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RESEARCH ARTICLE
Nonfatal Injuries to Law Enforcement Officers:
A Rise in Assaults
Hope M. Tiesman, PhD,
1
Melody Gwilliam, MPH,
1
Srinivas Konda, MPH,
1
Jeff Rojek, PhD,
2
Suzanne Marsh, MPA
1
Introduction: Limited studies exist that describe nonfatal work-related injuries to law enforcement
officers. The aim of this study is to provide national estimates and trends of nonfatal injuries to law
enforcement officers from 2003 through 2014.
Methods: Nonfatal injuries were obtained from the National Electronic Injury Surveillance
System−Occupational Supplement. Data were obtained for injuries treated in U.S. emergency
departments from 2003 to 2014. Nonfatal injury rates were calculated using denominators from the
Current Population Survey. Negative binomial regression was used to analyze temporal trends. Data
were analyzed in 2016–2017.
Results: Between 2003 and 2014, an estimated 669,100 law enforcement officers were treated in
U.S. emergency departments for nonfatal injuries. The overall rate of 635 per 10,000 full-time
equivalents was three times higher than all other U.S. workers rate (213 per 10,000 full-time
equivalents). The three leading injury events were assaults and violent acts (35%), bodily reactions
and exertion (15%), and transportation incidents (14%). Injury rates were highest for the youngest
officers, aged 21–24 years. Male and female law enforcement officers had similar nonfatal injury
rates. Rates for most injuries remained stable; however, rates for assault-related injuries grew among
law enforcement officers between 2003 and 2011.
Conclusions: National Electronic Injury Surveillance System−Occupational Supplement data
demonstrate a significant upward trend in assault injuries among U.S. law enforcement officers and
this warrants further investigation. Police−citizen interactions are dynamic social encounters and
evidence-based policing is vital to the health and safety of both police and civilians. The law
enforcement community should energize efforts toward the study of how policing tactics impact
both officer and citizen injuries.
Am J Prev Med 2017;](]):]]]–]]]. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine
INTRODUCTION
Law enforcement officers (LEOs) have had histor-
ically high rates of fatal and nonfatal injuries. LEO
fatalities are documented in several well-estab-
lished data systems, including the National Law Enforce-
ment Officer Memorial Fund, the Federal Bureau of
Investigation’s (FBI’s) Law Enforcement Officers Killed
and Assaulted database, and the Bureau of Labor
Statistics Census of Fatal Occupational Injury.
1–3
According to 2015 Census of Fatal Occupational Injury
data, police and sheriffs’officers had the 18th highest
fatality rate behind occupations such as loggers, roofers,
and construction laborers.
4
Although these systems
provide a national picture of officer fatalities, much less
is known about nonfatal injuries among officers and how
these injuries impact officers and agencies.
From the
1
Division of Safety Research, National Institute for Occupational
Safety and Health, Morgantown, West Virginia; and
2
Department of
Criminal Justice, University of Texas at El Paso, El Paso, Texas
Address correspondence to: Hope M. Tiesman, PhD, Division of Safety
Research, Analysis and Field Evaluations Branch, National Institute for
Occupational Safety and Health, 1095 Willowdale Road, M/S 1811,
Morgantown WV 26505. E-mail: htiesman@cdc.gov.
0749-3797/$36.00
https://doi.org/10.1016/j.amepre.2017.12.005
Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine Am J Prev Med 2017;](]):]]]–]]] 1
A handful of studies on nonfatal LEO injuries have been
conducted, but were limited by either size or scope. The
FBI’s Uniform Crime Reporting program collects monthly
data on nonfatal assaults of duly sworn university and
college, county, state, municipal, and tribal officers who
were performing a law enforcement function at the time of
the assault.
5
However, this program does not track unin-
tentional injuries, such as accidental falls or motor vehicle
crashes. Also, this program is voluntary and some agencies
do not participate.
6
These missing data make it difficult to
describe national nonfatal injury trends.
6
Another effort is
that of the International Association of Chiefs of Police
Reducing Officer Injuries Final Report, which collected
self-reported injury data from 18 law enforcement agen-
cies.
7
This report documented nearly 1,300 injuries, 6,000
missed work days, and $2 million in estimated overtime
costs in a single year. Although the study was a significant
undertaking, it used a nonspecificinjurydefinition that
may have included deaths, reports of pain, and off-duty
injuries.
