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Mihandoust S, Joseph A, Browning MHEM, Cha JS, Gonzales A, Markowitz J. Can pre-visit exposure to virtual tours of healthcare facilities help reduce child and parent anxiety during outpatient surgical procedures? APPLIED ERGONOMICS 2024; 119:104308. [PMID: 38761553 DOI: 10.1016/j.apergo.2024.104308] [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: 01/16/2024] [Revised: 04/11/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024]
Abstract
AIM The study aims to evaluate the impact of exposure to a highly realistic virtual facility tour prior to the on-site visit on patients and their parent/care partner's self-reported anxiety and physiological measures on the day of the procedure. BACKGROUND Preoperative anxiety impacts pediatric surgical outcomes; therefore, it is important for healthcare providers to address and manage preoperative anxiety in pediatric patients to promote better outcomes and overall wellbeing. Providing patients with a preview of the care setting before the actual procedure can be highly beneficial in mitigating preoperative anxiety. METHODOLOGY In this pilot randomized experimental study, sixteen patient-care partner dyads scheduled to undergo a gastrointestinal procedure either received a virtual tour identical to the places experienced on the day of the procedure (experimental group) or received no virtual tour (control group). Self-reported measures of anxiety were collected from participants before and on the day of the procedure. Physiological measures of heart rate variability and skin conductance were collected on the day of the procedure from both groups. RESULTS There were no significant differences between the self-reported and physiological measures of anxiety between the child groups. However, parents in the control group reported lower levels of anxiety and demonstrated lower levels of stress based on their physiological measures. CONCLUSION Exposure to virtual facility tours days before the surgery was not helpful in positively impacting the psychological measures related to preoperative anxiety levels for the participants.
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Affiliation(s)
- Sahar Mihandoust
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC, USA
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC, USA.
| | - Matthew H E M Browning
- Virtual Reality and Nature Lab, Department of Parks, Recreation and Tourism Management, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, USA
| | - Jackie S Cha
- Department of Industrial Engineering, Clemson University, USA
| | - Alec Gonzales
- Department of Industrial Engineering, Clemson University, USA
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Mithen LM, Weaver N, Walker FR, Inder KJ. Feasibility of biomarkers to measure stress, burnout and fatigue in emergency nurses: a cross-sectional study. BMJ Open 2023; 13:e072668. [PMID: 37643845 PMCID: PMC10465916 DOI: 10.1136/bmjopen-2023-072668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Retaining nurses in the workforce is an urgent concern in healthcare. Emergency nurses report high levels of stress and burnout, however, there is no gold standard of how to measure these responses. This study aims to measure stress, burnout, and fatigue in emergency nurses using biomarkers and psychometric instruments. Biomarkers will be used to better understand nurses' levels of stress and burnout and to assess the feasibility of using biomarkers as a viable stress measurement tool in a real-world setting. METHODS AND ANALYSIS A two stage cross-sectional design to measure stress, burnout and fatigue in emergency nurses while they work is proposed. All registered and enrolled nurses working in the emergency department from four hospitals in Australia will be invited to participate. Validated psychometric tools will be used in stage 1 to measure depression, anxiety, acute stress, chronic stress, burnout and fatigue. Biomarkers comprising hair cortisol, saliva alpha amylase and heart rate variability will be collected as an objective measure of stress and burnout in stage 2 over one working shift per participant. Written consent will be sought for stage 2 where nurses will provide one hair sample, wear a heart rate sensor and be asked to collect their saliva at three different time points of one shift. Data analysis will measure the domains of acute stress, chronic stress and burnout and explore relationships and correlation between psychometric measures and biomarkers. ETHICS AND DISSEMINATION Ethics approval obtained from the Human Research Ethics Committee of the Hunter New England Local Health District (approval number: HREC/2020/ETH01684) and University of Newcastle HREC (H-2022-0169). Results will be reported in peer-reviewed publications using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Public dissemination will occur by presenting at conferences and to the participating local health district.
