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Doheny BM, Inglis JJ, Boll KA, Lunos S, Surapaneni VL. Short animated video increases knowledge and perceived comfort in clinical counseling on inequitable health impacts of air pollution among interprofessional health learners and clinicians. BMC MEDICAL EDUCATION 2023; 23:858. [PMID: 37953249 PMCID: PMC10642052 DOI: 10.1186/s12909-023-04785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Air pollution is a major health risk contributing to global morbidity and mortality, yet clinicians do not routinely engage in counseling patients on this topic. Clinicians cite their lack of education as a common barrier. We developed a two-minute animated video on mitigating air pollution health risks and evaluated the efficacy of this video as an educational tool. METHODS In March-June 2021, a convenience sample of Minnesota interprofessional health learners and clinicians viewed the video and completed an electronic survey that assessed pre-/post-video intervention changes in (a) didactic and clinically applied knowledge on health impacts of air pollution, (b) perceived comfort in identifying at-risk patients and counseling them on relevant preventive health behaviors, (c) intentions/barriers to counseling patients, (d) beliefs and attitudes related to the health harms of air pollution, and (e) perceptions of the overall acceptability of the intervention. RESULTS The 218 participants included learners and clinicians in medicine, nursing, and advanced practice provision. Respondents' knowledge scores and self-reported level of comfort in identifying high-risk patients and counseling them on preventative health behaviors increased significantly pre-/post-intervention. The video also effectively altered participants' misperceptions about the health impacts of air pollution. While less than half of participants (43.6%) reported they intended to engage in counseling patients as a result of watching the video, 52.3% indicated they might do so. Lack of time during clinical encounters and lack of training were reported as persistent barriers to engaging in this counseling. Overall, participants found the video to be an effective educational tool, indicating that they wanted their colleagues and patients to watch the video and would like to see further short, animated videos on other environmental health topics. CONCLUSIONS A two-minute animated educational video significantly improved knowledge of inequitable health impacts of air pollution and improved perceived comfort in identifying and counseling at-risk patients among health professional learners and clinicians regardless of profession, level of training, or pre-intervention knowledge level. Academic health professional training programs and health systems should consider adopting this modality as a tool for educating learners, clinicians, and patients on environmental health risks.
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Affiliation(s)
- Brenna M Doheny
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth campus, 1035 University Drive, Duluth, MN, 55812-3031, USA.
| | - Jack J Inglis
- Hennepin Healthcare, 701 Park Avenue, MN, Minneapolis, 55415, USA
| | - Karly A Boll
- Hennepin Healthcare, 701 Park Avenue, MN, Minneapolis, 55415, USA
| | - Scott Lunos
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
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Moore CM, Thornburg J, Secor EA, Hamlington KL, Schiltz AM, Freeman KL, Everman JL, Fingerlin TE, Liu AH, Seibold MA. Breathing zone pollutant levels are associated with asthma exacerbations in high-risk children. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.22.23295971. [PMID: 37790375 PMCID: PMC10543064 DOI: 10.1101/2023.09.22.23295971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Indoor and outdoor air pollution levels are associated with poor asthma outcomes in children. However, few studies have evaluated whether breathing zone pollutant levels associate with asthma outcomes. Objective Determine breathing zone exposure levels of NO 2 , O 3 , total PM 10 and PM 10 constituents among children with exacerbation-prone asthma, and examine correspondence with in-home and community measurements and associations with outcomes. Methods We assessed children's personal breathing zone exposures using wearable monitors. Personal exposures were compared to in-home and community measurements and tested for association with lung function, asthma control, and asthma exacerbations. Results 81 children completed 219 monitoring sessions. Correlations between personal and community levels of PM 10 , NO 2 , and O 3 were poor, whereas personal PM 10 and NO 2 levels correlated with in-home measurements. However, in-home monitoring underdetected brown carbon (Personal:79%, Home:36.8%) and ETS (Personal:83.7%, Home:4.1%) personal exposures, and detected black carbon in participants without these personal exposures (Personal: 26.5%, Home: 96%). Personal exposures were not associated with lung function or asthma control. Children experiencing an asthma exacerbation within 60 days of personal exposure monitoring had 1.98, 2.21 and 2.04 times higher brown carbon (p<0.001), ETS (p=0.007), and endotoxin (p=0.012), respectively. These outcomes were not associated with community or in-home exposure levels. Conclusions Monitoring pollutant levels in the breathing zone is essential to understand how exposures influence asthma outcomes, as agreement between personal and in-home monitors is limited. Inhaled exposure to PM 10 constituents modifies asthma exacerbation risk, suggesting efforts to limit these exposures among high-risk children may decrease their asthma burden. CLINICAL IMPLICATIONS In-home and community monitoring of environmental pollutants may underestimate personal exposures. Levels of inhaled exposure to PM 10 constituents appear to strongly influence asthma exacerbation risk. Therefore, efforts should be made to mitigate these exposures. CAPSULE SUMMARY Leveraging wearable, breathing-zone monitors, we show exposures to inhaled pollutants are poorly proxied by in-home and community monitors, among children with exacerbation-prone asthma. Inhaled exposure to multiple PM 10 constituents is associated with asthma exacerbation risk.
