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Yiend J, Lam CLM, Schmidt N, Crane B, Heslin M, Kabir T, McGuire P, Meek C, Mouchlianitis E, Peters E, Stahl D, Trotta A, Shergill S. Cognitive bias modification for paranoia (CBM-pa): a randomised controlled feasibility study in patients with distressing paranoid beliefs. Psychol Med 2023; 53:4614-4626. [PMID: 35699135 PMCID: PMC10388312 DOI: 10.1017/s0033291722001520] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive Bias Modification for paranoia (CBM-pa) is a novel, theory-driven psychological intervention targeting the biased interpretation of emotional ambiguity associated with paranoia. Study objectives were (i) test the intervention's feasibility, (ii) provide effect size estimates, (iii) assess dose-response and (iv) select primary outcomes for future trials. METHODS In a double-blind randomised controlled trial, sixty-three outpatients with clinically significant paranoia were randomised to either CBM-pa or an active control (text reading) between April 2016 and September 2017. Patients received one 40 min session per week for 6 weeks. Assessments were given at baseline, after each interim session, post-treatment, and at 1- and 3-months post-treatment. RESULTS A total of 122 patients were screened and 63 were randomised. The recruitment rate was 51.2%, with few dropouts (four out of 63) and follow-up rates were 90.5% (1-month) and 93.7% (3-months). Each session took 30-40 min to complete. There was no statistical evidence of harmful effects of the intervention. Preliminary data were consistent with efficacy of CBM-pa over text-reading control: patients randomised to the intervention, compared to control patients, reported reduced interpretation bias (d = -0.48 to -0.76), improved symptoms of paranoia (d = -0.19 to -0.38), and lower depressed and anxious mood (d = -0.03 to -0.29). The intervention effect was evident after the third session. CONCLUSIONS CBM-pa is feasible for patients with paranoia. A fully powered randomised control trial is warranted.
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Affiliation(s)
- Jenny Yiend
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Charlene L. M. Lam
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
- Laboratory of Clinical Psychology and Affective Neuroscience, The University of Hong Kong, Hong Kong
| | - Nora Schmidt
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Bryony Crane
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Margaret Heslin
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | | | - Philip McGuire
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Christopher Meek
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Elias Mouchlianitis
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Daniel Stahl
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Antonella Trotta
- Laboratory of Clinical Psychology and Affective Neuroscience, The University of Hong Kong, Hong Kong
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Sukhwinder Shergill
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
- Kent and Medway Medical School, Canterbury, UK
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Yiend J, Trotta A, Meek C, Dzafic I, Baldus N, Crane B, Kabir T, Stahl D, Heslin M, Shergill S, McGuire P, Peters E. Cognitive Bias Modification for paranoia (CBM-pa): study protocol for a randomised controlled trial. Trials 2017; 18:298. [PMID: 28662715 PMCID: PMC5492504 DOI: 10.1186/s13063-017-2037-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Persecutory delusions are the most common type of delusions in psychosis and present in around 10-15% of the general population. Persecutory delusions are thought to be sustained by biased cognitive and emotional processes. Recent advances favour targeted interventions, focussing on specific symptoms or mechanisms. Our aim is to test the clinical feasibility of a novel psychological intervention, which manipulates biased interpretations toward more adaptive processing, in order to reduce paranoia in patients. METHODS The 'Cognitive Bias Modification for paranoia' (CBM-pa) study is a feasibility, double-blind, randomised controlled trial (RCT) for 60 stabilised outpatients with persistent, distressing paranoid symptoms. Patients will be randomised at a 50:50 ratio, to computerised CBM-pa or a text-reading control intervention, receiving one 40-min session per week, for 6 weeks. CBM-pa involves participants reading stories on a computer screen, completing missing words and answering questions about each story in a way that encourages more helpful beliefs about themselves and others. Treatment as Usual will continue for patients in both groups. Patients will be assessed by a researcher blind to allocation, at baseline, each interim session, post treatment and 1- and 3-month follow-up post treatment. The primary outcome is the feasibility parameters (trial design, recruitment rate and acceptability) of the intervention. The secondary outcomes are clinical symptoms (including severity of paranoia) as assessed by a clinical psychologist, and 'on-line' measurement of interpretation bias and stress/distress. The trial is funded by the NHS National Institute for Health Research. DISCUSSION This pilot study will test whether CBM-pa has the potential to be a cost-effective, accessible and flexible treatment. If the trial proves feasible and demonstrates preliminary evidence of efficacy, a fully powered RCT will be warranted. TRIAL REGISTRATION Current Controlled Trials ISRCTN: 90749868 . Retrospectively registered on 12 May 2016.
