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Cantinotti M, Voges I, Miller O, Raimondi F, Grotenhuis H, Bharucha T, Garrido AO, Valsangiacomo E, Roest A, Sunnegårdh J, Salaets T, Brun H, Khraiche D, Jossif A, Schokking M, Sebate-Rotes A, Meyer-Szary J, Deri A, Koopman L, Herberg U, du Marchie Sarvaas G, Leskinen M, Tchana B, Ten Harkel ADJ, Ödemis E, Morrison L, Steimetz M, Laser KT, Doros G, Bellshan-Revell H, Muntean I, Anagostopoulou A, Alpman MS, Hunter L, Ojala T, Bhat M, Olejnik P, Wacker J, Bonello B, Ramcharan T, Greil G, Marek J, DiSalvo G, McMahon CJ. Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities, and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group. Cardiol Young 2024:1-9. [PMID: 38439642 DOI: 10.1017/s1047951124000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND There is limited data on the organisation of paediatric echocardiography laboratories in Europe. METHODS A structured and approved questionnaire was circulated across all 95 Association for European Paediatric and Congenital Cardiology affiliated centres. The aims were to evaluate: (1) facilities in paediatric echocardiography laboratories across Europe, (2) accredited laboratories, (3) medical/paramedical staff employed, (4) time for echocardiographic studies and reporting, and (5) training, teaching, quality improvement, and research programs. RESULTS Respondents from forty-three centres (45%) in 22 countries completed the survey. Thirty-six centres (84%) have a dedicated paediatric echocardiography laboratory, only five (12%) of which reported they were European Association of Cardiovascular Imaging accredited. The median number of echocardiography rooms was three (range 1-12), and echocardiography machines was four (range 1-12). Only half of all the centres have dedicated imaging physiologists and/or nursing staff, while the majority (79%) have specialist imaging cardiologist(s). The median (range) duration of time for a new examination was 45 (20-60) minutes, and for repeat examination was 20 (5-30) minutes. More than half of respondents (58%) have dedicated time for reporting. An organised training program was present in most centres (78%), 44% undertake quality assurance, and 79% perform research. Guidelines for performing echocardiography were available in 32 centres (74%). CONCLUSION Facilities, staffing levels, study times, standards in teaching/training, and quality assurance vary widely across paediatric echocardiography laboratories in Europe. Greater support and investment to facilitate improvements in staffing levels, equipment, and governance would potentially improve European paediatric echocardiography laboratories.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), National Research Institute (CNR), Pisa, Italy
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- European Association Cardiovascular Imaging (EACVI), Taskforce on Congenital Heart Disease, Lyon, France
| | - Inga Voges
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- DZHK (German Center for Cardiovascular Research), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department for Congenital Cardiology and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Owen Miller
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- Department Paediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Francesca Raimondi
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- European Association Cardiovascular Imaging (EACVI), Taskforce on Congenital Heart Disease, Lyon, France
- Division of Pediatric Cardiology, Meyer University Hospital, Florence University, Firenze, Italy
| | - Heynric Grotenhuis
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- Department Pediatric Cardiology, Wilhelmina Children's Hospital / UMCU, Utrecht, The Netherlands
| | - Tara Bharucha
- European Association Cardiovascular Imaging (EACVI), Taskforce on Congenital Heart Disease, Lyon, France
- Department of Paediatric Cardiology, University Hospital Southampton, Southampton, UK
| | - Almudena Ortiz Garrido
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- Department Pediatric Cardiology, Hospital Materno Infantil, Malaga, AL, Spain
| | - Emanuela Valsangiacomo
- European Association Cardiovascular Imaging (EACVI), Taskforce on Congenital Heart Disease, Lyon, France
- Department of Paediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Arno Roest
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, Netherlands
| | - Jan Sunnegårdh
- Children's Heart Centre, The Queen Silvia Children's Hospital Sahlgrenska University Hospital, Göteborg, Sweden
| | - Thomas Salaets
- Department Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Henrik Brun
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | | | - Antonis Jossif
- Paedi Center for Specialized Pediatrics, Strovolos, Cyprus
| | | | - Anna Sebate-Rotes
- Servicio de Cardiología Pediátrica, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jaroslaw Meyer-Szary
- Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Antigoni Deri
- Department Paediatric Cardiology, Leeds University, Leeds, UK
| | - Laurens Koopman
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ulrike Herberg
- Department or Pediatric Cardiology and Congenital Heart Disease, University of Aachen, Aachen, Germany
| | - Gideon du Marchie Sarvaas
