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Rickey L, Zhang A, Dean N. Use of Evidence-Based Vital Signs in Pediatric Early Warning Score to Predict Clinical Deterioration on Acute Care Units. Clin Pediatr (Phila) 2024; 63:126-134. [PMID: 37036078 DOI: 10.1177/00099228231166264] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
The pediatric early warning score (PEWS) is a tool used to predict clinical deterioration. Referenced vital sign parameters are based on expert opinion but heart rate and respiratory rate percentiles in hospitalized children have been published. This retrospective case-control study of unplanned intensive care unit (ICU) transfers compares evidence-based vital signs (EBVS) effect on PEWS sensitivity and specificity, determines the impact of age categories on PEWS deterioration prediction, and evaluates whether EBVS PEWS is associated with need for invasive ICU supports. EBVS PEWS improved sensitivity (43%-71% vs 30%-63%) for unplanned transfers with slightly decreased specificity (88%-98% vs 93%-99%). Logistic regression analysis and odds ratios (ORs) demonstrated EBVS PEWS was associated with increased risk for ICU-specific supports (OR = 1.16, 95% confidence interval [CI] = 1.0-1.34, P = .0498). Evidence-based vital signs can improve PEWS sensitivity to identify unplanned ICU transfers and identify patients requiring ICU-specific interventions.
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Affiliation(s)
- Lisa Rickey
- Division of General Pediatrics of Pediatrics, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Anqing Zhang
- Division of Biostatistics and Study Methodology, Children's National Hospital, Washington, DC, USA
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Nathan Dean
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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2
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Rickey L, Auger K, Britto MT, Rodgers I, Field S, Odom A, Lehr M, Cronin A, Walsh KE. Measurement of Ambulatory Medication Errors in Children: A Scoping Review. Pediatrics 2023; 152:e2023061281. [PMID: 37986581 DOI: 10.1542/peds.2023-061281] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children use most medications in the ambulatory setting where errors are infrequently intercepted. There is currently no established measure set for ambulatory pediatric medication errors. We have sought to identify the range of existing measures of ambulatory pediatric medication errors, describe the data sources for error measurement, and describe their reliability. METHODS We performed a scoping review of the literature published since 1986 using PubMed, CINAHL, PsycINFO, Web of Science, Embase, and Cochrane and of grey literature. Studies were included if they measured ambulatory, including home, medication errors in children 0 to 26 years. Measures were grouped by phase of the medication use pathway and thematically by measure type. RESULTS We included 138 published studies and 4 studies from the grey literature and identified 21 measures of medication errors along the medication use pathway. Most measures addressed errors in medication prescribing (n = 6), and administration at home (n = 4), often using prescription-level data and observation, respectively. Measures assessing errors at multiple phases of the medication use pathway (n = 3) frequently used error reporting databases and prospective measurement through direct in-home observation. We identified few measures of dispensing and monitoring errors. Only 31 studies used measurement methods that included an assessment of reliability. CONCLUSIONS Although most available, reliable measures are too resource and time-intensive to assess errors at the health system or population level, we were able to identify some measures that may be adopted for continuous measurement and quality improvement.
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Affiliation(s)
- Lisa Rickey
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Katherine Auger
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria T Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Isabelle Rodgers
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Shayna Field
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Alayna Odom
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Madison Lehr
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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DiGiacomo D, Rickey L, Kirkorian A, Loomis J, Combs S, Jacobs S, Long M. A 9-Year-Old Girl With Painful "Spider Bites". Clin Pediatr (Phila) 2023; 62:645-648. [PMID: 36415052 DOI: 10.1177/00099228221139426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Daniel DiGiacomo
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Rickey
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Anna Kirkorian
- Department of Pediatrics, Children's National Hospital, Washington, DC, USA
- Division of Dermatology, Children's National Hospital, Washington, DC, USA
| | - Judyta Loomis
- Department of Pediatrics, Children's National Hospital, Washington, DC, USA
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, DC, USA
| | - Sarah Combs
- Department of Pediatrics, Children's National Hospital, Washington, DC, USA
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Shana Jacobs
- Department of Pediatrics, Children's National Hospital, Washington, DC, USA
- Division of Oncology, Children's National Hospital, Washington, DC, USA
| | - Melissa Long
- Department of Pediatrics, Children's National Hospital, Washington, DC, USA
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Kuzma N, Khan A, Rickey L, Hall M, Ramotar M, Spector ND, Landrigan CP, Srivastava R, Berry JG. Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions. J Hosp Med 2023; 18:316-320. [PMID: 36788740 DOI: 10.1002/jhm.13065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Children with complex chronic conditions (CCCs) are at risk for adverse events (AEs) during hospitalizations. OBJECTIVE We compared the effect of Patient and Family Centered (PFC)I-PASS on AE rates in children with and without CCCs. DESIGNS, SETTINGS, AND PARTICIPANTS Patients were drawn from the PFCI-PASS study, which included 3106 hospitalized children from seven North American pediatric hospitals between December 2014 and January 2017. MAIN OUTCOME AND MEASURES An effect modification analysis did not show difference in the intervention on children with and without CCCs (RRR 0.81, 95% CI [0.59-1.10]; p = .2). RESULTS In multivariable analysis, the adjusted incidence rate ratiofor AEs in children with CCCs was 0.5 (95% CI = 0.3-0.9, p = .01) with PFC I-PASS exposure; there was no statistically significant change in AEs for children without CCCs [IRR 0.6 (95% CI = 0.3-1.2; p = .1)].
