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PRIMER TABLE OF CONTENTS
I. Primer
Introduction
II. Distance
Learning: The Instructional Strategy
for the 90's
III. Overview
of Distance Learning Concepts and
Strategies
IV.
References/Resources for Distance
Learning
I.
PRIMER INTRODUCTION
It is our intention to provide this
primer as a "baseline informational
source" for all participants in the
Fifth Conference on Distance Learning
in Public Health. By definition, a
primer is "a textbook giving the first
principles of any subject..." Although
this primer may not have all
principles, it covers general
information, provides a glossary, and,
thanks to AT&T, provides us with a
detailed description of certain
distance learning technologies. For a
further listing of resources, we have
included a section entitled "Resources
for Distance Learning." We hope that
you find this helpful.
We are interested in receiving your
feedback concerning this primer. As
with any new activity, this too is a
"work in progress." We look forward to
your critique as we move further into
enhanced activities in distance
learning in public health. Please send
written comments to Scott J. Becker,
ASPH, 1660 L Street, NW, Suite 204,
Washington, DC 20036.
II. DISTANCE
LEARNING: THE INSTRUCTIONAL STRATEGY
FOR THE '90s
A description of distance learning
as practiced by Division of Media and Training
Services, Public Health Practice Program
Office, Centers for Disease Control and
Prevention as part of the Public Health Training
Network, October 1994
The following staff members of the
Division of Media and Training Services
(DMTS) contributed to the concepts in
this paper: Joan Edmondson, Nancy C.
Gathany, Nona C. Gibbs, Richard
Lincoln, Dennis M. McDowell, Elise
Ralls, Keith Ring, Jim Roppo, Stephen
Smith. The paper was written by: Betty
S. Segal, Senior Training Development
Specialist, Training and Media
Development Branch, DMTS
Distance Learning:
The Instructional Strategy for
the '90s
Distance learning is an idea whose
time has come. It is not a new
idea—correspondence study has
been with us for many years. But today,
a variety of sophisticated
communication technologies provide
instructor and learner with numerous
ways to participate in learning at a
distance. The purpose of this paper is
to present distance learning as an
increasingly attractive instructional
strategy for public health as we
prepare ourselves for the "Century of
Prevention" and to describe some of the
uses the Centers for Disease Control
and Prevention (CDC) and the Public
Health Training Network have made of
this approach to instruction.
Characteristics of Distance
Learning
1. Physical distance between
instructor and learner. The
distance learning strategy is often
given other names—distance
teaching, distance education,
distributed education, learning at a
distance. All of these names refer to
some form of instruction in which
instructor and learner are physically
separated from one another. This
physical separation is the
principal—and
defining—characteristic of
distance learning.
2. Independent study or study
groups. Distance learning may be
set up to have learners participate
either individually or in
groups—or both.
3. Many delivery options.
Instruction may be provided in a
variety of media, from printed
materials to live satellite
videoconferences to electronic messages
on the Internet.
Whatever you call it, and whatever
form it takes, distance learning can be
an effective and economical strategy
for reaching widely dispersed
learners—such as members of the
pubic health workforce.
Media Used with the Distance
Learning Strategy
Print. As noted earlier,
correspondence study as practiced by
universities, the military, and other
organizations is the classic distance
learning format. This format relies
almost exclusively on the medium of
print. Printed textbooks and training
manuals have allowed generations of
learners to add to their knowledge and
skills while remaining in their home
communities and continuing to meet
other responsibilities.
CDC has provided correspondence
study in public health topics since the
1960's. CDC's original self-study
courses were print-based. And we
continue to use print-based courses,
because print remains an efficient and
effective means of conveying large
amounts of information in an organized
way.
Personal computers. Although
print-based instruction can allow
learners to apply and assess their
knowledge in simple ways, used alone,
it does not easily allow the practice
and assessment of complex skills.
Computers provide an excellent means to
engage individual learners in active
problem-solving in a realistic
way.
Well-designed training via computer
is ideal for addressing some types of
learning objectives, but its
development is time-consuming and
costly. Perhaps for this reason, many
developers of computer-based
instruction unfortunately use the
computer mainly as a "page-turner," in
which the computer presents screen
after screen of text and the learner's
only interaction with the material is
to tell the computer to advance to the
next screen. This type of material is
better and less expensively performed
by printed materials.
