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Arevian AC, Springgate B, Jones F, Starks SL, Chung B, Wennerstrom A, Jones L, Kataoka SH, Griffith K, Sugarman OK, Williams P, Haywood C, Kirkland A, Meyers D, Pasternak R, Simmasalam R, Tang L, Castillo EG, Mahajan A, Stevens M, Wells KB. The Community and Patient Partnered Research Network (CPPRN): Application of Patient-Centered Outcomes Research to Promote Behavioral Health Equity. Ethn Dis 2018; 28:295-302. [PMID: 30202181 DOI: 10.18865/ed.28.s2.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective We describe the rationale, development, and progress on the Community and Patient Partnered Research Network (CPPRN). The CPPRN builds on more than a decade of partnered work and is designed to promote health equity by developing partnered research on behavioral health and social risk factors in Los Angeles and New Orleans. Setting A community-academic partnership across Los Angeles County and New Orleans. Methods Review of rationale, history, structure, activities and progress in applying community partnered participatory research (CPPR) to CPPRN. Findings Patient and community stakeholders participated in all phases of development, including local and national activities. Key developments include partnered planning efforts, progress on aggregating a large, de-identified dataset across county agencies, and development of an information technology-supported screening approach for behavioral and social determinants in health care, social, and community-based settings. Conclusion The CPPRN represents a promising approach for research data networks, balancing the potential benefit of information technology and data analytic approaches while addressing potential risks and priorities of relevant stakeholders.
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Affiliation(s)
- Armen C Arevian
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Sarah L Starks
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services; Harbor-UCLA Medical Center; UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Loretta Jones
- Healthy African American Families II; Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Sheryl H Kataoka
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Krystal Griffith
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Olivia K Sugarman
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Pluscedia Williams
- Healthy African American Families II; Charles R Drew University of Medicine and Science, Los Angeles, CA
| | | | | | | | - Ryan Pasternak
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Rubinee Simmasalam
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Lingqi Tang
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Enrico G Castillo
- UCLA David Geffen School of Medicine; Los Angeles County Department of Mental Health, Los Angeles, CA
| | | | - Max Stevens
- Los Angeles County Chief Executive Office, Los Angeles, CA
| | - Kenneth B Wells
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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Ashoor I, Aviles D, Pasternak R, Vehaskari VM. Sexually transmitted infections in pediatric renal transplant recipients: Time to take notice! Pediatr Transplant 2015; 19:584-7. [PMID: 26108149 DOI: 10.1111/petr.12554] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2015] [Indexed: 01/22/2023]
Abstract
We sought to assess the prevalence of STIs, contraception use, and unintentional pregnancy in our pediatric renal transplant recipients. We performed a retrospective chart review. Forty-nine of 65 patients in our program are currently in the high-risk age window of 13 yr or older (34 men, 15 women; mean age 17 yr old, range 13-23 yr old). There was a disproportionate difference in sexual behavior among the men and women, such that while only 15% of the men reported being sexually active, 53% of the women were sexually active. Among high-risk age-group women, 40% were on hormonal contraception. This increased to 75% in sexually active women. There were no cases of unintentional pregnancy. Thirty percent of sexually active recipients had at least one STI. This was higher among sexually active women (37.5%) compared to men (20%). STIs identified included gonococcal and chlamydial urethritis/cervicitis, Trichomonas vaginitis, HSV-2 genital sores, pelvic inflammatory disease, and HIV. In conclusion, STIs are a realistic public health concern in our pediatric renal transplant recipients. Consensus guidelines on STI screening and reproductive health counseling are needed to address this understudied problem.
