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Raykar NP, Raguveer V, Abdella YE, Ali-Awadh A, Arora H, Asamoah-Akuoko L, Barnes LS, Cap AP, Chowdhury A, Cooper Z, Delaney M, DelSignore M, Inam S, Ismavel VA, Jensen K, Kumar N, Lokoel G, Mammen JJ, Nathani P, Nisingizwe MP, Puyana JC, Riviello R, Roy N, Salim A, Tayou-Tagny C, Virk S, Wangamati CW. Innovative blood transfusion strategies to address global blood deserts: a consensus statement from the Blood Delivery via Emerging Strategies for Emergency Remote Transfusion (Blood DESERT) Coalition. Lancet Glob Health 2024; 12:e522-e529. [PMID: 38365422 PMCID: PMC10882207 DOI: 10.1016/s2214-109x(23)00564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/06/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
In rural settings worldwide, many people live in effective blood deserts without access to any blood transfusion. The traditional system of blood banking is logistically complex and expensive for many resource-restricted settings and demands innovative and multidisciplinary solutions. 17 international experts in medicine, industry, and policy participated in an exploratory process with a 2-day hybrid seminar centred on three promising innovative strategies for blood transfusions in blood deserts: civilian walking blood banks, intraoperative autotransfusion, and drone-based blood delivery. Participant working groups conducted literature reviews and interviews to develop three white papers focused on the current state and knowledge gaps of each innovation. Seminar discussion focused on defining blood deserts and developing innovation-specific implementation agendas with key research and policy priorities for future work. Moving forward, advocates should prioritise the identification of blood deserts and address the context-specific challenges for these innovations to alleviate the ongoing crisis in blood deserts.
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Affiliation(s)
- Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Vanitha Raguveer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | | | - Asma Ali-Awadh
- Sub-county Langata and Kibera, Nairobi Metropolitan Health Services, Nairobi, Kenya; Sisu Global Health, Baltimore, MD, USA
| | - Harshit Arora
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Lucy Asamoah-Akuoko
- Department of Research, Planning, Monitoring, and Evaluation, National Blood Service, Accra, Ghana
| | | | - Andrew P Cap
- US Army Institute of Surgical Research, Houston, TX, USA
| | - Aulina Chowdhury
- Department of Anesthesia, Boston Children's Hospital, Boston, MA, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Meghan Delaney
- Department of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | | | - Sidra Inam
- Allied Hospital Faisalabad, Faisalabad, Pakistan
| | | | - Kennedy Jensen
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nikathan Kumar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, University of California San Francisco, East Bay, Oakland, CA, USA
| | - Gilchrist Lokoel
- Department of Medical Services, Turkana County Government, Lodwar, Kenya
| | - Joy John Mammen
- Department of Transfusion Medicine, Christian Medical College, Vellore, India
| | - Priyansh Nathani
- Dr RN Cooper Municipal Medical College and General Hospital: Hinduhridaysamrat Balasaheb Thackeray Medical College and Rustom Narsi Cooper Municipal General Hospital, Mumbai, India; WHO Collaboration Center for Research in Surgical Care Delivery in Low and Middle Income Countries, Mumbai, India
| | - Marie Paul Nisingizwe
- Department of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Juan Carlos Puyana
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Nobhojit Roy
- Operative Care, Clinical Services and Systems, WHO, Geneva, Switzerland
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Claude Tayou-Tagny
- Department of Haematology and Transfusion Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - Sargun Virk
- WHO Collaboration Center for Research in Surgical Care Delivery in Low and Middle Income Countries, Mumbai, India
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Munoz-Valencia A, Aridi JO, Barnes LS, Rudd KE, Bidanda B, Epuu T, Kamu R, Kivuli T, Macleod J, Makanga CM, Makin J, Mate M, Muiru CN, Murithi G, Musa A, Nyagol H, Ochieng K, Rajgopal J, Raykar NP, Tian Y, Yazer MH, Zeng B, Olayo B, Kumar P, Puyana JC. Protocol: identifying policy, system, and environment change interventions to enhance availability of blood for transfusion in Kenya, a mixed-methods study. BMC Health Serv Res 2023; 23:963. [PMID: 37679772 PMCID: PMC10486046 DOI: 10.1186/s12913-023-09936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Safe blood is essential for the care of patients with life-threatening anemia and hemorrhage. Low blood donation rates, inefficient testing procedures, and other supply chain disruptions in blood administration affect patients in low-resource settings across Sub-Saharan countries, including Kenya. Most efforts to improve access to transfusion have been unidimensional, usually focusing on only point along the blood system continuum, and have excluded community stakeholders from early stages of intervention development. Context-appropriate interventions to improve the availability of safe blood at the point of use in low-resource settings are of paramount importance. Thus, this protocol proposes a multifaceted approach to characterize the Kenyan blood supply chain through quantitative and qualitative analyses as well as an industrial engineering approach. METHODS This study will use a mixed-methods approach in addition to engineering process