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Production of consonants by prelinguistically deafchildren with cochlear implantsMarie-Eve Gaul Bouchard a; Marie-Thérèse Le Normand b; Henri Cohen aca Cognitive Science Institute, Université du Québec à Montréal, Canadab INSERM Robert Debré Hospital, Paris, Francec Laboratoire de Psychologie et Neurosciences Cognitives, Université ParisDescartes-CNRS, France

Online Publication Date: 01 November 2007To cite this Article: Bouchard, Marie-Eve Gaul, Normand, Marie-Thérèse Le andCohen, Henri (2007) 'Production of consonants by prelinguistically deaf children withcochlear implants', Clinical Linguistics & Phonetics, 21:11, 875 - 884To link to this article: DOI: 10.1080/02699200701653634

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Production of consonants by prelinguistically deafchildren with cochlear implants

MARIE-EVE GAUL BOUCHARD1, MARIE-THERESE LE NORMAND2, &

HENRI COHEN1,3

1Cognitive Science Institute, Universite du Quebec a Montreal, Canada, 2INSERM Robert Debre

Hospital, Paris, France, and 3Laboratoire de Psychologie et Neurosciences Cognitives, Universite Paris

Descartes-CNRS, France

(Received 24 October 2006; accepted 21 May 2007)

AbstractConsonant production following the sensory restoration of audition was investigated in 22prelinguistically deaf French children who received cochlear implants. Spontaneous speechproductions were recorded at 6, 12, and 18 months post-surgery and consonant inventories werederived from both glossable and non-glossable phones using two acquisition criteria. The resultsshowed that children initiated appropriate production of consonants after six months of implant use.Stops and labials were the most frequently produced speech sounds, whereas glides and palatals werestill infrequent after 18 months. Speech accuracy also improved throughout the study. Consonantvisibility appeared to influence the order of acquisition in the first months following the implantationand, as experience with auditory information increased, patterns of development tended to resemblethose seen in children with normal hearing. Finally, a signed mode of communication and oralrehabilitation programs prior to implantation were better outcome predictors than age atimplantation.

Keywords: Speech development, hearing loss, sensory restoration, linguistic feature, mode ofcommunication

Introduction

Auditory input plays an important role in the acquisition and production of linguistic units.

Children who suffer from severe deafness cannot rely on this sensory contribution.

Cochlear implants permit the stimulation of the remaining surviving cells of auditory

pathways in some hearing-impaired (HI) children. A growing body of literature has shown

that this sensory restoration can benefit the acquisition of several speech skills such as

suprasegmental features (Tye-Murray, Spencer, & Woodworth, 1995), vowels (Ertmer,

Kirk, Seghal, Riley, & Osberger, 1997), consonants (Grogan, Barker, Dettman, & Blamey,

1999), as well as intelligibility (Osberger, Maso, & Sam, 1993) and conversational abilities

(Tobey, Geers, Brenner, Altuna, & Gabbert, 2003). Given the strong relationship between

Correspondence: Henri Cohen, Cognitive Science Institute, Universite du Quebec a Montreal, PB 8888, Station Centre-Ville

Montreal, QC H3C 3P8 Canada. E-mail: henri.cohen@uqam.ca

Clinical Linguistics & Phonetics, November–December

2007; 21(11–12): 875–884

ISSN 0269-9206 print/ISSN 1464-5076 online # 2007 Informa UK Ltd

DOI: 10.1080/02699200701653634

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speech perception and speech production, one way to evaluate the effectiveness of the

sensory restoration provided by the cochlear implant is to measure the quality of the

implanted child’s spoken language. Tobey et al. (2003) found that correct consonant

production was correlated with intelligibility and that it was strongly associated with

average speech use and sentence duration.

Consonant development in normally hearing children

The emergence of consonants in the prelinguistic vocalization of normally-hearing (NH)

infants has been studied extensively (Boysson-Bardies, Sagart, & Bacri, 1981; Robb, Bauer,

& Tyler, 1994), as well as how these phonemes are gradually integrated into the

productions of older children. Overall, results agree that there is no single universal order

for the acquisition of speech sounds (Dinnsen, Chin, & Elbert, 1992). However, some

developmental trends characterize both the phonetic and phonological development of this

class of phonemes regardless of the target language. Thus, with respect to manner, stops,

glides and nasals are the first to emerge, followed by fricatives and liquids. For place of

articulation, consonants produced in the front of the oral cavity precede the posteriorly

produced ones.

