Pediatric Critical Care Medicine Fellowship
The Pediatric Critical Care Medicine fellowship at MassGeneral Hospital for Children/Harvard Medical School provides fellows with a learning environment that will enable them to become expert practitioners and leaders in the field of Pediatric Critical Care Medicine.
Thank you for your interest in the Pediatric Critical Care Medicine (PCCM) fellowship at MassGeneral Hospital for Children/Harvard Medical School. The primary objective of the fellowship program is to provide fellows with a learning environment that will enable them to become expert practitioners and leaders in the field of Pediatric Critical Care Medicine. The fellowship director works closely with each fellow throughout their three years of training to tailor his/her experience to meet individual career aspirations. In the past this has included the design of ABP-approved dual subspecialty training in PCCM and other pediatric subspecialties, including emergency medicine and pulmonology.
The program is configured to support seven clinical fellows following the track toward certification by the sub-board of Pediatric Critical Care at the American Board of Pediatrics. The program is accredited by the Accreditation Council for Graduate Medical Education (ACGME).
The goals of the program are four-fold:
1) To provide fellows with an understanding of the pathophysiology of life-threatening disease and injury, and the cognitive and technical skills necessary to independently diagnose and manage critically ill infants, children and adolescents.
2) To foster an environment of intellectual curiosity, advance the fellows’ knowledge of the basic principles of research and mentor each fellow in the pursuit of scholarly activity related to pediatric critical care.
3) To enable fellows to become effective educators in pediatric critical care medicine.
4) To help the fellows become efficient administrators, through supervised acquisition of experience in management and problem-solving in a multidisciplinary pediatric intensive care unit.
The PICU fellow works closely with the on-service attending physician and is given graduated responsibility in his/her management of the service. The philosophy of the PICU faculty is that responsibility should increase commensurate with the increase in knowledge and skills that are gained over the three-year fellowship.
In addition to bedside teaching and daily case-based discussions on work rounds, the fellows attend weekly didactic teaching conferences (two, hour-long sessions per week) covering a wide array of topics, including basic pathophysiology and management of critical care illness and disease, biostatistics, innovative therapies and more.
Fellows participate in a Leadership Curriculum designed to teach leadership and crisis resource management skills. This curriculum includes participation in simulated case scenarios and attendance of didactic conferences. The emphasis of the curriculum is to improve communication and leadership skills during a crisis, with topics including:
- Role clarification during a clinical crisis
- Communication between medical team members during a crisis
- Communication styles that facilitate co-operation
- Closed loop communication when assigning or accepting tasks
- Speaking up against authority during a crisis
Fellows also participate in an Ethics Curriculum that includes rotating didactic lectures as well as group sessions with families who volunteer to come share with the group their memories of past PICU hospitalizations. The family symposium includes a Mother Grief Group, where families of children who have died in the PICU reflect with staff over the effective and ineffective communication styles they experienced during their ICU stay and the lasting impact these interactions had on them. The Ethics Curriculum also includes a Religious, Spiritual and Cultural Forum, where representatives from various religious faiths and cultures discuss recent cases, allowing the fellow to gain a better perspective of what critical illness and death mean to each one. It also teaches the fellows how to discuss particular concepts, such as brain death, in a culturally sensitive manner.
Fellows are expected to prepare for and participate in monthly morbidity and mortality conferences and journal clubs.
Fellows also participate in a monthly Collaborative Practice Meeting, a multidisciplinary conference focused on quality improvement efforts in the PICU.
Beyond these division-specific conferences, fellows are encouraged to take advantage of the many other didactic conferences offered by MassGeneral Hospital for Children, including Pediatric Grand Rounds, Trauma Conference, Pediatric ECMO conference, Pediatric Transport Conference, Pediatric Ethics Committee meetings and lecture series, and Adult Critical Care/Anesthesia/Pulmonary Conference.
There are three components to the telemedicine service provided through the MassGeneral Hospital for Children PICU.
First, through our state-of-the art telemedicine link, we provide live video conferencing between the PICU and select patient rooms in emergency departments at outlying community hospitals. Via this link, fellows provide on-demand medical advice and guidance to help assess, and if needed, stabilize critically ill infants and children and prepare them for transport to the PICU.
