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Perkins L, Adams L, Lerner D, Santorelli J, Smith AM, Kobayashi L. Predictors of direct oral anticoagulant concentrations in the trauma population. Trauma Surg Acute Care Open 2024; 9:e001208. [PMID: 38274020 PMCID: PMC10806470 DOI: 10.1136/tsaco-2023-001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Introduction Direct oral anticoagulant (DOAC) use is becoming more prevalent in patients presenting after trauma. We sought to identify the prevalence and predictors of subtherapeutic and therapeutic DOAC concentrations and hypothesized that increased anti-Xa levels would correlate with increased risk of bleeding and other poor outcomes. Methods A retrospective cohort study of all trauma patients on apixaban or rivaroxaban admitted to a level 1 trauma center between January 2015 and July 2021 was performed. Patients were excluded if they did not have a DOAC-specific anti-Xa level at presentation. Therapeutic levels were defined as an anti-Xa of 50 ng/mL to 250 ng/mL for rivaroxaban and 75 ng/mL to 250 ng/mL for apixaban. Linear regression was used to identify correlations between study variables and anti-Xa level, and binomial logistic regression was used to test the association of anti-Xa level with outcomes. Results There were 364 trauma patients admitted during the study period who were documented to be on apixaban or rivaroxaban. Of these, 245 patients had anti-Xa levels measured at admission. The population was 53% woman, with median age of 78 years, and median Injury Severity Score of 5. In total, 39% of patients had therapeutic and 20% had supratherapeutic anti-Xa levels. Female sex, increased age, decreased height and weight, and lower estimated creatinine clearance were associated with higher anti-Xa levels at admission. There was no correlation between anti-Xa level and the need for transfusion or reversal agent administration, admission diagnosis of intracranial hemorrhage (ICH), progression of ICH, hospital length of stay, or mortality. Conclusions Anti-Xa levels in trauma patients on DOACs vary widely; female patients who are older, smaller, and have decreased kidney function present with higher DOAC-specific anti-Xa levels after trauma. We were unable to detect an association between anti-Xa levels and clinical outcomes. Level of evidence III-Prognostic and Epidemiological.
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Affiliation(s)
- Louis Perkins
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, California, USA
| | - Laura Adams
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, California, USA
| | - Dmitri Lerner
- Department of Pharmacy, University of California San Diego, San Diego, California, USA
| | - Jarrett Santorelli
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, California, USA
| | - Alan M Smith
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, California, USA
| | - Leslie Kobayashi
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, California, USA
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Perkins L, Horita H, Adams L, Marshall W, Lee J, Doucet J, Smith A, Santorelli JE. Inhalation Injury: Which Providers Can Assess the Need for Intubation? J Burn Care Res 2023:7142618. [PMID: 37208913 DOI: 10.1093/jbcr/irad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Previous studies have suggested that many burn patients undergo unnecessary intubation due to concern for inhalation injury. We hypothesized that burn surgeons would intubate burn patients at a lower rate than non-burn acute care surgeons (ACSs). We performed a retrospective cohort study of all patients admitted to an American Burn Association-verified burn center who presented emergently following burn injury from June 2015 to December 2021. Patients excluded include polytrauma patients, isolated friction burns, and patients intubated prior to hospital arrival. Our primary outcome was intubation rates between burn and non-burn ACSs. 388 patients met inclusion criteria. 240 (62%) patients were evaluated by a burn provider and 148 (38%) were evaluated by a non-burn provider; the groups were well-matched. In total, 73 (19%) of patients underwent intubation. There was no difference in the rate of emergent intubation, diagnosis of inhalation injury on bronchoscopy, time to extubation, or incidence of extubation within 48 hours between burn and non-burn ACSs. We found no difference between burn and non-burn ACSs in the airway evaluation and management of burn patients. Surgical providers with acute care surgery backgrounds and Advanced Trauma Life Support training are well-equipped for initial airway management in burn patients. Further studies should seek to compare other types of provider groups to identify opportunities for intervention and education in preventing unnecessary intubations.
