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Patel R, Wee S, Ramaswamy R, Thadani S, Guruswamy G, Garg R, Calvanese N, Valko M, Rush A, Rentería M, Sarkar J, Kollins S. NeuroBlu: a natural language processing (NLP) electronic health record (EHR) data analytic tool to generate real-world evidence in mental healthcare. Eur Psychiatry 2022. [PMCID: PMC9563510 DOI: 10.1192/j.eurpsy.2022.286] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
EHRs contain a rich source of real-world data that can support evidence generation to better understand mental disorders and improve treatment outcomes. However, EHR datasets are complex and include unstructured free text data that are time consuming to manually review and analyse. We present NeuroBlu, a secure, cloud-based analytic tool that includes bespoke NLP software to enable users to analyse large volumes of EHR data to generate real-world evidence in mental healthcare. ![]()
Objectives (i) To assemble a large mental health EHR dataset in a secure, cloud-based environment. (ii) To apply NLP software to extract data on clinical features as part of the Mental State Examination (MSE). (iii) To analyse the distribution of NLP-derived MSE features by psychiatric diagnosis. Methods EHR data from 25 U.S. mental healthcare providers were de-identified and transformed into a common data model. NLP models were developed to extract 241 MSE features using a deep learning, long short-term memory (LSTM) approach. The NeuroBlu tool (https://www.neuroblu.ai/) was used to analyse the associations of MSE features in 543,849 patients. ![]()
Results The figure below illustrates the percentage of patients in each diagnostic category with at least one recorded MSE feature. ![]()
Conclusions Delusions and hallucinations were more likely to be recorded in people with schizophrenia and schizoaffective disorder, and cognitive features were more likely to be recorded in people with dementia. However, mood symptoms were frequently recorded across all diagnoses illustrating their importance as a transdiagnostic clinical feature. NLP-derived clinical information could enhance the potential of EHR data to generate real-world evidence in mental healthcare. Disclosure This study was funded in full by Holmusk.
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Davies M, Rimer R, Mani N, Kim S, Ramaswamy R, Malone C. Abstract No. 612 Impact of number of inflow lymphatics on efficacy of lymphangiography and embolization of postoperative groin and pelvic lymphoceles. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.673] [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] Open
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Nazeri A, Robinson X, Ramaswamy R, Malone C. 3:27 PM Abstract No. 367 Impact of time interval between computed tomography angiography and transcatheter angiography in reproducibility of arterial extravasation in lower gastrointestinal bleeding. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.427] [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: 11/26/2022] Open
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Liu K, Ramaswamy R, Guevara C, Kim S. 04:21 PM Abstract No. 402 Intranodal lymphangiography with thoracic duct embolization for chyle leak after head and neck surgeries. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.478] [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: 11/27/2022] Open
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Noda C, Yoon J, Raman H, Zhou M, Malone C, Ramaswamy R, Akinwande O. 04:12 PM Abstract No. 110 Comparative outcomes of liver-dominant metastatic neuroendocrine tumors treated with bland embolization, radioembolization, or chemoembolization in a single institution. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.156] [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: 11/26/2022] Open
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Khaddash T, Mokkarala M, Malone C, Kim S, Mani N, Ramaswamy R, Akinwande O. 03:09 PM Abstract No. 432 Effectiveness of carcinoembryonic antigen (CEA) vs. Response Evaluation Criteria in Solid Tumors (RECIST) response as survival predictors for patients with metastatic colorectal cancer following radioembolization (TARE). J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.512] [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: 10/27/2022] Open
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Mokkarala M, Noda C, Lancia S, Ramaswamy R, Akinwande O. 03:09 PM Abstract No. 326 Effectiveness of drug-eluting bead transarterial chemoembolization (DEB-TACE) and radioembolization (TARE) for patients with wild-type KRAS and mutant KRAS status. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.395] [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] Open
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Charalel R, Chang J, Noda C, Ramaswamy R, Foltz G, Darcy M, Akinwande O. 3:18 PM Abstract No. 324 Chemoembolization vs. radioembolization for the treatment of hepatic metastases from breast cancer: a comparative study. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.360] [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: 10/17/2022] Open