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Affiliation(s)
- Lucinda M Mithen
- School of Nursing & Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
| | - Natasha Weaver
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Frederick R Walker
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
- School of Biomedical Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Advanced Training Systems, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Kerry J Inder
- School of Nursing & Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
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Schlagintweit J, Laharnar N, Glos M, Zemann M, Demin AV, Lederer K, Penzel T, Fietze I. Effects of sleep fragmentation and partial sleep restriction on heart rate variability during night. Sci Rep 2023; 13:6202. [PMID: 37069226 PMCID: PMC10110519 DOI: 10.1038/s41598-023-33013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/05/2023] [Indexed: 04/19/2023] Open
Abstract
We developed a cross-over study design with two interventions in randomized order to compare the effects of sleep fragmentation and partial sleep restriction on cardiac autonomic tone. Twenty male subjects (40.6 ± 7.5 years old) underwent overnight polysomnography during 2 weeks, each week containing one undisturbed baseline night, one intervention night (either sleep restriction with 5 h of sleep or sleep fragmentation with awakening every hour) and two undisturbed recovery nights. Parameters of heart rate variability (HRV) were used to assess cardiac autonomic modulation during the nights. Sleep restriction showed significant higher heart rate (p = 0.018) and lower HRV-pNN50 (p = 0.012) during sleep stage N1 and lower HRV-SDNN (p = 0.009) during wakefulness compared to the respective baseline. For HR and SDNN there were recovery effects. There was no significant difference comparing fragmentation night and its baseline. Comparing both intervention nights, sleep restriction had lower HRV high frequency (HF) components in stage N1 (p = 0.018) and stage N2 (p = 0.012), lower HRV low frequency (LF) (p = 0.007) regarding the entire night and lower SDNN (p = 0.033) during WASO during sleep. Sleep restriction increases sympathetic tone and decreases vagal tone during night causing increased autonomic stress, while fragmented sleep does not affect cardiac autonomic parameters in our sample.
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Affiliation(s)
- Julia Schlagintweit
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Naima Laharnar
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Advanced Sleep Research GmbH, Luisenstraße 54-55, 10117, Berlin, Germany
| | - Maria Zemann
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Artem V Demin
- Institute of Biomedical Problems, Russian Academy of Science, 76a, Khoroshevskoe Shosse, Moscow, Russia, 123007
| | - Katharina Lederer
- Advanced Sleep Research GmbH, Luisenstraße 54-55, 10117, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- The Fourth People's Hospital of Guangyuan, Guangyuan, China
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Jelmini JD, Ross J, Whitehurst LN, Heebner NR. The effect of extended shift work on autonomic function in occupational settings: A systematic review and meta-analysis. J Occup Health 2023; 65:e12409. [PMID: 37287085 PMCID: PMC10247865 DOI: 10.1002/1348-9585.12409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE To examine the effect of 24-h shift work on autonomic nervous system function via heart rate variability (HRV) methodologies. METHODS Electronic databases (indexed in either PubMed, MEDLINE, CINAHL, SPORTDiscus, or OpenDissertations) were searched from January 1964 to March 2023. A modified Downs and Black checklist was used for assessing methodological quality and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the quality of evidence. Study design, study population, study sample, shift work description, and assessment of HRV metrics and methods were extracted from each study. FINDINGS A total of 58 478 study articles were identified, of which 12 articles met inclusion criteria. Sample sizes varied from eight to 60 participants, with the ratio of low- to high-frequency HRV (LF/HF) as the most common frequency-domain variable reported. Of the nine included studies that observed LF/HF, three (33.3%) demonstrated a significant increase after 24-h shift work. Moreover, of the five studies that reported HF, two (40%) noted a significant decrease after 24-h shift work. When observing risk of bias, two (16.6%) studies were low quality, five (41.7%) were moderate quality, and five (41.7%) were high quality. INTERPRETATION There were inconsistent findings demonstrating an effect of 24-h shift work on autonomic function, with a suggested shift away from parasympathetic dominance. Discrepancies in HRV methodologies, such as the duration of recordings and hardware used for measurement, may have contributed to the disparity in findings. In addition, differences in roles and responsibilities across occupations may explain the incongruence in findings across studies.
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Affiliation(s)
- Jacob D. Jelmini
- College of Health Sciences, Sports Medicine Research InstituteUniversity of KentuckyLexingtonKentuckyUSA
| | - Jeremy Ross
- College of Health Sciences, Sports Medicine Research InstituteUniversity of KentuckyLexingtonKentuckyUSA
| | | | - Nicholas R. Heebner
- College of Health Sciences, Sports Medicine Research InstituteUniversity of KentuckyLexingtonKentuckyUSA
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Keller E, Hittle BM, Smith CR. Tiredness Takes Its Toll: An Integrative Review on Sleep and Occupational Outcomes for Long-Term Care Workers. J Gerontol Nurs 2023; 49:27-33. [PMID: 36594911 DOI: 10.3928/00989134-20221206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Poor sleep quality and duration among health care professionals have negative impacts on worker safety, work readiness, and well-being. However, the consequences of impaired sleep among long-term care (LTC) workers remain understudied. The current integrative review sought to explore associations between sleep and occupational outcomes in LTC workers. Multiple database searches yielded 1,543 articles; nine articles met inclusion criteria. Results synthesized from included articles revealed sleep-associated occupational outcomes across three themes, Burnout/Fatigue, Mental and Physical Health, and Well-Being, which may affect performance measures and predict injuries/errors. Exploring outcomes of poor sleep quality and duration among LTC workers has highlighted the needs of this population and may inform future intervention development. LTC organizations should consider implementing strategies to better support the sleep quality of their workforce. In addition, further research is needed to explore how impaired sleep contributes to negative worker outcomes and patient care quality. [Journal of Gerontological Nursing, 49(1), 27-33.].
