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Child Abuse and Neglect

Child Abuse and Neglect

Definitions, Classifications, and a Framework for Research
Volume Editors: Margaret M. Feerick Ph.D., John F. Knutson Ph.D., Penelope K. Trickett Ph.D., Sally Flanzer Ph.D., Kyle L. Snow Ph.D.   Invited Contributors: N. Dickon Reppucci Ph.D., Jill Antonishak Ph.D., Marla R. Brassard Ph.D., Rosemary Chalk, David S. DeGarmo De Martinez Ph.D., Kera L. Donovan, Howard Dubowitz, Diana J. English Ph.D., Jeffrey J. Haugaard Ph.D., Deanna Heckenberg, Maryfrances R. Porter Ph.D., Sharon G. Portwood, John B. Reid Ph.D., Desmond K. Runyan, Cassandra Simmel M.S.W., Ph.D., David Watson Ph.D., Ying-Ying T. Yuan Ph.D.   Foreword Author: Mary Bruce Webb Ph.D.

ISBN: 978-1-55766-759-5
Pages: 440
Copyright: 2006
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This landmark book is the first to offer researchers and policymakers perspectives on developing a precise, scientifically valid system of defining, classifying, and measuring child maltreatment. Directly addressing the biggest barriers to research — lack of consistent definitions and measurement approaches — Child Abuse and Neglect is the result of two federally funded workshops that pooled the expertise of two dozen researchers. Together, these experts present a framework for conducting successful research, giving readers the information they need to

  • clarify the limitations of current definitions, classification systems, and measurement approaches
  • revise the research definitions for four types of abuse: physical abuse, sexual abuse, psychological maltreatment, and neglect
  • use multi-method, multi-source approaches to classification and measurement
  • understand how social policy trends help or hinder both research and practice
  • address the ethical challenges of conducting research with vulnerable children and families

An indispensable resource for researchers and policymakers, this timely volume will help the field reach consensus on how to define and measure child maltreatment — and facilitate research that lays the groundwork for better prevention and treatment efforts.

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Review by: Bette Bottoms, University of Illinois at Chicago
"Moves the field closer to the goals of developing treatments for the effects of child abuse and neglect, as well as policies to prevent it."
Review by: Jody Todd Manly, Clinical Director, Mt. Hope Family Center, University of Rochester
"A comprehensive synthesis of relevant issues . . . an essential resource for researchers and others with an interest in child maltreatment."
Review by: G. Reid Lyon, Executive VP for Research and Evaluation, Higher Ed Holdings, LLC and Whitney International University Systems
"Brilliantly written and organized . . . should be mandatory reading for anyone dedicated to eradicating child abuse and neglect."
Review by: John Lutzker, Executive Director, Marcus Institute, Atlanta, GA
"An extraordinary, timely volume."

About the Editors
About the Contributors
Foreword Edward Zigler
Foreword Catherine Nolan

I. Classification of Child Abuse and Neglect

  1. An Examination of Research in Child Abuse and Neglect: Past Practices and Future Directions
    Margaret M. Feerick and Kyle L. Snow
  2. Defining Child Abuse and Neglect: A Search for Consensus
    Rosemary Chalk
  3. Characteristics of Child Maltreatment Definitions: The Influence of Professional and Social Values
    Jeffrey J. Haugaard

II. Definition and Theory in Child Abuse and Neglect

  1. Operationally Defining Physical Abuse of Children
    John F. Knutson and Deanna Heckenberg
  2. . Defining Child Neglect
    Howard Dubowitz
  3. Defining Child Sexual Abuse
    Penelope K. Trickett
  4. Defining Psychological Maltreatment
    Marla R. Brassard and Kera L. Donovan
  5. In Search of Construct Validity: Using Basic Concepts and Principles of Psychological Measurement to Define Child Maltreatment
    David Watson

III. Current Approaches to Measurement

  1. Self-Report Approaches
    Sharon G. Portwood
  2. Measuring Child Child Abuse and Neglect Using Child Protective Services Records
    Desmond K. Runyan and Diana J. English
  3. Direct Observations and Laboratory Analog Measures in Research Definitions of Child Maltreatment
    David S. DeGarmo, John B. Reid, and John F. Knutson

