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Thibault B, Chow A, Mangual J, Badie N, Waddingham P, Mcspadden LUKE, Betts T, Calo L, Grieco D, Leyva F. Improvement in electrical synchrony during bi-ventricular vs. left ventricular pacing with dynamic atrioventricular delays may be predicted by conduction times. Europace 2022. [DOI: 10.1093/europace/euac053.504] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott
Introduction
Automatic adjustment of atrioventricular delay (AVD) with SyncAV has been shown to improve electrical synchrony with either biventricular (BiV) or left ventricular (LV) only pacing. Selecting the optimal pacing mode may be guided by measuring conduction delays between the right atrium (RA), right ventricle (RV), and LV.
Purpose
Evaluate correlations between inter-chamber conduction delays and the QRS duration (QRSd) reduction achieved by BiV or LV-only pacing with SyncAV.
Methods
CRT implant patients (LBBB, QRSd ≥ 150 ms) were prospectively enrolled. Blinded QRSd was measured from 12-lead ECG during BiV and LV-only pacing, with SyncAV enabled and optimized to minimize QRSd. Conduction delays were measured by the device from unipolar electrograms during pacing and sensing (e.g. RAp-RVs). Correlations between each delay and which mode had the narrower QRSd was assessed by binomial regression.
Results
In total, 68 patients were evaluated (66.1 yr, 67.1% male, 32.5% ischemic, 26.3% EF, 165.1 ms intrinsic QRSd). BiV+SyncAV and LV+SyncAV reduced QRSd by 23.8% and 21.3% (P<0.001) vs. intrinsic conduction. Of all delays, RVs-LVs and LVp-RVs were significantly correlated with patient probability of BiV+SyncAV yielding a narrower QRSd than LV+SyncAV. BiV+SyncAV was favored in 70.6% (48/68) of all patients, but was favored in 92.3% (24/26) of patients with LVp-RVs < median (143 ms) (P=0.030 vs all).
Conclusion
When combined with SyncAV, BiV yielded a narrower QRSd than LV-only in the majority of patients, but was favored in a greater proportion who exhibit LVp-RVs delays below the median. Such conduction delay cut-offs can be used to facilitate pacing mode selection.
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Affiliation(s)
- B Thibault
- Montreal Heart Institute, Montreal, Canada
| | - A Chow
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - J Mangual
- Abbott, Sylmar, United States of America
| | - N Badie
- Abbott, Sylmar, United States of America
| | - P Waddingham
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | | | - T Betts
- John Radcliffe Hospital, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - L Calo
- Polyclinic Casilino, Rome, Italy
| | - D Grieco
- Polyclinic Casilino, Rome, Italy
| | - F Leyva
- Aston Medical School, Birmingham, United Kingdom of Great Britain & Northern Ireland
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Thibault B, Chow A, Mangual J, Badie N, Waddingham P, Mcspadden L, Betts T, Calo L, Leyva F. Impact of pacing configuration and right ventricular lead location on dynamic atrioventricular delay optimization. Europace 2021. [DOI: 10.1093/europace/euab116.434] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott
Introduction
Automatic adjustment of atrioventricular delay (AVD) with SyncAV has been shown to improve electrical synchronization. However, the effect of pacing configuration and right ventricular (RV) lead location on SyncAV programming is unknown.
Purpose
Evaluate the effect of pacing configuration and lead location on SyncAV optimization during biventricular (BiV) and LV-only pacing, with and without MultiPoint Pacing (MPP).
Methods
Patients with LBBB and QRS duration (QRSd) ≥ 150 ms scheduled for CRT-P/D device implantation with quadripolar LV lead were enrolled in this prospective study. RV lead location was classified at implant by the operator via fluoroscopy. QRSd was measured post-implant from 12-lead surface ECG by blinded experts during the following pacing modes: intrinsic conduction, BiV (BiV = RV + LV1), MPP (MPP = RV + LV1 + LV2), LV-only single-site (LVSS = LV1 only), and LV-only MPP (LVMPP = LV1 + LV2). For each mode, SyncAV was enabled (e.g. BiV + SyncAV) with the patient-tailored SyncAV offset that minimized QRSd. For BiV and LVSS, LV1 was the latest activating LV cathode; for MPP and LVMPP, LV1 + LV2 were the two LV cathodes with the widest possible separation (≥30mm). All modes used minimal RV-LV and LV1-LV2 delays.
