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Sobotka SA, Lynch E, Golden SLS, Nageswaran S. Home Health Nursing Agencies' Services for Children With Medical Complexity: Parent and Nurse Perspectives. Acad Pediatr 2024; 24:477-485. [PMID: 38278479 DOI: 10.1016/j.acap.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Many children with medical complexity (CMC) require the services of home health nurses (HHNs). Home health agencies (HHAs) hire, train, and manage nurses. For children to flourish, families, nurses, and HHAs must establish successful working relationships. Our objective was to understand the perspectives of parents and nurses about HHAs. METHODS In Illinois (IL) from 2019 to 2022, HHNs for and parents of children with invasive mechanical ventilation were interviewed. In North Carolina (NC) from 2012 to 2013, parents of CMC were interviewed, and from 2013 to 2014 HHNs participated in focus groups. Each dataset was initially analyzed separately for main themes relating to HHAs. Using collaborative thematic analysis, we determined themes common across datasets. RESULTS In IL, 23 mothers, 12 fathers, and 20 nurses were interviewed. In NC, 19 mothers, 6 fathers, and 1 grandmother were interviewed; and 4 focus groups of 18 nurses were conducted. Four common themes were identified. 1) HHAs do not have a uniform process for hiring and assigning nurses to cases. 2) HHAs have marked variability in training offered to nurses. 3) Shift scheduling, notifications, and communications with the HHAs frustrate parents and nurses. 4) Nurses and parents have little allegiance to specific HHAs; they frequently change agencies or work with several simultaneously. CONCLUSIONS Parents and nurses perceive practices for hiring, training, and staffing as inconsistent, and experience communication challenges. HHA-level problems may contribute to issues with HHN retention and complicate the lives of the families of CMC. Further research about this critical health care sector is needed.
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Affiliation(s)
- Sarah A Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics (SA Sobotka, E Lynch), The University of Chicago, Chicago, IL.
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics (SA Sobotka, E Lynch), The University of Chicago, Chicago, IL
| | | | - Savithri Nageswaran
- Department of Pediatrics (S Nageswaran), Wake Forest University School of Medicine, Winston-Salem, NC
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Bas Ikizoglu N, Atag E, Ergenekon P, Gokdemir Y, Uyan ZS, Girit S, Kilinc Sakalli AA, Erdem Eralp E, Cakir E, Guven F, Aksoy ME, Karadag B, Karakoc F, Oktem S. Implementation of a high fidelity simulation based training program for physicians of children requiring long term invasive home ventilation: a study by ISPAT team. Front Pediatr 2024; 12:1325582. [PMID: 38362002 PMCID: PMC10867101 DOI: 10.3389/fped.2024.1325582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction The number of children requiring long-term invasive home ventilation (LTIHV) has increased worldwide in recent decades. The training of physicians caring for these children is crucial since they are at high risk for complications and adverse events. This study aimed to assess the efficacy of a comprehensive high-fidelity simulation-based training program for physicians caring for children on LTIHV. Methods A multimodal training program for tracheostomy and ventilator management was prepared by ISPAT (IStanbul PAediatric Tracheostomy) team. Participants were subjected to theoretical and practical pre-tests which evaluated their knowledge levels and skills for care, follow-up, and treatment of children on LTIHV. Following the theoretical education and hands-on training session with a simulation model, theoretical and practical post-tests were performed. Results Forty-three physicians from 7 tertiary pediatric clinics in Istanbul were enrolled in the training program. Seventy percent of them had never received standardized training programs about patients on home ventilation previously. The total number of correct answers from the participants significantly improved after the theoretical training (p < 0.001). The number of participants who performed the steps correctly also significantly increased following the hands-on training session (p < 0.001). All of the 43 participants who responded rated the course overall as good or excellent. Conclusion The knowledge and skills of clinicians caring for children on LTIHV can be enhanced through a comprehensive training program consisting of theoretical training combined with hands-on training in a simulation laboratory.