Consonant development in deaf children before and after cochlear implantation

Hearing-impaired children babble less (Maskarinec, Cairns, Butterfield, & Weamer, 1981),

enter the stage of canonical babbling later than their NH peers (Oller, 1986) and produce

fewer multisyllabic consonant-vowels strings (Kent, Osberger, Netsell, & Hustedde, 1987).

In contrast to their NH peers, the consonantal inventories of HI children are smaller and

remain stable or decrease with age (Stoel-Gammon & Otomo, 1986). Qualitatively, HI

children produce more labials because of the visual cues associated with the production of

this type of consonants (Smith, 1975; Stoel-Gammon, 1988). They also favour non-

syllabic, prolongable consonants such as nasals, fricatives, glides, and liquids because of

their tactile and kinaesthetic components (Stoel-Gammon, 1988). Thus in the absence of

auditory cues, extra-auditory factors appear to influence the nature of the phonetic

repertoire in HI children. Deafness also impacts consonant accuracy: fricatives and liquids

are more affected than nasals, stops, and glides (Markides, 1970), posterior consonants are

produced less accurately (Gold, 1970) and voicing errors are frequent (Smith, 1975).

The consonants produced by a child during the first 12 months following partial auditory

restoration has been studied by Ertmer and Mellon (2001). These authors noted the

influence of visual cues as reflected by the important proportion of labials early on, as well

as the gradual emergence of less visible places of articulation. These observations suggest

that the available acoustic information was progressively used by this child to monitor her

speech and diversify her production. One of the most detailed reports in the segment

inventories of implanted children is by Serry and Blamey (1999) and Blamey, Barry, and

Jacq (2001) who examined the speech production of nine prelinguistically deaf children

during their first 6 years post-implant. Using spontaneous speech samples, they used two

criteria to account for the phonetic and the phonologic acquisition of vowels and

consonants. Their results showed that the process of phone acquisition in these children

was systematic, but slower than in NH children.

The quality of consonants produced by implanted children and children wearing tactile

aids was found comparable at baseline, but differed greatly after 18 months of experience

876 M.-E. G. Bouchard et al.

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with their respective devices (Seghal, Kirk, Svirsky, Ertmer, & Osberger, 1998). Whereas

quality of production on the three consonant features improved with cochlear implants,

there was no change with vibrotactile aids during the same period. The authors concluded

that consonant features were more effectively transmitted by electrical stimulation of the

auditory nerve than by tactile stimulation delivered on the skin. Tye-Murray et al. (1995)

studied errors in consonant production made by HI children, implanted (31–170 months

of age) and who had an average of 36 months of auditory experience. They showed that

stops and nasals were accurately produced, as well as consonants with visible articulatory

movement.

The majority of the above-mentioned studies have principally relied on perceptual

judgement to examine changes in speech production following cochlear surgery. They also

focused on a single post-implantation point in time, or selected a first assessment period

close to the activation of the device and a second one years after experience with the

prosthesis. Although useful for examining linguistic progress, such studies have not

documented the gradual developmental changes. Another limitation is related to the type of

speech samples obtained. A variety of speech tasks may be used in evaluating speech

proficiency, including imitative tasks, standard articulation tests and spontaneous speaking.

The first two types allow greater homogeneity and control over the collected data, but

seldom reflect the child’s functional speech and everyday communication skills. In contrast,

spontaneous speech is usually more representative of the child’s abilities as it does not

depend upon imitation. Also, most studies to date have been case reports or included a very

small number of children. Though they are highly informative, it is difficult to draw general

conclusions from such studies with respect to the linguistic development of atypical

populations. Finally, normal development represents a foundation for the investigation of

speech acquisition in atypical populations. Yet, there is an absence of contrast with patterns

of development considered typical.

