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Njeru CM, Ansermino JM, Macharia WM, Dunsmuir DT. Variability of respiratory rate measurements in neonates- every minute counts. BMC Pediatr 2022; 22:16. [PMID: 34980049 PMCID: PMC8722355 DOI: 10.1186/s12887-021-03087-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Respiratory rate is difficult to measure, especially in neonates who have an irregular breathing pattern. The World Health Organisation recommends a one-minute count, but there is limited data to support this length of observation. We sought to evaluate agreement between the respiratory rate (RR) derived from capnography in neonates, over 15 s, 30 s, 120 s and 300 s, against the recommended 60 s. Methods Neonates at two hospitals in Nairobi were recruited and had capnograph waveforms recorded using the Masimo Rad 97. A single high quality 5 min epoch was randomly chosen from each subject. For each selected epoch, the mean RR was calculated using a breath-detection algorithm applied to the waveform. The RR in the first 60 s was compared to the mean RR measured over the first 15 s, 30 s, 120 s, full 300 s, and last 60 s. We calculated bias and limits of agreement for each comparison and used Bland-Altman plots for visual comparisons. Results A total of 306 capnographs were analysed from individual subjects. The subjects had a median gestation age of 39 weeks with slightly more females (52.3%) than males (47.7%). The majority of the population were term neonates (70.1%) with 39 (12.8%) having a primary respiratory pathology. There was poor agreement between all the comparisons based on the limits of agreement [confidence interval], ranging between 11.9 [− 6.79 to 6.23] breaths per minute in the one versus 2 min comparison, and 34.7 [− 17.59 to 20.53] breaths per minute in the first versus last minute comparison. Worsening agreement was observed in plots with higher RRs. Conclusions Neonates have high variability of RR, even over a short period of time. A slight degradation in the agreement is noted over periods shorter than 1 min. However, this is smaller than observations done 3 min apart in the same subject. Longer periods of observation also reduce agreement. For device developers, precise synchronization is needed when comparing devices to reduce the impact of RR variation. For clinicians, where possible, continuous or repeated monitoring of neonates would be preferable to one time RR measurements.
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Affiliation(s)
| | - J Mark Ansermino
- The University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada
| | | | - Dustin T Dunsmuir
- The University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada
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2
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Ponsiglione AM, Amato F, Romano M. Multiparametric Investigation of Dynamics in Fetal Heart Rate Signals. Bioengineering (Basel) 2021; 9:bioengineering9010008. [PMID: 35049717 PMCID: PMC8772900 DOI: 10.3390/bioengineering9010008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
In the field of electronic fetal health monitoring, computerized analysis of fetal heart rate (FHR) signals has emerged as a valid decision-support tool in the assessment of fetal wellbeing. Despite the availability of several approaches to analyze the variability of FHR signals (namely the FHRV), there are still shadows hindering a comprehensive understanding of how linear and nonlinear dynamics are involved in the control of the fetal heart rhythm. In this study, we propose a straightforward processing and modeling route for a deeper understanding of the relationships between the characteristics of the FHR signal. A multiparametric modeling and investigation of the factors influencing the FHR accelerations, chosen as major indicator of fetal wellbeing, is carried out by means of linear and nonlinear techniques, blockwise dimension reduction, and artificial neural networks. The obtained results show that linear features are more influential compared to nonlinear ones in the modeling of HRV in healthy fetuses. In addition, the results suggest that the investigation of nonlinear dynamics and the use of predictive tools in the field of FHRV should be undertaken carefully and limited to defined pregnancy periods and FHR mean values to provide interpretable and reliable information to clinicians and researchers.
