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Movahedi M, Siahafshari KM, Hajhashemi M, Khorvash F, Saeidi M, Allameh Z. Evaluation of Maternal and Fetal Outcomes in Pregnant Women with COVID-19 based on Different Trimesters. Adv Biomed Res 2023; 12:165. [PMID: 37564445 PMCID: PMC10410429 DOI: 10.4103/abr.abr_173_22] [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: 05/25/2022] [Revised: 07/06/2022] [Accepted: 07/16/2022] [Indexed: 08/12/2023] Open
Abstract
Background COVID-19 is the leading cause of the recent pandemic in the globe. This disease might have different effects on the maternal and fetal outcomes in pregnancy. The aim of this study was to assess these outcomes in pregnant women with COVID-19 infections in different trimesters. Materials and Methods This is a prospective cohort study that was performed in February 2020 to August 2021 in Isfahan on 430 pregnant women with definite diagnosis of COVID-19 infection admitted to our medical centers. The included cases were followed based on the gestational age in which they were diagnosed with COVID-19 infection. Patients were divided into three groups (first, second, and third trimesters) based on COVID-19 infection. Results The frequency of requiring mechanical ventilation was higher in mothers with COVID-19 in the second trimester (P = 0.049) and the frequency of PIH was significantly higher in mothers with COVID-19 in the third trimester compared to other women (P = 0.009). Fetal growth restriction (FGR) was also observed in 22 patients (5.3%) that was mostly observed with COVID-19 in the third trimester (P = 0.012). Oligohydramnios and fetal distress leading to C/S were observed in 19 patients (4.6%) and 12 patients (2.9%), respectively. The majority of maternal mortality was among cases with COVID-19 infection in the third trimester (44.4%). Conclusion We observed higher maternal and fetal complications in women especially those in the third trimester. Our results were in line with the findings of previous studies. Women with COVID-19 infection in the third trimester had highest frequencies of preterm labor and FGR.
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Affiliation(s)
- Minoo Movahedi
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Khadijeh M. Siahafshari
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Hajhashemi
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzin Khorvash
- Infectious Diseases Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Milad Saeidi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Allameh
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Metz TD, Clifton RG, Hughes BL, Sandoval GJ, Grobman WA, Saade GR, Manuck TA, Longo M, Sowles A, Clark K, Simhan HN, Rouse DJ, Mendez-Figueroa H, Gyamfi-Bannerman C, Bailit JL, Costantine MM, Sehdev HM, Tita ATN, Macones GA. Association Between Giving Birth During the Early Coronavirus Disease 2019 (COVID-19) Pandemic and Serious Maternal Morbidity. Obstet Gynecol 2023; 141:109-118. [PMID: 36357949 PMCID: PMC9892237 DOI: 10.1097/aog.0000000000004982] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate whether delivering during the early the coronavirus disease 2019 (COVID-19) pandemic was associated with increased risk of maternal death or serious morbidity from common obstetric complications compared with a historical control period. METHODS This was a multicenter retrospective cohort study with manual medical-record abstraction performed by centrally trained and certified research personnel at 17 U.S. hospitals. Individuals who gave birth on randomly selected dates in 2019 (before the pandemic) and 2020 (during the pandemic) were compared. Hospital, health care system, and community risk-mitigation strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in response to the early COVID-19 pandemic are described. The primary outcome was a composite of maternal death or serious morbidity from common obstetric complications, including hypertensive disorders of pregnancy (eclampsia, end organ dysfunction, or need for acute antihypertensive therapy), postpartum hemorrhage (operative intervention or receipt of 4 or more units blood products), and infections other than SARS-CoV-2 (sepsis, pelvic abscess, prolonged intravenous antibiotics, bacteremia, deep surgical site infection). The major secondary outcome was cesarean birth. RESULTS Overall, 12,133 patients giving birth during and 9,709 before the pandemic were included. Hospital, health care system, and community SARS-CoV-2 mitigation strategies were employed at all sites for a portion of 2020, with a peak in modifications from March to June 2020. Of patients delivering during the pandemic, 3% had a positive SARS-CoV-2 test result during pregnancy through 42 days postpartum. Giving birth during the pandemic was not associated with a change in the frequency of the primary composite outcome (9.3% vs 8.9%, adjusted relative risk [aRR] 1.02, 95% CI 0.93-1.11) or cesarean birth (32.4% vs 31.3%, aRR 1.02, 95% CI 0.97-1.07). No maternal deaths were observed. CONCLUSION Despite substantial hospital, health care, and community modifications, giving birth during the early COVID-19 pandemic was not associated with higher rates of serious maternal morbidity from common obstetric complications. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04519502.
