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Mentz RJ, Hernandez AF, Berdan LG, Rorick T, O'Brien EC, Ibarra JC, Curtis LH, Peterson ED. Good Clinical Practice Guidance and Pragmatic Clinical Trials: Balancing the Best of Both Worlds. Circulation 2016; 133:872-80. [PMID: 26927005 PMCID: PMC4777975 DOI: 10.1161/circulationaha.115.019902] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Randomized, clinical trials are commonly regarded as the highest level of evidence to support clinical decisions. Good Clinical Practice guidelines have been constructed to provide an ethical and scientific quality standard for trials that involve human subjects in a manner aligned with the Declaration of Helsinki. Originally designed to provide a unified standard of trial data to support submission to regulatory authorities, the principles may also be applied to other studies of human subjects. Although the application of Good Clinical Practice principles generally led to improvements in the quality and consistency of trial operations, these principles have also contributed to increasing trial complexity and costs. Alternatively, the growing availability of electronic health record data has facilitated the possibility for streamlined pragmatic clinical trials. The central tenets of Good Clinical Practice and pragmatic clinical trials represent potential tensions in trial design (stringent quality and highly efficient operations). In the present article, we highlight potential areas of discordance between Good Clinical Practice guidelines and the principles of pragmatic clinical trials and suggest strategies to streamline study conduct in an ethical manner to optimally perform clinical trials in the electronic age.
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Affiliation(s)
- Robert J Mentz
- From Duke Clinical Research Institute, Durham, NC (R.J.M., A.F.H., L.G.B., T.R., E.C.O'B., J.C.I., L.H.C., E.D.P.); and Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (R.J.M., AF.H., E.C.O'B., E.D.P.).
| | - Adrian F Hernandez
- From Duke Clinical Research Institute, Durham, NC (R.J.M., A.F.H., L.G.B., T.R., E.C.O'B., J.C.I., L.H.C., E.D.P.); and Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (R.J.M., AF.H., E.C.O'B., E.D.P.)
| | - Lisa G Berdan
- From Duke Clinical Research Institute, Durham, NC (R.J.M., A.F.H., L.G.B., T.R., E.C.O'B., J.C.I., L.H.C., E.D.P.); and Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (R.J.M., AF.H., E.C.O'B., E.D.P.)
| | - Tyrus Rorick
- From Duke Clinical Research Institute, Durham, NC (R.J.M., A.F.H., L.G.B., T.R., E.C.O'B., J.C.I., L.H.C., E.D.P.); and Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (R.J.M., AF.H., E.C.O'B., E.D.P.)
| | - Emily C O'Brien
- From Duke Clinical Research Institute, Durham, NC (R.J.M., A.F.H., L.G.B., T.R., E.C.O'B., J.C.I., L.H.C., E.D.P.); and Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (R.J.M., AF.H., E.C.O'B., E.D.P.)
| | - Jenny C Ibarra
- From Duke Clinical Research Institute, Durham, NC (R.J.M., A.F.H., L.G.B., T.R., E.C.O'B., J.C.I., L.H.C., E.D.P.); and Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (R.J.M., AF.H., E.C.O'B., E.D.P.)
| | - Lesley H Curtis
- From Duke Clinical Research Institute, Durham, NC (R.J.M., A.F.H., L.G.B., T.R., E.C.O'B., J.C.I., L.H.C., E.D.P.); and Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (R.J.M., AF.H., E.C.O'B., E.D.P.)
| | - Eric D Peterson
- From Duke Clinical Research Institute, Durham, NC (R.J.M., A.F.H., L.G.B., T.R., E.C.O'B., J.C.I., L.H.C., E.D.P.); and Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (R.J.M., AF.H., E.C.O'B., E.D.P.)