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3
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Oviedo GR, Garcia-Retortillo S, Carbó-Carreté M, Guerra-Balic M, Balagué N, Javierre C, Guàrdia-Olmos J. Cardiorespiratory Coordination During Exercise in Adults With Down Syndrome. Front Physiol 2021; 12:704062. [PMID: 34566677 PMCID: PMC8455928 DOI: 10.3389/fphys.2021.704062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/11/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction: Down syndrome (DS) is a chromosomal disorder affecting simultaneously cardiovascular and respiratory systems. There is no research studying the coupling between these systems during cardiorespiratory exercise testing in a population with DS. Cardiorespiratory coordination (CRC), evaluated through principal component analysis (PCA), measures the covariation of cardiorespiratory variables during exercise. Objective: To investigate and compare CRC in adults with and without DS during maximal cardiorespiratory exercise testing. Methods: Fifteen adults with DS and 15 adults without disabilities performed a maximal cardiorespiratory exercise test on a treadmill. First, the slope, and afterward the velocity was increased regularly until participants reached exhaustion. The time series of six selected cardiorespiratory variables [ventilation per minute, an expired fraction of O2, the expired fraction of CO2, heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP)] were extracted for the analysis. The number of principal components (PCs), the first PC eigenvalues (PC1), and the information entropy were computed for each group (non-DS and DS) and compared using a t-test or a Mann-Whitney U test. Results: Two PCs in the non-DS group and three PCs in the DS group captured the variance of the studied cardiorespiratory variables. The formation of an additional PC in the DS group was the result of the shift of SBP and DBP from the PC1 cluster of variables. Eigenvalues of PC1 were higher in the non-DS (U = 30; p = 0.02; d = 1.47) than in the DS group, and the entropy measure was higher in the DS compared with the non-DS group (U = 37.5; p = 0.008; d = 0.70). Conclusion: Adults with Down syndrome showed higher CRC dimensionality and a higher entropy measure than participants without disabilities. Both findings point toward a lower efficiency of the cardiorespiratory function during exercise in participants with DS. CRC appears as an alternative measure to investigate the cardiorespiratory function and its response to exercise in the DS population.
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Affiliation(s)
- Guillermo R Oviedo
- Faculty of Psychology, Education and Sport Science Blanquerna, University Ramon Llull, Barcelona, Spain.,School of Health Science Blanquerna, University Ramon Llull, Barcelona, Spain
| | - Sergi Garcia-Retortillo
- Keck Laboratory for Network Physiology, Department of Physics, Boston University, Boston, MA, United States.,School of Health and Sport Sciences (EUSES), Universitat de Girona, Salt, Spain.,Complex Systems in Sport Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC) University of Barcelona, Barcelona, Spain
| | - María Carbó-Carreté
- Serra Hunter Fellow, Department of Cognition, Development and Educational Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Myriam Guerra-Balic
- Faculty of Psychology, Education and Sport Science Blanquerna, University Ramon Llull, Barcelona, Spain
| | - Natàlia Balagué
- Complex Systems in Sport Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC) University of Barcelona, Barcelona, Spain
| | - Casimiro Javierre
- Department Physiological Sciences, University of Barcelona, Barcelona, Spain
| | - Joan Guàrdia-Olmos
- Institute of Neuroscience, University of Barcelona, Barcelona, Spain.,Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Universitat de Barcelona Institute of Complex Systems, Barcelona, Spain
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4
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Lucchini M, Pini N, Burtchen N, Signorini MG, Fifer WP. Transfer Entropy Modeling of Newborn Cardiorespiratory Regulation. Front Physiol 2020; 11:1095. [PMID: 32973570 PMCID: PMC7481456 DOI: 10.3389/fphys.2020.01095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/07/2020] [Indexed: 01/26/2023] Open
Abstract
This study investigates the complex interplay between the cardiac and respiratory systems in 268 healthy neonates born between 35 and 40 weeks of gestation. The aim is to provide a comprehensive description of the developing cardiorespiratory information transfer mechanisms as a function of gestational age (GA). This report proposes an extension of the traditional Transfer Entropy measure (TE), which employs multiple lagged versions of the time series of the intervals between two successive R waves of the QRS signal on the electrocardiogram (RR series) and respiration time series (RESP). The method aims to quantify the instantaneous and delayed effects between the two processes within a fine-grained time scale. Firstly, lagged TE was validated on a simulated dataset. Subsequently, lagged TE was employed on newborn cardiorespiratory data. Results indicate a progressive increase in information transfer as a function of gestational age, as well as significant differences in terms of instantaneous and delayed interactions between the cardiac and the respiratory system when comparing the two TE directionalities (RR→RESP vs. RESP→RR). The proposed investigation addresses the role of the different autonomic nervous system (ANS) branches involved in the cardiorespiratory system, since the sympathetic and parasympathetic branches operate at different time scales. Our results allow to infer that the two TE directionalities are uniquely and differently modulated by both branches of the ANS. TE adds an original quantitative tool to understanding cardiorespiratory imbalance in early infancy.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States.,Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Milan, Italy