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Majumdar S, Shoela R, Kim D, Ramaswamy R, Mani N, Salter A, Akinwande O. Abstract No. 640 Endovascular treatment of SVC syndrome secondary to fibrosing mediastinitis: a feasibility and safety analysis. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.685] [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: 11/24/2022] Open
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Ramaswamy R, Raman H, Jun E, Mani N, Kim S, Akinwande O. Abstract No. 647 Denali, Tulip, and Option inferior vena cava filter retrieval: a single-center experience. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.692] [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: 10/17/2022] Open
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Som A, Akinwande O, Connolly S, Ramaswamy R, Foltz G. Abstract No. 461 Development of iShadow, an automated shadowing program to expose first year medical students to interventional radiology. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.506] [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] Open
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Majumdar S, Akinwande O, Mani N, Picus D, Kim S, Darcy M, Ramaswamy R. Abstract No. 617 Technical predictors of initial transjugular intrahepatic portosystemic shunt dysfunction. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.662] [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] Open
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Kwak D, Ramaswamy R, Harrod M, Duncan J. Abstract No. 613 Comparing patient radiation exposure in standard and intravascular ultrasound-guided transjugular intrahepatic portosystemic shunt (TIPS) creation procedures. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.658] [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] Open
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Zhou M, Mills A, Noda C, Ramaswamy R, Akinwande O. 4:03 PM Abstract No. 247 Surveillance, Epidemiology, and End Results (SEER) survival study of stage T1a renal cell carcinoma treated with ablation vs. partial nephrectomy: a propensity-matched analysis. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.276] [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: 10/17/2022] Open
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Fung D, Kim S, Ramaswamy R, Salter A, Mani N, Akinwande O. 3:27 PM Abstract No. 36 Comparison of pathologic treatment response between conventional and doxorubicin-eluting bead chemoembolization in explanted livers. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.044] [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: 10/17/2022] Open
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Charalel R, Akinwande O, Picus D, Som A, Guevara C, Kavali P, Kim S, Giardina J, Darcy M, Ramaswamy R. 3:09 PM Abstract No. 283 Propensity-matched comparison of transjugular intrahepatic portosytemic shunt placement techniques: intravascular ultrasound versus fluoroscopic guidance. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.315] [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: 10/17/2022] Open
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Gould A, Akinwande O, Foltz G, Gould J, Molloy C, Sarah C, Darcy M, Ramaswamy R. 4:03 PM Abstract No. 299 Factors influencing selection of an interventional radiology training program. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.332] [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: 11/26/2022] Open
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Cassinadane AV, Ramaswamy R, Hussain SA, Govindarajan R, Srinivasan AR. Evaluation of Vitamin B12 status in type 2 Diabetes Mellitus Patients on Metformin therapy. Asian J Med Sci 2018. [DOI: 10.3126/ajms.v9i2.18806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: B12 deficiency is a silent epidemic with serious consequences. Long term use of metformin has been associated with malabsorption of vitamin B12 leading to its deficiency along with increased homocysteine levels. With this background we designed this study to assess the status of vitamin B12 and its markers in type 2 diabetes mellitus patients on metformin therapy who are attending tertiary care hospital in the peripheral area of Pondicherry.Aims and Objective: The current study aims to study the relationship if any, between the glycemic status and the status of Vitamin B12 among T2DM patients on metformin therapy.Materials and Methods: A case control study was done with a sample size of 100 (50 case and 50 control). The patients were selected according to the inclusion criteria and their blood sample were analyzed for the various parameters. The markers of vitamin B12 status are studied among both the control and the patients with T2DM on metformin therapy and compared with their glycaemic status.Results: There is a significant increase in the levels of FBS, HbA1c, insulin and C-peptide in the study group. It was observed that the mean levels of homocysteine and Methylmalonic acid were significantly higher with lower levels of vitamin B12 in patients who were on metformin therapy.Conclusion: There is moderate correlation between the markers of B12 status and levels of fasting blood sugar as well as HbA1C. There is a significant correlation between insulin and C-peptide with the markers of vitamin B12 status.Asian Journal of Medical Sciences Vol.9(2) 2018 9-12
