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Levy CE, Silverman E, Jia H, Geiss M, Omura D. Effects of physical therapy delivery via home video telerehabilitation on functional and health-related quality of life outcomes. ACTA ACUST UNITED AC 2016; 52:361-70. [PMID: 26230650 DOI: 10.1682/jrrd.2014.10.0239] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 02/12/2015] [Indexed: 11/05/2022]
Abstract
This study examined functional outcomes, health-related quality of life (HRQoL), and satisfaction in a group of Veterans who received physical therapy via an in-home video telerehabilitation program, the Rural Veterans TeleRehabilitation Initiative (RVTRI). A retrospective, pre-post study design was used. Measures obtained from 26 Veterans who received physical therapy in the RVTRI program between February 22, 2010, and April 1, 2011, were analyzed. Outcomes were the Functional Independence Measure (FIM); Quick Disabilities of the Arm, Shoulder, and Hand measure; Montreal Cognitive Assessment (MoCA); and the 2-minute walk test (2MWT). HRQoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12), and program satisfaction was evaluated using a telehealth satisfaction scale. Average length of participation was 99.2 +/- 43.3 d and Veterans, on average, received 15.2 +/- 6.0 therapeutic sessions. Significant improvement was shown in the participants' FIM (p < 0.001, r = 0.63), MoCA (p = 0.01, r = 0.44), 2MWT (p = 0.006, r = 0.73), and VR-12 (p = 0.02, r = 0.42). All Veterans reported satisfaction with their telerehabilitation experiences. Those enrolled in the RVTRI program avoided an average of 2,774.7 +/- 3,197.4 travel miles, 46.3 +/- 53.3 hr of driving time, and $1,151.50 +/- $1,326.90 in travel reimbursement. RVTRI provided an effective real-time, home-based, physical therapy.
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Bruce BB, Newman NJ, Pérez MA, Biousse V. Non-mydriatic ocular fundus photography and telemedicine: past, present, and future. Neuroophthalmology 2013; 37. [PMID: 24244059 DOI: 10.3109/01658107.2013.773451] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Non-mydriatic ocular fundus photography is a promising alternative to direct ophthalmoscopy, particularly when combined with telemedicine. This review discusses these technologies from a longitudinal perspective: past, present, and future. The focus is directed to the role that non-mydriatic fundus photography and telemedicine have played in medical research and patient care, with emphasis on the major advances to date. Also discussed are the challenges to their widespread application and their substantial promise for revitalizing the importance of the ocular fundus examination in patient care, providing improved access to ophthalmic consultative services, and facilitating clinical and epidemiologic research.
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Affiliation(s)
- Beau B Bruce
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA ; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA ; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA; and Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA, USA
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Hasan N, McColgan P, Bentley P, Edwards RJ, Sharma P. Towards the identification of blood biomarkers for acute stroke in humans: a comprehensive systematic review. Br J Clin Pharmacol 2012; 74:230-40. [PMID: 22320313 DOI: 10.1111/j.1365-2125.2012.04212.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Identification of biomarkers for stroke will aid our understanding of its aetiology, provide diagnostic and prognostic indicators for patient selection and stratification, and play a significant role in developing personalized medicine. We undertook the largest systematic review conducted to date in an attempt to characterize diagnostic and prognostic biomarkers in acute ischaemic and haemorrhagic stroke and those likely to predict complications following thrombolysis. METHODS A comprehensive literature search was carried out to identify diagnostic and prognostic stroke blood biomarkers. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated for each biomarker. RESULTS We identified a total of 141 relevant studies, interrogating 136 different biomarkers. Three biomarkers (C-reactive protein, P-selectin and homocysteine) significantly differentiated between ischaemic stroke and healthy control subjects. Furthermore, glial fibrillary acidic protein levels were significantly different between haemorrhagic stroke and ischaemic stroke patients (MD 224.58 ng l⁻¹; 95% CI 25.84, 423.32; P= 0.03), high levels of admission glucose were a strong predictor of poor prognosis after ischaemic stroke and symptomatic intracerebral haemorrhage post-thrombolysis, glutamate was found to be an indicator of progressive (unstable) stroke (MD 172.65 µmol l⁻¹, 95% CI 130.54, 214.75; P= 0.00001), D-dimer predicted in-hospital death (MD 0.67 µg ml⁻¹, 95% CI 0.35, 1.00; P= 0.0001), and high fibrinogen levels were associated with poor outcome at 3 months (MD 47.90 mg l⁻¹, 95% CI 14.88, 80.93; P= 0.004) following ischaemic stroke. CONCLUSIONS Few biomarkers currently investigated have meaningful clinical value. Admission glucose may be a strong marker of poor prognosis following acute thrombolytic treatment. However, molecules released in the bloodstream before, during or after stroke may have potential to be translated into sensitive blood-based tests.
