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Greenstein L, Abraham A, Tipping B. Treating complexity in the older adult - the role of the geriatric giants. S Afr Fam Pract (2004) 2019. [DOI: 10.4102/safp.v61i6.5065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
As people age, they accumulate medical conditions. Geriatric giants comprise a group of conditions that lead to significant mortality and morbidity and contribute to the complexity in treating geriatric patients. They are common and rarely occur in isolation. The 5 Is of geriatric giants are: iatrogenesis, immobility, instability, incontinence and impaired cognition. Consequences for the patient and their caregivers include loss of functional independence, institutionalisation and caregiver burnout. Primary care practitioners are often the first port of call for geriatric patients in South Africa and by asking a few key questions and performing a thorough examination; these conditions can be recognised early. Whilst there are often limitations to cure, the main aim is to maintain the older adult’s functional independence as much as possible, and by following an organised management approach to each of these conditions, the quality of life of patients can be improved.
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Cloutier A, Bond A, Taylor MI, Ablett J, Teubner A, Farrer K, Leahy G, Abraham A, Lal S. Successful implementation of remote video consultations for patients receiving home parenteral nutrition in a national UK Centre. Frontline Gastroenterol 2019; 11:280-284. [PMID: 32587671 PMCID: PMC7307045 DOI: 10.1136/flgastro-2019-101257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 02/04/2023] Open
Abstract
RATIONALE Our intestinal failure unit provides care for patients from a wide geographical area. Patients dependent on home parenteral nutrition (HPN) are routinely reviewed in the clinic at 3-6 monthly intervals. Between March 2008 and 2015, we noted a significant rise in the number of patients under our care, with an associated 51% increase in clinic appointments offered. We evaluated whether telemedicine would provide a strategy to reduce patients' need to travel while maintaining safe clinical standards. METHODS Implementation began in December 2015 via patient consultation and small tests of change. Clinical data were obtained from a prospectively maintained database. Remote video consultation discussions were carried out via internet video call service (Skype). An anonymous satisfaction questionnaire was offered to patients for completion following consultation. The number of miles saved by obviating the need to attend hospital was calculated for each patient. RESULTS During the study period, patients receiving HPN rose by 18% to 288. Twenty-five patients used telemedicine for HPN follow-up, three of these for follow-up with the psychologist. By avoiding hospital attendance, this saved a mean travel distance of 56.7 miles with a total of 18 346.6 cumulative miles saved. Sixty-three per cent of patients rated their satisfaction with the system at ≥90%, with a mean satisfaction of 85%. Eight per cent of the telemedicine cohort was admitted with an HPN complication, compared with an admission rate of 24% for the whole HPN cohort. One emergency admission was avoided. CONCLUSION Telemedicine can obviate the need for clinic attendance in HPN-dependent patients, so reducing the need of individuals with chronic illness to travel while maintaining standards for follow-up.
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Yadav SP, Abraham A, Nadig R, Vasudevan A. Burning Feet, Dilated Heart and Failed Kidneys. Indian J Nephrol 2019; 29:357-359. [PMID: 31571744 PMCID: PMC6755931 DOI: 10.4103/ijn.ijn_35_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Fabry's disease, X-linked lysosomal storage disease, results from deficient activity of alpha galactosidaseA (α-GalA). Renal manifestation usually begins at third decade of life. We report a 16 year male with initial presentation with end stage renal disease (ESRD) and the diagnosis confirmed by presence of myeloid bodies on electron microscopy of kidney biopsy and low serum α-GalA level.