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Affiliation(s)
- Isa Ashoor
- Nephrology, Children's Hospital of New Orleans, New Orleans, LA, USA
| | - Diego Aviles
- Nephrology, Children's Hospital of New Orleans, New Orleans, LA, USA
| | - Ryan Pasternak
- Adolescent Medicine, Children's Hospital of New Orleans, New Orleans, LA, USA
| | - Vesa M Vehaskari
- Nephrology, Children's Hospital of New Orleans, New Orleans, LA, USA
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Abstract
OBJECTIVE This study determined whether perceived parental monitoring (PPM) is associated with any of twelve selected outcomes related to sexual risk behaviors of young Black males (YBM). METHODS Recruitment occurred in clinics diagnosing and treating sexually transmitted infections. YBM living with a parent or guardian (N = 324) were administered a 9-item scale assessing level of PPM. The obtained range was 10 - 45, with higher scores representing more frequent monitoring. RESULTS The mean was 29.3 (sd=7.0). Eight of the twelve outcomes had significant associations with PPM (all in a direction indicating a protective effect). Of these eight, five retained significance in age-adjusted models were ever causing a pregnancy, discussing pregnancy prevention, safer sex, and condom use with sex partners, and using a condom during the last act of penile-vaginal sex. CONCLUSION Monitoring by a parent figure may be partly protective against conceiving a pregnancy for Black males 15-23 years of age.
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Affiliation(s)
- Richard Crosby
- College of Public Health at the University of Kentucky ; The Kinsey Institute for Research in Sex, Gender, and Reproduction
| | - Ivy Terrell
- Department of Pediatrics at Louisiana State University Health Sciences Center-New Orleans
| | - Ryan Pasternak
- Department of Pediatrics at Louisiana State University Health Sciences Center-New Orleans
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Crosby RA, Graham CA, Milhausen RR, Sanders SA, Yarber WL, Salazar LF, Terrell I, Pasternak R. Desire to father a child and condom use: a study of young black men at risk of sexually transmitted infections. Int J STD AIDS 2014; 26:941-4. [PMID: 25505038 DOI: 10.1177/0956462414563623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/12/2014] [Indexed: 11/15/2022]
Abstract
To determine whether men's reported desire to father a child or their perception that someone wanted to have their child was associated with elevated rates of unprotected vaginal sex, we studied a sample of young Black men at high risk of sexually transmitted infection acquisition. Data were collected in clinics treating sexually transmitted infections in three southern U.S. cities. Men 15-23 years of age who identified as Black/African American and reported recent (past two months) penile-vaginal sex were eligible (N = 578). Logistic regression was used to examine whether desire to conceive a child (self and perception of partners' desire) predicted condom use, adjusting for age and whether they had previously impregnated someone. Their own level of desire to conceive a child was not significantly associated with unprotected vaginal sex or the proportion of times a condom was used. However, those who perceived higher level of someone wanting to conceive their child were 1.73 times more likely to report unprotected vaginal sex (P = .006) and 1.62 times more likely to report a lower proportion of times condoms were used (P = .019). Young Black men attending sexually transmitted infection clinics in the USA may forego condom use based on a perceived desire of their partners to become pregnant, putting themselves at risk for sexually transmitted infection acquisition and unplanned pregnancy. Findings provide initial support for the relevance of the idea that perceptions of women partners' desire to conceive may be a critical determinant of condomless sex.
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Affiliation(s)
- Richard A Crosby
- College of Public Health at the University of Kentucky, Lexington, KY, USA The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA
| | - Cynthia A Graham
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA Department of Psychology at the University of Southampton, Southampton, UK
| | - Robin R Milhausen
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA Department of Family Relations and Applied Nutrition at the University of Guelph, Guelph, ON, Canada
| | - Stephanie A Sanders
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA Department of Gender Studies, Indiana University, Bloomington, IN, USA
| | - William L Yarber
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA School of Public Health, Indiana University, Bloomington, IN, USA
| | - Laura F Salazar
- Institute of Public Health, Georgia State University, Atlanta, GA, USA
| | - Ivy Terrell
- Louisiana State University, Department of Pediatrics, New Orleans, LA, USA
| | - Ryan Pasternak
- Louisiana State University, Department of Pediatrics, New Orleans, LA, USA
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Crosby RA, Charnigo RJ, Salazar LF, Pasternak R, Terrell IW, Ricks J, Smith RV, Taylor SN. Enhancing condom use among Black male youths: a randomized controlled trial. Am J Public Health 2014; 104:2219-25. [PMID: 25211749 DOI: 10.2105/ajph.2014.302131] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested the efficacy of a brief intervention to promote correct and consistent use of condoms among Black male youths attending sexually transmitted infection (STI) clinics in 3 southern US cities. METHODS In 2010 to 2012, we screened (n = 1102) and enrolled (n = 702) youths aged 15 to 23 years who identified as Black and reported recent (past 2 months) sexual activity and randomized them to a private, brief, interactive intervention (n = 349) or an attention-equivalent control condition (n = 353). Assessments occurred at baseline and 2 and 6 months after the intervention. RESULTS At 6 months, with adjustment for age and pretest nonequivalence of the outcome variable, an estimated odds ratio (EOR) of 1.63 (95% confidence interval [CI] = 1.07, 2.49; P = .02) indicated efficacy for correct condom use. An adjusted generalized estimating equations model with both 2- and 6-month condom use variables produced an EOR of 1.49 (95% CI = 1.06, 2.08; P = .02). We did not observe significant effects on chlamydia and gonorrhea incidence. CONCLUSIONS This brief intervention, delivered as part of STI clinical care, could help alleviate the disproportionate STI-HIV burden among young Black men.