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Affiliation(s)
- Louis Perkins
- University of California San Diego, San Diego, California, USA
| | - Henry Horita
- University of California San Diego, San Diego, California, USA
| | - Laura Adams
- University of California San Diego, San Diego, California, USA
| | | | - Jeanne Lee
- University of California San Diego, San Diego, California, USA
| | - Jay Doucet
- University of California San Diego, San Diego, California, USA
| | - Alan Smith
- University of California San Diego, San Diego, California, USA
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3
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Mapson R, Perkins L. The impact of the ‘Community Refocus Project’ on the Community dietitians service at Western Sussex Hospitals NHS Foundation Trust (WSHFT). Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Silbert L, Dodge H, Perkins L, Lahna D, Kaye J. Acceleration of White Matter Hyperintensity Burden Preceding Onset of Mild Cognitive Impairment (S24.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s24.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Silbert L, Perkins L, Lahna D, Kaye J. The Effects of Corpus Callosum and Cortical Connectivity on Motor Function in Cognitively Intact Elderly (P03.093). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Perkins L. Preclinical Models of Restenosis and Their Application to the Evaluation of Drug Eluting Stent Systems. Vet Pathol 2009. [DOI: 10.1354/vp.08-vp-0294-p-rev] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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7
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Wich S, Shumaker R, Perkins L, de Vries H. Captive and wild orangutan (Pongosp.) survivorship: a comparison and the influence of management. Am J Primatol 2009; 71:680-6. [DOI: 10.1002/ajp.20704] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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8
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Perkins L, Hughes E, Srinivasan L, Allsop J, Glover A, Kumar S, Fisk N, Rutherford M. Exploring cortical subplate evolution using magnetic resonance imaging of the fetal brain. Dev Neurosci 2008; 30:211-20. [PMID: 18075267 DOI: 10.1159/000109864] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Accepted: 06/30/2007] [Indexed: 01/06/2023] Open
Abstract
The subplate is a transient structure essential for normal development of the cortex. We used magnetic resonance imaging of the fetal brain to assess cortical subplate evolution between 20 and 35 weeks gestation. Two-dimensional measures of diameter were obtained for the cortex, subplate and fetal white matter. The subplate was originally seen as a continuous band at early gestations measuring up to 4.5 mm. It became magnetic resonance invisible from approximately 28 weeks initially from the depths of the sulci and then from the tops of the gyri. The disappearance of the subplate was regional, involuting most rapidly in the parietal lobe and remaining prominent in the anterior temporal lobe up to 35 weeks. x
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Affiliation(s)
- L Perkins
- Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, UK
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Parmee ER, Naylor EM, Perkins L, Colandrea VJ, Ok HO, Candelore MR, Cascieri MA, Deng L, Feeney WP, Forrest MJ, Hom GJ, MacIntyre DE, Miller RR, Stearns RA, Strader CD, Tota L, Wyvratt MJ, Fisher MH, Weber AE. Human beta3 adrenergic receptor agonists containing cyclic ureidobenzenesulfonamides. Bioorg Med Chem Lett 1999; 9:749-54. [PMID: 10201841 DOI: 10.1016/s0960-894x(99)00073-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [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: 10/27/2022]
Abstract
Human beta3 adrenergic receptor agonists containing 5-membered ring ureas were shown to be potent partial agonists with excellent selectivity over beta1 and beta2 binding. L-760,087 (4a) and L-764,646 (5a) (beta3 EC50 = 18 and 14 nM, respectively) stimulate lipolysis in rhesus monkeys (ED50 = 0.2 and 0.1 mg/kg, respectively) with minimal effects on heart rate. Oral absorption in dogs is improved over other urea analogs.
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Affiliation(s)
- E R Parmee
- Department of Medicinal Chemistry, Merck Research Laboratories, Rahway, NJ 07065, USA
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Naylor EM, Parmee ER, Colandrea VJ, Perkins L, Brockunier L, Candelore MR, Cascieri MA, Colwell LF, Deng L, Feeney WP, Forrest MJ, Hom GJ, MacIntyre DE, Strader CD, Tota L, Wang PR, Wyvratt MJ, Fisher MH, Weber AE. Human beta3 adrenergic receptor agonists containing imidazolidinone and imidazolone benzenesulfonamides. Bioorg Med Chem Lett 1999; 9:755-8. [PMID: 10201842 DOI: 10.1016/s0960-894x(99)00072-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [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: 10/27/2022]
Abstract
The cyclopentylpropylimidazolidinone L-766,892 is a potent beta3 AR agonist (EC50 5.7 nM, 64% activation) with 420- and 130-fold selectivity over binding to the beta1 and beta2 ARs, respectively. In anesthetized rhesus monkeys, L-766,892 elicited dose-dependent hyperglycerolemia (ED50 0.1 mg/kg) with minimal effects on heart rate.
