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The task force suggested that extensive and intensive behavioral interventions are the best way to help a child get to a healthy weight. A high BMI for a child is defined a little differently than it is for adults, although both use height and weight to estimate mass. Nearly 20% of children in the US have what’s considered a high BMI. The task force gives its guidelines letter grades based on the most up-to-date science. Under the Affordable Care Act, private insurers must cover preventive services that get a grade of A or B; the new child obesity recommendations got a B grade.
Persons: Susma Vaidya, , , Dr, Mona Sharifi, ” Sharifi, Thomas Robinson, Sarah Armstrong, haven’t, Sharifi, Justin Ryder, Stanley Manne, Robert H, Lurie, “ I’ve, ” Ryder, Wegovy, Alli, Lomaira, John Ruiz, Sanjay Gupta, “ There’s, ” Vaidya, Vaidya, pharmacotherapy Organizations: CNN, US Preventive Services, Force, American Academy of Pediatrics, BMI, US Centers for Disease Control, Affordable, National Hospital, Yale School of Medicine, Stanford Solutions Science Lab, Department of Pediatrics, Pediatrics, Adolescent Health, Duke University Medical School, Stanley Manne Children’s, Ann, Lurie Children’s Hospital of Chicago, University of Arizona, CNN Health, FDA Locations: Washington
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The Conversation —In September 2023, several people came down with dengue fever in Paris, France. Aedes has spread considerably further than in 2016, and the number of dengue cases worldwide has increased dramatically in the same period. For the Paris Olympics to become a super-spreader event, several factors must overlap. Most dengue cases are asymptomatic. At the Rio Carnival this year, a dengue outbreak just days before the event led to a public health emergency being called, but the event wasn’t cancelled.
Persons: Mary ”, Mary Mallon, Dr, Sanjay Gupta Organizations: CNN, Tokyo Olympics, Paris Olympics, Olympics, CNN Health Locations: Paris, France, Europe, COVID, Hunan Province, China, Peru, Brazil, Africa, Aedes
Then, three healthy ferrets were placed in the same enclosures with three of the sick animals. These animals could touch, nose and lick the sick animals, and all of them became ill.Next, the CDC tested airborne transmission by putting three healthy ferrets into an enclosure where they could breathe the same air as sick animals but couldn’t touch them. In her lab, ferrets with previous exposures to seasonal flu strains didn’t get as sick when exposed to new flu viruses compared to those with no prior exposure to seasonal strains. How much help we might get from past exposures to flu viruses is difficult to predict, however, which is why vaccination would still be important to tune up our immunity. They never spread the virus to any of the other animals in the facility — including themselves.
Persons: Mark Naniot, Naniot, , , It’s, Jeremy Farrar, Jesse Bloom, Fred Hutch, ” Naniot, Naniot hadn’t, Scott Weese, Weese, there’s, Covid, Rick Bright, Sanjay Gupta, Bright, Erin Sorrell, Zahl, Seema Lakdawala, hasn’t, ” Bright, Dr, Richard Webby, Jude Children’s, “ It’s, Ducks, Michael Osterholm, “ I’ve, he’s Organizations: CNN, Swiss Army, World Health Organization, Fred Hutch Cancer Center, University of Guelph, US Centers for Disease Control, CDC, Research, Development Authority, CNN Chief, Bright Global Health, Johns Hopkins Center for Health Security, Getty, Emory University, STAT, Administration, Strategic Preparedness, USDA, Jude Children’s Research, Infectious Disease, University of Minnesota, CNN Health Locations: Wisconsin’s, United States, Seattle, Canada, Texas, Vadso, Finnmark, Norway, AFP, Finland, St, Wisconsin
CNN —The US Food and Drug Administration is warning consumers and retailers to not “eat, sell or serve” any of Diamond Shruumz-brand’s microdosing chocolate bars after people across four states were left hospitalized. Eight people reported falling ill after eating Diamond Shruumz’s chocolates, the FDA said in an advisory. People who consumed the chocolate bars reported experiencing symptoms that include “seizures, central nervous system depression (loss of consciousness, confusion, sleepiness), agitation, abnormal heart rates, hyper and hypotension, nausea and vomiting,” said the FDA. CNN has reached out to Diamond Shruumz for comment but has not heard back by the time of publishing. If you or someone you know becomes ill after consuming Diamond Shruumz’s chocolate bars, the FDA recommends speaking to a health care provider and/or contacting the Poison Help Line at 1-800-222-1222.
