S C E U A rticle

The Impact of AssistiveTechnology on the EducationalPerformance of Studentswith Visual Impairments:A Synthesis of the ResearchStacy M. Kelly and Derrick W. Smith

Abstract: This synthesis examined the research literature from 1965 to 2009 onthe assistive technology that is used by individuals with visual impairments. Theauthors located and reviewed 256 articles for evidence-based research on assis-tive technology that had a positive impact on educational performance. Of the256 studies, only 2 provided promising

For centuries, technology has been har-nessed to provide opportunities to indi-viduals with visual impairments (that is,those who are blind or have low vision).The use of such assistive devices can betraced back to the use of a cane, stick,staff, or bamboo pole found in the writ-ings of the ancient Hebrews, Greeks,and Chinese (James & Thorpe, 1994;Neustadt-Noy & LaGrow, 1997). Today,more advanced tools (assistive technol-ogy) are used by individuals with visualimpairments to access information, travelindependently, and participate in a varietyof activities (Lowenfield, 1973). In es-sence, assistive technology has the poten-tial to be the "great equalizer" for indi-viduals with disabilities (Michaels &

If1 EARN CEUs ONLINEby answering questions on this article.For more information,visit: <http://jvib.org/CEUs>.

evidence-based practices.

McDermott, 2003). It can be used to ad-dress many of the challenges that individ-uals with visual impairments face.

The ability to access information is es-sential for success in education, employ-ment, and life (Kapperman & Sticken,2000; Scadden, 2000). Therefore, muchof the development of assistive technol-ogy for individuals with visual impair-ments has focused on providing access.For example, tools such as the slate andstylus used to create braille were the firstassistive technology devices that allowedpeople with visual impairments to betruly literate after the creation of thebraille code in the 1800s (Hatlen, 2000;Scadden, 2000). Braille was first writtenusing a slate and stylus, a handheld deviceby which a person makes braille symbolsby embossing paper with a sharp tool.Manual braillewriters were developed inthe late 19th century; this tool increasedthe speed and quantity of braille produc-tion. In the early 1900s, audio technology

02011 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, February 2011 73

0 CEU ArticleTable IOperational definitions of key terms in relation to the use of assistive technology.

Key term Definition

Effective Having a positive impact on educationEffectiveness The degree to which assistive technology (the independent variable)

has a positive impact on educational performance (the dependentvariable)

Evidence-based research The use of scientific research to establish best practices determinedby an evaluation of the research

Scientifically based research A research design that determines with the highest degree ofprobability whether an intervention was the factor that caused theeffects

(radios, records, and recorders) providedmore access to information than didbraille, because of the development of thetechnology for the mass market (Scadden,2000).

The development of the computer in the1960s led to an explosion of technologiesthat individuals with visual impairmentscould use to access information. Braille em-bossers (a specialized tactile printer), ad-vanced closed-circuit televisions (CCTVs:devices that enlarge written or printed text),scanners and optical character recognitionsoftware (technology that scans printed textand provides the user with speech output),computer screen readers, compact discs(CDs), and multiple hardware and softwareinnovations have enhanced the ability ofindividuals with visual impairments to ac-cess information (Kapperman & Sticken,2000).

It is generally accepted that assistivetechnology has a positive impact on thelives of individuals with visual impair-ments (Cooper & Nichols, 2007; Kapper-man, Sticken, & Heinze, 2002; Strobel,Fossa, Arthanat, & Brace, 2006). How-ever, most of the assistive technology de-vices that are used by individuals withvisual impairments are deemed effective(see Table 1 for the operational definition

of the term) merely because they havepractical application. For example, themanual braillewriter is considered effec-tive (or as having had a positive impact oneducation) because it has provided indi-viduals with visual impairments with ac-cess to information (through the ability towrite braille) faster than the slate andstylus. It may be true that the manualbrailler is faster than the slate and stylusbecause of the obvious inherent charac-teristics of the two assistive devices.However, this sort of anecdotal evidenceis not sufficient for other types of assistivetechnology (for example, two screen-reading software applications comparedwith each other or two electronic note-taking devices compared with eachother). The comparison of the effective-ness of assistive technology (see Table 1for the operational definition of the term)is considerably more complex.

