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   CANADIAN INJURED WORKERS SOCIETY
Workers Compensation in Canada
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Questionable Research and Medicine:
". . . be courageous. Don't dismiss it if you see a colleague acting in an unethical manner, or in a way that could possibly jeopardize a patient. Sometimes it's difficult, but speak out. Ethics is a shared responsibility." - Professor Abbyann Lynch - from the College of Physicians and Surgeons of Ontario




The CIWS is concerned about false medical reports being performed and questionable research being done by medical practitioners and academics who are being paid by insurance companies and/or workers compensation boards.

There are also dangerous funding relationships between workers compensation boards and universities, academics and physicians where research is being funded and/or controlled by WCBs. Long time-line research projects about injured workers' issues do nothing to address the present crisis that disabled workers face. These "research" projects appear to be deflection and delay tactics to avoid addressing the real crisis.

We are concerned about:
  • WCB-hired "independent" medical examiners who write false medical reports that assist WCB in delaying or denying disabled workers' claims.
  • WCB-funded or controlled research and educational material being distributed to medical professionals and the public.
  • WCB-funded or controlled research projects that serve to delay real action on the present crisis.
We feel that most medical professionals and academics are ethical, are not motivated solely by profit and would never knowingly become involved in this type of manipulation of evidence.

However, these relationships DO exist and therefore we are alerting medical professionals and the public to sources of potentially biased information that may be offered either through actual medical reports, case consultations, educational seminars or academic research project reports.

It appears that everyone is receiving funding EXCEPT disabled workers! Disabled workers do not need more studies - they need ACTION NOW!


WCB and SICKO

Report misconduct by your workers compensation system to:

We will use your info anonymously to compile a list of WCB wrongdoing.

This will be done anonymously. We will NOT reveal your identity without your express permission.

(We do not act as advocates for individual cases.)
Possible Sources of Biased Research and Information:

Dr. Jack Richman:
Canadian Institute for the Relief of Pain and Disability (CIRPD)
Assessmed Inc. / Complete Medical Associates
Canadian Society of Medical Evaluators
Canadian Pain Society
"Disability Medicine" Periodical of the American Board of Independent Medical Examiners (ABIME)
International Association for the Study of Pain
The Ontario Society of Occupational and Environmental Medicine
Accreditation Association for Ambulatory Health Care
International Conference in New York on "Back Pain and Disability - Unraveling the Puzzle"
International Conference on Symptom, Diagnostic and Disability Validity: Improving Patient Outcomes
American College of Occupational and Environmental Medicine
American Board of Independent Medical Evaluators
Work Fitness / Disability Evaluation Section
AMA Guides to the Evaluation of Permanent Impairment Newsletter
"The Medical Disability Advisor". - publication
Journal of Occupational & Environmental Medicine
Canadian Pain Coalition
Canadian Institutes of Health Research (CIHR)
The Canadian Cochrane Network and Centre
Iniversite de Montreal (University.of Montreal) - Insurance Medecine and Medicolegal Evaluation (Insurance Medicine and Medicolegal Expertise Program) - uses the CMSE (Canadian Society of Medical Evaluators) and Jack Richman as speakers



*** NOTE*** regarding American College of Occupational and Environmental Medicine (ACOEM) above, see ACOEM Guidelines "Highly Controversial" for WCB Pain Claimants - analysis by Pain Physicians


Dr. Sheldon Levy:
Riverfront Medical Evaluations Limited


TEKSMed / QuikCare / QuikCare Pro


AMA Guides - see New York State Rejects AMA Guides


"60 Summits Project" and ACOEM:
The 60 Summits Project is promoting adoption of the American College of Occupational and Environmental Medicine's (ACOEM) guideline "Preventing Needless Work Disability by Helping People Stay Employed" throughout Canada and the US. This guideline advocates paying SOME doctors - but not all doctors, saying: "Make billing for these services a privilege, not a right, for providers and make that privilege contingent on completion of training and an ongoing pattern of evidence-based care and good-faith effort to achieve optimal functional outcomes." (The CIWS believes that the insurance industry and workers compensation boards should not be involved in interfering with the medical profession. Privileged payment schemes to SOME doctors would constitute interference.) (Prudential Financial, Inc. has teamed up with the 60 Summits Project to promote adoption of the above ACOEM guideline.) Also related to this group are the "Florida Stay at Work Consortium" and the "Summit on Preventing Needless Work Disability".