Factors affecting speech production post-implantation

Age at implantation. The general conclusion is that an early age at time of implant surgery is

associated with good language production and recognition outcome (e.g. Connor, Hieber,

Arts, & Zwolan, 2000; Le Normand, 2005). Children who received their implant in infancy

(before 19 months of age) show normal language acquisition and significantly better speech

perception, speech intelligibility and spoken language than children implanted somewhat

later, between 19 and 30 months (Hammes, Novak, Rotz, Willis, Edmondson, & Thomas,

2002). Earlier implantation apparently helps capitalize upon this enhanced auditory

sensitivity.

Mode of communication. Systems of signing can integrate full language structures as in

American Sign Language (ASL) and French Sign Language (FSL), or structures similar to

spoken language as in Signed English (SE) or Signed French (SF). Another type of visual

support is Cued Speech (CS) consisting of manual cues designed to facilitate

speechreading by highlighting distinctive features of speech. Early use of manual

communication may have a positive impact on early language, reading and vocabulary

(Connor et al., 2000), but evidence shows that children enrolled in strictly oral programs

show better speech perception, production and language development (Moog & Geers,

2003; Tobey et al., 2003).

Consonant production by children with cochlear implants 877

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Language and speech. The language and speech abilities of the children at the time of

implantation is another important factor (Tye-Murray et al., 1995; Uziel, Mondain, & Reid,

1995). Although the literature is not yet conclusive (Nikolopoulos, Dyar, & Gibbin, 2004),

results tend to suggest that children who present important speech delays at the time of the

implantation would remain behind their counterparts with better expressive capacities at the

time of the surgery (Miyamoto, Svirsky, & Robbins, 1997). Thus, despite improvement in

speech performance, the progression speed of these delayed children wouldn’t permit them

to compensate for their initial lags (Loundon, Busquet, Roger, Moatti, & Garabedian, 2000).

Objectives of the study

This study pursued three main objectives: to examine the phonetic and phonological

development of consonants in spontaneous speech during the first 18 months following the

cochlear surgery; to investigate how preoperative level of oral communication, age at

implantation and mode of communication influence the acquisition of consonants; and to

determine the extent to which the acquisition patterns of these implanted children

correspond to those of their NH peers.

Method

Participants

The participants in this study were 22 prelingually deaf French children, 10 girls and 12 boys,

who received a multichannel cochlear implant. The socio-demographic and clinical

characteristics of the subjects are presented in Table I. They all had complete audiological,

neurological, and linguistic evaluations prior to receiving the cochlear implant. The

participants were followed at one of four French hospitals in Montpellier, Lyon, Toulouse

or Paris. The only exclusion criterion was the presence of a handicap other than deafness. All

participants lived in a home environment that principally used oral language, although

communicative support—such as cued speech, SF, and FSL—was offered to some of them.

Preoperative hearing loss in the better ear was expressed as pure-tone average threshold

(PTA) at frequencies of 500, 1000 and 2000Hz in dB HL. All the children in the study were

enrolled in auditory rehabilitation programs. Rehabilitation consisted of one-hour individual

sessions, from the time hearing loss was diagnosed through the post-operative period. The

frequency of the sessions varied from weekly to monthly visits as time progressed.

Cochlear implants. All participants except three children were implanted with the

multichannel Nucleus CI24M, manufactured by Cochlear Corporation and using one of

two speech strategies: the spectral peak (SPEAK) and the Continuous Interleaved Sampling

(CIS). Children 13, 16, and 18 were implanted with the Clarion multichannel cochlear

implant manufactured by Advanced Bionics Corporation and using the CIS strategy.

Procedure

Assessments were conducted at 6, 12, and 18 months post-implantation. Twenty-minute

speech samples were video- and audio-taped by clinicians in a standardized free-play

session. The set-up included Fisher-PriceH toys, a toy house, figurines and household

items. Children were asked to verbalize as many manipulations and actions as possible with

toys and objects in and around the house. Speech skills (production and comprehension)

878 M.-E. G. Bouchard et al.

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prior to implantation were assessed with a questionnaire completed by both parents and

speech therapist, listing words and phonemes that were produced and perceived by the

children in everyday situations. Word comprehension was scored on a 0- (none) to 5-point

(consistent identification of words in sentences) scale and speech production was expressed

on a 1- (none) to 5-point (few isolated words) scale.