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Affiliation(s)
- E M Naylor
- Department of Medicinal Chemistry, Merck Research Laboratories, Rahway, NJ 07065, USA
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13
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Weber AE, Ok HO, Alvaro RF, Candelore MR, Cascieri MA, Chiu SH, Deng L, Forrest MJ, Hom GJ, Hutchins JE, Kao J, MacIntyre DE, Mathvink RJ, McLoughlin D, Miller RR, Newbold RC, Olah TV, Parmee ER, Perkins L, Stearns RA, Strader CD, Szumiloski J, Tang YS, Tota L, Fisher MH. 3-Pyridyloxypropanolamine agonists of the beta 3 adrenergic receptor with improved pharmacokinetic properties. Bioorg Med Chem Lett 1998; 8:2111-6. [PMID: 9873496 DOI: 10.1016/s0960-894x(98)00381-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 11/26/2022]
Abstract
Pyridyloxypropanolamines L-749,372 (8, beta 3 EC50 = 3.6 nM) and L-750,355 (29, beta 3 EC50 = 13 nM) are selective partial agonists of the human receptor, with 33% and 49% activation, respectively. Both stimulate lipolysis in rhesus monkeys (ED50 = 2 and 0.8 mg/kg, respectively), with minimal effects on heart rate. Oral bioavailability in dogs, 41% for L-749,372 and 47% for L-750,355, is improved relative to phenol analogs.
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Affiliation(s)
- A E Weber
- Department of Medicinal Chemistry, Merck Research Laboratories, Rahway, New Jersey 07065, USA
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14
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Weber AE, Mathvink RJ, Perkins L, Hutchins JE, Candelore MR, Tota L, Strader CD, Wyvratt MJ, Fisher MH. Potent, selective benzenesulfonamide agonists of the human beta 3 adrenergic receptor. Bioorg Med Chem Lett 1998; 8:1101-6. [PMID: 9871716 DOI: 10.1016/s0960-894x(98)00169-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [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: 11/20/2022]
Abstract
A cloned human beta 3 adrenergic receptor assay was used to identify phenoxypropanolamine agonist 1. SAR studies led to the identification of benzenesulfonamide derivative 20, a 6.3 nM beta 3 agonist which shows 30-fold selectivity for beta 3 agonist activity over beta 1 and beta 2 receptor binding. Further refinement of this lead provided 4-bromo derivative 39, a subnanomolar agonist with 660-fold and 230-fold selectivity over beta 1 and beta 2, respectively.
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MESH Headings
- Adrenergic beta-Agonists/chemical synthesis
- Adrenergic beta-Agonists/chemistry
- Adrenergic beta-Agonists/pharmacology
- Cloning, Molecular
- Drug Design
- Humans
- Molecular Conformation
- Molecular Structure
- Propanolamines/chemical synthesis
- Propanolamines/chemistry
- Propanolamines/pharmacology
- Receptors, Adrenergic, beta/drug effects
- Receptors, Adrenergic, beta/physiology
- Receptors, Adrenergic, beta-1/drug effects
- Receptors, Adrenergic, beta-2/drug effects
- Receptors, Adrenergic, beta-3
- Recombinant Proteins/drug effects
- Recombinant Proteins/metabolism
- Stereoisomerism
- Structure-Activity Relationship
- Sulfonamides/chemical synthesis
- Sulfonamides/chemistry
- Sulfonamides/pharmacology
- Benzenesulfonamides
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Affiliation(s)
- A E Weber
- Department of Medicinal Chemistry, Merck Research Laboratories, Rahway, New Jersey 07065, USA
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15
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Mohler ER, Ryan T, Segar DS, Sawada SG, Sonel AF, Perkins L, Fineberg N, Feigenbaum H, Wilensky RL. Clinical utility of troponin T levels and echocardiography in the emergency department. Am Heart J 1998; 135:253-60. [PMID: 9489973 DOI: 10.1016/s0002-8703(98)70090-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We investigated the clinical utility of cardiac troponin T (TnT) and echocardiography in the emergency department to predict subsequent in-hospital diagnosis and adverse cardiac events. TnT is a cardiac-specific protein released during cell injury such as that following acute myocardial inFarction (MI). Unlike creatine kinase-MB isoenzymes, TnT is increased in a subset of patients with unstable angina, and these may be at higher risk for subsequent cardiac events. Echocardiography is a useful noninvasive imaging technique for the assessment of ischemic heart disease in acute care settings because of its mobility and rapid results. Serial TnT determinations and echocardiographic images were prospectively evaluated in 100 patients with chest discomfort and admitted to the hospital. Serum was obtained for CKMB and TnT on presentation to the emergency department and 4, 8, 16 and 24 hours later. TnT was considered increased when at values greater than 0.1 microg/L. Echocardiograms were recorded on videotape in the emergency department and images reviewed in a blinded fashion for wall-motion abnormalities. When available, current echocardiographic results were compared with previous results to determine whether a new wall-motion abnormality was present. Of the 100 patients (57 men, 43 women), TnT was increased in 21 of 21 with acute MI and 15 of 41 with unstable angina. One of the 38 patients with stable angina had an increased TnT value and died 5 months later of a noncardiac cause. Ninety percent of patients who sustained acute MI had a TnT increase detected within 4 hours of presentation. Fifteen of 18 patients with acute MI and 9 of 37 patients with unstable angina had a new wall-motion abnormality on echocardiography. The combination of TnT levels with echocardiography yielded a positive predictive value of 84% and a negative predictive value of 90% for adverse cardiac events in the follow-up population, which was more accurate than either test analyzed separately. TnT and echocardiography are useful tests in emergency department triage of unstable coronary syndromes. Both tests are predictive of discharge diagnosis and follow-up events. However, the combined utility of TnT levels and echocardiographic imaging is a more powerful predictor of adverse cardiac events than isolated results.
