# Child Abuse — GCMD Library living collection

Everything in the library about child abuse — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 28 cited statements

## Episodes
### Evidence & Research
- [JPS Journal Club: July 2019 Part 3](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606) — video · [machine version](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606.md)
- [Journal of Pediatric Surgery Article Review: June 2022, AAP Issue](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878) — video · 15:54 · [machine version](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878.md)
- [Journal of Pediatric Surgery Article Review: June 2022, AAP Issue](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881) — podcast · 15:54 · [machine version](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=0) Introduction and Context (Ep 1)
- [0:18](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=18) APSA Position Statement Recommendations 1-8 (Ep 1)
- [3:45](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=225) Abusive Head Trauma Recognition and Conclusion (Ep 1)
- [0:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=6) Introduction and Episode Overview (Ep 2)
- [1:56](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=116) Non-Accidental Trauma During COVID-19 Stay-at-Home Orders (Ep 2)
- [6:22](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=382) Metastatic Hepatoblastoma Cell Line Development (Ep 2)
- [9:18](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=558) Localization Techniques for Small Pulmonary Nodules (Ep 2)
- [12:26](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=746) Puberty and Growth in Pediatric Intestinal Failure (Ep 2)
- [15:08](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=908) Closing Remarks (Ep 2)
- [0:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=6) Introduction and Episode Overview (Ep 3)
- [1:56](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=116) Non-Accidental Trauma During COVID-19 Stay-at-Home Orders (Ep 3)
- [6:22](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=382) Metastatic Hepatoblastoma Cell Line Development (Ep 3)
- [9:18](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=558) Localization Techniques for Small Pulmonary Nodules (Ep 3)
- [12:26](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=746) Puberty and Growth in Pediatric Intestinal Failure (Ep 3)
- [15:08](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=908) Closing Remarks (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- NAT was higher after the lockdown, not during the lockdown — Todd Ponsky and Biran Modi (clinical) [Ep 2 · 4:07](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=247)
- During times of public health crises, it's important to maintain systems of protection for children — Nicole Chandler (opinion) [Ep 2 · 5:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=337)
- Management of metastatic hepatoblastoma continues to pose significant treatment challenges — Nicole Chandler (clinical) [Ep 2 · 7:13](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=433)
- PSORC (Pediatric Surgical Oncology Research Collaborative) is a multi-institutional consortium of North American pediatric surgeons focused on advancing care of children with cancer — Marcus Malek (clinical) [Ep 2 · 9:46](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=586)
- PSORC was founded because there was a need to amalgamate data from multiple institutions to better study surgical questions in pediatric cancer — Marcus Malek (clinical) [Ep 2 · 10:05](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=605)
- Image-guided localization techniques varied significantly among institutions but all were wildly successful, showing that experience is probably more important than the actual technique itself — Nicole Chandler (opinion) [Ep 2 · 12:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=726)
- Pediatric intestinal failure was defined as requirement of parenteral nutrition for 60 days or more at any time, with diagnosis before 8 years of age — Todd Ponsky and Biran Modi (clinical) [Ep 2 · 12:57](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=777)
- The hypothesis was that chronic pediatric intestinal failure would delay puberty and potentially dull the sharp spike of puberty in terms of peak height velocity — Todd Ponsky and Biran Modi (clinical) [Ep 2 · 13:44](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=824)
- There is a high incidence of short stature in chronic intestinal failure — Todd Ponsky and Biran Modi (clinical) [Ep 2 · 14:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=877)
- The finding that short stature is not because kids are missing out on pubertal timing and peak height velocity suggests we need to do a better job at setting them up to go into puberty with working on their height and linear growth — Todd Ponsky and Biran Modi (opinion) [Ep 2 · 14:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=877)
- NAT was higher after the lockdown, not during the lockdown — Todd Ponsky and Biran Modi (clinical) [Ep 3 · 4:07](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=247)
- During times of public health crises, it's important to maintain systems of protection for children — Nicole Chandler (opinion) [Ep 3 · 5:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=337)
- Management of metastatic hepatoblastoma continues to pose significant treatment challenges — Nicole Chandler (clinical) [Ep 3 · 7:13](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=433)
- We never had a hepatoblastoma cell line mouse model before — Todd Ponsky and Biran Modi (clinical) [Ep 3 · 8:29](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=509)
- PSORC (Pediatric Surgical Oncology Research Collaborative) is a multi-institutional consortium of North American pediatric surgeons focused on advancing care of children with cancer — Marcus Malek (clinical) [Ep 3 · 9:46](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=586)
- There has not been consistency in localization techniques for small pulmonary nodules across North America, with surgeons doing their own thing — Marcus Malek (clinical) [Ep 3 · 10:19](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=619)
- Time under anesthesia can be long and quite variable depending on whether institutions use hybrid ORs or have IR on different floors — Marcus Malek (clinical) [Ep 3 · 11:10](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=670)
