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McKevitt S, Jinks C, Healey EL, Quicke JG. The attitudes towards, and beliefs about, physical activity in people with osteoarthritis and comorbidity: A qualitative investigation. Musculoskeletal Care 2021; 20:167-179. [PMID: 34245657 DOI: 10.1002/msc.1579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the attitudes towards, and beliefs about, physical activity (PA) in older adults with osteoarthritis (OA) and comorbidity to understand experiences and seek ways to improve PA participation. METHODS Semi-structured interviews with adults aged ≥45, with self-reported OA and comorbidity (N = 17). Face-to-face interviews explored participant perspectives regarding; (1) attitudes and beliefs about PA in the context of OA and comorbidity and (2) how people with OA and comorbidity could be encouraged to improve and maintain PA levels. Data were transcribed verbatim and inductive thematic analysis was undertaken using a framework approach. RESULTS Participants did not conceptualise multiple long-term conditions (LTCs) together and instead self-prioritised OA over other LTCs. Barriers to PA included uncertainty about both the general management of individual LTCs and the effectiveness of PA for their LTCs; and, negative perceptions about their health, ageing and PA. Participants experienced dynamic and co-existing barriers to PA, and problematized this as a multi-level process, identifying a barrier, then a solution, followed by a new barrier. Facilitators of PA included social support and support from knowledgeable healthcare professionals (HCPs), together with PA adapted for OA and comorbidity and daily life. PA levels could be increased through targeted interventions to increase self-efficacy for managing OA alongside other LTCs and self-efficacy for PA. CONCLUSION People with OA and comorbidity experience complicated PA barriers. To increase PA levels, tailored PA interventions could include HCP and social support to anticipate and overcome multi-level PA barriers and target increased self-efficacy for LTC management and PA.
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Affiliation(s)
- Sarah McKevitt
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Clare Jinks
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Emma L Healey
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Jonathan G Quicke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK.,Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
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McKevitt S, Healey E, Jinks C, Rathod-Mistry T, Quicke J. The association between comorbidity and physical activity levels in people with osteoarthritis: Secondary analysis from two randomised controlled trials. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100057. [PMID: 32596692 PMCID: PMC7307638 DOI: 10.1016/j.ocarto.2020.100057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
Objective To determine whether comorbidity presence, frequency or type is associated with Physical Activity (PA) levels in people with Osteoarthritis (OA). Design Secondary data analysis of adults aged ≥45, with OA related pain recruited to the BEEP trial (knee pain, n = 514) (ISRCTN93634563) and the MOSAICS trial (peripheral joint pain, n = 525) (ISRCTN06984617). Comorbidities considered were respiratory, cardiovascular diseases (CVD), depression, type 2 diabetes and obesity. Self-report PA was measured using the Physical Activity Scale for the Elderly (PASE). Linear regression models were used to estimate the mean change (β) in PA with comorbidity presence, frequency and type adjusting for potential confounding covariates. Results In the BEEP trial comorbidity presence was associated with a decrease in PASE score (β = -32.25 [95% confidence interval (95% CI) −48.57, −15.93]). Each additional comorbidity was associated with an incrementally lower PASE score, one comorbidity (β = −24.42 [-42.45, −6.38]), two comorbidities β = −34.76 [-56.05, −13.48]), and three or more comorbidities β = −73.71 [-106.84, −40.58]) compared to those with no comorbidity. This pattern was similar in MOSAICS, but with a plateau in association from two comorbidities onward. In BEEP and MOSAICS, respiratory (β = −40.60 [-60.50, −20.35]; β = −11.82 [-34.95, 11.31]) and CVD (β = −27.15 [-53.25, −1.05]; β = −30.84 [-51.89, −9.80]) comorbidities were associated with the largest reduction in PASE scores respectively. Conclusion Comorbidity presence and frequency is associated with lower PA levels and respiratory and CVD comorbidities have the greatest impact. Future exploratory work needs to be done to understand how and why comorbidity is associated with PA levels in people with OA.