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Affiliation(s)
- E R Mohler
- Department of Medicine, Indiana University Medical School, Indianapolis, USA
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16
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Sorrel A, Gawad Y, Perkins L, Fineberg N, Wilensky R. Value of markers of myocardial injury and intracoronary thrombus in risk stratification of patients presenting to an emergency department with chest pain. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)81042-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Taveras AG, Remiszewski SW, Doll RJ, Cesarz D, Huang EC, Kirschmeier P, Pramanik BN, Snow ME, Wang YS, del Rosario JD, Vibulbhan B, Bauer BB, Brown JE, Carr D, Catino J, Evans CA, Girijavallabhan V, Heimark L, James L, Liberles S, Nash C, Perkins L, Senior MM, Tsarbopoulos A, Webber SE. Ras oncoprotein inhibitors: the discovery of potent, ras nucleotide exchange inhibitors and the structural determination of a drug-protein complex. Bioorg Med Chem 1997; 5:125-33. [PMID: 9043664 DOI: 10.1016/s0968-0896(96)00202-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.7] [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: 02/03/2023]
Abstract
The nucleotide exchange process is one of the key activation steps regulating the ras protein. This report describes the development of potent, non-nucleotide, small organic inhibitors of the ras nucleotide exchange process. These inhibitors bind to the ras protein in a previously unidentified binding pocket, without displacing bound nucleotide. This report also describes the development and use of mass spectrometry, NMR spectroscopy and molecular modeling techniques to elucidate the structure of a drug-protein complex, and aid in designing new ras inhibitor targets.
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Affiliation(s)
- A G Taveras
- Schering-Plough Research Institute, Kenilworth, NJ 07033, USA
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Abstract
This paper explores the impact of linguistic impairments on conversational ability in aphasia using conversation analysis (CA). Using a combination of quantitative and qualitative techniques, an analysis of the distribution of turns at talk in three aphasic participants' conversations with a relative and with the researcher is described. Using extracts from the conversations for illustration, three major factors are proposed which influence the sharing of conversational turns: (1) shared knowledge of interlocutors, (2) the manifestations of linguistic impairments in conversation, and (3) individual discourse styles. Finally, the implications of the findings for remediation are considered.
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Affiliation(s)
- L Perkins
- Department of Speech, University of Newcastle upon Tyne, UK
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19
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Thomson FJ, Perkins L, Ahern D, Clark M. Identification and characterization of a lysophosphatidic acid receptor. Mol Pharmacol 1994; 45:718-23. [PMID: 8183251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A specific binding site for 1-[3H]stearoyl-lysophosphatidic acid (stearoyl-LPA) was identified and characterized in membranes prepared from rat brain and Swiss 3T3 fibroblasts. Specific binding of [3H]LPA to these sites was protein dependent, was saturable, reached equilibrium in 15 min, and was displacable by the addition of excess unlabeled LPA. Scatchard analysis of saturation binding experiments indicated that these sites had affinities of 2.0 +/- 0.5 nM and 5.4 +/- 2.6 nM and densities of 19 +/- 3 fmol/micrograms of protein and 38 +/- 6 fmol/micrograms of protein in rat brain and 3T3 cell membranes, respectively. Various LPAs, with different acyl groups in the sn-1-position, competed with [3H]LPA for these binding sites, with a rank order of potency of 1-oleoyl-LPA > 1-stearoyl-LPA = 1-palmitoyl-LPA > 1-myristoyl-LPA. Phosphatidic acid also bound to these sites, but with lower affinity than any LPA tested. Neither lysophosphatidylcholine, lysophosphatidylethanolamine, nor any free fatty acid competed with [3H]LPA for these binding sites. Binding of [3H]LPA to these sites was regulated by nonhydrolyzable guanine nucleotides in both rat brain and 3T3 cell membranes. Furthermore, in 3T3 cells, these sites were regulated by cell density. It was subsequently determined that LPA induced a transient increase in intracellular Ca2+ levels in 3T3 cells. The concentrations required for this response, as well as the rank order of potency of the various LPAs and phosphatidic acid, correlated with the affinity of these compounds for the [3H]LPA binding site. These results suggest that the specific, high affinity, binding sites for [3H]LPA are G protein-coupled receptors.