Transcriptions. Broad transcription of speech utterances was adopted following Shriberg and

Lof (1991). Three transcribers completed transcriptions from the audiovisual recordings.

Both glossable and non-glossable utterances were transcribed. Crying, laughter, and

vegetative sounds were not considered in the transcriptions. An utterance was defined as a

vocalization or a group of vocalizations separated from all others by either audible ingressive

breaths or a by utterance boundaries indicated by a silence of 1s or longer in duration (e.g.

Lynch, Oller, & Steffens, 1989). Speech samples were transcribed using the symbols of the

International Phonetic Association (IPA) notation system and formatted in accordance with

the Codes for the Human Analysis of Transcripts (CHAT) transcription conventions of the

CHILDES (MacWhinney, 2000). As children were not equally talkative the transcriptions

were limited to the first 100 intelligible words of each sample.

Agreement of the phonetic transcriptions. Point-by-point comparisons of the transcriptions

were conducted. The average inter-rater agreement was over 85% for the 66 speech

samples transcribed (i.e. 22 participants 63 sessions).

Table I. Characteristics of implanted children.

Subject1Aetiology of

hearing loss

Age2 at

diagnosis

PTA

DHL

Pre-implant

Hearing Aid

Age2 at

surgery

Mode3 of

communication

Pre-surgery language4

Word

comprehension

Speech

production

1 Meningitis 25 107 11 35 Oral only 3 5

2 Unknown 6 100 47 59 CS 3 5

3 Unknown 28 115 42 73 CS, SF 3 5

4 Unknown 12 102 48 49 SFL 2 3

5 Connexin 26 21 108 12 48 CS 0 5

6 Hereditary 4 117 12 28 CS, SF 2 2

7Cytomegalo

Virus

8 112 36 58CS

0 1

8 Meningitis 4 105 18 28 CS 1 1

9 Unknown 16 98 18 48 CS, SF 0 2

10 Unknown 11 115 12 25 Oral only 2 3

11 Unknown 24 108 21 48 SF 0 1

12 Unknown 3 105 19 30 SF 0 2

13 Unknown 20 105 36 78 CS 0 5

14 Hereditary 12 98 30 45 CS 0 2

15 Unknown 6 110 30 39 SF 0 3

16 Hereditary 0 108 36 45 CS, SF 2 5

17 Unknown 14 117 18 48 CS, SF 0 1

18 Unknown 15 105 12 38 CS, SF 1 1

19 Unknown 15 115 14 28 SF 0 2

20 Unknown 4 105 27 31 SF 1 3

21 Hereditary 11 115 60 72 CS, SF 0 1

22 Unknown 11 105 39 50 CS 0 1

Notes: 1 Ss 1–10 are girls; 2 expressed in months; 3 CS: Cued speech, SFL: Signed French Language, SF: Signed

French; 4 based on questionnaires.

Consonant production by children with cochlear implants 879

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Phone classification. Transcribed consonants were divided into: glossable and non-glossable

categories. Two measures derived for glossable segments (Tye-Murray & Kirk, 1993): total

number of target sounds spoken (TSS) or number of times each sound was spoken in a

word context; correct production (CP) or number of times a spoken sound matched the

intended target. Another category, the total production (TP) referred to the number of

times a spoken phone was produced, whether in a glossable or a non-glossable utterance.

Acquisition criteria. Two criteria, the emergent phone (EP) and the acquired phone (AP)

(Serry & Blamey, 1999; Blamey et al., 2001), were used to define and identify two

endpoints in the development of consonants. The EP criterion required that at least two

tokens of a phone be found in the TP class; the AP criterion only counted phones in the

glossable category, requiring at least two occurrences of a phone in the TSS class and at

least 50% of these attempts to be a correct production. Group acquisition of a particular

phone required that 11 out of the 22 participants had reached the EP or AP criterion.

