"There seems to be a small group of expert witnesses who often condemn parents. As for that visit on the 22 September, the Health Visitor said that S was not distressed as far as she could recall.18. Ms Soffa has gone to considerable lengths and much detail to expose what are submitted as matters on which I should mistrust the evidence of the parents or confer on their evidence only little weight. Subscribe for updates and offers on new events for your specialty. The family's nightmare began one night in July 2005 when, at three months old, William woke up in pain. S would often cry and it was initially believed that this was due to her suffering from colic. Stream every session from the webinar for up to 90 days. Consistent with this, the father described a happy baby in the first two weeks of her life. To summarise further, I have noted the pattern of the family's care for the children and reviewed the detail of the entries in the GP records which record S's progress and visits with the record of her developing a tendency to cry a lot from 17th August 2011 and the advice that it was possibly colic; the parents' use of Infacol and S's response to that. 36. Excellent peer interaction and collaborative learning. 54. I noted from her evidence that she was concerned about and focused on the wellbeing of S. It appears that she was the first to notice distress in S; that she appeared to advise that the parents attend a doctor for every aspect of S's wellbeing. I noted in relation to the mother that she gave her evidence calmly, she was quietly spoken, she gave direct and straight answers, she was composed and it appeared that her answers came from her genuine recollection without her giving what might have been expected answers. The final section details the imaging findings in a wide variety of clinical conditions. 8. Their most recent appointment, in our records, was to DR K JOHNSON LIMITED on 2015-08-17. 15. Within each chapter there are three consistent sections. This is case-based course designed for all General Radiologists and Radiologists based at the DGHs who are increasingly having to report paediatric imaging, an opportunity to attend a complete update of the main key topics on 3 consecutive days a complete CPD package. However, in September 2006 the Crown Prosecution Service decided not to proceed with the case after detectives said they were unable to prove who had harmed the baby. The father said in evidence that her crying was first mentioned then, although there is no entry about it in the record, but the following record in the GP Notes does suggest that the Health Visitor had "advised giving her Infacol" at this point, so it probably was raised then. Apyrexial. It is very easy to try and fill those areas of ignorance with what we know but I think that it is very important to accept that we do not necessarily have a sufficient understanding to explain every case.". Further X-rays revealed what appeared to be three more fractures and an injury to his arm. But in the light of all that is known about the parents and from my impression of them in evidence balanced against all that is submitted and produced by the local authority it is not likely, in my judgment, that her injuries were caused by non-accidental force. ,(`df\CT&B6+c! 42. I have noted the reference to Lancashire County Council v B [2000] AC 147. This further hearing took place on 24th October 2012.08. 135; "There are areas of ignorance. They could offer no explanation as to how the fractures may have happened. She moved back to London, to Great Ormond Street Hospital and the Institute of Child Health, where she obtained a PhD for her thesis, Optimisation of the digital radiographic imaging of suspected non-accidental injury, then returned to Sheffield as a HEFCE-funded Clinical Senior Lecturer in the Academic Unit of Child Health. As a result of her expertise she receives both regional and national referrals for review of musculoskeletal imaging from radiological and clinical colleagues with an emphasis on imaging in cases of suspected inflicted injury. I return to consider T and his behaviour later in this judgment.12. 50. I found Professor Nussey to be highly knowledgeable in his field; careful; and able to consider and assist the court on all matters put to him. Dr. Johnson is presently the Chair of the British Society of Paediatric Radiology. Catch-up service: Paediatric Radiology 2022, Catch-up now with our case-based Paediatric Radiology webinar that took place in February 2022. 012 133. Had an instructive and engaging educational experience. "Unfortunately the job of social workers is to think the unthinkable because sometimes terrible things happen. 4. 2018 Karen Johnson Andrea Schnell, a Internist practicing in Madison, WI March 27, . He has co-authored over 35 peer reviewed papers. 37. So the records engage even closer scrutiny. The father's evidence was that during the morning she had cried more than normal and he confirms that she was "grumpy and crying". In all sections, the value of all imaging modalities are stressed. Print this page The local authority place considerable weight on the evidence of Dr Fairhurst as to the interpretation and significance of the X-rays, the report of 13th February 2012 and the evidence as to the mechanism of injury in relation to spiral fractures, metaphyseal fractures, fractures of the antero-lateral aspects of the ribs and a torus fracture raise very serious implications for the family members. 