One application of computer-based
instruction by CDC is the development
of practice problems in epidemiology.
Our first such offering was
Investigating an Outbreak:
Pharyngitis in Louisiana, which
allows public health workers who
already have a knowledge of general
epidemiologic principles to practice
outbreak investigation skills.
Videotape. The growth in the
quality of inexpensive videotape and
the general availability of VCR's have
made videotape an attractive medium for
distance learning. Recent advances in
computer technology make it possible to
include excellent computer-generated
graphics, including animation,
relatively inexpensively. Videos can be
used to allow students to hear an
instructor's lecture, but showing a
"talking head" is not the best use of
the medium. On the other hand, videos
are ideal for demonstrations, such as
the demonstration of laboratory
procedures.
CDC is increasingly using videotape
as a medium for distance learning.
Videotapes we produced during 1993 and
1994 include the following:
•A New Hantavirus
•E. coli O157:H7
•Darkfield Microscopy
•Morphology and Motility of
Treponema pallidum
•Your Baby: Protecting Your
Baby Against Hepatitis B
•Out of the Mouths of Babes:
Baby Bottle Tooth Decay Prevention
•The ABC's of Safe and Healthy
Child-care: Diapering
•The ABC's of Safe and Healthy
Child-care: Handwashing
•Diabetes Today
Telephone lines, compressed
video, and satellites. Instruction
provided exclusively through the media
discussed above usually separates
instructor and learner psychologically
as well as geographically. The writer
or presenter of the
instruction—whether print-,
computer-, or video-based—seldom
has any personal interaction with those
who learn from that instruction;
learners are sometimes frustrated at
not being able to explore what they are
learning more fully with an instructor.
Some organizations that provide
distance learning instruction attempt
to address this drawback by allowing
correspondence between instructor and
learner, but for many
organizations—including
CDC—this is not a satisfactory
alternative.
Recent developments in telephone and
satellite technology make it possible
for instructors and learners separated
by vast distances to come together in a
live, and lively, exchange of
information. Telephone bridge lines can
be used to hold audioconferences.
Compressed video can be added to voice
transmission via telephone lines,
allowing instructors and students to
both hear and see each other.
Satellites can transmit high quality
visual and auditory signals, although
satellites are usually used to transmit
sound and picture in one direction
only: from instructor to learner, but
telephone facsimile transmission can be
used to allow learners to submit
questions and comments during a
satellite telecast, and telephone
bridge lines and 800- call-in lines can
be used to allow instructors and
learners to talk directly with each
other. Psychological distance between
instructor and learner is greatly
reduced by these "live" forms of
distance learning.
CDC is using all three of these
media to provide learning experiences
to the public health workforce
nationwide. For example,
•Through a cooperative
agreement, the Public Health Foundation
manages a series of telephone
audioconferences, supported reference
materials, which provide public health
audiences with convenient and
inexpensive access to experts in
important areas, such as media
relations, tuberculosis case
management, health care reform, and
Hantavirus. During the 1993 and 1994
floods, audioconferences were quickly
developed to provide information on
these emergency situations. All of
these programs have proved to be
extremely popular.
•The CDC workforce at locations
from Colorado to Atlanta has been
equipped to send and receive compressed
video, allowing employees in all
locations to take part in training
sessions being held at any other
location.
•CDC has in the last two years
made extensive use of satellite
technology, combined with telephone
bridges, for a variety of purposes. For
example:
-"Principles of Epidemiology by
Satellite" provided lectures and group
exercises in a series of five bi-weekly
telecasts as a supplement to CDC's
print-based course
-"Youth and Elders Against Tobacco
Use" summarized the contents of the
1994 Surgeon General's report,
"Preventing Tobacco Use Among Young
People" and demonstrated effective
intervention programs to a national
audience of professionals working in
health, substance abuse prevention, and
prevention policy makers; youth
advocates; and youth leaders.
-"Programs that Work" presented two
HIV curricula that have been shown to
reduce sexual risk behaviors for HIV
among youth. This satellite telecast
allowed state HIV educators to question
the developers, researchers, and users
of each curriculum directly and to
assess the appropriateness of the two
curricula for use in their state.
-"Building Media Skills for Better
Nutrition" provided information and
facilitator-led group activities for
using media in nutrition
programming.
