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Adrogue RT, Herz N, Halpern DJ, Tracy J, Kahana MJ. Multitrial free recall for evaluating memory. Neuropsychology 2024; 38:58-68. [PMID: 37870806 DOI: 10.1037/neu0000910] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE Much of our knowledge concerning the neural basis of human memory derives from lab-based verbal recall tasks. Outside of the lab, clinicians use validated and normed neuropsychological tests to assess patients' memory function and to evaluate clinical interventions. Here we sought to establish the clinical validity of examining memory through multitrial free recall of semantically organized and unrelated word lists. METHOD We compare memory performance in multitrial free recall tasks with the Rey Auditory Verbal Learning Test and the California Verbal Learning Test, two common neuropsychological tests aimed at evaluating memory function in clinical settings. We compare predictive validity between the tasks by evaluating deficits in a patient sample and examining age-related declines in memory. We additionally compare test-retest reliability, establish convergent validity, and show the emergence of common recall dynamics between the tasks. RESULTS We demonstrate that both laboratory free recall tasks have better predictive validity and test-retest reliability than the established neuropsychological tests. We further show that all tasks have good convergent validity and reveal core memory processes, including temporal and semantic organization. However, we also demonstrate the benefits of repeated trials for evaluating the dynamics of memory search and their neuropsychological sequelae. CONCLUSIONS These results provide evidence for the clinical validity of lab-based multitrial free recall tasks and highlight their psychometric benefits over neuropsychological measures. Based on these results, we discuss the need to bridge the gap between clinical understanding of putative mechanisms underlying memory disorders and neuroscientific findings obtained using lab-based free recall tasks. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- R T Adrogue
- Department of Psychology, University of Pennsylvania
| | - N Herz
- Department of Psychology, University of Pennsylvania
| | - D J Halpern
- Department of Psychology, University of Pennsylvania
| | - J Tracy
- Department of Neuropsychology, Thomas Jefferson University
| | - M J Kahana
- Department of Psychology, University of Pennsylvania
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Wright FL, Cheema K, Goldacre R, Hall N, Herz N, Islam N, Karim Z, Moreno-Martos D, Morales DR, O'Connell D, Spata E, Akbari A, Ashworth M, Barber M, Briffa N, Canoy D, Denaxas S, Khunti K, Kurdi A, Mamas M, Priedon R, Sudlow C, Morris EJA, Lacey B, Banerjee A. Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries. Eur Heart J Qual Care Clin Outcomes 2022:6831631. [PMID: 36385522 DOI: 10.1093/ehjqcco/qcac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described. METHODS Analyses used national administrative electronic hospital records in England, Scotland and Wales for 2016-2021. Admissions and procedures during the pandemic (2020-2021) related to six major cardiovascular conditions (acute coronary syndrome, heart failure, stroke/transient ischaemic attack, peripheral arterial disease, aortic aneurysm, and venous thromboembolism) were compared to the annual average in the pre-pandemic period (2016-2019). Differences were assessed by time period and urgency of care. RESULTS In 2020, there were 31 064 (-6%) fewer hospital admissions (14 506 [-4%] fewer emergencies, 16 560 [-23%] fewer elective admissions) compared to 2016-2019 for the six major cardiovascular diseases combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries (-10 996 [-15%] fewer admissions). However, these reductions were offset by higher than expected total emergency admissions (+25 878 [+6%] higher admissions), notably for heart failure and stroke in England, and for venous thromboembolism in all three countries. Analyses for procedures showed similar temporal variations to admissions. CONCLUSION This study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.