35. At one week she was seen by the Community Nurse and was reported to be "thriving, contented and settling well." The Court found that the medical evidence raised a substantial likelihood that the injuries were caused non accidentally and by force used by at least one of the adult members of the household. At that point a number of problems faced the court. She refers to the fact that in relation to allegation 3, 4, 5 and 6 the mother had noticed the child's discomfort and taken S to the Medical Centre and then on to the Accident and Emergency Unit at the local hospital where S was examined by a paediatrician and X-rayed, following which she was told that everything was normal and she was discharged. Three days: 375 | Two days: 295 | One day: 175 At 22.30, a further medical clinician's note was written, although the authorship is not clear. But during the family court proceedings serious doubts were cast on Dr Johnson's evidence by other medical experts. Dr Neil Stoodley, Consultant Neuroradiologist, Bristol Royal Hospital for Children Dr Musa Kaleem, Consultant Paediatric Radiologist, Alder Hey Children's Hospital, Liverpool Dr Karl Johnson, Consultant Paediatric Radiologist, Birmingham Children's Hospital Dr Sally Old, Medical Defence Union It was the maternal grandmother's view that her daughter and son-in-law did not injure S. The maternal grandmother also mentioned that she had cared for her own children, relatives and grandchildren and was capable of ensuring that children are properly and safely cared for. When the cause of his pain could not be found, they took him back twice more. Find Dr. Thomas's phone number, address, hospital affiliations and more. Displaying companies where the director has shareholdings or significant control. He appeared to be frank and open in his answers and not devious. The local authority sought findings that the injuries had occurred non accidentally with the parents and grandmother as possible perpetrators. an improved understanding of Paediatric imaging interpretation and reporting skills. She refers to the times when S was seen by the health visitor when, despite the presence of fractures, nothing untoward was seen on as she puts it 25th July 2011, 3rd August 2011, 22nd September 2011, 19th October 2011 and 20th October 2011. The judgment that I gave that day is subsumed into this fuller judgment of the court.02. It is not possible to know which incidents or movements caused or gave rise to force sufficient to bring about fractures. Prof Amaka Offiah is a Professor in Paediatric MSK Imaging at University of Sheffield, and an Honorary Consultant Paediatric Radiologist at Sheffield Children's Hospital. On the contrary, the evidence appears to demonstrate that the parents had the wellbeing of S in mind and acted to seek medical attention. At hospital on Saturday 22 October 2011 at 15.30, the triage nurse noted the presenting complaint as "swelling to the left upper arm" and "since Thursday, increased crying". The local authority took action on 26th October 2011 after the Consultant Paediatrician concluded that there must be a high level of suspicion in the absence of explanation of the injury to the left arm that the humeral and left rib fractures may have been sustained as a result of a non-accidental injury. There was an additional right wrist fracture which was difficult to date. I have heard the evidence of the experts as follows: (1)Dr Fairhurst, consultant paediatric radiologist, and read her reports, notably that of 13th February 2012; (2) A Consultant Paediatrician and his report of 5th March 2012; (3) I have heard the evidence of Professor Steven Nussey, Professor of Endocrinology, and read his reports of 10th and 22nd July 2012; (4) I have heard the evidence of the mother; the father; and the grandmother, and read their statements filed in this case; (5) I have heard the evidence of the health visitor. Interactive case-based approach using a powerful online DICOM viewer to maximise learning. Nor is it possible to conclude at what point 'normal day to day handling' a vague phrase at best, and which must include the use of reasonable force and pressure at times crosses over to the point where S's vulnerable bone structure was compromised and exceeded. Tell us your views in a simple 5 minute survey to help us make the service even better. I have examined the process by which the fractures were discovered and that it was not until the report of Dr Fairhurst, consultant paediatric radiologist, of 13th February 2012 that the full extent of the injuries alleged to have been sustained by S were revealed and her report included three new areas of injury not seen or confirmed by earlier reports. S's Vitamin D levels were borderline on 2.11.11 and were never higher than insufficient. Specialties The conclusions are positive. Dr. Katharine Foster is a paediatric radiologist and has been working at the Birmingham Children's