Serious brain injury and even death can occur. Rabbitt, A.L., Olson, N.L., Niegl, M.N., et al. Laurent-Vannier A, Adamsbaum C, Raul JS, et al. Abusive head trauma: experience improves diagnosis, Evaluating abusive head trauma in children <5 years old: Risk factors and the importance of the social history. Abusive Head Trauma in Infants and Children in Japan. Pediatr Radiol. Syndrome, and Abusive Head Trauma Texas A&M Extension Online Available at . Additionally, according to the American Academy of Neurology, babies have weak neck muscles and large, heavy heads and shaking makes their fragile brain bounce back and forth inside the skull. Effectiveness of Educational Materials Designed to Improve Knowledge Regarding Crying and Shaken Baby Syndrome in Mothers of Hispanic Population. Figueira Rodrigues Vieira G & Guedes Correa JF. January 2016. Dudas L, Petrohoy G, Esernio-Jenssen D, et al. Counties could form local and regional Child Fatality Review Teams (CFRTs) as well. Delaplain PT, Grigorian A, Won E, et al. Most skull fractures can be best shown with an X-ray. Multiple giant retinal tears due to inflicted injury in a neonate. Neurotrauma Reports. September 2020. Beaulieu E, Jiang A, Zheng A, et al. Choudary, et al. Shur N. American Journal of Medical Genetics. Stray-Pedersen, A., Strisland, F., Rognum, T.O., et al. Check full statistics of Texas deaths in 2021. March 2022. Bentivegna, K., Grant-Kels, J.M., & Livingston, N. Journal of the American Academy of Dermatology. occurs when a person violently shakes a baby. Facing the loss of siblings in childhood: Interactions and dynamics between bereaved siblings and their parents. Journal of American Association for Pediatric Ophthalmology and Strabismus. What other types of injuries might occur as a result of shaking? May 2019. November 2015. Racial Disparities in Child Physical and Sexual Abuse Substantiations: Associations with Childs and Accused Individuals Race. The Journal of Emergency Medicine. Racial and Ethnic Disparities and Bias in the Evaluation and Reporting of Abusive Head Trauma. The American Academy of Pediatrics describes Shaken Baby Syndrome as: a term often used by physicians and the public to describe abusive head trauma inflicted on infants and young children. Pediatrics. Changing diagnostic patterns in cases of sudden and unexpected natural death in infants and young children: 19942018. Forensic Science, Medicine and Pathology. 2. August 2022. Watson, A.E., Oliver, C., Wilson, R.F., et al. The Association Between Maternal Shaking Behavior and Inappropriate Infant Parenting: The Japan Environment and Children's Study. July 2022. June 2022. Sept. 2018. J Pediatr Ophthalmol Strabismus. How can Shaken Baby Syndrome/Abusive Head Trauma (AHT) be prevented? Journal of Neuroimaging. 1. March 2022. Asnes, A.G., Kzmir, S., & Leventhal, J.M. A National Analysis of Ophthalmic Features and Mortality in Abusive Head Trauma. February 2017. Messing-Junger, M., & Alhourani, J. May 2022. June 2018. Shaken baby dies at 35: Court records indicate that Terry McKirchy lived in this Hollywood, Fla., home in July 1984, when she is accused of violently shaking 5-month-old Benjamin Dowling while . Haas-Lude K, Roulet-Perez E,Dbler-Neumann M, et al. This can cause bruising of the brain (cerebral . January2021. A Biomechanical Assessment of Shaken Baby Syndrome: What About the Spine? July 2022. September 2021. April 2021. Screening for Child Abuse in Children With Isolated Skull Fractures. [Epub ahead of print]. April 2022. Forensic Science, Medicine and Pathology. Lifetime Cost of Abusive Head Trauma at Ages 0-4, USA. Pediatric Radiology. Nadarasa J, Deck C, Meyer F, et al. Parreco J, Quiroz HJ, Willobee BA, et al. Pediatric Radiology. BMJ: Archives of Disease in Childhood. Radiologists' Diagnostic Performance in Differentiation of Rickets and Classic Metaphyseal Lesions on Radiographs: A Multicenter StudyKarmazyn. March 2022. June 2020. Pediatric Emergency Care. Identifying abusive head trauma and its mimics: diagnostic nuances. . Early Recognition of Physical Abuse: Bridging the Gap between Knowledge and Practice. Newborn Risk Factors for Subsequent Physical Abuse Hospitalizations. Vitamin D level and fractures in children and adolescents: a systematic review and meta-analysis. Menna, G., Tamburrini, G., & Bianchi, F. Child's Nervous System. Sat 18 Sep 2021 16.00 EDT Last modified on Sat 18 Sep 2021 16.01 EDT. American Journal of Roentgenology. April 2017. January 2019. Inter-rater reliability of physical abuse determinations in young children with fractures. 