWLS)

Test of Written Language (TOWL-4)

Test of Early Written Language-2 (TEWL-2)

Test of Written Expression (TOWE)
Comprehensive Test of Phonological Processing (CTOPP)

Lindamood Auditory Conceptualization-3 (LAC-3)

The Phonological Awareness Test-2 (TPA-2)

Test of Phonological Awareness in Spanish (TPAS)

Ekwall-Shanker

Yopp-Singer
Really Great Reading Decoding Surveys

Test of Word Reading Efficiency (TOWRE) - Decodable words & sight words

Phono-Graphix

Wilson

See more on “Informal Test” slide
Receptive
PPVT-4
ROWPVT

Expressive
EVT-2
EOWPVT
Test of Reading Comprehension, 3rd Edition (TORC-3)
Dynamic Indicators of Basic Early Literacy Skills (DIBELS)

Developmental Reading Assessment-2 (DRA-2)

Qualitative Reading Intervention-4 (QRI-4)

Gray Oral Reading Test-4 (GORT-4)

Woodcock Johnson Test of Achievement III (WJ III) certain subtests - gold standard
Portfolio review

Parent/teacher interview

Classroom observation

Letter naming task

Sound-symbol inventory: consonants, short vowels, consonant digraphs, vowel digraphs, vowel diphthongs

Dolch word inventory

Spelling inventory

Running record (formal or informal)

Informal writing sample
Pediatric Reading & Writing - SLP's Role
ASHA's position statement: Roles and Responsibilities of Speech-Language Pathologist With Respect to Reading and Writing in Children and Adolescents (2005)
“The specific roles assumed by SLPs vary with employment settings and availability of other professionals who can provide language-focused interventions for problems with written-language development. However, the intervention work of speech-language pathologist should always be collaborative in nature, working closely with teachers primarily responsible for literacy instruction as well as other resources personnel providing intervention.”
preventing written language problems by fostering language acquisition and emergent literacy

identifying children at risk for reading and writing problems

assessing reading and writing

providing intervention and documentation for reading and writing (yes, this includes all of the five areas)

assuming other roles, such as providing assistance to general education teachers, parents, and students; advocating for effective literacy practices; and advancing the knowledge base.”
“These roles include, but are not limited to:
The reauthorization of IDEA (1997) says that intervention needs to be relevant to the general curriculum.

You are an expert in reading and a valuable member of the team.

Collaborate with others.
Neural Signatures

Typical Reading Development

5 Areas of Reading

Define Dyslexia

Written Language Assessments

SLPs Role
Underactivatiom
By the end of this lecture you should:

Understand the Basic Principles of How We Read

Have a basic understanding of how the brain functions during reading in a typical individual

Have a basic understanding of how the brain functions in individuals with reading difficulties

Be able to describe normal reading development from K-3
Define the five major areas of reading

Describe how a deficit in one of the five areas of reading may impact the other areas

Define dyslexia and list its characteristics

Define what dyslexia isn’t
Know how to assess the five major areas of reading

Become familiar with some standardized and informal assessments including a running record

Become familiar with possible, appropriate referrals

Understand ASHA’s position on the roles and responsibilities of SLP regarding reading and writing in children and adolescents
Logographic Stage:

Associate spoken words with features of print such as logos or brand names

E.g., Identifying that the word Coke on a soda bottle
Alphabetic Stage:

Decoding using letter-sound relationships

Also learn sight words & irregular words
If you struggle with reading, you read less, and if you read less, you have less general knowledge, which can cause you to do more poorly on an IQ test

I.e., IQ results could be an underestimate, which can lead to less of a discrepancy and possibly a delay in identification/remediation
Transition Stage:

Occurs once the child receives some formal instruction

Child uses some letter-sound cues in words
E.g., Story has a picture of a monkey and a tiger, & the child uses this picture cue and the first letter in the printed word monkey to read it.
Orthographic Stage:

Recognizes print patterns and chunks

Reads word endings, 2-syllable words

Develops fluency up to 80-100 wpm

Uses context to self-correct and learn new word meanings
Writes many upper and lowercase letters

Writes own name, names in family, pets’ names

Knows the sounds of almost all letters (consonants & short vowels)

Masters the alphabetic principle: sequence of the letters in a word = number & sequence of the sounds

Begins to decode (sound out) simple words

Starts to identify sight words (you, my, are, the)

Uses inventive spelling (e.g. cap = kpp)
Additionally,

Can just be a slow reader - “struggling reader”

Acquired dyslexia: CVA, TBI, AIDS (dementia)
It’s a language based LD

Hallmark deficit is phonological

Normal IQ
Under Kahmi’s “simple view” - dyslexia is the only true reading disorder