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Abraham A, Ostroff G, Levitz SM, Oyston PCF. A novel vaccine platform using glucan particles for induction of protective responses against Francisella tularensis and other pathogens. Clin Exp Immunol 2019; 198:143-152. [PMID: 31400225 PMCID: PMC6797901 DOI: 10.1111/cei.13356] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/13/2022] Open
Abstract
Vaccines are considered the bedrock of preventive medicine. However, for many pathogens, it has been challenging to develop vaccines that stimulate protective, long-lasting immunity. We have developed a novel approach using β-1,3-D-glucans (BGs), natural polysaccharides abundantly present in fungal cell walls, as a biomaterial platform for vaccine delivery. BGs simultaneously provide for receptor-targeted antigen delivery to specialized antigen-presenting cells together with adjuvant properties to stimulate antigen-specific and trained non-specific immune responses. This review focuses on various approaches of using BG particles (GPs) to develop bacterial and fungal vaccine candidates. A special case history for the development of an effective GP tularaemia vaccine candidate is highlighted.
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Bogdan A, Barnett C, Ali A, AlQwaifly M, Abraham A, Mannan S, Ng E, Bril V. Chronic stress, depression and personality type in patients with myasthenia gravis. Eur J Neurol 2019; 27:204-209. [PMID: 31408565 DOI: 10.1111/ene.14057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Stress is a known risk factor for the onset and modulation of disease activity in autoimmune disorders. The aim of this cross-sectional study was to determine any associations between myasthenia gravis (MG) severity and chronic stress, depression and personality type. METHODS In all, 179 consecutive adult patients with confirmed MG attending the Neuromuscular Clinic between March 2017 and December 2017 were included. At baseline, patients were assessed clinically and they completed self-administered scales for disease severity, perceived stress, depression and personality type. RESULTS Higher disease severity [Myasthenia Gravis Impairment Index (MGII)] showed a moderate correlation with depression score (Beck's Depression Inventory, Second Edition, r = 0.52, P < 0.001) and a lower correlation with chronic stress (Trier Inventory for Assessment of Chronic Stress, r = 0.28, P = 0.001). Chronic stress scores were different according to personality types (anova, P = 0.02). The linear regression model with MGII score as the dependent variable showed R2 = 0.34, likelihood ratio chi-squared 74.55, with P < 0.0001. The only variables that predicted disease severity were depression scores (P < 0.0001) and female sex (P = 0.003). CONCLUSIONS A significant association of MG severity with depression and chronic stress was found, as well as with female gender. These findings should raise awareness that the long-term management of MG should address depression and potential stress and consider behavioural management to prevent stress-related immune imbalance.
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Chadwick P, Abraham A, Ryan K, Teubner A, Bond A, Lal S. SUN-PO262: Sensitivity of Differential Time to Positivity Compared to Pour Plates for Diagnosing Catheter-Related Blood Stream Infection: An Evaluation in Patients with Chronic Intestinal Failure. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abraham A, Sawbridge D, Cloutier A, Teubner A, Taylor M, Lal S. SUN-PO263: Are Femoral Tunnelled Central Venous Catheters Safe to use for HPN? Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thomas TVV, Gandhi S, Nittala M, Albert A, Abraham A, Packianathan S, Vijayakumar S. Stage Migration in Cervical Cancer Using the FIGO 2018 Staging System: A Retrospective Survival Analysis Using a Single Institution Patient Cohort. Is There a Will Rogers Phenomenon? Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Soop M, Khan H, Nixon E, Teubner A, Abraham A, Carlson G, Lal S. SUN-PO306: Causes and Outcomes of Intestinal Failure in Crohn’s Disease: An 18-Year Experience from a National Centre. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32936-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vengaloor Thomas T, Perekattu Kuruvilla T, Bhanat E, Albert A, Abraham A, Parr A, Vijayakumar S. Gender Disparities In Radiation Oncology Residency Programs In The United States- Current Status. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bond A, Teubner A, Taylor M, Cawley C, Varden J, Abraham A, Chadwick P, Soop M, Carlson G, Lal S. Catheter-related infections in patients with acute type II intestinal failure admitted to a national centre: Incidence and outcomes. Clin Nutr 2019; 38:1828-1832. [DOI: 10.1016/j.clnu.2018.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/18/2018] [Indexed: 01/09/2023]