- Department of Pediatric Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Markku Leskinen
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Bertrand Tchana
- Parma University Hospital, Department of Mother and Child Pediatric Cardiology Unit, Parma, Italy
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Ender Ödemis
- Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Louise Morrison
- Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Micheal Steimetz
- Department of Pediatric Cardiology and Intensive Care Medicine (M.S.), University Medical Center, Georg-August-University, Goettingen, Germany
| | - Kai Thorsten Laser
- Department of Congenital Heart Defects, Heart and Diabetes Center, North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Gabriela Doros
- Victor Babes UMF, IIIrd Pediatric Clinic, Louis Turcanu Emergency Children Hospital, Timisoara, Romania
| | | | - Iolanda Muntean
- Clinic of Paediatric Cardiology, Institute for Cardiovascular Diseases and Transplantation, UMFST "George Emil Palade", Timisoara, Romania
| | | | - Maria Sjoborg Alpman
- Pediatric Cardiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Lindsey Hunter
- Department Paediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Tiina Ojala
- Department Pediatric Cardiology, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Misha Bhat
- Department of Pediatric Cardiology, Children's Heart Center, Skåne University Hospital in Lund, Lund, Sweden
| | - Peter Olejnik
- Pediatric Cardiology Center, Bratislava, Slovakia and Department of Pediatric Cardiology, Faculty of Medicine, National Institute of Cardiovascular Diseases, Comenius University, Bratislava, Slovakia
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of Woman, Child and Adolescent Medicine, Children University Hospital of Geneva, Geneva, Switzerland
| | - Beatrice Bonello
- Department Paediatric Cardiology, Great Ormond Street NHS Trust, London, England
| | | | - Gerald Greil
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- Department of Pediatrics, Division of Pediatric Cardiology, UT Southwestern, Dallas, TX, USA
| | - Jan Marek
- Department Paediatric Cardiology, Great Ormond Street NHS Trust, London, England
| | - Giovanni DiSalvo
- European Association Cardiovascular Imaging (EACVI), Taskforce on Congenital Heart Disease, Lyon, France
- Paediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padova, University of Padua, Padua, Italy
| | - Colin J McMahon
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- University School of Medicine, University College Dublin 4, Dublin, Ireland
- Children's Health Ireland and Crumlin, Dublin, Ireland
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
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Levine JC, Colan S, Trachtenberg F, Marcus E, Ferguson M, Parthiban A, Taylor C, Dragulescu A, Goot B, Lacro RV, McFarland C, Narasimhan S, O'Connor M, Schamberger M, Srivistava S, Taylor M, Nathan M. Echocardiographic image collection and evaluation in infants with CHD: lessons learned from the imaging core lab for the Residual Lesion Score study. Cardiol Young 2024; 34:570-575. [PMID: 37605979 DOI: 10.1017/s1047951123003037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Many factors affect patient outcome after congenital heart surgery, including the complexity of the heart disease, pre-operative status, patient specific factors (prematurity, nutritional status and/or presence of comorbid conditions or genetic syndromes), and post-operative residual lesions. The Residual Lesion Score is a novel tool for assessing whether specific residual cardiac lesions after surgery have a measurable impact on outcome. The goal is to understand which residual lesions can be tolerated and which should be addressed prior to leaving the operating room. The Residual Lesion Score study is a large multicentre prospective study designed to evaluate the association of Residual Lesion Score to outcomes in infants undergoing surgery for CHD. This Pediatric Heart Network and National Heart, Lung, and Blood Institute-funded study prospectively enrolled 1,149 infants undergoing 5 different congenital cardiac surgical repairs at 17 surgical centres. Given the contribution of echocardiographic measurements in assigning the Residual Lesion Score, the Residual Lesion Score study made use of a centralised core lab in addition to site review of all data. The data collection plan was designed with the added goal of collecting image quality information in a way that would permit us to improve our understanding of the reproducibility, variability, and feasibility of the echocardiographic measurements being made. There were significant challenges along the way, including the coordination, de-identification, storage, and interpretation of very large quantities of imaging data. This necessitated the development of new infrastructure and technology, as well as use of novel statistical methods. The study was successfully completed, but the size and complexity of the population being studied and the data being extracted required more technologic and human resources than expected which impacted the length and cost of conducting the study. This paper outlines the process of designing and executing this complex protocol, some of the barriers to implementation and lessons to be considered in the design of future studies.
