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Wittich W, Pichora-Fuller MK, Johnson A, Joubert S, Kehayia E, Bachir V, Aubin G, Jaiswal A, Phillips N. Effect of Reading Rehabilitation for Age-Related Macular Degeneration on Cognitive Functioning: Protocol for a Nonrandomized Pre-Post Intervention Study. JMIR Res Protoc 2021; 10:e19931. [PMID: 33704074 PMCID: PMC7995070 DOI: 10.2196/19931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/24/2020] [Accepted: 02/24/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Age-related vision impairments and dementia both become more prevalent with increasing age. Research into the mechanisms of these conditions has proposed that some of their causes (eg, macular degeneration/glaucoma and Alzheimer's disease) could be symptoms of an underlying common cause. Research into sensory-cognitive aging has provided data that sensory decline may be linked to the progression of dementia through reduced sensory stimulation. While hearing loss rehabilitation may have a beneficial effect on cognitive functioning, there are no data available on whether low vision rehabilitation, specifically for reading, could have a beneficial effect on cognitive health. OBJECTIVE The research questions are: (1) Does low vision rehabilitation reduce reading effort? (2) If so, does reduced reading effort increase reading activity, and (3) If so, does increased reading activity improve cognitive functioning? The primary objective is to evaluate cognition before, as well as at 6 months and 12 months after, 3 weeks of low vision reading rehabilitation using magnification in individuals with age-related macular degeneration, with or without coexisting hearing impairments. We hypothesize that improvements postrehab will be observed at 6 months and maintained at 12 months for participants with vision loss and less so for those with dual sensory loss. The secondary objective is to correlate participant characteristics with all cognitive outcomes to identify which may play an important role in reading rehabilitation. METHODS We employ a quasiexperimental approach (nonrandomized, pre-post intervention study). A 3x3 design (3 groups x 3 time points) allows us to examine whether cognitive performance will change before and after 6 months and 12 months of a low vision reading intervention, when comparing 75 low vision and 75 dual sensory impaired (vision & hearing) participants to 75 age-matched healthy controls. The study includes outcome measures of vision (eg, reading acuity and speed), cognition (eg, short-term and long-term memory, processing speed), participant descriptors, demographics, and clinical data (eg, speech perception in noise, mental health). RESULTS The study has received approval, and recruitment began on April 24, 2019. As of March 4, 2021, 38 low vision and 7 control participants have been enrolled. Lockdown forced a pause in recruitment, which will recommence once the COVID-19 crisis has reached a point where face-to-face data collection with older adults becomes feasible again. CONCLUSIONS Evidence of protective effects caused by reading rehabilitation will have a considerable impact on the vision rehabilitation community and their clients as well as all professionals involved in the care of older adults with or without dementia. If we demonstrate that reading rehabilitation has a beneficial effect on cognition, the demand for rehabilitation services will increase, potentially preventing cognitive decline across groups of older adults at risk of developing macular degeneration. TRIAL REGISTRATION ClinicalTrials.gov NCT04276610; Unique Protocol ID: CRIR-1284-1217; https://clinicaltrials.gov/ct2/show/NCT04276610. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/19931.
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Affiliation(s)
- Walter Wittich
- School of Optometry, Université de Montréal, Montreal, QC, Canada.,Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada.,Centre de réadaptation Lethbridge-Layton-Mackay du CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, Montreal, QC, Canada.,Center for Interdisciplinary Rehabilitation Research of Greater Montreal, Montreal, QC, Canada.,Department of Psychology, Concordia University, Montreal, QC, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | | | - Aaron Johnson
- Centre de réadaptation Lethbridge-Layton-Mackay du CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, Montreal, QC, Canada.,Center for Interdisciplinary Rehabilitation Research of Greater Montreal, Montreal, QC, Canada.,Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Sven Joubert
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Eva Kehayia
- Center for Interdisciplinary Rehabilitation Research of Greater Montreal, Montreal, QC, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Vanessa Bachir
- School of Optometry, Université de Montréal, Montreal, QC, Canada.,Center for Interdisciplinary Rehabilitation Research of Greater Montreal, Montreal, QC, Canada
| | - Gabrielle Aubin
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada.,Centre de réadaptation Lethbridge-Layton-Mackay du CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, Montreal, QC, Canada.,Center for Interdisciplinary Rehabilitation Research of Greater Montreal, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Atul Jaiswal
- School of Optometry, Université de Montréal, Montreal, QC, Canada.,Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada.,Center for Interdisciplinary Rehabilitation Research of Greater Montreal, Montreal, QC, Canada
| | - Natalie Phillips
- Department of Psychology, Concordia University, Montreal, QC, Canada
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Zuo X, Zhuang J, Chen NK, Cousins S, Cunha P, Lad EM, Madden DJ, Potter G, Whitson HE. Relationship between neural functional connectivity and memory performance in age-related macular degeneration. Neurobiol Aging 2020; 95:176-185. [PMID: 32829250 DOI: 10.1016/j.neurobiolaging.2020.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
Age-related macular degeneration (AMD) has been linked to memory deficits, with no established neural mechanisms. We collected resting-state brain functional magnetic resonance imaging and standardized verbal recall tests from 42 older adults with AMD and 41 age-matched controls. We used seed-based whole brain analysis to quantify the strength of functional connectivity between hubs of the default mode network and a network of medial temporal regions relevant for memory. Our results indicated neither memory performance nor network connectivity differed by AMD status. However, the AMD participants exhibited stronger relationships than the controls between memory performance and connectivity from the memory network hub (left parahippocampal) to 2 other regions: the left temporal pole and the right superior/middle frontal gyri. Also, the connectivity between the medial prefrontal cortex and posterior cingulate cortex of default mode network correlated more strongly with memory performance in AMD compared to control. We concluded that stronger brain-behavior correlation in AMD may suggest a role for region-specific connectivity in supporting memory in the context of AMD.