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Willenbrock F, Cox C, Wilhelm-benartzic C, Owens R, Sabbagh A, Abraham A, Maughan T, Hurt C, O’Neill E, Mukherjee S. CCL5 is associated with poor prognosis in locally advanced pancreatic cancer (LAPC): biomarker analysis from the randomised phase II SCALOP trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stewart K, Eska J, Chisholm G, Abraham A, Fleming N, Frumovitz M, Meyer L, Westin S, Aloia T, Soliman P. Implementation of a sentinel lymph node mapping algorithm for endometrial cancer: Surgical outcomes and hospital charges. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bond A, Teubner A, Taylor M, Willbraham L, Gillespie L, Farrer K, McMahon M, Leahy G, Abraham A, Soop M, Clamp AR, Hasan J, Mitchell C, Jayson GC, Lal S. A novel discharge pathway for patients with advanced cancer requiring home parenteral nutrition. J Hum Nutr Diet 2019; 32:492-500. [PMID: 31006921 DOI: 10.1111/jhn.12650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The use of home parenteral nutrition (HPN) for palliative indications is increasing internationally and is the leading indication in some countries. Discharge on HPN can be complex in metabolically unstable patients and requires intestinal failure expertise. METHODS Between 2012 and 2018, we performed a retrospective analysis aiming to assess the impact of a novel remote discharge pathway for palliative HPN patients. This was evaluated using a quality improvement approach. RESULTS One hundred and twenty-five patients with active malignancy [mean (range) age 58 (25-80) years] were referred to the intestinal failure unit (IFU) for remote discharge. Of 82 patients were discharged from the oncology Centre on HPN using the pathway. The remaining 43 patients either declined HPN or the Oncology team felt that the patient became too unwell for HPN or died prior to discharge. There was an increase in patients referred for remote discharge from 13 in 2012 to 43 in 2017. The mean number of days between receipt of referral by the IFU to discharge on HPN from the oncology centre reduced from 29.4 days to 10.1 days. Following remote discharge, the mean number of days on HPN was 215.9 days. Catheter-related blood stream infection rates in this cohort were very low at 0.169 per 1000 catheter days. CONCLUSIONS This is the first study to demonstrate the remote safe, effective and rapid discharge of patients requiring palliative HPN between two hospital sites. This allows patients with a short prognosis more time in their desired location.
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Ferrini M, Abraham A, Nguyen S, Flores M, Luna R, Artaza J, Rajfer J. 076 Exogenous Administration of L-arginine Does Not Stimulate the Endogenous NO-cGMP Pathway in Rat Penile Corpora Smooth Muscle Cells. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bond A, Purssell H, Taylor M, Teubner A, Abraham A, Soop M, Carlson G, Lal S. Home parenteral nutrition in the elderly: experience from a national intestinal failure centre. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2018.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bond A, Teubner A, Taylor M, Willbraham L, Gillespie L, Farrer K, Leahy G, Abraham A, Clamp A, Jayson G, Lal S. A novel discharge pathway for patients requiring palliative home parenteral nutrition. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2018.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bond A, Teubner A, Taylor M, Cawley C, Abraham A, Dibb M, Chadwick P, Soop M, Carlson G, Lal S. Assessing the impact of quality improvement measures on catheter related blood stream infections and catheter salvage: Experience from a national intestinal failure unit. Clin Nutr 2018; 37:2097-2101. [DOI: 10.1016/j.clnu.2017.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/21/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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Vasant DH, Kalaiselvan R, Ablett J, Bond A, Abraham A, Teubner A, Green D, Paine PA, Lal S. The chronic intestinal pseudo-obstruction subtype has prognostic significance in patients with severe gastrointestinal dysmotility related intestinal failure. Clin Nutr 2018; 37:1967-1975. [DOI: 10.1016/j.clnu.2018.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/16/2022]