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Affiliation(s)
- Jami C Levine
- Department Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven Colan
- Department Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Edward Marcus
- Department Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Ferguson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Anitha Parthiban
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Carolyn Taylor
- Department of Pediatrics, Medical University of South Carolina Children's Hospital, Charleston, SC, USA
| | - Andreea Dragulescu
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Benjamin Goot
- Department of Pediatrics, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ronald V Lacro
- Department Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Carol McFarland
- Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Shanthi Narasimhan
- Department of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Matthew O'Connor
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Marcus Schamberger
- Department of Pediatrics, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shubhika Srivistava
- Department of Pediatrics, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Michael Taylor
- Department of Pediatrics, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Meena Nathan
- Department Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Pletzer SA, Atz AM, Chowdhury SM. The Relationship Between Pre-operative Left Ventricular Longitudinal Strain and Post-operative Length of Stay in Patients Undergoing Arterial Switch Operation Is Age Dependent. Pediatr Cardiol 2019; 40:366-373. [PMID: 30413855 PMCID: PMC6415533 DOI: 10.1007/s00246-018-2018-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/01/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Post-operative length of stay (LOS) after the arterial switch operation (ASO) is variable. The association between pre-operative non-invasive measures of ventricular function and post-operative course has not been well established. The aims of this study were to (1) evaluate the relationship between pre-operative non-invasive measures of ventricular function and post-operative LOS and (2) evaluate the change in ventricular function after ASO. METHODS Data were reviewed in consecutive ASO patients between 2010 and 2016. The primary outcome was post-operative LOS. Echocardiograms obtained during the pre-operative period and at the time of discharge were retrospectively analyzed using speckle-tracking echocardiography. Pearson's correlation between patient-specific, pre-operative, and echocardiographic data versus post-operative LOS was assessed. RESULTS Fifty-two patients were included in analyses, 39 neonates and 13 infants. Left ventricular (LV) longitudinal strain correlated with post-operative LOS for infants age > 28 days (r = 0.62, p = 0.03), but not for neonates (r = 0.14, p = 0.40). Operative age (r = - 0.42, p = 0.003), weight at surgery (r = - 0.48, p ≤ 0.001), and cardiopulmonary bypass time (r = 0.30, p = 0.045) also correlated with post-operative LOS. Standard 2D measures of ventricular function did not correlate with post-operative LOS. LV ejection fraction and longitudinal strain worsened post-operatively. CONCLUSION Higher pre-operative LV longitudinal strain (representing worse LV function) is associated with increased post-operative LOS after ASO in infants > 28 days, but not in neonates. LV ejection fraction and longitudinal strain worsened after ASO. Future studies should assess the utility of performing STE in risk stratifying patients prior to ASO.