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Affiliation(s)
- Richard A Crosby
- Richard A. Crosby, Richard J. Charnigo, and Rachel V. Smith are with the College of Public Health, University of Kentucky, Lexington. Laura F. Salazar is with the Institute of Public Health, Georgia State University, Atlanta. Ryan Pasternak and Ivy Terrell are with the Health Sciences Center, and Stephanie N. Taylor is with the Delgado Personal Health Center STD Clinic, Louisiana State University, New Orleans. JaNelle Ricks is with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
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Crosby R, Pasternak R, Salazar LF, Terrell I. How do young black men having sex with only women differ from those also having sex with men? Sex Health 2014; 10:474-5. [PMID: 24119436 DOI: 10.1071/sh13113] [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: 07/26/2013] [Accepted: 08/06/2013] [Indexed: 11/23/2022]
Abstract
In the US, young Black men (YBM) disproportionately acquire sexually transmissible infections (STI), including infection with HIV. This secondary analysis compared sexual behaviours of YBM (n = 568) not reporting sex with men with those of YBM who have sex with men (YBMSM). In the present study YBMSM were generally less likely to report engagement in sexual risk behaviours, less likely to report incarceration and more likely to ever be tested for HIV. The findings suggest that elevated rates of HIV and/or STI among YBMSM may be a product of higher prevalence rates in sexual networks.
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Affiliation(s)
- Richard Crosby
- College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40506-0003, USA
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Hergenroeder A, Benson P, Britto M, Catallozzi M, D'Angelo L, Emans J, Kish E, Pasternak R, Slap G. Response to the commentary "Advancing medical education training in adolescent health". Pediatrics 2009; 123:e176-7; author reply e177-8. [PMID: 19117844 DOI: 10.1542/peds.2008-3050] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Albert Hergenroeder
- Division of Adolescent and Sports Medicine
Baylor College of Medicine and Texas Children's Hospital
Houston, Texas
| | - Paul Benson
- Division of Adolescent Medicine
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio
| | - Maria Britto
- Division of Adolescent Medicine
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio
| | - Marina Catallozzi
- Division of Adolescent Medicine
Columbia University
College of Physicians and Surgeons
New York, New York
| | - Lawrence D'Angelo
- Division of Adolescent Medicine
Children's National Medical Center
Center for Community Pediatric Health
Washington, DC
| | - Jean Emans
- Division of Adolescent/Young Adult Medicine
Children's Hospital
Boston, Massachusetts
| | - Erin Kish
- Division of Adolescent and Sports Medicine
Baylor College of Medicine and Texas Children's Hospital
Houston, Texas
| | - Ryan Pasternak
- Department of Pediatrics
Louisiana State University School of Medicine
New Orleans, Louisiana
| | - Gail Slap
- Department of Pediatrics
University of Pennsylvania School of Medicine and Children's Hospital
Philadelphia, Pennsylvania
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8
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Agwu AG, Pasternak R, Joyner M, Carver CL, Francis HW, Siberry GK. Nontypeable Haemophilus influenzae meningitis complicated by hearing loss in a 9-year-old HIV-infected boy. AIDS Patient Care STDS 2006; 20:531-5. [PMID: 16893321 DOI: 10.1089/apc.2006.20.531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 9-year old boy with perinatal HIV infection developed meningitis due to nontypeable Haemophilus influenzae. His course was complicated by progressive hearing loss due to labyrinthitis ossificans. Placement of cochlear implant improved hearing thresholds. Nontypeable H. influenzae meningitis and use of cochlear implants have not previously been in HIV-infected children.