Persons: Diamond, , Dr, Sanjay Gupta, Diamond Shruumz Organizations: CNN, Food and Drug Administration, FDA, People, CNN Health, US Centers for Disease Control, Centers Locations: Arizona, Indiana, Nevada, Pennsylvania
CNN —There could be a combined Covid-19 and flu shot in our future, although it won’t be ready for this year’s flu season. On Monday, vaccine maker Moderna announced positive late-stage trial results for its Covid/flu combination vaccine it calls mRNA-1083. Other companies have been testing a combined Covid-flu vaccine, but Moderna is the first to announce positive late-stage trial results. The trial studied the vaccine in two different age groups with about 4,000 adults in each age category. Few people got the latest Covid shot, studies show.
Persons: , Francesca Ceddia, ” Ceddia, Covid, Spikevax, Moderna, Sue Peschin, Dr, Sanjay Gupta, Peschin, ” Peschin, Organizations: CNN, Moderna, Public, US Centers for Disease Control, Food, Covid, FDA, Alliance for Aging Research, CNN Health, CDC Locations: United States
How therapy can boost happiness
  + stars: | 2024-06-09 | by ( Andrea Kane | ) edition.cnn.com   time to read: +8 min
“(One) is that you’re going to go in, you’re going to download the problem of the week, and you’re going to leave, and you’re basically just complaining and getting validated for your complaints. Therapy helps to connect with othersModern times have created an epidemic of loneliness; the pandemic only made it worse. Therapy helps us see the big pictureTherapy helps people see that they are part of larger forces, and not simply individuals who formed with no external influences. “(Therapy) helps you to process that unfinished business.”She pointed out that our parents were human and often did what they learned from their parents. Therapy helps us control our storyOur life is a narrative, and therapy can help us make sense of it.
Persons: it’s, don’t, Lori Gottlieb, Sanjay Gupta, Gottlieb, I’m, , they’d, ” Gottlieb, you’re, you’ve, who’s, , , ’ ”, … they’re Organizations: CNN, Pew Research Center
Read previewNetflix's "Hit Man" is based on the true story of former fake hitman Gary Johnson (Glen Powell) — but the ending is different from reality. Adria Arjona as Madison and Glen Powell as Gary Johnson in "Hit Man." Last year, Netflix bought "Hit Man" for $20 million to stream on their platform. In 'Hit Man,' Gary and Madison get away with killing two people and raise a family togetherAdria Arjona and Glen Powell in "Hit Man." The real Gary Johnson didn't murder anyone or marry MadisonAustin Amelio, Sanjay Rao, and Retta as New Orleans detectives Jasper, Phil, and Claudette in "Hit Man."
Persons: , Gary Johnson, Glen Powell, Gary, Austin Amelio, Adria Arjona, Brian Roedel, Skip Hollandsworth, Richard Linklater, Powell, Linklater, Madison, Ron, empathizes, Jasper, Gary suffocates, Madison Austin Amelio, Sanjay Rao, Phil, Claudette, Johnson, Hollandsworth, Rick Kern, Netflix Powell, floodgate, It's Organizations: Service, New Orleans Police Department, Business, Madison, Netflix, Texas Monthly, Monthly, AGC, Gary, Texas, Getty, UPI Locations: New Orleans, Jasper, Madison, Gary
CNN —After decades of false starts, researchers say they are finally making progress on a long-acting and reversible birth control option for men. The gel was developed by the National Institutes of Health and the nonprofit Population Council, and it takes much the same approach as birth control pills for women. “I would say our expectation was that it would be similar to hormonal birth control pills. The gel also seems to have other advantages over female birth control. To him, it doesn’t feel fair that his partner has to shoulder the burden of birth control.