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Affiliation(s)
- Jenny Yiend
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Antonella Trotta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Christopher Meek
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ilvana Dzafic
- Queensland Brain Institute, University of Queensland, Brisbane, QLD Australia
| | - Nora Baldus
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Bryony Crane
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Daniel Stahl
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Margaret Heslin
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sukhwinder Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Coats W, Pedigo K, Noble G, Glispin C, Agha A, Bazaldua A, Aranoff M, Bennett H, Crowling A, Gonzales N, Montoux A, Espinoza A, Almazan S, Allman C, Kaye C, Allman J, Crane B, Villegas A, Broughton B, McDonald R. Modeling of the PTF1‐L/Foxa2 Transcription Factor Complex Controlling Pancreatic Development. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.lb56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ward Coats
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - K Pedigo
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - G Noble
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - C Glispin
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Agha
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Bazaldua
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - M Aranoff
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - H Bennett
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Crowling
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - N Gonzales
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Montoux
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Espinoza
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - S Almazan
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - C Allman
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - C Kaye
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - J Allman
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - B Crane
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Villegas
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - B Broughton
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - Ray McDonald
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
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Mulavisala KP, Norrie J, Crane B, Barwell N. Continuous blood glucose monitoring reduces the risk to ICU patients. Crit Care 2015. [PMCID: PMC4472672 DOI: 10.1186/cc14449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Affiliation(s)
- KP Mulavisala
- Axon Anaesthesia Associates Care Hospital Nampally, Hyderabad, India
| | - PB Gopal
- Apollo Hospitals, Hyderabad, India
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Mullooly JP, Crane B, Chun C. Trivalent inactivated influenza vaccine safety in children: Assessing the contribution of telephone encounters. Vaccine 2006; 24:2256-63. [PMID: 16375995 DOI: 10.1016/j.vaccine.2005.11.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 11/10/2005] [Accepted: 11/18/2005] [Indexed: 11/18/2022]
Abstract
We assessed the contribution of telephone medical care encounters to surveillance of adverse events (AE) following trivalent influenza vaccination in children age 6 months to 17 years. We used retrospective, self-controlled, case-series analysis to estimate adverse event incidence rate ratios for post-vaccination risk intervals relative to 15-28 days prior to vaccination. We confirmed possible vaccination reactions by medical record abstraction. Detection of 10 of 20 elevated incidence rate ratios required telephone data. We conclude that telephone encounters substantially contribute to the detection of possible influenza vaccination reactions, primarily local injection site and systemic reactions.
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Affiliation(s)
- J P Mullooly
- Kaiser Permanente, Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA.