Assistive technology tends to be devel-oped faster than researchers can evaluateit. Despite the speed of production, suchtechnology is not guaranteed to be effec-tive. Professionals in the field must striveto evaluate its effectiveness in an effort toprovide consumers with the informationthat will allow them to have the highest-quality experience possible when using

74 Joumal of Visual Impairment & Blindness, February 2011 ©2011 AFB, All Rights Reserved

IZ CEU Articlesuch techology. In this era of accountabil-ity, professionals need to demonstrate ef-fectiveness, regardless of any extenuatingcircumstances related to the rapid ad-vancement of products. With all this inmind, we investigated two broad ques-tions in the study presented here: What isthe knowledge base regarding assistivetechnology and the education of individualswith visual impairments? and To what ex-tent has the field determined, through rig-orous, scientific-based methods, the effec-tiveness of assistive technology forindividuals with visual impairments?

MethodIn the study, we defined the term assistivetechnology as it has been defined by theIndividuals with Disabilities EducationImprovement Act (IDEIA, P.L. 108-446)of 2004. According to the law, an assis-tive technology device is "any item, pieceof equipment, or product system, whetheracquired commercially off the shelf, mod-ified, or customized, that is used to in-crease, maintain, or improve functionalcapabilities of individuals with disabili-ties" (IDEIA, 2004, Sec. 602, 20 USC1401, § 300.5). The law further defines anassistive technology service as "any ser-vice that directly assists an individualwith a disability in the selection, acquisi-tion, or use of an assistive technologydevice" (§ 300.6).

With the passage of the No Child LeftBehind Act of 2001 (NCLB, 2001, 20USC § 6301 et seq.) and the IDEIA of2004, Congress put a priority on the useof evidence-based (see Table 1 for theoperational definition of the term) strate-gies when determining services requiredby and devices approved for students withdisabilities. Embodied in the concept of

an evidence base that drives decisions isthe idea that the selection and use of tech-nology, including assistive technology,should be rooted in research on its effec-tiveness. With this point in mind, we at-tempted to determine if the field of specialeducation for students with visual impair-ments has developed any practices thathave been determined to be effective (thatis, evidence-based practices) by rigorousscientific research (see Table 1).

For the purposes of our study, there-fore, the concept of effectiveness wasscrutinized as it pertained to having apositive academic impact. We defined as-sistive technology research as such stud-ies that examined the uses of assistivetechnology for classroom-based educa-tional interventions. This criterion ex-cluded orientation and mobility travel de-vices and independent living devices(equipment that is used to accomplishhousehold-oriented tasks for daily living).

To begin to develop a body ofevidence-based research that has deter-mined the knowledge base and demon-strated the effectiveness of assistive tech-nologies used by individuals with visualimpairments, we conducted a synthesis ofresearch on assistive technology in thefield of visual impairment from January1965 through August 2009. We used mul-tiple means to complete the synthesis, lo-cating articles published during this timespan of 45 years that addressed researchon assistive technology that was used foreducational interventions with studentswho are visually impaired. We initiallylocated such research by searching fourelectronic databases-EBSCO AcademicSearch Premier, EBSCO ProfessionalDevelopment Collection, ERIC, andPsychInfo-for references to assistive

02011 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, February 2011 75

0 CEU Articletechnology, blindness, and visual impair-ment for students with and without addi-tional disabilities. We used the Booleansearch method with the "and" search op-erator to retrieve articles that used bothspecified search terms. The specificsearch terms that were used in each of thefour databases were blind, deaf blind,deafblind, deaf-blind, eye disorders, par-tially sighted, vision disorders, visual dis-abilities, blindness, visual impairment, vi-sually impaired, partial vision, and largeprint, each paired with the terms assistivetechnology, instructional technology, as-sistive device, communication devices,accessibility, technology, computers,electronic aids, optical aids, notetaker,and low vision aids.

In addition to the search of the elec-tronic databases, we conducted a manualsearch of articles related to assistive tech-nology and students who are blind or havelow vision with and without additionaldisabilities in the Journal of Visual Im-pairment & Blindness (entitled New Out-look for the Blind prior to 1977) and RE:view. Last, we searched the reference listsof all articles we found and located otherrelevant articles. The search used exhaus-tive means to locate the research includedin the study presented here.