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Affiliation(s)
- Sarah McKevitt
- School of Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, ST5 5BG, UK
| | - Emma Healey
- School of Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, ST5 5BG, UK
| | - Clare Jinks
- School of Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, ST5 5BG, UK
| | - Trishna Rathod-Mistry
- School of Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, ST5 5BG, UK
| | - Jonathan Quicke
- School of Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, ST5 5BG, UK
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Late-onset systemic lupus erythematosus: characteristics and outcome in comparison to juvenile- and adult-onset patients-a multicenter retrospective cohort. Clin Rheumatol 2019; 39:435-442. [PMID: 31758421 DOI: 10.1007/s10067-019-04776-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/21/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the characteristics and outcome of systemic lupus erythematosus (SLE) among elderly-onset patients. METHODS This study included 575 SLE patients managed at Cairo, Alexandria, and Helwan universities from August 2014 to 2018: of whom 49 (8.5%), 420 (73%), and 106 (18.4%) were elderly- (> 50 years), adult- (17-50 years), and juvenile- (≤ 16 years) onset patients, respectively. Cumulative characteristics were recorded. Disease activity at the last visit was investigated through the Systemic Lupus Erythematosus Disease Activity Index-2K (SLEDAI-2K), whereby lupus low disease activity (LLDA) was defined as a SLEDAI-2K score ≤ 4. The disease outcome was assessed through investigating disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)) and the prevalence of mortality. Quantitative and categorical data were compared using Kruskal-Wallis and Mann-Whitney tests, and chi-square (χ2) test, respectively. RESULTS Late-onset SLE (LSLE) patients demonstrated the lowest prevalence of constitutional and mucocutaneous manifestations (p < 0.001), serositis (p = 0.006), nephritis (p < 0.001), neuropsychiatric involvement (p < 0.001), and hypocomplementinemia (p < 0.001), but showed the highest prevalence of comorbidities and multimorbidity (comorbidities ≥ 2) (p < 0.001), and positive anti-ds DNA antibodies (p < 0.001). Elderly-onset patients demonstrated the lowest SLEDAI-2K and SDI scores, achieved LLDA the most (p < 0.001), and developed any damage (SDI ≥ 1) the least (p < 0.001). The prevalence of mortality was comparable across the three age groups (p = 0.6). CONCLUSIONS Late-onset SLE patients (8.5%) showed the lowest prevalence of major organ involvement and the highest prevalence of comorbidities, and demonstrated more favorable disease activity and damage indices.Key Points• The disease characteristics and outcome among LSLE patients are characterized by being controversial, with studies from the Middle East being limited. Our cohort constituted of 8.5% elderly-onset SLE patients-who were characterized by the lowest prevalence of major organ involvement and the lowest activity and damage indices-making the disease pattern more favorable in this age group, despite being characterized by the highest prevalence of comorbidities.
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Badley EM, Goulart CM, Millstone DB, Perruccio AV. An Update on Arthritis in Canada - National and Provincial Data Regarding the Past, Present, and Future. J Rheumatol 2019; 46:579-586. [PMID: 30770501 DOI: 10.3899/jrheum.180147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To provide updated arthritis estimates for Canada given a change in wording in the 2015 Canadian Community Health Survey (CCHS) arthritis question. METHODS Prevalence data from the 2000 to 2016 CCHS were used to document trends in the prevalence of arthritis over time. Projections of arthritis prevalence were also calculated using data from CCHS 2015 in conjunction with Statistics Canada's published population projections. Data for 2015 were also used to provide summary data on the effect of arthritis. RESULTS Between 2000 and 2014 there were some fluctuations in the prevalence of arthritis (age ≥ 15 yrs), with the range of prevalence varying between 15.4% and 17.6%. There was a significant increase in overall prevalence to over 20% with the 2015 and 2016 surveys (6 million Canadians), coinciding with a revised wording of the arthritis question. This increase was observed in all age and sex groups, except for men aged 85+. The overall characteristics of the 2015 arthritis population were similar to those in 2007/08. Using the updated 2015 CCHS arthritis data, projection estimates suggest the population prevalence of arthritis will increase to just over 24% by 2040, with the number of Canadians living with arthritis projected to increase by about 50% from 2015 to 2040. CONCLUSION The revised question likely increased ascertainment of arthritis owing to inclusion of examples of arthritis diagnoses in the CCHS question and more explicit wording in the French version, resulting in a large increase in the estimated prevalence and numbers of people with arthritis in Canada.