Cancer research based on the findings of Oxford University's Sir Richard Doll because of findings by injurywatch of possible conflicts of interest regarding "substantial payments from variously Turner and Newall, the notorious asbestos company, Monsanto the American chemicals giant, and from the industry body, the Chemical Manufacturers Association."

The following are, or have been funded or controlled by WCBs and so are corporate-funded research agencies whose research may or may not be tainted by this funding relationship:

Bancroft Institute - an organization that does not reveal its funding structure publicly

Canadian Institutes of Health Research - - see Jack Richman above and also affiliated with the WCB-controlled Institute for Work & Health

Research Action Alliance on the Consequences of Work Injury - administered through the University of Toronto and allied with the Bancroft Institiute, an organization that does not reveal its funding structure publicly. RAACWI is also allied with the WCB-controlled Institute for Work and Health

Canadian Association for Research on Work and Health - - Organized and/or funded by the WCB-controlled Institute for Work and Health

Occupational Health and Safety Research Institute (IRSST)- - funded and/or controlled by WCB and employer lobby groups

Institute for Work and Health - - core funding by the WSIB (WCB)

Program of Care for Lower Extremity Injuries (Lower Extremity Injuries Program of Care) - WSIB funded and controlled research

Chronic Pain Program of Care - WSIB funded and controlled

Chronic Pain Expert Advisory Panel - WSIB funded and controlled

Centre of Research Expertise in the Prevention of Musculoskeletal Disorders (CRE-MSD), - funded by the WSIB

Centre of Research Expertise in Occupational Disease (CRE-OD), - funded by the WSIB


Centre of Research Expertise in Improved Disability Outcomes (CRE-IDO )- funded by the WSIB

Solutions for Workplace Change- funded by the WSIB


The following are largely governed, controlled or highly influenced by the American Insurance industry:
Workers Compensation Research Institute (WCRI): (see article)
Expert Clinical Benchmarks (ECB) - a research subsidiary of MedRisk, Inc.



Dr. Jack Richman - AssessMed / Complete Medical Associates:
The CIWS is not alleging any misconduct on the part of Dr. Richman or AssessMed, however, we feel it important to outline Dr. Richman's network of influence amongst the medical and research communities in light of his company's legal history (see CBC case below and another case here).
Canadian Institute for the Relief of Pain and Disability (CIRPD)- Dr. Jack Richman - President
Assessmed Inc. / Complete Medical Associates - Dr. Jack Richman - Executive Vice President and Medical Director
Canadian Society of Medical Evaluators - Dr. Jack Richman - Past President and lecturer as of Jan. 2007
Canadian Pain Society - Dr. Jack Richman - founding Member
"Disability Medicine" Periodical of the American Board of Independent Medical Examiners (ABIME)- Dr. Jack Richman - on the editorial advisory board up to 2003
International Association for the Study of Pain - Dr. Jack Richman - founding Member
The Ontario Society of Occupational and Environmental Medicine - Dr. Jack Richman - founder and first president
Accreditation Association for Ambulatory Health Care. - Dr. Jack Richman - served on the Board of Directors
International Conference in New York on "Back Pain and Disability - Unraveling the Puzzle" - Dr. Jack Richman - served on the Scientific Planning Committee
International Conference on Symptom, Diagnostic and Disability Validity: Improving Patient Outcomes - Dr. Jack Richman - was on the Scientific Planning Committee and Co-Chair
American College of Occupational and Environmental Medicine - Dr. Jack Richman - past Chair of the Committee for Accreditation in Occupation and Environmental Medicine Quality Assurance and presenter at the American Occupational Health Conference (as of 2007).
Work Fitness / Disability Evaluation Section - Dr. Jack Richman - Chairman and developing standards for disability evaluations,
AMA Guides to the Evaluation of Permanent Impairment Newsletter - Dr. Jack Richman - consultant
"The Medical Disability Advisor". - publication- Dr. Jack Richman - is on the Medical Advisory Board
Journal of Occupational & Environmental Medicine- Dr. Jack Richman, Paul Green, et al - "Objective Tests of Symptom Exaggeration in Independent Medical Examinations". This study used the Medical Symptom Validity Test (MSVT) to examine disability claimants and concluded that exaggeration of cognitive symptoms is widespread in disability-related evaluations. However, Paul Green is the sole distributor of the MSVT software and all the assessments were done at AssessMed (see above as well as court case below).
Canadian Pain Coalition - The Canadian Pain Society (above) and the Canadian Institute for the Relief of Pain and Disability (CIRPD) (above) are partners.
Canadian Institutes of Health Research (CIHR) - the Government of Canada's health research funding agency collaborates with the Canadian Institute for the Relief of Pain and Disability (CIRPD) (above).
The Canadian Cochrane Network and Centre - lists the Canadian Institute for the Relief of Pain and Disability (CIRPD) (above) as an affiliate.