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Affiliation(s)
- Allison George Agwu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA
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Cheitlin MD, Gerstenblith G, Hazzard WR, Pasternak R, Fried LP, Rich MW, Krumholz HM, Peterson E, Reves JG, McKay C, Saksena S, Shen WK, Akhtar M, Brass LM, Biller J. AHA Conference Proceedings: Do existing databases hold the answers to clinical questions in geriatric cardiovascular disease and stroke? Executive Summary. Database Conference, January 27-30, 2000. Washington, DC, USA. Circulation 2001; 104:E39. [PMID: 11502721 DOI: 10.1161/hc3001.095127] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cheitlin MD, Gerstenblith G, Hazzard WR, Pasternak R, Fried LP, Rich MW, Krumholz HM, Peterson E, Reves JG, McKay C, Saksena S, Shen WK, Akhtar M, Brass LM, Biller J. Database Conference January 27-30, 2000, Washington D.C.--Do existing databases answer clinical questions about geriatric cardiovascular disease and stroke? Am J Geriatr Cardiol 2001; 10:207-23. [PMID: 11455241 DOI: 10.1111/j.1076-7460.2003.00696.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
EXECUTIVE SUMMARY: Most randomized, controlled trials evaluating the effectiveness of pharmaceutical, surgical, and device interventions for the prevention and treatment of cardiovascular disease have excluded patients over 75 years of age. Consequently, the use of these therapies in the older population is based on extrapolation of safety and effectiveness data obtained from younger patients. However, there are many registries and observational databases that contain large amounts of data on patients 75 years of age and older, as well as on younger patients. Although conclusions from such data are limited, it is possible to define the characteristics of patients who did well and those who did poorly. The goal of this conference was to convene the principal investigators of these databases, and others in the field of geriatric cardiology, to address questions relating to the safety and effectiveness of treatment interventions for several cardiovascular conditions in the elderly. Seven committees discussed the following topics: (I) Risk Factor Modification in the Elderly; (II) Chronic Heart Failure; (III) Chronic Coronary Artery Disease: Role of Revascularization; (IV) Acute Myocardial Infarction; (V) Valve Surgery in the Elderly; (VI) Electrophysiology, Pacemaker, and Automatic Internal Cardioverter Defibrillators Databases; (VII) Carotid Endarterectomy in the Elderly. The chairs of these committees were asked to invite principal investigators of key databases in each of these areas to discuss and prepare a written statement concerning the available safety and efficacy data regarding interventions for these conditions and to identify and prioritize areas for future study. The ultimate goal is to stimulate further collaborative outcomes research in the elderly so as to place the treatment of cardiovascular disease on a more scientific basis.
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Affiliation(s)
- M D Cheitlin
- Division of Cardiology, San Francisco General Hospital, San Francisco, CA, USA
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Grundy SM, Pasternak R, Greenland P, Smith S, Fuster V. AHA/ACC scientific statement: Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 1999; 34:1348-59. [PMID: 10520820 DOI: 10.1016/s0735-1097(99)00387-3] [Citation(s) in RCA: 267] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grundy SM, Pasternak R, Greenland P, Smith S, Fuster V. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation 1999; 100:1481-92. [PMID: 10500053 DOI: 10.1161/01.cir.100.13.1481] [Citation(s) in RCA: 635] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mosca L, Grundy SM, Judelson D, King K, Limacher M, Oparil S, Pasternak R, Pearson TA, Redberg RF, Smith SC, Winston M, Zinberg S. Guide to Preventive Cardiology for Women.AHA/ACC Scientific Statement Consensus panel statement. Circulation 1999; 99:2480-4. [PMID: 10318674 DOI: 10.1161/01.cir.99.18.2480] [Citation(s) in RCA: 231] [Impact Index Per Article: 9.2] [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: 11/16/2022]
Affiliation(s)
- L Mosca
- American Heart Association, Public Information, Dallas, TX 75231-4596, USA