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Affiliation(s)
- F J Thomson
- Schering Plough Research Institute, Kenilworth, New Jersey 07033
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20
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Perkins L. The use of off-duty police as additional security in an emergency department setting. J Healthc Prot Manage 1994; 9:104-12. [PMID: 10129059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The author discusses the use of off-duty police officers to reduce violence in a hospital's emergency room. He provides the results from an assessment of the program.
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Affiliation(s)
- L Perkins
- Memorial Medical Center, Savannah, GA
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21
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Li CQ, Windsor RA, Perkins L, Goldenberg RL, Lowe JB. The impact on infant birth weight and gestational age of cotinine-validated smoking reduction during pregnancy. JAMA 1993; 269:1519-24. [PMID: 8445814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the impact of cotinine-confirmed smoking reduction during pregnancy on infant birth weight and gestational age at birth. DESIGN Group analyses from a prospective, randomized smoking-cessation intervention trial using cotinine levels to assess smoking cessation and reduction. SETTING Four maternity clinics of Jefferson County Health Department in Birmingham, Ala. PATIENTS A total of 803 pregnant smokers and 474 never smokers with a fetal gestational age of 32 weeks or less at the first prenatal visit to a clinic. MAIN OUTCOME MEASURES Infant birth weight and gestational age at birth. RESULTS Infants who were born to women who quit smoking (quitters) had the highest mean birth weight (3371 +/- 581 g), followed by infants who were born to women who did not change smoking behavior (no changers) (3043 +/- 587 g). The mean infant birth weight of infants born to the quitters, adjusted by mother's age, race, height, weight at baseline, and gestational age at delivery was 241 g heavier than that among the no changers (P = .0008) and 167 g heavier than the reducers (P = .04). The adjusted mean infant birth weight of infants born to the reducers was 92 g heavier than that among the no changers (P = .08). White reducers with baseline cotinine levels greater than 100 ng/mL had infants who were 241 g heavier than did white no changers. A 220-g difference was also seen in black reducers with a baseline cotinine level of 100 ng/mL or less. Although smoking cessation increased infant gestational age at delivery by 1 week, smoking reduction had little effect. CONCLUSION Cotinine-validated smoking reduction rates were positively associated with an increase in infant birth weight. While smoking cessation must continue to be the primary objective for pregnant smokers, specific intervention methods should also be directed toward smoking reduction for women who cannot quit.
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Affiliation(s)
- C Q Li
- Office of Educational Research and Development, School of Medicine, University of Alabama, Birmingham 35294-2041
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22
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Story WC, Caruso JA, Heitkemper DT, Perkins L. Elimination of the chloride interference on the determination of arsenic using hydride generation inductively coupled plasma mass spectrometry. J Chromatogr Sci 1992; 30:427-32. [PMID: 1474130 DOI: 10.1093/chromsci/30.11.427] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In the determination of arsenic, attention has recently focused on the speciation of As(III) and As(V). Reversed-phase HPLC can be used to efficiently separate these two arsenic species. When inductively coupled plasma mass spectrometry is used for arsenic detection, an isobaric interference at m/z 75 is caused by the presence of chloride in the sample. These experiments describe the use of hydride generation in conjunction with a polypropylene-membrane gas-liquid separator to completely eliminate the transport of chloride to the plasma. A detection limit of 0.46 ppb for As(III) was achieved with this system. The chromatographic resolution of the system was not compromised by the addition of the gas-liquid separator. A determination of the arsenic content of a NIST urine sample was performed to demonstrate the effectiveness of the chloride elimination.