4,507. Pediatrics International. 4. The hotline is toll-free 24 hours a day, 7 days a week. Child Abuse & Neglect. Journal of Pediatrics. July 2015. Abusive Head Trauma in Infants and Children. July 2020. Improving Follow-Up Skeletal Survey Completion in Children with Suspected Nonaccidental Trauma. Child Abuse & Neglect. Orman G, Kralik SF, Meoded A, et al. Cornell EM and Powell EC. April 2021. May 2022. January 2021. Journal of Paediatric Neurology. Child Abuse & Neglect. Selective Skeletal Surveys for Infants With Skull Fractures: Examining the Rates of Return to Medical Care for Concern of Physical Abuse. September 2022. A case of broken bones and systems: The threat of irresponsible testimony. A changing history: When is it a red flag for child abuse? Blumenthal, A. June 2020. June 2021. [Epub ahead of print], Hospital Variation in Cervical Spine Imaging of Young Children with Traumatic Brain Injury. Ferguson, N.M., Rebsamen, S., Field A.S., et al. Ueda S, Yamaguchi T, & Ehara A. Neuroscience Letters. April 2022. Dating of Traumatic Brain Injury in Forensic Cases Using Immunohistochemical Markers (I): Neurofilaments and -Amyloid Precursor Protein. Henry KM, French B, Feudtner, C, et al. Berger R and Lindberg DM. Pediatric Radiology. December 2022. Patterns of Osteopontin Expression in Abusive Head Trauma Compared with Other Cases of Pediatric Traumatic Brain Injury. False Controversy Regarding Abusive Head Trauma Endangers Vulnerable Children. Journal of American Association for Pediatric Ophthalmology and Strabismus. $13.5 Billion Cost to the U.S. in 2010. Child Abuse & Neglect. The "New Science" of Abusive Head Trauma. Chen, Q., Chen, X., Xu, L., et al. What is the outcome or prognosis of victims of Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT)? O'Hara, M.A., Valvano, T., Kashyap, M., et al. Flom L, Fromkin J, Panigrahy A, Tyler-Kabara E, Berger RP. COVID-19 Report. Overturned abusive head trauma and shaken baby syndrome convictions in the United States: Prevalence, legal basis, and medical evidence. A Cost Analysis of a Validated Screening Tool for Pediatric Abusive Head Trauma. December 2018. The diagnostic performance of chest computed tomography in the detection of rib fractures in children investigated for suspected physical abuse: a systematic review and meta-analysis. Child's Nervous System. July 2020. External Validation of the PediBIRN Screening Tool for Abusive Head Trauma in Pediatric Emergency Department Settings. Paid Family Leave: An Upstream Intervention to Prevent Family Violence. February 2023. Mannes, I., Drissi, C., & Adamsbaum, C. Child's Nervous System. Sudden infant death syndrome (SIDS) is the abrupt and unexplained death of an infant less than 1-year old. February 2021. Wang G, Zhang XP, Gao Z, et al. September 2022. Management of Traumatic Epidural Hematoma in Infants Younger than One Year: 50 Cases Single Center Experience. Identification of Initial and Subsequent Injury in Young Infants. An MRI (magnetic resonance imaging) is medical imagining that gives pictures of organs and different structures of the body which gives different information about the body than can be seen with an X-ray, ultrasound, or CT scan. Long-term Impact of Abusive Head Trauma in Young Children: Outcomes at 5 and 11 Years Old. Prevalence of cerebral sinovenous thrombosis in abusive head trauma. Carole Jenny, et al. Understanding Bilateral Skull Fractures in Infancy: A Retrospective Multicenter Case Review. Child Abuse Review. Head biomechanics of video recorded falls involving children in a childcare setting. April 2017. Journal of Pediatric Surgery. Circumstances of injury in children with abusive versus non-abusive injuries. June 2020. Inequities in Pediatric Abusive Head Trauma According to Neighborhood Social and Material Deprivation: A Population-level Study in British Columbia, Canada, Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study, Long-term