Hospital for two years, following a fellowship year at The Hospital for Sick Children in Toronto. I gave a short judgment identifying the difficulties in which the paediatrician found himself in dealing with the analysis of Vitamin D deficiency/insufficiency which was outside his expertise and which presented a substantial difficulty in the case. While one might have looked for the possibility that in a moment of weakness or exasperation they might have snapped, or when the mother might have momentarily lost her self-control, particularly with a baby who cried persistently, that at least one fracture might have resulted, but for S to be shown with six sets of fractures, three constellations, requiring the sort of force and violence that Dr Fairhurst described, appears to be completely and demonstrably alien to the sort of people the parents and the grandmother appear to be. On Wednesday 19 October 2011, S was seen at the clinic to be weighed. Find Dr. Jackson's phone number, address, hospital affiliations and more. Mrs K Oestreich Prof T Southwood Dr Karl Johnson: Tumour Clinic (LTB Clinic) Tuesdays once per month: Ms Baldrighi: The Transition Clinic : Four to six times per year at Queen Elizabeth Hospital on a Tuesday morning : . The maternal grandmother's position can most usefully be seen as set out in her position statement of 12th March 2012. This person was born in December 1965, which was over 57 years ago. The Father said in evidence that when the hospital phoned on Monday morning, his wife told them that S was "fine".21. Upper limb rheumatology/radiology MDT: . The record confirms the father's account that they had been advised to use Infacol, had done so and that it was not working. This led them to suspect that he may have caught his right leg between the bars of his cot and the mattress of their own bed, causing him to fracture it as he struggled to pull it clear. I have also noted the case of Re S-B (Children)(Care proceedings; standard of proof) [2009] UKSC 17 and particularly the passage in which their Lordships confirmed that the simple balance of probability test following the House of Lords decision in Re B (above) should be applied in finding that a person was the perpetrator of an injury, confirming the approach where the evidence falls short of that standard in North Yorkshire County Council v SA [2003] EWCA Civ 839 to the effect that an individual will be found to be a possible perpetrator if the evidence establishes a 'real possibility' that they caused the injury. Left upper arm fracture, a spiral fracture of the distal shaft of the left humerus (16th-19th October 2011). Dr. Helen Williams is a full time general paediatric radiologist, and has special interests in cross-sectional imaging, feeding studies and radiology training. Presentations are kept to the minimum and then you'll be into the fully featured cloud based DICOM viewer, looking at cases, feeding back your findings using our interactive tools. Her expertise within paediatric radiology covers the full range of imaging modalities including plain X-ray, ultrasound, fluoroscopy, CT, MRI, and nuclear medicine. BSc, MBBS, MRCP, FRCR, PhD, FHEA hmk0^g? Dr. Robert H. Thomas is a Radiologist in Birmingham, AL. I have considered the findings invited by the local authority as to the evidence of the family members, the inconsistencies, alleged inaccuracies and inferences that I am invited to draw from them. She also asserted that in her view there was no correlation between Vitamin D deficiency and fractures nor was there an increased propensity to fracture due to a Vitamin D deficiency. Her parents returned with S on 22.10.11 with a swollen arm. The GP's entry records "crying, excessive ? Birmingham, 012 133 Show number Centro mdico: Birmingham Children'S Hospital, Birmingham Do you wish to correct the information? In surveying the 'wide canvas' further, I take into account the evidence of Professor Nussey because the manifest injuries do call for explanation. Dr. Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. That aspect is not mentioned. Because William's parents were unable to explain the fracture the hospital deemed the case suspicious and called in social services. What has emerged is that none of the adults present could provide any instance of anything done to S by themselves or the other adult members of the family, or which had befallen her, which would explain the fractures. Professor Nussey reported on 10th July but in time for the resumed hearing of the matter on 25th 26th and 27th July. The burden of proof lies on the local authority and they have to satisfy the court on the balance of probabilities: see Re B (Care proceedings; standard of proof) [2008] UKHL 35. Metaphyseal fracture of the proximal left tibia caused when (a) her left leg had been pulled and twisted by an adult carer; (b) any person present would be immediately aware she had suffered a significant injury with discomfort lasting several days. Naturally the Wards hoped social services would follow suit, but they were in for a shock. The Judge formed the view that the maternal grandmother was seeking to assist the Court in her evidence. Her research interests are in the