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Affiliation(s)
- Xintong Zuo
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA; Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Jie Zhuang
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - Nan-Kuei Chen
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
| | - Scott Cousins
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Priscila Cunha
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - David J Madden
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Guy Potter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Heather E Whitson
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA; Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA; Department of Medicine (Geriatrics), Duke University Medical Center, Durham, NC, USA; Geriatrics Research Education & Clinical Center, Durham VA Medical Center, Durham, NC, USA.
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Cognitive Impairment among Veterans in Outpatient Vision Rehabilitation. Optom Vis Sci 2020; 97:462-469. [PMID: 32511169 DOI: 10.1097/opx.0000000000001522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Outpatient vision rehabilitation improves function in veterans with vision impairment, but the prevalence of cognitive impairment and the degree to which it may affect rehabilitation outcomes in the Veterans Affairs system are unknown. PURPOSE The purpose of this study was to determine the prevalence of cognitive impairment among veterans receiving outpatient vision rehabilitation in the Veterans Affairs system and compare the benefits of rehabilitation in veterans with and without cognitive impairment. METHODS We conducted cognitive assessments and a nested longitudinal cohort study in veterans with eye disorders at two outpatient rehabilitation sites. Cognition was assessed with the Modified Telephone Interview for Cognitive Status administered in person. Eligible veterans and their companions in the longitudinal study responded to questions about the veteran's function at baseline and 90 days later. Visual function was measured with the 48-item Low Vision Visual Function Questionnaire (LV-VFQ-48) and items from the Activity Inventory. RESULTS Of 291 veterans assessed (mean ± standard deviation age, 78.2 ± 12 years), 136 (46.7%) were cognitively intact (Modified Telephone Interview for Cognitive Status scores, ≥33), whereas 58 (19.9%) had borderline scores of 30 to 32, 82 (28.2%) had scores suggesting mild/moderate cognitive impairment (scores of 20 to 29), and 15 (5.2%) had scores suggesting severe cognitive impairment (score of <20). After 90 days, mean LV-VFQ-48 reading scores tended to improve in veterans with (n = 21) and without (n = 28) cognitive impairment. The magnitude of self-reported improvement in LV-VFQ-48 scores was greater among cognitively intact, compared with cognitively impaired, veterans (effect size, 0.56 for reading; 0.71 for visual motor). Veterans and companions reported similar 90-day reduction in difficulty with the veterans' top 3 Activity Inventory goals, regardless of cognitive status. CONCLUSIONS Approximately one in three veterans referred to outpatient vision rehabilitation has detectable cognitive impairment, yet many still experience functional improvements. Future research should determine best practices to accommodate challenges associated with cognitive impairment in vision rehabilitation and to track clinically meaningful outcomes.
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Leon M, Woo C. Environmental Enrichment and Successful Aging. Front Behav Neurosci 2018; 12:155. [PMID: 30083097 PMCID: PMC6065351 DOI: 10.3389/fnbeh.2018.00155] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/04/2018] [Indexed: 12/18/2022] Open
Abstract
The human brain sustains a slow but progressive decline in function as it ages and these changes are particularly profound in cognitive processing. A potential contributor to this deterioration is the gradual decline in the functioning of multiple sensory systems and the effects they have on areas of the brain that mediate cognitive function. In older adults, diminished capacity is typically observed in the visual, auditory, masticatory, olfactory, and motor systems, and these age-related declines are associated with both a decline in cognitive proficiency, and a loss of neurons in regions of the brain. We will review how the loss of hearing, vision, mastication skills, olfactory impairment, and motoric decline accompany cognitive loss, and how improved functioning of these systems may aid in the restoration of the cognitive abilities in older adults. The human brain appears to require a great deal of stimulation to maintain its cognitive efficacy as people age and environmental enrichment may aid in its maintenance and recovery.