visual outcomes following abusive head trauma with retinal hemorrrhage, MRI Findings in Pediatric Abusive Head Trauma: A Review. Pediatric Neurology. Preventing Maltreatment of Children. Injuries that characterize Shaken Baby Syndrome are intracranial hemorrhage (bleeding in and around the brain); retinal hemorrhage (bleeding in the retina of the eye); and fractures of the ribs and at the ends of the long bones. January 2023. Radiographics. Nonaccidental injury presenting as unilateral Retinal Detachment in two infants. Incidence of hospitalization for abusive head trauma in Chiba City, Japan. Characteristics that distinguish abusive from nonabusive cases of sudden unexpected infant deaths. [PubMed: 32241102] 30. Ophthalmological lesions in shaken baby syndrome: a retrospective analysis of 133 consecutive cases (1992-2018). Amagasa S, Matsui H, Tsuji S, Moriya T, Kinoshita K. Am J Emerg Med. January 2023. November 2022. April 2018. Dominguez, M.M., Moore, J.L., Cook, M., et al. Harris, C.K., & Stagner, A.M. Septermber 2022. Inj Prev. The role of household composition of children diagnosed with abusive head trauma. Pendharkar, H., Jabeen, S., Pruthi, N., et al. May 2020. Rossant, C., & Brook, C. Forensic Science International: Synergy. Discrepancies in Physician and Coroner Findings in Cases of Fatal Suspected Physical Child Abuse. Rise in the incidence of abusive head trauma during the COVID-19 pandemic. Prevention of Sudden Infant Death Syndrome and Use of Safe Sleeping Practices for Children of All Ages : . The infant mortality rate is the number of infant deaths for every 1,000 live births. Nurse Educ Pract. Shaken baby syndrome in an infant treated for retinopathy of prematurity with anti-VEGF injection. Zhao C, Starke M, Tompson J, & Sabharwal S. Journal of the American Academy of Orthopaedic Surgeons. Abusive head trauma (AHT), which includes shaken baby syndrome, is a preventable and severe form of physical child abuse that results in an injury to the brain of an infant or child. A National Analysis of Ophthalmic Features and Mortality in Abusive Head Trauma. Changing diagnostic patterns in cases of sudden and unexpected natural death in infants and young children: 19942018. Mild abusive head injury: diagnosis and pitfalls. Identifying Maltreatment in Infants and Young Children Presenting with Fractures: Does Age Matter? Vinchon, M., Noule, N., Toubol, A., et al. The neuroimaging mimics of abusive head trauma. September 2022. Implementation of a brain injury screen MRI for infants at risk for abusive head trauma. Kymel KP, Wang M, Chinchilli VM, et all. Predictors for Nonaccidental Trauma in Child with a Fracture - A National Inpatient Database Study. Child Abuse & Neglect. Pediatric Abusive Head Trauma (Shaken Baby Syndrome). Although shaking an infant has the potential to cause neurologic injury, blunt impact or a combination of shaking and blunt impact cause injury as well. Accidental and Abusive Mandible Fractures in Infants and Toddlers. Chen, Y., & Feng, J. Shaken baby injuries most often occur in children younger than 2 years old, but may be seen in children up to 5 years old. Journal of Pediatrics. JAMA Pediatrics. Trends in shaken baby syndrome diagnosis codes among young children hospitalized for abuse. The incidence of abusive head injury in children is highest in infancy and less frequently seen in children over 3 years of age. Pediatric Emergency Care. Benign extracerebral fluid collection complicated by subdural hematoma and fluid collection: clinical characteristics and management. January 2018 [epub ahead of print]. Although the Shaken Baby Syndrome hypothesis was popularized in the early 2000s, it has never been scientifically validated. American Journal of Neuroradiology. Increased severity of abusive head trauma during the first year of the COVID-19 pandemic. Forensic Science, Medicine and Pathology. December 2017 [epub ahead of print]. March 2018. Flawed Swedish study on traumatic shaking is already being used by defence lawyers and its findings must be ignored. September 25, 2018 at 1:22 pm . Practice Variation in Use of Neuroimaging Among Infants With Concern for Abuse Treated in Childrens Hospitals. Birth-related subdural hemorrhage: prevalence and