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Gallo E, Bressan S, Baraldo S, Bottigliengo D, Geremia S, Acar AS, Zagolin L, Marson G, Da Dalt L, Gregori D. Increased risk of emergency department presentations for bronchiolitis in infants exposed to air pollution. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:1137-1144. [PMID: 35989078 DOI: 10.1111/risa.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Air pollution has been linked to an increased risk of several respiratory diseases in children, especially respiratory tract infections. The present study aims to evaluate the association between pediatric emergency department (PED) presentations for bronchiolitis and air pollution. PED presentations due to bronchiolitis in children aged less than 1 year were retrospectively collected from 2007 to 2018 in Padova, Italy, together with daily environmental data. A conditional logistic regression based on a time-stratified case-crossover design was performed to evaluate the association between PED presentations and exposure to NO2 , PM2.5, and PM10. Models were adjusted for temperature, relative humidity, atmospheric pressure, and public holidays. Delayed effects in time were evaluated using distributed lag non-linear models. Odds ratio for lagged exposure from 0 to 14 days were obtained. Overall, 2251 children presented to the PED for bronchiolitis. Infants' exposure to higher concentrations of PM10 and PM2.5 in the 5 days before the presentation to the PED increased the risk of accessing the PED by more than 10%, whereas high concentrations of NO2 between 2 and 12 days before the PED presentation were associated with an increased risk of up to 30%. The association between pollutants and infants who required hospitalization was even greater. A cumulative effect of NO2 among the 2 weeks preceding the presentation was also observed. In summary, PM and NO2 concentrations are associated with PED presentations and hospitalizations for bronchiolitis. Exposure of infants to air pollution could damage the respiratory tract mucosa, facilitating viral infections and exacerbating symptoms.