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Rahbar MH, Dickerson AS, Cai C, Pedroza C, Hessabi M, Shen L, Pandurengan R, Jacobs ANM, Indupuru H, Sline MR, Delgado RI, Macdonald C, Ford GA, Grotta JC, Barreto AD. Methodological issues for designing and conducting a multicenter, international clinical trial in Acute Stroke: Experience from ARTSS-2 trial. Contemp Clin Trials 2015; 44:139-148. [PMID: 26278031 DOI: 10.1016/j.cct.2015.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/06/2015] [Accepted: 08/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND We describe innovations in the study design and the efficient data coordination of a randomized multicenter trial of Argatroban in Combination with Recombinant Tissue Plasminogen Activator for Acute Stroke (ARTSS-2). METHODS ARTSS-2 is a 3-arm, multisite/multiregional randomized controlled trials (RCTs) of two doses of Argatroban injection (low, high) in combination with recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke patients and rt-PA alone. We developed a covariate adaptive randomization program that balanced the study arms with respect to study site as well as hemorrhage after thrombolysis (HAT) score and presence of distal internal carotid artery occlusion (DICAO). We used simulation studies to validate performance of the randomization program before making any adaptations during the trial. For the first 90 patients enrolled in ARTSS-2, we evaluated performance of our randomization program using chi-square tests of homogeneity or extended Fisher's exact test. We also designed a four-step partly Bayesian safety stopping rule for low and high dose Argatroban arms. RESULTS Homogeneity of the study arms was confirmed with respect to distribution of study site (UK sites vs. US sites, P=0.98), HAT score (0-2 vs. 3-5, P=1.0), and DICAO (N/A vs. No vs. Yes, P=0.97). Our stopping thresholds for safety of low and high dose Argatroban were not crossed. Despite challenges, data quality was assured. CONCLUSIONS We recommend adaptive designs for randomization and Bayesian safety stopping rules for multisite Phase I/II RCTs for maintaining additional flexibility. Efficient data coordination could lead to improved data quality.
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Affiliation(s)
- Mohammad H Rahbar
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA; Division of Epidemiology, Human Genetics, and Environmental Sciences (EHGES), University of Texas School of Public Health at Houston, Houston, TX 77030, USA; Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Aisha S Dickerson
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Chunyan Cai
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA; Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Loren Shen
- Department of Neurology, Stroke Program, University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Renganayaki Pandurengan
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Amber Nicole M Jacobs
- Department of Neurology, Stroke Program, University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Hari Indupuru
- Department of Neurology, Stroke Program, University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Melvin R Sline
- Department of Neurology, Stroke Program, University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Rigoberto I Delgado
- Department of Management, Policy & Community Health, University of Texas School of Public Health at Houston, Houston, TX 77030, USA.
| | - Claire Macdonald
- Newcastle Clinical Trials Unit (NCTU), Newcastle University, Newcastle upon Tyne NE2 4AE, United Kingdom.
| | - Gary A Ford
- Newcastle Clinical Trials Unit (NCTU), Newcastle University, Newcastle upon Tyne NE2 4AE, United Kingdom; Oxford Academic Health Science Network, Magdalen Centre North, Oxford Science Park, OX4 4GA, United Kingdom.
| | - James C Grotta
- Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX 77030, USA.
| | - Andrew D Barreto
- Department of Neurology, Stroke Program, University of Texas Medical School at Houston, Houston, TX 77030, USA.
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Weber JS, Levit LA, Adamson PC, Bruinooge S, Burris HA, Carducci MA, Dicker AP, Gönen M, Keefe SM, Postow MA, Thompson MA, Waterhouse DM, Weiner SL, Schuchter LM. American Society of Clinical Oncology policy statement update: the critical role of phase I trials in cancer research and treatment. J Clin Oncol 2014; 33:278-84. [PMID: 25512456 DOI: 10.1200/jco.2014.58.2635] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Jeffrey S Weber
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC.
| | - Laura A Levit
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Peter C Adamson
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Suanna Bruinooge
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Howard A Burris
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Michael A Carducci
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Adam P Dicker
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Mithat Gönen
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Stephen M Keefe
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Michael A Postow
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Michael A Thompson
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - David M Waterhouse
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Susan L Weiner
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Lynn M Schuchter
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
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