imaging morphology. Physical Examination Sensitivity for Skull Fracture in Pediatric Patients with Blunt Head Trauma: A Secondary Analysis of the National Emergency X-Radiography Utilization Study II Head Computed Tomography Validation Study. Pediatric Emergency Care. May 2022. May 2019. December 2022. Common factors associated with increased risk of child abuse are often individual characteristics, substance abuse, and young age of the parent or caregivers; the age, health, physical, mental, emotional, and social development of the child; history of violence within the family structure; poverty and economic conditions, social attitudes, promotion of violence, and cultural norms of the community; lack of education and resources for the family. Pediatric Emergency Care. Identification of Abusive Head Trauma in High-Risk Infants: A Cost-Effectiveness Analysis. Each death certificate identifies a single underlying cause of death that is defined as the disease or injury that initiated the events resulting in death. Bliss, L., Mehta, N., Trolard, A., et al. Laurent-Vannier A, Bernard JY, & Chevignard M. Child Abuse Review. February 2019. Kovski. Gericho was a biracial child and extremely light . A tiny hand reached out and grabbed a huge fistful of first birthday cake. Validation of a Prediction Tool for Abusive Head Trauma. Stewart TC, Gilliland J, Parry NG, Fraser DD. Abusive and positive parenting behavior in Japan during the COVID-19 pandemic under the state of emergency. Child and Adolescent Psychiatry and Mental Health. April 2022. February 2020. Keywords: autopsy; death; shaken baby syndrome. Relevance of Abusive Head Trauma to Intracranial Hemorrhagesand Bleeding Disorders. Paine CW, Fakeye O, Christian CW, and Wood JN. Increased severity of abusive head trauma during the first year of the COVID-19 pandemic. Certificates are available upon successful completion. Biomarkers in Moderate to Severe Pediatric Traumatic Brain Injury-A Review of the Literature. July 2016. American Journal of Ophthalmology Case Reports. Pediatric Radiology. A 1987 study reviewed 48 cases of "shaken baby syndrome" in the Philadelphia area and found that of the 13 fatalities, all had signs of impact, too. November 2021. International Journal of Legal Medicine. Song, H.H., Thoreson, W.B., Dong, P., et al. Financial Impact of Abusive Head Trauma to Age 17. Photographic assessment of retinal hemorrhages in infant head injury: the Childhood Hemorrhagic Retinopathy Study. August 2022. Suh DW, Song HH, Mozafari H, & Thoreson WB. Pediatric Rib Fractures Identified by Chest Radiography. Development of a finite-element eye model to investigate retinal hemorrhages in shaken baby syndrome, Predictors of long-term neurological outcomes in non-accidental head injury, A Retrospective Study of Cervicla Spine MRI Findings in Children with Abusive Head Trauma. Children. A CT (computed tomography) scan is an X-ray technique that produces a detailed cross-section of tissue structure. The effect of a shaken baby syndrome prevention program on Turkish mothers' awareness and knowledge: A randomized controlled study. Berger RP, Furtado AD, Flom LL, Fromkin JB, & Panigrahy A.Pediatric Radiology. Abusive head trauma: two case reports. Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma. Journal of Forensic Sciences. January 2022. November 2022. December 2021. The Journal of Bone & Joint Surgery. [Epub ahead of print]. November 2022. Catching the red eye: A retrospective review of factors associated with retinal hemorrhage in child physical abuse. Koti, A.S., Vega, S., Johnson, K., et al. Journal of American Association for Pediatric Ophthalmology and Strabismus. July 2016. Shaken baby syndrome in Italy: socio-cultural and medico-legal perspective. Petska H, Frasier LD, Livingston N, et al. The role of the pediatric neurosurgeon in abusive head injuries: a survey of members of the International Society for Pediatric Neurosurgery. Parental awareness, knowledge, and attitude about shaken baby syndrome in Riyadh, Saudi Arabia: a cross-sectional study. October 2022. January 2020. A bad time for kids in lockdown: The relationship between negative pandemic events, parenting stress, and maltreatment related parenting behaviors. So, what should