- ICG will become much more popular and more effective for nodule localization in 5 years — Todd Ponsky and Biran Modi (opinion) [Ep 3 · 11:54](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=714)
- Image guided localization techniques varied significantly among institutions but all were wildly successful, showing that experience is probably more important than the actual technique itself — Nicole Chandler (opinion) [Ep 3 · 12:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=726)
- The study focused on patients with pediatric intestinal failure, defined as requirement of parenteral nutrition for 60 days or more at any time, who had the diagnosis before age 8 and were older than 8 at time of study — Todd Ponsky and Biran Modi (clinical) [Ep 3 · 12:52](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=772)
- Puberty is at least partially dependent on having good nutritional stores based on hormonal drivers of puberty — Todd Ponsky and Biran Modi (clinical) [Ep 3 · 13:38](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=818)
- The hypothesis was that chronic pediatric intestinal failure would delay puberty and potentially dull the sharp spike of peak height velocity — Todd Ponsky and Biran Modi (clinical) [Ep 3 · 13:45](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=825)
- Children with intestinal failure might be slightly short statured but are not severely undersized compared to the general population — Todd Ponsky and Biran Modi (clinical) [Ep 3 · 14:20](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=860)
- There is a high incidence of short stature in chronic intestinal failure — Todd Ponsky and Biran Modi (clinical) [Ep 3 · 14:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=877)
- The finding that kids with intestinal failure are not missing out on pubertal timing and peak height velocity suggests we need to do a better job at setting them up to go into puberty by working on their height and linear growth — Todd Ponsky and Biran Modi (opinion) [Ep 3 · 14:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=877)
- Standardization eliminates chance of errors in child abuse evaluation (opinion) [Ep 1 · 1:31](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=91)
- Providers are terrible at predicting when there was child abuse when relying on subjective judgment (clinical) [Ep 1 · 2:36](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=156)
- Institutional protocols should mandate automatic child abuse workup for sentinel injuries such as head injury in anyone under six months of age, removing opinion and emotion from the decision (opinion) [Ep 1 · 2:55](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=175)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The Midwest Pediatric Surgery Research Consortium (MWPSC) was established by departments of Pediatric Surgery from 11 children's hospitals — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 2 · 2:15](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=135)
- The NAT study used historical patterns captured by trauma registries to predict what the volume should have been during the initial COVID time period and compared that to observed rates — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 2 · 3:42](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=222)
- Initially non-accidental trauma rates dropped a little bit, but after that the rate increased above what they had expected during the stay at home orders — Nicole Chandler summarizing the discussion [Ep 2 · 4:16](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=256)
- Patients disproportionately affected were older kids who were older than 5 years who would most commonly be in school, minority children, and lower socioeconomic groups as determined by the social vulnerability index — Nicole Chandler summarizing the discussion [Ep 2 · 4:31](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=271)
- CDC Social Vulnerability Index was uniquely created to see neighborhood's vulnerability during times of crises — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 2 · 5:12](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=312)
- One has to be careful not to make too strong of conclusions based on any data when it's related to simply ICD 10 codes, regardless of how many institutions and how long the evaluation period was — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 2 · 6:07](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=367)
- There are very few cell lines available to study hepatoblastoma, and a number of cell lines touted to be hepatoblastoma are actually hepatocellular carcinoma — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 2 · 6:47](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=407)
- The new hepatoblastoma cell line was created by injecting labeled cells into mouse tail vein, harvesting lung metastases, culturing surviving cells, and repeating the process until establishing a reliably metastatic cell line — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 2 · 7:24](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=444)
- Compared to the original human cell line, the new cell line exhibited increased tumorigenicity, invasiveness, and increased resistance to chemotherapy — Nicole Chandler summarizing the discussion [Ep 2 · 8:14](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=494)
- The most common localization techniques for small pulmonary nodules were wire and methylene blue dye, followed by methylene blue dye only — Nicole Chandler summarizing the discussion [Ep 2 · 10:49](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=649)
- There was no difference in successful IR localization or successful resection of pulmonary nodules when comparing different localization techniques — Nicole Chandler summarizing the discussion [Ep 2 · 10:56](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=656)
- Peak height velocity occurred at significantly younger ages for both males and females with intestinal failure — Nicole Chandler summarizing the discussion [Ep 2 · 14:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=840)
- Puberty onset occurred significantly earlier compared to established norms for males, meaning they reached pubertal onset earlier than the CDC 50th percentile — Nicole Chandler summarizing the discussion [Ep 2 · 14:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=840)
- The Midwest Pediatric Surgery Research Consortium (MWPSC) was established by departments of Pediatric Surgery from 11 children's hospitals — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 2:15](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=135)