IV. Social Policy Issues

  1. Policy and Applied Definitions of Child Maltreatment
    Maryfrances R. Porter, Jill Antonishak, and N. Dickon Reppucci
  2. The Impact of Information Technology on Defining and Classifying Child Abuse and Neglect
    Sally M. Flanzer, Ying-Ying Yuan, and Diana J. English
  3. A New Look at Ethical Issues in Child Maltreatment Research
    Cassandra Simmel, Sally M. Flanzer, and Mary Bruce Webb
  4. Conclusions and Future Research Directions
    Margaret M. Feerick and Kyle L. Snow


Excerpted from Chapter 2 of Child Abuse and Neglect: Definitions, Classifications, and a Framework for Research, edited by Margaret M. Feerick, Ph.D., John F. Knutson, Ph.D., Penelope K. Trickett, Ph.D., and, Sally M. Flanzer, Ph.D.

Copyright © 2006 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

The author recognizes the research contributions of Purva Rawal in developing this chapter.

In 1991, Dr. Wade Horn, then Commissioner for the Administration on Children, Youth and Families (ACYF) in the U.S. Department of Health and Human Services (DHHS), asked the National Academy of Sciences to develop a research agenda that could guide future studies of child maltreatment. Several factors prompted his request. The research community had long expressed interest in developing a synthesis of findings from the extensive research literature that had emerged since the passage of the Child Abuse Prevention and Treatment Act of 1974 (PL 93–247). In addition, program staff within DHHS were concerned with the quality of the future child maltreatment research program. Their objective was to develop a set of programmatic research priorities that could offer protection against persistent congressional efforts to set aside, or “earmark,” funds in the federal child abuse research program for special interest service delivery projects. Up to that time, child abuse and neglect research projects within the ACYF were largely responsive to immediate and programmatic information needs within the child protection and child welfare services practice community and were generally uninformed by conceptual or disciplinary frameworks. The result was a fragmentary and patchwork research field that had second-class status within the scientific community when compared with theory-driven research sponsored by the National Institute of Child Health and Human Development (NICHD), the National Institute of Mental Health (NIMH), and other components of the National Institutes of Health (NIH). Furthermore, stakeholders within the federal government and the research community were hopeful that the development of a coherent rationale and research agenda on child maltreatment would lead to the expansion of funds available to support studies in the area.

In response to the Commissioner’s request, the National Academy of Sciences (NAS) convened a study panel, referred to as the Panel on Research on Child Abuse and Neglect, within the National Research Council (NRC), the operating arm of the NAS that was responsible for ad hoc studies. The panel was chaired by Anne C. Petersen, Ph.D., a well-known researcher in the field of adolescent development who was then Vice President for Research and Dean of the graduate school at the University of Minnesota. The 16 panel members included distinguished researchers in the field of child abuse and neglect, as well as others who were not directly associated with this field but who presented solid credentials and expertise in the areas of epidemiology, statistics, pediatric medicine, child development, and sociology.

The composition of the NRC panel was designed to mix researchers who had expertise in the field with others who could critique the quality and coherence of child abuse and neglect studies by comparing this research literature with other areas of child and family studies. The NRC panel conducted its work through a series of public and private deliberations, an extensive review of the research literature, the development of commissioned papers, and a survey of leading organizations in child maltreatment research.

The purpose of the panel was to perform a comprehensive examination of the theoretical and pragmatic research needs in the field of child abuse and neglect. More specifically, the study was designed to 1) review and assess research on child abuse and neglect, including work previously conducted by the ACYF and other public and private agencies; 2) identify research relevant to the child abuse and neglect field; and 3) outline research priorities for the upcoming decade. Research priorities that were identified included shaping building blocks for knowledge development in child maltreatment, finding new research avenues that could be funded by public and private agencies, and suggesting research areas within the field that might no longer be funding priorities.

The report of the panel, Understanding Child Abuse and Neglect (NRC, 1993), is now considered a landmark synthesis of child abuse and neglect research. It provided a foundation that has since guided many discussions about the importance of developing a common conceptual framework, research definitions, rigorous classification, and empirical measurement in the field of child maltreatment. The panel’s study also represented a pivotal moment in shifting the field from a patchwork effort of applied research studies to a more cohesive set of activities striving to improve theory, instrumentation, measurement, and data collection efforts.