you be aware of, what should you watch for? Child Abuse & Neglect. Combatting misinformation about abusive head trauma: AAP endorses new report. Learn more about topics such as healthy brain development, safe sleep, shaken baby syndrome, and abusive head trauma. Pediatric Radiology: 2014, George Edwards. Shaken baby syndrome (SBS), also known as non-accidental trauma (NAT) , is a diagnosis that may include a combination of findings including broken long bones such as arms or legs, skull fractures, brain bleeding and retinal hemorrhages. January 2019. Amagasa S, Uematsu S, & Tsuji S. Journal of Neurosurgery. Snelling, P.J., Thanasingam, A.A., Jones, P., et al. Shaken Baby Syndrome (also known as Shaken Impact Syndrome) is a serious form of abuse inflicted upon a child. February 2023. Hymel, K.P., Boos, S.T., Armijo-Garcia, V., et al. Barr RG, Barr M, Rajabali F, et al. N.L., Hill, H.D., Mooney, S.J., et al. Brain injury biomechanics and abusive head trauma. Improving Follow-Up Skeletal Survey Completion in Children with Suspected Nonaccidental Trauma. August 2022. Eismann EA, Shapiro RA, Makoroff KL, et al. March 2021. The Relationship Between Temperature and Temporal Patterns and Incidence of Abusive Head Trauma in a Midwest Region Hospital. Caron, F., Tourneux, P., Kuekou, H.T., et al. Long-term outcome in a case of shaken baby syndrome. Journal of Neuropathology & Experimental Neurology. Child Abuse & Neglect. Pediatric Neurology. Journal of Pediatrics. January 2017. About 1,360 babies died of SIDS in 2017, the last year for which such statistics are available. The Association of Low-Income Housing Tax Credit Units and Reports of Child Abuse and Neglect. Paediatric chronic subdural hematoma: what are the predisposing factors and outcomes in management of these cases? Pediatric Radiology 2017. In addition to giving us key information about maternal and infant health, the infant mortality rate is an important marker of the overall health of a society. Abusive head trauma in small children a single-centre experience in Finland. Child Maltreatment. The Eyes Have It: How Critical are Ophthalmic Findings to the Diagnosis of Pediatric Abusive Head Trauma? Pediatric Surgery International. June 2020. January 2016. Yamaoka, Y., Obikane, E., Isumi, A., et al. September 2020. Journal of Korean Neurosurgical Society. Feldman, K.W., Wright, J.N., Menashe, S.J., et al. Laurent-Vannier A & Chevignard M. Archives de Pediatrie. September 2015. Clinical history, physiologic data, and imaging are the three (3) sources physicians use to establish the timing of head injuries. In Vivo Demonstration of Traumatic Rupture of the Bridging Veins in Abusive Head Trauma. An infants brain has a higher water content and less myelination than an adult brain and is more gelatinous and is easily compressed and distorted within the skull during a shaking episode. Paid family leave's effect on hospital admissions for pediatric abusive head trauma. Health services utilization and cost of abusive head trauma in Taiwan: A population-based retrospective matched cohort study. August 2022. Chest CT in the evaluation of child abuse When is it useful? Shaken baby syndrome (SBS) occurs when a person violently shakes a baby. But the Court of Criminal Appeals stopped his death, sending the case back to the trial court for further review after the scientific consensus on shaken baby syndrome shifted. Child's Nervous System. March 2018. Judicial handling of cases of non-accidental head trauma in infants: Review and analysis of expert assessments. February 2021. April 2022. Burtard, C., Panks, J., Silverman, L.B., et al. Oct. 2018. Parental awareness, knowledge, and attitude about shaken baby syndrome in Riyadh, Saudi Arabia: a cross-sectional study. Knox BL, Rorke-Adams LB, Luyet FM. Identification of Initial and Subsequent Injury in Young Infants. Berger RP, Pak BJ, Kolesnikova MD. Consensus statement on abusive head trauma: additional endorsements. Sept. 2018. Fracture Patterns Differ Between Osteogenesis Imperfecta and Routine Pediatric Fractures. Gise R, Truong T, Poulsen DM, et al. Derivation and Validation of a Serum Biomarker Panel to Identify Infants with Acute Intracranial Hemorrhage. According to the New Scientist, at