Secondly, our telemedicine technology currently supports an international link between the Buen Samaritano Hospital in Aguadilla, Puerto Rico and our PICU. Under the supervision of the on-service attending, the fellow provides teaching and consultation on challenging pediatric cases presented by faculty in Puerto Rico.
Finally, this innovative technology is designed to support live video conferencing between the PICU team in-house overnight and the on-service attending, at home. Any member of the team may request a teleconference with the attending for the purpose of virtual bedside evaluation of a new patient, reassessment of a patient whose condition may be deteriorating, or a team meeting with other subspecialty consultants and family members at the bedside. One of the many advantages of this technology is that it allows the on-call fellow the opportunity to be on the frontline, independently leading the unit overnight while still having access to appropriate faculty supervision. All faculty live in close proximity to the hospital and can return to the hospital within minutes to provide direct supervision of the fellow when needed.
Read a recent article about the Mass General PICU Telemedicine Program.
The PICU at MassGeneral Hospital for Children provides an active critical care transport service for local and regional hospitals throughout New England. All transport calls are fielded by the PICU fellow by telephone or, in some cases, via telemedicine link between the PICU and the outlying hospital. The PICU fellow is required to assess the level of acuity of the patient and to identify the patient’s immediate and transport needs. He/she is expected to provide management advice to the referring physician, determine and coordinate the best mode of transport, and provide ongoing consultation with the transporting team en route to the PICU. All of this is done under the direct supervision of the on-service attending. Senior fellows interested in moonlighting as a transport physician may request permission from the Program Director to do so as long as these hours abide by the duty hours rules set by the ACGME.
The block rotations in the first year of the Pediatric Intensive Care Unit (PICU) fellowship training are focused on the development of clinical skills in the ICU, advanced airway management, and an introduction to the principles of research design and performance. Clinical rotations typically include two months in the PICU, one month in the Pediatric Burn ICU at Shriners Hospitals for Children- Boston next door to Massachusetts General Hospital, one month in the Cardiac Intensive Care Unit at Children’s Hospital Boston, and one month in Anesthesia. Fellows also gain experience providing procedural sedation to infants and children undergoing painful procedures or studies requiring no movement.
The first-year fellow is expected to participate in regularly scheduled teaching conferences, morbidity and mortality conference, journal club, mock codes and fellow-run didactic teaching for pediatric residents and medical students on basic pediatric critical care topics.
With respect to scholarly activity, the first-year fellow is scheduled for approximately four months of dedicated research time during which he/she explores various research opportunities and begins laying the foundation for a scholarly project under the guidance of a research mentor.
The second-year curriculum continues to provide clinical experience, including two months in the PICU, one month in the burn ICU and one month in the CICU. The second-year fellow is expected to display progressively independent thought and management skills during these service months. The remainder of the year is dedicated to research, with continued participation in weekly teaching conferences and continued contributions to the teaching of pediatric residents and medical students in pediatric critical care medicine.
The third-year curriculum continues to focus more on research and teaching, though it also provides clinical experience, including one to two months in the PICU, one month in the burn ICU and one month in the CICU. The third-year fellow is expected to take responsibility for leading work rounds and team meetings and to take on a greater proportion of formal teaching in rounds and lectures. The remaining seven to eight months is dedicated to research, during which time the fellow is expected to complete his/her research project and often present his/her findings at a national conference.
A meaningful supervised research experience is an integral component of the Pediatric Critical Care fellowship at MassGeneral Hospital for Children (MGHfC). Support for the trainee’s research project begins in the first months of fellowship. First-year fellows meet with the Program Director at regular intervals to help identify an area of interest, to visit different labs and to meet with prospective mentors in the Mass General/Harvard system. Research opportunities abound throughout Mass General, Harvard Medical School, Harvard School for Public Health, as well as other academic health care centers in Boston. Offerings range from basic science and translational research to clinical investigation, ethics, international health and education. Each member of the PICU faculty is actively engaged in various types of scholarly activity, and many have acted as research mentors for past fellows. Other fellows have identified research projects and mentors beyond the PICU.
Examples of scholarly activity undertaken during fellowship:
Prodhan P, Noviski NN, Kinane TB. Salmeterol for the prevention of high-altitude pulmonary edema. N Engl J Med. 2002 Oct 17; 347(16):1282-5; author reply 1282-5.