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Affiliation(s)
- Scott A. Pletzer
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, MSC 915, 165 Ashley Ave, Charleston, SC 29425, USA
| | - Andrew M. Atz
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, MSC 915, 165 Ashley Ave, Charleston, SC 29425, USA
| | - Shahryar M. Chowdhury
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, MSC 915, 165 Ashley Ave, Charleston, SC 29425, USA
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Jone PN, Gould R, Barrett C, Younoszai AK, Fonseca B. Data-Driven Quality Improvement Project to Increase the Value of the Congenital Echocardiographic Report. Pediatr Cardiol 2018; 39:726-730. [PMID: 29350246 DOI: 10.1007/s00246-018-1812-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Abstract
Echocardiography is the primary diagnostic modality for congenital heart disease patients. The written report is used to communicate with the care team and organization is often divided into the body with detailed findings and the conclusions with important findings summarized. Strategies to increase workflow efficiency include batch writing of reports after performance of multiple echocardiograms and the use of report templates which may contribute to discrepancies within report leading to potential downstream medical errors. The aim of this project was to measure the rate of inconsistencies in the echocardiogram reports and through an iterative series of process improvement decrease this rate while maintaining sonographer efficiency and diagnostic accuracy. The discrepancy rate, diagnostic error rate, and sonographer productivity were collected one-year prior and during the iterative quality improvement process. The primary outcome and discrepancies in reports were determined by two reviewers: an experienced pediatric echocardiographic cardiologist and a senior sonographer. Minor discrepancies were defined as contradictions between the body and the conclusion of the report that were unlikely to affect patient care. Major discrepancies were defined as discrepancies between the body and the conclusion that had significant potential to affect patient care. Sonographer productivity was measured as studies per sonographer per month. Our primary intervention was to initiate a quarterly QI meeting and to decrease the batch writing of preliminary echocardiogram reports. No major discrepancies were identified pre- or post-intervention. The minor discrepancies decreased from 40.7 to 6%. Sonographer productivity was not significantly changed with a slight increase from 100 studies/sonographer/month during the baseline to 101 studies/sonographer/month during the intervention. There was no change in major or minor diagnostic error rate. Our quality improvement intervention increased the value of our reports by significantly decreasing minor discrepancies without negatively impacting sonographer productivity or diagnostic accuracy.
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Affiliation(s)
- Pei-Ni Jone
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA.
| | - Ruthanne Gould
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA
| | - Cindy Barrett
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA
| | - Adel K Younoszai
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA
| | - Brian Fonseca
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO, 80045, USA
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Lodin D, Mavrothalassitis O, Haberer K, Sunderji S, Quek RGW, Peyvandi S, Moon-Grady A, Karamlou T. Revisiting the utility of technical performance scores following tetralogy of Fallot repair. J Thorac Cardiovasc Surg 2017; 154:585-595.e3. [PMID: 28461051 DOI: 10.1016/j.jtcvs.2017.02.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 01/18/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Although an important quality metric, current technical performance scores may not be generalizable and may omit operative factors that influence outcomes. We examined factors not included in current technical performance scores that may contribute to increased postoperative length of stay, major complications, and cost after primary repair of tetralogy of Fallot. METHODS This is a retrospective single site study of patients younger than age 2 years with tetralogy of Fallot undergoing complete repair between 2007 and 2015. Medical record data and discharge echocardiograms were reviewed to ascertain component and composite technical performance scores. Primary outcomes included postoperative length of stay, major complications, and total hospital costs. Multivariable logistic and linear regression identified determinants of each outcome. RESULTS Patient population (n = 115) had a median postoperative length of stay of 8 days (interquartile range, 6-10 days), and a median total cost of $71,147. Major complications occurred in 33 patients (29%) with 1 death. Technical performance scores assigned were optimum in 28 patients (25%), adequate in 59 patients (52%), and inadequate in 26 patients (23%). Neither technical performance score components nor composite scores were associated with increased postoperative length of stay. Optimum or adequate repairs versus inadequate had equal risk of a complication (P = .79), and equivalent mean total cost ($100,000 vs $187,000; P = .25). Longer cardiopulmonary bypass time per 1-minute increase (P < .01) was associated with longer postoperative length of stay and reintervention (P = .02). The need to return to bypass also increased total cost (P < .01). CONCLUSIONS Current tetralogy of Fallot technical performance scores were not associated with selected outcomes in our postoperative population. Although returning to bypass and bypass length are not included as components in the current score, these are important factors influencing complications and resource use in our population. Revisions anticipated from a prospective trial should consider including these variables.
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Affiliation(s)
- Daud Lodin
- San Juan Bautista School of Medicine, Caguas, Puerto Rico
| | | | - Kim Haberer
- Division of Pediatric Cardiology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, Calif
| | - Sherzana Sunderji
- Division of Pediatric Cardiology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, Calif
| | - Ruben G W Quek
- Global Health Economics, Amgen Inc, Thousand Oaks, Calif
| | - Shabnam Peyvandi
- Division of Pediatric Cardiology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, Calif
| | - Anita Moon-Grady
- Division of Pediatric Cardiology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, Calif
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery, Phoenix Children's Hospital, Phoenix, Ariz.
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