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R E S E A R C H A R T I C L E Open Access
Walking barefoot vs. with minimalist
footwear –influence on gait in younger
and older adults
Evi Petersen
1*
, Astrid Zech
2
and Daniel Hamacher
2
Abstract
Background: In recent years, minimalist footwear has been increasingly promoted for its use in sportive and
recreational activities. These shoes are considered to function naturally like barefoot walking while providing a
protective surface. Despite a growing popularity of these shoes in the older population, little is known about the
influence of minimalist footwear on gait patterns. This study investigated whether overground walking with minimalist
shoes is comparable to barefoot walking regarding gait stability and variability parameters.
Methods: In a randomized within-subject study design, 31 healthy younger (29 ± 4 years) and 33 healthy community-
dwelling older adults (71 ± 4 years) volunteered. Participants walked on flat ground, once barefoot and once with
minimalist shoes. Gait variability of minimum toe clearance (MTC), stride length, stride time, and local dynamic gait
stability were analysed.
Results: The results for both age groups showed significant condition effects (minimalist shoes vs. barefoot walking)
for the outcomes of local dynamic stability (p=.013),MTCvariability(p= .018), and stride length variability (p<.001)
indicating increased local dynamic stability and decreased gait variability during the minimalist shoe condition. Group
effects (young vs. older adults) were detected in all gait outcomes.
Conclusion: Walking with minimalist shoes appeared to be associated with better gait performance than walking
barefoot in both age groups. Thus, walking with minimalist shoes is not similar to barefoot walking. With respect to
reducing the risk of falling, we suggest that minimalist shoes could be an alternative to barefoot walking or a transition
option between shoes to barefoot for older adults.
Keywords: Elderly, Community-dwelling, Inertial sensors, Leguano, Minimalist shoes, Barefoot
Background
Bipedal gait is one of the most fundamental sensori-
motor tasks performed every day [1]. Especially in older
adults, a well-functioning gait pattern is recognized to
be essential for autonomous participation in daily life
[2]. With an increase in age, however, deficiencies in gait
frequently evolve while the risk of falling increases [3].
Due to degenerative processes of the neuromuscular sys-
tem and other age-related adaptations, older adults typ-
ically exhibit the following gait characteristics: (i) a
wider stance and extended bipedal ground contact with
shorter steps [4] as well as (ii) a diminished swing phase
[5]. Besides internal factors, evidence reveals that foot-
wear as an external criterion has a significant impact on
the gait pattern [6,7].
Footwear has been implicated as a factor in falls, which
again is a crucial issue affecting health and quality of life
in older adults [8,9]. In relation to this, older adults are
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
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data made available in this article, unless otherwise stated in a credit line to the data.
* Correspondence: evi.petersen@usn.no
1
Institute of Sports, Physical Education and Outdoor Life, University of
South-Eastern Norway, Bø and Telemark, Norway
Full list of author information is available at the end of the article
Petersen et al. BMC Geriatrics (2020) 20:88
https://doi.org/10.1186/s12877-020-1486-3
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
often advised to wear shoes with low heels and firm slip-
resistant soles [10]. McKeon et al. [11] noted that per-
manent support to the foot might result in degenerative
efficiency in foot muscles and sensitivity, and therefore
carry a potential of adverse effects on the gait pattern.
Accordingly, [11] suggest that walking barefoot is less
restricting for motion control, which increases the sensi-
tivity of the sensory mechanisms and activates the foot
and lower leg muscles. Both sensory feedback sensitivity
[12] and increased foot strength [13] showed to improve
balance in older adults, and are therefore significant pre-
dictors in the prevention of falls. Thus, barefoot walking
might result in beneficial effects on sensorimotor
control.
In recent years, minimalist footwear (characterized by
light weight, high flexibility and absence of cushioning
material) has been increasingly promoted for its use in
sportive and recreational activities. Wear of such foot-
wear has been shown to be closely related to barefoot
running conditions [14–16]. Therefore, it considered to
function naturally like barefoot walking while providing
a protective surface. Despite the growing popularity of
these shoes in the older population, little is known about
the influence of minimalist footwear on gait patterns
and performance [17,18]. In relation to this, local dy-
namic gait stability, as well as gait variability measures,
were associated with gait performance and the likelihood
of falling [19,20]. More specifically, measures of local
dynamic gait stability (LDS) are capable of distinguishing
between cohorts of younger and older adults, while
lower levels of LDS are associated with a higher risk of
falling [21]. Furthermore, the minimum foot clearance
(MFC) variability is a promising gait variable that can
predict the risk of falling, with greater variabilities of
MFC indicating a higher risk of falling [22].