Persons: “ We’ve, , Diana Blithe, Blithe, , that’s, Matthew Treviño, it’s, he’s, “ I’ve, Emily Fletcher, , Roe, Wade, ’ “ Fletcher, Treviño, ” Treviño, That’s, Christina Wang, Dr, Sanjay Gupta, Wang, they’ll, Brian Nguyen Organizations: CNN, National Institutes of Health, Population Council, NIH’s National Institute of Child Health, Human, Endocrine Society, World Health Organization, University of California, UC Davis, US Food and Drug Administration, Lundquist, Medical, Get CNN, CNN Health, University of Southern Locations: Boston, Sacramento , California, Davis, University of Southern California
According to most polls, India’s election was a foregone conclusion. Prime Minister Narendra Modi’s right-wing, Hindu-nationalist alliance was expected to secure a supermajority – and with it the power to enact radical change unopposed. To Modi’s critics and opponents, India was on the fast track to becoming a de-facto one-party state. Going into this election, Modi had set a goal of winning 400 seats in the lower house of parliament, or Lok Sabha. The BJP’s inability to secure an outright majority “pricks the bubble of Modi’s authority,” wrote political scientist Pratap Bhanu Mehta Tuesday night.
Persons: Narendra Modi’s, Modi, Bharatiya Janata Party wouldn’t, God, , Pratap Bhanu Mehta, , Jawaharlal Nehru, Ritesh Shukla, Arathi Jerath, India’s, Arvind Kejriwal, Critics, , ” Mehta, Sanjay Singh, “ Modi, Neelanjan Sircar Organizations: CNN, Bharatiya Janata Party, , BJP, Aadmi Party, , National Democratic Alliance, Center for Policy Research Locations: India, Lok Sabha, , Ayodhya, New Delhi, Delhi
And the rate of maternal deaths among Black women in the United States remains even higher, at nearly 50 deaths per 100,000 live births, the new report shows. Meanwhile, half of the high-income nations in the new report had fewer than 5 maternal deaths per 100,000 live births, and one country recorded zero maternal deaths: Norway. The three nations with the lowest maternal death rate were Norway with zero, Switzerland with a rate of 1 death per 100,000 live births and Sweden with about 3 deaths per 100,000 live births. The US maternal mortality rate fell from 32.9 maternal deaths per 100,000 live births in 2021 to 22.3 per 100,000 in 2022, according to data from the CDC. “Maternal deaths are a preventable problem, and this problem can be solved.
Persons: , Munira Gunja, ” Gunja, , Dr, Laurie Zephyrin, Dimes, , , Tochi, Michelle Owens, ” Owens, “ ACOG, Christopher Zahn, ” Zahn, Sanjay Gupta, Roe, Wade Organizations: CNN, Commonwealth Fund, International Program, Health, , US Centers for Disease Control, Organisation for Economic Co, CDC, World Health Organization, , Commonwealth, American Academy of Family Physicians, American College of Obstetricians, CNN Health Locations: United States, Norway, Australia, Canada, Chile, France, Germany, Japan, Korea, Netherlands, New Zealand, Sweden, Switzerland, Covid, U.S, United Kingdom, Long Island , New York, Jackson , Mississippi, States, Commonwealth
5 tips to turn your anxiety into a positive force
  + stars: | 2024-06-02 | by ( Andrea Kane | ) edition.cnn.com   time to read: +6 min
Most have experienced this sort of anxiety — not clinical anxiety, which might result in a full-on panic attack, but the run-of-the-mill kind that leaves you feeling uncomfortable. She is also the author of “Good Anxiety: Harnessing the Power of the Most Misunderstood Emotion.”“The misunderstanding is that it is valuable,” Suzuki said. 1 reason to learn how to modulate that stress response.”The first step toward getting to “good” anxiety, Suzuki said, is learning how to lower your level of everyday anxiety. To enhance productivity and reduce worry, transform your anxious what-if list into a productive to-do list, Suzuki advised. “This simple act can release dopamine and improve your own mood.”We hope these five tips help you turn your anxiety into something more productive.
Persons: Sanjay Gupta, , Wendy Suzuki, , , ’ ”, Suzuki, ” Suzuki, , Deepak Chopra, Wendy Organizations: CNN, New York University, school’s College of Arts and Science
CNN —Honduras has declared a national health emergency after reporting a rise in hospitalizations and deaths from dengue, the health ministry announced on Friday. The Honduran health ministry has reported 23,037 suspected cases of dengue in the first 20 weeks of the year. That’s one of the highest totals in the Americas, according to data collected by the Pan American Health Organization (PAHO). The entire region has already reported more than 8.65 million cases in the first five months of 2024 – almost twice as many as the more than 4.5 million cases reported in all of 2023, which was a record at the time. Get CNN Health's weekly newsletter Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.