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Affiliation(s)
- F Lucy Wright
- The Big Data Institute, Nuffield Department Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Raph Goldacre
- The Big Data Institute, Nuffield Department Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nick Hall
- The Big Data Institute, Nuffield Department Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Nazrul Islam
- The Big Data Institute, Nuffield Department Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - David Moreno-Martos
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Daniel R Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, UK.,Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Enti Spata
- The Big Data Institute, Nuffield Department Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Wales, UK
| | | | - Mark Barber
- Scottish Stroke Care Audit, Public Health Scotland, Glasgow, UK
| | - Norman Briffa
- Sheffield Teaching Hospitals & University of Sheffield, Sheffield, UK
| | - Dexter Canoy
- Population Health Sciences Institute, University of Newcastle, Newcastle, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK.,British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
| | - Rouven Priedon
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Cathie Sudlow
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Eva J A Morris
- The Big Data Institute, Nuffield Department Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ben Lacey
- The Big Data Institute, Nuffield Department Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK.,Department of Cardiology, Barts Health NHS Trust, London, UK
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Cheema K, O'Connell D, Herz N, Adebayo A, Thorpe J, Benson-Clarke A, Perkins G. P120 The influence of locked automated external defibrillators (AEDs) cabinets on the rates of vandalism and theft. Resuscitation 2022. [DOI: 10.1016/s0300-9572(22)00530-5] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kuyt K, Mullen M, Fullwood C, Chang TP, Fenwick J, Withey V, McIntosh R, Herz N, MacKinnon RJ. The assessment of a manikin-based low-dose, high-frequency cardiac resuscitation quality improvement program in early UK adopter hospitals. Adv Simul (Lond) 2021; 6:14. [PMID: 33883025 PMCID: PMC8058602 DOI: 10.1186/s41077-021-00168-y] [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] [Received: 12/23/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adult and paediatric basic life support (BLS) training are often conducted via group training with an accredited instructor every 24 months. Multiple studies have demonstrated a decline in the quality of cardio-pulmonary resuscitation (CPR) performed as soon as 3-month post-training. The 'Resuscitation Quality Improvement' (RQI) programme is a quarterly low-dose, high-frequency training, based around the use of manikins connected to a cart providing real-time and summative feedback. We aimed to evaluate the effects of the RQI Programme on CPR psychomotor skills in UK hospitals that had adopted this as a method of BLS training, and establish whether this program leads to increased compliance in CPR training. METHODS The study took place across three adopter sites and one control site. Participants completed a baseline assessment without live feedback. Following this, participants at the adopter sites followed the RQI curriculum for adult CPR, or adult and infant CPR. The curriculum was split into quarterly training blocks, and live feedback was given on technique during the training session via the RQI cart. After following the curriculum for 12/24 months, participants completed a second assessment without live feedback. RESULTS At the adopter sites, there was a significant improvement in the overall score between baseline and assessment for infant ventilations (N = 167, p < 0.001), adult ventilations (n = 129, p < 0.001), infant compressions (n = 163, p < 0.001) adult compressions (n = 205, p < 0.001), and adult CPR (n = 249, p < 0.001). There was no significant improvement in the overall score for infant CPR (n = 206, p = 0.08). Data from the control site demonstrated a statistically significant improvement in mean score for adult CPR (n = 22, p = 0.02), but not for adult compressions (N = 18, p = 0.39) or ventilations (n = 17, p = 0.08). No statistically significant difference in improvement of mean scores was found between the grouped adopter sites and the control site. The effect of the duration of the RQI curriculum on CPR performance appeared to be minimal in this data set. Compliance with the RQI curriculum varied by site, one site maintained hospital compliance at 90% over a 1 year period, however compliance reduced over time at all sites. CONCLUSIONS This data demonstrated an increased adherence with guidelines for high-quality CPR post-training with the RQI cart, for all adult and most infant measures, but not infant CPR. However, the relationship between a formalised quarterly RQI curriculum and improvements in resuscitation skills is not clear. It is also unclear whether the RQI approach is superior to the current classroom-based BLS training for CPR skill acquisition in the UK. Further research is required to establish how to optimally implement the RQI system in the UK and how to optimally improve hospital wide compliance with CPR training to improve the outcomes of in-hospital cardiac arrests.