Dr. Jack Richman and Dr. Shah, who worked for AssessMed, were plaintiffs in a lawsuit alleging the CBC program 'Prove It If You Can' defamed them. On November 10, 1998 CBC-TV aired a 26-minute segment on its program "The Fifth Estate" entitled, PROVE IT...IF YOU CAN. Three disabled individuals and their experiences with insurance companies were highlighted, including the experience with THE INDEPENDENT MEDICAL EXAMINATION conducted at AssessMed Ltd.. The theme of the case is that AssessMed Inc. believes that the words and actions of the CBC series "The Fifth Estate" in their broadcast of the program "Prove It...If you Can" were defamatory and brought into question their impartiality, competence and credibility. As a result, AssessMed Inc. feels that their business as Independent Medical Examiners is being threatened.

The CBC's "The Fifth Estate", program entitled "Prove It If You Can" told the stories of three individuals who suffered serious injuries in motor vehicle accidents. It depicted how insurance companies did not always treat accident victims fairly. The program alleged that insurers accomplished this, in the Janet Hough case, by referring her to a medical assessment firm such as AssessMed and obtaining a neuropsychological report which supported the view that she was not disabled. Accident benefits payable under existing insurance legislation were then discontinued, in spite of medical reports from her treating physicians which supported her entitlement to these benefits.

Dr. Richman's allegations were struck down by the judge in 2004 and this judge's decision was upheld by the Court of Appeal in June 2006. The appeal judge stated:

http://www.ontariocourts.on.ca/decisions/2006/june/C39832.htm
[72] The general philosophy of AssessMed, the manner in which Dr. Shah crafted his report, and the conclusions he expressed can also lead to a reasonable conclusion that his report was biased.


Dr. Richman has been a roster physician for the Workplace Safety & Insurance Board of Ontario (WSIB).

Dr. Richman has been an expert witness in arbitration, court, and WCAT (Workers' Compensation Appeals Tribunal) hearings.



The following are excerpts from the court transcript:
COURT FILE NO.: 99-CV-162046 DATE: 20040302
http://www.canlii.org/on/cas/onsc/2004/2004onsc10581.html

BACKGROUND[5] The plaintiff Jack Richman ("Richman") is a medical doctor. He is a director of AssessMed and is its Chief Medical Officer.[6] The plaintiff Hemendra Shah ("Shah") is a psychologist who worked under contract for AssessMed.

[76] In September of 1998, an article entitled "Manufacturing Disability", authored by Dr. Richman, appeared in this magazine. (The Canadian Insurance Magazine) In this article, Dr. Richman asserted that, having conducted medical assessments for more than 29 years, he found an increasing number of claimants with minor injuries wilfully misrepresented their situation, often backed by health care practitioners. He said that at AssessMed, where more than 3,000 assessments had been done, only "approximately ten percent of patients were found to have significant impairments". He said that of this ten percent, only three percent required long-term disability benefits. Of the remaining 90%, more than half wilfully failed to give a fair effort. He accused the medical, psychological and rehabilitation community of supporting these claimants, thereby manufacturing disability to obtain lucrative disability benefits. He argued that pain could not be defined as an impairment because it was subjective and could not be measured.[77] Dr. Richman went on to say that the most appropriate measure to determine functional abilities was an Independent Medical Evaluation plus a Functional Abilities Evaluation. He alleged a majority of heath care workers, who were held in high esteem by society, had become unaccountable and closed their eyes to fraudulent behaviour, believing they would not be challenged. He argued these members of the health care profession created illness and did far more psychological harm than any accident could.[78] This article manifested an intellectual tendency on the part of Dr. Richman to treat claimants with suspicion and to question the validity of the opinions expressed by their treating health care workers. It was an attractive approach for those insurers who questioned the extent of their insured's disability, but left doubt as to whether the approach resulting from this ideology was objective or impartial. [79] While Dr. Richman's opinions find some support in medical literature, they are considered too skeptical by others. Dr. Richman's research in this area was based on discussions with assessors at AssessMed but not on any empirical or validated study. In my view, it reflected a tendentious approach to assessments, which subjected AssessMed to being viewed as partial to insurers.