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Affiliation(s)
- Nazeeha Hasan
- Imperial College Cerebrovascular Research Unit-ICCRU, Division of Experimental Medicine, Imperial College, London, UK
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Hargroves D. Will telemedicine facilitate access to hyper acute stroke care across the UK? Br J Hosp Med (Lond) 2012; 73:155-9. [PMID: 22411646 DOI: 10.12968/hmed.2012.73.3.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David Hargroves
- South East Coast Strategic Health Authority and East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, Kent TN24 0LZ.
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Calvet D, Bracard S, Mas JL. [Treatment of arterial and venous brain ischemia. Experts' recommendations: stroke management in the intensive care unit]. Rev Neurol (Paris) 2012; 168:512-21. [PMID: 22647807 DOI: 10.1016/j.neurol.2012.01.587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 12/30/2011] [Accepted: 01/03/2012] [Indexed: 12/20/2022]
Abstract
With thrombolysis, intravenous alteplase (0.9 mg/kg body weight, maximum 90 mg), with 10% of the dose given as a bolus followed by a 60-minute infusion, is recommended within 4.5 hours of onset of ischemic stroke. When indicated, intravenous thrombolysis must be initiated as soon as possible. It is possible to use intravenous alteplase in patients with seizures at stroke onset, if the neurological deficit is related to acute cerebral ischemia. Intravenous alteplase can be discussed for use on a case-by-case basis, according to risk of bleeding, in selected patients under 18 years and over 80 years of age, although for the current European recommendations this would be an off-label use. In hospitals with a stroke unit, intravenous thrombolysis is prescribed by a neurologist (current French labelling) or a physician having the French certification for neurovascular diseases (outside the current French labelling). The patient must be monitored in the stroke unit or in case of multiple organ failure in an intensive and critical care unit. In hospitals without a stroke unit, thrombolysis must be decided by the neurologist from the corresponding stroke unit via telemedicine. It is recommended to perform brain imaging 24 hours after thromboysis. Intra-arterial thrombolysis can be contemplated on a case-by-case basis after multidisciplinary discussion within a 6-hour time window for patients with acute middle cerebral artery or carotid occlusions, and within a larger time window for patients with basilar artery occlusion, because of their very poor spontaneous prognosis. Mechanical thrombectomy can also be contemplated in the same situations. With antiplatelet agents, it is recommended that patients receive aspirin (160 mg-325 mg) within 48 hours of ischemic stroke onset. When thrombolysis is performed or contemplated, it is recommended to delay the initiation of aspirin or other antithrombotic drugs for 24 hours. The use of antiplatelet agents that inhibit the glycoprotein IIb/IIIa receptor is not recommended. Urgent anticoagulation using heparin, low-molecular-weight heparins or danaparoid with the goal to treat ischemic stroke patients is not recommended. Secondary prevention by anticoagulation can be used, immediately or within the first days, after minor ischemic stroke or TIA in patients with a high risk for cardioembolism, if uncontrolled hypertension is absent. In patients with large infarcts and a high risk for cardioembolism, the timing for initiating anticoagulation must be decided on a case-by-case basis. In patients with anticoagulation who had an ischemic stroke, the decision to temporarily stop or maintain anticoagulation must be made on a case-by-case basis, depending on thromboembolic risk, level of anticoagulation at stroke onset and estimated risk of hemorrhagic transformation. It is not recommended to use neuroprotective agents in ischemic stroke patients. Patients with cerebral venous thrombosis must be treated with therapeutic doses of heparin, even in case of concomitant intracranial hemorrhage related to cerebral venous thrombosis. If the patient's status worsens despite adequate anticoagulation, thrombolysis may be used in selected cases. The optimal administration route (local or intravenous), thrombolytic agent (urokinase or alteplase) and dose are unknown. There is currently no recommendation with regard to local thrombolytic therapy in patients with dural sinus thrombosis. Urgent blood transfusions are recommended to reduce hemoglobin S to <30% in patients with sickle cell disease and acute ischemic stroke.