mapping, modeling and simulation of blood availability in Kenya. It will be guided by a multidimensional three-by-three-by-three matrix: three socioeconomic settings, three components of the blood system continuum, and three levels of urgency of blood transfusion. Qualitative data collection includes one-on-one interviews and focus group discussions with stakeholders across the continuum to characterize ground-level deficits and potential policy, systems, and environment (PSE) interventions. Prospectively-collected quantitative data will be used to estimate blood collection and transfusion of blood. We will create a process map of the blood system continuum to model the response to PSE changes proposed by stakeholders. Lastly, we will identify those PSE changes that may have the greatest impact on blood transfusion availability, accounting for differences across socioeconomic settings and levels of urgency. DISCUSSION Identifying and prioritizing community-driven interventions to improve blood supply in low-resource settings are of utmost importance. Varied constraints in blood collection, processing, delivery, and use make each socioeconomic setting unique. Using a multifaceted approach to understand the Kenyan blood supply and model the response to stakeholder-proposed PSE changes may lead to identification of contextually appropriate intervention targets to meet the transfusion needs of the population.
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Affiliation(s)
- Alejandro Munoz-Valencia
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jackline O Aridi
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Linda S Barnes
- Linda S. Barnes Consulting, Seattle, WA, USA
- Doctor of Public Health Leadership, University of Illinois-Chicago, Chicago, IL, USA
| | - Kristina E Rudd
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bopaya Bidanda
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tonny Epuu
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Robert Kamu
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Tecla Kivuli
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Jana Macleod
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
- Department of Surgery, Kenyatta University, Nairobi, Kenya
| | - Cindy M Makanga
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Jennifer Makin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee Women's Hospital, Pittsburgh, PA, USA
| | - Muthoni Mate
- Center for Public Health and Development, Kisumu, Kenya
| | - Carolyne Njoki Muiru
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
- Department of Surgery, Egerton University, Nakuru, Kenya
| | | | - Abdirahaman Musa
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
- Ministry of Health & Sanitation, Turkana County Government, Turkana, Kenya
| | - Hellen Nyagol
- Center for Public Health and Development, Kisumu, Kenya
| | - Kevin Ochieng
- Center for Public Health and Development, Kisumu, Kenya
| | - Jayant Rajgopal
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nakul P Raykar
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Yiqi Tian
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bo Zeng
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bernard Olayo
- Center for Public Health and Development, Kisumu, Kenya
| | - Pratap Kumar
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya.
| | - Juan Carlos Puyana
- Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Ipe TS, Eichbaum Q, El-Ekiaby M, Owusu-Ofori S, Vermeulen M, Mapako T, Tagny CT, Dembele B, Bloch EM, Barnes LS. Transfusion medicine research in Africa: Insights from investigators in the field. Vox Sang 2023; 118:281-287. [PMID: 36734301 PMCID: PMC11005390 DOI: 10.1111/vox.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Research in low-resource settings is inherently challenging. We sought to assess the factors that have impeded or facilitated transfusion medicine (TM) research in various African settings. MATERIALS AND METHODS A qualitative case study was conducted of selected investigators in Africa; selection was based on productivity-spanning publication, leadership and research in TM. We designed a questionnaire to explore the factors impeding or facilitating TM research to understand the impact on the investigators' careers. Written responses were independently coded and double-checked for precision. Qualitative analysis was conducted, whereby responses were grouped thematically and clustered by relationship. The initial findings were discussed with respondents to validate and refine the interpretations. The recorded transcript was analysed and incorporated into the final analysis. RESULTS Six investigators participated in the study. Their responses yielded 471 coded comments: 389 from the questionnaires and 82 from the ensuing discussion. The most frequently cited factors described included knowledge and intellectual abilities (n = 104), personal effectiveness (n = 99), research and governance structure (n = 97), and engagement, influence and impact (n = 75). Four relationship clusters emerged from the facilitators (n = 42), barriers (n = 28), and common approaches (n = 26) to research, informing summary themes of adaptation, collaboration, perseverance, and resiliency. CONCLUSION Individual attributes were found to be central to a successful TM research career in African settings. However, given other public health priorities and constraints, interpersonal relationships, organizational structures and the broader research context were important to TM researchers. Overcoming complexities demands adaptation, collaboration, perseverance and resiliency.
