In cooperation with Reuters News and Reuters Health, we are proud to provide you with our continuously updated news feed. We select news that applies to physicians in all the major clinical specialties, as well as on finance, science, technology, and other areas.

Dialysis patients at U.S. nursing home had higher rate of COVID-19 -CDC

By Vishwadha Chander (Reuters) - Nursing home residents on kidney dialysis had roughly three times the rate of COVID-19 compared to those not receiving treatment, U.S. health researchers found in a

Trump says U.S. inks agreement with Moderna for 100 mln doses of COVID-19 vaccine candidate

By Reuters Staff (Reuters) - The United States has penned an agreement with drugmaker Moderna Inc to acquire 100 million doses of its potential COVID-19 vaccine, U.S. president Donald Trump said in a

Vir Biotech to begin mid-to-late stage study of COVID-19 drug candidate in August

By Reuters Staff (Reuters) - Vir Biotechnology Inc said on Tuesday it plans to start a mid-to-late stage trial of its COVID-19 drug candidate in August, as drugmakers across the globe rush to find

Pandemic seen changing how women get reproductive health care

By Elsa Ohlen LONDON (Thomson Reuters Foundation) - The coronavirus pandemic could bring wider use of self-managed abortions and contraception, extending reproductive health care to more women and

U.S. insurers' coronavirus costs are less than feared so far

By Alwyn Scott (Reuters) - The coronavirus pandemic dealt a relatively modest $2.5 billion blow to five insurers with large U.S. operations in the second quarter - a cost that was far less than feared

Standardized care for testicular cancer may help overcome disparities

By Lisa Rapaport (Reuters Health) - Offering standardized care for testicular cancer at both academic medical centers and safety net hospitals may help reduce sociodemographic disparities in survival

COVID-19 often mild in pregnant women, Spanish study finds

By Linda Carroll (Reuters Health) - Antibody tests in first- and third-trimester Spanish women found those who had been infected with SARS-CoV-2 were often asymptomatic and few became sick enough to

Cardiologists urge caution on cannabis

By Anne Harding NEW YORK (Reuters Health) - Cannabis use may pose cardiovascular risks, especially for vulnerable patients, while it has no well-documented cardiovascular benefits, the American Heart

Prenatal cannabis exposure tied to increased autism risk in kids

By Lisa Rapaport (Reuters Health) - Mothers who use cannabis during pregnancy are more likely to have children with autism than mothers who don't, a Canadian study suggests. Researchers examined birth

Allogenic cardiac stem cells show some promise for LV remodeling post-MI

By Marilynn Larkin NEW YORK (Reuters Health) - Infusion of allogenic cardiosphere-derived cells (CDCs) in patients with left ventricular (LV) dysfunction after acute myocardial infarction (MI) did not

Prion reduction shows promise in mice with prion disease

By David Douglas NEW YORK (Reuters Health) - Preclinical studies suggest that prion-protein reduction may provide therapeutic benefit in prion diseases, according to a multinational group of

Multifocal contact lenses with high add power help slow myopia progression

By Megan Brooks NEW YORK (Reuters Health) - Soft multifocal contact lenses with a high add power help slow progression of myopia in children, more so than multifocal lenses with medium add power or

Few kids eligible for diabetes screening test positive

By Lisa Rapaport (Reuters Health) - While roughly one in four U.S. youth are eligible for screening for diabetes under current guidelines from the American Diabetes Association, very few children and

Delay routine dental checkups, WHO urges, until COVID risk is known

By Stephanie Nebehay GENEVA (Reuters) - Dental patients and staff need to be protected from any potential infection by aerosol-generating procedures, the World Health Organization (WHO) said on

J&J eyes 1 bln doses of potential COVID-19 shot in 2021, weighs challenge trials

By Francesco Guarascio BRUSSELS (Reuters) - Johnson & Johnson could produce 1 billion doses of its potential COVID-19 vaccine next year if it proves successful and would consider injecting healthy

Novavax expects it can meet U.S. COVID-19 vaccine demand in 2021, executives say

By Carl O'Donnell and Abhijith G (Reuters) - Novavax Inc's manufacturing capacity is sufficient to meet the U.S. demand for COVID-19 vaccines in 2021, which it believes could be as high as 500 million