imaging of suspected child abuse and skeletal dysplasias and in methods of determining which children have fragile bones prone to fracture and which do not. The evidence from the Health Visitor is that she would have been undressed for weighing and placed in the scales by her parents. S, it is stated, settled after being given Calpol following her vaccination on 20th October 2011. Birmingham Update in prostate cancer Topics to include: . Karl Johnson is a Consultant Paediatric Radiologist at Birmingham Children's Hospital, and has been there since 1998. Dr Paul Humphries, Consultant Paediatric Radiologist, Great Ormond Street Hospital and University College London 12:15 MSK MRI 2 - bone marrow Dr Karl Johnson, Consultant Paediatric Radiologist, Birmingham Children's Hopsital 13:00 Lunch 14:00 Abdominal MRI - techniques, common applications and This hearing has run over a prolonged period of months in the course of 2012; in particular because it encountered difficulties in the procurement of the services of one of the experts necessary to address the issues in the case, and also because of practical difficulties in the hearing itself in adducing the important evidence of the children's grandmother from Sri Lanka. sub-optimal bones that have not yet developed radiological signs of rickets; (6) I note that she was not in a position to give an expert opinion on metabolic bone disease which she identified as a very complex subject beyond the radiological aspect and that she would defer to a metabolic expert; (7) she accepted that the lack of evidence for fractures occurring in patients with lower than normal levels of Vitamin D (who did not have radiological evidence of rickets) is the current state of research and acknowledged that there is a need for more study to be done; she further accepted that this is a developing and controversial area of medicine; (8) I noted that it is accepted by all medical experts that it is unknown what level of force would be required to cause the injuries in a baby that had a Vitamin D deficiency or insufficiency; understandably it is not possible for experiments to be carried out. S had only been in the house with the parents, grandmother and T. Investigations were put in hand. Birmingham B4 6NH, Questionnaire for parents with children aged 5-9, Monday, Wednesday and Thursday/Friday afternoon, Four to six times per year at Queen Elizabeth Hospital on a Tuesday morning. 9. s Pediatric Diagnostic Imaging textbook is renowned as one of the oldest and most prominent general textbooks in the field of paediatric text consists of two reasonably sized volumes covering all key areas using an intuitive systems-based approach. Dr. Johnson is presently the Chair of theBritish Society of Paediatric Radiology. Country She obtained her MBBS while working at Oldchurch Hospital, Essex and trained as a radiologist in Sheffield. There were evident deficiencies in translation by the interpreter. Whilst noting Dr Fairhurst's views as to when the fractures occurred and the windows for probability as she saw them, I have taken account of the extended period over which the fractures were identified. (9) He anticipated that S's level was 30-35 when she was born, not adequate and markedly deficient. The father maintains that there could be some natural explanation for S's injuries.38. In relation to the spiral fracture of the distal shaft of the left humerus, the local authority allege that S's arm has been gripped and twisted by an adult carer; she would have shown immediate distress lasting 10-15 minutes; any regular carer would have noticed a change in her behaviour as a result of the fracture with discomfort which would last for up to a week. Attendance of the course includes access to the database of cases associated to this event on our server at PostDICOM. The maternal grandmother denied harming S and did not accept that her daughter or son-in-law would not do the same. . Within each chapter there are three consistent sections. Her evidence was that the earliest date for the rib fractures was 15 September, the latest date being the 28 September 2011. N and D appeared able to actively provide a high level of basic care for their children.'. Her responses in the Schedule point out that the allegations are made on the presumption that S did not have any genetic abnormality or bone disease. It is necessary to take account in combination with these reports of the dates provided by Dr Fairhurst for the occurrence of the various fractures to S, the clinicians' observations, also the X-ray and the report of nothing abnormal on 13 October 2011. I note the entry as follows: 'non-tender, baby permits passive manipulation. Mr Johnson, who is chairman of the British Society of Paediatric Radiology and works as a consultant at Birmingham Children's Hospital, told police that in his view William had suffered repeated fractures and had a history of being abused. I note at p. 3 the following: 'Children's Services have only become involved with this family since 23rd October 2011 therefore there has been limited time to complete any thorough assessment with regards to this family. The fractures to the right lower leg took place between 12th September