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Affiliation(s)
- Tina S. Ipe
- Medical Division, Our Blood Institute, Oklahoma City, Oklahoma, USA
- Department of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Quentin Eichbaum
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Magdy El-Ekiaby
- Blood Transfusion and Hemophilia Center, Shabrawishi Hospital, Cairo, Egypt
| | | | - Marion Vermeulen
- The South African National Blood Service, Roodepoort, South Africa
| | - Tonderai Mapako
- Business Development Department, National Blood Service Zimbabwe, Harare, Zimbabwe
| | - Claude Tayou Tagny
- Department of Hematology and Blood Transfusion, University of Yaounde, Yaounde, Cameroon
| | - Bamory Dembele
- National Blood Transfusion Center Laboratory and, Pharmaceutical and Biological Sciences Training and Research Unit, University Félix Houphouet-Boigny, Abidjan, Côte d’Ivoire
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Linda S. Barnes
- School of Public Health, University of Illinois, Chicago, Illinois, USA
- Linda S. Barnes Consulting, Seattle, Washington, USA
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Barnes LS, Stanley J, Bloch EM, Pagano MB, Ipe TS, Eichbaum Q, Wendel S, Indrikovs A, Cai W, Delaney M. Status of hospital-based blood transfusion services in low-income and middle-income countries: a cross-sectional international survey. BMJ Open 2022; 12:e055017. [PMID: 35168978 PMCID: PMC8852762 DOI: 10.1136/bmjopen-2021-055017] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Blood transfusion is life-saving for patients experiencing acute blood loss and severe anaemia. In low-income and middle-income countries (LMICs), low blood donation rates and unavailability of whole blood and blood components (blood products) impairs timely blood transfusion. To fulfil patient-specific blood orders, a hospital blood transfusion service (HBTS) receives orders from a prescriber for blood transfusion, tests and prepares blood products for the patient. This study sought to describe the current state of LMIC HBTS. DESIGN A cross-sectional survey explored LMIC HBTS access to blood products, testing methods, policies and structure. Surveys were administered in English, Spanish, French and Russian, followed by a mixed-methods analysis. SETTING HBTS within LMICs. PARTICIPANTS From among 124 public and private facilities invited to participate, we received 71 (57%) responses. Of these responses, 50 HBTS from 27 LMICs performed on-site blood transfusions. RESULTS Most LMIC HBTS perform blood collection to generate blood products for their patients (36/47, 77%); few relied exclusively on an external supply of blood products (11/47, 23%). The primary reason for blood transfusion was adult anaemia for non-malignant conditions (17/112, 15%). Testing methods varied by gross national income per capita. Blood transfusion delays to patients were common (17/30, 57%) attributed to inadequate blood inventories (13/29, 45%). Other barriers included lack of regular clinician education about transfusion (8/29, 28%) and sustainable financial models for the HBTS (4/29, 14%). CONCLUSION This survey describes the status of HBTS in diverse LMICs, illustrating that the availability of blood products remains a principal problem, requiring HBTS to generate its own facility's blood supply. Currently, blood shortages are not reported as a patient-specific adverse event making systematic tracking of delays in transfusion difficult. These findings highlight areas for further exploration related to the lack of available blood inventories for transfusions at HBTS in LMICs.