Persons: , Dr, Sanjay Gupta Organizations: CNN, Pan American Health Organization, Central, CNN Health, World Health Organization, US Centers for Disease Control, Prevention Locations: Honduras, hospitalizations, Honduran, Americas, Brazil, Central America, Caribbean, “ Honduras, American Isthmus, Mexico
CNN —A genetically engineered pig kidney has been removed from a transplant patient after it started losing function, according to a statement on Friday from NYU Langone Health. Lisa Pisano looks at photos of her dog after her surgeries at NYU Langone Health in New York on Monday, April 22, 2024. Shelby Lum/AP/FILEThe kidney had to be removed due “unique challenges in managing both her cardiovascular health and kidney function” 47 days after the transplant, NYU Langone Health said. Pisano family/NYU Langone Health“Lisa is a pioneer and a hero in the effort to create a sustainable option for people waiting for an organ transplant. While the kidney ultimately had to be removed from Pisano, Montgomery said the kidney would be studied for further insights and stressed the importance of her contribution to the larger goal.
Persons: Lisa Pisano, Pisano, NYU Langone, Shelby Lum, , Robert Montgomery, Todd, Lisa, Dr, Sanjay Gupta, It’s, Montgomery, and, “ Lisa, ” Montgomery, CNN’s Katherine Dillinger Organizations: CNN, NYU Langone Health, NYU, NYU Langone Transplant Institute, Procurement, Transplantation Network, CNN Health, US Food and Drug Administration Locations: Lisa Pisano of New Jersey, New York, Montgomery, Pisano
CNN —Reassuring new evidence suggests that feeding children smooth peanut butter during infancy and early childhood can help reduce their risk of developing a peanut allergy even years later. “Peanut allergy develops very early in most children between six and 12 months of life. The LEAP-Trio trial set out to examine whether that reduced risk of peanut allergy would last into adolescence. At that age, peanut allergy remained “significantly more prevalent” among the children who originally avoided peanuts, with about 15% having a peanut allergy. Among those who originally consumed peanuts, about 4% had a peanut allergy, the researchers found.
Persons: ” Gideon Lack, ” Lack, , Dr, Jeanne Marrazzo, , Purvi, ” Parikh, it’s, Sanjay Gupta, Daniel DiGiacomo, ” DiGiacomo Organizations: CNN, King’s College London, American Academy of Pediatrics, AAP, US National Institute of Allergy, immunologist, NYU Langone, Allergy, Asthma Network, CNN Health, Children’s, Jersey Shore University Medical Locations: United Kingdom, Israel, United States, New York, Neptune , New Jersey
CNN —Highly pathogenic avian influenza, sometimes called bird flu, has been confirmed in alpacas for the first time, according to the US Department of Agriculture’s National Veterinary Services Laboratories. The animals that tested positive were on a farm in Idaho where poultry had tested positive for the virus and were culled in May. The alpacas tested positive May 16, the USDA said in a news release. The gene sequence of viruses isolated from the alpacas shows that it is closely related to the H5N1 viruses that are currently circulating in dairy cattle. Scientists have closely watched the H5N1 virus for roughly two decades.
Persons: Dr, Sanjay Gupta Organizations: CNN, US Department of, National Veterinary Services Laboratories, USDA, CNN Health, Alpaca Owners Association, Scientists Locations: alpacas, Idaho
CNN —It was supposed to be a celebration, but one family’s unique meal of black bear meat sent several members to the hospital instead. One family member, a hunter, brought some black bear meat that he had harvested in northern Saskatchewan in May 2022. Rather, it was “difficult for the family members to visually ascertain the level of doneness” because the meat was dark in color. Tests soon confirmed that that was the case, and tests were recommended for the other family members. Four had eaten bear meat and vegetables, but the other two had eaten only vegetables cooked with the meat.
Persons: outfitter, Trichinellosis, Dr, Sanjay Gupta Organizations: CNN, US Centers for Disease Control, World Organisation for Animal Health, CDC, Get CNN, CNN Health, Public Health Agency of Canada Locations: South Dakota, Saskatchewan
Dr. Sanjay Gupta: Rewiring your brain for happiness
  + stars: | 2024-05-25 | by ( Dr. Sanjay Gupta | ) edition.cnn.com   time to read: +10 min
CNN —Happiness is an idea that has been woven into the fabric of humanity, going back to ancient civilizations. Santos believes, however, that with some diligent and intentional practice, you can start to turn up your thermostat of happiness. “Every available study of happy people suggests that happy people are more social,” Santos said. And I would gather the opposite is also true: Social people are happier. Listen to the full episode with happiness professor Laurie Santos here, and join us next week on the podcast when we explore the surprising link between happiness and anxiety.