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Affiliation(s)
- Elisa Gallo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Silvia Bressan
- Department of Women's and Children's Health, University of Padova, Padova, Italy
- Division of Pediatric Emergency Medicine, University Hospital of Padova, Padova, Italy
| | - Simonetta Baraldo
- Respiratory Diseases Clinic, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Daniele Bottigliengo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sara Geremia
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- University of Bologna, Bologna, Italy
| | | | - Luca Zagolin
- Environmental Protection and Prevention Agency of the Veneto Region, Venezia, Italy
| | - Giovanna Marson
- Environmental Protection and Prevention Agency of the Veneto Region, Venezia, Italy
| | - Liviana Da Dalt
- Department of Women's and Children's Health, University of Padova, Padova, Italy
- Division of Pediatric Emergency Medicine, University Hospital of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Li M, Tang J, Yang H, Zhao L, Liu Y, Xu H, Fan Y, Hong J, Long Z, Li X, Zhang J, Guo W, Liu M, Yang L, Lai X, Zhang X. Short-term exposure to ambient particulate matter and outpatient visits for respiratory diseases among children: A time-series study in five Chinese cities. CHEMOSPHERE 2021; 263:128214. [PMID: 33297172 DOI: 10.1016/j.chemosphere.2020.128214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/25/2020] [Accepted: 08/29/2020] [Indexed: 06/12/2023]
Abstract
There was limited evidence regarding the association between short-term exposure to ambient particulate matter (PM) and respiratory outpatient visits among children at a multicity level. In this study, a time-series study was conducted among children aged 0-14 years in five Chinese cities from 2013 to 2018. City-specific effects of fine particles (PM2.5), inhalable particles (PM10) and coarse particles (PM10-2.5) were estimated for time lags of zero up to seven previous days using the overdispersed generalized additive models after adjusting for time trends, meteorological variables, day of the week and holidays. Meta-analyses were applied to pool the overall effects, while the exposure-response (E-R) curves were evaluated using a cubic regression spline. The overall effects of PM were significantly associated with total and cause-specific respiratory outpatients among children, even at PM2.5 and PM10 levels below the current Chinese Ambient Air Quality Standards (CAAQS) Grade II. Each 10 μg/m3 increment in PM2.5, PM10 and PM10-2.5 at lag 07 was associated with a 1.39% (95% CI: 0.38%, 2.40%), 1.10% (95% CI: 0.38%, 1.83%) and 2.93% (95% CI: 1.05%, 4.84%) increase in total respiratory outpatients, respectively. An E-R relationship was observed except for PM2.5 in Beijing and PM10 and PM10-2.5 in Shanghai. The effects of PM were stronger in cold season in 3 southern cities, while it was stronger in transition season in 2 northern cities. In conclusion, short-term PM exposures were dose-responsive associated with increased respiratory outpatient visits among children, even for PM2.5 and PM10 levels below current CAAQS II in certain cities.
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Affiliation(s)
- Meng Li
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Huihua Yang
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Lei Zhao
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Ya Liu
- Department of Medical Record, Beijing Hospital, Beijing, China
| | - Haoli Xu
- Department of Healthcare, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yali Fan
- Qinghai Provincial Women and Children's Hospital, Xining, China
| | - Jun Hong
- Qinghai Provincial Women and Children's Hospital, Xining, China
| | - Zhen Long
- Department of Pediatric respiratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, HUST, Wuhan, China
| | - Xiaojuan Li
- Department of Medical Record and Statistics, Emergency General Hospital, Beijing, China
| | - Jianduan Zhang
- Department of Woman and Child's Care and Adolescence Health, School of Public Health, Tongji Medical College, HUST, Wuhan, China
| | - Wenting Guo
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Miao Liu
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Liangle Yang
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Xuefeng Lai
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Xiaomin Zhang
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.
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Gutiérrez-Torres JD. Temporal lagged relationship between a vegetation index and cutaneous leishmaniasis cases in Colombia: an analysis implementing a distributed lag nonlinear model. Parasitol Res 2020; 119:1075-1082. [PMID: 31901109 DOI: 10.1007/s00436-019-06592-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/22/2019] [Indexed: 11/25/2022]
Abstract
Cutaneous leishmaniasis is a neglected tropical disease with a strong environmental component. The aim of this research was to implement a distributed lag nonlinear model to explore the temporal lagged relationship between a vegetation index and cutaneous leishmaniasis cases. In this ecological study, a time series of weekly cases of cutaneous leishmaniasis reported between 2007 and 2016 in the five municipalities in Colombia with the most cases of the disease and a vegetation index was analyzed. During the study period, a total of 16,321 cases were reported in these five municipalities. Two municipalities showed a lagged nonlinear positive association between the risk of occurrence of new cases and the magnitude of the vegetation index; two municipalities showed a negative association; and in the remaining municipality, the risk was associated with the vegetation index but its confidence interval was not significant. Our results show different patterns and magnitudes of the lagged relationship between the vegetation index and cutaneous leishmaniasis cases and suggest the possibility of using the lag pattern of the vegetation index in the development of an early warning system where a lagged positive relationship is identified.