Arcturus Therapeutics begins human trials of potential COVID-19 vaccine

By Reuters Staff (Reuters) - Arcturus Therapeutics Holdings Inc said on Tuesday the first group of participants had been dosed in an early-stage trial testing its COVID-19 vaccine candidate and that

Sinovac launches Phase 3 trial for COVID-19 vaccine in Indonesia, reports Phase 2 details

By Stanley Widianto and Roxanne Liu JAKARTA/BEIJING (Reuters) - China's Sinovac Biotech Ltd launched a late-stage human trial on Tuesday that will involve as many as 1,620 patients in Indonesia for a

ECMO beneficial in extreme cases of COVID-19 respiratory failure

By Will Boggs MD NEW YORK (Reuters Health) - Extracorporeal membrane oxygenation (ECMO) allows early extubation of patients with COVID-19 who have severe respiratory failure, according to a

Researchers propose criteria for confirming vertical transmission of SARS-CoV-2

By Will Boggs MD NEW YORK (Reuters Health) - Specific testing for SARS-CoV-2 within certain times and using placental tissue is necessary to confirm transmission of SARS-CoV-2 from infected pregnant

Acute kidney injury underrecognized in hospitalized children

By Will Boggs MD NEW YORK (Reuters Health) - Acute kidney injury (AKI) in hospitalized children is often underrecognized and commonly not followed up after discharge, according to a study of

Atypical thyroiditis possible with COVID-19

By Will Boggs MD NEW YORK (Reuters Health) - As many as 15% of patients infected with SARS-CoV-2 can develop atypical thyroiditis, according to a study of intensive-care unit (ICU) patients. "This

U.S. health chief, visiting Taiwan, attacks China's pandemic response

By Yimou Lee TAIPEI (Reuters) - U.S. Health Secretary Alex Azar attacked China's response to the coronavirus pandemic on Tuesday and said that if such an outbreak had emerged in Taiwan or the United

Some U.S. colleges stick to in-person reopening in pandemic despite doubts, pushback

By Jan Wolfe and Catherine Koppel (Reuters) - Many U.S. universities are revamping campuses to resume in-person classes despite COVID-19, requiring students to be tested, wear masks and socially

New cases end New Zealand's 'COVID-free' status; Auckland back in lockdown

By Praveen Menon WELLINGTON (Reuters) - New Zealand announced on Tuesday it was shutting down its largest city, Auckland, after four new cases of COVID-19 were discovered in the city, the first

California's public health officer resigns after COVID-19 undercount problem

By Steve Gorman (Reuters) - California's top public health officer has resigned following data-collection failures that led to an undercount of coronavirus cases as the state was reporting a downward

Humanity versus disease showcased as London's Science Museum reopens doors

By Hanna Rantala (Reuters) - Exhibits showcasing humanity's battle with infectious disease will greet visitors recently emerged from coronavirus lockdowns when London's Science Museum re-opens its

EXPLAINER-When will a coronavirus vaccine be ready?

By Carl O'Donnell (Reuters) - Around the world, politicians, drugmakers and regulators offer contradictory outlooks on when a COVID-19 vaccine will be ready. Much depends on what 'ready' means and for

Scientists ask: Without trial data, how can we trust Russia's COVID vaccine?

By Kate Kelland LONDON (Reuters) - An announcement by Russia on Tuesday that it will approve a COVID-19 vaccine after less than two months of human testing prompted alarm among global health experts,

Many U.S. internal medicine programs lack health disparities training

By Linda Carroll (Reuters Health) - Among U.S. internal medicine programs surveyed in 2015, just 40% offered health disparities training, according to a report in JAMA Network Open. "Graduate student

Prenatal depression tied to weakened brain connections, aggression in preschool boys

By Marilynn Larkin NEW YORK (Reuters Health) - Prenatal depression alters brain connectivity in the fetus, putting children - especially boys - at greater risk for aggression, hyperactivity and

REFILE-Overdose deaths often misclassified as out-of-hospital cardiac arrest

(Refiles to fix coding issue seen by some clients.) By Lisa Rappaport (Reuters Health) - More than one in six overdose deaths in the U.S. may have been misclassified as out-of-hospital cardiac arrest,

COVID SCIENCE-A cheaper saliva test seeks FDA approval; stroke risks in younger patients