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Affiliation(s)
- Elizabeth M Badley
- From the Dalla Lana School of Public Health, University of Toronto; Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. .,E.M. Badley, DPhil, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research, Krembil Research Institute, University Health Network; C.M. Goulart, MPH, Dalla Lana School of Public Health, University of Toronto; D.B. Millstone, MPH, Health Care and Outcomes Research, Krembil Research Institute, University Health Network; A.V. Perruccio, PhD, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, and Department of Surgery, Faculty of Medicine, University of Toronto.
| | - Céline M Goulart
- From the Dalla Lana School of Public Health, University of Toronto; Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,E.M. Badley, DPhil, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research, Krembil Research Institute, University Health Network; C.M. Goulart, MPH, Dalla Lana School of Public Health, University of Toronto; D.B. Millstone, MPH, Health Care and Outcomes Research, Krembil Research Institute, University Health Network; A.V. Perruccio, PhD, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, and Department of Surgery, Faculty of Medicine, University of Toronto
| | - Dov B Millstone
- From the Dalla Lana School of Public Health, University of Toronto; Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,E.M. Badley, DPhil, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research, Krembil Research Institute, University Health Network; C.M. Goulart, MPH, Dalla Lana School of Public Health, University of Toronto; D.B. Millstone, MPH, Health Care and Outcomes Research, Krembil Research Institute, University Health Network; A.V. Perruccio, PhD, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, and Department of Surgery, Faculty of Medicine, University of Toronto
| | - Anthony V Perruccio
- From the Dalla Lana School of Public Health, University of Toronto; Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,E.M. Badley, DPhil, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research, Krembil Research Institute, University Health Network; C.M. Goulart, MPH, Dalla Lana School of Public Health, University of Toronto; D.B. Millstone, MPH, Health Care and Outcomes Research, Krembil Research Institute, University Health Network; A.V. Perruccio, PhD, Dalla Lana School of Public Health, University of Toronto, and Health Care and Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, and Department of Surgery, Faculty of Medicine, University of Toronto
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Perruccio AV, Yip C, Power JD, Canizares M, Badley EM. Discordance Between Population Impact of Musculoskeletal Disorders and Scientific Representation: A Bibliometric Study. Arthritis Care Res (Hoboken) 2018; 71:56-60. [DOI: 10.1002/acr.23583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/10/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Anthony V. Perruccio
- Krembil Research InstituteUniversity Health NetworkArthritis Community Research and Evaluation Unitand Dalla Lana School of Public HealthUniversity of Toronto Toronto Ontario Canada
| | - Calvin Yip
- Krembil Research InstituteUniversity Health Network Toronto Ontario Canada
| | - J. Denise Power
- Krembil Research InstituteUniversity Health Network Toronto Ontario Canada
| | - Mayilee Canizares
- Krembil Research InstituteUniversity Health Network Toronto Ontario Canada
| | - Elizabeth M. Badley
- Krembil Research InstituteUniversity Health NetworkArthritis Community Research and Evaluation Unitand Dalla Lana School of Public HealthUniversity of Toronto Toronto Ontario Canada
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Tayer-Shifman OE, Rosen CF, Wakani L, Touma Z. Novel biological therapeutic approaches to cutaneous lupus erythematosus. Expert Opin Biol Ther 2018; 18:1041-1047. [DOI: 10.1080/14712598.2018.1513484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - Cheryl F. Rosen
- Division of Dermatology, Toronto Western Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Laura Wakani
- Centre For Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, Toronto, Canada
| | - Zahi Touma
- Centre For Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, Toronto, Canada
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Barbour KE, Moss S, Croft JB, Helmick CG, Theis KA, Brady TJ, Murphy LB, Hootman JM, Greenlund KJ, Lu H, Wang Y. Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management - United States, 2015. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2018; 67:1-28. [PMID: 29543787 PMCID: PMC5857191 DOI: 10.15585/mmwr.ss6704a1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Problem/Condition Doctor-diagnosed arthritis is a common chronic condition affecting an estimated 23% (54 million) of adults in the United States, greatly influencing quality of life and costing approximately $300 billion annually. The geographic variations in arthritis prevalence, health-related characteristics, and management among states and territories are unknown. Therefore, public health professionals need to understand arthritis in their areas to target dissemination of evidence-based interventions that reduce arthritis morbidity. Reporting Period 2015. Description of System The Behavioral Risk Factor Surveillance System is an annual, random-digit–dialed landline and