Electronic communication.
Advances in computer technology have
enabled widely separated groups to
communicate quickly and easily through
electronic mail and the Internet.
Instructors in universities,
especially, are beginning to use this
medium for communicating with learners.
It can be used for discussions held
simultaneously or over a period of
time. It allows learners to ask
instructors questions and receive an
answer promptly with little
inconvenience to either.
As yet, CDC has not made use of this
medium for distance learning, but we
view it as a promising one, as health
workers are given increasing access to
computers and develop knowledge and
comfort in the use of communication
tools.
The best medium. There is no
one medium that is best for
distance learning. All have their
advantages and limitations. As
practiced—at CDC and
elsewhere—the best distance
learning experiences combine a variety
of media, selected for different
purposes. Also,CDC's experience has
shown that learners are more likely to
complete an extended print-based
course—one that requires
considerable study—if they are
organized into groups under a
facilitator, especially if the groups
meet periodically to discuss what they
are learning. For this reason, we have
recruited group leaders in state and
local health departments and academic
settings to organize study groups and
act as facilitators in our distance
learning courses.
The format for a particular distance
learning course, then, could combine
print (for presenting a body of
information and for providing practice
exercises and feedback) with group
study under a local facilitator who
leads a discussion of a section of the
printed text, brings in a guest speaker
on the topic, shows a video that is a
part of the course as designed, or
arranges for learners to take part in
one or more live, interactive audio
teleconferences or satellite
videoconferences on the subject.
To enable our distance learners to
experience such an enriched format, CDC
has collaborated with state health
departments nationwide to develop a
distance learning network, the Public
Health Training Network, in which
partners in the states act as distance
learning coordinators, group leaders,
site coordinators for satellite
videoconferences, as well as in many
other roles. These state partners play
a crucial role in the success of
"learning at a distance" as practiced
through the Public Health Training
Network.
Why Use a Distance Learning
Strategy?
There are many reasons why CDC has
chosen a distance learning strategy to
deliver much of its training to the
public health workforce.
First, the workforce is widely
dispersed, making it expensive in time
and money for instructors to travel to
the learners. In fact, CDC does not
have enough instructors in any subject
to be able to deliver a course to every
part of the public health audience. And
states find it prohibitively expensive
to send learners to CDC. Also, some
information and skills can be taught in
a day or less, making travel in either
direction less cost effective.
Second, instruction using a distance
learning strategy can be designed to
allow learners to fit the instruction
into their schedules when it is
convenient for them. They are not
locked into a fixed period of time.
They can read printed text, watch a
video, or work on computer-based
instruction and still meet their
regular responsibilities.
Third, instruction using a distance
learning strategy can be designed to
allow learners to progress at their own
rates; they can skip over what they
already know or repeat parts they have
difficulty with.
Fourth, when the primary purpose is
to provide information, a distance
learning strategy can be used to
provide the same information
simultaneously, usually by satellite,
to a nationwide audience. An example of
such an application is the release of
new guidelines—such as those
guiding TB and immunization practices.
When satellite is used as the medium,
field audiences are able to seek
clarification from those who were
involved in setting policy and
developing guidelines. The provision of
information in this way may not be
considered training in a strict sense,
but it does enable public health
workers to perform more
effectively.
How Do We Know It Works?
Evaluation plays an increasingly
important role in CDC's distance
learning efforts. For some instruction
that carries continuing education
credit, CDC uses a final exam that is
designed to measure mastery of the
instruction. Information is also
routinely collected on learner
perceptions of the instructors, the
delivery medium, the content and other
features of distance learning efforts
that are strictly instructional. Many
evaluations are being broadened to
allow learners to develop action plans
for applying what they have learned on
the job. Thus far, these evaluations
indicate that well-designed instruction
using a distance learning strategy is
preferred to other approaches.
In the future, a greater emphasis
will be placed on collecting data on
distance learning efficiency from a
range of key
"stakeholders"—supervisors,
distance learning coordinators, group
leaders, site facilitators,
instructors, professional associations,
and others.
What Makes It Work?