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Ghosh DK, Rashid MB, Crane B, Taskar V, Mast M, Misukonis MA, Weinberg JB, Eissa NT. Characterization of key residues in the subdomain encoded by exons 8 and 9 of human inducible nitric oxide synthase: a critical role for Asp-280 in substrate binding and subunit interactions. Proc Natl Acad Sci U S A 2001; 98:10392-7. [PMID: 11517317 PMCID: PMC56971 DOI: 10.1073/pnas.181251298] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Human inducible nitric oxide synthase (iNOS) is active as a dimer of two identical subunits. Each subunit has an amino-terminal oxygenase domain that binds the substrate l-Arg and the cofactors heme and tetrahydrobiopterin and a carboxyl-terminal reductase domain that binds FMN, FAD, and NADPH. We previously demonstrated that a subdomain in the oxygenase domain encoded by exons 8 and 9 is important for dimer formation and NO synthesis. Further, we identified Trp-260, Asn-261, Tyr-267, and Asp-280 as key residues in that subdomain. In this study, using an Escherichia coli expression system, we produced, purified, and characterized wild-type iNOS and iNOS-Ala mutants. Using H(2)O(2)-supported oxidation of N(omega)-hydroxy-l-Arg, we demonstrate that the iNOS mutants' inabilities to synthesize NO are due to selective defects in the oxygenase domain activity. Detailed characterization of the Asp-280-Ala mutant revealed that it retains a functional reductase domain, as measured by its ability to reduce cytochrome c. Gel permeation chromatography confirmed that the Asp-280-Ala mutant exists as a dimer, but, in contrast to wild-type iNOS, urea-generated monomers of the mutant fail to reassociate into dimers when incubated with l-Arg and tetrahydrobiopterin, suggesting inadequate subunit interaction. Spectral analysis reveals that the Asp-280-Ala mutant does not bind l-Arg. This indicates that, in addition to dimerization, proper subunit interaction is required for substrate binding. These data, by defining a critical role for Asp-280 in substrate binding and subunit interactions, give insights into the mechanisms of regulation of iNOS activity.
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Affiliation(s)
- D K Ghosh
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
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Carpenter RL, Hogan QH, Liu SS, Crane B, Moore J. Lumbosacral cerebrospinal fluid volume is the primary determinant of sensory block extent and duration during spinal anesthesia. Anesthesiology 1998; 89:24-9. [PMID: 9667290 DOI: 10.1097/00000542-199807000-00007] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED BACKGROUND. Injection of local anesthetic into cerebrospinal fluid (CSF) produces anesthesia of unpredictable extent and duration. Although many factors have been identified that affect the extent of spinal anesthesia, correlations are relatively poor and the extent of spread remains unpredictable. This study was designed to determine whether variability in the volume of lumbosacral CSF among individuals is a contributing factor in the variability of spinal anesthesia. METHODS Spinal anesthesia was administered to 10 healthy volunteers with 50 mg lidocaine in 7.5% dextrose. The technique was standardized to minimize variability in factors known to affect the distribution of spinal anesthesia. The extent of sensory anesthesia was assessed by pin-prick and by transcutaneous electrical stimulation. Motor blockade was assessed in the quadriceps and gastrocnemius muscles by force dynamometry. Duration of anesthesia was assessed by pinprick, transcutaneous electrical stimulation, and duration of motor blockade. Lumbosacral CSF volumes were calculated from low thoracic, lumbar, and sacral axial magnetic resonance images obtained at 8-mm increments. Volumes of CSF were correlated with measures of extent and duration of spinal anesthesia using the Kendall rank correlation test. RESULTS Lumbosacral CSF volumes ranged from 42.7 to 81.1 ml. Volumes of CSF correlated with pin-prick assessments of peak sensory block height (P = 0.02) and duration of surgical anesthesia (as assessed by the duration of tolerance to transcutaneous electrical stimulation at the ankle (P < 0.05). CONCLUSIONS Variability in lumbosacral CSF volume is the most important factor identified to date that contributes to the variability in the spread of spinal sensory anesthesia.
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Affiliation(s)
- R L Carpenter
- Department of Anesthesiology, Bowman Gray School of Medicine at Wake Forest University, Winston-Salem, North Carolina, USA.
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Phillips P, Voak D, Knowles S, Campbell G, Crane B, Downie DM, Haigh T, Whitton C. An explanation and the clinical significance of the failure of microcolumn tests to detect weak ABO and other antibodies. Transfus Med 1997; 7:47-53. [PMID: 9089985 DOI: 10.1046/j.1365-3148.1997.d01-79.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Shear forces are proposed to explain the failure of antiglobulin and 'neutral' (no antiglobulin) microcolumn tests at 37 degrees C to detect weak ABO incompatibilities and other weak antibodies, clearly detectable by spin-tube methods. These shear forces can be minimized in a microcolumn test using a biphasic centrifugation phase. Although this biphasic test is not suitable for routine use, it may be of use as an investigational method for reference laboratories. This failure of microcolumn test to detect weak ABO incompatibilities is of little clinical significance as the antibodies are dubiously active at 37 degrees C.
