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Goldberg AE, Frost RL. "Saying 'I'm not okay' is extremely risky": Postpartum mental health, delayed help-seeking, and fears of the child welfare system among queer parents. FAMILY PROCESS 2024. [PMID: 38922870 DOI: 10.1111/famp.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/28/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
Parent mental health challenges in the postpartum and early parenthood have profound implications for parent, child, and family well-being. Little research has focused on postpartum mental health challenges and barriers to help-seeking among queer birthing people, including members of this community who may be particularly vulnerable to mental health difficulties, such as queer cis women partnered with men, trans/nonbinary parents, and queer parents who are young, low-income, and/or of color. This mixed-methods study of queer parents (n = 99), all of whom were assigned female at birth (AFAB) and gave birth to a child within the past several years, explores parents' postpartum mental health difficulties and perceived barriers to seeking help. Using a structural stigma framework, this study found that participants reported high rates of postpartum mental health difficulties (89%) and reported various barriers to seeking support including fears of discrimination and being deemed "unfit" by providers, which might lead to child welfare system involvement. Young parents and low-income parents were particularly fearful of child welfare system contact and potential child removal. Factors that encouraged help-seeking (e.g., desire to be a good parent; partner pressure to seek help) and implications for family practitioners are discussed.
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Walsh M, Varshneya A, Beauchemin E, Rahman L, Schick AB, Goldberg M, Ades V. Homelessness Is a Form of Structural Violence That Leads to Adverse Obstetrical Outcomes. Am J Public Health 2023; 113:1160-1162. [PMID: 37708426 PMCID: PMC10568510 DOI: 10.2105/ajph.2023.307421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Affiliation(s)
- Madeleine Walsh
- Madeleine Walsh and Madeleine Goldberg are with the New York University (NYU) Grossman School of Medicine, New York, NY. Avni Varshneya and Esther Beauchemin are with the NYU School of Global Public Health. Lameya Rahman is with the School of Arts and Sciences at Hunter College of the City University of New York, New York, NY. Anna Beth Schick is with the NYU Steinhardt School of Culture, Education, and Human Development. Veronica Ades is with the Department of Obstetrics and Gynecology at NYU Grossman School of Medicine
| | - Avni Varshneya
- Madeleine Walsh and Madeleine Goldberg are with the New York University (NYU) Grossman School of Medicine, New York, NY. Avni Varshneya and Esther Beauchemin are with the NYU School of Global Public Health. Lameya Rahman is with the School of Arts and Sciences at Hunter College of the City University of New York, New York, NY. Anna Beth Schick is with the NYU Steinhardt School of Culture, Education, and Human Development. Veronica Ades is with the Department of Obstetrics and Gynecology at NYU Grossman School of Medicine
| | - Esther Beauchemin
- Madeleine Walsh and Madeleine Goldberg are with the New York University (NYU) Grossman School of Medicine, New York, NY. Avni Varshneya and Esther Beauchemin are with the NYU School of Global Public Health. Lameya Rahman is with the School of Arts and Sciences at Hunter College of the City University of New York, New York, NY. Anna Beth Schick is with the NYU Steinhardt School of Culture, Education, and Human Development. Veronica Ades is with the Department of Obstetrics and Gynecology at NYU Grossman School of Medicine
| | - Lameya Rahman
- Madeleine Walsh and Madeleine Goldberg are with the New York University (NYU) Grossman School of Medicine, New York, NY. Avni Varshneya and Esther Beauchemin are with the NYU School of Global Public Health. Lameya Rahman is with the School of Arts and Sciences at Hunter College of the City University of New York, New York, NY. Anna Beth Schick is with the NYU Steinhardt School of Culture, Education, and Human Development. Veronica Ades is with the Department of Obstetrics and Gynecology at NYU Grossman School of Medicine
| | - Anna Beth Schick
- Madeleine Walsh and Madeleine Goldberg are with the New York University (NYU) Grossman School of Medicine, New York, NY. Avni Varshneya and Esther Beauchemin are with the NYU School of Global Public Health. Lameya Rahman is with the School of Arts and Sciences at Hunter College of the City University of New York, New York, NY. Anna Beth Schick is with the NYU Steinhardt School of Culture, Education, and Human Development. Veronica Ades is with the Department of Obstetrics and Gynecology at NYU Grossman School of Medicine
| | - Madeleine Goldberg
- Madeleine Walsh and Madeleine Goldberg are with the New York University (NYU) Grossman School of Medicine, New York, NY. Avni Varshneya and Esther Beauchemin are with the NYU School of Global Public Health. Lameya Rahman is with the School of Arts and Sciences at Hunter College of the City University of New York, New York, NY. Anna Beth Schick is with the NYU Steinhardt School of Culture, Education, and Human Development. Veronica Ades is with the Department of Obstetrics and Gynecology at NYU Grossman School of Medicine
| | - Veronica Ades