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Affiliation(s)
- Katherine Kuyt
- Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Montana Mullen
- Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Catherine Fullwood
- Medical Statistics Group, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Todd P Chang
- Division of Emergency Medicine and Transport, Children's Hospital of Los Angeles, Los Angeles, USA
| | - James Fenwick
- Resuscitation Service, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, UK
| | | | - Rod McIntosh
- Department of Resuscitation, Borders General Hospital, Borders NHS, Selkirk, UK
| | | | - Ralph James MacKinnon
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
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Macmillan T, Pennington M, Summers JA, Goddard K, Zala D, Herz N, Peacock JL, Keevil S, Chalkidou A. SecurAcath for Securing Peripherally Inserted Central Catheters: A NICE Medical Technology Guidance. Appl Health Econ Health Policy 2018; 16:779-791. [PMID: 30123950 PMCID: PMC6244619 DOI: 10.1007/s40258-018-0427-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Central venous catheters are commonly used to deliver therapies and to monitor patients, and require securing at the point of percutaneous entry to avoid dislodgement. SecurAcath is a catheter securement device designed for central venous catheters. The National Institute for Health and Care Excellence, as a part of its Medical Technologies Evaluation Programme, selected this device for evaluation and invited the manufacturer, Interrad Medical, to submit clinical and economic evidence. The King's Technology Evaluation Centre, an External Assessment Centre commissioned by the National Institute for Health and Care Excellence, independently critiqued the manufacturer's submissions. The External Assessment Centre found a lack of evidence comparing SecurAcath with alternative approaches to securement (StatLock, suturing, tape securement), with one unpublished randomised controlled trial providing the strongest evidence. The External Assessment Centre conducted a new systematic review and meta-analysis and concluded that there is some evidence indicating the non-inferiority of SecurAcath compared to StatLock. The External Assessment Centre considered the manufacturer's economic model to be appropriate but made revisions to some parameters and noted significant heterogeneity in the included studies. The revised model indicated that StatLock was more cost effective than SecurAcath for catheter indwell times of up to 5 days; however, for medium- and long-term indwell times, SecurAcath was the most cost-effective option. The National Institute for Health and Care Excellence Medical Technologies Guidance MTG 34, issued in June 2017, recommended the adoption of SecurAcath for securing peripherally inserted central catheters within the National Health Service in England.
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Affiliation(s)
- Tom Macmillan
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK.
| | - Mark Pennington
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jennifer A Summers
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Kate Goddard
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Darshan Zala
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Naomi Herz
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Janet L Peacock
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Stephen Keevil
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Anastasia Chalkidou
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
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Wimmer NJ, Robbins S, Ssemaganda H, Yang E, Normand SL, Matheny ME, Herz N, Rising J, Resnic FS. Assessing the cost burden of United States FDA-mandated post-approval studies for medical devices. J Health Care Finance 2016; 2016:http://www.healthfinancejournal.com/~junland/index.php/johcf/article/view/82/83. [PMID: 28280294 PMCID: PMC5340422] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Approved medical devices frequently undergo FDA mandated post-approval studies (PAS). However, there is uncertainty as to the value of PAS in assessing the safety of medical devices and the cost of these studies to the healthcare system is unknown. Since PAS costs are funded through device manufacturers who do not share the costs with regulators, we sought to estimate the total PAS costs through interviews with a panel of experts in medical device clinical trial design in order to design a general cost model for PAS which was then applied to the FDA PAS. A total of 277 PAS were initiated between 3/1/05 through 6/30/13 and demonstrated a median cost of $2.16 million per study and an overall cost of $1.22 billion over the 8.25 years of study. While these costs are funded through manufacturers, the ultimate cost is borne by the healthcare system through the medical device costs. Given concerns regarding the informational value of PAS, the resources used to support mandated PAS may be better allocated to other approaches to assure safety.
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Affiliation(s)
- Neil J. Wimmer
- Christiana Care, Division of Cardiology, Newark, DE, USA
| | - Susan Robbins
- Comparative Effectiveness Research Institute and Department of Cardiovascular Medicine, Lahey Clinic Foundation, Burlington, MA, USA
| | - Henry Ssemaganda
- Comparative Effectiveness Research Institute and Department of Cardiovascular Medicine, Lahey Clinic Foundation, Burlington, MA, USA
| | - Erin Yang
- Comparative Effectiveness Research Institute and Department of Cardiovascular Medicine, Lahey Clinic Foundation, Burlington, MA, USA
| | - Sharon-Lise Normand
- Department of Healthcare Policy, Harvard Medical School, and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael E. Matheny