Prodhan P, Noviski NN, Butler WE, Eskandar E, Ellen Grant P, Whalen MJ. Orbital compartment syndrome mimicking cerebral herniation in a 12-yr-old boy with severe traumatic asphyxia. Pediatr Crit Care Med. 2003 Jul; 4(3):367-9.
Prodhan P, Noviski N. Pediatric acute hypoxemic respiratory failure: management of oxygenation. J Intensive Care Med. 2004 May-Jun; 19(3):140-53.
Sheibani N, Grabowski EF, Schoenfeld DA, Whalen MJ. Effect of granulocyte colony-stimulating factor on functional and histopathologic outcome after traumatic brain injury in mice. Crit Care Med. 2004 Nov;32(11):2274-8.
Prodhan P, Casavant D, Medlock MD, Yager P, Kim J, Noviski N., Inhaled nitric oxide in neurogenic cardiopulmonary dysfunction: implications for organ donation. Transplant Proc. 2004 Nov; 36(9):2570-2572.
Zhu X, Bernecker OY, Manohar NS, Hajjar RJ, Hellman J, Ichinose F, Valdivia HH, Schmidt U. Increased leakage of sarcoplasmic reticulum Ca2+ contributes to abnormal myocyte Ca2+ handling and shortening in sepsis. Crit Care Med. 2005 Mar;33(3):598-604.
Paris JJ, Billinngs JA, Cummings B, Moreland MP. Howe v. MGH and Hudson v. Texas Children's Hospital: two approaches to resolving family-physician disputes in end-of-life care. J Perinatol. 2006 Dec; 26(12):726-9.
You Z, Yang J, Takahashi K, Yager P, Kim HH, Qin T, Stahl GL, Ezekowitz RA, Carroll MC, Whalen MJ. Reduced tissue damage and improved recovery of motor function after traumatic brain injury in mice deficient in complement component C4. J Cereb Blood Flow Metab. 2007 Dec; 27(12):1954-1964.
Yager P, You Z, Qin T, Kim HH, Takahashi K, Ezekowitz AB, Stahl GL, Carroll MC, Whalen MJ., Mannose binding lectin gene deficiency increases susceptibility to traumatic brain injury in mice. Cereb Blood Flow Metab. 2008 May; 28(5):1030-1039.
Gupta P, Goyal S, Gonzalez-Mendoza LE, Noviski N, Vezmar M, Brathwaite CD, Misra M. Corticotropin-independent cushing syndrome in a child with an ovarian tumor misdiagnosed as nonclassic congenital adrenal hyperplasia. Endocr Pract. 2008 Oct;14(7):875-9.
Prodhan P, Dela Rosa RS, Shubina M, Haver KE, Matthews BD, Buck S, Kacmarek RM, Noviski NN. Wheeze detection in the pediatric intensive care unit: comparison among physician, nurses, respiratory therapists, and a computerized respiratory sound monitor. Respir Care. 2008 Oct; 53(10):1304-9.
Prodhan P, Westra SJ, Lin J, Karni-Sharoor S, Regan S, Noviski N. Chest radiological patterns predict the duration of mechanical ventilation in children with RSV infection. Pediatr Radiol. 2009 Feb;39(2):117-23.
Gupta P, Tobias JD, Goyal S, Miller MD, De Moor MM, Noviski N, Mehta V. Preliminary experience with a combination of dexmedetomidine and propofol infusions for diagnostic cardiac catheterization in children. J Pediatr Pharmacol Ther. 2009 Apr;14(2):106-12.
Melendez E, Bachur R. Serious adverse events during procedural sedation with ketamine. Pediatr Emerg Care. 2009 May;25(5):325-8.
Li Y, Liu B, Zhao H, Sailhamer EA, Fukudome EY, Zhang X, Kheirbek T, Finkelstein RA, Velmahos GC, deMoya M, Hales CA, Alam HB. Protective effect of suberoylanilide hydroxamic acid against LPS-induced septic shock in rodents. Shock. 2009 Nov;32(5):517-23.
Gupta P, Tobias JD, Goyal S, Miller MD, Melendez E, Noviski N, De Moor MM, Mehta V. Sudden cardiac death under anesthesia in pediatric patient with Williams syndrome: a case report and review of literature. Ann Card Anaesth. 2010 Jan-Apr;13(1):44-8
Alam HB, Hashmi S, Finkelstein RA, Shuja F, Fukudome EY, Li Y, Liu B, Demoya M, Velmahos GC. Alterations in gene expression after induction of profound hypothermia for the treatment of lethal hemorrhage. J Trauma. 2010 May;68(5):1084-98. Erratum in: J Trauma. 2010 Jul;69(1):242.