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Affiliation(s)
- Nilay Bas Ikizoglu
- Division of Pediatric Pulmonology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkiye
| | - Emine Atag
- Division of Pediatric Pulmonology, School of Medicine, Maltepe University, Istanbul, Turkiye
| | - Pinar Ergenekon
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, School of Medicine, Koc University, Istanbul, Turkiye
| | - Saniye Girit
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkiye
| | - Ayse Ayzit Kilinc Sakalli
- Division of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul-Cerrahpasa University, Istanbul, Turkiye
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Istinye University, Istanbul, Turkiye
| | - Feray Guven
- Center of Advanced Simulation and Education (CASE), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkiye
| | - Mehmet Emin Aksoy
- Center of Advanced Simulation and Education (CASE), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkiye
| | - Bulent Karadag
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Sedat Oktem
- Division of Pediatric Pulmonology, School of Medicine, Medipol University, Istanbul, Turkiye
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Kukora SK, Van Horn A, Thatcher A, Pace RA, Schumacher RE, Attar MA. Risk of death at home or on hospital readmission after discharge with pediatric tracheostomy. J Perinatol 2023; 43:1020-1028. [PMID: 37443270 DOI: 10.1038/s41372-023-01721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To evaluate outcomes of patients discharged home following tracheostomy, including the timing and place of death for non-survivors. STUDY DESIGN We retrospectively reviewed medical records of infants undergoing tracheostomy between 2006 and 2017, within the first year of life for congenital or acquired neonatal conditions. RESULTS Of the 224 patients discharged after tracheostomy, 127 (57%) required home mechanical ventilation (MV). Overall, 40 (18%) patients died (65% were on MV); 38% of the deaths occurred at home and 63% at a subsequent hospitalization. Having tube feeding was identified as significantly associated with increased mortality on multivariate analysis. Having a tracheostomy for upper airway obstruction was the only variable significantly associated with increased risk of death at home on multivariate analysis. CONCLUSIONS Having tube feeding was associated with increased risk of death overall and having the tracheostomy for obstructive airway conditions was associated with death occurring at home.
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Affiliation(s)
- Stephanie K Kukora
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Adam Van Horn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Aaron Thatcher
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Rachel A Pace
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Robert E Schumacher
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Mohammad A Attar
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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Uyan ZS, Atag E, Ergenekon AP, Gokdemir Y, Gokler O, Ay P, Bas İkizoglu N, Cenk M, Erdem Eralp E, Sivrikaya GU, Girit S, Cakir E, Kilic AA, Yazan H, Can Oksay S, Hepkaya E, Kiyan G, Karadag B, Karakoc F, Oktem S. Efficacy of standardized tracheostomy training with a simulation model for healthcare providers: A study by ISPAT team. Pediatr Pulmonol 2022; 57:418-426. [PMID: 34821480 DOI: 10.1002/ppul.25772] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/30/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Tracheostomy care in children may be challenging, due to lack of knowledge of healthcare providers (HCPs). The aim of this study was to determine the level of knowledge of HCP who follow patients with tracheostomy and to increase this level with theoretical training and training in a simulation laboratory. MATERIALS AND METHODS ISPAT (IStanbul PAediatric Tracheostomy), a multidisciplinary team for tracheostomy care was established and a training program was prepared. Participants were subjected to theoretical and practical pretests which evaluated their knowledge levels and skills for care, follow-up, and treatment of a patient with tracheostomy. After the theoretical and practical training given to the participants with a simulation model, theoretical and practical posttests were applied. RESULTS Fifty-one HCP from nine tertiary pediatric clinics in Istanbul were enrolled in the training program. Only six (11.8%) of them had received standardized training programs previously. Regarding the theoretical tests, seven of the 33 questions were indicated as essential. The knowledge level of the participants based on the essential questions significantly increased after the training (p < 0.05 for all of the essential questions). The total number of correct answers and correct answers of three subheadings also significantly increased after the practical training (p < 0.001 for all). Ninety-five percent of the participants assessed the course as good or excellent in general. CONCLUSION Training in a simulation laboratory in combination with theoretical education can improve the knowledge and skills of the HCP enabling improved care of children with a tracheostomy.