In conclusion, walking with minimalist shoes seems
to merge the positive effects of barefoot walking while
providing a protective surface. However, the effects
on the gait pattern were not sufficiently studied yet.
Consequently, the primary aim of our study was to
investigate if overground walking with minimalist
shoes is comparable to barefoot walking regarding
gait stability and variability. A study by Smith et al.
[23] showed that minimalist shoes provided better
overall and anterior-posterior static balance than
walking barefoot. Additionally, [17]suggestedthat
wearing minimalist shoes could provide benefits of
barefoot walking in respect to fall prevention, while
simultaneously offering some protection and support
to the feet. Therefore, we predicted that overground
walking with minimalist shoes is associated with
higher gait stability and lower gait variability. We fur-
thermore analyzed whether this relationship is similar
in young and older adults.
Methods
Participants
In a randomized within-subject study design, gait data of
31 healthy younger (17 female, 14 male, age: 29 ± 4 years;
BMI: 23 ± 2) and 33 healthy community-dwelling older
(20 female, 13 male, age: 71 ± 4 years; BMI: 27 ± 4) par-
ticipants were collected. We advertised in the local
newspaper and at a local sport club to recruit the partic-
ipants of this study.
Inclusion criteria were the age of ≤35 years for the
younger group and ≥65 years for the older group. Partic-
ipants had to be able to walk throughout 5 minutes
without the need to pause or the use of assisting equip-
ment. Additionally, participants had to be unfamiliar
with regular barefoot walking or walking with minimalist
shoes. Any self-reported motor-functional impairments
that could affect gait performance, such as acute muscu-
loskeletal disorders or neurological diseases, led to ex-
clusion from the study. All subjects provided their
written informed consent to their voluntary participation
in this study as well as their allowance for publication,
which has been approved by the local ethics committee
(protocol no. FSV 16/13) and followed the principles of
the Helsinki Declaration.
Testing procedure
To capture kinematic data, wireless inertial sensors
(MTw2, Xsens Technologies B.V., Enschede, The
Netherlands, range of measurement of angular velocity: ±
1200 deg/s, sampling rate: 100 Hz) were attached to the
participants’right forefeet using tape. The participants
were block randomized to the different test condition se-
quences by using the computer-based program Research
Randomizer (https://www.randomizer.org/). Further, par-
ticipants were asked to walk at their preferred walking
pace back and forth on a 25 m track inside a sports hall
with flat ground. The following test conditions were per-
formed in a randomized and balanced order: 1) barefoot
walking and 2) walking with minimalist shoes (leguano
classic, leguano GmbH, Buchholz, Germany; material:
53% polyamide, 38% lyocell, 7% polypropylene, 2% elas-
tane, Sole: 100% LIFOLIT®). Participants walked for 3 mi-
nutes under each condition. The resting time between the
test conditions was 5 minutes. Prior to each of the testing
conditions, participants walked for approximately 1 mi-
nute back and forth the track to familiarize themselves
with the corresponding test condition and to improve reli-
ability [24].
Data analysis and statistics
The data analysis included gait variability measures as
well as the local dynamic gait stability for which the lar-
gest Lyapunov exponent (λ) was calculated. We removed
the first strides (from the start to the first turn after 25
Petersen et al. BMC Geriatrics (2020) 20:88 Page 2 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
m) of each trial as well as the last strides (from the last
turn to the stop) to avoid possible transients, e.g. to
analyze steady-state gait [25]. Furthermore, we removed
the first 2.5 m of each section between two successive
turns to exclude the acceleration periods after turning
[26]. To account for possible deceleration periods before
turning, the last 2.5 m were excluded from the subse-
quent analysis as well. At least 50 strides should be ana-
lyzed for gait variability measures [27]. In this study, the
first 80 valid strides within each trial were analyzed.