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Matre D, Goffeng E, Nordby KC, Lie JAS. Extended Work Shifts Increase Subjective Pain Complaints Among Cabin Crewmembers, but Not Among Airline Pilots or Healthcare Workers: A Repeated-Measures Study. J Occup Environ Med 2022; 64:e381-e386. [PMID: 35761426 DOI: 10.1097/jom.0000000000002543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether four consecutive extended work shifts are associated with an increased risk of subjective pain complaints, sleep duration, and sleep disturbances. METHODS Forty-three healthcare workers, 41 cabin crewmembers, and 18 airline pilots working 4 consecutive extended workdays reported subjective pain complaints and sleep after the 1st and 4th workday. RESULTS The risk of headache (odds ratio [OR] 21.4, 95% confidence interval [CI] 1.85 to 246.5) and pain in the hands, arms, or wrists (OR 3.78, 95% CI 1.84 to 7.76) increased after workday 4 versus workday 1 in cabin crewmembers. Sleep duration was longer (0.6 to 1.1 hours), and sleep disturbances fewer, the night before the fourth extended workday, compared with before the first workday, in all occupations. CONCLUSIONS We found no general support for an association between extended work shifts and subjective pain, whereas sleep duration was improved, and sleep disturbances reduced after 4 consecutive extended workdays.
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Affiliation(s)
- Dagfinn Matre
- From the Department of Research, National Institute of Occupational Health (STAMI), Oslo, Norway
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Niotis K, Saif N, Simonetto M, Wu X, Yan P, Lakis JP, Ariza IE, Buckholz AP, Sharma N, Fink ME, Isaacson RS. Feasibility of a wearable biosensor device to characterize exercise and sleep in neurology residents. Expert Rev Med Devices 2021; 18:1123-1131. [PMID: 34632903 DOI: 10.1080/17434440.2021.1990038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Research suggests optimizing sleep, exercise and work-life balance may improve resident physician burnout. Wearable biosensors may allow residents to detect and correct poor sleep and exercise habits before burnout develops. Our objectives were to evaluate the feasibility of a wearable biosensor to characterize exercise/sleep in neurology residents and examine its relationship to self-reported, validated survey measures. We also assessed the device's impact on well-being and barriers to use. METHODS This prospective cohort study evaluated the WHOOP Strap 2.0 in neurology residents. Participants completed regular online surveys, including self-reported hours of sleep/exercise, and validated sleep/exercise scales at 3-month intervals. Autonomic, exercise, and sleep measures were obtained from WHOOP. Changes were evaluated over time via linear regression. Survey and WHOOP metrics were compared using Pearson correlations. RESULTS Sixteen (72.7%) of 22 eligible participants enrolled. Eleven (68.8%) met the minimum usage requirement (6+ months) and were classified as 'consecutive wearers.' Significant increases were found in sleep duration and exercise intensity. Moderate-to-low correlations were found between survey responses and WHOOP measures. Most (73%) participants reported a positive impact on well-being. Barriers to use included 'Forgetting to wear' (20%) and 'not motivational' (23.3%). CONCLUSION Wearable biosensors may be a feasible tool to evaluate sleep/exercise in residents.