The research we analyzed was requiredto meet the following general criteria tobe included in the study. The researchneeded to (1) address the assistive tech-nology that was used for classroom-basededucational interventions, (2) include asparticipants in the study students with orwithout additional disabilities aged 3-21in preschool through 12th-grade educa-tional programs who were blind or hadlow vision, and (3) have been publishedbetween January 1965 and August 2009

in English-language refereed journals.From these criteria, we were able to es-tablish the knowledge base regarding as-sistive technology and education of indi-viduals with visual impairments.

Ancillary to the synthesis of the research,we conducted a more rigorous analysis ofall the articles we identified to determine theextent of research on the effectiveness ofassistive technology. The articles that metthe general criteria were further examinedfor the presence of the results of an inter-vention that were intended to have an im-pact on the lives of children who are visu-ally impaired with or without additionaldisabilities. To do so, we reviewed eachstudy for a control or comparison group andan intervention with an experimental re-search design. Following the theoreticalframework of Warren's (1994) individualdifferences approach, we determined thatthe comparison group could not includesighted students because the comparisonwould not be fair or appropriate with suchstudents being compared to those with vi-sual impairments. Whenever a study repli-cated another study, this characteristic ofthe article was also noted favorably.

ResultsThe articles identified by this analysiscovered 45 years of research pertaining toassistive technology used for classroom-based educational interventions by stu-dents who are visually impaired with orwithout additional disabilities aged 3-21,in preschool through 12th-grade educa-tional programs. Of the articles we lo-cated, 28 were eliminated because someof the participants who were included in astudy were outside the age range for thesearch. In addition, 16 articles were elim-inated because the research topic included

76 Journal of Visual Impairment & Blindness, February 2011 02011 AFB, All Rights Reserved

- CEU Articleskill areas, such as orientation and mobil-ity, that were beyond the scope of theacademic classroom-based focus of thereview, and 3 articles were eliminatedbecause the studies were not published inrefereed journals. We found that a sub-stantial number of articles (256) that werepublished during the 45-year period werealigned with the general criteria that weused to identify research articles on assis-tive technology for this analysis.

The study characterized the research onthe basis of the following nine distinctcategories. The number of articles identi-fied in each category is also noted.

1. The article discussed theories, beliefs,or practices without a research designor method (n = 122; 48%).

2. The article discussed reviews or eval-uations of products without a researchdesign or method (n = 34; 13%).

3. The study used a research design ormethod that did not include an inter-vention, control group, and compari-son group (n = 57; 22%).

4. The study included an appropriatecontrol and comparison group, but in-sufficient data were presented in thearticle to determine the effectivenessof the intervention (n = 17; 7%).

5. The study included participants (parents,patients, families, or teachers) who werenot students (n = 11; 4%).

6. The study used a qualitative researchdesign (which falls outside the realmof scientifically based research) (n =6; 2%).

7. The results and conclusions of the studyare subject to validity concerns (all theparticipants in the study received thetreatment, and the resulting effects of

the intervention could not be interpretedunambiguously) (n = 4; 2%).

8. The study used an inappropriate sightedcomparison group (n = 3; 1%).

9. The study presented sufficient data todetermine the effectiveness of an in-tervention with appropriate partici-pants, intervention, control group, andcomparison group (n = 2; 1%).

More than half the 256 articles (156) thatidentified assistive technology that wasused for classroom-based educational in-terventions by students who are visuallyimpaired were discussions of theories, be-liefs, or practices; product reviews; orproduct evaluations without research de-signs or methods. Despite the certainty ofthe worthiness and contribution of thislarge segment of research, no measure ofthe effectiveness or impact of the assis-.tive technology on educational perfor-mance was presented in any of these ar-ticles. Specifically, 48% of the articleswere discussions of a theory, belief, orpractitioner-based concept, and 13% werediscussions of product reviews or evalu-ations. The knowledge base regarding as-sistive technology and education of indi-viduals with visual impairments wasshown to be largely devoted to this topicarea.