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Affiliation(s)
- Michael Leon
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
| | - Cynthia Woo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
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Gervais MÈ, Couture M, Le Blanc S, Blanchet S, Gagné MÈ, Ouellet MC. Evaluation of Cognitive Functioning in the Context of Rehabilitation for Visual Impairment in Older Adults: A Case Series. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2017. [DOI: 10.1080/02703181.2017.1339758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marie-Ève Gervais
- Institut de réadaptation en déficience physique de Québec, Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, Canada
| | - Mélanie Couture
- Institut de réadaptation en déficience physique de Québec, Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, Canada
| | - Stéphanie Le Blanc
- Institut de réadaptation en déficience physique de Québec, Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, Canada
| | - Sophie Blanchet
- Institut de réadaptation en déficience physique de Québec, Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, Canada
- Université René Descartes - Paris 5, Paris, France
| | - Marie-Ève Gagné
- Institut de réadaptation en déficience physique de Québec, Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, Canada
- School of Psychology, Université Laval, Québec, Canada
| | - Marie-Christine Ouellet
- Institut de réadaptation en déficience physique de Québec, Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, Canada
- School of Psychology, Université Laval, Québec, Canada
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Barstow BA, Warren M, Thaker S, Hallman A, Batts P. Client and therapist perspectives on the influence of low vision and chronic conditions on performance and occupational therapy intervention. Am J Occup Ther 2015; 69:6903270010. [PMID: 25871599 DOI: 10.5014/ajot.2015.014605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We explored how vision loss and comorbid chronic conditions influence occupational therapy intervention by gathering perspectives from occupational therapists treating clients with low vision and from older adults with low vision. METHOD We surveyed 59 occupational therapists on the frequency of comorbidities in their clients and their influence on low vision intervention. Eight older adults with low vision participated in in-depth interviews and observations on the influence of low vision and comorbidities on their occupational performance. Conclusions reflect data analysis from both methods. RESULTS The occupational therapists modified low vision interventions to address the added effect of each comorbidity. Modifications included more treatment sessions, home visits, referrals to other professions, and provision of strategies to address comorbidities. The older adults viewed vision loss as a stronger influence than comorbidities on independence in daily occupations. CONCLUSION Both vision loss and comorbidities influence occupational performance, supporting the need for interventions to address both conditions.
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Affiliation(s)
- Beth A Barstow
- Beth A. Barstow, PhD, OTR/L, SCLV, FAOTA, is Associate Professor, Department of Occupational Therapy, University of Alabama at Birmingham;
| | - Mary Warren
- Mary Warren, PhD, OTR/L, SCLV, FAOTA, is Associate Professor, Department of Occupational Therapy, University of Alabama at Birmingham
| | - Swetal Thaker
- Swetal Thaker, MS, OTR/L, is Student, Department of Occupational Therapy, University of Alabama at Birmingham
| | - Allison Hallman
- Allison Hallman, MS, OTR/L, is Student, Department of Occupational Therapy, University of Alabama at Birmingham
| | - Penelope Batts
- Penelope Batts, MS, OTR/L, is Student, Department of Occupational Therapy, University of Alabama at Birmingham
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Rovner BW, Casten RJ, Hegel MT, Massof RW, Leiby BE, Ho AC, Tasman WS. Personality and Functional Vision in Older Adults with Age-Related Macular Degeneration. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2014. [DOI: 10.1177/0145482x1410800303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The purpose of the study was to determine whether personality traits influence self-reported functional vision in patients with age-related macular degeneration (AMD). Methods This is a prospective cross-sectional analysis of baseline data from the Low Vision Depression Prevention Trial. Participants ( N = 182) over age 65 with bilateral AMD, visual acuity worse than 20/70 in the better-seeing eye, and subthreshold depression were recruited from the Wills Eye Hospital retina practice. Assessments included visual acuity, contrast sensitivity, National Eye Institute Visual Function Questionnaire–25 plus Supplement (NEI VFQ–25) near and distance subscales, depression, and personality testing. Structural equation models were used to investigate the relationship of the NEI VFQ near activities and distance activities with the various demographic, clinical, and psychological predictors. Results In the single-predictor model for near functional vision, visual acuity at logMAR ≤ 1 (estimate = −0.33 [95% confidence interval {CI} −0.46, −0.20]; p ≤ 0.001), neuroticism (estimate = −0.05 [95% CI −0.08, −0.01]; p = 0.01), and education (estimate = −0.08 [95% CI 0.01, 0.15]; p = 0.03) were statistically significant predictors. In the single-predictor model for distance functional vision, only visual acuity at logMAR ≤ 1 (estimate = −0.49 [95% CI −0.69, −0.29]; p ≤ 0.001) and neuroticism (estimate = −0.09 [95% CI −0.15, 0.02]; p = 0.008) were statistically significant predictors. Discussion: Self-reported functional vision depends on the severity of vision loss as well as the personality trait of neuroticism. Implications for practitioners Assessment of personality traits, particularly neuroticism, may increase the precision of rating scales of functional vision and suggest new rehabilitative interventions to improve the functional vision and quality of life of patients with AMD.