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Cassinadane AV, Ramaswamy R, Govindarajan R, Srinivasan AR. A genetic perspective of Metformin induced Vitamin B12 deficiency in Type 2 Diabetes mellitus patients. Asian J Med Sci 2018. [DOI: 10.3126/ajms.v9i1.18723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Metformin, a commonly prescribed hypoglycemic agent is a first line medication for the management of Type 2 diabetes mellitus. Numerous studies have depicted that metformin therapy has been associated with vitamin B12 and folate deficiency. Vitamin B12 deficiency is frequently missed or misdiagnosed by the clinicians because it is not routinely tested by most of the physicians, further the low end of the laboratory reference range is too low and misinterpreted as diabetic peripheral neuropathy. Vitamin B12 deficiency is a silent epidemic with serious consequences. Long term use of metformin has been associated with increased homocysteine levels and malabsorption of vitamin B12 leading to its deficiency and neurological manifestations. Polymorphisms of certain genes associated with the metabolism of vitamin B12 and folate might help in predicting the deficiency status of vitamin B12.Asian Journal of Medical Sciences Vol.9(1) 2018 11-14
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Jayanthi R, Srinivasan AR, Gopal N, Ramaswamy R. Association of divalent cations and insulin resistance with thyroid hormones in patients with type 2 diabetes mellitus. Diabetes Metab Syndr 2017; 11 Suppl 2:S885-S890. [PMID: 28701285 DOI: 10.1016/j.dsx.2017.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Received: 06/04/2017] [Accepted: 07/01/2017] [Indexed: 12/12/2022]
Abstract
AIM The study was primarily aimed at investigating the association of Magnesium and Zinc levels in the serum of adult Non- obese and Obese type 2 diabetic patients, with particular reference to thyroid comorbidity. METHODS 108 patients with T2DM of both genders (24 Non obese and 84 Obese) were enrolled from a tertiary health care unit in Puducherry. The cardio-metabolic risk factors were assessed through body mass index, Waist hip ratio, blood pressure, fasting blood glucose, lipid profile and glycated haemoglobin. Zinc and Magnesium were quantitated. Insulin resistance was by Homeostasis model assessment. Serum free T4, T3 and TSH were also measured. RESULTS In non-obese type 2 diabetic group, Glycated haemoglobin had a strong positive correlation with free T4(r=0.784; p=0.003).TSH also depicted a positive association with HOMA-IR (r=0.924; p<0.001); whereas,T3 and Insulin had negative correlation with Magnesium (r=-0.599* and r=-0.620*; p 0.04 and 0.031). The levels of Zinc and Magnesium in the serum of obese diabetic patients had a positive correlation among them (r=0.565#; p<0.001). TAG/HDL ratio a measure of small dense LDL is positively correlated with LDL in both groups (r=0.881 and 0.912) with p value<0.001 for both. CONCLUSION Correlation among Glycemic control, Insulin resistance, Thyroid hormones, divalent cations and dyslipidemia depict differential characteristics in obese and non-obese type2 diabetes with Thyroid comorbidity.
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Affiliation(s)
- Rajendran Jayanthi
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - Abu Raghavan Srinivasan
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India.
| | - Niranjan Gopal
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - Ramesh Ramaswamy
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
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Alexe G, Dalgin G, Ramaswamy R, Delisi C, Bhanot G. Data Perturbation Independent Diagnosis and Validation of Breast Cancer Subtypes Using Clustering and Patterns. Cancer Inform 2017. [DOI: 10.1177/117693510600200006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Molecular stratification of disease based on expression levels of sets of genes can help guide therapeutic decisions if such classifications can be shown to be stable against variations in sample source and data perturbation. Classifications inferred from one set of samples in one lab should be able to consistently stratify a different set of samples in another lab. We present a method for assessing such stability and apply it to the breast cancer (BCA) datasets of Sorlie et al. 2003 and Ma et al. 2003. We find that within the now commonly accepted BCA categories identified by Sorlie et al. Luminal A and Basal are robust, but Luminal B and ERBB2+ are not. In particular, 36% of the samples identified as Luminal B and 55% identified as ERBB2+ cannot be assigned an accurate category because the classification is sensitive to data perturbation. We identify a “core cluster” of samples for each category, and from these we determine “patterns” of gene expression that distinguish the core clusters from each other. We find that the best markers for Luminal A and Basal are (ESR1, LIV1, GATA-3) and (CCNE1, LAD1, KRT5), respectively. Pathways enriched in the patterns regulate apoptosis, tissue remodeling and the immune response. We use a different dataset (Ma et al. 2003) to test the accuracy with which samples can be allocated to the four disease subtypes. We find, as expected, that the classification of samples identified as Luminal A and Basal is robust but classification into the other two subtypes is not.
