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Poh JXY, Chan KH, Tan SSL, Xu T. Occupational therapists' perceptions of the feasibility of using tele-assessment for remote prescription of assistive devices in Singapore: A qualitative study. Work 2024; 77:1153-1163. [PMID: 38007633 DOI: 10.3233/wor-230168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Occupational therapists (OT) assess and prescribe assistive devices to older adults with limitations in performing daily living activities. Timely prescription of assistive devices to accommodate the rising demand has been affected by the COVID-19 pandemic. Tele-assessment allows for continuity of care, but its success depends on therapists' acceptance. OBJECTIVE This study examined OTs' perceptions of the feasibility of conducting tele-assessment and developing a clinical practice guideline for remote prescription of assistive devices for older adults in Singapore. METHODS Eligible OTs were recruited from purposive sampling. Semi-structured interviews were conducted via a virtual platform (Zoom). Audio recordings were transcribed verbatim. Inductive thematic analysis using a line-by-line coding method was used to identify common trends. RESULTS Interviews with 10 participants revealed three main themes: (1) therapists' perceptions of the feasibility of tele-assessment, (2) criteria for safe and appropriate prescription of assistive devices via tele-assessment, and (3) practical considerations for the implementation of tele-assessment. Participants felt that tele-assessment increases efficiency with more older adults being more receptive towards technology. They also raised suggestions to address OTs' concerns regarding the safety and accuracy prescription of assistive devices following tele-assessment. This included establishing the client's suitability for assistive device prescription, characteristics of assistive devices, resources required, and considering the preferences of stakeholders involved. CONCLUSION Tele-assessment for assistive device prescription by OTs appears feasible in Singapore. OTs should consider collaborating with other stakeholders to develop a tele-assessment clinical practice guideline for assistive device prescription. Further studies testing its clinical effectiveness during and/or post-pandemic are warranted.
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Affiliation(s)
- Jess Xiu Yi Poh
- Rehabilitation Department, National University Hospital, Singapore
| | - Kuang Hong Chan
- Department of Occupational Therapy, Institute of Mental Health, Singapore
| | - Samantha Si Li Tan
- Department of Occupational Therapy, Singapore General Hospital, Singapore
| | - Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
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Mesoros MJ, Schein RM, Pramana G, Schiappa VJ, Schmeler MR, Dicianno BE. Functional mobility, employment and safety benefits of seat elevating devices. Assist Technol 2023; 35:471-476. [PMID: 36112503 DOI: 10.1080/10400435.2022.2124469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 10/14/2022] Open
Abstract
STATUS OF RESEARCH PROCESS Study completed. INVOLVEMENT OF ASSISTIVE TECHNOLOGY USERS Participants were power wheelchair users.
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Affiliation(s)
- Matthew J Mesoros
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Richard M Schein
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gede Pramana
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vince J Schiappa
- Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark R Schmeler
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Sarsak HI, von Zweck C, Ledgerd R. Wheeled and Seated Mobility Devices Provision: Quantitative Findings and SWOT Thematic Analysis of a Global Occupational Therapist Survey. Healthcare (Basel) 2023; 11:healthcare11081075. [PMID: 37107909 PMCID: PMC10137666 DOI: 10.3390/healthcare11081075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE To better understand the global role of occupational therapists and explore facilitators and barriers impacting user access to high quality, affordable wheeled and seated mobility device (WSMD) provision worldwide. METHODS Mixed-method approach utilizing quantitative findings and qualitative strengths, weaknesses, opportunities, and threats (SWOT) analysis of a global online survey. RESULTS A total of 696 occupational therapists from 61 countries completed the survey. Almost 49% had 10 or more years of experience with the provision of WSMDs. WSMD provision had positive, significant associations with attainment of certification (0.000), higher service funding (0.000), higher country income (0.001), standardized training (0.003), continuous professional development (0.004), higher experience (0.004), higher user satisfaction (0.032), custom-made device provision (0.038), higher staff capacity (0.040), and more time working with users (0.050); negative, significant associations were identified with high cost of WSMDs (0.006) and pre-made device provision (0.019). SWOT analysis identified high country income, funding, experience, training, certification from global partners, variety of roles and practice settings, and interdisciplinary teamwork as strengths and opportunities for professional growth, while low country income, lack of time/staff capacity/standardization/support services, and poor access to proper devices were indicated as weaknesses and threats. CONCLUSION Occupational therapists are skilled healthcare professionals and provide a variety of WSMD services. Efforts to build collaborative partnerships, enhance access to occupational therapists and funding options, improve service and standards for WMSD service delivery, and promote professional development will help to overcome challenges and facilitate WSMD provision globally. Promoting practices based on best available evidence for WSMD provision worldwide should be prioritized.