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Affiliation(s)
- Nicholas Kuzma
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Alisa Khan
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lisa Rickey
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Matthew Ramotar
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nancy D Spector
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Christopher P Landrigan
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rajendu Srivastava
- Department of Pediatrics, University of Utah School of Medicine at Primary Children's Hospital, Salt Lake City, Utah, USA
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
| | - Jay G Berry
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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Choi J, St. Martin B, Swallow C, Rickey L, Harmanli O. Resection of infected sacrohysteropexy mesh. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rickey L, Shay R, Liddle D, Aldrich J, Schwartz B, Kim E, Shah R, Parikh K. A Pediatric Resident Safety Council: A Framework for Developing Quality and Safety Leadership. Hosp Pediatr 2021; 11:515-520. [PMID: 33903169 DOI: 10.1542/hpeds.2020-002519] [Citation(s) in RCA: 1] [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] [Indexed: 06/12/2023]
Abstract
Quality improvement (QI) and patient safety are essential to the practice of medicine. Specific training in these fields has become a requirement in graduate medical education, although there is great variation in how residency programs choose to approach trainee education in QI and patient safety. Residents have a unique vantage point into the operations of a health care system and can guide the development of system improvement initiatives. In this report, we (1) describe the context that led to the creation of a pediatric resident safety council (PRSC) in its current structure, (2) identify the organizational features implemented to best meet the objectives of this council, and (3) describe the local and institutional impact of the PRSC. A PRSC is a useful model to build resident engagement in safe and high-quality patient care within a residency program and health care system. A PRSC encourages the professional development of future pediatric safety leaders and facilitates experiential training in patient safety and QI science.
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Affiliation(s)
- Lisa Rickey
- Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts;
| | - Rebecca Shay
- Children's Hospital Colorado and University of Colorado Hospital, Aurora, Colorado
| | - David Liddle
- Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Bryanna Schwartz
- Children's National Hospital, Washington, District of Columbia; and
| | - Esther Kim
- Children's National Hospital, Washington, District of Columbia; and
| | - Rahul Shah
- Children's National Hospital, Washington, District of Columbia; and
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Kavita Parikh
- Children's National Hospital, Washington, District of Columbia; and
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
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Suh C, Rickey L, Bercik R, Harmanli O. 41: Sling plication for persistent stress urinary incontinence after midurethral sling. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Andiman S, Jorgensen E, Rickey L. 27: Robotic-assisted laparoscopic excision of bladder endometriosis with cystoscopic guidance. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Norton P, Brubaker L, Nager C, Stoddard A, Sirls L, Lemack G, Zyczynski H, Rickey L, Varner R. Pelvic Organ Prolapse in a Cohort of Women Treated for Stress Urinary Incontinence. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2013.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brubaker L, Litman HJ, Rickey L, Dyer KY, Markland AD, Sirls L, Norton P, Casiano E, Paraiso MFR, Ghetti C, Rahn DD, Kusek JW. Surgical preparation: are patients "ready" for stress urinary incontinence surgery? Int Urogynecol J 2013; 25:41-6. [PMID: 23912506 DOI: 10.1007/s00192-013-2184-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/27/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patient preparedness for stress urinary incontinence (SUI) surgery is associated with improvements in post-operative satisfaction, symptoms and quality of life (QoL). This planned secondary analysis examined the association of patient preparedness with surgical outcomes, treatment satisfaction and quality of life. METHODS The ValUE trial compared the effect of pre-operative urodynamic studies with a standardized office evaluation of outcomes of SUI surgery at 1 year. In addition to primary and secondary outcome measures, patient satisfaction with treatment was measured using a five-point Likert scale (very dissatisfied to very satisfied) that queried subjects to rate the treatment's effect on overall incontinence, urge incontinence, SUI, and frequency. Preparedness for surgery was assessed using an 11-question Patient Preparedness Questionnaire (PPQ). RESULTS Based on PPQ question 11, 4 out of 5 (81 %) of women reported they "agreed" or "strongly agreed" that they were prepared for surgery. Selected demographic and clinical characteristics were similar in unprepared and prepared women. Among SUI severity baseline measures, total UDI score was significantly but weakly associated with preparedness (question 11 of the PPQ; Spearman's r = 0.13, p = 0.001). Although preparedness for surgery was not associated with successful outcomes, it was associated with satisfaction (r s = 0.11, p = 0.02) and larger PGI-S improvement (increase; p = 0.008). CONCLUSIONS Approximately half (48 %) of women "strongly agreed" that they felt prepared for SUI. Women with higher pre-operative preparedness scores were more satisfied, although surgical outcomes did not differ.