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Affiliation(s)
- G. Alexe
- Computational Biology Center, IBM Thomas J. Watson Research Center, Yorktown Heights, NY 10598, U.S.A
- The Simons Center for Systems Biology, Institute for Advanced Study, Princeton NJ 08540, U.S.A
| | - G.S. Dalgin
- Molecular Biology, Cell Biology and Biochemistry Program, Boston University, 2 Cummington Street, Boston, MA 02215, U.S.A
| | - R. Ramaswamy
- The Simons Center for Systems Biology, Institute for Advanced Study, Princeton NJ 08540, U.S.A
- School of Information Technology, Jawaharlal Nehru University, New Delhi 110 067, India
| | - C. Delisi
- Biomedical Engineering, Boston University, 44 Cummington Street, Boston, MA 02215, U.S.A
| | - G. Bhanot
- Computational Biology Center, IBM Thomas J. Watson Research Center, Yorktown Heights, NY 10598, U.S.A
- The Simons Center for Systems Biology, Institute for Advanced Study, Princeton NJ 08540, U.S.A
- Biomedical Engineering, Boston University, 44 Cummington Street, Boston, MA 02215, U.S.A
- Department of Biomedical Engineering and BioMaPS Institute, Rutgers University, Piscataway, NJ 08854
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Owen M, Goodman D, Pfeiffer E, Ramaswamy R, Olufolabi A, Tetteh C, Srofenyoh E. The Impact of a Triage System Designed to Reduce Waiting Time and
Prioritize Care for High-Risk Obstetric Patients in a Ghanaian Regional
Hospital. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Goodman D, Ramaswamy R, Jeuland M, Srofenyoh E, Engmann C, Olufolabi A, Owen M. Evaluating the Cost-Effectiveness of an Integrated Program to Reduce
Maternal and Neonatal Mortality in Ghana. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.495] [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: 10/19/2022] Open
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Petcharoen H, Suwanpong N, Ramaswamy R. Participatory Capacity Building Strategies for Improving Quality of Child
Care Centers in Thailand. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.251] [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: 11/25/2022] Open
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Kim D, Raman H, Ramaswamy R, Salter A, Weiss C, Akinwande O. Retrospective analysis of outcomes related to left gastric artery embolization. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.751] [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: 11/25/2022] Open
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Abstract
Diallyl bisphenol A–formaldehyde copolymer (ABPF) was addition cured with bisphenol A bismaleimide (BMIP) making use of the Alder-ene reaction at high temperatures. The lap shear strength (LSS) of the system was found to depend on the conditions of cure and the stoichiometry of the reactants. Moderate cross linking achieved at a 1:1 maleimide:allylphenol stoichiometry and a stepwise cure, up to a maximum of 250 °C for 2 h, was found to be the most effective in achieving the optimum LSS properties. The system exhibited greater than 100% retention of the LSS at temperatures up to 250 °C. Matrix modification using polysulfone (PS) and polycarbonate (PC) resulted in a remarkable improvement in the adhesive characteristics, although the high-temperature retention was marginally adversely affected. The performance advantage both at room temperature (RT) and at high temperature was greater in the case of PS modification, showing an optimum improvement at 20% loading as against PC modification, exhibiting maximum properties at 10% loading. Scanning electron microscopy (SEM) analysis confirmed that the fine dispersion of PS, rather than large size nodules found in PC, was conducive for the better performance of the former. Dynamic mechanical analysis (DMA) corroborated the observations made in SEM. The existence of co-continuous phases of thermoplastic, matrix and thermoplasticdissolved matrix was evidenced in the PS modification and a clear phase separation was evident in the case of the PC modified system, manifesting independent glass transitions by the individual phases.
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Affiliation(s)
| | | | - R Ramaswamy
- Polymers and Special Chemicals Division, Vikram Sarabhai Space Centre, Thiruvananthapuram-695022, India
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Ramaswamy R, Owen M, Srofenyoh E. Building integrated clinical and operational capacity to reduce maternal
and neonatal mortality at Ridge Regional Hospital at Accra, Ghana. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.107] [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] Open
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Narsinh K, Shaw G, DeYoung E, Ramaswamy R, Kikolski S, Rose S. FEATURED ABSTRACT. Surrogate markers of embolization endpoint during hepatic arterial oncologic interventions using anti-reflux devices: potential role for intraprocedural hepatic arterial pressure measurement. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.104] [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] Open
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Sandrasegaran K, Tahir B, Patel A, Ramaswamy R, Bertrand K, Akisik FM, Saxena R. The usefulness of diffusion-weighted imaging in the characterization of liver lesions in patients with cirrhosis. Clin Radiol 2013; 68:708-15. [PMID: 23510619 DOI: 10.1016/j.crad.2012.10.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 09/25/2012] [Accepted: 10/16/2012] [Indexed: 12/23/2022]
Abstract
AIM To evaluate if diffusion-weighted imaging (DWI) is useful in characterizing liver lesions in patients with cirrhosis. MATERIALS AND METHODS A retrospective review revealed 37 patients with cirrhosis who had 41 histologically proven hepatocellular carcinoma (HCC) lesions. Another 20 patents with cirrhosis had 29 solid nodules that remained stable for at least 12 months and were deemed to be benign hepatic nodules (BHN). Of the HCC lesions, 14 were well-differentiated (WD HCC), 20 were moderately differentiated, and seven were poorly differentiated histology. For all lesions, two reviewers analysed signal characteristics and made apparent diffusion coefficient value (ADC) measurements. RESULTS Visual analysis of DWI was useful in that no HCC was hypointense and no BHN was hyperintense to liver. Visual analysis of DWI was not useful in separating WD HCC from higher grades. There was substantial overlap in ADC values of the HCC and BHN. Among HCC lesions, ADC values of more than 0.99 × 10(-3) mm(2)/s had sensitivity and specificity of 85% and 86% for reviewer 1, and 63% and 64% for reviewer 2 in diagnosing WD HCC. CONCLUSIONS ADC measurements of BHN were higher than that of HCC, and the ADC values of WD HCC were higher than that of more aggressive grades of HCC. However, quantitative measurements may not help in determining the histological grade of individual cases of HCC.