One result of the NRC panel’s report was that the NIH and the Children’s Bureau in the Administration on Children, Youth and Families convened two workshops focused on defining and classifying child abuse and neglect (the first in December 1999 and the second in September 2000) that were the inspiration for this book. Therefore, it is useful to reexamine the basic framework and approach adopted by the NRC panel and to consider their relevance for contemporary discussions of classification, theory, measurement, and definitions of child abuse and neglect.


The work of the NRC panel was inf luenced indirectly by other studies that were underway within the NRC in the late 1980s and early 1990s. In 1988, a consortium of federal agencies—the National Institute of Justice, the National Science Foundation, and the Centers for Disease Control—had asked the NAS to assess the state of scientific knowledge about violence, to consider the implications of that understanding for preventive interventions, and to design research and evaluation studies that could improve the understanding and the control of violence. In response, the NAS created the NRC Panel on the Understanding and Control of Violent Behavior, chaired by sociologist Albert Reiss from Yale University. The Reiss panel eventually published a four-volume series of reports that included a summary report as well as a series of background papers commissioned by the committee (NRC, 1993/1994).

Although the activities of these two studies occurred at the same time, the two groups did not meet, nor did they share research materials. However, the conceptual framework that evolved from the Reiss panel was “in the air” at the time the Petersen panel was convening, and it helped to guide discussions that focused on how to move the field of child abuse away from an applied research orientation toward one that was grounded more firmly in theory, measurement, classification, and data. One important contribution from the Petersen panel was the recognition of the need for multiple classification schemes in addressing violent events as well as of the inherent limits of using administrative data records to guide empirical and scientific studies. Because research on child abuse and neglect had often depended (and continues to depend) on records from child protective and child welfare agencies rather than from population-based, longitudinal, or experimental studies, the need to disaggregate different types of child abuse and neglect into new categories based on a theory-driven classification scheme acquired central importance in the Petersen panel.

The studies on violence research and child abuse were the first in what would become a series of reports on other aspects of family violence published by the NRC. Subsequent publications included “Understanding Violence against Women” (1996); “Violence in Families: Assessing Prevention and Treatment Programs” (1998); and, in 2002, “Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence.” Each report had its own study committee, study sponsor, and study director, and each report considered separate research literatures. Nevertheless, the research literatures examined in these multiple reports showed a movement toward a gradual acceptance of the importance of conceptual frameworks and the need for stronger theory to guide the discovery of fundamental processes in the study of complex human behavior, parenting practices, and family systems.

Two influential lines of research were emerging within the child development literature that drew child maltreatment studies toward a broader ecological framework of parent–child interactions. The first, ecological systems theory, developed by Urie Bronfenbrenner (1979) and others, has had a profound inf luence on research in child development. Ecological systems theory, as described by Bronfenbrenner, asserts that child development occurs through a complex process of interactions between the immediate environment of the child and broader environmental layers, such as the family, school, church, community, and larger society and cultural norms. Development is shaped at the microsystem level by family and local community factors, at the mesosystem level by intermediate societal factors and institutions, and at the macrosystem level by national and global factors. Disruption at any one of these layers affects the others as well. Thus, child development is a complex interaction between the child’s biology and proximal and distal environmental influences (Bronfenbrenner, 1979).

Second, studies of violence in the latter part of the 20th century moved toward an analysis of biobehavioral actions within social settings and studies of child development and parental caregiving. These shifts were inf luenced by transitions in new theories that sought to account for the role of social and cultural factors in human behavior and interpersonal relationships (Garbarino, 1977; Wolfe, 1991). Researchers began conceptualizing child maltreatment from a transactional perspective, in which factors associated with families, communities, and the larger society and culture acquired greater importance in examining processes that contributed to child maltreatment as well as child development. The result was a de-emphasis on personal factors, such as parental psychopathology, and greater attention to the examination of interactions among individual, family, and community stressors (Belsky, 1980; Cicchetti & Lynch, 1993). The increasing level of sophistication in consideration of multiple causal pathways and processes was characteristic of other social policy studies at the time.