Li Y, Liu B, Fukudome EY, Kochanek AR, Finkelstein RA, Chong W, Jin G, Lu J, deMoya MA, Velmahos GC, Alam HB. Surviving lethal septic shock without fluid resuscitation in a rodent model. Surgery. 2010 Aug;148(2):246-54.
Gupta P, Tobias JD, Goyal S, Kuperstock JE, Hashmi SF, Shin J, Hartnick CJ, Noviski N. Perioperative care following complex laryngotracheal reconstruction in infants and children. Saudi J Anaesth. 2010 Sep;4(3):186-96.
Finkelstein RA, Li Y, Liu B, Shuja F, Fukudome E, Velmahos GC, deMoya M, Alam HB. Treatment with histone deacetylase inhibitor attenuates MAP kinase mediated liver injury in a lethal model of septic shock. J Surg Res. 2010 Sep;163(1):146-54.
Gupta P, Goyal S, Grant E, Fawaz R, Noviski N, Yager P, Sharma A, Lok J, Browning M. Acute Liver Failure and leukoencephalopathy in a pediatric patient with homocystinuria: A case report and review of literature. J Pediatr Gastroenterol Nutr. 2010 Nov; 51(5):668-671.
Cummings BM, Noviski N. Autoresuscitation in a child: The young Lazarus. Resuscitation. 2011 Jan; 82(1):134.
Prodhan P, Sharoor-Karni S, Lin J, Noviski N. Predictors of respiratory failure among previously healthy children with respiratory syncytial virus infection. Am J Emerg Med. 2011 Feb;29(2):168-73.
Shuja F, Finkelstein RA, Fukudome E, Duggan M, Kheirbek T, Hamwi K, Fischer TH, Fikry K, deMoya M, Velmahos GC, Alam HB. Development and testing of low-volume hyperoncotic, hyperosmotic spray-dried plasma for the treatment of trauma-associated coagulopathy. J Trauma. 2011 Mar;70(3):664-71.
Murphy S, Cserti-Gazdewich C, Dhabangi A, Musoke C, Nabukeera-Barungi N, Price D, King ME, Romero J, Noviski N, Dzik W. Ultrasound findings in Plasmodium falciparum malaria: a pilot study. Pediatr Crit Care Med. 2011 Mar;12(2):e58-63.
Gupta P, Tobias JD, Goyal S, Hervie P, Harris JB, Sadot E, Noviski N. Prolonged mechanical support in children with severe adenoviral infections: a case series and review of the literature. J Intensive Care Med. 2011 Jul-Aug;26(4):267-72.
Gupta P, Goyal S, Tobias JD, Prodhan P, Purohit P, Gossett JM, Chow V, Noviski N. Risk factors associated with hospital admission among healthy children with adenovirus infection. Turk J Pediatr. 2011 Nov-Dec;53(6):597-603.
Kim SW, Maturo S, Dwyer D, Monash B, Yager PH, Zanger K, Hartnick CJ. Interdisciplinary development and implementation of communication checklist for postoperative management of pediatric airway patients. Otolaryngol Head Neck Surg. 2012 Jan; 146(1):129-34.
Kollidon VA64, a membrane-resealing agent, reduces histopathology and improves functional outcome after controlled cortical impact in mice. J Cereb Blood Flow Metab. 2012 Mar; 32(3):515-24.
Cowl AS, Cummings BM, Yager P, Miller B, Noviski N. Organ donation after cardiac death in children: acceptance of a protocol by multidisciplinary staff. Am J Crit Care. 2012 21(5):322-327.
Dapul HR, Park J, Zhang J, Lee C, Daneshmand A, Lok J, Ayata C, Gray T, Scalzo A, Qiu J, Lo EH, Whalen MJ. Concussive Injury before or after Controlled Cortical Impact Exacerbates Histopathology and Functional Outcome in a Mixed Traumatic Brain Injury Model in Mice. J Neurotrauma. 2013 Mar 1;30(5):382-91.