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Affiliation(s)
| | - Claudia von Zweck
- World Federation of Occupational Therapists, 1211 Geneva, Switzerland
| | - Ritchard Ledgerd
- World Federation of Occupational Therapists, 1211 Geneva, Switzerland
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Hayes K, Dos Santos V, Costigan M, Morante D. Extension, austerity, and emergence: Themes identified from a global scoping review of non-urban occupational therapy services. Aust Occup Ther J 2023; 70:142-156. [PMID: 36193547 PMCID: PMC10092512 DOI: 10.1111/1440-1630.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Rural communities contribute to national wellbeing, identities, economies, and social fabrics yet experience increased risk of mortality, morbidity, and disability, coupled with lower levels of income, formal education, and employment than urban citizens. Despite higher need, occupational therapy services are maldistributed to urban locations. Publications about non-urban services discuss predominantly outreach-based, individualist, rehabilitation for specified diagnoses/age groups. However, given this population level inequity, it is unclear why individualist focussed services are more commonly discussed. Understanding intentions expressed in publications about non-urban service design may identify assumptions/limitations to current approaches and contribute to improved future services. METHODS Each of 117 publications identified in a scoping review was read by two reviewers to independently identify themes. Provisional themes were discussed and modified in an iterative process to develop final themes/subthemes. The first author reinterrogated the publications and coded data to identify relevant examples to support the identified themes. RESULTS Three key themes and nine subthemes were identified. Hegemonic perspectives were found in the themes (i) Extension of urban practice and (ii) Austerity, particularly in the Global North. Non-urban services were typically extended to non-urban contexts underpinned by austerity and neoliberal values such that non-urban persons and their context were problematised rather than service or funding design. A counter-hegemonic perspective was found in the theme (iii) Responses to situational realities more commonly in Global South publications, which valued non-urban contexts, and focussed on developing non-urban communities and promoting justice. CONCLUSION The hegemonic paradigm links occupational therapy services with neoliberal notions of individualism, private provision of care, and efficiency/market value, rather than the occupational therapy values for justice. The profession must consider our role in perpetuating injustice for non-urban people and consider if and how more contextually tailored counter hegemonic place-based paradigms can be developed from and with regional, rural, and remote practice.
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Affiliation(s)
- Karen Hayes
- School of Allied Health, Exercise and Sports SciencesCharles Sturt UniversityPort MacquarieNew South WalesAustralia
| | - Vagner Dos Santos
- School of Allied Health, Exercise and Sports SciencesCharles Sturt UniversityPort MacquarieNew South WalesAustralia
| | - Moses Costigan
- Manning Mental Health UnitNSW HealthTareeNew South WalesAustralia
- Providence WellbeingPort MacquarieNew South WalesAustralia
| | - Danielle Morante
- Port Macquarie Base HospitalNSW HealthPort MacquarieNew South WalesAustralia
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Johnson E, Lincoln M, Cumming S. Principles of disability support in rural and remote Australia: Lessons from parents and carers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2208-2217. [PMID: 32462722 DOI: 10.1111/hsc.13033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/13/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
This study describes the understanding, experiences and expectations of families living in rural and remote Australia regarding core concepts relating to disability service provision, including person-centred practice (PCP), family-centred practice (FCP), transdisciplinary practice (TDP), choice, control, inclusion, and equity. Thirteen parents or carers, each with a child with an intellectual disability aged between 6 and 16 years, living in rural and remote areas as described by the Australian Standard Geographical Classification - Remoteness Area (ASGC-RA) and Modified Monash Model (MMM) - were recruited through distribution of flyers (hard copies or by email) to clinicians, schools, and advocacy agencies. Semi-structured interviews were conducted with participants either in-person or via telephone between July and October 2015. Data were analysed using thematic analysis. Participants reported that their understanding of many of the disability principles (PCP, FCP, choice, control, inclusion, and equity) was different from providers, and that many providers struggled to understand families, and therefore they did not share meaning of the principles of best practice disability supports. Families did not identify transdisciplinary practice as a core issue or tenet of effective service delivery. Families also reported experiences of missing out on services, feeling a sense of isolation in their communities, struggling to access skilled therapists, and difficulty finding supports and goals that were relevant to their child. The quality of supports that these families accessed was often below the standard that they expected. They did not expect that support standards will change in rural and remote Australia, so many have very low expectations of the National Disability Insurance Scheme (NDIS) in the future. Although more data will need to be collected as the NDIS and its markets mature, these data show that many rural and remote participants and their supporters have a variety of concerns about how they will access quality allied health services through the Scheme.