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Affiliation(s)
- Linda S Barnes
- Doctor of Public Health Leadership, University of Illinois--Chicago, Chicago, Illinois, USA
- American Association of Blood Banks, Bethesda, Maryland, USA
| | | | - Evan M Bloch
- Pathology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Monica B Pagano
- Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Tina S Ipe
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Quentin Eichbaum
- Pathology, Immunology and Microbiology | Medical Education and Administration, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Wei Cai
- Stanford Health Care, Stanford, California, USA
| | - Meghan Delaney
- Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA
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Barnes LS, Al-Riyami AZ, Ipe TS, Bloch EM, Sibinga CS, Eichbaum QG. COVID-19 and the impact on blood availability and transfusion practices in low- and middle-income countries. Transfusion 2022; 62:336-345. [PMID: 35023585 DOI: 10.1111/trf.16798] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/04/2021] [Accepted: 12/12/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND/CASE STUDIES The coronavirus disease 2019 (COVID-19) pandemic disrupted the global blood supply. Low- and middle-income countries (LMICs) already experienced blood supply deficits that preceded the pandemic. We sought to characterize the challenges experienced during the pandemic, and adaptations, such as COVID-19 convalescent plasma (CCP). STUDY DESIGN/METHODS A cross-sectional survey explored blood availability, challenges, and adaptations. The survey contained 31 questions, e-mailed in English, French, or Spanish, to selected LMIC blood transfusion practitioners. Data acquisition occurred between October 28 and December 28, 2020. A mixed methods analysis followed. RESULTS/FINDINGS A total of 31 responses from 111 invitations represented 26 LMIC countries. Languages included English (22, 71%), Spanish (7, 22.6%), and French (2, 6.4%). Most respondents (29/31, 93.5%) collected blood; 58% also transfused blood (18/31). The supply of blood came from hospital-based blood donations (61%, 11/18); blood suppliers (17%, 3/18); and both sources (22%, 4/18). Collectively, 77.4% (24/31) of respondents experienced a decline in blood availability, ranging from 10% to 50%. Contributing factors included public fear of COVID-19 (21/24); stay-at-home measures (18/24); logistics (14/24); and canceled blood drives (16/24). Adaptations included increased collaboration within and between institutions (17/27), donor eligibility changes (21/31); social media or phone promotion (22/39); and replacement donation (3/27). Fifteen of 31 responses reported CCP donation (48.4%); CCP transfusion occurred in 6 (19.4%). The primary barrier was engaging recovered patients for donation (7/15). CONCLUSION Our survey describes challenges experienced by LMIC blood systems during the COVID-19 pandemic. While the decline in blood supplies was severe, adaptive measures included collaboration, outreach, and CCP programs.
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Affiliation(s)
- Linda S Barnes
- Biotherapies, AABB, Bethesda, Maryland, USA
- Doctor of Public Health Leadership Department, University of Illinois at Chicago, Chicago, Illinois, USA
- X-CellSystem, Inc., Seattle, Washington, USA
| | - Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Tina S Ipe
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cees Smit Sibinga
- International Development of Transfusion Medicine, University of Groningen, Zuidhorn, The Netherlands
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Abstract
The association between help-seeking and nearly lethal suicide attempts was evaluated using data from a population-based, case-control study of 153 13- to 34-year-old suicide attempt case-patients treated at emergency departments in Houston, Texas, and a random sample of 513 control-subjects. Measures of help-seeking included whether the participant sought help for health/emotional problems in the past month, type of consultant contacted, and whether suicide was discussed during the interaction. Overall, friends/family were consulted most frequently (48%). After controlling for potential confounders, case-patients were less likely than control-subjects to seek help from any consultant (OR = 0.5, 95% CI = 0.3-0.8) or a professional (e.g., physician, counselor) consultant (OR = 0.5, 95%CI = 0.29-0.8). Among those who sought help, case-patients were more likely than to discuss suicide (OR = 2.6, 95% CI = 1.2-5.4), particularly with professionals (OR = 11.8, 95% CI = 3.2-43.2). Our findings suggest that efforts to better understand the role of help-seeking in suicide prevention, including help sought from family and friends, deserves further attention.
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Affiliation(s)
- L S Barnes
- National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention in Atlanta, GA 30341, USA.
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Gill IJ, Overend DJ, Barnes LS. Parasitism in a rusa deer herd grazing irrigated pasture. Aust Vet J 1986; 63:97-8. [PMID: 3729843 DOI: 10.1111/j.1751-0813.1986.tb02946.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Barnes LS. SOME CONSIDERATIONS RELATING TO PAIN AND TENDERNESS IN ACUTE MASTOIDITIS. Can Med Assoc J 1933; 28:533-535. [PMID: 20319106 PMCID: PMC402842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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