To calculate the gait measures a) stride length, b)
stride time and c) minimum toe clearance (MTC), we
used a published algorithm [25]. As gait variability mea-
sures, the intraindividual standard deviations of each gait
measure were analysed. To quantify λ,we time-
normalized the three-dimensional angular velocity data
of the 80 valid strides to 8000 samples. To reconstruct
the state space, we applied the embedding approach.
The time delay (9 samples) and the embedded dimen-
sion (dE = 6) were determined, using the first minimum
mutual information [28] and the global false nearest
neighbors method, respectively [29]. The λwas deter-
mined using the Rosensteins algorithm [30], which we
implemented in MATLAB (version 2016a, TheMath-
Works BV, Natrick, USA). The Euclidean distance of
each nearest neighbor state space was tracked while the
mean of the logarithm of the divergence curve was
calculated. λis defined as the slope (linear fit) through
0–0.5 strides. The implementation was validated previ-
ously [25]. Using IBM SPSS Statistics (V 21.0) for all
statistical procedures, a two factor (condition: barefoot
and minimalist footwear; age: younger and older adults)
variance analysis with repeated measures was applied to
identify differences across the two conditions.
Results
As Fig. 1illustrates, the results show significant condi-
tion effects (minimalist shoes vs. barefoot walking) for
the outcomes of local dynamic stability (p= .013, partial
η
2
= 0.10), MTC variability (p= .018, partial η
2
= 0.09),
and stride length variability (p< .001, partial η
2
= 0.26).
These outcomes indicate increased local dynamic stabil-
ity (lower largest Lyapunov exponent) and decreased gait
variability during the minimalist shoe condition. There
was no condition effect on stride time variability. Group
effects (young vs. older adults) in all gait outcomes
(LDS: p< .001, partial η
2
= 0.30; MTC variability:
p= .006, partial η
2
= 0.12; stride length variability:
p= .004, partial η
2
= 0.13; stride time variability:
p= <.001, partial η
2
= 0.26) were found. These effects in-
dicate better LDS in younger participants and, surpris-
ingly, better (lower) gait variability in older participants.
There was no significant interaction effect between the
walking condition and the group condition.
Fig. 1 Gait stability and variability in younger and older adults –barefoot vs. minimalist shoes
Petersen et al. BMC Geriatrics (2020) 20:88 Page 3 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Discussion
To the best of our knowledge, this is the first study that
investigated whether overground walking with minimal-
ist shoes is comparable to barefoot walking regarding
gait stability and variability parameters in both younger
and older adults. Current research discussed the use of
minimalist shoes as an alternative to barefoot running or
a method of transitioning between shod and barefoot
running for athletes [23]. Overall and valid for both age
groups, our results suggest that walking with minimalist
shoes is associated with better gait stability and variabil-
ity measures, thus, with a lower risk of falling [21,22].
Consequently, walking with minimalist shoes is not simi-
lar to barefoot walking, and the positive effects of bare-
foot walking [11] are not necessarily generalizable to
walking with minimalist shoes.
In order to reduce the risk of falling, we suggest that
walking training with minimalist shoes could be an alter-
native to barefoot walking or a transition option between
shoes to barefoot for older adults. Our proposition is in
line with [17], who state that wearing minimalist shoes
could provide benefits of barefoot walking in respect of
fall prevention, while simultaneously offering some pro-
tection and support to the feet. Further, wearing minim-
alist shoes might help older adults to overcome different
barriers, which are associated with walking barefoot.
Often reported barriers are being ashamed of one’s own
feet, fear of falling or fear of instability as well as the
sense of having cold feet [10,31].
Research on younger adults and children [15] showed
that barefoot training can result in long-term outcomes,
such as reduced ankle dorsiflexion at foot strike. That
points to the prospect that wearing minimalist footwear
regularly could have a positive impact on reducing the
risk of falling. In one of their recent studies, Franklin
et al. [32] investigated whether wearing minimalist shoes
daily for 4 months could lead to improvements in bal-
ance and foot strength, which are both critical variables
concerning a functional gait pattern. Preliminary results
show that training with minimalist shoes can improve
both parameters and thereby emphasize the potential of
minimalist shoe use to reduce the risk of falling. That is
in line with our results, which show that the use of min-
imalist shoes improved gait stability compared to bare-
foot walking.