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Affiliation(s)
- D Calvet
- Service de neurologie et unité neurovasculaire, INSERM UMR 894, université Paris Descartes, centre hospitalier Sainte-Anne, 1 rue Cabanis, Paris cedex 14, France.
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Haahr RG, Duun SB, Toft MH, Belhage B, Larsen J, Birkelund K, Thomsen EV. An Electronic Patch for wearable health monitoring by reflectance pulse oximetry. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2012; 6:45-53. [PMID: 23852744 DOI: 10.1109/tbcas.2011.2164247] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report the development of an Electronic Patch for wearable health monitoring. The Electronic Patch is a new health monitoring system incorporating biomedical sensors, microelectronics, radio frequency (RF) communication, and a battery embedded in a 3-dimensional hydrocolloid polymer. In this paper the Electronic Patch is demonstrated with a new optical biomedical sensor for reflectance pulse oximetry so that the Electronic Patch in this case can measure the pulse and the oxygen saturation. The reflectance pulse oximetry solution is based on a recently developed annular backside silicon photodiode to enable low power consumption by the light emitting components. The Electronic Patch has a disposable part of soft adhesive hydrocolloid polymer and a reusable part of hard polylaurinlactam. The disposable part contains the battery. The reusable part contains the reflectance pulse oximetry sensor and microelectronics. The reusable part is 'clicked' into the disposable part when the patch is prepared for use. The patch has a size of 88 mm by 60 mm and a thickness of 5 mm.
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Affiliation(s)
- Rasmus G Haahr
- Department of Micro and Nanotechnology, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark.
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Shinozuka K, Dailey T, Tajiri N, Ishikawa H, Kim DW, Pabon M, Acosta S, Kaneko Y, Borlongan CV. Stem Cells for Neurovascular Repair in Stroke. ACTA ACUST UNITED AC 2012; 4:12912. [PMID: 24077523 DOI: 10.4172/2157-7633.s4-004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Stem cells exert therapeutic effects against ischemic stroke via transplantation of exogenous stem cells or stimulation of endogenous stem cells within the neurogenic niches of subventricular zone and subgranular zone, or recruited from the bone marrow through peripheral circulation. In this paper, we review the different sources of stem cells that have been tested in animal models of stroke. In addition, we discuss specific mechanisms of action, in particular neurovascular repair by endothelial progenitor cells, as key translational research for advancing the clinical applications of stem cells for ischemic stroke.
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Affiliation(s)
- Kazutaka Shinozuka
- Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, 12901 Bruce B. Downs Blvd. MDC78, Tampa, Florida 33612, USA
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Alberts MJ, Latchaw RE, Jagoda A, Wechsler LR, Crocco T, George MG, Connolly ES, Mancini B, Prudhomme S, Gress D, Jensen ME, Bass R, Ruff R, Foell K, Armonda RA, Emr M, Warren M, Baranski J, Walker MD. Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition. Stroke 2011; 42:2651-65. [PMID: 21868727 DOI: 10.1161/strokeaha.111.615336] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. METHODS We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. RESULTS Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. CONCLUSIONS Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center.
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Affiliation(s)
- Mark J Alberts
- Northwestern University, 710 N Lake Shore Drive, Chicago, IL 60611, USA.