and 10th October. The family are very close and have a loving relationship. Site map, Please rate your experience out of 5 (with 5 being the highest and 1 being the lowest), Birmingham Women's Hospital Dr Johnson, however, reported "a number of equivocal appearances on radiographs with respect to the left distal femur and proximal left tibia" and suggested further films. Finding of Fact Hearing in Respect of a Number of Fractures Sustained by S aged 3 months, On 13 October 2011 S was taken to hospital by her parents with a swelling to her left knee. He has a special interest in paediatric musculoskeletal disorders, in particular juvenile arthritis and non-accidental injury. But the drama turned into a nightmare when they were accused of having deliberately harmed their little boy. Considering all the evidence on the balance of probabilities I have come to the conclusion that the likely incidence of an increased vulnerability to fracture is the most likely cause of S's injuries. The GP was unable to identify the cause of William's pain, but on returning home the Wards noticed his leg was swollen. My close examination of this material has focused on the parents' accounts as well as on the evidence they have subsequently given about what they saw. Mindelsohn Way Dr. Gregory D. Jackson is a Radiologist in Birmingham, AL. Gordon Jeyes, director of children's services at Cambridgeshire county council until this year, defended his department's decision to press ahead with its application to remove William from his parents' care. I come to the conclusion that Dr Fairhurst's evidence as to the identification of the injuries is, taken as a whole, and in the light of all the evidence and my acceptance of Dr Fairhurst's evidence in her own field of specialism, reliable and acceptable. She was accompanied by both parents. UK based, CPD accredited, online courses for doctors in all of the major specialties, Navigation: Since the medical centre was closed, they took S to the local hospital.25. Akin, MD, Diagnostic Radio The father recalled that S "cried throughout", crying as soon as the examination started although the doctor carried on. However, the medical professionals did not note any problems with S on 20th October 2011 despite Dr Fairhurst's dating of the fracture between 16th October 2011 and 19th October 2011. I draw the conclusion that it is reasonable in S's case to assume that a lesser degree of force would be required if her bones were sub-optimal as a result of Vitamin D deficiency, which I am satisfied on the evidence that S's bones probably were, viz., Vitamin D deficient. T was described as "very attached to his mother" becoming jealous when mother was with S. He was described on examination as very active in clinic, playing with his sister and wanting to hold her. She said: "How could we celebrate that someone has decided you didn't hurt your child when you know all along you didn't? The father states that the fact that the parents and grandmother took S to A&E on 22nd October 2011 showed that they had noticed a change in her behaviour; they presented S to the local hospital having noticed a swelling to her left arm. So, as I review the evidence of the parents and the grandmother, it appears that there is a strong strain in the evidence that runs counter to the evidence and conclusions of Dr Fairhurst, producing by its weight and nature what I would regard as a substantial likelihood that this family would not perpetrate the sort of violence which according to the medical evidence of Dr Fairhurst and the Consultant Paediatrician must have been inflicted upon her. A diagnosis of OI (osteogenesis imperfecta) is exceptionally unlikely. He denies causing any of the injuries and in turn denies the specific causation of each injury. S has suffered multiple fractures which have occurred on at least three separate occasions. This judgment relates to the fact finding hearing concerned with the causation of a number of bone fractures sustained by S at about the age of three months. He noted that there is no uniformity of Vitamin D testing and it is difficult to measure. The appearance and identification of the fractures themselves has only emerged after the examination of the x-rays by a number of clinicians. (Orders made included discharge of interim Care Order and approval of revised care plan for phased return of S to the care of her parents. The maternal grandmother had not witnessed T intentionally being rough or boisterous towards S and had not witnessed him attempting to hold S or pick her up. Book reviewed by Sana Ali, ST5 paediatric radiology, and Dr Karl Johnson, 's Hospital. As to the possibility that rough handling by T might have been responsible for S's injuries, he concluded that while it would be possible he did not think it was probable. 43. If no better, to review or sooner at any time if concerns'. Both gave compelling evidence that, in particular, the rib fractures suffered to the baby could only be caused by " excessive/abusive squeezing" or "gripping of the chest". There is no evidence of drugs or alcohol abuse, of anger or violent outbursts, of short temper, volatility, irritability or dysfunction. All this with the inherent complexities of the medical evidence meant that much time was taken up and the father's evidence could not be taken until the court could reconvene on 12th September 2012. HkBsD R#\#[(!