New paradigms were created to reconcile the nature and sources of aggression and violence in human relationships with emerging theory describing stages of child development, parental caregiving and disciplinary practices, and family interactions in coping with stress and conf lict. The result was a significant shift in both the field of violence research and the field of child development, away from a narrow focus on mechanistic models that isolated individual psychiatric and psychological factors toward a more expansive, yet still poorly conceptualized, approach that put greater emphasis on settings, cultural forces, and dynamics in child development and their role in multiple pathways to abuse and neglect (Cicchetti & Lynch, 1993; Wolfe, 1991). Greater research attention was devoted to understanding the role of risk and protective factors in the social environment; the processes of resiliency; and the ways in which the presence or absence of psychological, social, and cultural supports within the family and community help to mediate or inf luence certain types of stressful interactions involving care for children, particularly those who are young (Belsky, 1980; Egeland, Breitenbucher, & Rosenberg, 1980; Polansky, Gaudin, & Kilpatrick, 1992).

These and other research developments influenced the Petersen panel to adopt an ecological, developmental perspective in examining the etiology, incidence, and consequences of child maltreatment. For instance, Egeland et al. (1980) conducted a prospective study of the antecedents of child maltreatment in which they compared families that had been reported for child maltreatment with high-risk families that appeared to provide adequate levels of care. Results demonstrated that the association between risk level in families and whether children were maltreated was far from linear; in fact, many mothers who were considered high-risk for maltreating their children did not do so, and many incidents of maltreatment occurred among mothers judged to be at low risk (Egeland et al., 1980). This study demonstrated the complexity of the relationships among parental characteristics, environmental stressors, and the occurrence of child maltreatment.

The shift in research paradigms had profound implications for the definition and classification of child abuse and neglect experiences. In addition, recognition of the variations and gaps associated with legal and administrative definitions of child maltreatment emerged within policy and programmatic fields, fostering more receptivity to research-based definitions and measurement. However, the research field itself was changing and rearranging conceptual frameworks (Belsky, 1980; Cicchetti & Lynch, 1993). For instance, Garbarino (1977) and Belsky (1980) created ecological models of child maltreatment based largely on Bronfenbrenner’s work. Cicchetti and Lynch (1993) later created transactional and interactive models of child maltreatment, in which combinations of risk factors and protective factors were assumed to interact across all ecological levels to contribute to the occurrence of child maltreatment behaviors. The result of these new frameworks was greater ambiguity and confusion as to how to define the principal elements of abuse and neglect and how to align science-based definitions with legal standards and administrative records. However, this ambiguity should not be viewed as a step backwards. Indeed, it acted as a precursor to a deeper understanding of the critical elements of abuse and neglect, and it offered an opportunity to reframe definitions that could subsequently guide policy and practice by focusing on the most critical aspects of child maltreatment as well as those behaviors that might be most amenable to change.

One other body of research literature deserves mention here, although it did not receive major consideration in the NRC study on child abuse and neglect. In the mid-1980s, public health agencies on injury began to form more rigorous classification and definitional standards to improve the quality of surveillance and epidemiological studies of injury. In 1985, a NRC study, “Injury in America: A Continuing Public Health Program,” summarized these efforts, recommending improving the systematic collection of injury data to strengthen prevention strategies. The report concluded, among other things, that significant uncertainties and gaps in the epidemiology of injury occurrence impeded scientific understanding of the causes and consequences of assaultive injuries. Most importantly for the child maltreatment field, the report recommended that funding for research on the prevention of injury and maltreatment of children should be proportionate to its status as the largest cause of death and disability in youth.

The public health injury surveillance system began to pay attention to child abuse and neglect within the category of “intentional injuries,” and it eventually developed a detailed classification scheme that is now part of the International Classification of Disease (ICD) codes. Newer versions of the ICD codes include “E-codes,” which classify external causes of injury, such as the use of guns or knives in assault injuries. It is noteworthy that the child development and violence research literatures are still explaining how to adapt the detailed ICD classification scheme to provide additional injury-specific information, such as identifying the time of day or locations where injuries occur or their association with particular actions such as feeding or disciplinary behaviors.