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Affiliation(s)
- W C Story
- Department of Chemistry, University of Cincinnati, Ohio 45221-0172
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23
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Orden SR, Dyer AR, Liu K, Perkins L, Ruth KJ, Burke G, Manolio TA. Random digit dialing in Chicago CARDIA: comparison of individuals with unlisted and listed telephone numbers. Am J Epidemiol 1992; 135:697-709. [PMID: 1580246 DOI: 10.1093/oxfordjournals.aje.a116349] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Young adult blacks and whites aged 18-30 years of both low and high educational levels were recruited through random digit dialing to participate in the Chicago, Illinois, portion of a longitudinal study, Coronary Artery Risk Development in Young Adults (CARDIA). Overall, 31% of randomly selected persons eligible to participate had unlisted telephone numbers--about 50% of black men and women and 11% and 17% of white men and women, respectively. There was no difference in proportions of numbers unlisted by educational level, except for white men, who were more likely to have unlisted numbers at a low educational level than at a high educational level. There was no consistent pattern of differences in rates of participation across race, sex, or education subgroups for unlisted and listed numbers, and there were no significant differences for selected health measures, except smoking. The findings suggest that in Chicago, there is a potential bias in estimates of sociodemographic characteristics from the exclusion of unlisted numbers, but it is likely to be insignificant if recruitment is stratified according to race, sex, and education. Within strata, there was little bias with respect to the attributes measured. Ideally, to guard against possible bias, random digit dialing is recommended as the preferred way to select a representative population-based sample.
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Affiliation(s)
- S R Orden
- Department of Community Health and Preventive Medicine, Northwestern University Medical School, Chicago, IL 60611
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24
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Abstract
This paper proposes a collaborative model of repair in aphasic discourse, derived from the procedures of conversation analysis (CA). First, it is suggested that relative to other pragmatic orientations CA can offer a particularly illuminating and practically useful perspective on aphasic discourse. Repair strategies are then examined, first in relation to normal conversation then in relation to aphasic conversation' where one or more of the participants is aphasic. Next, Clark and Schaefer's CA-style model of conversational organization (1 987, 1989) is outlined, with attention to its relevance to the organization of repair in aphasic conversation. Finally, we apply this model in an analysis of some aphasic conversational sequences where the collaborative negotiation of repair is particularly evident.
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Affiliation(s)
- L Milroy
- Department of Speech, University of Newcastle upon Tyne, UK
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25
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Abstract
The pulmonary response to mineral dust inhalation was investigated by characterizing markers of lung injury and inflammation, macrophage activation, dust clearance, and histopathology. Rats were exposed (6 hr/day x 5 days) to air or 50 mg/m3 crystalline silica (SiO2) or titanium dioxide (TiO2). At 7, 14, 28, and 63 days after exposure, bronchoalveolar lavage fluid (BALF) was analyzed for lactate dehydrogenase (LDH), total protein, and N-acetylglucosaminidase, as well as cell number, type, and viability. Alveolar macrophages (AM) obtained in BALF were cultured with or without LPS and release of interleukin-1 (IL-1) and fibronectin was determined. Histopathology was conducted at 28 and 63 days. The exposure protocol resulted in 1.8-1.9 mg of mineral dust being deposited in the pulmonary region. Clearance of SiO2 was significantly less than TiO2. SiO2 increased BALF neutrophils (Days 14, 28, and 63), total protein (Days 28 and 63), and LDH and lymphocytes (Day 63). SiO2 increased AM-derived fibronectin release (Day 63) and LPS-induced IL-1 release (all time points), but not spontaneous release of IL-1. TiO2 did not change BALF biochemical or cellular parameters or AM secretory activity. Histopathology revealed minimal interstitial inflammation with SiO2 and no significant response in control or TiO2 rats. These results demonstrate the pulmonary response to inhaled SiO2 can be differentiated from the relatively innocuous TiO2 by changes in BALF markers of injury and inflammation further supporting the use of BALF analysis to make relative assessments of pulmonary toxicity. The stimulation of macrophage fibronectin release by the fibrogenic dust SiO2 and not TiO2 is consistent with a role for this glycoprotein in lung injury and repair. Last, the early and persistent effect of SiO2 on LPS-induced AM IL-1 release indicates this response may represent a sensitive early marker of dust-induced changes in the AM population.