- Geriatrics Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Veteran's Health Administration, Murfreesboro, TN; Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Naomi Herz
- The Pew Charitable Trusts, Washington, D.C., USA
| | - Josh Rising
- The Pew Charitable Trusts, Washington, D.C., USA
| | - Frederic S. Resnic
- Comparative Effectiveness Research Institute and Department of Cardiovascular Medicine, Lahey Clinic Foundation, Burlington, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
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Aggarwal A, Herz N, Campbell P, Arkush L, Short S, Rees J. Diagnostic delay and survival in high-grade gliomas - evidence of the 'waiting time paradox'? Br J Neurosurg 2015; 29:520-3. [PMID: 25738427 DOI: 10.3109/02688697.2015.1012050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We present a retrospective single-centre study to determine whether delays in diagnosis of high-grade glioma (HGG) impact on overall survival (OS). MATERIAL AND METHODS Consecutive patients diagnosed with HGG at a single neuroscience centre in 2011 were reviewed. Route of referral and time from initial presentation to diagnosis were analysed and correlated with OS. RESULTS 118 patients were studied - 92 patients with glioblastoma (GBM). Diagnosis of GBM in patients presenting to emergency services was quicker than that through outpatients (8 days vs. 26 days, p < 0.0001), but these patients had significantly worse OS (181 days vs. 386 days p = 0.0075). This trend was observed for the whole cohort (Grade III and GBM), with OS 278 days in patients presenting to emergency services compared with 423 days for patients presenting via outpatients (p = 0.0034). Patients presenting to outpatients were younger (median age: 54 years) compared with patients presenting to emergency services (median age: 62.5 years) (p = 0.0106). There were no other differences between the two groups with respect to the nature of presenting symptoms. CONCLUSION Earlier diagnosis is paradoxically associated with a worse OS in GBM. An 'aggressive' phenotype with rapid symptomatic deterioration and hence emergency presentation is a poor prognostic factor not influenced by earlier diagnosis.
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Affiliation(s)
- Ajay Aggarwal
- a National Hospital for Neurology and Neurosurgery , Queen Square, London , UK
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Aggarwal A, Herz N, Arkush L, Short S, Rees J. OP30 * DIAGNOSTIC DELAY AND SURVIVAL IN HIGH GRADE GLIOMAS - EVIDENCE OF THE "WAITING TIME PARADOX". Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou251.28] [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: 11/12/2022] Open
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Pinnow E, Herz N, Loyo-Berrios N, Tarver M. Enrollment and monitoring of women in post-approval studies for medical devices mandated by the Food and Drug Administration. J Womens Health (Larchmt) 2014; 23:218-23. [PMID: 24405314 DOI: 10.1089/jwh.2013.4343] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Disease presentation, prevalence, and treatment effects vary by sex, thus it is important to ensure adequate participation of both sexes in medical device post-approval studies (PAS). METHODS The goals of this study were to determine the participation rate of women in PAS mandated by the Food and Drug Administration (FDA) and if participation varied by clinical area. The study also evaluated the frequency in which enrollment by sex is reported by applicant reports and FDA reviews, as well as the frequency in which final study reports analyze whether outcomes differ by sex. RESULTS Of 89 studies with enrollment completed, data on sex of participants were available in 93% of submitted reports, while data on enrollment by sex was evaluated and noted in 43% of FDA review memos. Study participation varied by clinical area, with female participation ranging from 32% in cardiovascular PAS to 90% in PAS for reconstructive devices. Of 53 completed studies, data on enrollment by sex was provided in 49 of the final reports. Of these 14% included a multivariate analysis that included sex as a covariate and 4% included a subgroup analysis for female participants. CONCLUSIONS Data on sex was not routinely assessed in FDA reviews. Based on these findings, FDA implemented new procedures to ensure participation by sex is evaluated in PAS reviews. FDA will continue working with applicants to develop PAS that enroll and retain proportions of women consistent with the sex-specific prevalence for the disease or condition the device is used to treat.
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Affiliation(s)
- Ellen Pinnow
- Food and Drug Administration , Center for Devices and Radiologic Health, Silver Spring, Maryland
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Abstract
Classical Greek inscriptions cut in marble, whose association as original stelai by archeological methods was debatable, were selected for study. Using traditional geological techniques and determinations of the per mil increments in carbon-13 and oxygen-18, it was determined that fragments could be positively assigned to three stelai, but that fragments from three other stelai had been incorrectly associated.
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Abstract
Most anorthosites lie in two principal belts when plotted on a predrift continental reconstruction. Anorthosite ages in the belts cluster around 1300 +/- 200 million years and range from 1100 to 1700 million years. This suggests that anorthosites are the product of a unique cataclysmic event or a thermal event that was normal only during the earth's early history.
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Herz N. On Manly's Less Stately Jargon. Science 1968; 160:833. [PMID: 17774387 DOI: 10.1126/science.160.3830.833-a] [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: 11/02/2022]
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