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Podcast Episode 040: Hearing aids to help people listen

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Bettina Turnbull provides a unique perspective on listening – with expertise in both linguistics and audiology. Bettina has worked in research at the National Acoustic Laboratories, working directly with hearing impaired patients and as a teacher of Audiometry. She has spent the last 5 years introducing hearing care professionals to a client-centered, and more recently, a family-centered approach, which requires an understanding of both the difficulties a hearing loss poses to the ability to listen and the skill to be a good listener.

Bettina shares the story of a visually impaired teacher, who caused her to think about the importance of listening. He wouldn’t use a stick, or be assisted by a guide dog, but instead clicked his fingers and listened, to gauge his surroundings.

Bettina’s education in linguistics taught her to listen first in order to create, in particular, listening to different sounds. She is multi-lingual, and must listen intently when listening across languages.

As an audiologist, Bettina has strategies to provide the best opportunities for clear speaking and listening: slowing down one’s speech, facing people straight on, and situating in a location that is well lit. We can be reluctant to admit we’re not listening well, meaning steps aren’t taken to remedy it.

Tune in to Learn

    • Why you might ask a speaker to slow down
    • The difference between hearing and listening
    • How to listen for grammar
    • How the ear works – how, biologically, we listen

Transcript

Episode 40: Deep Listening with Bettina Turnbull

 

Oscar Trimboli:

Deep Listening, impact beyond words.

Hi, I’m Oscar Trimboli, and this is the Deep Listening Podcast Series, designed to move you from an unconscious listener to a deep and productive listener. Did you know you spend 55% of your day listening, yet only 2% of us have had any listening training whatsoever? Frustration, misunderstanding, wasted time and opportunity, along with creating poor relationships are just some of the costs of not listening. Each episode of the series is designed to provide you with practical, actionable, and impactful tips to move you through the five levels of listening. I invite you to visit oscartrimboli.com/facebook to learn about the five levels of listening, and how others are making an impact beyond words.

Bettina Turnbull:               

I find often people say things, but they mean something quite different. People say, “I don’t want a hearing aid,” but they do want help, so I guess what they’re really saying is, “I need you to help me,” and sometimes we need to listen through the denials or the resistance to understand what’s the underlying fear or barrier that this person is experiencing, and to help them find a way through that. It takes a real effort, certainly for me, I’m not a natural listener, I have to consciously listen, it’s to try and quiet the mind and really be in the moment and be present with the person that you’re talking to, and perhaps try and pick up also on the underlying emotion that might be in what they’re saying.

Oscar Trimboli:                   

In this episode of Deep Listening: Impact Beyond Words, we hear from Bettina, an audiologist and a linguist. Bettina deconstructs one of the more fundamental components of listening, hearing. She explains the mechanics of hearing, how hearing is developed when you’re just inside your mother’s womb, but also explores, through a linguistic framework, the importance of listening for emotion, the importance of listening for meaning, the importance of not responding with content and creating a connection between those who are speaking and those who are listening. Bettina does a great job of explaining the cost of not listening as it relates to high court judges, politicians, and even talks about how to save a marriage. Let’s listen to Bettina.

Oscar Trimboli:                   

Going into school, was there any influential teachers or music teachers that modeled listening well to you?

Bettina Turnbull:               

When I came to Australia, I went to a school where we had a blind music teacher, and he was the first one where I probably consciously thought about listening, because he didn’t use a stick and he didn’t have a dog. He did have a dog, but it wasn’t a blind dog. He would find his way around the school, and if he got sort of stuck, he would click his fingers and listen for the echo, to see if it was coming back, and it would tell him if he was close to a wall or not. I study linguistics, and so we, as part of our course, we had to produce certain sounds and we had to listen to each other very carefully to see whether we were producing them correctly. When you’re studying the phonetic alphabet and phonology, part of the course of study is to learn to produce them, so for example, having to produce a glottal stop, which I’m not going to do now, because it takes hours of practice to actually do, or the clicks that a Calihari bushman makes. We used to practice quite a lot and listen and see, “Does it really sound like that?”

Oscar Trimboli:                   

How does having a perspective across two continents help you with your listening?