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Affiliation(s)
- K E Driscoll
- Procter & Gamble Company, Miami Valley Laboratories, Cincinnati, Ohio 45239-8707
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Scherwitz L, Perkins L, Chesney M, Hughes G. Cook-Medley Hostility scale and subsets: relationship to demographic and psychosocial characteristics in young adults in the CARDIA study. Psychosom Med 1991; 53:36-49. [PMID: 2011649 DOI: 10.1097/00006842-199101000-00004] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This report describes the relationships between scores obtained on the Cook-Medley Hostility (Ho) scale and race, education, gender, and age in a sample of 5115 young adult participants in a prospective study of coronary heart disease (CHD) risk factors. Large differences were observed in total Ho scale scores and in six recently identified subsets according to race, education, gender, and age. Young black males with limited education had the highest Ho scale levels (mean = 26.2) while older white females with more education had the lowest levels (mean = 15.5). In all subgroups, education was inversely associated with hostility. The findings suggest a possible mechanism whereby CHD risk is higher in males than females, in the less educated than the more educated, and in blacks than whites. In all race and gender subgroups, total Ho scale scores and the six subsets were positively correlated with negative life events and negatively correlated with social support, supporting a pattern of psychosocial vulnerability found in other studies.
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Affiliation(s)
- L Scherwitz
- Department of Dental Public Health and Hygiene, University of California, San Francisco 94143
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27
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Windsor R, Morris J, Cutter G, Lowe J, Higginbotham J, Perkins L, Konkol L. Sensitivity, specificity and predictive value of saliva thiocyanate among pregnant women. Addict Behav 1989; 14:447-52. [PMID: 2782126 DOI: 10.1016/0306-4603(89)90032-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- R Windsor
- University of Alabama, School of Public Health, Birmingham 35294
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Abstract
A study of 26 patients with truncus arteriosus showed a high prevalence of facial dysmorphism, aortic arch abnormalities, extracardiac malformations, and significant prenatal risk factors. There was little evidence of parathyroid or thymic abnormalities. However, there was laboratory evidence of immune deficiency, especially T-helper lymphocytes, and clinical evidence of predilection to infection. These findings suggest that patients with truncus arteriosus belong to the spectrum of the Di George syndrome.
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Affiliation(s)
- D J Radford
- Department of Cardiology, Prince Charles Hospital, Brisbane, Australia
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Lowe JB, Perkins L, Windsor RA. Smokeless tobacco use among Alabama youth. Ala J Med Sci 1987; 24:270-5. [PMID: 3661893] [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: 01/06/2023]
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Kemper AJ, Force T, Perkins L, Gilfoil M, Parisi AF. In vivo prediction of the transmural extent of experimental acute myocardial infarction using contrast echocardiography. J Am Coll Cardiol 1986; 8:143-9. [PMID: 3711509 DOI: 10.1016/s0735-1097(86)80105-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.0] [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: 01/07/2023]
Abstract
Acute myocardial infarction progresses radially from endocardium to epicardium within the ischemic area. The amount of progression is highly variable, but depends largely on the transmural distribution of myocardial blood flow. Recent contrast echocardiographic observations indicate that slowly appearing low levels of contrast enhancement are often seen in the ischemic region, particularly in the epicardial level, and that ischemic regions which show these low levels of contrast have significantly more blood flow than those that do not. This study was designed to determine whether the transmural distribution of this delayed contrast enhancement can sufficiently discriminate between regions of high and low flow to serve as an in vivo predictor of the transmural extent of acute infarction. Twenty-four dogs had acute circumflex coronary ligation which was maintained for 6 hours. Contrast echocardiographic studies were performed at the level of the mitral chordae 2 hours after occlusion using a dilute hydrogen peroxide and blood solution as a contrast agent. Comparison was made with the pathologic infarct measured by triphenyltetrazolium chloride staining. The mean transmural extent of infarction ranged from 0 to 89% and was predicted in vivo by the transmural extent of the delayed contrast defect (r = 0.92; infarction [percent transmural] = 0.74 contrast [percent transmural] + 11%; SEE = 10%). Reproducibility for the transmural extent of delayed contrast defects was good (r = 0.89 to 0.98.) These data further support the concept that the transmural distribution of delayed contrast enhancement parallels blood flow and indicate that the mean transmural extent of acute infarction can be predicted in vivo 2 hours after coronary occlusion from the residual contrast defect.