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Mosca L, Grundy SM, Judelson D, King K, Limacher M, Oparil S, Pasternak R, Pearson TA, Redberg RF, Smith SC, Winston M, Zinberg S. AHA/ACC scientific statement: consensus panel statement. Guide to preventive cardiology for women. American Heart Association/American College of Cardiology. J Am Coll Cardiol 1999; 33:1751-5. [PMID: 10334455 DOI: 10.1016/s0735-1097(99)00190-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Trzepacz PT, Mulsant BH, Dew MA, Pasternak R, Sweet RA, Zubenko GS. Is delirium different when it occurs in dementia? A study using the delirium rating scale. J Neuropsychiatry Clin Neurosci 1998; 10:199-204. [PMID: 9608409 DOI: 10.1176/jnp.10.2.199] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The authors studied 61 geropsychiatric patients with delirium from a cohort of 843 consecutive admissions to a geriatric clinical research unit. A central study goal was to assess how the presence of dementia affected the presentation of delirium. Eighteen delirious (D) and 43 delirious-demented (D-D) patients were compared on the Delirium Rating Scale (DRS), Mini-Mental State Examination (MMSE), Brief Psychiatric Rating Scale (BPRS), and EEG. D-D patients had lower MMSE scores, but no differences were found in total DRS or BPRS scores or in EEG grade. DRS items were similar in the two groups except that D-D had more cognitive impairment than D. An exploratory principal components analysis of DRS items identified two core factors. The authors conclude that the presentation of delirium in the setting of concurrent dementia is very similar to delirium without dementia, with subtle differences probably attributable to dementia.
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Affiliation(s)
- P T Trzepacz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson 39216, USA
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Pasternak R, Rosenweig A, Booth B, Fox A, Morycz R, Mulsant B, Sweet R, Zubenko GS, Reynolds CF, Shear MK. Morbidity of homebound versus inpatient elderly psychiatric patients. Int Psychogeriatr 1998; 10:117-25. [PMID: 9677499 DOI: 10.1017/s1041610298005237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study compares the demographic and clinical characteristics of homebound (HB) elders referred for psychiatric services (N = 251) with those of inpatients (IP) admitted to a geriatric psychiatry unit (N = 594). Demographically, HB patients were older (78.8 vs 74.7 years), were more likely to be women (83% vs 68%), were widowed (54% vs. 44%), and had fewer years of education (10.3 vs. 11.1), but were similar in race, income, and proportion living alone. Clinically, HB patients had less functional disability, less severe depression, less cognitive impairment, and fewer medical problems. However, they were similar in the distribution of most psychiatric diagnoses except dementia (higher in the IP group) and dementia with depression (higher in the HB group). Outcome data for the HB group over 15 (range, 1 to 38) months revealed medical hospitalization in 20.7%, psychiatric hospitalization in 16.3%, nursing home placement in 9.2% and mortality in 8.4%. These preliminary data show that the HB group had psychiatric problems that were comparable to those of the IP group but were not as severely impaired.
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Affiliation(s)
- R Pasternak
- University of Pittsburgh School of Medicine, Western Psychiatry Institute and Clinic, Pennsylvania, USA.
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Abstract
The aim of this pilot study was to compare cerebral changes on magnetic resonance imaging (MRI) scans in elderly schizophrenic subjects with those in psychiatric and normal control subjects. We compared the MRIs of 19 subjects with schizophrenia, 19 age- and gender-matched subjects with recurrent major depression, and 19 age- and gender-matched nonpsychiatric control subjects. Deep white matter hyperintensities (DWMH) in right posterior regions were significantly more prominent in the schizophrenic group than in the two comparison groups. Total ratings of MRI abnormalities were significantly related to age in both the normal control and schizophrenic groups, but not in the depressive group. Age of onset was positively associated with total ratings in the depressive group, but not in the schizophrenic group. Thus, a subset of elderly patients with schizophrenia appear to have cerebral white matter abnormalities; such abnormalities may not be confined to late-onset schizophrenia. Systematic MRI studies of early- and late-onset schizophrenia in late life are needed to resolve this question.
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Affiliation(s)
- M S Keshavan
- Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213-2593, USA
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Abstract
Among 547 elderly inpatients grouped by DSM-III-R axis I diagnoses, the diagnostic rate of comorbid personality disorder varied four-fold, from 6% in patients with an organic mental disorder to 24% in those with major depression. The previously reported low prevalence of comorbid personality disorder in geriatric patients may be due to its lower rate of diagnosis among patients with organic mental disorders.