Bettina Turnbull:               

I guess when I’m in Europe, I hear lots of different languages, and the workplace I usually go to, Switzerland, speaks a form of German that’s something akin to Highland Gaelic, I guess, for an English speaker, so it’s quite complicated to listen to. There’s a lot of intent listening when two people are speaking Suisse-Deustch with each other. For me, it’s almost easier to understand Dutch than it is to understand the Suisse-Deutsche, because grew up closer to the Dutch border. I guess that’s where I’m really listening hard.

Oscar Trimboli:                   

How do you think growing up with two language perspectives helps you to listen?

Bettina Turnbull:               

That’s an interesting question, it’s quite different to the one people usually ask me, which is, “Which language do you think in?” I guess when I’m listening to each language, the German grammatical structure is quite different from English. Much of the vocabulary is quite similar, but the grammar is quite different, so I guess in German you’d be listening more for that, there are more grammatical morphing to listen to compared to English.

Oscar Trimboli:                                                      

In workplaces where English is a spoken language in Australia, what do you think the advantages enjoyed for people who have a second language, and what do you think the disadvantages are for people who have a second language?

Bettina Turnbull:               

I think certainly some of the advantages are that you have access to meanings that aren’t conveyed in English particularly. There are just some words that can’t be translated exactly, and [foreign language 00:06:21] is one of them, it’s a sense of warm and cozy, but also of mental well-being that just doesn’t exist in English. There are many facets to linguistics, I studied more on the analytical side, so phonetics, phonology, which is the way sounds come together in a particular language, the rules, as it were, for sounds, morphology, syntax, semantics, so syntax being the grammar, semantics being the meaning, speech science, which is getting down into acoustics and the way the voice produces sounds, and I’m studying formants so the differences, what do different vowels sound like.

It gets quite scientific at that point. When I was studying voice recognition systems, we’re just starting, it was sort of a pipe dream at that time, and we see over the last 20 years how far that’s come, we’re now using our voice as commands almost on a daily basis.

Oscar Trimboli:

Given your deep linguistic background, what are the patterns of speaking that help you become better understood?

Bettina Turnbull:               

We audiologists tend to have our audiology voice and then our home voice. Our audiology voice, we would slow down our speech, we would articulate very well, we would look directly at somebody, make sure we were facing them, make sure we have lots of light. No sitting in front of a bright window, for example, somebody who can’t hear you well and can’t see your facial expression, or we all do lip reading to some extent, these are the sorts of tips that we would use on a daily basis with people who aren’t so good at hearing.

Oscar Trimboli:                   

What is it about slowing down that helps to improve how the speech is heard by the other person?

Bettina Turnbull:                                                  

When you get to a very technical level, I guess there are some temporal, there’s timing within words and within sounds that if we can slow them down, it can make it a little easier for somebody to pick up. When you have a hearing impairment, you can’t hear some of the sounds, so sometimes the volume is okay, it’s some of the sounds you can’t hear or they’re distorted. Sometimes that can cause confusions, so for example, the word “fun” and the word ” sun” sound very similar, and if you have a high-pitched hearing loss, then the “f” and the “s” sound can easily become confused. The brain is working overtime trying to fill in that little gap, and that’s when we use the context of the sentence to see, “Well, which one is it, this one or that one?”, and that causes an extra delay because the brain is actively having to work to work out what was in that gap. By slowing down, it gives the person a little bit more time, that time that they need mentally to fill in that gap.

Oscar Trimboli:                                                      

What is the role of silence in improving comprehension and understanding?

Bettina Turnbull:               

As a listener, we would definitely use silence. Sometimes people are reluctant to either acknowledge that they’re not hearing so well, and sometimes they’re trying to overcome that fear or the resistance that they need help, and sometimes by asking a question and then sitting with the silence, it allows people to think about and process what’s happening.

Oscar Trimboli:                   

Bringing together the two levels of profession that you’ve come from, both linguistics and audiology, we can speak at about 125 to 150 words a minute, and maybe a horse race caller might get up to 200 words a minute, but in terms of our ability to hear and comprehend, up to 400 words a minute. What techniques would you advise people listening to deal with the gap between somebody speaking at 125 to 150 words a minute, where they can effectively fill in the gap with the other 400 words, is there any advice you’d provide people to bridge the gap?