By Nancy Lapid (Reuters) - The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by

Overdose deaths often misclassified as out-of-hospital cardiac arrest

By Lisa Rappaport (Reuters Health) - More than one in six overdose deaths in the U.S. may have been misclassified as out-of-hospital cardiac arrest, according to a new study in California that

CSF genotyping may help predict course of advanced lung cancer

By Marilynn Larkin NEW YORK (Reuters Health) - A retrospective study of patients with advanced lung cancer and central nervous system (CNS) metastases suggests genetic profiling of cerebral spinal

Simple score predicts likelihood of CAR T-cell-associated neurotoxicity

By Megan Brooks NEW YORK (Reuters Health) - Clinicians from Boston have developed a score based on readily available clinical factors that can help predict which patients undergoing chimeric antigen

MI hospitalizations fall, mortality rises during pandemic in U.S.

By Will Boggs MD NEW YORK (Reuters Health) - Acute myocardial infarction (AMI) hospitalizations decreased and mortality rates have increased in the COVID-19 pandemic, according to a retrospective U.S.

England COVID test and trace scheme changes tack after mixed results

By Estelle Shirbon LONDON (Reuters) - England's COVID-19 Test and Trace scheme is to become more locally targeted, the government said on Monday, after data suggested it was not reaching as many

COVID-19 cases in U.S. children soared in late July, report says

By Reuters Staff (Reuters) - The number of new COVID-19 cases among children in the United States rose 40% in the last two weeks of July, according to a report released just weeks before tens of

Intramuscular electrical stimulation relieves pain after open pancreaticoduodenectomy

By Will Boggs MD NEW YORK (Reuters Health) - Intramuscular electrical stimulation can help relieve pain following open pancreaticoduodenectomy, according to results from a randomized clinical trial. "

Genomic profiles of prostate cancers differ between men of African and European ancestry

By Will Boggs MD NEW YORK (Reuters Health) - The genomic profiles of prostate cancers in African-American men and men of European ancestry show several differences, researchers report. "This study

High pregnancy and live birth rates after bariatric surgery in PCOS patients

By Lisa Rappaport (Reuters Health) - Women with polycystic ovary syndrome (PCOS) often struggle to conceive, but a new study links weight loss following bariatric surgery in very obese PCOS patients

China's Sinopharm starts Phase III trial of COVID-19 vaccine in Bahrain

By Reuters Staff DUBAI (Reuters) - Chinese state-owned pharmaceutical company Sinopharm has begun Phase III clinical trials of a COVID-19 vaccine in Bahrain, after launching similar trials in the

Omeros' COVID-19 treatment shows promise in small study

By Vishwadha Chander (Reuters) - Omeros Corp said on Monday its experimental treatment helped six patients, with acute respiratory distress syndrome caused by COVID-19, recover and get discharged from

Gilead files U.S. marketing application for remdesivir

By Reuters Staff (Reuters) - Gilead Sciences Inc said on Monday it has filed a marketing application with the U.S. Food and Drug Administration for its experimental COVID-19 drug remdesivir. The

UK orders recall of 741,000 coronavirus testing kits over safety concerns

By Reuters Staff LONDON (Reuters) - Randox Laboratories, a Northern Ireland-based medical technology company, has been instructed by Britain's medicines regulator to recall up to 741,000 coronavirus

New Zealand records 100 days without domestic virus case but warns against complacency

By Reuters Staff WELLINGTON (Reuters) - New Zealand marked 100 days without a domestic transmission of the coronavirus on Sunday, but warned against complacency as countries like Vietnam and Australia

Australia says COVID-19 outbreak shows signs of peaking

By Colin Packham SYDNEY (Reuters) - Australia recorded its biggest one-day rise in COVID-19 deaths on Monday although a slowdown in new cases gave hope that a second wave of new infections in the

Epstein-Barr virus causes gastric adenocarcinoma by altering the epigenetic landscape

By Will Boggs MD NEW YORK (Reuters Health) - Epstein-Barr virus (EBV) alters the epigenetic landscape of host cells in a way that facilitates the development of gastric adenocarcinoma, researchers

Relief Therapeutics sees 60-70% chance of COVID-19 drug approval

By Reuters Staff ZURICH (Reuters) - Relief Therapeutics' chairman said he was optimistic its RLF-100 (aviptadil) drug will win approval for treating COVID-19 patients in a matter of months. The Swiss