- Madeleine Walsh and Madeleine Goldberg are with the New York University (NYU) Grossman School of Medicine, New York, NY. Avni Varshneya and Esther Beauchemin are with the NYU School of Global Public Health. Lameya Rahman is with the School of Arts and Sciences at Hunter College of the City University of New York, New York, NY. Anna Beth Schick is with the NYU Steinhardt School of Culture, Education, and Human Development. Veronica Ades is with the Department of Obstetrics and Gynecology at NYU Grossman School of Medicine
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Goldberg AE. LGBTQ-parent families: Diversity, intersectionality, and social context. Curr Opin Psychol 2023; 49:101517. [PMID: 36502588 DOI: 10.1016/j.copsyc.2022.101517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
Abstract
Lesbian, gay, bisexual, queer, and trans (LGBTQ) parents become parents in a variety of ways, including via reproductive technologies, through foster care and adoption, and in the context of different-gender relationships. This review addresses research developments over the past 5-6 years, revealing that LGBTQ people continue to face barriers in becoming parents, especially those who are trans, of color, and have limited financial means. Bisexual and trans parents are increasingly centered in research, and have unique experiences of parenthood related to navigating (in)visibility and stigma in various contexts. Recent work has documented the impacts of sociopolitical events (e.g., COVID-19, the Trump presidency) on LGBTQ parent families, particularly those with multiply marginalized statuses. Likewise, an increasingly intersectional lens has exposed how axes of privilege and oppression impact LGBTQ parents' sense of belongingness in various contexts and social groups. Finally, recent work has continued to document the powerful role of context and family processes in the lives and adjustment of youth raised by LGBTQ parents. More research is needed on LGBTQ parents with marginalized identities that have been poorly represented in the literature, such as nonbinary parents and parents with disabilities.
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Redefining Child Protection: Addressing the Harms of Structural Racism and Punitive Approaches for Birthing People, Dyads, and Families Affected by Substance Use. Obstet Gynecol 2022; 140:167-173. [PMID: 35852265 DOI: 10.1097/aog.0000000000004786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
There has been growing attention on the effect of substance use, including opioid use disorder, on pregnant and birthing people and their infants. Although effective medication treatment for opioid use disorder is the standard of care, racial disparities are evident in access during pregnancy. Structural racism affects treatment access and approaches to reporting to child welfare services. Black people and their newborns are more likely to be drug tested in medical settings, and Black newborns are more likely to be reported to child welfare services. Child welfare models often focus on substance use as being the dominant issue that drives risk for abuse or neglect of a child, and current reporting practices, which vary by state, contribute to these disparities. This commentary proposes an alternate way of thinking about family-based support. We suggest changes to law, institutional policy, clinical care, and ideology. Specifically, we propose realigning around shared goals of supporting the birthing person-infant dyad and recognizing that substance use is not synonymous with abuse or neglect; creating an anonymous notification process outside of the child welfare system to meet federal data-collection requirements; limiting perinatal drug testing and requiring written, informed consent for parental and neonatal testing; and developing integrated care teams and hospital settings and policies that support dyadic care.
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North CS, Williams E, Lee MH, Pollio DE. A prospective longitudinal study of child custody status among homeless population mothers. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2021; 32:104-113. [PMID: 37303597 PMCID: PMC10254570 DOI: 10.1080/10530789.2021.2002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/24/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
Most women in homeless populations are mothers, the majority being single mothers. Retaining child custody is challenging in homeless circumstances. Prospective longitudinal studies are needed to follow the moving pieces of housing and child custody in the context carefully-assessed psychiatric and substance use disorders over time. A 2-year prospective longitudinal study of an epidemiologic sample of individuals with literal homelessness included 59 mothers. Annual assessments included structured diagnostic interviews, detailed assessment of homeless circumstances, urine drug testing, and service use documented by both self report and data from agencies serving these individuals. More than one-third of the mothers consistently lacked child custody throughout the course of the study and the proportions of mothers with child custody did not increase significantly. Nearly one-half of the mothers had a current year drug use disorder at baseline, including cocaine disorder in most. Continuing lack of child custody over time was associated with longitudinal lack of housing and use of drugs. The importance of drug use disorders in the longitudinal course of child custody points to a critical need for formal substance abuse treatment, not just initiatives to decrease drug use, in helping mothers regain and maintain custody of their children.