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Affiliation(s)
- M E Kunik
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA
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Feldman M, Pasternak R, Paul S. Morbidity and mortality after ambulatory surgery. JAMA 1994; 271:823. [PMID: 8114230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Fabrega H, Mulsant BM, Rifai AH, Sweet RA, Pasternak R, Ulrich R, Zubenko GS. Ethnicity and psychopathology in an aging hospital-based population. A comparison of African-American and Anglo-European patients. J Nerv Ment Dis 1994; 182:136-44. [PMID: 8113773 DOI: 10.1097/00005053-199403000-00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study analyzes the effect of ethnicity, classified as African-American and Anglo-European, on diagnosis, symptomatology, and response to inpatient treatment in a sample of geriatric patients of a research unit of a tertiary care facility. Variables that might confound the effects of ethnicity, such as age, gender, education, and associated diagnoses, were statistically controlled. Psychotic diagnoses were significantly associated with ethnicity, being higher in African-Americans, weakening the claim that such an association stems from the confounding effects of social class. Variability in the ratings on the Brief Psychiatric Rating Scale and Hamilton Depression Scale was significantly associated with ethnicity in several instances. African-Americans appeared to obtain comparatively higher therapeutic benefits from hospitalization. Results are discussed using knowledge of the field of cultural and social psychiatry.
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Affiliation(s)
- H Fabrega
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pennsylvania 15213
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Abstract
The Delirium Rating Scale (DRS) has been shown to be a valid instrument for identifying and grading the severity of delirium in patients admitted to a general hospital for medical or surgical treatment. However, its accuracy in identifying delirium among elderly patients admitted to a psychiatric hospital for evaluation and treatment of psychiatric illness has not been previously addressed. The DRS was administered to 791 elderly patients who were consecutively admitted to a psychogeriatric unit; 70 met DSM-III-R criteria for delirium. A DRS threshold score of > or = 10 correctly identified delirious patients with a sensitivity of 94% and a specificity of 82%. Both psychosis and cognitive impairment appeared to falsely elevate the DRS score in this population.
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Affiliation(s)
- J Rosen
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213
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Mulsant BH, Stergiou A, Keshavan MS, Sweet RA, Rifai AH, Pasternak R, Zubenko GS. Schizophrenia in late life: elderly patients admitted to an acute care psychiatric hospital. Schizophr Bull 1993; 19:709-21. [PMID: 8303222 DOI: 10.1093/schbul/19.4.709] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Although a considerable body of biological and clinical data has been accumulated on the mood disorders and organic disorders of late life, only a handful of studies have focused on aging schizophrenia patients. Using the results of a comprehensive evaluation of all elderly patients admitted over a 30-month period to a 26-bed acute care geriatric unit, we compared the demographic, social, and clinical characteristics of schizophrenia patients, patients with recurrent major depression with and without psychotic features, and patients with primary degenerative dementia of the Alzheimer's type with and without delusions. The main findings of this study are that elderly schizophrenia patients were younger, more often African-American, more often single, and poorer than the other groups. A concomitant history of substance abuse and institutionalization as an outcome were more frequent among schizophrenia patients. Like the older depressed and demented patients, schizophrenia patients were predominantly female and commonly presented with several medical disorders. The potential significance of these findings is discussed in the context of the literature on the long-term outcome of schizophrenia.