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Force T, Kemper A, Perkins L, Gilfoil M, Cohen C, Parisi AF. Overestimation of infarct size by quantitative two-dimensional echocardiography: the role of tethering and of analytic procedures. Circulation 1986; 73:1360-8. [PMID: 3698262 DOI: 10.1161/01.cir.73.6.1360] [Citation(s) in RCA: 105] [Impact Index Per Article: 2.8] [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: 01/07/2023]
Abstract
Analyses of regional left ventricular systolic wall motion or thickening overestimate infarct size. We used quantitative two-dimensional echocardiographic analysis of systolic thickening and contrast two-dimensional echocardiography to evaluate causes for that overestimation. The following possibilities were considered: "tethering," defined as dysfunction of contrast-enhancing myocardium adjacent to ischemic or contrast-negative regions, and the role of standard center of mass analysis algorithms, which may overestimate wall motion abnormalities because of the axis shift produced by simultaneous systolic expansion of the ischemic segment and systolic contraction of the nonischemic segment. In the short-axis view in 12 animals, the echo contrast defect (ECD) occupied 32 +/- 7% of the left ventricular circumference. Extent of dysfunction by the center of mass analysis was 39 +/- 5% of the left ventricular circumference and correlation with ECD size was .68 (SEE = 5.2%). Thus 8 +/- 6% of the circumference of the left ventricle was assessed to be dysfunctional yet enhanced with contrast. Tethering accounted for only half of this (4 +/- 4% of left ventricular circumference) and involved less than 1 cm on either side of the ECD. The remaining overestimation by the center of mass analysis correlated significantly (r = .89, p less than .01) with the amount of systolic expansion of the ECD. This expansion of the ECD (increase in angle subtended by the ECD of 11 +/- 8%) was produced by the systolic shift in the center of mass toward the dysfunctional segment from contraction of the opposite, nonischemic segment.(ABSTRACT TRUNCATED AT 250 WORDS)
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Kemper AJ, Force T, Kloner R, Gilfoil M, Perkins L, Hale S, Alker K, Parisi AF. Contrast echocardiographic estimation of regional myocardial blood flow after acute coronary occlusion. Circulation 1985; 72:1115-24. [PMID: 4042299 DOI: 10.1161/01.cir.72.5.1115] [Citation(s) in RCA: 69] [Impact Index Per Article: 1.8] [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: 01/08/2023]
Abstract
Contrast echocardiography can predict pathologic area at risk during acute coronary occlusion. In this study we evaluated (1) whether the intensity and timing of contrast appearance in ischemic regions can provide a quantitative measure of residual myocardial perfusion, and (2) whether changes in these parameters observed after serial injections reflect changes in blood flow to acutely ischemic tissue. Supra-aortic hydrogen peroxide contrast echocardiography was performed in 12 consecutive dogs at 1, 20, and 120 min after acute circumflex coronary occlusion. Contrast enhancement was determined qualitatively with a segmental four-point scoring system based on the appearance time and peak perceived intensity of contrast enhancement and quantitatively with a computer algorithm designed to reflect these parameters. Comparison was made in each segment to concomitant radioactive microsphere blood flow. Qualitative scoring related systematically to normalized segmental blood flow (3+ = 93%; 2+ = 61%; 1+ = 32%; 0 = 18%; p less than .01 for each vs adjacent value), as did quantitative analysis including all segments (r = .78; p less than .01) and isolated to the ischemic region (flow = 1.13 intensity change +6.8%; r = .83, p less than .001). Changes in microsphere flow in ischemic regions between sequential observations were correlated with changes in qualitative score (r = .88, p less than .001) and results of quantitative analysis (r = 0.70, p less than .01). The amount of contrast enhancement can provide quantitative information about residual myocardial blood flow in ischemic regions and can also be used to track changing patterns of flow in vivo after acute coronary occlusion.
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Abstract
It has been reported that sensitive dentin is present in no less than one of seven normal patients with a higher incidence among postperiodontal therapy patients. Numerous agents have been developed to relieve this sensitivity without any being universally acceptable. Two new dentifrices, Protect and Protect with fluoride were compared clinically with Sensodyne to determine the relative ability of these three products to relieve both thermal and tactile sensitivity in sensitive dentin. Double blind analyses were completed and results compared using appropriate statistical tests for each hypothesis tested. The three dentifrices relieved both tactile and thermal sensitivity, but there was no statistical difference at 8 weeks between the three agents. There was a difference in the time it took the dentifrices to achieve a statistically significant reduction in dentin sensitivity.
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Williams V, Perkins L. Continuous ultrafiltration. A new ICU procedure for the treatment of fluid overload. Crit Care Nurse 1984; 4:44-9. [PMID: 6565570] [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: 04/05/2023]
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