CanSino to start Phase III trial of COVID-19 vaccine in Saudi

By Reuters Staff DUBAI (Reuters) - Saudi Arabia will soon begin Phase III clinical trials on around 5,000 people for a COVID-19 vaccine developed by China's CanSino Biologics Inc, a Saudi health

COVID-stricken Anchorage wins court ruling in diner dispute

By Yereth Rosen ANCHORAGE, Alaska (Reuters) - As COVID-19 cases spike and hospital bed space dwindles in Alaska's largest city, Anchorage officials on Friday won a key ruling in favor of a ban on

U.S.'s Azar says any U.S. vaccine would be shared once U.S. needs met

By Reuters Staff TAIPEI (Reuters) - U.S. Health Secretary Alex Azar said on Monday that any U.S. vaccine or treatment for COVID-19 would be shared fairly with the rest of the world, once the U.S. need

WHO decries 'vast global gap' in funds needed to fight coronavirus

By Stephanie Nebehay GENEVA (Reuters) - There is a "vast global gap" between funds needed to fight the coronavirus pandemic and funds committed, World Health Organization chief Tedros Adhanom

Common wrist fracture does not need surgical repair in most cases

By Linda Carroll (Reuters Health) - Most scaphoid waist fractures in adults do not need to be repaired surgically, a new study finds. Outcomes from just over 400 patients with scaphoid waist fractures

Malnutrition tied to worse post-discharge heart failure outcomes

By Lisa Rapaport (Reuters Health) - Hospitalized heart failure patients with insufficient calorie intake may have a poor quality of life and a higher chance of readmission after discharge than their

ARBs may best ACE-inhibitors at preserving cognition in patients with MCI

By Linda Carroll (Reuters Health) - Older adults with mild cognitive impairment (MCI) and high blood pressure had superior cognitive outcomes after a year of treatment with candesartan compared to

Rare TP53 mutation implicated in familial cancers in Ashkenazi Jews, but with low penetrance

By Marilynn Larkin NEW YORK (Reuters Health) - A rare TP53 mutation common in Ashkenazi Jews confers risk of multiple cancers, but while some are early-onset, others may occur later, a genetic

Metformin may benefit overweight women with PCOS undergoing IVF

By Megan Brooks NEW YORK (Reuters Health) - Metformin treatment may be helpful in overweight women (BMI 26 or greater) with polycystic ovary syndrome (PCOS) who are undergoing assisted reproduction,

Dedicated flu clinics may reduce impact of the illness

By Linda Carroll (Reuters Health) - Having clinics designed to treat only the flu might reduce the impact of the disease, a new computer model suggests. By isolating people who have the disease, or

COVID SCIENCE-New clues on virus reproduction mystery; non-COVID vaccines may help

By Nancy Lapid (Reuters) - The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by

AI could help track response to anti-VEGF therapy for diabetic macular edema

By Reuters Staff NEW YORK (Reuters Health) - Artificial intelligence (AI) analysis of imaging data could help monitor treatment response in patients with diabetic macular edema (DME) undergoing

Molecular signatures of non-smoking lung cancer in East Asians identified

By Reuters Staff NEW YORK (Reuters Health) - A comprehensive proteogenomic study of non-smoking lung cancer reveals molecular signatures of pathogenesis and progression, researchers in Taiwan report.

Bisphosphonates reduce bone toughness over time

By Will Boggs MD NEW YORK (Reuters Health) - Using bisphosphonates for several years is associated with increasing brittleness and decreasing toughness of bone, according to a new review. "Long-term

Pfizer to make Gilead's COVID-19 treatment remdesivir

By Reuters Staff (Reuters) - Pfizer Inc said on Friday it signed a multiyear agreement to make COVID-19 treatment remdesivir for developer Gilead Sciences Inc, which is under pressure to increase

U.S. surpasses 160,000 coronavirus deaths as school openings near

By Aurora Ellis and Maria Caspani NEW YORK (Reuters) - More than 160,000 people have died from the coronavirus pandemic in the United States, nearly a quarter of the global total, according to a