We found less LDS in older adults compared to youn-
ger adults. This outcome has been frequently reported
[19–21]. In contrast, it is surprising that older adults
showed better (lower) gait variability than younger
adults. A recent study by Hamacher et al. [33] reported
similar outcomes. In their study, younger and older par-
ticipants walked in their own shoes; however, the same
system and algorithms were applied [33]. In the current
study, younger adults show a much higher MTC, stride
length and stride time variability during barefoot walking
and walking with minimalist shoes compared to the
younger participants of [33], walking in their own shoes.
The older adults of the current study, on the other hand,
show only a minor increase in gait variability compared
to the older participants of the other study. We conclude
that the group effect of the gait variability measures
could be the result of younger adults adapting more
quickly to an unfamiliar walking condition (walking
barefoot / walking with minimalist shoes) to maintain
local dynamic stability. This effect seems to be less pro-
nounced in older adults. Since this is speculative, more
research is needed to investigate the issue.
Study limitations and future research implications
We want to acknowledge four main study limitations.
First, this research involved healthy community-dwelling
older adults. Therefore, our current findings may not
apply to older adults with health issues or already exist-
ing impairments. Most older adults have a higher risk of
falling when confronted with existing dysfunctions con-
cerning the gait pattern [34]. This fact points to the po-
tential of future research within clinical settings.
Second, the participants of this study did not walk in their
own shoes. Implementing this third condition to the testing
procedure could have revealed more knowledge of how
minimalist shoes influence gait in comparison to normal
shoes, which are worn in daily life. Additionally, it would
have made our results even more comparable to other stud-
ies. However, this question was not subject of our current
study. We also ran our tests for only one type of minimalist
shoe. Considering the growth of diversity in products, we
encourage future research to compare the influence of dif-
ferent minimalist footwear as well as to include aspects of
practicability regarding minimalist shoes for older adults.
Third, the application side in this study was a gym,
proving a flat ground. Thus, our findings are limited to
overground walking on an even surface. According to
Zurales et al. [35], however, uneven surfaces are strong
predictors of falls among older adults. Additionally and
in line with Li et al. [36], falls occurred more often out-
doors than indoors among older adults. Thus, future re-
search should consider testing on an uneven surface, for
instance, outdoors.
Last, this study focused on short-term effects. We sug-
gest that future research should target long-term effects
of fall prevention training with minimalist shoes or ex-
tended periods of wearing minimalist shoes during daily
activity. Certainly, a systematic overview of the existing
literature would enrich this scope of research.
Conclusion
This study demonstrates for walking in a straight line on
flat ground that minimalist shoes, as compared to
Petersen et al. BMC Geriatrics (2020) 20:88 Page 4 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
walking barefoot, have significantly different effects on
gait and fall predicting parameters such as gait stability
(LDS) and variability (MTC). Effects were observed for
the group of younger as well as older adults. Walking
with minimalist shoes was overall associated with better
gait performance than walking barefoot. This finding
hence demonstrates the potential of minimalist shoes as
a means to prevent falls. We conclude that there is a
need for future research to investigate the benefits of
minimalist shoes for more complex walking tasks such
as walking on uneven ground. Further, the long-term ef-
fects of minimalist usage need to be explored, particulary
in relation to standard footwear. Simultaneously, we
make a call for a systematic review of the literature con-
cerned with minimalist footwear and the risk of falling.
Abbreviations
LDS: Local dynamic gait stability; MFC: Minimum foot clearance;
MTC: Minimum toe clearance; λ: Lyapunov exponent
Acknowledgments
We thank all participants of this study and the two reviewer.
Authors’contributions
EP, DH and AZ were all fully involved in the planning of the study and
preparation of the manuscript. EP collected the data for this study. EP and
DH wrote the first draft of the manuscript and AZ advised. Each of the
authors has read and concurs with the content in the final manuscript. The
author(s) read and approved the final manuscript.