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Affiliation(s)
- B H Mulsant
- Geriatric Clinical Research Unit, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213
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Deedwania P, Cheitlin M, Das S, Pool P, Singh J, Pasternak R, Carabello B. Double-blind crossover comparison of amlodipine at three dose levels and placebo in chronic stable angina. Am Heart J 1989; 118:1132-3. [PMID: 2530874 DOI: 10.1016/0002-8703(89)90844-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 01/01/2023]
Affiliation(s)
- P Deedwania
- Veterans Administration Medical Center, Fresno, CA 93703
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Pasternak R, Brodziak A. [Establishing the theoretical and experimental principles of a simple medical neurolinguistic test]. Pol Tyg Lek 1988; 43:756-9. [PMID: 3237515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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30
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Brodziak A, Pasternak R. [The nature of pain perception]. Wiad Lek 1988; 41:195-208. [PMID: 2842968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
Three city data sources (CDSs)--police reports, ambulance reports, and medica examiner (ME) logs--were evaluated for their usefulness in epidemiologic studies of trauma. The CDSs were employed to identify all cases of penetrating injury to the chest and/or abdomen severe enough to require care in a medical institution during 1979 and 1980 in Baltimore city. The percent of cases identified by source was: police, 66.8%; ambulance, 47.9%; ME, 16.6%; police plus ambulance, 89.4%; police plus ME, 82.9%; and ambulance plus ME, 50.1%. Hospital admissions to six study hospitals due to chest and/or abdomen penetrating injury were located and matched to the CDS reports: 89.2% of the hospitalized cases were reported in one or more CDS, and 34.7% of the cases identified by one or more CDS could not be located in the hospital records. Using hospital records as the standard, each source was determined to have the following completeness of case reporting: police, 66.2%; ambulance, 72.9%; and ME, 92.2%. The authors conclude that existing CDSs should be used with caution, and that the usefulness of data from multiple sources far outweighs that from any single source.
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DiPasquale G, Caccese R, Pasternak R, Conaty J, Hubbs S, Perry K. Proteoglycan- and collagen-degrading enzymes from human interleukin 1-stimulated chondrocytes from several species: proteoglycanase and collagenase inhibitors as potentially new disease-modifying antiarthritic agents. Proc Soc Exp Biol Med 1986; 183:262-7. [PMID: 3020566 DOI: 10.3181/00379727-183-42416] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Human IL-1-stimulated chondrocytes derived from rabbit, bovine, and human articular cartilage produce proteoglycan- and collagen-degrading enzymes. These studies demonstrate that the biological activity of IL-1 is not species specific. Several thiol, carboxyalkyl, and hydroxamic acid peptide inhibitors showed differential effects. The thiols were equipotent inhibitors of both the collagen- and proteoglycan-degrading enzymes whereas the carboxyalkyls appear to inhibit solely the proteoglycan-degrading enzyme(s). The hydroxamic acid peptides, the most potent inhibitors, appear to be more active against the proteoglycan-degrading enzymes. These synthetic inhibitors of proteoglycan- and/or collagen-degrading enzymes may represent a new class of disease-modifying antiarthritic agents.
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Brodziak A, Amanowicz K, Pasternak R. [Neuronal memory and the nature of the imagination]. Pol Tyg Lek 1986; 41:771-6. [PMID: 3774605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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34
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DiPasquale G, Caccese R, Pasternak R, Caputo CB, Conaty J, Hubbs S. Lack of response of rat chondrosarcoma chondrocytes to interleukin-1 to produce proteoglycan- and collagen-degrading enzymes. Res Commun Chem Pathol Pharmacol 1986; 52:333-9. [PMID: 3526479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Chondrocytes obtained from rat articular cartilage and Swarm rat chondrosarcoma were maintained in culture. Human interleukin-1 (IL-1) was added at confluency, and three days later the spent media was evaluated for proteoglycan- and collagen-degrading enzymes. Unlike chondrocytes from articular cartilage from several species, chondrocytes from Swarm rat chondrosarcoma did not respond to IL-1 stimulation. This lack of sensitivity to IL-1 may be a useful biochemical marker to classify various types of chondrosarcomas. However, it appears that the use of chondrosarcoma chondrocyte cultures are not useful as a source for metalloproteinases.
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Pasternak R. Oral health status in the United States: implications for dental education. J Dent Educ 1986; 50:160-1. [PMID: 3456363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Lewis BS, Hasin Y, Pasternak R, Gotsman MS. Echocardiographic aortic root motion in ventricular volume overload and the effect of mitral incompetence. Eur J Cardiol 1979; 10:375-84. [PMID: 510347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Echocardiographic aortic root motion in systole was studied in 57 patients: 13 normal subjects, 4 patients with left ventricular (LV) volume overload due to anaemia, 16 patients with mitral incompetence, 13 with aortic incompetence and 11 with mitral stenosis. In normal subjects, patients with mitral stenosis and in patients with LV volume overload, in whom the increased stroke volume was ejected forwards into the ascending aorta (anaemia, aortic incompetence) the amplitude of motion of the posterior aortic wall (vp), the aortic widening fraction (AWF) and total aortic motion (TAM) were increased. In mitral incompetence, however, despite the large increase in total LV stroke index, there was a decrease in vp (P less than 0.01), AWF (P less than 0.001) and TAM (P less than 0.001), and the decrease in aortic motion for a given stroke index was related to the mitral regurgitant fraction, indicating that aortic wall movement in systole depended predominantly on forward ejection of the LV stroke volume. Reduced echocardiographic aortic root motion and widening during systole are useful echocardiographic signs of mitral regurgitation.