Alzheimer's drug from Biogen to get speedy U.S. review

By Dania Nadeem and Manojna Maddipatla (Reuters) - The U.S. Food and Drug Administration will conduct an expedited review of an experimental Alzheimer's drug from Biogen Inc and Japan's Eisai Co Ltd,

Mitral valve-in-valve replacements seem safe and successful

By David Douglas NEW YORK (Reuters Health) - Transcatheter mitral valve-in-valve (MViV) replacement of degenerated bioprosthetic valves using the Edwards Lifesciences SAPIEN 3 prosthesis has a high

Fecal microbiota transplantation reduces IBS symptoms

By Will Bogga MD NEW YORK (Reuters Health) - Fecal microbiota transplantation (FMT) reduces symptoms of irritable bowel syndrome (IBS) in some patients, but the benefits wane over time, according to

University of Washington forecasts 300,000 U.S. COVID-19 deaths

By Doina Chiacu and Rich McKay WASHINGTON (Reuters) - Nearly 300,000 Americans could be dead from COVID-19 by Dec. 1, University of Washington health experts forecast on Thursday, although they said

Beta-2 agonists can improve athletes' speed and strength

By Lisa Rapaport (Reuters Health) - Beta-2 agonists can improve speed and strength in athletes without asthma, according to a new study that also suggests this might be true for versions of these

Regular MRI screening suggested for women with familial breast cancer risk

By Marilynn Larkin NEW YORK (Reuters Health) - Women ages 35-60 with a family history of breast cancer can be cost-effectively screened with magnetic resonance imaging (MRI) every 18 months, an

UPDATE 1-Children rapidly deported from the United States strain Guatemalan shelters

(Adds July data on border apprehensions) By Sofia Menchu and Mimi Dwyer GUATEMALA CITY/LOS ANGELES (Reuters) - Hundreds of migrant children rapidly expelled from the United States under a coronavirus

Risks, benefits of IV belimumab in children with SLE consistent with adults

By Marilynn Larkin NEW YORK (Reuters Health) - Intravenous belimumab 10 mg/kg every four weeks was safe and effective in childhood-onset systemic lupus erythematosus (cSLE) in a phase-2

Family wellbeing similar with parents or grandparents heading household

By Lisa Rapaport (Reuters Health) - Grandparents raising children seem to cope as well with parenting duties as parents, even though they're more likely to care for kids with more developmental and

Vitamin D supplements may improve benign paroxysmal positional vertigo

By Lisa Rapaport (Reuters Health) - Some patients with benign paroxysmal positional vertigo (BPPV) may have fewer recurrences if they take vitamin D and calcium supplements, new trial results suggest.

UPDATE 1-U.S. lifts global health coronavirus travel advisory

By David Shepardson and Doina Chiacu WASHINGTON (Reuters) - The U.S. State Department on Thursday lifted a global "Do Not Travel" advisory from March recommending U.S. citizens avoid all international

Fatal pulmonary fibrosis can occur with COVID-19

By Will Boggs MD NEW YORK (Reuters Health) - COVID-19 can result in fatal pulmonary fibrosis, according to a new case report. "We hope that our results will remind clinicians of pulmonary fibrosis as

Coronavirus, other respiratory viruses can cause severe bronchiolitis

By Reuters Staff NEW YORK (Reuters Health) - Coinfections with endemic coronaviruses and other respiratory viruses can cause severe bronchiolitis, according to new findings. Four endemic coronaviruses

Online CPR videos rarely feature women, study finds

By Carolyn Crist NEW YORK (Reuters Health) - About 98% of instructional videos found on online sites about CPR include men or a manikin without a female anatomy, according to a new analysis. Worldwide

Number of incident cancers dropped as pandemic took hold

By Anne Harding NEW YORK (Reuters Health) - The number of newly identified patients with cancer declined significantly after the onset of the pandemic, a new analysis of clinical laboratory data

Global recovery will come faster if COVID vaccine available to all -WHO chief

By Reuters Staff GENEVA (Reuters) - Economic recovery around the world could comes faster if any COVID-19 vaccine is made available to all as a public good, World Health Organization Director General

Antiviral combo shows early promise against HCV in pregnancy

By Scott Baltic NEW YORK (Reuters Health) - The combination of ledipasvir and sofosbuvir appears to be safe and effective in treating pregnant women infected with genotype 1 hepatitis C virus (HCV),