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Affiliation(s)
- P Phillips
- National Institute for Biological Standards and Control, Potters Bar, UK
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Greenberg SJ, Olanow CW, Dawson DV, Crane B, Roses AD. Autologous mixed lymphocyte reaction in patients with myasthenia gravis: correlation with disease activity. The Journal of Immunology 1984. [DOI: 10.4049/jimmunol.132.3.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Enriched subpopulations of peripheral blood mononuclear cells from patients with myasthenia gravis and from normal control individuals were tested for proliferative ability in the autologous mixed lymphocyte reactions. Myasthenia gravis patients were studied at various phases of therapy. Longitudinal patient populations were studied. Purified T cells from untreated patients with active myasthenia gravis demonstrated enhanced proliferative responses when co-cultured with nonmodified autologous non-T cells. Furthermore, treatment by thymectomy with or without prior plasmapheresis was associated with a consequent normalization of the autologous reaction. The enhanced autologous mixed lymphocyte reaction in the pre-treatment group of myasthenia gravis patients was significantly different from the post-treatment and normal control groups (Stimulation Index, p less than 0.01 and p less than 0.02, respectively). This difference in activity was also confirmed in a longitudinal study of 10 patients followed pre- and post-treatment (Stimulation Index, p less than 0.02). There was no difference between the responses of post-treatment patients and normal control individuals. There was no evidence of altered T cell responsiveness or non-T cell stimulation, as measured by the allogeneic mixed lymphocyte reaction or by mitogen-induced lymphocyte proliferation, between pretreatment and post-treatment patients as compared to controls. The responses were not affected by serum substitution experiments whereby myasthenic responder T cells were co-cultured with pooled normal human sera. Other parameters studied included clinical status, anti-acetylcholine receptor antibody levels, and thymic pathology. An intriguing connection between abnormalities in the thymic cell populations and the autoaggressive state in myasthenia may be reflected by the in vitro autologous mixed lymphocyte reaction.
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Greenberg SJ, Olanow CW, Dawson DV, Crane B, Roses AD. Autologous mixed lymphocyte reaction in patients with myasthenia gravis: correlation with disease activity. J Immunol 1984; 132:1229-36. [PMID: 6229579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Enriched subpopulations of peripheral blood mononuclear cells from patients with myasthenia gravis and from normal control individuals were tested for proliferative ability in the autologous mixed lymphocyte reactions. Myasthenia gravis patients were studied at various phases of therapy. Longitudinal patient populations were studied. Purified T cells from untreated patients with active myasthenia gravis demonstrated enhanced proliferative responses when co-cultured with nonmodified autologous non-T cells. Furthermore, treatment by thymectomy with or without prior plasmapheresis was associated with a consequent normalization of the autologous reaction. The enhanced autologous mixed lymphocyte reaction in the pre-treatment group of myasthenia gravis patients was significantly different from the post-treatment and normal control groups (Stimulation Index, p less than 0.01 and p less than 0.02, respectively). This difference in activity was also confirmed in a longitudinal study of 10 patients followed pre- and post-treatment (Stimulation Index, p less than 0.02). There was no difference between the responses of post-treatment patients and normal control individuals. There was no evidence of altered T cell responsiveness or non-T cell stimulation, as measured by the allogeneic mixed lymphocyte reaction or by mitogen-induced lymphocyte proliferation, between pretreatment and post-treatment patients as compared to controls. The responses were not affected by serum substitution experiments whereby myasthenic responder T cells were co-cultured with pooled normal human sera. Other parameters studied included clinical status, anti-acetylcholine receptor antibody levels, and thymic pathology. An intriguing connection between abnormalities in the thymic cell populations and the autoaggressive state in myasthenia may be reflected by the in vitro autologous mixed lymphocyte reaction.
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Abstract
Modifications have been made to the reagent system of the semiautomated method for the determination of plasma free fatty acids by Baird et al. (1967), and results are reported of investigations into parameters affecting sensitivity and analytical range.
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