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Affiliation(s)
- Zeynep S Uyan
- Division of Pediatric Pulmonology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Emine Atag
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Almala P Ergenekon
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ozan Gokler
- Department of Otorhinolaryngology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Pinar Ay
- Department of Public Health, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nilay Bas İkizoglu
- Division of Pediatric Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muruvvet Cenk
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - G Ulufer Sivrikaya
- Rahmi M. Koc Academy of Interventional Medicine, Education and Simulation (RMK AIMES), Istanbul, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse A Kilic
- Division of Pediatric Pulmonology, Faculty of Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Sinem Can Oksay
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Evrim Hepkaya
- Division of Pediatric Pulmonology, Faculty of Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Gursu Kiyan
- Department of Pediatric Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Sedat Oktem
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
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Pettitt-Schieber B, Mahendran G, Tey CS, Prickett KK. Risk factors for return visits in children discharged with tracheostomy. Int J Pediatr Otorhinolaryngol 2021; 150:110860. [PMID: 34403974 DOI: 10.1016/j.ijporl.2021.110860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/11/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVES To determine associations between demographic and clinical characteristics and rate of unplanned returns to system (RTS) in pediatric patients discharged with tracheostomy. METHODS Medical records were examined for pediatric patients discharged after tracheostomy placement between January 1, 2011 and December 31, 2015. Exclusion criteria included death or decannulation prior to discharge and lack of follow-up through 180 days post-discharge. Readmissions were grouped by time interval after discharge (within 30 days or within 31-180 days). Chi-squared analysis and Fisher's Exact Test were utilized to determine associations between patient characteristics, rate and frequency of RTS, and type of admission (Emergency Department [ED] or inpatient [IP]). RESULTS One hundred twenty-one patients were eligible for the study, and 80 (66.1 %) had an unanticipated RTS during the follow-up period. Patients with early RTS had a higher total number of RTS. Patients with two or more RTS were more likely to be younger, while patients with five or more RTS were more likely to have greater organ system involvement and cardiovascular (CV) disease in particular. Patients presenting with GI diagnoses were more likely to be discharged from the ED. The rate of RTS remained constant throughout the time period examined. CONCLUSION Pediatric patients discharged with tracheostomy are medically complex and at high risk of RTS, especially for respiratory and GI problems. This risk does not decrease after the initial post-discharge period and long-term follow-up is warranted. Younger patients and patients with history of early RTS are at highest risk for repeat RTS and should be identified for closer outpatient care.
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Affiliation(s)
| | | | - Ching Siong Tey
- School of Medicine, Department of Pediatrics, Emory University, USA
| | - Kara K Prickett
- School of Medicine, Department of Pediatrics, Emory University, USA; School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Emory University, USA.
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Colley N, Komizunai S, Konno A, Kanai S, Ninomiya S. Relationship Between Tracheal Suctioning Catheter Motion and Secretion Amount Based on Viscosity. SAGE Open Nurs 2021; 6:2377960820969385. [PMID: 33415305 PMCID: PMC7774403 DOI: 10.1177/2377960820969385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/30/2020] [Accepted: 10/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background To provide safe tracheal suctioning, the American Association of Respiratory Care guideline discusses the length of suctioning catheter, but the most effective tracheal suctioning catheter technique is still unknown. Objective The aim of this study is to compare the amount of simulated secretion produced by five different handlings of a catheter at two different viscosities and in two different models to discover the most effective suctioning maneuver in the various mucus conditions. Design In vitro experimental design. Methods The amount of secretion aspirated by our researcher's manipulation of a suctioning catheter was measured. The tip of the catheter was recorded using a high-speed video camera to visualize the secretion motion. Results The most effective suctioning technique differed depending on the viscosity of the secretion. There were no significant differences between five suctioning methods applied to high-viscosity phlegm in a tracheal membrane model, but the flexion technique was the most efficient for low-viscosity secretion. Conclusions Our results imply that the flexion technique was reasonably safe and the most effective of these five methods for low-viscosity secretion.