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Affiliation(s)
- K Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Alam MJ, Devi GR, Singh RKB, Ramaswamy R, Thakur SC, Sharma BI. Stochastic synchronization of interacting pathways in testosterone model. Comput Biol Chem 2012; 41:10-7. [PMID: 23131789 DOI: 10.1016/j.compbiolchem.2012.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 07/13/2012] [Accepted: 08/05/2012] [Indexed: 11/26/2022]
Abstract
We examine the possibilities of various coupling mechanisms among a group of identical stochastic oscillators via Chemical Langevin formalism where each oscillator is modeled by stochastic model of testosterone (T) releasing pathway. Our results show that the rate of synchrony among the coupled oscillators depends on various parameters namely fluctuating factor, coupling constants [symbol; see text], and interestingly on system size. The results show that synchronization is achieved much faster in classical deterministic system rather than stochastic system. Then we do large scale simulation of such coupled pathways using stochastic simulation algorithm and the detection of synchrony is measured by various order parameters such as synchronization manifolds, phase plots etc and found that the proper synchrony of the oscillators is maintained in different coupling mechanisms and support our theoretical claims. We also found that the coupling constant follows power law behavior with the systems size (V) by [symbol; see text] ~ AV(-γ), where γ=1 and A is a constant. We also examine the phase transition like behavior in all coupling mechanisms that we have considered for simulation. The behavior of the system is also investigated at thermodynamic limit; where V → ∞, molecular population, N → ∞ but N/V → finite, to see the role of noise in information processing and found the destructive role in the rate of synchronization.
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Affiliation(s)
- Md Jahoor Alam
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India
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Banerjee R, Ghosh D, Padmanaban E, Ramaswamy R, Pecora LM, Dana SK. Enhancing synchrony in chaotic oscillators by dynamic relaying. Phys Rev E Stat Nonlin Soft Matter Phys 2012; 85:027201. [PMID: 22463360 DOI: 10.1103/physreve.85.027201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 12/09/2011] [Indexed: 05/31/2023]
Abstract
In a chain of mutually coupled oscillators, the coupling threshold for synchronization between the outermost identical oscillators decreases when a type of impurity (in terms of parameter mismatch) is introduced in the inner oscillator(s). The outer oscillators interact indirectly via dynamic relaying, mediated by the inner oscillator(s). We confirm this enhancing of critical coupling in the chaotic regimes of the Lorenz system, in the Rössler system in the absence of coupling delay, and in the Mackey-Glass system with delay coupling. The enhancing effect is experimentally verified in the electronic circuit of Rössler oscillators.
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Affiliation(s)
- Ranjib Banerjee
- Department of Mathematics, Gargi Memorial Institute of Technology, Kolkata, India
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Sandrasegaran K, Patel AA, Ramaswamy R, Samuel VP, Northcutt BG, Frank MS, Francis IR. Characterization of adrenal masses with diffusion-weighted imaging. Int Braz J Urol 2011. [DOI: 10.1590/s1677-55382011000600020] [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: 11/21/2022] Open
Affiliation(s)
| | - AA Patel
- Indiana University School of Medicine
| | | | - VP Samuel
- Indiana University School of Medicine
| | | | - MS Frank
- Indiana University School of Medicine
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Tahir B, Sandrasegaran K, Ramaswamy R, Bertrand K, Mhapsekar R, Akisik FM, Saxena R. Does the hepatocellular phase of gadobenate dimeglumine help to differentiate hepatocellular carcinoma in cirrhotic patients according to histological grade? Clin Radiol 2011; 66:845-52. [PMID: 21771548 DOI: 10.1016/j.crad.2011.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 03/23/2011] [Indexed: 02/09/2023]
Abstract