Becton Dickinson on track to produce 1 bln syringes in 12-18 months

By Reuters Staff (Reuters) - Medical device maker Becton Dickinson and Co said on Thursday it would be able to produce 1 billion syringes in the next 12-18 months. The company has received a total

Why the coronavirus is killing so many of Mexico's healthcare workers

By Diego Oré MEXICO CITY (Reuters) - When the coronavirus epidemic began to intensify in Mexico at the end of March, Doctor Jose Garcia said his bosses at a public trauma hospital in Mexico City

Children rapidly deported from the United States strain Guatemalan shelters

By Sofia Menchu and Mimi Dwyer GUATEMALA CITY/LOS ANGELES (Reuters) - Hundreds of migrant children rapidly expelled from the United States under a coronavirus immigration policy are returning to

Women with AF feel worse than men even after ablation

By David Douglas NEW YORK (Reuters Health) - Both before and after catheter ablation to treat atrial fibrillation (AF), women have significantly worse symptom scores and health-related quality of life

Government health experts warn U.S. cities of "trouble ahead"

By Doina Chiacu WASHINGTON (Reuters) - White House health experts are warning of an uptick in the percentage of people testing positive for COVID-19 in U.S. cities including Boston, Chicago and

Trump says coronavirus vaccine possible before Nov. 3

By Reuters Staff WASHINGTON (Reuters) - U.S. President Donald Trump said on Thursday it was possible the United States would have a coronavirus vaccine before the Nov. 3 election, a more optimistic

Patients with gynecologic cancers not at increased risk for severe COVID-19

By Reuters Staff NEW YORK (Reuters Health) - Women with gynecologic cancer do not appear to be at increased risk of being hospitalized with COVID-19 or dying from the infection, according to a study

Worldwide, gout cases and years of disability rising

By Linda Carroll (Reuters Health) - The prevalence of gout and the years lived with disability due to the condition are on the rise worldwide, a new study finds. An analysis of nearly three decades of

EXCLUSIVE-Fauci says regulators promise politics will not guide vaccine timing

By Jeff Mason and Michael Erman WASHINGTON (Reuters) - U.S. regulators have assured scientists that political pressure will not determine when a coronavirus vaccine is approved even as the White House

NY home health workers report personal risks during COVID-19 pandemic

By Lisa Rapaport (Reuters Health) - Home health care workers in New York City report feeling invisible and at personal risk during the COVID-19 pandemic, a small study suggests. Researchers performed

Physicians overlook some preventive services tied to longer life

By Lisa Rapaport (Reuters Health) - Most physicians prioritize which preventive services to discuss with patients based on time constraints and assumptions about which interventions improve quality or

Urgent care membership programs may expand access, not cut costs

By Lisa Rapaport (Reuters Health) - Urgent care center membership programs may provide convenience and expanded access to care to people who are uninsured or underinsured without necessarily saving

Subcutaneous ICDs non-inferior to transvenous devices when pacing isn't needed

By Gene Emery (Reuters Health) - Subcutaneous implantable cardioverter-defibrillators are as effective as conventional transvenous ICDs, according to the first head-to-head prospective comparison,

Risk of mobile phone interference with implanted electronic devices presently low

By Marilynn Larkin NEW YORK (Reuters Health) - The risk of mobile phone-induced electromagnetic inference with cardiovascular implantable electronic devices (CIEDs) was low in an observational study

For relapsing MS, leukemia drug produces one-third improvement over teriflunomide

By Gene Emery (Reuters Health) - In patients with relapsing multiple sclerosis, subcutaneous ofatumumab therapy lowers the 6-month odds of worsening disability by 32% (P=0.01) compared with oral

Cannabidiol has potential to safely treat cannabidiol use disorder

By Marilynn Larkin NEW YORK (Reuters Health) - A phase IIa randomized trial of oral cannabidiol (CBD) for cannabis use disorder showed that 400 mg and 800 mg doses were safe and more effective than

Doctors say Turkish COVID-19 outbreak worse than reported as hospitalisations swell

By Ali Kucukgocmen and Yesim Dikmen ISTANBUL (Reuters) - Doctors in Turkey's coronavirus hotspots say hospitals are filling up with more cases than are reflected in the official nationwide count,

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