Results

For the 6, 12, and 18-months assessments, t-tests on glossable-only and both glossable and

non-glossable inventories yielded no significant differences on the total number of consonants

produced between the two types of inventories. Therefore, only results from glossable and

non-glossable inventories, or total production, will be reported in the results section.

Inventory

With respect to manner of articulation, stops were the predominant class of consonants,

ranging between 55% (6-months assessment) and 45% (18-months assessment). The other

classes of consonants followed with smaller rates, which varied between 10 and 15%. With

respect to place of articulation, labials were the top ranking category at 6 months. Alveolars

increased gradually over the three assessment periods. Finally, voiced consonants

represented the most frequent class of phonemes at each assessment period.

Patterns of acquisition. As early as 6 months post-implantation [m, p] had already been

acquired following both the emergent (EP) and the acquired (AP) criteria. Over the duration

of the study, 10 other consonants reached the two criteria [l, b, n, w, t, j, d, s, r, s].

Speech errors. The consonant production of the 22 subjects were further assessed for

accuracy of production. Confusion matrices showed that as early as 6 months post-

implantation, speech production was relatively good with accuracy ranging between 64%

for fricatives and 95% for stops. Stops remained the most accurately produced phonemes at

all assessment periods and fricatives remained the less accurately produced. When

substitution occurred, fricatives were usually replaced by a stop consonant.

Mode of communication, age at implantation and pre-implant level of oral communi-

cation. Pearson’s r correlations were conducted to determine the relationship between

speech production and level of oral communication pre-implantation, age at implantation

and mode of communication. Computations were performed on both glossable-only

inventories and total production. With respect to the preoperative level of oral

communication, significant correlations were obtained for the glossable inventories at 6

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months (r(20)5.58, p,.05), 12 months (r(20)5.56, p,.05), and 18 months (r(20)5.44,

p,.05). For total production, there was a significant relationship at the 6-month

assessment only (r(20)5.42, p,.05).

A positive relationship was found between age at implantation and total production at 6

months post-implantation (r(20)5.52, p,.05) only. Biserial correlations were computed

on the two inventories to establish the relationship between mode of communication and

vowel production. The oral system (oral and cued speech) was given a value of 1, whereas

total communication approach (SF and/or SFL) was given a value of 0. When a child used

both CS with any form of total communication, he or she received a score of 0. No

correlation was found to be significant in the both glossable and non-glossable inventory.

Significant correlations of interest were found in the glossable-only inventory, at the 6-

month (r(20)5.49, p,.05) and 18-month assessments (r(20)5.46, p,.05) suggesting that

children in oral communication produced more phonologically-aimed consonants.

Discussion

The present study investigated the phonetic and phonological development of consonants

during the first 18 months post-surgery in prelinguistically deaf French children who

received a cochlear implant. The results revealed three key findings. Stops and labials are

the most frequently produced phonemes following partial restoration of auditory

experience, whereas glides and palatals are still infrequent after 18 months of auditory

experience. Second, speech accuracy is relatively good as early as 6 months and improves

throughout the study. Finally, the pre-implant level of oral communication is more strongly

related to consonant production than are clinical variables such as age at implantation and

mode of communication.

With respect to speech production, results showed that consonant visibility appeared to

influence the order of acquisition initially, but as experience with auditory information

increased, patterns of development became more similar to those seen in NH children.

However, the influence of auditory restoration on consonant development is complex. In

children, psychological maturation and the plasticity of the sensory pathways take part in

the natural evolution of communication. This makes it difficult to tease out the

contribution of the acoustic information from maturation and rehabilitation effects. Also,

these children still have limited hearing in one ear and their aided thresholds in the

implanted ear remain in the mild to moderate range of hearing impairment. As such, they

still receive less than optimal access to speech at conversational frequencies.

Despite this limited perception, the correspondence between acquisition patterns of

these implanted children and NH children can be determined. The dominance of stop

consonants is in marked contrast to several studies conducted with HI children for whom

fricatives and glides were favoured and stops seldom produced (Stoel-Gammon, 1988).

Pre-implantation factors such as early diagnosis of the hearing impairment and use of

amplification devices may have helped some of these children to develop a phonetic

repertoire similar to that of their NH peers (e.g. Kent et al., 1987; Ertmer & Mellon, 2001).