Bettina Turnbull:               

It takes a real effort, certainly for me, I’m not a natural listener, I have to consciously listen, it’s to try and quiet the mind and really be in the moment and be present with the person that you’re talking to, and perhaps try and pick up also on the underlying emotion that might be in what they’re saying. In my work, often there is such emotion that can be difficult to express, and sometimes we just need to give a little time for people to connect with those emotions and learn what that means to them.

Oscar Trimboli:                                                      

For those of us in the audience who use the term “hearing” and “listening” interchangeably, how would you draw a distinction between the two?

Bettina Turnbull:                                                  

Hearing is very much about being able to pick up a sound, like hearing a bird or perhaps an environmental sound, listening means to me that there is intent. You can be walking through the street and you can be hearing all sorts of things, but you can be kind of goofing off, listening means you’re in the moment, you’re trying to understand, meaning you’re trying to understand emotion, you’re trying to understand context. Audiologists test hearing, so we look after the ear, we also look after balance, it’s very closely related. In my work particularly, I would be looking after people, children all the way through adults who have a hearing impairment. It’s quite different from people who are in the deaf community who might be signing, and could be using hearing aids as augmenting, but culturally see themselves as deaf.

Hearing impaired have a different perspective, in that they feel there’s something missing. This is, I think, sometimes their hurdle that they have to jump both physically and mentally.

Oscar Trimboli:                                                      

When you speak to them, depending on how they’ve come to you, how do they respond? Are some people frustrated, are they liberated, are they annoyed? What state of mind are people coming in to see an audiologist?

 

Bettina Turnbull:               

I’ve seen pretty much the whole range. One of the things that I do like to do is to actually find out exactly what emotion is attached to them, because that can often help them move on if they’re a little stuck. Some people come in and they need a hearing aid, and that’s like buying a pair of glasses, they just come in, say, “All right, what have you got?”, and off they go and that’s great. Other people are a little unsure, sometimes a little afraid perhaps, and by understanding the underlying emotions attached to events where they might not be hearing so well can often help them to better understand what’s actually going on and make a little bit real for them that it’s not just something that comes and goes, but that’s something that’s been probably present for quite some time. On average, it takes about seven to 10 years for somebody to actually do something, to take action after they first noticed that they might be having a problem.

Oscar Trimboli:                                                      

Seven to 10 years, wow. If there’s one practical thing you could recommend to people who do maybe annually, or more frequently than seven to 10 years, what would you recommend to help them?

Bettina Turnbull:                                                  

Well, certainly having regular hearing checks once a year is a good start, that you can pretty much have them free of charge by most providers these days. Pensioners have free access to Australian office of hearing services. I guess the one thing that people most complain about that would maybe trigger that maybe you’re not hearing so well, or maybe you should get a check, is that if you start having difficulty hearing voices in amongst others. If you’re down at the pub having a beer with your mates, and you’re finding it more and more difficult to understand what’s going on, or you’re missing that punchline at the end of the joke, then perhaps it’s time to have a hearing check.

Oscar Trimboli:                   

For those people who haven’t had a hearing check, what’s involved?

Bettina Turnbull:               

Generally, you can even do them online these days. There’s different types, the most traditional type of hearing test is that you sit in a sound-treated room, and you have a headset on and a little button generally, and then you’ll hear some pure tone sounds which are through the speech range, and you would respond to those. What we’re looking for is the threshold of hearing in each frequency, so the very softest sounds that you can hear, and what we produce out of that is called an audiogram. It’s the graph of your hearing, and that then determines whether your levels are within the normal range or outside of the normal range. The online tests tend to be a little different, so you tend to have some noise and you have to perhaps hear some numbers or something like that, so it doesn’t produce an audiogram, but it can tell you whether perhaps there could be cause to go and book in for an audiogram.

 

Testimonial:                                                            

As an intercultural management consultant, I work with clients to increase their cross-cultural effectiveness. A critical skill I encourage them to do is develop the ability to listen to the unspoken messages during cross-cultural interactions. Many cultures have a high context speech pattern, where the message is not just in what is being said, but also in how it is being said, and at times, what is not being said. I find Oscar’s work in deep listening very useful for both myself and my clients.

Oscar Trimboli:                   

In your work, you must see firsthand the cost of not being able to hear. Do you have some stories that you could share about the cost of not listening?