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Affiliation(s)
- Torri D Metz
- Divisions of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Northwestern University, Chicago, Illinois, University of Texas Medical Branch, Galveston, and University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas, University of Pittsburgh, Pittsburgh, and University of Pennsylvania, Philadelphia, Pennsylvania, Brown University, Providence, Rhode Island, Columbia University, New York, New York, MetroHealth Medical Center, Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio, and University of Alabama at Birmingham, Birmingham, Alabama; the George Washington University Biostatistics Center, Washington, DC; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; and the Department of Women's Health, University of Texas at Austin, Austin, Texas
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3
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Klüßendorf A, Richter MF, Webermann S, Schild RL, Morfeld CA. [COVID-19 in Pregnancy - a Risk for the Unborn Child?]. Z Geburtshilfe Neonatol 2022; 226:343-348. [PMID: 36228609 DOI: 10.1055/a-1915-5612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Geburtskliniken werden zunehmend mit an Covid-19 erkrankten Schwangeren konfrontiert. Dies stellt Geburtshelfer vor große Herausforderungen, da einige Fragestellungen noch nicht ausreichend wissenschaftlich erforscht sind. Über Covid-19 während der Schwangerschaft und seine Auswirkungen auf das ungeborene und neugeborene Kind ist nicht viel bekannt.
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Affiliation(s)
| | | | | | - Ralf L Schild
- Perinatalzentrum, DIAKOVERE gGmbH, Hannover, Germany
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4
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Zavala E, Krubiner CB, Jaffe EF, Nicklin A, Gur-Arie R, Wonodi C, Faden RR, Karron RA. Global disparities in public health guidance for the use of COVID-19 vaccines in pregnancy. BMJ Glob Health 2022; 7:e007730. [PMID: 35210309 PMCID: PMC8882664 DOI: 10.1136/bmjgh-2021-007730] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/15/2022] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Gaps in information about the safety and efficacy of COVID-19 vaccines in pregnancy have led to substantial global variation in public health guidance regarding the use of COVID-19 vaccines in pregnancy over the course of the pandemic. METHODS We conducted systematic screenings of public health authorities' websites across 224 countries and territories every 3 weeks to track the development of policies on COVID-19 vaccine use in pregnancy. Policies were categorised using a 1-5 permissiveness scale, with 1 indicating policies that recommended use, and 5 indicating policies that recommended against use. RESULTS As of 30 September 2021, 176 countries/territories had issued explicit guidance on COVID-19 vaccine use in pregnancy, with 38% recommending use, 28% permitting use, 15% permitting use with qualifications, 2% not recommending but with exceptions, and 17% not recommending use whatsoever. This represented a significant shift from May 2021, when only 6% of countries/territories with such policies recommended the use of COVID-19 vaccines in pregnancy (p<0.001). However, no policy positions could be found for 21% of all countries and territories, the vast majority being low and middle income. Policy positions also varied widely by vaccine product, with Pfizer/BioNTech and Moderna vaccines being most commonly recommended or permitted. CONCLUSION Our study highlights the evolution of policies regarding COVID-19 vaccine use in pregnancy over a 5-month period in 2021, the role of pregnancy-specific data in shaping these policies and how inequities in access for pregnant people persist, both within countries and globally.
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Affiliation(s)
- Eleonor Zavala
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carleigh B Krubiner
- Center for Global Development, Washington, District of Columbia, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elana F Jaffe
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew Nicklin
- Centers for Civic Impact, Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachel Gur-Arie
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chizoba Wonodi
- Department of International Health, International Vaccine Access Center at the Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ruth R Faden
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruth A Karron
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Zöllkau J, Hagenbeck C, Hecher K, Pecks U, Schlembach D, Simon A, Schlösser R, Schleußner E. [Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed - Update November 2021 (Long Version)]. Z Geburtshilfe Neonatol 2021; 226:e1-e35. [PMID: 34918334 DOI: 10.1055/a-1688-9398] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have given birth, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the long version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).
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Affiliation(s)
- Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Deutschland
| | - Carsten Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Deutschland
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Deutschland
| | - Dietmar Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Rolf Schlösser
- Schwerpunkt Neonatologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Deutschland
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Schwab-Reese LM, Renner LM, King H, Miller RP, Forman D, Krumenacker JS, DeMaria AL. "They're very passionate about making sure that women stay healthy": a qualitative examination of women's experiences participating in a community paramedicine program. BMC Health Serv Res 2021; 21:1167. [PMID: 34706727 PMCID: PMC8550812 DOI: 10.1186/s12913-021-07192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community paramedicine programs (i.e., physician-directed preventive care by emergency medical services personnel embedded in communities) offer a novel approach to community-based health care. Project Swaddle, a community paramedicine program for mothers and their infants, seeks to address (directly or through referrals) the physical, mental, social, and economic needs of its participants. The objective of this process evaluation was to describe women's experiences in Project Swaddle. By understanding their experiences, our work begins to build the foundation for similar programs and future examinations of the efficacy and effectiveness of these approaches. METHODS We completed 21 interviews with women living in Indiana (July 2019-February 2020) who were currently participating in or had graduated from Project Swaddle. Interviews were audio-recorded, transcribed, and analyzed using a six-phase approach to thematic analysis. RESULTS Program enrollment was influenced by the community paramedics' experience and connections, as well as information received in the community from related clinics or organizations. Participants viewed the community paramedic as a trusted provider who supplied necessary health information and support and served as their advocate. In their role as physician extenders, the community paramedics enhanced patient care through monitoring critical situations, facilitating communication with other providers, and supporting routine healthcare. Women noted how community paramedics connected them to outside resources (i.e., other experts, tangible goods), which aimed to support their holistic health and wellbeing. CONCLUSIONS Results demonstrate Project Swaddle helped women connect with other healthcare providers, including increased access to mental health services. The community paramedics were able to help women establish care with primary care providers and pediatricians, then facilitate communication with these providers. Women were supported through their early motherhood experience, received education on parenting and taking control of their health, and gained access to resources that met their diverse needs.