7
Also, these data may not be generalizable to the
law enforcement community as a whole.
Recent events involving LEOs have called attention to a
wide range of internal policing issues, including use of force,
discipline of officers, and policing culture. Conversely, these
events have also caused law enforcement practitioners,
criminologists, and occupational safety and health profes-
sionals to consider the impact of police work on the health
and safety of officers. The purpose of this article is to extend
prior work by enumerating and describing nonfatal injuries
among on-duty LEOs between 2003 and 2014. To the best of
the authors’knowledge, this will be the first study to examine
nonfatal injuries among LEOs on a national scale.
METHODS
Study Sample
On-duty nonfatal injuries occurring between January 1, 2003 and
December 31, 2014 to U.S. LEOs were obtained from the National
Electronic Injury Surveillance System Occupational Injury Supple-
ment (NEISS−Work). The National Institute for Occupational
Safety and Health (NIOSH), in collaboration with the Consumer
Product Safety Commission, collects surveillance data on work-
related nonfatal injuries and illnesses treated in U.S. hospitals with
a 24-hour emergency department (ED).
a
The sample of hospitals
is a national stratified probability sample of 67 U.S. hospitals
divided into strata by hospital size, based on number of annual
ED visits.
8
An injury is considered work-related if it occurred to a
civilian, non-institutionalized worker who was working for pay,
performing farm-related activities, traveling between locations as
part of a job requirement, or volunteering for an organized group.
Injuries are identified from ED medical records by trained coders
at each participating hospital. To calculate national estimates, each
case is assigned a statistical weight based on the inverse probability
of selection of the hospital in the sample, and adjustments are
made for nonresponding hospitals during each calendar year.
Injury event characteristics for 2003 through 2011 were coded
based on the Bureau of Labor Statistics Occupational Injury and
Illness Classification System, version 1.01.
9,10
Data from 2012 to
2014 were coded using Occupational Injury and Illness Classi-
fication System, version 2.01.
10
Thus, 2012 is considered a break in
series for injury event data. NEISS−Work does not follow a
standard coding classification system for the occupation and
industry of workers. No review was required by NIOSH’s IRB
because the analysis was conducted using existing surveillance
data.
Measures
For this analysis, LEO was defined as a state or local officer who
carried a firearm and had full arrest powers. Law enforcement
occupations, such as animal control officers, security guards,
correctional/detention officers, federal LEOs, parole officers,
school safety/resource officers, private investigators, crossing
guards, volunteer police, public safety officers serving in a fire
capacity, and off-duty officers were excluded. Inclusion and
exclusion criteria for occupational classification purposes are
important, as the criteria may affect injury rates.
11
Because NEISS−Work does not include standardized industry
and occupation codes, a stepwise process was used to identify LEO
cases. The inclusion/exclusion criteria noted here was used to
develop a list of law enforcement keywords. These keywords were
used to search three variables: business type, employer name, and
occupation type. If all three variables included a law enforcement
keyword, cases were included without further review. Remaining
cases were then reviewed manually if: (1) two of the three variables
(business type, employer name, occupation type) included a law
enforcement keyword, (2) occupation type included a law enforce-
ment keyword and the other two variables did not include an
exclusion term listed here, or (3) occupation type was missing and
one of the other two variables included a law enforcement
keyword. For these remaining cases, the injury incident narrative
variable was reviewed to determine if the injury could be attributed
to police work. Cases were kept where the activity was unique to
law enforcement, such as (1) chasing or pursuing a suspect, (2)
arresting or restraining a suspect, (3) fighting an assailant/suspect,
or (4) participating in police-related training. Cases were
excluded when the injury incident narrative was generic, such as
fell at work.
An additional step was taken for remaining cases where the
occupation type variable was trainee. Because trainee could be
interpreted as a cadet (non-sworn officer) or as a sworn officer
participating in physical training or under the supervision of a field
training officer, the injury incident text was manually reviewed to
exclude non-sworn officers from the study. Questionable cases at
any stage in this process were reviewed by two additional co-
authors to arrive at consensus. After removing officers aged o21
years, the final dataset included 12,270 cases that were identified as
LEOs with certainty.
a
NIOSH collects NEISS−Work data in collaboration with the Consumer
Product Safety Commission, which operates the base NEISS hospital
system for the collection of data on consumer product−related injuries.