In a word: PEOPLE. For CDC, this
means people at CDC and people out in
the states. The key players include the
learners themselves and those who
support their involvement (for example,
managers who endorse distance learning
and make it possible for learners to
take part in group meetings during the
work day), distance learning
coordinators (currently most states
have named distance learning
coordinators who serve as
conduits,making it possible for state
and local health department staff to
access PHTN products), faculty (who may
or may not be CDC staff members),
facilitators and group leaders, site
coordinators for satellite
videoconferences, instructional
developers, including graphic artists
and TV producers, directors, camera
persons, videotape editors, and many
others.
CDC has found that success in
distance learning relies first on how
well it is designed. We use specialists
in instructional design at every step,
up to and sometimes including
implementation. For example,
instructional designers
•establish who the audience is,
what training they need, whether there
are any constraints on either CDC or
the audience in delivering or receiving
the training
•determine the best media for
delivering the training and design the
"package," which may include a mix of
media
•develop all parts of the
training as designed—for example,
computer-based instruction, video
scripts, print-based manuals
•participate in designing and
conducting formative evaluation of the
design and materials
•coordinate, in many instances,
the delivery of the training by, for
example, preparing facilitators guides,
writing scripts for videoconference
speakers, holding practice sessions for
speakers
What's on the Horizon?
CDC is committed to using a distance
learning strategy. We will continue to
work to make it as efficient and
effective as possible. We expect to
increase our use of technology-based
media. We will undoubtedly produce
satellite videoconferences at an
increasing rate. Eventually we expect
to develop training products in an
interactive video format which learners
can use at their desks.
CDC's partners in the Public Health
Training Network (PHTN) are crucial to
making this strategy succeed. Their
assistance is invaluable in determining
training needs, identifying and
registering learners, providing
appropriate learning environments,
facilitating groups, producing
pertinent programs, and providing
feedback on how a training package can
be improved. The list of partners grows
daily.
Among PHTN's pioneering partners
are:
Association of Schools of Public
Health (ASPH)
Association of State and Territorial
Health Officials (ASTHO)
Association of State and Territorial
Public Health Laboratory Directors
(ASTPHLD)
Black College Satellite Network
(BCSN)
Council of State and Territorial
Epidemiologists (CSTE)
Federal Drug Administration
(FDA)
National Association of County and
City Health Officials
Public Health Foundation (PHF)
State and local health
departments
U.S. Department of Agriculture
(USDA)
We look forward to working closely
with our current and future PHTN
partners as we continue to seek the
most effective means for readying the
public health workforce for the
challenges of the twenty-first
century—the Century of
Prevention.
III. OVERVIEW OF DISTANCE
LEARNING CONCEPTS AND
STRATEGIES
We would like to thank AT&T for
allowing us to include the following
handbook that was a collaborative
effort of the Indiana University Center
for Excellence in Education and the
AT&T Center for Excellence in
Distance Learning.
The handbook was written and edited
by Michael Yoakam, Indiana University
Center for Excellence in Education and
Alan Chute Ph.D., AT&T Center for
Excellence in Distance Learning.
TECHNOLOGIES &
APPLICATIONS
When planning and implementing
distance learning systems,
understanding the technologies involved
is important. These technologies are
organized into three areas: telephones,
computers, and video. Before beginning
a discussion of these technologies,
understanding several concepts will be
helpful.
Convergence: While the
telephone, computer, and video
industries have traditionally been
separate, today's changing
technological arena is blurring these
distinctions. The common denominator is
information in a digital format, making
it possible for telephone networks to
deliver video and data services and
cable companies to offer telephone
service. Computers are coming to market
that will handle all of the
communications media.
Interaction : The level of
interaction between instructors and
learners in distance learning systems
varies. Correspondence courses provide
one level of interaction, satellite
video programs another, and two-way
video yet another. Interaction does not
always need to be a real-time
communication. Good examples of non-
real-time interaction include voice
mail and computer email.
Distance Learning Systems : A
comprehensive distance learning system
will include a combination of
technologies. For example, in a
distance learning system that uses
video as the primary method of
delivery, voice mail, electronic mail,
networked multimedia databases and fax
technologies might be employed for
additional interaction between learners
and faculty and to provide support
sevices for the distance learning
system.
Point to point vs. multipoint:
As the name implies, a point to
point connection involves interaction
between two locations, and a multipoint
connection involves three or more
locations simultaneously. These terms
are used to describe all types of
conferencing: voice, data, and
video.