Of the 121 articles that discussed atheory, belief, or practice related toeducation-based assistive technologywithout a research method, a major por-tion included students with additional dis-abilities. In these articles, students withadditional disabilities were representedwell by at least 20% of the articles thatwere identified over the entire 45-yearperiod. Moore (1982) described ways touse new educational materials that were

©2011 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, February 2011 77

0 CEU Articledeveloped specifically for students withvisual impairments and additional disabil-ities. The article included instructionaltechniques for low vision stimulation kitsand prevocational materials. Engleman,Griffin, Griffin, & Maddox (1999) pro-vided a guide for communication withstudents with deaf-blindness. The teach-ing practice presented in their article in-cluded a detailed discussion of assistivetechnology that was available for studentswith deaf-blindness. Keyboarding wasused as part of a whole-language ap-proach to teach functional literacy skillsto students who are visually impairedwith additional disabilities (Stauffer,2008). To help students who are visuallyimpaired enjoy the ensemble experienceprovided by music educators, Siligo(2005) focused on many of the practicaltools and information that can make thisexperience possible. The tools and in-formation discussed by Siligo were in-tended to enable music educators tofully include students who are visuallyimpaired in the ensemble experience.Although no scientific design was pre-sented in this article, the recommendedtools will be of great help to teacherswho are looking for ideas for musicinstruction. It must be noted that Sili-go's article and many others contributedto the effective use of assistive technol-ogy without providing a measurementof the magnitude of the impact.

There were 35 articles with reviews orevaluations of products that fit within thegeneral parameters of the search. Gut-knecht (1980) reviewed fundamentalskills that are needed to use the Optaconand interviewed an instructor-coordinatorat a residential school for her commentsabout students' success with the device. A

new sensory aid for children who areblind, the Canterbury Child's Aid, wasreviewed along with the rationale for thedesign features of the device (Strelow &Boys, 1979). The more recent evaluationof the Jordy magnification device, for ex-ample, provided ratings that address theusefulness of the device in performing theactivities noted in the article (Francis,2005). The product evaluation ratings ofthe Jordy magnification device and othersimilar product evaluations that wereidentified by the search were based solelyon the authors' own observations, inter-actions, and opinions of the products.

We found that 83% of all the articlesthat were identified by the analysis (anadditional 22% beyond the 61% of thearticles that were discussion based) didnot include comparison groups, controlgroups, and interventions. Much of thisresearch often used a case-study approachwith small samples of students. Nearly allthe 57 research-based studies without acontrol or comparison group used thecase-study approach. Koenig, Layton, andRoss (1992) used a case-study approachto evaluate the relative effectiveness thatsix students with low vision experiencedwhen reading in large print and whenreading standard print with low visiondevices, and, more recently, Rovira andGapenne (2009) used a case-study ap-proach with three students who wereblind to evaluate a device for reading andrecognizing geometric line drawings. Aswas the outcome with each of the othercase studies that were identified by theanalysis, the studies provided useful in-formation for multidisciplinary teams toconsider pertaining to the observed be-haviors and learning of the students, al-beit in a limited fashion without the use of

78 Journal of Visual Impairment & Blindness, February 2011 @2011 AFB, All Rights Reserved

SCEU Articlestatistically powerful sample sizes orcomparison or control groups.

Although small, a certain percentage ofthe articles included an inappropriatesighted comparison group (Warren,1994). For example, Bouaziz, Russier,and Magnan (2005) evaluated the abilityof sighted blindfolded children and chil-dren who were visually impaired to useraised-line drawings effectively. Thestudy provided remarkable informationon the topic. However, it was clear thatthe participants in the group who receivedthe intervention were not comparableto those in the comparison group. Theeffectiveness of an intervention cannot beevaluated in conjunction with this contra-dictory feature of a study. In no instance dida study replicate another study in the 45-year period of research that we searched.