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Affiliation(s)
- Juan David Gutiérrez-Torres
- Facultad de Ingeniería, Grupo Ambiental de Investigación Aplicada-GAIA, Universidad de Santander, Bucaramanga, Colombia.
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Assessing the impact of air pollution on childhood asthma morbidity: how, when, and what to do. Curr Opin Allergy Clin Immunol 2019; 18:124-131. [PMID: 29493555 DOI: 10.1097/aci.0000000000000422] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Exposure to air pollutants is linked with poor asthma control in children and represents a potentially modifiable risk factor for impaired lung function, rescue medication use, and increased asthma-related healthcare utilization. Identification of the most relevant pollutants to asthma as well as susceptibility factors and strategies to reduce exposure are needed to improve child health. RECENT FINDINGS The current available literature supports the association between pollutants and negative asthma outcomes. Ethnicity, socioeconomic status, and presence of certain gene polymorphisms may impact susceptibility to the negative health effects of air pollution. Improved air quality standards were associated with better asthma outcomes. SUMMARY The link between air pollution and pediatric asthma morbidity is supported by the recent relevant literature. Continued efforts are needed to identify the most vulnerable populations and develop strategies to reduce exposures and improve air quality.
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Zhu L, Ge X, Chen Y, Zeng X, Pan W, Zhang X, Ben S, Yuan Q, Xin J, Shao W, Ge Y, Wu D, Han Z, Zhang Z, Chu H, Wang M. Short-term effects of ambient air pollution and childhood lower respiratory diseases. Sci Rep 2017; 7:4414. [PMID: 28667279 PMCID: PMC5493680 DOI: 10.1038/s41598-017-04310-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/12/2017] [Indexed: 12/18/2022] Open
Abstract
The association between air pollution and childhood respiratory disease is inconsistent. In the present study, we investigated a short-term effect of ambient air pollutants and daily childhood lower respiratory diseases (CLRD). Daily air pollutants, weather data, and CLRD data were collected from January 2014 to April 2015 (452 days) in Nanjing, China. Time-series regression and generalized additive models were used to assess the effects of air pollutants (PM10, PM2.5, NO2, SO2, O3, and CO) on CLRD. We observed that an interquartile range (IQR) increase in concentrations of PM10, NO2, and SO2 significantly increased the daily CLRD with 6 days cumulative effects (difference of estimates: 2.8%, 95% CI: 0.6–5.0%; 4.1%, 1.2–7.0%; 5.6%, 2.6–8.6%, respectively). However, no significant association was found in IQR concentrations of PM2.5, O3, and CO. Specifically, elevated PM10, PM2.5, NO2, and SO2 significantly increased the numbers of CLRD in cool season (3.6%, 1.5–5.7%; 2.4%, 0.3–4.5%; 4.9%, 2.9–7.0%; 6.3%, 3.7–9.0%, respectively). Additionally, the effect estimates of PM10, NO2, and SO2 in female and age >27 months were more pronounced than in male and age ≤27 months. This study suggested that short-term exposure to ambient PM10, NO2, and SO2 were associated with the increased CLRD numbers.
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Affiliation(s)
- Liyang Zhu
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.,Department of Statistics, School of Economics, Nanjing University Of Finance & Economics, Nanjing, China
| | - Xuhua Ge
- Department of Emergency, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yaoyao Chen
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Xinying Zeng
- Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wang Pan
- Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xu Zhang
- Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shuai Ben
- School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Qi Yuan
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Junyi Xin
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Wei Shao
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Yuqiu Ge
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Dongmei Wu
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Zhong Han
- Department of Statistics, School of Economics, Nanjing University Of Finance & Economics, Nanjing, China
| | - Zhengdong Zhang
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.
| | - Haiyan Chu
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.
| | - Meilin Wang
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.
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Frieri M, Kumar K, Boutin A. Environmental effect on health: Air pollution and smoke. ENVIRONMENTAL DISEASE 2016. [DOI: 10.4103/2468-5690.198620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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