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Affiliation(s)
- Carol S. North
- The Altshuler Center for Education & Research, Metrocare Services, Dallas, TX, USA
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Errett Williams
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Min Hyung Lee
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Sabatello M, Insel BJ, Link BG, Phelan JC, Appelbaum PS. The Psychiatric Genetic Data of Children in Proceedings to Terminate Parental Rights. THE JOURNAL OF THE AMERICAN ACADEMY OF PSYCHIATRY AND THE LAW 2021; 49:166-178. [PMID: 33579734 PMCID: PMC8217070 DOI: 10.29158/jaapl.200066-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The introduction of psychiatric genetic evidence in court proceedings to terminate parental rights raises concerns that such information will result in misconceived assumptions about the child's mental health trajectory and unjust rulings on termination of parental rights. We conducted an online vignette-based survey with a nationally representative sample of adults from the general public (n = 300 respondents) to assess their views on how evidence about a child's psychiatric genetic makeup may affect key decisions in termination proceedings. Our findings indicate that genetic evidence increased the child's labeling as having a psychiatric disorder, regardless of the presence of symptoms, treatment recommendations, evaluation of prescription medication, and beliefs in treatment efficacy. Genetic evidence alone did not affect whether participants would terminate parental rights, but participants who thought that the child did not have a psychiatric disorder were more likely to terminate in the presence of genetic test results. We conclude that psychiatric genetic evidence in termination proceedings may have unintended consequences, and that measures should be taken to ensure that it does not unfairly affect outcomes.
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Affiliation(s)
- Maya Sabatello
- Dr. Sabatello is Associate Professor of Clinical Bioethics, and Co-Director of the Precision Medicine, Ethics, Politics, and Culture Project, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY. Dr. Insel is a research assistant at Research Foundation for Mental Hygiene, New York, NY. Dr. Link is Distinguished Professor of Sociology and Public Policy, School of Public Policy, University of California, Riverside, CA. Dr. Phelan is Professor Emerita, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Dr. Appelbaum is Dollard Professor of Psychiatry, Medicine, and Law, and Director, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY.
| | - Beverly J Insel
- Dr. Sabatello is Associate Professor of Clinical Bioethics, and Co-Director of the Precision Medicine, Ethics, Politics, and Culture Project, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY. Dr. Insel is a research assistant at Research Foundation for Mental Hygiene, New York, NY. Dr. Link is Distinguished Professor of Sociology and Public Policy, School of Public Policy, University of California, Riverside, CA. Dr. Phelan is Professor Emerita, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Dr. Appelbaum is Dollard Professor of Psychiatry, Medicine, and Law, and Director, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY
| | - Bruce G Link
- Dr. Sabatello is Associate Professor of Clinical Bioethics, and Co-Director of the Precision Medicine, Ethics, Politics, and Culture Project, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY. Dr. Insel is a research assistant at Research Foundation for Mental Hygiene, New York, NY. Dr. Link is Distinguished Professor of Sociology and Public Policy, School of Public Policy, University of California, Riverside, CA. Dr. Phelan is Professor Emerita, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Dr. Appelbaum is Dollard Professor of Psychiatry, Medicine, and Law, and Director, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY
| | - Jo C Phelan
- Dr. Sabatello is Associate Professor of Clinical Bioethics, and Co-Director of the Precision Medicine, Ethics, Politics, and Culture Project, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY. Dr. Insel is a research assistant at Research Foundation for Mental Hygiene, New York, NY. Dr. Link is Distinguished Professor of Sociology and Public Policy, School of Public Policy, University of California, Riverside, CA. Dr. Phelan is Professor Emerita, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Dr. Appelbaum is Dollard Professor of Psychiatry, Medicine, and Law, and Director, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY
| | - Paul S Appelbaum
- Dr. Sabatello is Associate Professor of Clinical Bioethics, and Co-Director of the Precision Medicine, Ethics, Politics, and Culture Project, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY. Dr. Insel is a research assistant at Research Foundation for Mental Hygiene, New York, NY. Dr. Link is Distinguished Professor of Sociology and Public Policy, School of Public Policy, University of California, Riverside, CA. Dr. Phelan is Professor Emerita, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Dr. Appelbaum is Dollard Professor of Psychiatry, Medicine, and Law, and Director, Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Department of Psychiatry, Columbia University, New York, NY