The 1974 Child Abuse and Prevention Treatment Act (CAPTA; PL 93–247) stipulated that the new National Center on Child Abuse and Neglect (NCCAN) investigate the incidence of child abuse and neglect across the country. CAPTA and the research that emerged from it led to more specific classification of child abuse and neglect. At the time that the Petersen panel began its work, four general categories of child maltreatment—a result of CAPTA—were commonly recognized in the research literature: physical abuse, sexual abuse, neglect, and emotional or psychological maltreatment. Most research studies had focused on physical and sexual abuse. The amount of attention focused on neglect in the research community was limited, despite the fact that cases of child neglect constituted more than half of the reports received annually by child protection agencies, were widely recognized as the most common individual type of maltreatment. The second National Incidence Study (NIS–2; DHHS, 1988) also demonstrated that neglect was involved in 63% of the reported cases. Wolock and Horowitz, commenting on this phenomenon, wrote about “the neglect of neglect” in a 1984 paper.

Recognizing that these four categories encompassed a broad range of behaviors, the NRC report “Understanding Child Abuse and Neglect” (1993) stated that although broad consensus might exist around extreme forms of child abuse and neglect (e.g., beatings, disfigurement, and sexual abuse), less severe manifestations presented more complicated issues with respect to definition and classification. Furthermore, a classification scheme by types of abuse might be useful for pragmatic or legal reasons, but it lacked the conceptual constructs that could help research studies differentiate the pathways to and outcomes associated with abuse and neglect. Co-occurrence of different types of maltreatment was common, blurring even the appearance of mutually exclusive sequelae by type. The “types of abuse” typology also provided little support in comparing research findings across studies or in explaining the sequence, timing, or relationship of maltreatment to other family processes and social behaviors. Therefore, the panel was searching for alternative frameworks and definitions that could address these limitations and help to improve data collection efforts that would strengthen the overall field of child abuse and neglect research.


In the absence of universal definitions of child abuse and neglect, different service sectors and the research community had developed separate and multiple criteria and classification frameworks for each of the four traditional categories of child maltreatment: physical abuse, sexual abuse, neglect, and emotional or psychological maltreatment. Definitions of child abuse and neglect were largely driven by state laws and regulations, creating inconsistencies and variations that impeded the use of standardized assessment instruments. Additional complications were associated with high caseloads and gaps in social services, inaccurate or incomplete information, and limited services for affected families (Hoaglin, Light, McPeek, Mosteller, & Stoto, 1982; Leventhal, 1990). The NRC report reviewed these approaches, indicating that although service-oriented definitions were necessary for delivery, practice, and policy purposes, they were characterized by fragmentation and inconsistencies that represented serious impediments to improving the quality of data and knowledge in this field. Medical and clinical definitions, social services definitions, and legal and judicial definitions are reviewed in the following sections.

Medical and Clinical Definitions

For decades, physicians had recognized child abuse and neglect as a disturbing and sometimes unique set of physical conditions, frequently characterized by fractures, burns, scars, other injuries, and parental deprivation of medical care. In the early 1990s, however, no universal medical definition of child abuse and neglect, much less of physical abuse per se, existed. If physicians thought in terms beyond injury and treatment, their classifications were likely to be hindered by state definitions that included ambiguous terms such as substantial, unjustified, and allowable (Johnson, 1990). Over time, health professionals acquired greater expertise through clinical experience and improved instrumentation in detecting signs of abuse or neglect. For example, in the case of “shaken baby syndrome,” physicians began to search for physical signs of shaking (e.g., bruises, retinal hemorrhaging) and for more moderate symptoms, including poor feeding history or flu-like symptoms in the absence of diarrhea or fever (Palmer, 2000). Other tell-tale signs of abuse and/or neglect included discrepant or vague explanations of child injuries, delay in seeking care, a family crisis or history of abuse, trigger behaviors by the child, unrealistic expectations of the child by the parents (often involving personal hygiene, feeding, or emotional regulation), isolation of the family, and the parent’s own history of abuse (Krugman, 1983).

In the area of sexual abuse, the medical literature focused predominantly on physical findings, such as chafing, abrasions, bruising of the inner thighs and genitalia, scarring in specific genital areas, and specific abnormalities of the hymen (American Academy of Pediatrics, 1991). According to a report published by the Office of Juvenile Justice and Delinquency Prevention, the presence of certain sexually transmitted diseases also often served as the first indicator of sexual abuse, especially among young children (Hammerschlag, 2001).