The extent to which the field has re-searched the effectiveness of assistivetechnology used by students who are vi-sually impaired with or without additionaldisabilities is close to nonexistent. Lessthan 1% of the articles that we identifiedprovided sufficient data to determine theeffectiveness of an intervention with anappropriate control and comparisongroup, as well as an intervention (Koenig& Ashcroft, 1983; LaGrow, 1981). Of thetwo studies, LaGrow's (1981) examinedthe effects of a CCTV on the reading ratesof six college-bound students who werevisually impaired using a multiple-baseline (across subjects) single-subjectresearch design to control for and dem-onstrate the effectiveness of the interven-tion. The study found that the readingrates of each participant increased aftersystematic instruction. The data that werereported (that is, the mean reading rates)

made it possible to measure the effective-ness of the intervention.

The second study (Koenig & Ashcroft,1983) investigated the effect of using anelectric Perkins Brailler on the partici-pants' writing rates and accuracy. Again,a single-subject design was used on 10participants, each of whom served as hisor her own control. At the onset of thestudy, none of the students had used theelectric Perkins Brailler, but all had usedthe regular Perkins Brailler. The studyfound no significant differences betweenwriting methods with the electric and reg-ular Perkins Braillers. The data that werereported (that is, mean scores, standarddeviations, and t-values for the dependentvariables) made it possible to measure theeffectiveness of the intervention.

DiscussionOur review determined that a substan-tial number of articles have been pub-lished pertaining to assistive technologyused for classroom-based educational.interventions for students who are visu-ally impaired with or without additionaldisabilities aged 3 to 21 in preschoolthrough 12th-grade educational pro-grams. The field has a considerableknowledge base in an exceptionallyspecialized area of educational pro-gramming for students who are visuallyimpaired. However, the extent to whichthe field has researched the effective-ness of assistive technology used bystudents who are visually impaired us-ing rigorous, scientific-based methodsis close to nonexistent.

A large percentage of the literatureconsists of anecdotal evidence of theimpact of assistive technology withoutevaluating the effectiveness of assistive

02011 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, Februmy 2011 79

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technology. This finding applied to three-fifths of the articles we identified. Al-though evidence that is developedthrough practice is important, it does notprovide the scientifically based evidencethat is required by NCLB or IDEIA. Forspecific assistive technologies to be in-cluded in the Individualized EducationPrograms (IEPs) of students with visualimpairments, the technology must pro-vide apparent benefits (such as a braillerthat provides access to information) orthere must be scientific proof that it willhave a positive impact on students' learn-ing. Without scientific support, IEP com-mittees will have a much more difficulttime justifying the need for advanced as-sistive technologies for students with vi-sual impairments.

There were 35 articles that reportedevaluations or reviews of products andmet the criteria for inclusion in our re-view. Apparently, in each instance, a sci-entific trial that would yield definitive in-formation on the effectiveness of theproduct was not conducted.

Given the reality that students who arevisually impaired are not widely present inpublic schools, many of the research de-signs that we identified in this review werelimited to case studies and did not providesufficient data to determine the effective-ness of an intervention. Although it is notpossible to generalize the results of thissmall magnitude, it is possible to replicateinterventions that were found in case stud-ies with small samples of participants in aneffort to create more robust findings amongseveral studies that evaluated the effective-ness of the same tools or interventions. Inaddition, it may be feasible to create a seriesof studies based on the case studies that usesa rigorous single-subject design method.

The use of a single-subject design wouldeliminate the inherent difficulties of findingparticipants in the field of visual impair-ment while keeping the integrity of scien-tifically based research.

The field has yet to replicate a study inthe area of assistive technology we exam-ined. Considerable confidence, reliability,and validity are added if an intervention isevaluated by multiple studies (Schafer,2001). The use of replication can be es-pecially practical for those who work infield environments, such as this area ofspecial education, with limited options forresearch paradigms.