The Consumer Product Safety Commission product-related injury esti-
mates exclude work-related injuries, whereas NEISS−Work estimates
include all work-related injuries regardless of product involvement (i.e.,
NEISS and NEISS−Work cases are mutually exclusive).
Tiesman et al / Am J Prev Med 2017;](]):]]]–]]]2
www.ajpmonline.org
Statistical Analysis
Data were analyzed in 2016–2017 using SAS, version 9.3. Nonfatal,
ED-treated injury estimates were obtained by summing the
statistical weights assigned to each case. Nonfatal injury rates were
calculated using denominator data from the Bureau of Labor
Statistics’Current Population Survey (CPS). The CPS is a national
household survey, conducted monthly on approximately 60,000
non-institutionalized residents aged ≥15 years.
12
Respondents
provide information on their occupation, industry, hours of work,
and other work-related characteristics.
12
The CPS provides infor-
mation on the number of full-time equivalent (FTE) workers based
on the 2002 and 2010 Bureau of Census Occupation codes.
13
Federal officers and those aged o21 years were removed to match
the numerator data.
Estimated injuries with 95% CIs were calculated using PROC
SURVEYMEANS. Nonfatal injury rates were calculated as the
estimated number of nonfatal injuries divided by the estimated
FTE and expressed as injuries per 10,000 FTEs per year. The 95%
CIs for rates were calculated by pooling the variances for the
NEISS−Work injuries and CPS data. Sociodemographics (sex and
age) were compared with rate ratios and 95% CIs. Trends over
time were analyzed using a negative binomial regression model to
correct for overdispersion that occurred when using a Poisson
model.
RESULTS
Between 2003 and 2014, the overall nonfatal, ED-treated
injury rate for LEOs was 635 per 10,000 FTEs (95%
CI¼436, 834). The LEO nonfatal injury rate was three
times higher than the injury rate of 213 per 10,000 FTEs
for all other U.S. workers (excluding LEOs). The annual
LEO nonfatal injury rate increased from 2007 to 2011
and then decreased until 2014. This resulted in a 1.2%
annual increase across the 12-year period (p¼0.18;
Figure 1). The LEO nonfatal injury trend is in contrast
with the trend for all other U.S. workers. Between 2003
and 2014, nonfatal injury rates for all other U.S. workers
significantly decreased 2.6% annually (po0.0001).
Between 2003 and 2014, an estimated 669,100 (95%
CI¼461,000, 877,200) officers were treated in EDs for a
nonfatal injury (Table 1). Although 88% of the injuries
occurred in male LEOs, male and female LEOs had
similar injury rates (male, n¼652; female, n¼535, rate
ratio¼1.2, 95% CI¼0.6, 1.8). As age increased, nonfatal
injury rates decreased. Officers aged between 21 and 24
years had the highest injury rate (1,230 per 10,000 FTEs).
Sixty-three percent of nonfatal injuries among LEOs
occurred in municipal officers (n¼423,800) and 27%
occurred in county-level officers (n¼185,600). Most
injured LEOs were treated and released from the ED
(n¼654,400, 98%).
Table 2 describes the body part injured and diagnosis.
The two most commonly injured body part categories
were hands and fingers (n¼157,600, 24%) and lower
extremities (n¼147,100, 22%). The most common injury
diagnosis was sprains and strains (n¼199,000, 30%). The
leading nonfatal injury events from 2003 to 2011 were
assaults and violent acts (n¼181,100, 35%, 95%
CI¼119,400, 242,800), bodily reactions and exertion
(includes overexertion from running and repetitive
motion injuries; n¼74,000, 15%, 95% CI¼401,000,
107,900), transportation incidents (n¼71,000, 14%,
95% CI¼46,200, 95,800), contact with objects
(n¼66,000, 13%, 95% CI¼46,400, 85,600), and falls
(n¼57,400, 11%, 95% CI¼37,500, 77,300). Nonfatal
injury rates for bodily reaction and transportation
injuries did not significantly change during the 9-year
time period. Rates for assault-related injuries signifi-
cantly increased 9.6% annually from 2003 to 2011
(po0.0001, Figure 2A).