| | - Nina Burtchen
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Maria G Signorini
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Milan, Italy
| | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
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5
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Perzanowski MS, Savary KW, Arteaga-Solis E, Lautenbacher LA, Brito NH, Rauh VA, Nugent JD, Elliott AJ, Myers MM, Fifer WP. Associations between Parasympathetic Activity in the Month after Birth and Wheeze at Age 2-3 Years. Am J Respir Crit Care Med 2019; 198:532-534. [PMID: 29787287 DOI: 10.1164/rccm.201712-2591le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Khalil W Savary
- 2 Columbia University College of Physicians and Surgeons New York, New York
| | | | | | | | - Virginia A Rauh
- 1 Columbia University Mailman School of Public Health New York, New York
| | - J David Nugent
- 2 Columbia University College of Physicians and Surgeons New York, New York
| | - Amy J Elliott
- 4 Avera Research Institute Sioux Falls, South Dakota and.,5 University of South Dakota School of Medicine Sioux Falls, South Dakota
| | - Michael M Myers
- 2 Columbia University College of Physicians and Surgeons New York, New York
| | - William P Fifer
- 2 Columbia University College of Physicians and Surgeons New York, New York
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6
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Abstract
Primary headaches are one of the most prevalent neurological disorders and can occur during a wide range of lifespan. Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack. There is no systematic review of whether these symptoms changes during lifespan. Indeed, the clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in contrast, largely an absence of autonomic signs and a more often bilateral headache in the elderly. The age-dependent differences in the clinical presentation are less distinct in cluster headache and, especially, in tension-type headache. The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.
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Affiliation(s)
- Andreas Straube
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-University, 81377, Munich, Germany.
| | - Anna Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,The Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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7
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Cardiovascular autonomic dysfunction in sudden infant death syndrome. Clin Auton Res 2018; 28:535-543. [PMID: 29299712 DOI: 10.1007/s10286-017-0490-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
A failure of cardiorespiratory control mechanisms, together with an impaired arousal response from sleep, are believed to play an important role in the final event of sudden infant death syndrome (SIDS). The 'triple risk model' describes SIDS as an event that results from the intersection of three overlapping factors: (1) a vulnerable infant, (2) a critical developmental period in homeostatic control and (3) an exogenous stressor. In an attempt to understand how the triple risk hypothesis is related to infant cardiorespiratory physiology, many researchers have examined how the known risk and protective factors for SIDS alter infant cardiovascular control during sleep. This review discusses the association between the three components of the triple risk hypothesis and major risk factors for SIDS, such as prone sleeping, maternal smoking, together with three "protective" factors, and cardiovascular control during sleep in infants, and discusses their potential involvement in SIDS.
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8
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Myers MM, Elliott AJ, Odendaal HJ, Burd L, Angal J, Groenewald C, Nugent JD, Yang JS, Isler JR, Dukes KA, Robinson F, Fifer WP. Cardiorespiratory physiology in the safe passage study: protocol, methods and normative values in unexposed infants. Acta Paediatr 2017; 106:1260-1272. [PMID: 28419567 DOI: 10.1111/apa.13873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/03/2017] [Accepted: 04/10/2017] [Indexed: 11/27/2022]
Abstract
AIM The Safe Passage Study, conducted by the Prenatal Alcohol in SIDS and Stillbirth Network, is investigating contributions of prenatal alcohol exposure to foetal and infant demise. This current report presents physiological data from full-term infants with no prenatal exposure to alcohol or maternal smoking. METHODS Data are from 666 infants from the Northern Plains (North and South Dakota) and South Africa. A standardised protocol assessed cardiorespiratory function during baseline and head-up tilts shortly after birth and at one month of age. RESULTS Analyses revealed significant increases in heart rate and decreases in BP from the newborn to one-month time period as well as diminished heart rate responses to head-up tilt in one-month-old infants. CONCLUSION The Safe Passage Study was successful in characterising physiology in a large number of infants at sites known to have elevated risks for SIDS. Results demonstrate that even with low prenatal adverse exposures, there are significant changes in cardiorespiratory function as infants enter the window of increased risk for SIDS.