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Canfield M, Norton S, Downs J, Gilchrist G. Parental status and characteristics of women in substance use treatment services: Analysis of electronic patient records. J Subst Abuse Treat 2021; 127:108365. [PMID: 34134870 DOI: 10.1016/j.jsat.2021.108365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/03/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many women receiving substance use treatment services are mothers. Despite this, research has not proved whether substance use treatment services are addressing the specific needs of mothers. This study explored differences in sociodemographic, psychological, patterns of substance use, and treatment characteristics between mothers and women without children, and between mothers whose children were in alternative care. METHOD The study extracted data from electronic patient records (EPRs) of women who attended South London and Maudsley (SLaM) National Health Services (NHS) Foundation Trust addiction services between 2013 and 2020 (N = 4370). RESULTS The study identified 1730 participants (39.6%) as mothers, of whom 1340 (77.4%) had dependent children. The average number of births was 1.83 (SD = 1.0). Of the participants, 54.3% of mothers did not disclose whether their dependent child(ren) was under their care and 37.5% of mothers indicated that at least one of their child(ren) was in alternative care. Alcohol was the most reported type of substance used in the past 28 days. Mothers also highly reported suicide attempts and hospitalization due to mental health problems. Compared to women without children, mothers were more likely to be young, experience housing problems, use opioids and/or crack-cocaine in the past 28 days and experience lifetime domestic violence victimizations. Mothers were also less likely to have alcohol-related problems, experience overdose, and social isolation than women without children. CONCLUSION The study highlights the need for substance use services to invest in approaches to improve mothers' disclosure of parenting and childcare issues. It also demonstrates that EPRs can identify key characteristics of mothers.
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Affiliation(s)
- Martha Canfield
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Sam Norton
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Abstract
Severe mental health disparities exist in the United States, with reduced access to community-based care and poorer recovery outcomes associated with people of color, women, and lesbian, gay, bisexual, or transgender individuals. One strategy to reduce these disparities is to incorporate the perspectives of mental health consumers and their families into care planning and delivery. Successful integration of personal experience with evidence-based interventions can help reduce stigma and improve retention in care. To leverage public policy to reduce mental health disparities, New York City has launched ThriveNYC, the nation's largest municipal-level investment in mental health.
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Harp KLH, Bunting AM. The Racialized Nature of Child Welfare Policies and the Social Control of Black Bodies. SOCIAL POLITICS 2020; 27:258-281. [PMID: 32714000 PMCID: PMC7372952 DOI: 10.1093/sp/jxz039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Black women are disproportionately involved in the child welfare system. This state-level intervention occurs at two levels-a higher likelihood of being (i) screened for drug use during pregnancy and (ii) reported to child welfare authorities after delivery. Consequently, they face further enmeshment in state-systems, including custody loss and lower reunification odds. Using evidence from the past forty years of research and media reports, we argue that systemic forces and policies largely contribute to racial disproportionality in the child welfare system, and assert this state intervention serves as a mechanism to control black reproduction.
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Affiliation(s)
- Kathi L H Harp
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Amanda M Bunting
- Department of Sociology, University of Kentucky, Lexington, KY, USA
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Harp KLH, Oser CB. A longitudinal analysis of the impact of child custody loss on drug use and crime among a sample of African American mothers. CHILD ABUSE & NEGLECT 2018; 77:1-12. [PMID: 29287167 PMCID: PMC5857224 DOI: 10.1016/j.chiabu.2017.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 12/06/2017] [Accepted: 12/18/2017] [Indexed: 05/22/2023]
Abstract
UNLABELLED This study examines the influence of child custody loss on drug use and crime among a sample of African American mothers. Two types of custody loss are examined: informal custody loss (child living apart from mother but courts not involved), and official loss (child removed from mother's care by authorities). METHODS Using data from 339 African American women, longitudinal random coefficient models analyzed the effects of each type of custody loss on subsequent drug use and crime. RESULTS indicated that both informal and official custody loss predicted increased drug use, and informal loss predicted increased criminal involvement. Findings demonstrate that child custody loss has negative health implications for African American mothers, potentially reducing their likelihood of regaining or retaining custody of their children. CONCLUSIONS This study highlights the need to integrate drug treatment and other types of assistance into family case plans to improve reunification rates and outcomes among mothers, children, and families. Additionally, the finding that informal loss predicts increased drug use suggests that community-based efforts within the mother's social network could be implemented to intervene before child welfare system involvement becomes necessary.
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Affiliation(s)
- Kathi L H Harp
- University of Kentucky College of Public Health, Department of Health Management and Policy, 111 Washington Avenue, College of Public Health Building, Lexington, KY 40536, United States.
| | - Carrie B Oser
- University of Kentucky, Department of Sociology, Center on Drug and Alcohol Research, Patterson Office Tower, Lexington, KY 40506, United States.
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