Cummings BM, Macklin EA, Yager PH, Sharma A, Noviski N. Potassium Abnormalities in a Pediatric Intensive Care Unit: Frequency and Severity. J Intensive Care Med. 2013 Jun 6.
Bhupali C, Cummings BM, Parker L, Young R, Noviski N. Positive lidocaine toxicology screen after j-tip for venipuncture. Pediatr Emerg Care. 2013 Dec; 29(12):1278-9.
Prodhan P, Lin J, Regan S, Westra J, Yager P, Karni-Sharoor S, Noviski N. Critically ill children with respiratory syncytial virus and acute respiratory failure: initial chest radiological patterns as predictors of outcome. Poster presentation, 5th World Congress on Pediatric Critical Care, Geneva, Switzerland, 2007.
Sadot E, Prodhan P, Yager P, Noviski N. Neurological findings in hospitalized children with severe status asthmaticus. Pediatric Academic Societies’ Annual Meeting, Honolulu, HI. 2008.
Cummings B, Yager P, Riley J, Carew A and Noviski N. Impact of hospital-based pediatric transport team closure on transports and transport requests to a pediatric intensive care unit. Poster presentation, Society of Critical Care Medicine 40th Critical Care Conference, San Diego CA January 2011.
Byrnes C, Cummings B, Noviski N, Stathopoulos W and Gordon J. Objectively Evaluating Pediatric Resident Performance using Closed Malpractice Claims in a Simulator Based Testing Environment. Poster presentation, Society of Critical Care Medicine 40th Critical Care Conference, San Diego CA January 2011.
Fuenfer, M. Injury To The Abdominal Aorta In Children Resulting From Blunt Trauma. Poster Presentation, Massachusetts General Hospital Scientific Advisory Committee Poster Day, Boston MA April 2012.
Ode O, Cummings BM, Lawrence C, Hartnick C, Noviski N. Chest Radiographic Patterns after Laryngotracheal Reconstructions in Children. Poster Presentation, ATS International Conference in San Francisco, CA May 2012.
Fuenfer M, Gilchrist B et al. Revision Circumcisions and Re-Educating Clinicians. Brian Gilchrist. Poster presentation, 93rd Annual New England Surgical Association Meeting, Rockport ME September 2012.
Helena Crowley H, Fuenfer M, Gilchrist B. Argon Beam Coagulation Negates the Need for Drainage in the Excision of Cystic Hygromas. Poster Presentation, 93rd Annual New England Surgical Association Meeting, Rockport ME September 2012.
Fuenfer M, Cummings BM, Noviski N. Lifeguard Down: Causative Factors in US Civil Air Ambulance Accidents From 1982-2009. Poster Presentation, American College of Surgeons, Annual Clinical Congress, Chicago, September 2012.
Ahmed F, Cummings BM, Noviski N. Reduction Of Repetitive Imaging On Pediatric Patients Referred To A PICU: A Quality Initiative. Poster presentation, Society of Critical Care Medicine 42th Critical Care Conference, San Juan, PR January 2013.
Cummings BM, Cowl A, Yager P, El Saleeby C, Shank E, Noviski N. Cardiovascular effects of dexmedetomidine infusion without a loading dose in critically ill children. Poster presentation, Society of Critical Care Medicine 42th Critical Care Conference, San Juan, PR January 2013.
Fuenfer M, Lemierre’s Syndrome Resulting from Parotidis. Poster Presentation, Mass. General Hospital Scientific Advisory Committee Poster Day, Boston MA March 2013.
Duran C, Noviski N. Fiberoptic flexible bronchoscopy in children with pulmonary disease (Broncoscopía con fibra óptica en el paciente pediátrico). In: Quiñones E, Ugazzi F, Donoso F, and Endara S, eds. Bases de neumología pediátrica. Quito: Ed. Noción; 2006. p. 126-35.
Tsifansky M, Duran C, Noviski, N. Asma Casi Mortal. Epidemiología, Fisipatología Y Manejo. In: Quinones, E, Ugazzi, M, Campos, S, Donoso, F, Noviski, N. eds. Bases de pediatria critica, 4th ed. Quito: Cmiuio; 2007. p. 102-08.