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Whitehead MT, Smitthimedhin A, Webb J, Mahdi ES, Khademian ZP, Carpenter JL, Abraham A. Cerebral Blood Flow and Marrow Diffusion Alterations in Children with Sickle Cell Anemia after Bone Marrow Transplantation and Transfusion. AJNR Am J Neuroradiol 2018; 39:2132-2139. [PMID: 30309846 DOI: 10.3174/ajnr.a5830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 08/15/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Hematopoietic marrow hyperplasia and hyperperfusion are compensatory mechanisms in sickle cell anemia. We have observed marrow diffusion and arterial spin-labeling perfusion changes in sickle cell anemia following bone marrow transplantation. We aimed to compare arterial spin-labeling perfusion and marrow diffusion/ADC values in patients with sickle cell anemia before and after bone marrow transplantation or transfusion. MATERIALS AND METHODS We reviewed brain MRIs from patients with sickle cell anemia obtained during 6 consecutive years at a children's hospital. Quantitative marrow diffusion values were procured from the occipital and sphenoid bones. Pseudocontinuous arterial spin-labeling perfusion values (milliliters/100 g of tissue/min) of MCA, anterior cerebral artery, and posterior cerebral artery territories were determined. Territorial CBF, whole-brain average CBF, and marrow ADC values were compared for changes before and after either bone marrow transplantation or transfusion. Bone marrow transplantation and transfusion groups were compared. Two-tailed paired and unpaired Student t tests were used; P < .05 was considered significant. RESULTS Fifty-three examinations from 17 patients with bone marrow transplantation and 29 examinations from 9 patients with transfusion were included. ADC values significantly increased in the sphenoid and occipital marrow following bone marrow transplantation in contrast to patients with transfusion (P > .83). Whole-brain mean CBF significantly decreased following bone marrow transplantation (77.39 ± 13.78 to 60.39 ± 13.62 ml/100 g tissue/min; P < .001), without significant change thereafter. CBF did not significantly change following the first (81.11 ± 12.23 to 80.25 ± 8.27 ml/100 g tissue/min; P = .47) or subsequent transfusions. There was no significant difference in mean CBF between groups before intervention (P = .22). CONCLUSIONS Improved CBF and marrow diffusion eventuate following bone marrow transplantation in children with sickle cell anemia in contrast to transfusion therapy.
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Bond A, Hayes S, Abraham A, Teubner A, Farrer K, Pironi L, Lal S. Reversal of intestinal failure associated liver disease fibrosis in a patient receiving long term home parenteral nutrition. Clin Nutr ESPEN 2018; 28:228-231. [PMID: 30390886 DOI: 10.1016/j.clnesp.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/19/2018] [Accepted: 09/11/2018] [Indexed: 12/24/2022]
Abstract
Intestinal failure associated liver disease (IFALD) is frequent problem encountered when managing patients receiving parenteral nutrition (PN). Its occurrence is often multifactorial and modification of these factors is vital for the management of such hepatic dysfunction. The use of novel lipid preparations can form part of this management strategy. We present a case whereby such modification of contributing factors, including lipid preparations, led to improvements in IFALD and reversal of hepatic fibrosis.
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Bond A, Taylor M, Abraham A, Ablett J, Teubner A, Slater C, Leahy G, Lal S. Successful implementation of remote video consultations for patients receiving home parenteral nutrition. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bond A, Teubner A, Taylor M, Gillespie L, Farrer K, Abraham A, Wilbraham L, Clamp A, Jayson G, Lal S. A remote discharge pathway for patients requiring palliative home parenteral nutrition. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bond A, Teubner A, Taylor M, Cawley C, Varden J, Abraham A, Chadwick P, Soop M, Carlson G, Lal S. Catheter related infections in patients with acute type ii intestinal failure admitted to a national centre: Incidence and outcomes. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sawbridge D, Bond A, Taylor M, Abraham A, Teubner A, Abidin N, Chadwick P, Lal S. Infective endocarditis as a complication of central venous catheters used for home parenteral nutrition: Experience from a national intestinal failure centre. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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