Also, the children in this study produced more anterior consonants, reflecting a reliance on

visible cues (Dodd, 1976). Also, labials that are highly visible had the highest the

production rates. They were followed by alveolars, velar/uvulars, and palatals. This

ordering models a continuum of consonant visibility and supports the results of other

investigations (Grogan et al., 1999; Ertmer & Mellon, 2001).

Consonant production by children with cochlear implants 881

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Though useful, vision is still insufficient to convey all of the information necessary for the

perception and production of the full consonant inventory (Kuhl & Meltzoff, 1984). The

emergence of the less visible places of articulation, as well as the high frequency and

motorically more complex fricatives, are suggestive of a more sustained reliance on the

acoustic signal. The results of this study also suggest that the major period of consonant

emergence occurs somewhere around 12 months post-implantation. Increased use of

auditory cues and self-correction helps with the acquisition of more complex and less

visible consonants as well as the integration of phones in phonologically adequate contexts.

Speech errors

Analysis of the speech errors revealed that overall accuracy in consonant production was

relatively good. This is in agreement with Tye-Murray et al. (1995) but in contrast to

results reported by Smith (1975) and McGarr (1987) with profoundly deaf children using

conventional hearing aids. It appears that restoration of the auditory modality enhances

phone contrasts and use of auditory feedback in refining the articulatory strategies of the

implanted children.

Fricatives are known to represent particularly difficult phonetic and phonological targets

for HI children (Kent, 1992). Normally developing French children also have a strong

tendency to avoid or miss this class of phonemes (Boysson-Bardies et al., 1981). Also, the

higher frequency regions of these phonemes constitute an added difficulty for HI

children—who can hardly perceive them prior to receiving the cochlear implant.

Predicting factors

The analysis of the relationship between age at implantation, mode of communication and

level of oral language pre-implant with consonant production underlines the importance of

separately considering glossable and non-glossable segments. There were significant

correlations when analyzing glossable inventories, but not when considering the total

production. The results showed that age at implantation was not related to consonant

production, although implantation at a later age is frequently considered as having

deleterious effects on perceptual outcome following the sensory restoration (e.g. Manrique,

Francisco, Huarte, & Molina, 2004; McConkey Robbins, Koch, Osberger, Zimmerman-

Phillips, & Kishon-Rabin, 2004).

Mode of communication, however, was found to influence the number of phones

produced in the glossable inventories. This finding suggests that oral approaches were more

beneficial than total communication for the production of speech in linguistically aimed

utterances. In the present study, total communication children relied principally on signs to

communicate. Tye-Murray et al. (1995) reported that children who used sign systems prior

to receiving a cochlear implant, kept relying on them after for at least 2 years after surgery.

Apparently, sign users must visually attend to both oral and manual gestures, whereas oral

communication users can focus on oral articulation only (Bergeson & Pisoni, 2004).

A key finding of the present study was the influence of pre-implant level of oral

communication on consonant production. A poor level of oral communication prior to the

sensory restoration persists after the implantation and negatively influences consonant

development. Recently, Loundon et al. (2000) concluded that the preoperative level of oral

communication was the most important prognostic factor when considering post-implant

speech production; no matter the linguistic or perceptual abilities assessed, this was always

882 M.-E. G. Bouchard et al.

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a principal factor, regardless of age at implantation. Results from studies by Archbold et al.

(2000) with more than 20 children, and Tait and Lutman (1994) with 20 infants, showed

that children who demonstrated good auditory-vocal abilities before the auditory

restoration were those with higher post-implantation language performance.

Taken together, these results suggest that consonant development following the cochlear

implantation is not only a matter of demographic and clinical variables such as age at

implantation, auditory input, or education. It appears that how well the children

communicate prior to auditory restoration is an essential component. This is a novel

observation in the implant literature which, until now, has principally been concerned with

the role of demographic and clinical variables to explain post-surgery outcome. Thus, the

need to extend the scope of research on post-surgery variability to factors other than clinical

and socio-demographic, appears crucial in this context.

Acknowledgment

This research was aided by a grant from SSHRC (Ottawa).

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