Duran C, Prodhan P, Noviski N. Manejo Del Fracaso Respiratorio Hipoxemico Agudo. In: Quinones, E, Ugazzi, M, Campos, S, Donoso, F, Noviski, N., eds.. Bases de pediatria critica, 4th ed. Quito: Cmiuio; 2007. p. 291-302.
Duran C, Noviski N. Broncoscopia Con Fibra Óptica En El Pactiente Pediátrico. In: Quinones, E, Ugazzi, M, Campos, S, Donoso, F, Noviski, N., eds.. Bases de pediatria critica, 4th ed. Quito: Cmiuio; 2007. p. 200-10.
Tsifansky M, Duran C, Noviski N. Asma casi mortal eidemiologia, fisiopatologia y manejo. [Near-fatal asthma: epidemiology, pathophysiology and management.] In: Quinones E, Ugazzi M, Campos S, Donoso F, eds. Noviski N, assoc. ed. Bases de pediatria critica, 5th ed. Quito: Cmiuio; 2010. p. 100-06.
Duran C, Noviski N. Broncoscopia con fibra optica en el paciente pediatrico. [Flexible bronchoscopy in the pediatric patient.] In: Quinones E, Ugazzi M, Campos S, Donoso F, eds. Noviski N, assoc. ed. Bases de pediatria critica, 5th ed. Quito: Cmiuio; 2010. p. 194-203.
Duran C, Prodhan P, Noviski N. Manejo del fracaso respirtorio hipoxemico agudo. [Management of Acute Hypoxemic Respiratory Failure.] In: Quinones E, Ugazzi M, Campos S, Donoso F, eds. Noviski N, assoc. ed. Bases de pediatria critica, 5th ed. Quito: Cmiuio; 2010. p. 285-96
Byrnes, C. Harvard Macy Fellowship in Education, 2008-2009.
Finkelstein, R. Winner of the Massachusetts State Basic Science Competition, 2010 American College of Surgeons Committee on Trauma Competition.
Dapul, H. Research citation finalist, 10th National Neurotrauma Symposium in 2011.
Munoz Pareja, J. Best Physician-In-Training Award, The American Academy of Pediatrics, 2013.
After identifying a project and research mentor, a scholarship oversight committee (SOC) is created to oversee the scholarly activity of the fellow. In addition, trainees are introduced to basic science techniques, study design, data collection, statistical analysis, and other fundamental areas of study design through seminars offered throughout the Mass General/Harvard Medical School community.
Trainees interested in pursuing a fellowship in Pediatric Critical Care Medicine at MassGeneral Hospital for Children may submit an application online through the Electronic Residency Application Service (ERAS).
NOTE: CHANGE IN RESIDENCY REQUIREMENT STARTING THE 2015/2016 APPLICATION CYCLE: Per the ACGME, “All required clinical education for entry into ACGME-accredited fellowship programs must be completed in an ACGME-accredited residency program, or in an RCPSC-accredited or CFPC- accredited residency program located in Canada.” To be eligible, you must have graduated from an accredited pediatric residency program in either the United States or Canada; international pediatric residency programs are no longer acceptable.
Completed applications should include the following documents:
- Common Application Form (CAF)
- Curriculum vitae
- Personal statement
- Three (3) letters of recommendation
- Wallet-sized photograph
- Official medical school transcript
- USMLE transcript
- ECFMG status report (international medical graduates only)
Once your application has been received in its entirety and the information reviewed, competitive applicants will be contacted to arrange for a personal interview.
If you have any questions regarding our program, the application process, or the status of your application, please feel free to contact Pat McCarthy, Fellowship Coordinator, by telephone: 617-724-4380 or by e-mail: firstname.lastname@example.org
MGHfC Critical Care Medicine Fellowship ProgramCPZS-5
175 Cambridge Street
Boston, MA 02114
Public Transportation Access: yes
Disabled Access: yes
If you have any questions regarding our program, the application process or the status of your application, please don’t hesitate to contact us. We look forward to hearing from you and would be happy to talk to you more about how we might tailor the program to meet your individual needs.
MassGeneral Hospital for Children
Department of Pediatric Critical Care Medicine
175 Cambridge Street, CPZS-5
Boston, MA 02114
Fellowship Program Coordinator
Phoebe Yager, MD
Fellowship Program Director
Natan Noviski, MD
Chief, Pediatric Critical Care Medicine
Associate Chair, Department of Pediatrics
Massachusetts General Hospital for Children
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