Bettina Turnbull:               

Yes. As quite a young audiologist, I had a lady come and see me, she was in her early 40s and she was very, very unsure, and she wanted a tiny, tiny little hearing aid, she felt she just couldn’t hear. We generally tend to fit hearing aids, and we let people go out into their world for two or three weeks before they come back, and they tell us if they want to keep their hearing aids or if we need to adjust them. It’s a very personalized, individualized fitting, and when it was her time to come back, I was sure she was going to hand them back to me, and she said, “Don’t change a thing. You have changed my life. I have literally just come to tell you that, that you’ve saved my marriage.”

As a young audiologist of 25 or 26, I thought that was pretty profound. It’s one of those goosebumps moments that you get. I said to her, “Tell me, how did I do that?” She said, “My family finally realized that it wasn’t that I wasn’t listening, I wasn’t actually hearing them.” She said her husband had this great epiphany, and had actually felt quite bad. Her teenage children were much calmer because the TV was down to a level that they could tolerate, and she said that the whole thing just brought a calmness to the family.

Oscar Trimboli:                   

I guess the opposite is true too, when you can’t hear, there’s costs associated with that, whether it’s social isolation or frustration. Have you got some other examples of that maybe, for younger people or older people?

Bettina Turnbull:               

I’ve fitted hearing aids to judges who’ve found it very difficult to hear witnesses, defendants. I’ve fitted politicians at the very highest level who found, when they came back to me and said, “For the first time, I’m listening again, I’m not just spending all my effort on hearing.” Imagine as a politician, when your entire life really revolves around listening, the arguments and the counter-arguments that you have to form and the effort it takes to hear on top of then having to form a counter-argument, it’s enormous, and the cognitive load, we call that “cognitive load”, is extraordinary in those circumstances. Helping somebody to overcome at least some of that, that feels good.

 

Oscar Trimboli:                   

What about for those who are younger?

Bettina Turnbull:               

In the case of children, they’re actually learning language for the first time, so the implications are quite different. An adult who hasn’t heard some sounds for some time might take three or four months to get used to those sounds again, but ultimately the language is already there, so they have the foundation. With children, for example in English, the sound “s” denotes plural in some instances, so if you’re a young child with hearing loss in the high pitches and you can’t hear that “s”, first of all, it’s then difficult for you to produce because you can’t produce what you’re not hearing, so it takes hours of speech therapy to produce that “s”, and also to form that grammatical or that syntactical understanding that the “s” means that there is more than one.

It makes learning language much more complicated. If a child is born with a hearing impairment, it’s set back a long way, because we actually start to hear when we’re still in the womb. The ear is fully formed at somewhere between 16 and 20 weeks’ gestation, so the baby is already hearing mostly low frequency sounds, but if there’s a hearing impairment, then that’s already missing. These days, in many countries there is what they call universal neo-natal screenings, so the babies are tested within a few days of being born, and we can screen, and then hopefully they get referred quickly.

Here in Australia, we’re very lucky that children tend to be fitted with hearing aids or have the option of cochlear implants very very early on, and I’m talking within three to six months. In other countries, that can take much, much longer. Yeah, I work in the Asia-Pacific most of the time now, and there are some countries where the children may not even be diagnosed ’til they’re two years old, and that puts them at an enormous disadvantage.

Oscar Trimboli:                   

I’m curious what you think you bring to your field in audiology because of your linguistic background, and how that enhances it.

Bettina Turnbull:               

Certainly when you are fitting a hearing aid, and especially to a child, having an understanding of phonology and syntax and phonetics is, to me, essential to really understand, because you have to work closely with speech therapists. Being able to ensure that a baby is getting those high-pitched sounds, the difference between a “s” and a “sh” sound, for example, that’s really, really important. When you’re fitting, you need to be able to understand how to ensure that that’s happening.

Oscar Trimboli:                   

One of the things you touched on earlier was through your linguistic field, is the importance of being able to listen for meaning. Thinking about those in the audience right now, is there a tip you would provide to them in any conversation about how to stay focused not only on the words and the syntax, as you mentioned, but more about what the meaning that it creates, and how you can listen for meaning, not just for words?