[250] The evidence at trial does confirm that most of AssessMed's work was performed on behalf of insurers. Dr. Richman's article supports the allegation that most claimants assessed at AssessMed are not found to be entitled to long-term disability benefits.

[194] The article 'Manufacturing Liability' authored by Dr. Richman did manifest an approach to medical evaluations where claimants were treated with suspicion. In the program, Dr. Richman said there was an honest belief in many claimants they saw that they are disabled, and they are not. They are self-deluding.

[227] In the context of Dr. Richman's article, 'Manufacturing Liability', AssessMed's approach and ideology, the difficulties encountered by Ms. Hough in obtaining continued disability benefits, and the conclusions of Dr. Shah in his report, I am satisfied that it was reasonable to state Dr. Richman was a doctor who took a critical approach to claimants' positions in conducting assessments for insurance companies -- that he did "play hardball for insurance companies."

[241] The point made in the program was that there were three treating professionals who had views which did not accord with Dr. Shah's opinion. Dr. Shah performed the neuropsychological testing with the measures he chose and reached a conclusion which was at odds with those of Ms. Hough's doctors.

[246] I am satisfied that Dr. Rathbone was presented with Dr. Shah's report during his interview, and that he took the time to review it. Although Dr. Rathbone testified that Englishmen are rarely horrified, I accept that this was a reasonable characterization of his reaction to Dr. Shah's report. He felt the report was biased and clearly in error.

[249] Mr. MacIntyre stated in the broadcast: "AssessMed do most of their evaluations for the insurance industry. And – surprise, surprise – most of them go against accident victims like Janet Hough." [250] The evidence at trial does confirm that most of AssessMed's work was performed on behalf of insurers. Dr. Richman's article supports the allegation that most claimants assessed at AssessMed are not found to be entitled to long-term disability benefits. [251] The language used by Mr. MacIntyre was somewhat colourful but the comment was not untrue.

[252] The statement in the broadcast that Dr. Richman believes most claims referred to AssessMed are fraudulent, is supported by Dr. Richman's evidence at trial and his article, 'Manufacturing Liability'.

[273] The philosophy and approach adhered to by AssessMed, Dr. Richman's article, "Manufacturing Liability", and the difficulties encountered by Prewer, Hough and MacMullin gave reasonable cause to believe accident victims were not always treated fairly by insurers.

[298] The issue of Dr. Shah's qualifications was raised and considered by the CBC. The program did not, however, pursue that issue. Had the program been an attack of Dr. Shah, as is urged by the plaintiffs, one would have expected the CBC to refer to Dr. Shah's past difficulties with the College of Psychologists, his educational background and experience. The CBC did not purse that aspect of the research in its program. [299] There was also evidence that another doctor at AssessMed may not have been qualified to perform the assessments he undertook. This was also left out of the program.

[311] On the evidence before me, I cannot conclude there was spite, ill will, any indirect motive or ulterior purpose on the part of the CBC. The defendants honestly believed that what was said on the program was true. As a result, the plaintiffs have failed to establish actual or express malice.

[313] In this case, the plaintiff AssessMed Inc.'s claim is for special damages, that is, its loss of business revenue in the years 1999 to 2003. Dr. Richman's claim is for general damages only. Dr. Shah claims general damages as well as special damages for the decline in the number of assessments referred to him by AssessMed, following the broadcast. [314] The plaintiffs also seek aggravated and punitive damages.