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Affiliation(s)
- L Brubaker
- Departments of OG and Urology, Loyola University Chicago, Stritch School of Medicine, 2160 South First Avenue, Maywood, Chicago, IL, 60153, USA,
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Park-Windhol C, Zhang P, Zhu M, Su J, Chaves L, Maldonado AE, King ME, Rickey L, Cullen D, Mende U. Gq/11-mediated signaling and hypertrophy in mice with cardiac-specific transgenic expression of regulator of G-protein signaling 2. PLoS One 2012; 7:e40048. [PMID: 22802950 PMCID: PMC3388988 DOI: 10.1371/journal.pone.0040048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 05/31/2012] [Indexed: 01/19/2023] Open
Abstract
Cardiac hypertrophy is a well-established risk factor for cardiovascular morbidity and mortality. Activation of G(q/11)-mediated signaling is required for pressure overload-induced cardiomyocyte (CM) hypertrophy to develop. We previously showed that among Regulators of G protein Signaling, RGS2 selectively inhibits G(q/11) signaling and its hypertrophic effects in isolated CM. In this study, we generated transgenic mice with CM-specific, conditional RGS2 expression (dTG) to investigate whether RGS2 overexpression can be used to attenuate G(q/11)-mediated signaling and hypertrophy in vivo. Transverse aortic constriction (TAC) induced a comparable rise in ventricular mass and ANF expression and corresponding hemodynamic changes in dTG compared to wild types (WT), regardless of the TAC duration (1-8 wks) and timing of RGS2 expression (from birth or adulthood). Inhibition of endothelin-1-induced G(q/11)-mediated phospholipase C β activity in ventricles and atrial appendages indicated functionality of transgenic RGS2. However, the inhibitory effect of transgenic RGS2 on G(q/11)-mediated PLCβ activation differed between ventricles and atria: (i) in sham-operated dTG mice the magnitude of the inhibitory effect was less pronounced in ventricles than in atria, and (ii) after TAC, negative regulation of G(q/11) signaling was absent in ventricles but fully preserved in atria. Neither difference could be explained by differences in expression levels, including marked RGS2 downregulation after TAC in left ventricle and atrium. Counter-regulatory changes in other G(q/11)-regulating RGS proteins (RGS4, RGS5, RGS6) and random insertion were also excluded as potential causes. Taken together, despite ample evidence for a role of RGS2 in negatively regulating G(q/11) signaling and hypertrophy in CM, CM-specific RGS2 overexpression in transgenic mice in vivo did not lead to attenuate ventricular G(q/11)-mediated signaling and hypertrophy in response to pressure overload. Furthermore, our study suggests chamber-specific differences in the regulation of RGS2 functionality and potential future utility of the new transgenic model in mitigating G(q/11) signaling in the atria in vivo.
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Affiliation(s)
- Cindy Park-Windhol
- Cardiology Division, Cardiovascular Research Center, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Department of Molecular Pharmacology, Physiology and Biotechnology, Brown University, Providence, Rhode Island, United States of America
| | - Peng Zhang
- Cardiology Division, Cardiovascular Research Center, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Ming Zhu
- Cardiology Division, Cardiovascular Research Center, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Jialin Su
- Cardiology Division, Cardiovascular Research Center, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Leonard Chaves
- Cardiology Division, Cardiovascular Research Center, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Angel E. Maldonado
- Cardiology Division, Cardiovascular Research Center, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Michelle E. King
- Cardiology Division, Cardiovascular Research Center, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Lisa Rickey
- Cardiology Division, Cardiovascular Research Center, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Department of Molecular Pharmacology, Physiology and Biotechnology, Brown University, Providence, Rhode Island, United States of America
| | - Darragh Cullen
- Cardiac Muscle Research Laboratory, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ulrike Mende
- Cardiology Division, Cardiovascular Research Center, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
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Rickey L. Using simulation methods for orthopaedic implant design. Med Device Technol 2009; 20:46-47. [PMID: 19852183] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
New virtual test methods are being used to better understand the functional performance of implants within the musculoskeletal system. Developing validated virtual models and tests reduces prototyping costs and compresses product development cycles.
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Affiliation(s)
- L Rickey
- MSC Software, Santa Ana, California 92707,
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