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Gonzalez MA, Hanna N, Rodrigo ME, Satler LF, Waksman R. Reliability of prehospital real-time cellular video phone in assessing the simplified National Institutes Of Health Stroke Scale in patients with acute stroke: a novel telemedicine technology. Stroke 2011; 42:1522-7. [PMID: 21512180 DOI: 10.1161/strokeaha.110.600296] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The National Institutes of Health Stroke Scale (NIHSS) is the gold standard to assess patients with acute stroke. We aimed to examine the feasibility and reliability of prehospital real-time cellular video phone (VP) in performing the NIHSS. METHODS Forty physicians prospectively performed a simplified NIHSS (sNIHSS) on a standardized patient remotely using VP with the assistance of a bedside emergency medical technician and later performed a bedside examination. We tested the hypothesis that there is high reliability between these 2 methods. Physicians were timed and sNIHSS scores were recorded. Finally, physicians were asked to rate the VP technology. RESULTS A total of 480 pair comparisons of the sNIHSS scores between the VP and bedside examination were generated. After adjusting for the physician's specialty, level of training, and certification status, there was a strong positive linear correlation (r=0.97, P < 0.01) between the 2 methods with high average physician reliability (0.99; 95% CI, 0.992 to 0.995). The mean sNIHSS scores using VP and bedside examination were not different (6.82 ± 1.06 versus 6.63 ± 0.98; P=0.08). The mean time to perform the sNIHSS using VP was approximately 38 seconds longer than the bedside examination (3.38 ± 0.77 versus 2.93 ± 0.83 minutes; P=0.006). CONCLUSIONS The VP is a feasible, reliable, and timely tool with the potential for remotely assessing the sNIHSS for patients presenting with acute stroke and may expedite the initial evaluation and treatment strategies.
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Affiliation(s)
- Manuel A Gonzalez
- Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA
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Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: A systematic review of reviews. Int J Med Inform 2010; 79:736-71. [PMID: 20884286 DOI: 10.1016/j.ijmedinf.2010.08.006] [Citation(s) in RCA: 582] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 07/11/2010] [Accepted: 08/29/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Anne G Ekeland
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, P.O. Box 6060, N-9038 Tromsø, Norway.
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Bahaadinbeigy K, Yogesan K, Wootton R. Gaps in the systematic reviews of the telemedicine field. J Telemed Telecare 2010; 16:414-6. [DOI: 10.1258/jtt.2010.100505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kambiz Bahaadinbeigy
- Australian e-Health Research Centre, ICT Centre, CSIRO, Perth
- University of Western Australia, Australia
| | | | - Richard Wootton
- Norwegian Centre for Integrated Care and Telemedicine, Tromsø, Norway
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Implementation of Telemedicine and Stroke Network in Thrombolytic Administration: Comparison Between Walk-in and Referred Patients. Neurocrit Care 2010; 13:62-6. [DOI: 10.1007/s12028-010-9360-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schwamm LH, Holloway RG, Amarenco P, Audebert HJ, Bakas T, Chumbler NR, Handschu R, Jauch EC, Knight WA, Levine SR, Mayberg M, Meyer BC, Meyers PM, Skalabrin E, Wechsler LR. A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke 2009; 40:2616-34. [PMID: 19423852 DOI: 10.1161/strokeaha.109.192360] [Citation(s) in RCA: 341] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this new statement is to provide a comprehensive and evidence-based review of the scientific data evaluating the use of telemedicine for stroke care delivery and to provide consensus recommendations based on the available evidence. The evidence is organized and presented within the context of the American Heart Association's Stroke Systems of Care framework and is classified according to the joint American Heart Association/American College of Cardiology Foundation and supplementary American Heart Association Stroke Council methods of classifying the level of certainty and the class of evidence. Evidence-based recommendations are included for the use of telemedicine in general neurological assessment and primary prevention of stroke; notification and response of emergency medical services; acute stroke treatment, including the hyperacute and emergency department phases; hospital-based subacute stroke treatment and secondary prevention; and rehabilitation.
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Leitlinien zum Management von Patienten mit akutem Hirninfarkt oder TIA der Europäischen Schlaganfallorganisation 2008. DER NERVENARZT 2008; 79:936-57. [DOI: 10.1007/s00115-008-2531-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25:457-507. [PMID: 18477843 DOI: 10.1159/000131083] [Citation(s) in RCA: 1668] [Impact Index Per Article: 104.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 03/27/2008] [Indexed: 12/13/2022] Open
Abstract
This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation.
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References. J Telemed Telecare 2007. [DOI: 10.1258/135763307782213534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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