Bettina Turnbull:               

I find often people say things, but they mean something quite different. People say, “I don’t want a hearing aid,” but they do want help. I guess what they’re really saying is, “I need you to help me,” and sometimes we need to listen through the denials or the resistance to understand what’s the underlying fear or barrier that this person is experiencing, and to help them find a way through that. The way I like to do it is to ask them specifically about areas of difficulty, and then understanding or asking them to tell me what the emotion is that they feel at that time. That often helps them to realize that perhaps it’s something other than, ” I just don’t want to.” Suddenly, they realize, “Hm, maybe it’s because I feel silly in front of my friends, or I’m worried that I’ll look stupid, or I’m concerned that my younger wife thinks I’m getting old.”

These are the sorts of fears and barriers, you know it could be about cosmetics, but you have to just be patient and dig a little further to find out what it is, and then try and help people through that. I had a lovely gentleman who came for a hearing test, and he had a whopping hearing loss, but his main concern was that his hearing was fine, his wife’s voice was fading. I asked him why did he think his wife’s voice was fading, and he said, “You know, she’s not a very confident creature, and she hides away like this.” I said, ” Has she always been like this?”, and he said, “Oh no no, she was quite a stunner in her younger years.” I suggested that perhaps the EMT next door would like to examine his wife, to make sure that her voice was indeed not fading.

In the next visit some months later, he brought her along, and she was the most glorious creature, very confident with a very strong voice. It just took some time to understand that he had in fact also had sleep apnea diagnosed quite recently, and he was now wearing one of these machines, and he was very concerned about his wife’s view and attitude towards that, and having hearing aids on top of this just was too much for him. It took us over a year to get there, but I saw him probably five or six times during that time, and as he grew more comfortable with his nightly routine, we trialed some hearing aids. It took about three different goes before he accepted them and decided that the benefits outweighed the worries that he had.

Oscar Trimboli:                   

If you had one wish for people to safeguard their hearing, a tip for the audience, what would that be?

Bettina Turnbull:               

Don’t listen too loud too long. There’s a noise dose of about eight hours at 80 decibels, which is a noisy pub I guess, would be about 80 decibels. Every three decibels, the intensity actually doubles, so that means at 83 decibels, we’re down to four hours, and so on. By the time you get to 100 decibels, it’s only really a very short time.

Oscar Trimboli:                   

What’s your wish for everybody out there to listen to others better?

Bettina Turnbull:               

Slow down your thoughts, and look at the body language as well as listening to the words.

Oscar Trimboli:                                                      

What is it in my body language you’re looking for right now?

Bettina Turnbull:               

You seem very relaxed to me, I feel that you’re really listening to me, there’s lots of eye contact. You’re responding to me by nodding and you’re smiling, so these are signs to me that you’re listening to what I’m saying, and I feel heard and understood.

Oscar Trimboli:                                                      

As a linguist, how do you listen for what’s unsaid?

Bettina Turnbull: 

                                 

I guess it’s trying to, the body language is one thing, like if somebody’s leaning in or leaning away, whether they’re tapping or distracted. Also, listening for the emotion, again, to me emotional content is very important in what you’re listening to. You tend to be able to see on the face or hear in the voice whether somebody’s distressed, happy, anxious, or excited. Even though they might not be saying they’re excited, you can hear in the voice or by the brightness of their eyes whether that’s in fact where they are, and perhaps listen to that and ask about that. I guess when people ask us questions, the default often is to come back with content or information, and that’s quite hard to resist, but I think if you want to have a really good conversation and really understand, put your content aside.

Particularly in my field, where there’s a lot of technology, a lot of knowledge, a lot of expertise that people would like to share, when you ask clients, they often expect that expertise. What they don’t expect is that real engagement, or what they’re really looking for is that therapeutic relationship, and that can’t be formed by regurgitating technical details that people quite often don’t understand or not really interested in, unless they’re a sound engineer. Yeah, so resist answering with content, perhaps.

Oscar Trimboli:                                                      

I wonder what you took out from Bettina’s interview. What I took out was, how do you listen for the emotion in what people say? I also took out that you need to do an annual checkup for your hearing. I also learned that it’s really critical to work with silence. Finally, my big takeaway was, listening is a really important part of people’s social interaction in life, and without hearing, they can become socially isolated very quickly. That’s probably why it’s critical to book in for an annual hearing checkup as well. I think Bettina highlighted why she is a master of her craft, not just audiology, but linguistics as well, and it’s the combination of those two fields coming together that makes her an expert throughout Asia-Pacific and the world when it comes not only to hearing, but also to listening beyond the words.