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Affiliation(s)
- Noriyo Colley
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Shunsuke Komizunai
- Faculty of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Atsushi Konno
- Faculty of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Satoshi Kanai
- Faculty of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Shinji Ninomiya
- Department of Clinical Engineering, Hiroshima International University, Hiroshima, Japan
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Estrem B, Wall J, Paitich L, Maynard R. The Ventilator-Dependent Child: Best Practices for Educating Home Care Nurses. Home Healthc Now 2020; 38:75-79. [PMID: 32134814 DOI: 10.1097/nhh.0000000000000852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pediatric Home Service (PHS) in Roseville, Minnesota, has provided home care for children with medical complexity for over 30 years. This article describes the PHS program for educating and training home care nurses (HCNs). Since the inception of the company, advanced training for family and professional caregivers of ventilator-dependent children has been an important focus. The current program for HCN has three components and incorporates simulation and in-home training. Standardizing educational requirements and competencies for pediatric HCNs across nursing agencies has the potential to improve outcomes for children with medical complexity receiving home healthcare services.
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Affiliation(s)
- Bruce Estrem
- Bruce Estrem, BA, RRT-NPS, is a Manager of Clinical Education, Pediatric Home Service, Roseville, Minnesota. Jill Wall, BSN, CRNI, is a Nurse Educator, Pediatric Home Service, Roseville, Minnesota. Lindsey Paitich, BSN, RN, is Director of Home Care Nursing, Pediatric Home Service, Roseville, Minnesota. Roy Maynard, MD, FAAP, is Medical Director, Pediatric Home Service, Roseville, Minnesota, and Committee Member, Section on Home Care, American Academy of Pediatrics
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Kohn J, McKeon M, Munhall D, Blanchette S, Wells S, Watters K. Standardization of pediatric tracheostomy care with "Go-bags". Int J Pediatr Otorhinolaryngol 2019; 121:154-156. [PMID: 30913503 DOI: 10.1016/j.ijporl.2019.03.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/17/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe how pediatric tracheostomy emergency supplies and education are standardized with the use of "Go-bags" and to demonstrate how this has impacted tracheostomy-related adverse events. METHODS A prospective study was completed at an urban pediatric tertiary care center. Standardized "Go-bags" of tracheostomy supplies were provided to pediatric patients with tracheostomy. All caregivers received standardized tracheostomy education. Check lists were used to monitor contents at return visits or admissions. Tracheostomy related adverse events were tracked on all patients with tracheostomy from July 2016 to May 2018, and rates were compared for patients who had received a "Go-bag" to those who had not. RESULTS 292 "Go-bags" were distributed during the two-year study period. 35% were distributed by inpatient respiratory therapists, 23% by the home ventilation team, and 22% by a tracheostomy clinic nurse. Supply checks have led to more than 185 cases of emergency tracheostomy equipment replacement. 35% of tracheostomy-related adverse event (TRAE) occurred in patients who did not have a "Go-bag", while 22% of TRAEs occurred in patients who had "Go-bags". CONCLUSION Standardized pediatric tracheostomy care is critical to patient safety, both in and out of the hospital. Standardized tracheostomy "Go-bags" are a simple and efficient method to educate caregivers, improve the quality of care for children with tracheostomy, and ultimately reduce tracheostomy related adverse events.
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Affiliation(s)
- Jocelyn Kohn
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Mallory McKeon
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Daphne Munhall
- Department of Respiratory Care, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Susan Blanchette
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Sarah Wells
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Karen Watters
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA.
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