Funding
This research did not receive any grant from funding agencies in the public,
commercial, or not-for-profit sectors.
Availability of data and materials
The dataset for this manuscript is not publicly available, however, requests to
access the datasets can be directed to Evi Petersen (evi.petersen@usn.no).
Ethics approval and consent to participate
All subjects provided their written informed consent to their voluntary
participation in this study and for the publication of their data. The study has
been approved by the local ethics committee of Faculty of Social and Behavioural
Sciences, Friedrich Schiller University Jena (protocol number: FSV 16/13) and
followed the principles of the Helsinki Declaration.
Consent for publication
Not applicable.
Competing interests
None. The authors declare that the research was conducted in the absence
of any commercial or financial relationships that could be construed as a
potential conflict of interest.
Author details
1
Institute of Sports, Physical Education and Outdoor Life, University of
South-Eastern Norway, Bø and Telemark, Norway.
2
Institute of Sports Science,
Friedrich-Schiller University of Jena, Jena, Thuringia, Germany.
Received: 13 May 2019 Accepted: 20 February 2020
References
1. Bramble DM, Lieberman DE. Endurance running and the evolution of
homo. Nature. 2004;432(7015):345–52.
2. Stolze H, Klebe S, Zechlin C, Baecker C, Friege L, Deuschl G. Falls in frequent
neurological diseases. J Neurol. 2004;251(1):79–84.
3. Maki BE. Gait changes in older adults: predictors of falls or indicators of fear?
J Am Geriatr Soc. 1997;45(3):313–20.
4. Judge JO, Davis RB 3rd, Ounpuu S. Step length reductions in advanced age: the
role of ankle and hip kinetics. J Gerontol A Biol Sci Med Sci. 1996;51(6):M303–12.
5. Jahn K, Zwergal A, Schniepp R. Gait disturbances in old age: classification,
diagnosis, and treatment from a neurological perspective. Dtsch Arztebl Int.
2010;107(17):306–15 quiz 16.
6. Lord SR. Shoe characteristics and balance in older women. J Am Geriatr Soc.
1996;44(4):429–33.
7. Connell BR, Wolf SL. Environmental and behavioral circumstances associated
with falls at home among healthy elderly individuals. Arch Phys Med
Rehabil. 1997;78(2):179–86.
8. Lord S, Sherrington C, Menz H, Close J. Falls in older people: risk factors and
strategies for prevention. Cambridge: Cambridge University Press; 2007.
https://doi.org/10.1017/CBO9780511722233.
9. Bloch F, Thibaud M, Tournoux-Facon C, Brèque C, Rigaud AS, Dugué B, et al.
Estimation of the risk factors for falls in the elderly: can meta-analysis
provide a valid answer? Geriatr Gerontol Int. 2013;13(2):250–63.
10. Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Optimizing footwear for
older people at risk of falls. J Rehabil Res Dev. 2008;45(8):1167–81.
11. McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new
paradigm for understanding intrinsic foot muscle function. Br J Sports Med.
2014;49:290.
12. Machado ÁS, da Silva CBP, da Rocha ES, Carpes FP. Effects of plantar foot
sensitivity manipulation on postural control of young adult and elderly. Rev
Bras Reumatol Engl Ed. 2017;57(1):30–6.
13. Spink MJ, Fotoohabadi MR, Wee E, Hill KD, Lord SR, Menz HB. Foot and
ankle strength, range of motion, posture, and deformity are associated with
balance and functional ability in older adults. Arch Phys Med Rehabil. 2011;
92(1):68–75.
14. Perkins KP, Hanney WJ, Rothschild CE. The risks and benefits of running
barefoot or in minimalist shoes: a systematic review. Sports Health. 2014;
6(6):475–80.
15. Hollander K, Heidt C, Van Der Zwaard B, Braumann KM, Zech A. Long-term
effects of habitual barefoot running and walking: a systematic review. Med
Sci Sports Exerc. 2017;49(4):752–62.
16. Jenkins DW, Cauthon DJ. Barefoot running claims and controversies: a
review of the literature. J Am Podiatr Med Assoc. 2011;101(3):231–46.