AIM To assess the role of the hepatocellular phase on magnetic resonance imaging (MRI) following gadobenate in characterizing the grade of hepatocellular carcinoma (HCC) in cirrhotic patients. MATERIALS AND METHODS A retrospective review of the MRI database from October 2004 to February 2009, performed for this Institutional Review Board-approved and Health Insurance Portability and Accountability Act (HIPAA)-complaint study, revealed 237 cirrhotic patients with focal liver lesions. Patients who had both a hepatocellular phase after gadobenate and pathological confirmation of HCC were included. Forty-six patients with 73 HCC were analysed independently by two reviewers for signal characteristics. Absolute contrast-to-noise ratio (CNR) and enhancement ratio (ER) were calculated. Univariate analysis, stepwise logistic regression analysis, and receiver operating characteristic curves (ROC) were performed. RESULTS The mean age was 61.3 years (range 45 to 78 years). There were 11 females and 35 males, who had 22 well-differentiated (WD HCC), 35 moderately-differentiated (MD HCC), and 16 poorly-differentiated (PD HCC) hepatocellular carcinomas. On visual analysis of the hepatocellular phase, a hyperintense or isointense lesion had a sensitivity and specificity of 45% and 76%, respectively, for WD HCC. On quantitative analysis, the only significant predictor of the grade of HCC was the ER on the hepatocellular phase (p=0.019 and 0.001 for the two reviewers in logistic regression model). On ROC analysis, an ER of >13% was 47% sensitive and 89% specific in predicting WD HCC histology. CONCLUSION Although the hepatocellular phase of gadobenate may help to differentiate some cases of WD HCC from the more aggressive grades, there is overlap between the different grades on qualitative and quantitative analysis.
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Affiliation(s)
- B Tahir
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Rossi AB, Leyden JJ, Pappert AS, Ramaswamy A, Nkengne A, Ramaswamy R, Nighland M. A pilot methodology study for the photographic assessment of post-inflammatory hyperpigmentation in patients treated with tretinoin. J Eur Acad Dermatol Venereol 2011; 25:398-402. [DOI: 10.1111/j.1468-3083.2010.03798.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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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Ramaswamy R, Kosashvili Y, Cameron H. Total hip replacement in patients with multiple epiphyseal dysplasia with a mean follow-up of 15 years and survival analysis. ACTA ACUST UNITED AC 2010; 92:489-95. [DOI: 10.1302/0301-620x.92b4.22897] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The hip joint is commonly involved in multiple epiphyseal dysplasia and patients may require total hip replacement before the age of 30 years. We retrospectively reviewed nine patients (16 hips) from four families. The diagnosis of multiple epiphyseal dysplasia was based on a family history, genetic counselling, clinical features and radiological findings. The mean age at surgery was 32 years (17 to 63), with a mean follow-up of 15.9 years (5.5 to 24). Of the 16 hips, ten required revision at a mean of 12.5 years (5 to 15) consisting of complete revision of the acetabular component in three hips and isolated exchange of the liner in seven. No femoral component has loosened or required revision during the period of follow-up. With revision for any reason, the 15-year survival was only 11.4% (95% confidence interval 1.4 to 21.4). However, when considering revision of the acetabular shell in isolation the survival at ten years was 93.7% (95% confidence interval 87.7 to 99.7), reducing to 76.7% (95% confidence interval 87.7 to 98.7) at 15 and 20 years, respectively.
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Affiliation(s)
| | - Y. Kosashvili
- Orthopaedic Department Division of Arthroplasty, Assaf Harofeh Hospital, Zerrifin, 70300 Israel
| | - H. Cameron
- Holland Orthopaedic and Arthritic Centre, 43 Wellesley Street, East Toronto, Ontario M4Y 1H1, Canada
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Cruz JM, Escalona J, Parmananda P, Karnatak R, Prasad A, Ramaswamy R. Phase-flip transition in coupled electrochemical cells. Phys Rev E Stat Nonlin Soft Matter Phys 2010; 81:046213. [PMID: 20481813 DOI: 10.1103/physreve.81.046213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 03/15/2010] [Indexed: 05/29/2023]
Abstract
Time delay is introduced in the coupling between a pair of electrochemical cells. As coupling parameters are varied, the anodic current in the two cells oscillate in synchrony in regimes of periodic as well as chaotic dynamics. When the time delay is varied a phase-flip transition is observed: the relative phase between the synchronized oscillations changes abruptly by pi . This is accompanied by an experimentally measurable discontinuous change in the frequency of the synchronized oscillators.