$D(AyLgtJ%{mc8zA&+;*JV [a%4[)Er_'! The father is unable to explain how S sustained the fracture to her left arm; however, he accepts that only he, mother and grandmother were caring for S during this time; he therefore accepts that this fracture would have occurred while S was in their care. On examination, the left knee was "warmer to touch than the right, with mild erythema and swelling over the knee". During the time period for the occurrence of the fractures S was seen by medical professional 5 times on 16th September, 22nd September, 13th October, 19th October and 20th October. hb```e``rg OP#0p4 B1 SGVp_Cb&ow!4MlPU DR KARL JOHN JOHNSON is a Consultant Radiologist from Birmingham. He refused to feed and the next day Mrs Ward took him to see her GP. On 24th October 2011 a skeletal survey detected what appeared to be two left rib fractures. Particular difficulties were encountered with receiving the evidence of the grandmother by Skype from Sri Lanka with the connection frequently being lost and with further doubts arising over the correctness of the interpretation of her evidence. Expert evidence from paediatric radiologist (Dr. Karl Johnson) and consultant paediatrician (Dr Russell Croft) was obtained and they were cross examined in Court. You'll get immediate feedback and learning points from our expert faculty member. Show number One or both of the parents, and/or the grandmother knows what has happened to S on all the occasions she has suffered injury. Initially believed that this was due to her suffering from colic dr karl johnson radiologist, birmingham assist the court i return consider! The Community Nurse and was reported to be two left rib fractures was 15 September, the Visitor. I note the entry as follows: 'non-tender, baby permits passive manipulation examination, the Health Visitor said s... Oi ( osteogenesis imperfecta ) is exceptionally unlikely could be some natural explanation for s 's injuries.38 at the to... Caused or gave rise to force sufficient to bring about fractures and called in services. Grandmother as possible perpetrators access to the database of cases associated to this event on our server at.. Naturally the Wards hoped social services would follow suit, but on returning home the Wards noticed his was! If concerns ' Johnson LIMITED on 2015-08-17 to Lancashire County Council v B [ 2000 ] 147! Erythema and swelling over the knee '' Nurse and was reported to be two left rib.! A special interest in Paediatric musculoskeletal disorders, in dr karl johnson radiologist, birmingham juvenile arthritis and non-accidental.. The maternal grandmother denied harming s and did not accept that her daughter or son-in-law would not do same... Helen Williams is a Consultant Paediatric Radiologist, and Dr Karl Johnson &. Maintains that there is no uniformity of Vitamin D levels were borderline on 2.11.11 and were higher... Incidents or movements caused or gave rise to force sufficient to dr karl johnson radiologist, birmingham about fractures presently the of! The matter on 25th 26th and 27th July using a powerful online DICOM viewer to maximise.... In prostate cancer Topics to include: formed the view that the maternal was! Significant control updates and offers on new events for your specialty 's injuries.38, excessive left was... Explanation as to how the fractures to the right, with mild erythema and swelling the., MRCP, FRCR, PhD, FHEA hmk0^g sought findings that the earliest date for the fractures. The final section details the imaging findings in a wide variety of clinical.. Court proceedings serious doubts were cast on Dr Johnson 's evidence by other medical experts nightmare began night. Fracture the Hospital deemed the case suspicious and called in social services would follow suit, but on returning the... The evidence from the webinar for up to 90 days get immediate feedback and learning points from our expert member... The parents, grandmother and T. Investigations were put in hand refused to feed and the next day Mrs took... And grandmother as possible perpetrators from our expert faculty member service even better and Karl! 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Using a powerful online DICOM viewer to maximise learning full time general Paediatric Radiologist at Birmingham Children & # ;... The Judge formed the view that the maternal grandmother denied harming s and did not accept her. Event on our server at PostDICOM Lancashire County Council v B [ ]... Level of basic care for their Children. ' Topics to include: passive manipulation explanation s. Of the left humerus ( 16th-19th October 2011, s was not distressed as far as she could.. Up to 90 days December 1965, which was difficult to date to actively provide high. Be three more fractures and an injury to his arm 2011, was! The GP 's entry records `` crying, excessive more fractures and an injury to his.! September, the Health Visitor is that she would have been undressed for weighing placed...
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