Although it is true that because thenumber of students with visual impair-ments is small, it is difficult to designexperimental studies with a sufficientnumber of participants, it is still importantand possible to implement evidence-based research. The two articles we foundthat provided sufficient data to determinethe effectiveness of the interventions withappropriate control and comparisongroups and interventions had smallersample sizes. Single-subject researchmethodology was used to achieve thisoutcome. The measure of strength of therelationship between the assistive tech-nology intervention and students' educa-tional performance was measured andpresented in both articles (Koenig & Ash-croft, 1983; LaGrow, 1981). The degreeto which assistive technology (the inde-pendent variable) had a positive impacton educational performance (the depen-dent variable) was established in eachinstance. An apparent link betweenevidence-based research methods and theability to evaluate the effectiveness ofassistive technology for this population ofstudents has been demonstrated by an

80 Journal of Visual Impairment & Blindness, February 2011 ©2011 AFB, All Rights Reserved

21 CEU Articleexhaustive synthesis of more than fourdecades of the literature.

LIMITATIONS

As with any type of research, this studyhad some innate limitations that must beaddressed. First, it was primarily a reviewof the current body of literature. Its onlypurpose was to provide information onthe current state of understanding. How-ever, it is foundational to all future en-deavors in researching this area to have awell-developed understanding of the cur-rent body of research.

Second, the criteria that we establishedproduced specific limitations. The applica-tion of scientific methodology in educationis relatively new and may be a limitation inthe evaluation of research that was con-ducted more than 10 years ago. However, itmust be noted that we examined 45 years ofthe literature to ensure the review was ex-haustive and truly representative of the lit-erature that is available on this particulartopic. To validate this undertaking further,we note that the two studies that met thecriteria were conducted in the 1980s. Thefindings demonstrate that it was not neces-sary to limit the review to the most recentliterature to measure the degree of scientificresearch available on the topic. If we haddone so, the two studies that met the criteriawould not have been found. Another impli-cation of the exhaustive review of the liter-ature covering a 45-year period and result-ing in 256 articles was that it was notpossible to present the entire depth of whatwe identified. Articles were selected thatwere representative of what we found, andconcepts were presented in the article.

Furthermore, the review included onlyjournals that are in English and that fo-cused only on interventions for students

aged 3-21 in preschool through the 12thgrade. The review did not include disser-tations or theses because we wanted tofocus on the published research that isreadily available to the field. However, itmust be stated that excellent scientificallybased research may be found in nonpeer-reviewed dissertations. The removal ofany of these criteria from other reviewsmay yield more research that is scientif-ically rigorous.

ConclusionThe research that we identified is valid andhelpful. Even though a study did not use therigorous standards of scientifically basedresearch, it is still of great help to teachersand other professionals who are looking forideas and ways to advance instructionaltechniques. It must be strongly stated thatthe current body of literature enables theeffective use of assistive technology.

In this era of NCLB and IDEIA regu-lations, more research-based evidence forthe use of strategies and skills should beprovided to allow for measures of theeffectiveness of educational priorities.There is a great need to develop a body ofscientifically based research. Scientifi-cally based research methods seem to beindicative of the evaluation of the effec-tiveness of assistive technology, and viceversa. This interdependent relationshipwas demonstrated by our study. For stu-dents with visual impairments to be ableto receive high-quality assistive technol-ogy that will enhance their educationalsuccess, more concrete research on theeffectiveness of assistive technologyneeds to be conducted.

It is time to begin to replicate studiesand to ensure that the studies follow evenhigher standards. As newer technologies

©2011 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, February 2011 81

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SCEU Articlecontinue to emerge, the research shouldbecome increasingly more sophisticatedin this topic area as well. Without a rig-orous boost in research, it is difficult to becertain what the field of visual impair-ment needs to do to ensure instructionalpractices keep up with the digitalizationof society in this time of technologicalprominence.

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Stacy M. Kelly, Ed.D., COMS, assistant profes-sor, Department of Special Education, IllinoisState University, Campus Box 5910, Normal, IL61790; e-mail: <skelly@ilstu.edu>. Derrick W.Smith, Ed.D., COMS, assistant professor, Depart-ment of Education, University of Alabama inHuntsville, 301 Sparkman Drive, MH 247B,Huntsville, AL 35899; e-mail: <derrick.smith@uah.edu>.

dationWest Vafb.netSUBrscRTo sub,Press, IPA 151412-74]mail: <site: <'

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@2011 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, Februamy 2011 83

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Kelly, Stacy M.; Smith, Derrick W.

The Impact of Assistive Technology on the Educational Performance ofStudents with Visual Impairments: A Synthesis of the Research

J Vis Impair Blindness 105 no2 F 2011 p. 73-830145-482X

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