least three of the 1,600 ended up on death row. Prevalence of Abuse Among Young Children With Rib Fractures. Yonai, Y., Merav, B.N., Finkel, B., et al. Pediatric Abusive Head Trauma Prevention Initiatives: A Literature Review. Kriss, S., Morris, J., & Martich, V. American Journal of Roentgenology. Fracture Patterns Differ Between Osteogenesis Imperfecta and Routine Pediatric Fractures. Benign extracerebral fluid collection complicated by subdural hematoma and fluid collection: clinical characteristics and management. Orru' E, Huisman TAGM, and Izbudak I. One third (1/3) of SBS/AHT victims who develop symptoms either do not have significant disabling conditions or the outcomes are less well-defined. Eight-year outcome of implementation of abusive head trauma prevention. This move brings the team in alignment with the emerging conception of child fatality review . The effect of a shaken baby syndrome prevention program on Turkish mothers' awareness and knowledge: A randomized controlled study. Child Abuse & Neglect. Minns, R.A., Jones, P.A., Fleck, B.W., et al. Factors associated with poor neurological outcome in children after abusive head trauma: A multicenter retrospective study. May 2015. Kelly, J.P., Feldman, K.W., & Weiss, A. Retinal Cases and Brief Reports. The diagnostic performance of chest computed tomography in the detection of rib fractures in children investigated for suspected physical abuse: a systematic review and meta-analysis. Acceptance of Shaken Baby Syndrome and Abusive Head Trauma as Medical Diagnoses. Lzrescu, A.M., Benichi, S., & Blauwblomme, T. JAMA Network Open. September 2022. Journal of Pediatric Nursing. International Journal of Injury Control and Safety Promotion. Cutaneous mimics of child abuse and neglect: Part II. A Biomechanical Assessment of Shaken Baby Syndrome: What About the Spine? Neuroradiology. Forensic Imaging. January 2019. Child Abuse & Neglect. June 2020. Why admitted cases of AHT make a low quality reference standard: A survey of people accused of AHT in France. Infant skull fracture risk for low height falls. Change in Incidence and Severity of Abusive Head Trauma in the Paediatric Age Group Pre- and During COVID-19 Lockdown in the North East of England. Part 2: axial skeleton and differential diagnoses, Evaluation of the Hypothesis that Choking/ALTE May Mimic Abusive Head Trauma. A systematic autopsy survey of human infant bridging veins. 2021. Akie, T.E., Gupta, M., Rodriguez, R.M., et al. Child abuse-related homicides precipitated by caregiver use of harsh physical punishment. Child's Nervous System. ICD-10-CM Codes for the Identification of Abusive Head Trauma in Administrative Datasets. MRI Findings in Pediatric Abusive Head Trauma: A Review. Screening for Child Abuse in Children With Isolated Skull Fractures. July 2016 [Epub ahead of print], Accuracy of the history of injury obtained from the caregiver in infantile head trauma. The Challenge of Identifying Pediatric Abusive Head Trauma During the COVID-19 Pandemic. January 2020. Long-term Impact of Abusive Head Trauma in Young Children: Outcomes at 5 and 11 Years Old. Patterened Bruises from Abusive Screening. August 2017. Journal of Neurotrauma. November 2019. Peddada KV, Sullivan BT, Margalit A, et al. Child Abuse & Neglect. Abusive Head Trauma and Mortality - An Analysis From an International Comparative Effectiveness Study of Children With Severe Traumatic Brain Injury. Part I: A systematic review of animal modelsPart I: A systematic review of animal models. In Vivo Demonstration of Traumatic Rupture of the Bridging Veins in Abusive Head Trauma. July 2022. Chest CT in the Evaluation of the hypothesis that Choking/ALTE May Mimic Head... Orru ' E, Huisman TAGM, and Wood JN on Hospital admissions for Pediatric and! A randomized controlled study neurological outcome in Children with Abusive versus non-abusive injuries less well-defined the. Diagnosed with Abusive Head Trauma Compared with other cases of sudden infant death syndrome ( )... Skull Fractures in Children with Fractures: Does Age Matter parenting Behavior in Japan during COVID-19... Infant deaths for every 1,000 live births of Head injuries song HH, Mozafari H, & Leventhal,.! 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