Persons: Rebecca, I’m, It’s, Laurie Santos, we’re, , Santos, Kelly McGonigal, ” Santos, , ” She’s, Robert Waldinger, , Waldinger Organizations: CNN, Independence, Liberty, Gallup, Yale University, Harvard Locations: United States
Diabetes is a key risk factor for kidney disease, which is one of the leading causes of death in the United States and worldwide; about 1 in 3 people with diabetes also has chronic kidney disease, according to the US Centers for Disease Control and Prevention. But new research shows that weekly injections of semaglutide cut the risk of severe outcomes from diabetic kidney disease by about 24%. The new study found even broader related benefits of semaglutide treatment among people with diabetic kidney disease. “Kidney disease attributed to diabetes, or diabetic kidney disease, is one of the most common and deadly complications of diabetes. Yet, unfortunately, there’s very low awareness around it,” said Dr. Katherine Tuttle, chair of the Diabetic Kidney Disease Collaborative for the American Society of Nephrology.
Persons: , Vlado Perkovic, “ Semaglutide, Martin Holst Lange, Katherine Tuttle, ” It’s, Tuttle, semaglutide, It’s, Dr, Sanjay Gupta, White, ” Tuttle Organizations: CNN, Diabetes, US Centers for Disease Control, New England, of Medicine, European Renal Association Congress, University of New, University of New South Wales Sydney, Novo Nordisk, American Society of Nephrology, Providence Inland Northwest Health, Health Sciences, University of Washington, CNN Health Locations: United States, University of New South, Danish, American
Professional organizations have set this as a guideline for when to reassess whether a treatment is providing clinically meaningful weight loss. People who met with their providers less frequently – and those living in underserved regions with broader health inequities – were more likely to discontinue GLP-1 treatment sooner. But using GLP-1 treatments are still an investment in many ways. These injected medications, called GLP-1 agonists, are in high demand because they have proved to be so effective for weight loss. And experts warn that the GLP-1 treatment process can be different for everyone.
Persons: , Disha, Wegovy, Jody Dushay, Beth, There’s, Razia Hashmi, ” Hashmi, it’s, , Dr, Sanjay Gupta, ” Narang, ” Dushay Organizations: CNN, Endeavor Health, Beth Israel Deaconess Medical Center, Harvard Medical School, Shield, Dandelion Health, CNN Health, Locations: Chicago, , GLP
Injected medications called GLP-1 agonists are in high demand because they have proved to be so effective for weight loss. The difference, which was statistically significant, amounted to a 52% increased risk of being diagnosed with stomach paralysis while on a GLP-1 medication. Compared with those who were not taking a GLP-1 medication, those who did were about 66% more likely to be diagnosed with gastroparesis. This study found that 0.53% of patients on GLP-1 medications were diagnosed with stomach paralysis, or about 1 case of gastroparesis for every 200 people taking the drugs. People taking GLP-1 medications were also more likely to have nausea and vomiting or gastroesophageal reflux disease (GERD) and to be prescribed a proton pump inhibitor.
Persons: gastroparesis, GERD, , Prateek Sharma, Sharma, ” Sharma, Michael Camilleri, , Camilleri, It’s, who’d, Dr, Sanjay Gupta, it’s Organizations: CNN, Drugmaker, Nordisk, University Hospitals, Diabetes, University of Kansas, University of Kansas School of Medicine, American Society, Mayo Clinic, CNN Health Locations: Washington, Cleveland, GLP, Mayo
CNN —The US Centers for Disease Control and Prevention is urging doctors to be on the lookout for potentially deadly meningococcal disease linked to travel to Saudi Arabia. Meningococcal disease is highly contagious among unvaccinated people. Meningococcal disease, including meningitis, is an uncommon illness caused by the bacteria Neisseria meningitidis. Meningococcal disease can be treated with antibiotics if it’s caught early enough. One such instance is before travel to countries where meningococcal disease is more common.