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Affiliation(s)
- Edward Johnson
- Faculty of Medicine and Health, University of Sydney, Australia
| | | | - Steven Cumming
- Faculty of Medicine and Health, University of Sydney, Australia
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Venkataraman K, Morgan M, Amis KA, Landerman LR, Koh GC, Caves K, Hoenig H. Tele-Assessment of the Berg Balance Scale: Effects of Transmission Characteristics. Arch Phys Med Rehabil 2016; 98:659-664.e1. [PMID: 27894732 DOI: 10.1016/j.apmr.2016.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/07/2016] [Accepted: 10/27/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare Berg Balance Scale (BBS) rating using videos with differing transmission characteristics with direct in-person rating. DESIGN Repeated-measures study for the assessment of the BBS in 8 configurations: in person, high-definition video with slow motion review, standard-definition videos with varying bandwidths and frame rates (768 kilobytes per second [kbps] videos at 8, 15, and 30 frames per second [fps], 30 fps videos at 128, 384, and 768 kbps). SETTING Medical center. PARTICIPANTS Patients with limitations (N=45) in ≥1 of 3 specific aspects of motor function: fine motor coordination, gross motor coordination, and gait and balance. INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES Ability to rate the BBS in person and using videos with differing bandwidths and frame rates in frontal and lateral views. RESULTS Compared with in-person rating (7%), 18% (P=.29) of high-definition videos and 37% (P=.03) of standard-definition videos could not be rated. Interrater reliability for the high-definition videos was .96 (95% confidence interval, .94-.97). Rating failure proportions increased from 20% in videos with the highest bandwidth to 60% (P<.001) in videos with the lowest bandwidth, with no significant differences in proportions across frame rate categories. Both frontal and lateral views were critical for successful rating using videos, with 60% to 70% (P<.001) of videos unable to be rated on a single view. CONCLUSIONS Although there is some loss of information when using videos to rate the BBS compared to in-person ratings, it is feasible to reliably rate the BBS remotely in standard clinical spaces. However, optimal video rating requires frontal and lateral views for each assessment, high-definition video with high bandwidth, and the ability to carry out slow motion review.
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Affiliation(s)
- Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
| | | | - Kristopher A Amis
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC
| | | | - Gerald C Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kevin Caves
- Speech and Audiology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC; Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC
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Cason J. Telehealth and Occupational Therapy: Integral to the Triple Aim of Health Care Reform. Am J Occup Ther 2015; 69:6902090010p1-8. [PMID: 26122676 DOI: 10.5014/ajot.2015.692003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Programs and concepts included in the Patient Protection and Affordable Care Act of 2010 are expected to transform health care in the United States from a volume-based health system to a value-based health system with increased emphasis on prevention and health promotion. The Triple Aim, a framework set forth by the Institute for Healthcare Improvement, focuses on improving the health care experience, the health of populations, and the affordability of care. This article describes telehealth as an integral component in achieving the Triple Aim of health care and discusses implications for occupational therapy practitioners.
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Affiliation(s)
- Jana Cason
- Jana Cason, DHS, OTR/L, FAOTA, is Associate Professor, Auerbach School of Occupational Therapy, Spalding University, Louisville, KY; Chair, Telerehabilitation Special Interest Group, American Telemedicine Association, Washington, DC; and Chair, Technology Special Interest Section, American Occupational Therapy Association, Bethesda, MD;
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Foti MK, Eleazar C, Furphy KA. Teleconsultation with a developing country: student reported outcomes of learning. Int J Telerehabil 2015; 6:41-9. [PMID: 25945222 PMCID: PMC4352993 DOI: 10.5195/ijt.2014.6140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This qualitative study explored the benefits of implementing (international) teleconsultation in a Master of Science in Occupational Therapy (MSOT) curriculum. Twenty-one students provided supervised teleconsultative services to individuals with disabilities in Guatemala and were responsible for completing assessments, setting goals, and providing resources to address goals and improve quality of life. Data were collected through student presentations and coded for relevant themes. Analysis revealed new learning in the areas of the occupational therapy process, cultural awareness, and technology. Three themes emerged: Increased Understanding of Awareness of and Challenges to Working with People of a Different Culture; Need for Adaptability and Flexibility as Practicing Clinicians; Emerging Role of Technology in Occupational Therapy. Based on results from this study, occupational therapy academicians should consider implementing similar programs into curricula and conduct related research in order to promote not only student learning, but also to advance the use of telehealth technology in occupational therapy practice.