The NRC report indicated that although the medical diagnosis of child abuse had improved, especially in the area of physical abuse, research in this area was retrospective, clinical, and frequently derived from observation of individuals from one institution. A major shortcoming in the development of medical definitions of abuse was the absence of prospective and population-based studies that could describe the routine as well as extreme range of physical conditions that occur during the development of young children within different racial and ethnic groups. These physical conditions include sexual development and the array of injuries that may be particularly damaging at certain critical developmental periods for infants, toddlers, and preschoolers, regardless of their origins.

Social Services Definitions

Most of the data associated with child maltreatment studies is derived from case records and administrative data collected by child protective services (CPS) and child welfare agencies. In the early 1990s, with support from Congress, NCCAN began a series of initiatives to standardize the application of definitions and classification guidelines within the child protection and child welfare administrative datasets and the state data collection systems that were used to track and report individual cases. These initiatives included the development of the National Child Abuse and Neglect Data Systems (NCANDS), the State Automated Child Welfare Information System, and, more recently, the Adoption Foster Care Analysis and Reporting System (DHHS, 2006).

The development of standardized case definitions and classification criteria was challenged by the long-standing tradition of child protection and child welfare as a state-based responsibility within the United States. This fragmentation and the absence of a separate data system to guide scientific studies hampered progress in developing generalizable knowledge and theory. In seeking to upgrade the quality of state information and tracking systems, federal agencies needed to respect and accommodate significant variations in state law, reporting requirements, and administrative capacity at the local and county levels. Through a series of conferences and technical assistance and consensus-building efforts, the quality of the NCANDS data and the automated child protection and child welfare information systems began to improve; however, major shortcomings that continue to deter classification efforts still remain in the areas of incomplete or missing data, duplicated cases, and inconsistent reporting practices.

One important limitation in using administrative datasets to define and classify child abuse and neglect cases is the variation that is introduced by uncontrolled methods of case detection and selection into those datasets. The resource limitations within the child protection and child welfare fields contribute to case selection strategies that are comparable to the clinical bias that exists in medical settings. CPS samples rarely include mild forms of child maltreatment, because such cases are routinely screened out when physical evidence to support allegations is lacking. The frequency of contacts between social services agencies and poor children may contribute to overrepresentation of these populations in the CPS case records. As noted in the NRC report, regional or chronological differences in maltreatment rates may ref lect different patterns and standards of reporting and selection criteria as well as differences in agency resources, rather than true differences in underlying rates of occurrences of abuse and neglect.

Legal and Judicial Definitions

The NRC report also reviewed the role of legal and judicial standards in developing early definitions of child abuse and neglect. The panel noted that legislative acts, such as CAPTA (1974), began to broaden the study of prohibited behaviors by moving attention beyond the precise characteristics of abusive acts themselves to include greater consideration of their consequences for the child. Broader legal definitions of child abuse included emotional injury, neglect, lack of provision of medical services by parents, and factors damaging children’s moral development, in addition to physical abuse (Cicchetti & Barnett, 1991). The Juvenile Justice Standards Project used three major categories to define child abuse: physical harm, emotional damage, and sexual abuse, with strict standards within each of the three categories (Wald, 1977). In the absence of empirical definitions, the law and the courts drew on evidentiary standards derived from legislative guidelines, professional opinion, and customary practice. These definitions were intended to guide legal interventions, not long-term treatment or prevention efforts or research studies, and their focus was often more stringent than the approaches used in medical, social services, or research settings, searching out the aspects of the report or event that made the best evidence for a successful prosecution.

For example, in the Juvenile Justice Standards Project (Wald, 1977), the following definitions were used:

  • Physical harm is defined as disfigurement, impairment of bodily functions, or other serious physical injury.

  • Emotional damage is evidenced by severe anxiety, depression or withdrawal, or untoward aggressive behavior toward self or others; and the child’s parents are unwilling to provide treatment for him or her.

  • Sexual abuse is limited to those cases in which the child is seriously harmed physically or emotionally thereby. Such a definition excludes many cases in which consequences are not immediately apparent but may emerge at later points in the developmental cycle.

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