Because data from three hospitals in a single metro-
politan area had large increases in assault-related injuries
compared with other hospitals, the assault-related injury
trend was also examined, excluding these hospitals
(Figure 2A). This trend analysis was run with adjusted
weights because of the removal of three hospitals. This
trend also increased significantly, 2.9% annually from
2003 to 2011 (p¼0.002). Because 2012 represented a
break in series for injury event codes, 2012–2014 data
were examined separately (Figure 2B). Between 2012 and
2014, the leading nonfatal injury events were violence
and other injuries by people or animals (n¼73,500, 45%,
95% CI¼41,000, 106,000); transportation incidents
(n¼19,600, 12%, 95% CI¼9,900, 29,300); falls, slips,
and trips (n¼18,700, 11%, 95% CI¼11,800, 25,600),
contact with objects and equipment (n¼18,400, 11%,
95% CI¼13,000, 238,000), and overexertion and bodily
reactions (n¼15,800, 10%, 95% CI¼9,900, 21,700).
Figure 1. Nonfatal injury rates per 10,000 FTEs among U.S.
LEOs and all other U.S. workers: NEISS—Work, 2003–2014.
FTE, full-time equivalent; LEO, law enforcement officer; NEISS, National
Electronic Injury Surveillance System.
Tiesman et al / Am J Prev Med 2017;](]):]]]–]]] 3
]2017
Injury rates for transportation incidents and falls, slips,
and trips decreased significantly during this time period
(p¼0.04 and po0.0001, respectively). Comparatively,
injury rates because of violence increased 6% annually,
though this increase was not statistically significant
(p¼0.53).
Table 1. Number and Rate of Nonfatal Injuries Among LEOs by Sex, Age, Disposition, and Agency Type: NEISS—Work,
2003–2014
Characteristic
Weighted injury estimates
a
(95% CI) %
Labor estimate
b
(FTE)
Rate per 10,000 FTE
(95% CI)
RR
(95% CI)
Sex
Male 590,400 (406,700, 774,100) 88 9,060,500 652 (447, 857) 1.2 (0.6, 1.8)
Female 78,800 (51,400, 106,200) 12 1,472,900 535 (324, 746) 1.0
Age group, years
21–24 45,300 (27,300, 63,300) 7 367,300 1,230 (530, 1930) 7.1 (2.1, 12.1)
25–34 301,300 (203,200, 399,400) 45 2,941,900 1,020 (662, 1378) 5.9 (2.7, 9.1)
35–44 233,700 (151,400, 316,000) 35 3,788,800 617 (391, 843) 3.5 (1.6, 5.4)
45–54 71,200 (49,800, 92,600) 11 2,426,400 293 (195, 391) 1.7 (0.8, 2.6)
≥55 17,600 (11,600, 23,600) 3 1,009,100 174 (102, 246) 1.0
Disposition
Treated and
released
654,400 (448,000, 860,800) 98 10,533,400 620 (423, 817) —
Treated and
admitted
14,600 (8,800, 20,400) 2 10,533,400 13 (8, 18) —
Agency type
Municipal 423,800 (237,500, 610,100) 63 ———
Sheriff
c
185,600 (37,400, 333,800) 27 ———
State 30,300 (18,100, 42,500) 5 ———
Other 29,400 (14,500, 44,300) 4 ———
Total 669,100 (461,000, 877,200) 100 10,533,400 635 (436, 834)
a
Number may not sum to total due to rounding.
b
Labor estimates from the Current Population Survey.
c
Estimate is statistically unreliable with a 40% coefficient of variation.
FTE, full-time equivalent; LEO, law enforcement officer; NEISS, National Electronic Injury Surveillance System; RR, rate ratio.