[333] My assessment of the evidence is that the plaintiffs had an excellent reputation with the insurers, but a poor reputation with the claimants' representatives. [334] After the broadcast, many insurance adjusters, who were the plaintiffs' primary clients, stopped using AssessMed. They did so because it was felt AssessMed's reports may no longer be given credence in the courts. Generally, the evidence led by the plaintiffs was to the effect that although insurance adjusters did not think less of the plaintiffs following the program, they ceased referring work to AssessMed because AssessMed's reports would be subject to the criticism they were biased in favour of insurers. [335] Dr. Richman's reputation was tied to AssessMed's reputation because he was considered to be the voice and the face of AssessMed. The insurance industry held Dr. Richman in high esteem while claimants' lawyers viewed him as favouring the insurers' interests. The article 'Manufacturing Liability' enhanced Dr. Richman's position with insurance companies. Plaintiffs' lawyers viewed that article as confirmatory of the bias Dr. Richman displayed against injured people.



Dr. Richman has been a roster physician for the Workplace Safety & Insurance Board of Ontario (WSIB).

Dr. Richman has been an expert witness in arbitration, court, and WCAT (Workers' Compensation Appeals Tribunal) hearings.








Riverfront Medical Evaluations Limited:
The following lawsuit concludes that:
"In my view Riverfront in this case, went far beyond what can be considered a proper “quality control” function. While I am not prepared to find that they were motivated by a desire to assist the defendant, nonetheless I find their actions constituted an unwarranted and undesirable interference with the proper function of an expert witness."

While the CIWS acknowledges Justice Spiegel in the court's assertion that it is not prepared to find that Riverfront Medical Evaluations Limited were motivated by a desire to assist the defendant (Sun Life Assurance Company of Canada), and therefore, stops short of a finding of 'bias', the court's finding of "unwarranted and undesirable interference with the proper function of an expert witness" gives us the moral duty to alert the medical community to these important issues currently being decided in the courts particularly considering that Riverfront Medical Evaluations Limited does work for the Workers safety Insurance Board (WSIB).

Riverfront Medical Evaluations Limited does evaluations for the Workplace Safety and Insurance Board of Ontario (WSIB).

Lawsuit involving Riverfront Medical Evaluations Limited:

Ontario Superior Court of Justice
2006 CanLII 41669 (ON S.C.) Citation: Macdonald v. Sun Life Assurance Company of Canada,
Date: 2006-12-13 Docket: 99-CV-168309CM4
http://www.canlii.org/on/cas/onsc/2006/2006onsc16831.html

Excerpts:
[6] . . . . However, it soon became apparent to me that the text of the document before Dr. Lipson was different from the served report.

[16] It need hardly be said that I found Dr. Lipson’s evidence about the origin of the various documents filed as exhibits to be confusing and in some respects self-contradictory. Before adjourning on May 30th, I suggested to Dr. Lipson that he check his home computer, his secretary’s computer as well as the computer at Riverfront in order to determine when and how these documents were prepared.

[26] . . . It was only on May 30, 2005 that he discovered that Riverfront had sent out a report with his stamped signature affixed that was different from what he expected.

[27] . . . He testified that these changes must have been made by Riverfront without his authority.

[28] Based on the evidence before me on the voir dire I ruled that Dr. Lipson was not entitled to testify as an expert witness on behalf of the defendant.

[30] Based on the uncontradicted evidence of Dr. Lipson, the served report was not signed by him. . . . Dr. Lipson has testified that he did not authorize his signature stamp to be affixed to the report that was delivered by Riverfront to the solicitors for the defendant.

[32] . . . If Dr. Lipson was permitted to continue with his testimony it is obvious that he would have been cross-examined at great length with respect to the discrepancies between his draft report and the served report. The jury would likely have had to devote a great deal of time in determining to what extent Dr. Lipson’s opinion was influenced by the “quality control” activities of Riverfront.

[33] Moreover in view of the unsatisfactory nature of Dr. Lipson’s evidence with respect to the origin of the reports in question, in addition to the undue delay which would be caused by the presentation of his evidence, his evidence would be more likely to confuse and confound the jurors rather than to assist them in their fact finding task. In such circumstances, there is a residual discretion in the court on a cost benefit analysis to refuse to admit the expert evidence[1].