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Affiliation(s)
- J M Cruz
- Facultad de Ciencias, UAEM, Avenida Universidad 1001, Colonia Chamilpa, Cuernavaca, Morelos, México
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Ramaswamy R, Kosashvili Y, Cameron HU, Cameron JC. Total knee replacement with rotational proximal tibial osteotomy for osteoarthritis with severe external tibial torsion and patellar instability. ACTA ACUST UNITED AC 2009; 91:1466-71. [DOI: 10.1302/0301-620x.91b11.22658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The management of osteoarthritis of the knee associated with patellar instability secondary to external tibial torsion > 45° is challenging. Patellofemoral biomechanics in these patients cannot be achieved by intra-articular correction using standard techniques of total knee replacement. We reviewed seven patients (eight knees) with recurrent patellar dislocation and one with bilateral irreducible lateral dislocation who had undergone simultaneous total knee replacement and internal tibial derotational osteotomy. All had osteoarthritis and severe external tibial torsion. The mean follow-up was for 47.2 months (24 to 120). The mean objective and functional Knee Society scores improved significantly (p = 0.0001) from 29.7 and 41.5 pre-operatively to 71.4 and 73.5 post-operatively, respectively. In all patients the osteotomies healed and patellar stability was restored. Excessive external tibial torsion should be identified and corrected in patients with osteoarthritis and patellar instability. Simultaneous internal rotation osteotomy of the tibia and total knee replacement is a technically demanding but effective treatment for such patients.
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Affiliation(s)
- R. Ramaswamy
- Holland Orthopaedic and Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario, Canada, M4Y 1H1
| | - Y. Kosashvili
- Holland Orthopaedic and Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario, Canada, M4Y 1H1
| | - H. U. Cameron
- Holland Orthopaedic and Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario, Canada, M4Y 1H1
| | - J. C. Cameron
- Holland Orthopaedic and Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario, Canada, M4Y 1H1
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Abstract
Osteogenesis imperfecta is a rare inherited disorder of connective tissue which may present with recurrent fractures which are prone to nonunion and malunion resulting in deformity. Some patients develop osteoarthritis of the hip. Formation of hyperplastic callus after recurrent fractures may deform the shape of the femur and preclude the use of standard implants at joint replacement. Replacement can thus be technically demanding. We present a case of bilateral hip replacement in a patient with osteogenesis imperfecta and hyperplastic callus which was treated by the use of long femoral allografts and cemented femoral stems.
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Affiliation(s)
- R. Ramaswamy
- Holland Orthopaedic and Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario, Canada M4Y 1H1
| | - Y. Kosashvili
- Holland Orthopaedic and Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario, Canada M4Y 1H1
| | - H. Cameron
- Holland Orthopaedic and Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario, Canada M4Y 1H1
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Ngamga EJ, Nandi A, Ramaswamy R, Romano MC, Thiel M, Kurths J. Recurrence analysis of strange nonchaotic dynamics. Phys Rev E Stat Nonlin Soft Matter Phys 2007; 75:036222. [PMID: 17500784 DOI: 10.1103/physreve.75.036222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Indexed: 05/15/2023]
Abstract
We present methods to detect the transitions from quasiperiodic to chaotic motion via strange nonchaotic attractors (SNAs). These procedures are based on the time needed by the system to recur to a previously visited state and a quantification of the synchronization of trajectories on SNAs. The applicability of these techniques is demonstrated by detecting the transition to SNAs or the transition from SNAs to chaos in representative quasiperiodically forced discrete maps. The fractalization transition to SNAs--for which most existing diagnostics are inadequate--is clearly detected by recurrence analysis. These methods are robust to additive noise, and thus can be used in analyzing experimental time series.
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Affiliation(s)
- E J Ngamga
- Nonlinear Dynamics Group, Institute of Physics, University of Potsdam, Potsdam 14415, Germany
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Alexe G, Dalgin G, Ramaswamy R, DeLisi C, Bhanot G. Data perturbation independent diagnosis and validation of breast cancer subtypes using clustering and patterns. Cancer Inform 2007; 2:243-74. [PMID: 19458770 PMCID: PMC2675483] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Molecular stratification of disease based on expression levels of sets of genes can help guide therapeutic decisions if such classifications can be shown to be stable against variations in sample source and data perturbation. Classifications inferred from one set of samples in one lab should be able to consistently stratify a different set of samples in another lab. We present a method for assessing such stability and apply it to the breast cancer (BCA) datasets of Sorlie et al. 2003 and Ma et al. 2003. We find that within the now commonly accepted BCA categories identified by Sorlie et al. Luminal A and Basal are robust, but Luminal B and ERBB2+ are not. In particular, 36% of the samples identified as Luminal B and 55% identified as ERBB2+ cannot be assigned an accurate category because the classification is sensitive to data perturbation. We identify a "core cluster" of samples for each category, and from these we determine "patterns" of gene expression that distinguish the core clusters from each other. We find that the best markers for Luminal A and Basal are (ESR1, LIV1, GATA-3) and (CCNE1, LAD1, KRT5), respectively. Pathways enriched in the patterns regulate apoptosis, tissue remodeling and the immune response. We use a different dataset (Ma et al. 2003) to test the accuracy with which samples can be allocated to the four disease subtypes. We find, as expected, that the classification of samples identified as Luminal A and Basal is robust but classification into the other two subtypes is not.