Table 2. Number and Percentage of Nonfatal Injuries Among LEOs by Body Part Injured and Diagnosis: NEISS—Work,
2003–2014
Variable Weighted injury estimates
a
(95% CI) %
a
Body part injured
Hand and fingers 157,600 (108,500, 206,700) 24
Lower extremities 147,100 (103,200, 191,000) 22
Trunk and neck 108,900 (73,200, 144,600) 16
Head and face 90,400 (56,800, 124,000) 14
Upper extremity 82,400 (55,100, 109,700) 12
Shoulder 42,200 (26,600, 57,800) 6
All other 29,100 (17,700, 40,500) 4
Diagnosis
Sprain and strain 199,000 (125,900, 272,100) 30
All other 194,400 (140,100, 248,700) 29
Contusions and abrasions 181,200 (110,500, 251,900) 27
Laceration 50,800 (36,200, 65,400) 8
Fracture and dislocation 43,700 (30,700, 56,700) 7
Total 669,100 (461,000, 877,200) 100
a
Number may not sum to total due to rounding.
LEO, law enforcement officer; NEISS, National Electronic Injury Surveillance System.
Tiesman et al / Am J Prev Med 2017;](]):]]]–]]]4
www.ajpmonline.org
DISCUSSION
This research provides a national description of nonfatal,
ED-treated injuries occurring to U.S. LEOs between 2003
and 2014. Nonfatal injury rates for LEOs remained high
compared with all other U.S. workers, and these rates
increased from 2007 until 2011. This trend was divergent
from the trend for all other U.S. workers, which
decreased significantly from 2003 to 2014. The increase
in nonfatal injury rates among LEOs may be driven by
the large and significant increase in assault-related
injuries that started in 2008 and continued until 2012.
Unfortunately, because of the break in injury event
coding in 2012, data on the cause of injuries cannot be
compared between 2011 and 2012.
This is the first study to demonstrate an upward
national trend in assault-related injuries among LEOs.
The primary database used to track assaults among LEOs
is the FBI’s Law Enforcement Officers Killed and
Assaulted, which is part of the Uniform Crime Report
data and has substantial limitations.
14
Per a former FBI
director, “Because reporting is voluntary, our data is
incomplete and therefore, in aggregate, unreliable ….”
15
Yet, studies have used the Law Enforcement Officers
Killed and Assaulted data to describe national trends and
may be reaching erroneous conclusions. For example,
Chang et al.
16
reported the number of police assaulted in
the line of duty decreased significantly from 2003 to
2011. Using data systems that rely on voluntary reporting
could provide misleading results compromising the
interpretations concerning police and civilian interac-
tions. The NEISS−Work data may reflect more valid
national nonfatal injury rates for LEOs. Although the
current study improves upon nonreporting and incom-
plete data biases, it is crucial to consider all possible
reasons for increases among assault-related injuries. One
potential theory is that the increase reflects changing
policies across the law enforcement community to better
document civilian−officer interactions. For example, one
such policy may require officers to visit EDs to document
a civilian encounter, regardless of the presence or severity
of the officer’s injury. A second hypothesis is that the
landscape of civilian−officer dynamics is changing.
It is no surprise that assaults are a leading injury for
LEOs. Officers can encounter highly unpredictable and
dangerous situations, making it difficult to fully plan
prevention strategies and tactics in advance.
17
Of the ten
risk factors for workplace violence, seven are applicable
to the law enforcement profession.
18
There is also
growing evidence that interactions between police and
the public may be changing. The FBI’s Assailant Study
interviewed officers and command staff in agencies
where an officer had been killed in the line of duty.
19
During these interviews, officers expressed concerns over
increasing interactions with people in drug-induced
states, an overall justification of violence against police,
and a perceived general public distrust in the police.
19
Also, a recent Pew Research Center national survey of
police officers showed that officers believe police−civilian
interactions have become more tense and 93% of police
officers are concerned about their safety on the job.
20
Although the understanding and prevention of fatal
shootings of LEOs is imperative, these findings on
nonfatal assaults among LEOs identify issues that are
equally deserving of inquiry. Police−citizen interactions
are dynamic social encounters where force can occur
when an officer seeks to maintain control during
resistance.
21,22
This resistance can range from passive
efforts, such as pulling away, to direct physical assaults
on officers.
20,21
The likelihood of injury to officers and
citizens depends partially on the level of resistance by the
citizen, as well as the force applied by the officer.
23
The
increase in assault-related injuries reported here may be
reflective of an increasing willingness of citizens to resist
officers. Conversely, it is possible that officers have
Figure 2. (A) Assault-related injury rates per 10,000 FTEs
among U.S. LEOs: NEISS—Work, 2003–2011. (B) Nonfatal
injury rates per 10,000 FTEs among U.S. LEOs for three
leading injury events: NEISS—Work, 2012–2014.