17. Franklin S, Grey MJ, Heneghan N, Bowen L, Li FX. Barefoot vs common
footwear: a systematic review of the kinematic, kinetic and muscle activity
differences during walking. Gait Posture. 2015;42(3):230–9.
18. Broscheid KC, Zech A. Influence of barefoot, minimalist, and standard
footwear conditions on gait and balance in healthy older adults. J Am
Geriatr Soc. 2016;64(2):435–7.
19. Bruijn S, Meijer O, Beek P, Van Dieën J. Assessing the stability of human
locomotion: a review of current measures. J R Soc Interface. 2013;10(83):
20120999.
20. Hamacher D, Singh N, Van Dieen J, Heller M, Taylor W. Kinematic measures
for assessing gait stability in elderly individuals: a systematic review. J R Soc
Interface. 2011;8(65):1682–98.
21. Hamacher D, Hamacher D, Singh NB, Taylor WR, Schega L. Towards the
assessment of local dynamic stability of level-grounded walking in an older
population. Med Eng Phys. 2015;37(12):1152–5.
22. Barrett R, Mills P, Begg R. A systematic review of the effect of ageing and
falls history on minimum foot clearance characteristics during level walking.
Gait Posture. 2010;32(4):429–35.
23. Smith BS, Burton B, Johnson D, Kendrick S, Meyer E, Yuan W. Effects of
wearing athletic shoes, five-toed shoes, and standing barefoot on balance
performance in young adults. Int J Sports Phys Ther. 2015;10(1):69.
24. Hamacher D, Hamacher D, Krowicki M, Schega L. Between-day test–retest
reliability of gait variability in older individuals improves with a
familiarization trial. Aging Clin Exp Res. 2017;29(2):327–9.
25. Hamacher D, Hamacher D, Taylor WR, Singh NB, Schega L. Towards clinical
application: repetitive sensor position re-calibration for improved reliability
of gait parameters. Gait Posture. 2014;39(4):1146–8.
26. Lindemann U, Najafi B, Zijlstra W, Hauer K, Muche R, Becker C, et al. Distance
to achieve steady state walking speed in frail elderly persons. Gait Posture.
2008;27(1):91–6.
27. König N, Singh NB, Von Beckerath J, Janke L, Taylor WR. Is gait variability
reliable? An assessment of spatio-temporal parameters of gait variability
during continuous overground walking. Gait Posture. 2014;39(1):615–7.
Petersen et al. BMC Geriatrics (2020) 20:88 Page 5 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
28. Fraser AM, Swinney HL. Independent coordinates for strange attractors from
mutual information. Phys Rev A Gen Phys. 1986;33(2):1134.
29. Kennel MB, Brown R, Abarbanel HD. Determining embedding dimension for
phase-space reconstruction using a geometrical construction. Phys Rev A.
1992;45(6):3403.
30. Rosenstein MT, Collins JJ, De Luca CJ. A practical method for calculating
largest Lyapunov exponents from small data sets. Physica D. 1993;65(1–2):
117–34.
31. Mitty E. Nursing Care of the Aging Foot. Geriatr Nurs. 2009;30(5):350–4.
32. Franklin S, Grey MJ, Li F-X. Do minimalist shoes improve balance and foot
strength in older adults? Footwear Sci. 2017;9(sup1):S39–40.
33. Hamacher D, Hamacher D, Müller R, Schega L, Zech A. The effect of a
cognitive dual task on the control of minimum toe clearance while walking.
Mot Control. 2019;00:1–10.
34. Davis A, Haines T, Williams C. Do footwear styles cause falls or increase falls
risk in healthy older adults? A systematic review. Footwear Sci. 2019;11(1):
13–23.
35. Zurales K, DeMott TK, Kim H, Allet L, Ashton-Miller JA, Richardson JK. Gait
efficiency on an uneven surface is associated with falls and injury in older
subjects with a spectrum of lower limb neuromuscular function: a
prospective study. Am J Phys Med Rehabil. 2016;95(2):83.
36. Li W, Keegan THM, Sternfeld B, Sidney S, Charles P, Quesenberry J, Kelsey JL.
Outdoor falls among middle-aged and older adults: a neglected public
health problem. Am J Public Health. 2006;96(7):1192–200.
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