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Affiliation(s)
- Michael M. Myers
- Department of Psychiatry; Columbia University Medical Center; New York NY USA
- Department of Pediatrics; Columbia University Medical Center; New York NY USA
- Division of Developmental Neuroscience; New York State Psychiatric Institute; New York NY USA
| | - Amy J. Elliott
- Community and Population Health Sciences; Sanford Research; Sioux Falls SD USA
- Department of Pediatrics; Sanford School of Medicine; University of South Dakota; Sioux Falls SD USA
| | - Hein J. Odendaal
- Department of Obstetrics and Gynecology; Faculty of Medicine and Health Science; Stellenbosch University; Cape Town Western Cape South Africa
| | - Larry Burd
- University of North Dakota Medical School; Grand Forks ND USA
| | - Jyoti Angal
- Community and Population Health Sciences; Sanford Research; Sioux Falls SD USA
- Department of Pediatrics; Sanford School of Medicine; University of South Dakota; Sioux Falls SD USA
| | - Coen Groenewald
- Department of Obstetrics and Gynecology; Faculty of Medicine and Health Science; Stellenbosch University; Cape Town Western Cape South Africa
| | - James David Nugent
- Division of Developmental Neuroscience; New York State Psychiatric Institute; New York NY USA
| | - Joel S. Yang
- Division of Developmental Neuroscience; New York State Psychiatric Institute; New York NY USA
| | - Joseph R. Isler
- Department of Pediatrics; Columbia University Medical Center; New York NY USA
| | | | | | - William P. Fifer
- Department of Psychiatry; Columbia University Medical Center; New York NY USA
- Department of Pediatrics; Columbia University Medical Center; New York NY USA
- Division of Developmental Neuroscience; New York State Psychiatric Institute; New York NY USA
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9
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Isler JR, Thai T, Myers MM, Fifer WP. An automated method for coding sleep states in human infants based on respiratory rate variability. Dev Psychobiol 2016; 58:1108-1115. [PMID: 27761898 PMCID: PMC5119274 DOI: 10.1002/dev.21482] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/24/2016] [Indexed: 11/05/2022]
Abstract
A novel quantitative method for coding epochs of active and quiet sleep in infants using respiration is reported. The approach uses the variance of the instantaneous breathing rate within brief epochs of sleep. Variances are normalized within subject by dividing by the 75th percentile variance across epochs. Then, a normalized variance active sleep threshold of 0.29 was determined to produce the highest concordance with a method based on visual inspection of respiratory variability (100% and 90% for quiet and active sleep, respectively). The method was independently validated by comparing to standard polysomnographic state coding (87% and 80% concordance for quiet and active sleep) as well as with behavioral state coding (92% and 78% for quiet and active sleep). Validity was also demonstrated by showing that sleep states identified by the method resulted in the expected state differences in infant heart rate variability and electrocortical activity.
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Affiliation(s)
- Joseph R. Isler
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Tracy Thai
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY
| | - Michael M. Myers
- Department of Pediatrics, Columbia University Medical Center, New York, NY
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY
- Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - William P. Fifer
- Department of Pediatrics, Columbia University Medical Center, New York, NY
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY
- Department of Psychiatry, Columbia University Medical Center, New York, NY
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Hakeem GF, Oddy L, Holcroft CA, Abenhaim HA. Incidence and determinants of sudden infant death syndrome: a population-based study on 37 million births. World J Pediatr 2015; 11:41-7. [PMID: 25447630 DOI: 10.1007/s12519-014-0530-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/08/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of our study is to measure the incidence of sudden infant death syndrome (SIDS), estimate the birth to death interval, and identify associated maternal and infant risk factors. METHODS We carried out a population-based cohort study on 37 418 280 births using data from the Centers for Disease Control and Prevention's "Linked Birth-Infant Death" and "Fetal Death" data files from 1995 to 2004. Descriptive statistics and cox-proportional hazard models were used to estimate the adjusted effect of maternal and newborn characteristics on the risk of SIDS. RESULTS There were 24 101 cases of SIDS identified for an overall 10-year incidence of 6.4 cases per 10 000 births. Over the study period, the incidence decreased from 8.1 to 5.6 per 10 000 and appeared to be most common among infants aged 2-4 months. Risk factors included maternal age <20 years, black, non-Hispanic race, smoking, increasing parity, inadequate prenatal care, prematurity and growth restriction. CONCLUSIONS While the incidence of SIDS in the US has declined, it currently remains the leading cause of post-neonatal mortality, highlighting an important public health priority. Educational campaigns should be targeted towards mothers at increased risk in order to raise their awareness of modifiable risk factors for SIDS such as maternal smoking and inadequate prenatal care.
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Affiliation(s)
- Ghaidaa F Hakeem
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, Canada
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