Note: Data points for each year are slightly adjusted to the right of the
corresponding year to aid visualization. Assault-related injury trend
examined with three hospitals from a single metropolitan area removed.
FTE, full-time equivalent; LEO, law enforcement officer; NEISS, National
Electronic Injury Surveillance System.
Tiesman et al / Am J Prev Med 2017;](]):]]]–]]] 5
]2017
become more inclined to use greater force in their
encounters with citizens. A complete understanding of
the dynamics of police encounters that result in force is
critical to effectively reduce assault-related injuries to
LEOs, as well as associated injuries to citizens. If violence
against LEOs is increasing, many questions remain,
including how violence impacts the profession of polic-
ing in general.
Recent data support the theory that the law enforce-
ment community has begun to engage in “de-policing,”
or a reduction in policing duties.
24
Seventy-two percent
of officers in the Pew study reported they were less
willing to stop and question suspicious people, and 76%
were reluctant to use force even when it was appropriate
to do so.
20
Another study of more than 100 agencies in a
single state found that officers were making significantly
fewer vehicle stops and searches in 2015 compared with
2014.
24
Although available studies have not shown a
connection between de-policing strategies and overall
crime rates, it is yet to be determined whether de-policing
strategies and the severity and frequency of officer
injuries may be associated.
24,25
Also, there has been
increased scholarly interest in officer injuries following
high-profile use-of-force events, such as what occurred in
Ferguson, Missouri in 2014.
26
More specifically, in recent
years, is there an increased willingness among citizens to
resist or assault officers?
26
It is important to note that the
time frame under examination in the current study does
not overlap with these use-of-force events.
Limitations
There are limitations to these data. First, NEISS−Work
does not use a standardized coding system for occupation
or industry; therefore, a systematic case-finding method-
ology was used to identify LEOs. Because this approach
erred on specificity over sensitivity, it is possible that
some LEOs were missed. Also, the injury incident
variable was used to define cases when other employment
variables were missing. This may have inflated the
number of assault-related cases because cases were
included if they involved suspect-related activities. Sec-
ond, LEOs may visit EDs for minor injuries to fully
document use of force incidents. If so, these results may
be overestimates of nonfatal injury rates. On the other
hand, because NEISS−Work only collects ED data, it
excludes injuries seen in other medical venues; therefore,
these results could also underestimate the true rates.
Finally, NEISS−Work does not collect standardized
information on confounding factors, such as rank,
work conditions, lifestyle factors, physical or mental
comorbidities, and the use of certain tactics and
equipment.
CONCLUSIONS
Although officer fatalities are fairly well documented,
nonfatal injuries are harder to define, capture, and study
from a national perspective. The few efforts to do so have
been limited. This study demonstrated that nonfatal
injury rates for LEOs remain quite high compared with
all other U.S. workers, in spite of a decline in overall
worker rates. Additionally, nonfatal injury trends for
LEOs increased from 2007 to 2011, and this increase
appears to have been driven primarily by assaults.
However, it cannot be determined if this significant
increase indicates a more dangerous risk environment
for officers or other potential reasons, such as simply
policy changes that required LEOs to visit EDs to
document police–civilian encounters. A more thorough
analysis is underway to answer these questions. Although
it may be premature to recommend the implementation
of approaches to mitigate assaults occurring to LEOs, it is
important to note that studies of how policing tactics
impact both officer and civilian injuries are virtually
nonexistent. Both citizens and LEOs are impacted by
violence, and evidence-based policing is vital to the
health and safety of both.
27
A more complete under-
standing of policing procedures and tactics that are truly
evidence-based is needed.
ACKNOWLEDGMENTS
The findings and conclusions in this report are those of the
authors and do not necessarily represent the views of the
National Institute for Occupational Safety and Health (NIOSH).
Mention of any company or product does not constitute
endorsement by NIOSH. In addition, citations to websites
external to NIOSH do not constitute endorsement of the
sponsoring organizations or their programs or products. Fur-
thermore, NIOSH is not responsible for the content of these
websites. All web addresses referenced in this document were
accessible as of the publication date.
The authors of this manuscript do not have any conflicts of
interest or financial disclosures.
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