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Affiliation(s)
- G. Alexe
- Computational Biology Center, IBM Thomas J. Watson Research Center, Yorktown Heights, NY 10598, U.S.A, The Simons Center for Systems Biology, Institute for Advanced Study, Princeton NJ 08540, U.S.A
| | - G.S. Dalgin
- Molecular Biology, Cell Biology and Biochemistry Program, Boston University, 2 Cummington Street, Boston, MA 02215, U.S.A
| | - R. Ramaswamy
- The Simons Center for Systems Biology, Institute for Advanced Study, Princeton NJ 08540, U.S.A, School of Information Technology, Jawaharlal Nehru University, New Delhi 110 067, India
| | - C. DeLisi
- Biomedical Engineering, Boston University, 44 Cummington Street, Boston, MA 02215, U.S.A
| | - G. Bhanot
- Computational Biology Center, IBM Thomas J. Watson Research Center, Yorktown Heights, NY 10598, U.S.A, The Simons Center for Systems Biology, Institute for Advanced Study, Princeton NJ 08540, U.S.A, Biomedical Engineering, Boston University, 44 Cummington Street, Boston, MA 02215, U.S.A, Department of Biomedical Engineering and BioMaPS Institute, Rutgers University, Piscataway, NJ 08854,Correspondence: Gyan Bhanot.
; Fax: 609-951-4438
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Francis B, Thomas S, Sadhana R, Thuaud N, Ramaswamy R, Jose S, Rao VL. Diglycidyl ether of bisphenol-A epoxy resin modified using poly(ether ether ketone) with pendenttert-butyl groups. ACTA ACUST UNITED AC 2007. [DOI: 10.1002/polb.21238] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Francis B, Ramaswamy R, Lakshmana Rao V, Thomas S. Toughening of Diglycidyl Ether of Bisphenol-A Epoxy Resin Using Poly (Ether Ether Ketone) with Pendent Ditert-Butyl Groups. INT J POLYM MATER PO 2006. [DOI: 10.1080/00914030500323326] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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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Francis B, Rao VL, Vanden Poel G, Posada F, Groeninckx G, Ramaswamy R, Thomas S. Cure kinetics, morphological and dynamic mechanical analysis of diglycidyl ether of bisphenol-A epoxy resin modified with hydroxyl terminated poly(ether ether ketone) containing pendent tertiary butyl groups. POLYMER 2006. [DOI: 10.1016/j.polymer.2006.05.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Affiliation(s)
- M Damodaran
- The University Biochemical Laboratory, Chepauk, Madras
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46
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Abstract
We demonstrate a technique for the enhancement of chaos in a computational model of a periodically stimulated excitable neuron. "Anticontrol" of chaos is achieved through intermittent adaptive intervention, which is based on finite-time Lyapunov exponents measured from the time series. Our results suggest that an adaptive strategy for chaos anticontrol is viable for increasing the complexity in physiological systems that are typically both noisy and nonstationary.
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Affiliation(s)
- Kopal Gupta
- Department of Physics and Astrophysics, University of Delhi, Delhi 110007, India
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Abraham G, Packirisamy S, Ramaswamy R. Adhesive and Thermal Properties of Epoxy-Imide Resins Obtained from Different Diimide-Diacids: Structure-Property Correlations. INT J POLYM MATER PO 2006. [DOI: 10.1080/009140390916503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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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Abstract
Penetrating injuries involving the spinal cord are not common. The incidence is, however, much higher in armed conflict. In a civilian population, gunshot wounds and stabbings account for the majority of such injuries. A pencil causing penetrating injury involving the spinal cord is very rare. We present the case of a young boy who accidentally suffered a penetrating injury involving the spinal cord from a pencil in his coat pocket.
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Abraham G, Packirisamy S, Ramaswamy R, Thomas S. Epoxy-Imide Resins from N-(4- and 3-Carboxyphenyl) Trimellitimides: Modified with Reactive Rubbers. INT J POLYM MATER PO 2005. [DOI: 10.1080/009140390894120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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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Francis B, Thomas S, Jose J, Ramaswamy R, Lakshmana Rao V. Hydroxyl terminated poly(ether ether ketone) with pendent methyl group toughened epoxy resin: miscibility, morphology and mechanical properties. POLYMER 2005. [DOI: 10.1016/j.polymer.2005.10.103] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [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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