Bridging: Multipoint
connections are created using an audio
bridge for voice only conferences or a
Multipoint Control Unit (MCU) for
connecting video calls. Network based
multipoint services, billed on a usage
basis, are available from AT&T, or
AT&T's Definity based multipoint
technology can be installed at the
customers site as part of the distance
learning system.
Analog vs. Digital: Today's
distance learning technology is a mix
of analog and digital technology. These
terms refer to the characteristics of
representing information in electronic
form. Analog is a continuous waveform
representation that varies by time and
intensity whereas digital
representation codes everything into a
binary language of ones and zeros.
Traditionally, voice and video
technologies were analog. Computer
technology is digital. The convergence
of these media is creating all digital
systems. The challenge is to best
leverage what exists today within the
vision of the digital future.
TELEPHONE TECHNOLOGY
One of the simplest, most cost
effective distance learning
technologies available is the
telephone. With user friendly
equipment, you can access distance
learning experiences, interact with
experts, receive information updates,
and share ideas with almost anyone,
anywhere. The telephone often serves as
the audio component of other distance
learning systems such as audio
graphics, and satellite one-way video,
two-way audio systems.
The audio component of a distance
learning system can be as simple as a
telephone and as complex as a system of
microphones, cabling, audio mixers, and
echo cancelingequipment. Audio is among
the most critical components of a
system to ensure effective interactive
communication. (Try turning the sound
down on your television and following
what's going on. Contrast that to
turning off the picture and listening
to the sound only.)
Distance learning applications using
telephone technology include:
Audio Conferencing: The
devices used for audio conferencing
range from individual telephones and
speakerphones to specially designed
room systems that include speakers,
microphones, and equipment to mix the
sound. Audio conferences can be used
for a variety of applications including
meetings, the delivery of courses and
training, and for guest lectures in any
kind of classroom.
Callback Device: One-way
video systems, like satellite delivered
programs, can be combined with
telephones to allow learners at remote
sites to call into the originating
location to interact with instructors
and other learners.
Voice Mail: This application
can provide an effective vehicle for
learner/instructor conferences,
parent/teacher communication, and the
"homework hotline."
FAX: Another easy, effective
way to send information from one
classroom to another is by using fax
machines.
Finally the telephone can serve as a
valuable backup device in other
distance learning environments. When
necessary, the telephone can help
troubleshoot problems and provide an
audio fallback for instruction.
COMPUTER TECHNOLOGY
Personal computer technology is
becoming an important, integrated
element for distance learning. Some
powerful applications for computer
technology include communication,
search and retrieval of information
resources from a global network
environment such as the Internet,
access to collaborative learning
environments, and desktop
videoconferencing.
The technology of computer based
distance learning starts with the
desktop computer, and can include a
variety of peripheral devices and
communications tools. Connectivity to
networks is provided by either a modern
and telephone line or a direct
connection to high speed data networks.
The computer may serve as the primary
distance learning platform, as in
Computer Based training, or as a
support system in other distance
learning environments. A good example
of the latter is the use of email for
communication between learners and
instructors.
Some applications that use the
persortal computer platform for
distance learning are:
Computer Based Training
(CBT): The electronic version of
the correspondence course, CBT is
typically self-paced instruction that
learners access from desktop computers.
The training materials might be
installed on the local computer,
CD-ROM, Laserdisk, or accessed from a
computer network.
Email: Electronic mail allows
learners and instructors to communicate
across time and distance using typed
messages sent over both local and
global networks.
On-line classes: This term
refers to courses where lectures,
readings, and assignments are posted on
computer bulletin boards and learners
access and download the course
materials. Other applications such as
email are used for private
communication between learners and
instructors.
Computer Conferencing:
Interactive computer based
communication environments can be real
time "chat" modes where participants
converse by typing on the keyboard or
modes where communications are posted
to electronic discussion groups called
bulletin boards.
Groupware: This is the term
used to describe some emerging
applications that allow an electronic
work space for collaborative work,
sharing of ideas, and group process.
Starting with the conferencing concept
above, groupware is able to store,
sort, and organize the inputs of
participants and to support group
processes such as idea generation,
evaluation and consensus building.