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Meyer A, Pasternak R. Through-bond and through-space interactions. Tetrahedron 1977. [DOI: 10.1016/0040-4020(77)80143-9] [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: 10/18/2022]
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Abstract
To evaluate the fate of the boronary arteries after aortocoronary bypass, 40 patients underwent serial selective coronary angiographic studies 1 year apart, and the frequency of progression of coronary artery disease was estimated. Thirty-two had saphenous vein bypass surgery after the first procedure, six had Vineberg operations, and two had no interim operation. In each patient, the right, left, anterior descending and circumflex coronary arteries (including their branches) were separately evaluated. Progressive narrowing was evident in 31 of 50 (62 per cent) bypassed vessels and in only 11 to 113 (9.7 per cent) nonbypassed arteries (p less than 0.001). Coronary arteries with moderate to severe obstruction initially (50 to 99 per cent occluded) manifested progressive diseasee more frequently (33 of 70 arteries) than did arteries that were normal or mildly narrowed initially (4 of 71) (p less than 0.001. Considering only those vessels with 50 to 99 per cent obstruction initially, 27 of 35 (77 per cent) of the bypassed arteries and only 6 of 35 (17 per cent) of the nonbypassed arteries showed progression (p less than 0.001). We conclude that moderately or severely narrowed coronary arteries are more likely to show progressive narrowing than normal or mildly obstructed ones and that progression of coronary disease is greater in bypassed vessels than in nonbypassed vessels. In view of potential graft closure, the implications of these findings must be considered in selecting patients for aortocoronary bypass.
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Kisslo J, Wolfson S, Ross A, Pasternak R, Hammond G, Cohen LS. Ultrasound assessment of left ventricular function following aortocoronary saphenous vein bypass grafting. Circulation 1973; 48:III156-61. [PMID: 4541744 DOI: 10.1161/01.cir.48.1s3.iii-156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Three serial determinations of left ventricular function were performed by echocardiographic techniques in ten patients undergoing aortocoronary saphenous vein grafting for occlusive coronary artery disease. There were significant increases in maximum posterior wall velocity, mean posterior wall velocity, amplitude of left ventricular wall excursion, and ejection fraction when the preoperative values were compared with those obtained one week and six weeks after surgery. Improvements in these indices seemed independent of heart rate and blood pressure and, therefore, probably reflected an improvement in ventricular function attributable to surgery. These data, of course, must be interpreted with care in patients with coronary artery disease who may have asynchronous ventricular contraction. The findings in this paper support previously reported data showing enhancement of ventricular function following aortocoronary saphenous vein grafting and provide a means for the serial evaluation of large numbers of patients by noninvasive techniques.
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Pasternak R. Letter to the editor: "Insurance surplus awarded to Research and Education Foundation". Bull Tenth Dist Dent Soc (Rockville Centre) 1970; 22:10. [PMID: 5266222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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44
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Pasternak R. Reasoning in the continuum. Bull Tenth Dist Dent Soc (Rockville Centre) 1969; 21:6-7. [PMID: 5252871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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45
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Gorelick L, Pasternak R. Fingersucking in children with cleft palate. N Y State Dent J 1969; 35:94-9. [PMID: 5249278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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46
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Hughes ED, Ingold CK, Pasternak R. 784. Mechanism of elimination reactions. Part XVIII. Kinetics and steric course of elimination from isomeric benzene hexachlorides. ACTA ACUST UNITED AC 1953. [DOI: 10.1039/jr9530003832] [Citation(s) in RCA: 8] [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: 11/21/2022]
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48
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