- The NAT study used historical patterns captured by trauma registries to predict what the volume should have been during the initial COVID time period and compared that to observed rates — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 3:42](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=222)
- Initially non-accidental trauma rates dropped a little bit, but after that the rate increased above what they had expected during the stay at home orders — Nicole Chandler summarizing the discussion [Ep 3 · 4:16](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=256)
- Patients disproportionately affected were older kids who were older than 5 years who would most commonly be in school, minority children, and lower socioeconomic groups as determined by the social vulnerability index — Nicole Chandler summarizing the discussion [Ep 3 · 4:31](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=271)
- CDC's Social Vulnerability Index was uniquely created to see neighborhood's vulnerability during times of crises — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 5:12](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=312)
- One has to be careful not to make too strong of conclusions based on ICD 10 codes, no matter how many institutions and how long the evaluation period was — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 6:07](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=367)
- There are very few cell lines available to study hepatoblastoma, and a number of cell lines touted to be hepatoblastoma are actually hepatocellular carcinoma — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 6:47](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=407)
- The researchers labeled hepatoblastoma cells with luciferase, injected them into mouse tail veins where they preferentially went to lungs, harvested and cultured surviving cells, and repeated this process until establishing a reliable metastatic cell line — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 7:24](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=444)
- The new metastatic hepatoblastoma cell line exhibited increased tumorigenicity, invasiveness, and increased resistance to chemotherapy compared to the original human cell line — Nicole Chandler summarizing the discussion [Ep 3 · 8:14](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=494)
- The most common localization techniques were wire and methylene blue dye, followed by methylene blue dye only — Nicole Chandler summarizing the discussion [Ep 3 · 10:49](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=649)
- There was no difference in successful IR localization or successful resection of pulmonary nodules among the different localization techniques — Nicole Chandler summarizing the discussion [Ep 3 · 10:56](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=656)
- Peak height velocity occurred at significantly younger ages for both males and females with intestinal failure — Nicole Chandler summarizing the discussion [Ep 3 · 14:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=840)
- Puberty onset occurred significantly earlier compared to established norms for males, meaning they reached pubertal onset earlier than the CDC 50th percentile — Nicole Chandler summarizing the discussion [Ep 3 · 14:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=840)
- APSA position statement number one: child abuse equals traumatic disease and justifies the resource utilization of a trauma system — The host summarizing a resource [Ep 1 · 0:18](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=18)
- APSA supports admission to a surgical trauma service to ensure coordination of care for child abuse patients — The host summarizing a resource [Ep 1 · 0:40](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=40)
- APSA supports a multi-disciplinary team for screening, evaluation and management of child abuse patients — The host summarizing a resource [Ep 1 · 1:04](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=64)
- APSA recommends creation of a child abuse team as established by the American College of Surgeons and the children surgery verification program — The host summarizing a resource [Ep 1 · 1:04](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=64)
- APSA recommends systematic evaluation including checklists and institutional protocols to be followed every time — The host summarizing a resource [Ep 1 · 1:31](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=91)
- Any reasonable suspicion of child abuse should be followed by a report to CPS as mandated by law — The host summarizing a resource [Ep 1 · 1:53](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=113)
- Transfer to another facility does not absolve the provider of mandatory reporting responsibility for suspected child abuse — The host summarizing a resource [Ep 1 · 1:53](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=113)
- APSA emphasizes universal screening with standardized tools applied across the board regardless of socio economic status, race, ethnicity, or gender — The host summarizing a resource [Ep 1 · 2:16](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=136)
- Institutional protocols include recognizing sentinel injuries and educating providers at all levels to identify risk factors — The host summarizing a resource [Ep 1 · 3:21](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=201)
- APSA recommends data collection using a trauma registry and reporting to national trauma databases for benchmarking and quality improvements — The host summarizing a resource [Ep 1 · 3:21](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=201)
- APSA recognizes the existence of abusive head trauma as a recognized form of child physical abuse — The host summarizing a resource [Ep 1 · 3:45](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=225)
- Abusive head trauma causes permanent and significant brain damage and neurodevelopmental issues — The host summarizing a resource [Ep 1 · 4:10](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=250)
- The term 'shaken baby syndrome' is no longer used for abusive head trauma — The host summarizing a resource [Ep 1 · 4:10](https://origin-library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606?t=250)

## Changelog
- Sep 25: 3 items added automatically

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