Hyperlexia is considered to be a language disorder
The Blimbat

Once when I was a yoder, my tomly and I were mayle in line to buy mott for the Blimbat. Finally, there was only one plam between us and the mott counter. This plam made a big impression on me. There were eight utzs, all probably under the age of 12. You could tell meyle did not have a lot of willen. Their pards were not yanker, but tures were clean. The utzs were well-behaved, all of them meyle in line, two-by-two behind their potent holding zibits. Tures were excitedly temering about the plums, fonts, and other acts tures would see that night.
Definition of Dyslexia

4. Dyslexia is a language-based disorder that impairs your ability to read. TRUE

5. Dyslexia is not a language-based disorder. Its etiology is rooted solely in occipital lobe (vision lobe) dysfunction. FALSE

6. An intellectual disability (mental retardation) and dyslexia can coexist. FALSE
7. ADHD and dyslexia can coexist. TRUE

8. Dyslexia = reading disorder TRUE

9. Phonics falls under phonological awareness but phonological awareness does not fall under phonemic awareness. TRUE

10. Dyslexia is when children see letters or words backwards. FALSE
POST TEST

Scope of Practice

1. An SLP cannot diagnose dyslexia. TRUE

2. Treating dyslexia is not in an SLPs scope of practice. FALSE

3. SLPs can work on reading comprehension but should refer to a reading specialist for all other areas of reading, such as phonics. FALSE
(McCormick 2007)
References

American Speech-Language Hearing Association. (2001). Roles and responsibilities of speech-language pathologists with respect to reading and writing in children and adolescents (position statement, executive summary of guidelines, technical report). ASHA Supplement 21, 12-28. Rockville, MD: Author

Armbruster, B.B., Lehr, F., & Osborn, J. (2001). Put reading first: The research building blocks for teaching children to read. Washington, DC: National Institute for Literacy.

Catts, H.W., Hogan, T.P., & Adlof, S.M. (2005). Developmental changes in reading and reading disabilities. In H. Catts & A. Kamhi (Eds.), The connection between language and reading disabilities. (pp. 23-36). Mahwah, NJ: Erlbaum.

Catts, H.W., Hogan, T.P., & Fey, M. (2003). Subgrouping poor readers on the basis of reading-related abilities. Journal of Learning Disabilities, 36, 151-164.

Catts, H.W., & Kamhi, A.G. (1999). Language and learning disabilities. Boston, MA: Allyn and Bacon.

Ehri, L.C. (1991). Learning to read and spell words. In L. Rieben & C. Perfetti (Eds.), Learning to read: Basic research and its implications (pp. 57-73). Hillsdale, NJ: Erlbaum.

Ehri, L.C. (1991). The development of reading and spelling in children: An overview. In M. Snowling & M. Thomson (Eds.), Dyslexia: integrating theory and ractice (pp. 63-79). London, England: Whurr Publishers.

Lyon, G. R., Shaywitz, S.E. & Shaywitz, B.A. (2003). A definition of dyslexia. Annals of Dyslexia, 53, 1-14.

McCormick, S. (2007). Instructing students who have literacy problems (5th ed.). Upper Saddle River, NJ: Pearson Merrill/Prentice Hall.

National Institute of Child Health and Human Development. (2000). Report of the National Reading Panel. Teaching children to read: An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction (NIH Publication No. 00-4769). Washington, DC: U.S. Government Printing Office.

National Institute of Child Health and Human Development. (2000). Report of the National Reading Panel. Teaching children to read: an evidence-based assessment of the scientific research literature on reading and its implications for reading instruction: Reports of the subgroups (NIH Publication No. 00-4754). Washington, DC: U.S. Government Printing Office.

National Institute of Child Health and Human Development. (2000). Report of the National Reading Panel. Teaching children to read: an evidence-based assessment of the scientific research literature on reading and its implications for reading instruction: Reports of the subgroups (NIH Publication No. 00-4754). Washington, DC: U.S. Government Printing Office.

Shaywitz, S. (2002, August 2).Children's Reading Disability Attributed To Brain Impairment. (2002) Retrieved January 7, 2009, from National Institute of Child Health and Development website: http://www.nichd.nih.gov/news/releases/reading_disability.cfm

Shaywitz, S. (2003). Overcoming dyslexia: A new and complete science-based program for reading problems at any level. New York: Random House.

Teacher’s manual read naturally masters edition (ME). (1997). Saint Paul, Minnesota. Read Naturally.

Wolfe, P., & Nevil, P. (2004). Building the reading brain, Pre-K-3. Thousand Oaks, California: Corwin Press.
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