AUDIOGRAPHIC TECHNOLOGY
The combination of the telephone and
the computer creates a distance
learning application called
audiographics. In this environment the
telephone is used for voice interaction
and the computer is used for sharing
graphic materials and collaborative
work. Participants can interact with
visual presentations and
audioconference at the same time.
Applications using audiographics can
range from one-time training exercises
to semester-long academic course
work.
Each site is equipped with
speakerphone, computer and software,
modem, and optional peripheral devices
like mouse, graphics tablet, scanner
and camera.
Class sessions are set up using the
switched telephone network (standard
telephone lines). Some audiographics
systems combine the voice and computer
signals on a single phone line. Other
systems use two phone lines, one for
voice and one for the computer.
Connections can be either point to
point or bridged into multipoint
sessions.
VIDEO TECHNOLOGY
The abillty for instructors and
students to see and hear one another
brings new levels of Interaction to the
distance learning experience.
Collaborative problem solving,
demonstration, behavior modeling, and
skills practice are all enhanced by the
addition of video. Distance learning
applications using video technology
fall into two general categories,
one-way video and two-way video.
One-Way Video: The
distinguishing characteristic with this
distance learning application is that
video signals are transmitted in one
direction, from the instructor to the
learners. The most common method of
delivering the broadcast is by
satellite. Components of a satellite
broadcast system include the
origination site, the satellite uplink
for transmissionof the program to a
satellite orbiting the earth, the
satellite transponder that receives the
earth signal and retransmits that
signal back to earth, satellite
downlink equipment, and finally a site
for people to view the program on
standard television monitors.
The program that originates from one
site is transmitted by satellite to a
"footprint" that covers a very wide
area. For example, satellite programs
originating at one site in North
Arnerica can be received simultaneously
at a limitless number of sites anywhere
in the United States, thus serving a
geographically dispersed audience. Real
time interactivity among the sites and
the originating location is
accomplished using telephones, data
collection key pads, and faxes.
Two-way Video: Another
distance learning system provides video
and audio communications in both
directions between learners and
instructors. This is referred to as
two-way video. All locations in a
two-way video system are equipped with
cameras, monitors, and microphones .
Point to point and muitipoint
connections link learning sites and
instructors and learners can see and
hear each other. These connections use
circuits that can deliver a range of
video services. In each system, the
learning site is equipped with cameras,
microphones and other peripheral
equipment to support the full range of
instructional needs.
Compressed Video: These
systems offer the flexibillty of a
variety of bandwidth services to the
user. The audio and video signals go
through digital signal processing that
reduces the amount of information that
is sent from location to location.
These compressed signals can be sent to
virtually any location via satellite or
over the switched telephone network.
Using digital telephone services, the
quality of the picture is a function of
how the bandwidth is used. This can
range from ll2Kbps, the most commonly
used bandwidth, up to 384 Kbps,
7GSKbps, or even a full T-l circuit of
1.5 Mbps. The cost for the connection
is based on the bandwidth used.
Full Motion Systems: A full
motion video distance learning system
is one that provides picture quality
that is comparable to the quality of
commercial television. These systems
typically require an investment in
fiber optic cables and high capacity
circuits to network learning sites
together. High capacity networks are
often built with private, dedicated
circuits between locations.
The selection of a video system is
influenced by learning requirements and
cost factors. The technology is
changing rapidly, and the trend is
toward better quality video and audio
on less expensive worldwide transport
services.
As mentioned earlier, a
comprehensive approach to distance
learning applications will consider all
of the technology options and build
systems that include many of the
technologies mentioned. A variety of
combinations are in use today--an
example might be a two-way video system
that uses FAX and computer email for
additional interaction.
IV.
REFERENCES/RESOURCES FOR DISTANCE
LEARNING
Armstrong, L., Yang, D., &
Cuneo, A. (2/28/94). The learning
revolution, Business Week, pp.
80-86, 88.
Arnst, C. (1/9/95). Talk
about dialing for dollars. Business
Week, p. 78.
Balabanian, N. (9/94).
Computer networks and equity.
Preliminary report of a conference
on the use and abuse of computer
networks: Ethical, legal and technical
aspects. (Held December 17-19,
1993, Irvine, CA.) Washington, DC: The
American Association for the
Advancement of Science.
Bates, A.W. (1994).
Costing distance education
technologies: Developing a
methodology. (Preliminary
Discussion Paper.) Burnaby, B.C. The
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