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Affiliation(s)
- Barry W. Rovner
- Departments of Psychiatry and Neurology, Jefferson Medical College, Jefferson Hospital for Neuroscience, 900 Walnut Street, Philadelphia, PA 19107
| | - Robin J. Casten
- Associate professor, Department of Psychiatry and Human Behavior, Jefferson Medical College, Jefferson Hospital for Neuroscience
| | - Mark T. Hegel
- Professor, Departments of Psychiatry and Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH03756
| | - Robert W. Massof
- Professor, Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Sixth Floor, 550 North Broadway, Baltimore, MD 21205
| | - Benjamin E. Leiby
- Assistant professor, Department of Pharmacology and Experimental Therapeutics, Jefferson Medical College, 1015 Chestnut Street, Suite M100, Philadelphia, PA 19107
| | - Allen C. Ho
- Associate professor, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107, and Department of Ophthalmology, Jefferson Medical College
| | - William S. Tasman
- Professor, Wills Eye Hospital, Philadelphia, PA, and Department of Ophthalmology, Jefferson Medical College
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Whitson HE, Whitaker D, Potter G, McConnell E, Tripp F, Sanders LL, Muir KW, Cohen HJ, Cousins SW. A low-vision rehabilitation program for patients with mild cognitive deficits. JAMA Ophthalmol 2013; 131:912-9. [PMID: 23619914 DOI: 10.1001/jamaophthalmol.2013.1700] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE We are unaware of any standardized protocols within low-vision rehabilitation (LVR) to address cognitive impairment. OBJECTIVE To design and pilot-test an LVR program for patients with macular disease and cognitive deficits. DESIGN The Memory or Reasoning Enhanced Low Vision Rehabilitation (MORE-LVR) program was created by a team representing optometry, occupational therapy, ophthalmology, neuropsychology, and geriatrics. This pilot study compares outcomes before and after participation in the MORE-LVR program. SETTING Eligible patients were recruited from an LVR clinic from October 1, 2010, through March 31, 2011. PARTICIPANTS Twelve patients completed the intervention, and 11 companions attended at least 1 training session. INTERVENTION Key components of the MORE-LVR intervention are as follows: (1) repetitive training with a therapist twice weekly during a 6-week period, (2) simplified training experience addressing no more than 3 individualized goals in a minimally distracting environment, and (3) involvement of an informal companion (friend or family member). MAIN OUTCOME MEASURES Version 2000 National Eye Institute Vision Function Questionnaire-25; timed performance measures, Telephone Interview for Cognitive Status-modified(TICS-m), Logical Memory tests, satisfaction with activities of daily living, and goal attainment scales. RESULTS Twelve patients without dementia (mean age, 84.5 years; 75% female) who screened positive for cognitive deficits completed the MORE-LVR program. Participants demonstrated improved mean (SD) scores on the National Eye Institute's Visual Function Questionnaire-25 composite score (47.2 [16.3] to 54.8 [13.8], P = .01) and near-activities score (21.5 [14.0] to 41.0 [23.1], P = .02), timed performance measures (writing a grocery list [P = .03], filling in a crossword puzzle answer [P = .003]), a score indicating satisfaction with independence (P = .05), and logical memory (P = .02). All patients and companions reported progress toward at least 1 individualized goal; more than 70% reported progress toward all 3 goals. CONCLUSIONS AND RELEVANCE This pilot study demonstrates feasibility of an LVR program for patients with macular disease and mild cognitive deficits. Participants demonstrated improvements in vision-related function and cognitive measures and expressed high satisfaction. Future work is needed to determine whether MORE-LVR is superior to usual outpatient LVR for persons with coexisting visual and cognitive impairments.
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Affiliation(s)
- Heather E Whitson
- Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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