[38] Dr. Sheldon Levy is the President and principal shareholder of Riverfront. He is a medical doctor who has been certified as an internist since 1994. He purchased Riverfront from its founder, Dr. Harvey Lewis in 2003. Prior to purchasing, he conducted 6 months of due diligence. Riverfront has achieved an International Standards Organization (ISO) designation that signifies that its administrative policies and procedures comply with ISO standards. Riverfront provides independent and impartial medical evaluations to insurance companies, the Workers Safety Insurance Board, and lawyers representing defendants in casualty cases. Riverfront produces 3500 – 4000 reports per annum at an average cost of about $1,000 a report. It has 15 employees with a payroll of about $800,000. There are about 350 physicians on their roster across Canada. The largest fields of expertise are orthopedics, physiatry, psychiatry, psychology and neurology.

39] . . . Eighty percent of the assessments are performed at Riverfront’s offices at 180 Dundas Street West, Toronto. Riverfront provides the physical plant, i.e., the examining room, necessary equipment, stethoscope, etc., a translator if necessary. The physician will dictate his or her report on a cassette and Riverfront staff will transcribe the report and put it in the format that complies with ISO standards. The report is checked for spelling and grammar to ensure that it reads well, is clear and concise and that it answers the questions of the referring party. This is described as a quality control function performed by Riverfront. The report is then given back to the physician for review and signature.

[41] No report is sent out without it being “quality controlled”. . . . When asked whether the Riverfront “edits” the report he indicated that he resented the word “edit”.

[42] As Medical Director of Riverfront Dr. Levy reads the reports to ensure that they answer the questions posed by the client. They also have a registered nurse Anna Tsagerellis (Anna), the Marketing Director of Riverfront, who proofreads the reports. . . .

43] Twenty percent of their physicians conduct their assessments off site in which case the physicians will prepare their reports and send it to Riverfront by fax or other electronic means. Riverfront performs its quality control function and sends the report to the physician for comments if required. . . .

[44] In many cases Riverfront has a signature stamp of the doctor, which the doctor authorizes them in writing to use. . . .

[53] In a rather emotional statement Dr. Levy insisted that at no time was there any intention to alter a report for the purpose of making it better for a client. This would be a breach of his moral and ethical standard.

Was Dr. Lipson's signature affixed to the served report without his authority?
[87] . . . Taken at its highest for Riverfront, the statement merely repeats what is undisputed in the evidence, namely, that Dr. Lipson did not authorize the deletion, but that he did not recall objecting to it either. . . . In any event, the crucial issue is not whether Linda affixed Dr. Lipson’s signature to the report knowing that she knew was not authorized do so but rather whether Riverfront took reasonable steps to ensure that the report that was sent out under Dr. Lipson’s signature was in fact authorized by him. I must regretfully conclude that they did not.

[88] It is stating the obvious that an expert’s report delivered for the purpose of compliance with the Rules of Civil Procedure and the Evidence Act is an extremely important document. Anyone involved in the preparation of such reports must know that courts place a very strong reliance on the contents of these reports and that the proper administration of justice demands that these reports accurately reflect the opinion of the expert who has written them. The requirement in the Rules of Civil Procedure and the Evidence Act that the expert sign the report is intended to provide assurance that the statements in the report are those of the expert.

Was it was proper for Riverfront to have suggested to Dr. Lipson that highlighted portion be deleted?
[101] In my view Riverfront in this case, went far beyond what can be considered a proper “quality control” function. While I am not prepared to find that they were motivated by a desire to assist the defendant, nonetheless I find their actions constituted an unwarranted and undesirable interference with the proper function of an expert witness.

[102] The function of an expert witness is to provide an independent and unbiased opinion for the assistance of the court. An expert witness’ evidence should be and should be seen to be the independent product of the expert uninfluenced as to form and content by the exigencies of litigation.[2] This principle has often been cited with approval in our courts, and has been considered a factor to be considered in assessing the weight to be given to the expert’s testimony. It has occasionally been treated as the basis for the disqualification of the witness entirely.[3]

[103] In my view any activity that may tend to detract from this all-important objective diminishes the integrity of the litigation and trial process and should be met with appropriate sanctions designed to send a clear message that such conduct will not be tolerated.

H. SPIEGEL J. Released: December 13, 2006
http://www.canlii.org/on/cas/onsc/2006/2006onsc16831.html

Riverfront Medical Evaluations Limited does evaluations for the Workplace Safety and Insurance Board of Ontario (WSIB).

    


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