Immediately after this, Bettina does a great job of deconstructing the mechanics of hearing, and explains to me and Johnny, my sound engineer, how hearing is transmitted from the speaker to a human ear and into the brain, so that you can listen. A big thank you to Johnny, Nell, and June, the team that sits behind the Deep Listening podcast. If you’ve got a question, feel free to jump onto oscartrimboli.com/facebook, and interact with other people who are looking to make an impact beyond words. Thanks for listening.

Oscar Trimboli:                   

Deep Listening: Impact Beyond Words.

At its most basic level, Bettina, when I’m speaking, what’s happening for this sound to be transmitted to you so you can hear it, what’s the mechanics of the ear?

Bettina Turnbull:               

The mechanics of the ear is that we have a little tube, or we have the pinna that collects the sound and helps us a little bit with direction, so localizing sound. The sound goes down the ear canal and hits the ear drum. Now, it’s a very interesting thing about the ear canal, it’s about 25 millimeters long in an adult, and when you look at acoustics of a closed tube, which is a tube that’s closed at one end, it resonates at a particular frequency, and in a human ear, that’s at about 2.7 kilohertz, which interestingly, is also the area where the speech spectrum is at its strongest.

Our voice box and our ears somehow evolved together, we’re not sure which one evolved first, but human speech has most of its intensity around that two to three kilohertz, and our ear has a natural resonance that amplifies by around 20 decibels. The sound is already somewhat amplified, speech is already somewhat amplified before it even hits the eardrum. The eardrum is then connected to three little bones called the ossicles, and the last ossicle, the sticches, the foot plate, sits in the round window, which is right against the cochlea, which is the inner organ. There is an amplification between the eardrum, which is about 17 times bigger than the oval window.

The reason we need this is because the cochlea is filled with fluid, and we need to overcome and impedance from airborne sound into fluid. Once it gets into the cochlea, which is shaped like a little snail, the high frequency is sort of just about behind the oval window, and then when you go all the way into the inner part, or the very inside part of the snail, it’s the [basilurn 00:35:08], that’s where the low frequencies reside, if you unrolled it, we would have sort of like piano keys from high to low. We have little hair cells in there, there are three rows of outer hair cells and one row of inner hair cells. The outer hair cells are little motor cells, and the fluid goes past them and ripples, and they hit a little membrane called the tectorial membrane, which then sends the sound up along the auditory nerve, up into the auditory cortex, which is in the brain, where the sound is then deciphered.

Oscar Trimboli:

That only gets us so far, that gets us to the physical connection between my voice and your ear, but then the linguistic and cognitive part of the process takes over. What happens then inside the brain?

 

Bettina Turnbull:    

Yeah, well the sound is deciphered, and it’s still a bit of a mystery, I think. We know that if the auditory cortex is damaged in young children, then that function moves to another part of the brain, so there’s some plasticity in the brain for this. When we determine hearing loss, there are different causes and places hearing loss occurs. From the outer ear, something as simple as a wax blockage can cause a hearing loss. In the middle ear, if we have a middle ear infection, for example, the middle ear might fill up with fluid. Once you get into the inner ear, the little hair cells might become weak or die off with age through noise exposure, they just at some point keel over and say, “I’ve had enough.”

It could be through certain types of drugs, medications, so we call that [ototoxic 00:37:17] substances, that might kill some of the hair cells. There could be congenital or other diseases that can, mumps is one that will do it, rubella is another one. Thankfully through vaccinations, we’re getting much fewer cases like this. Then there’s the auditory nerve itself, which might have a tumor on it, or might be degraded through some other disease such as multiple sclerosis, where the outer tissues of the nerves are affected. Sometimes it could be vascular, so the supply of blood to the cochlea could be stopped through a virus, for example, so there are a number of different ways that hearing can be affected. The way hearing loss, I guess, depends on and how much it affects the person depends on where along the line that hearing loss occurs.

Once we get up into the brain stem and the auditory cortex, could be through trauma, through stroke, for example, so there are all sorts of different ways that we can be affected. There is a whole host of auditory processing disorders, that is a field that is still being explored at this point.

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