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Affiliation(s)
- Kellyann Niotis
- 2019-2020 McGraw Fellow in Neurology Research; Department of Neurology, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | - Nabeel Saif
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Marialaura Simonetto
- Departments of Internal Medicine and Neurology, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | - Xian Wu
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine and Department of Healthcare Policy & Research, New York-Presbyterian, New York, NY, USA
| | - Peter Yan
- Department of Neurology, Beth Israel Deaconess Hospital-Milton Center for Specialty Care, Milton, MA, USA
| | - Jessica P Lakis
- Office of Development, New York-Presbyterian, New York, NY, USA
| | | | - Adam P Buckholz
- Department of Internal Medicine, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | | | - Matthew E Fink
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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Lecca LI, Setzu D, Del Rio A, Campagna M, Cocco P, Meloni M. Indexes of cardiac autonomic profile detected with short term Holter ECG in health care shift workers: a cross sectional study. LA MEDICINA DEL LAVORO 2019; 110:437-445. [PMID: 31846448 PMCID: PMC7809936 DOI: 10.23749/mdl.v110i6.8048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 12/02/2019] [Indexed: 01/08/2023]
Abstract
Background: The assessment of early effect of shift work-related circadian rhythms desynchronization and work-related stress in health care workers has gained a primary role among the duties of the occupational physician. Objectives: Aim of our study was to assess the cardiac autonomic modulation through quantification of sinus rhythm variability, as an index of the adaptability to shift work of the cardiovascular system in healthcare shift workers. Methods: We measured Heart Rate Variability (HRV) by short-term (60 minutes) Holter Electrocardiography (ECG) during the regular duties in the respective department of 42 healthcare workers (31 nurses and 11 physicians) of an Italian Hospital (12 male and 30 females, aged 24-58 years), working on 3 shifts with a forward fast rotation with rest at the end of the night shift (7 am - 2 pm; 2 pm - 10 pm; 10 pm - 7 am) or in a fixed daytime shift (8 am - 2 pm). Measurements were all performed between 9 am and 12 am for fixed day workers and between 9 am and 12 pm or between 10 pm and 1 am for shift workers. The following HRV parameters were compared between the subgroups of shift workers and daytime workers: mean heart rate (HR), standard deviation of all normal RR (NN) intervals (SDNN), standard deviation of the averages of NN intervals in all 5-minute segments of a recording (SDaNN) and the triangular index (the integral of the density distribution divided by the maximum of the density distribution). We used parametric tests for independent series to compare HRV parameters by subgroups within the study subjects. We also tested correlation between the variables of interest and the association between HRV and shift work modality, along with other covariates, by means of a multiple linear regression analysis. Results: We found significantly lower values of SDaNN in shift workers compared with workers engaged solely on day shifts (50.80 ms vs 66.71 ms; p=0,014). The mean heart rate did not show any significant difference between day workers and shift workers (85.78 bmp vs 85.53 bpm respectively). Multivariate analysis showed a significant association between SDNN and female gender and age, while no significant associations were found between HRV and shift work. Discussion: The autonomic control of the heart rhythm could be disrupted by desynchronization of the biological rhythm secondary to the organization of shift work and night work. Shift work is an important factor of social and biological distress, influencing the adaptability of the cardiovascular system to stimuli and demands of work organization.
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Affiliation(s)
- Luigi Isaia Lecca
- Department of Medical Science and Public Health, University of Cagliari, Italy..
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Robinson C, Lawless R, Zarzaur BL, Timsina L, Feliciano DV, Coleman JJ. Physiologic stress among surgeons who take in-house call. Am J Surg 2019; 218:1181-1184. [PMID: 31570199 DOI: 10.1016/j.amjsurg.2019.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/06/2019] [Accepted: 08/24/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Burnout and depression is higher in trauma surgeons as compared to surgeons in other specialties. Clinical practice for many acute care surgeons (ACS) includes in-house call (IHC). The goal of this study was to quantitate physiologic stress among ACS who take IHC. METHODS ACS with IHC responsibilities from two Level I trauma centers were studied. Participants wore a fitness and heart rate variability (HRV) device over 3 months. HRV was categorized as normal if 85% of baseline, moderate stress when HRV <85% but >50%, and high stress when HRV< 50%. RESULTS 1421 nights were recorded among 17 surgeons (35.3% female; mean age 45.5 years). Excluding IHC, mean HRV = 32.23, and 95.63% of days were consistent with moderate or high stress. Post-call day 2 had significantly highest percentage of high stress (65.82%, p = 0.0495). High and moderate stress levels returned to baseline on post-call day 3. CONCLUSIONS High and moderate stress beyond IHC is common among ACS. Future study is needed to determine consequences of persistent stress and identify factors which impact recovery after IHC.
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Affiliation(s)
- Caitlin Robinson
- Denver Health Medical Center, University of Colorado School of Medicine, USA
| | - Ryan Lawless
- Denver Health Medical Center, University of Colorado School of Medicine, USA
| | | | | | | | - Jamie J Coleman
- Denver Health Medical Center, University of Colorado School of Medicine, USA.
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