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Affiliation(s)
- Laura M Schwab-Reese
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA.
| | - Lynette M Renner
- School of Social Work, College of Education and Human Development, University of Minnesota, St. Paul, MN, USA
| | - Hannah King
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - R Paul Miller
- City of Crawfordsville Fire Department, Crawfordsville, IN, USA
| | - Darren Forman
- City of Crawfordsville Fire Department, Crawfordsville, IN, USA
| | | | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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Berry M, Wang A, Clark SM, Harirah HM, Jain S, Olson GL, Pacheco LD, Saade GR, Saad AF. Clinical Stratification of Pregnant COVID-19 Patients based on Severity: A Single Academic Center Experience. Am J Perinatol 2021; 38:515-522. [PMID: 33548937 DOI: 10.1055/s-0041-1723761] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes. STUDY DESIGN This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant. RESULTS Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were asymptomatic, 34.1% were symptomatic, and 4.4% required oxygen support. Our population was mainly Hispanic (80.2%), multiparous (76.9%), obese (70.3%), and with a median age of 27 years. Median gestational age at symptom onset or diagnosis was 36 weeks. Significant differences were found between gestational age and disease severity. Maternal characteristics including age, body mass index (BMI), and presence of comorbid conditions did not appear to influence severity of SARS-CoV-2 infection. Significant laboratory findings associated with increasing disease severity included decreasing hemoglobin and white blood cell count, lymphopenia, and increasing levels of inflammatory markers including CRP, ferritin, and procalcitonin. Maternal and neonatal outcomes did not differ among groups. No SARS-CoV-2 was detected by polymerase chain reaction testing in neonates of mothers with COVID-19. CONCLUSION Pregnant patients with COVID-19 infection are predominantly asymptomatic. Patients appear to be at increased risk for more severe infection requiring oxygen support later in pregnancy. KEY POINTS · The majority of pregnant patients with COVID-19 are asymptomatic and <1 in 20 require oxygen support.. · Women in the later stages of pregnancy may be at increased risk for severe infection.. · Anemia, leukopenia, CRP, ferritin, and procalcitonin are associated with increasing severity..
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Affiliation(s)
- Marissa Berry
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Amanda Wang
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Shannon M Clark
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Hassan M Harirah
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Sangeeta Jain
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Gayle L Olson
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Luis D Pacheco
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - George R Saade
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Antonio F Saad
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
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Heiselman CJ, Iovino N, Herrera KM. A case report of co-infection with rhinovirus and SARS-CoV-2 in pregnancy. CASE REPORTS IN PERINATAL MEDICINE 2020. [DOI: 10.1515/crpm-2020-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
A novel betacoronavirus, SARV-COV-2, was first reported in China on December 31, 2019. Since that time, the number of cases worldwide has grown exponentially. Because this coronavirus was newly described in the human population, strategies to combat spread, to test appropriately, and to identify those at higher risk for severe disease changed frequently as understanding evolved.
Case presentation
This is a report of a case that demonstrate that coinfection with SARS-CoV-2 is possible and likely more common than initially projected. The patient is a 28-year-old G2P1001 at 31 weeks and four days gestation that presented with a 5-day history of high fevers, cough, myalgias, malaise and headache. Patient was diagnosed with Rhinovirus/Enterovirus, admitted for supportive care, and no longer considered a person under investigation for COVID19 because of her positive respiratory panel. Patient’s SARS-CoV-2 screen came back positive two days after her discharge from the hospital. Patient required readmission for worsening symptoms later that night, presenting with tachypnea, hypotension, and pneumonia. Patient was successfully discharged home on hospital day six.
Conclusions
Co-infection with other respiratory viruses happens more than originally thought, therefore going forward protocols should be cognizant of this. When patients present with symptoms suspicious of COVID-19, he or she should be tested regardless of the status of the respiratory viral panel, including influenza.
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Affiliation(s)
- Cassandra J. Heiselman
- Department of Obstetrics, Gynecology and Reproductive Medicine , Renaissance School of Medicine Stony Brook University , Stony Brook , NY , USA
| | - Nicole Iovino
- Department of Obstetrics, Gynecology and Reproductive Medicine , Renaissance School of Medicine Stony Brook University , Stony Brook , NY , USA
| | - Kimberly M. Herrera
- Department of Obstetrics, Gynecology and Reproductive Medicine , Renaissance School of Medicine Stony Brook University , Stony Brook , NY , USA
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