cellular telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. Unadjusted and age-standardized prevalences of arthritis, arthritis health-related characteristics, and arthritis management were calculated. County-level estimates were calculated using a validated statistical modeling method. Results In 2015, in the 50 states and the District of Columbia, median age-standardized prevalence of arthritis was 23.0% (range: 17.2%–33.6%). Modeled prevalence of arthritis varied considerably by county (range: 11.2%–42.7%). In 13 states that administered the arthritis management module, among adults with arthritis, the age-standardized median percentage of participation in a self-management education course was 14.5% (range: 9.1%–19.0%), being told by a health care provider to engage in physical activity or exercise was 58.5% (range: 52.3%–61.9%), and being told to lose weight to manage arthritis symptoms (if overweight or obese) was 44.5% (range: 35.1%–53.2%). Respondents with arthritis who lived in the quartile of states with the highest prevalences of arthritis had the highest percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain, and arthritis-attributable social participation restriction; ≥14 physically unhealthy days during the past 30 days; ≥14 mentally unhealthy days during the past 30 days; obesity; and leisure-time physical inactivity) and the lowest percentage of leisure-time walking. Interpretation The prevalence, health-related characteristics, and management of arthritis varied substantially across states. The modeled prevalence of arthritis varied considerably by county. Public Health Action The findings highlight notable geographic variability in prevalence, health-related characteristics, and management of arthritis. Targeted use of evidence-based interventions that focus on physical activity and self-management education can reduce pain and improve function and quality of life for adults with arthritis and thus might reduce these geographic disparities.
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Affiliation(s)
- Kamil E Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | | | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Charles G Helmick
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kristina A Theis
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Teresa J Brady
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Louise B Murphy
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Jennifer M Hootman
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Hua Lu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Yan Wang
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Curtis JR, Herrem C, Ndlovu 'MN, O'Brien C, Yazici Y. A somatization comorbidity phenotype impacts response to therapy in rheumatoid arthritis: post-hoc results from the certolizumab pegol phase 4 PREDICT trial. Arthritis Res Ther 2017; 19:215. [PMID: 28962590 PMCID: PMC5622491 DOI: 10.1186/s13075-017-1412-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/29/2017] [Indexed: 01/09/2023] Open
Abstract
Background Comorbidities may contribute to disease activity and treatment response in rheumatoid arthritis (RA) patients. We defined a somatization comorbidity phenotype (SCP) and examined its influence on response to certolizumab pegol (CZP) using data from the PREDICT trial. Methods Patients in PREDICT were randomized to the patient-reported Routine Assessment of Patient Index Data 3 (RAPID3) or physician-based Clinical Disease Activity Index (CDAI) for treatment response assessment. Post-hoc analyses identified patients with the SCP, which included diagnosis of depression, fibromyalgia/myalgias, and/or use of medications indicated for treatment of depression, anxiety, or neuropathic pain. The effect of the SCP on RAPID3 or CDAI response at week 12 and low disease activity (LDA; Disease Activity Score in 28 joints based on erythrocyte sedimentation rate ≤ 3.2) at week 52, in week-12 responders, was analyzed using non-parametric analysis of covariance (ANCOVA). Results At baseline, 43% (313/733) of patients met the SCP classification. Patients with the SCP were 9% more likely to withdraw from the trial. American College of Rheumatology 20% (ACR20), ACR50, and ACR70 responses were 5–14% lower among those with the SCP, and 11% more patients reported adverse events (AEs). Patients without SCP in the CDAI arm were twice as likely to achieve LDA at week 52 compared with those with SCP (32% versus 16%). No differentiation by SCP was observed in the RAPID3 arm (pooled result 21.5%). Conclusions We operationalized a potentially important somatization comorbidity phenotype in a trial setting that was associated with a substantially lower likelihood of treatment response and a higher frequency of AEs. Including large numbers of patients with this phenotype in RA trials may reduce the measured clinical effectiveness of a new molecule. Trial registration ClinicalTrials.gov, NCT01255761. Registered on 6 December 2010. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1412-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, FOT 802, 510 20th Street South, Birmingham, AL, 35294, USA.
| | | | | | - Cathy O'Brien
- UCB Pharma, Allée de la Recherche 60, 1070, Brussels, Belgium
| | - Yusuf Yazici
- NYU Hospital for Joint Diseases, New York University School of Medicine, 301 East 17th Street, New York, NY, 10003, USA
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