Persons: Prophet Muhammad, it’s, serogroup C, Dr, Sanjay Gupta Organizations: CNN, Centers for Disease Control, Research, CDC, Pfizer, Hajj, Health Alert Network, CNN Health Locations: Saudi Arabia, Mecca, United States, France, United Kingdom, People
Blood biomarkers of telltale signs of early Alzheimer’s disease in the brain of his patient, 55-year-old entrepreneur Simon Nicholls, had all but disappeared in a mere 14 months. “I don’t use the term ‘reverse.’ I don’t know what reverse means when it comes to the field of Alzheimer’s,” Isaacson said. ‘It was time to turn to my brain’Slowly, Nicholls’ heart condition began to improve, but the bad news didn’t end there. A brain scan found telltale signs of vascular damage in Nicholls’ brain, which occurs when the tiniest blood vessels are starved of oxygen. Not only was Nicholls blood negative for amyloid and tau, the test suggested that his brain amyloid might be normal, with no distinguishable signs of the disease.
Persons: Sanjay Gupta, Anderson Cooper ”, Richard Isaacson, Simon Nicholls, , , Isaacson, “ Simon, ” Isaacson, Nicholls, ” Nicholls, Anderson Cooper, It’s, APOE4, Simon, ” Simon Nicholls, Sylver, Lewy, Richard Isaacson ‘, APOE ε4, “ I’ve, Isaacson doesn’t, “ I’m, Shocked, Dr, we’d, “ It’s, Salvadore, Richard Isaacson “, ‘ It’s, I’m Organizations: CNN, telltale, ” CNN, Boca Raton Locations: Boca Raton , Florida, New York City, Florida, Nature, Miami, Isaacson’s Florida, tirzepatide
FLiRT variants are offshoots of the JN.1 variant — all part of the broader Omicron family — that caused this winter’s wave. The mutations of the FLiRT variants make increased transmissibility — and a possible summer wave — a real threat. “We learned from the laboratories that FLiRT variants appeared, so far, to be as transmissible as the other Omicron subvariants, which means they’re really quite contagious. As of May 1, the requirement for all hospitals to report Covid-19 data to the federal government has expired. While the FLiRT variants pose some risk this summer, experts remain focused on what might happen in the fall.
Persons: CNN —, , Andy Pekosz, “ We’ve, William Schaffner, ” Schaffner, it’s, ” Pekosz, , Dr, Sanjay Gupta, we’ve Organizations: CNN, US Centers for Disease Control, Data, Johns Hopkins Bloomberg School of Public Health, Vanderbilt University, Schaffner’s Vanderbilt University Medical Center, CDC, JAMA, CNN Health, JN, US Food Locations: United States, Covid
Blum turned to programs mostly in states where abortion access — and, by extension, abortion training — is likely to remain protected, like California, Colorado, and New Mexico. The AAMC analysis found the number of applicants to OB-GYN residency programs in abortion ban states dropped by 6.7%, compared with a 0.4% increase in states where abortion remains legal. For internal medicine, the drop observed in abortion ban states was over five times as much as in states where abortion is legal. The AAMC analysis notes that even in states with abortion bans, residency programs are filling their positions — mostly because there are more graduating medical students in the U.S. and abroad than there are residency slots. Stulberg and others worry that this self-selection away from states with abortion restrictions will exacerbate the shortages of physicians in rural and underserved areas.
Persons: — Isabella Rosario Blum, Blum, , , , Atul Grover, ” Jack Resneck Jr, Wade, Resneck, Beverly Gray, Gray, Duke, Rohini Kousalya Siva, Kousalya Siva, “ We’re, Debra Stulberg, Stulberg, Hannah Light, Olson, Dr, Sanjay Gupta Organizations: Health, , Association of American Medical Colleges, KFF Health, OB, Research, Action Institute, American Medical Association, Duke University School of Medicine, MedStar Washington Hospital Center, Washington , D.C, D.C, American Medical Student Association, Department of Family Medicine, University of Chicago, University of California, CNN, CNN Health, Residents, KFF Locations: Arizona, California , Colorado, New Mexico . Arizona, Seattle, Midwest, U.S, North Carolina, Washington ,, Maryland , New Hampshire , New York, Washington, Virginia, Tennessee, San Francisco, California, New York
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