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Affiliation(s)
- Megan K Foti
- The Richard Stockton College Of New Jersey, Galloway, Nj, USA
| | - Crystal Eleazar
- The Richard Stockton College Of New Jersey, Galloway, Nj, USA
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Abstract
Over the past decade, the practice of occupational therapy has been increasingly influenced by technological advances in the use of information and communication technologies (ICT) and associated changes in health care policy. Emergent from this evolution is the application of telehealth to deliver occupational therapy services to a client who is in a different physical location than the provider. This article furnishes an overview of the evidence for telehealth use in occupational therapy, discusses key policy considerations, and provides resources to guide practitioners in the ethical use of telehealth.
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Affiliation(s)
- Jana Cason
- Auerbach School Of Occupational Therapy, Spalding University, Louisville, Kentucky, USA
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Tan KK, Narayanan AS, Koh GCH, Kyaw KKH, Hoenig HM. Development of telerehabilitation application with designated consultation categories. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2014; 51:1383-96. [PMID: 25785371 DOI: 10.1682/jrrd.2014.02.0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/21/2014] [Indexed: 11/05/2022]
Abstract
Telerehabilitation (TR) is getting ever more popular because it is effective in bringing rehabilitation services to rural populations by means of audiovisual systems and its initial implementation studies presented encouraging results. TR is proven to be helpful, with benefits in terms of reduced travel time, cost, and availability of specialists' support in local communities. However, TR systems that are usable under low-bandwidth network environments are rare. This article introduces the development of a TR system with customized consultation categories for users to choose from, depending on requirements. Each category, with its preset parameter values, is discussed in detail by demonstrating relevant rehabilitation exercises. A novel bandwidth adaptation algorithm is also presented for optimal utilization of the dynamic network conditions, which ensures the system functionality even under narrow-bandwidth environments. Experiment results show that the system is able to perform effectively in each consultation category while the rehabilitation exercises are being performed. The proposed algorithm is also verified for its ability to adapt the content quality and effectively utilize the network under constrained conditions. A survey conducted on the video quality of the system under low-bandwidth conditions shows encouraging results for a large scale deployment of the application.
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Faett BL, Geyer MJ, Hoffman LA, Brienza DM. Design and development of a telerehabilitation self-management program for persons with chronic lower limb swelling and mobility limitations: preliminary evidence. Nurs Res Pract 2012; 2012:608059. [PMID: 23227323 PMCID: PMC3514836 DOI: 10.1155/2012/608059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/08/2012] [Accepted: 10/09/2012] [Indexed: 11/21/2022] Open
Abstract
This paper describes design and development of a self-management program, delivered by telerehabilitation (TR), to address the problem of chronic lower limb swelling in persons with limited mobility. The 18.6 million persons with limited mobility in the USA are at increased risk for chronic lower limb swelling and related secondary complications, including cellulitis and skin ulcers. Over time, chronic swelling often progresses to lymphedema, an incurable condition requiring lifelong care. Without successful self-management, lymphedema and its related complications inevitably worsen. Access and adherence to appropriate treatment are challenging for persons with limited mobility. Program development involved a structured process to establish content validity (videos and manuals), readability, suitability, and selection of a TR platform to deliver the educational program. Our goal was to develop a program that would engage patients in self-management skills. The TR software platform chosen, Versatile and Integrated System for Telerehabilitation (VISYTER) was designed to facilitate face-to-face delivery of an interactive home-based self-management program via the internet in real time. Results demonstrated validity of the educational program and ease of use with TR. Future plans are to evaluate ability of this approach to promote self-management skills, home monitoring, and improved management of persons with lymphedema and limited mobility.
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Affiliation(s)
- Becky L. Faett
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA
| | - Mary Jo Geyer
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA
| | - Leslie A. Hoffman
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA
| | - David M. Brienza
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA
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