Results
Fifty-three patients (68% male, 36% ischemic, 26% ejection fraction, 169 ms intrinsic QRSd) completed device implant and QRSd assessment. RV leads were implanted in either the septum (48%) or apex (52%), according to implanting physician preference. Relative to intrinsic conduction, BiV + SyncAV and MPP + SyncAV reduced QRSd by 23% and 27%, respectively (p < 0.01). LVSS + SyncAV reduced QRSd by 22% (p < 0.01 vs BiV + SyncAV), and LVMPP + SyncAV reduced QRSd by 25% (p < 0.05 vs MPP + SyncAV). RV apex or septum lead location did not have a significant impact on QRS reduction for each pacing configuration. As a percent of PR interval, optimal SyncAV offsets were similar for BiV + SyncAV and MPP + SyncAV (16% vs 13%, p = 0.05), and for LVSS + SyncAV and LVMPP + SyncAV (18% vs 21%, p = 0.46), but were significantly higher for LV-only settings vs. corresponding BiV/MPP settings (p < 0.05 for both pairs). For BiV + SyncAV, apical vs septal RV leads required greater SyncAV offsets (22% vs 11%, p < 0.05). SyncAV offsets also tended to be higher in apical vs septal RV leads for MPP (21% vs 11%), LVSS (20% vs 15%), and LVMPP (25% vs 16%), but without statistical significance.
Conclusion
SyncAV improves acute electrical synchronization in CRT patients with LBBB, particularly with patient-specific SyncAV programming. Pacing configuration (RV + LV or LV only, with or without MPP) and RV lead location (apex or septum) could potentially influence optimal SyncAV programming. Abstract Figure.
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Affiliation(s)
- B Thibault
- Montreal Heart Institute, Montreal, Canada
| | - A Chow
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - J Mangual
- Abbott, Sylmar, United States of America
| | - N Badie
- Abbott, Sylmar, United States of America
| | - P Waddingham
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | | | - T Betts
- John Radcliffe Hospital, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - L Calo
- Polyclinic Casilino of Rome, Rome, Italy
| | - F Leyva
- Aston Medical School, Birmingham, United Kingdom of Great Britain & Northern Ireland
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Chow A, Waddingham P, Betts T, Mangual J, Badie N, Mcspadden L, Pappone C, Calo L, Leyva F, Thibault B. 862Syncav with multipoint pacing improves acute left ventricular hemodynamics. Europace 2020. [DOI: 10.1093/europace/euaa162.197] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Abbott
Introduction
SyncAV has been shown to improve electrical synchronization by automatically adjusting atrioventricular delay (AVD) according to the intrinsic atrioventricular conduction time. Additional incremental electrical synchronization may be gained by the addition of second left ventricular (LV) pulse with MultiPoint Pacing (MPP). While the electrical synchronization benefits of SyncAV have been previously explored, there has been no assessment of the acute hemodynamic impact of SyncAV with or without MPP.
Objective
Evaluate the acute LV hemodynamic impact of SyncAV with and without MPP.
Methods
Heart failure patients with LBBB and QRS duration (QRSd) > 140 ms undergoing CRT-P/D implant with a quadripolar LV lead were enrolled in this prospective study. A guidewire or catheter with pressure transducer was placed in the LV chamber and the maximum pressure change (dP/dtmax) was recorded during the following pacing modes: intrinsic conduction, conventional biventricular pacing with SyncAV (BiV + SyncAV), and MPP with SyncAV (MPP + SyncAV). Twelve-lead surface ECG was used to determine the patient-tailored SyncAV offset that minimized QRSd.
Results
Twenty-seven patients (67% male, 44% ischemic, 30 ± 7% ejection fraction) completed the acute recordings. Relative to the intrinsic QRSd of 163 ms, BiV + SyncAV reduced QRSd by 21.5% to 124 ms (p < 0.001 vs. intrinsic) and MPP + SyncAV reduced QRSd by 26.6% to 120 ms (p < 0.05 vs. BiV + SyncAV). Beyond electrical synchronization, SyncAV significantly improved acute hemodynamics. Relative to the intrinsic dP/dtmax of 842 mmHg/s, BiV + SyncAV elevated dP/dtmax by 6.3% to 900 mmHg/s (p < 0.001 vs. intrinsic) and MPP + SyncAV elevated dP/dtmax by 8.8% to 926 mmHg/s (p < 0.005 vs. BiV + SyncAV). Despite both QRSd and dP/dtmax improvement with SyncAV and MPP, correlation between electrical and hemodynamic measurements was poor (R2 = 0.0 for BiV + SyncAV, R2 = 0.1 for MPP + SyncAV).
Conclusion
SyncAV may significantly improve acute LV hemodynamics in addition to electrical synchrony in LBBB patients. Further incremental improvement was achieved by combining SyncAV with MPP.
Abstract Figure.
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Affiliation(s)
- A Chow
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - P Waddingham
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - T Betts
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J Mangual
- Abbott, Sylmar, United States of America
| | - N Badie
- Abbott, Sylmar, United States of America
| | | | - C Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - L Calo
- Polyclinic Casilino of Rome, Rome, Italy
| | - F Leyva
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Thibault
- Montreal Heart Institute, Montreal, Canada
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Thibault B, Chow A, Mangual J, Badie N, Waddingham P, Mcspadden L, Betts T, Calo L, Leyva F. 43Dynamic atrioventricular delay achieves superior electrical synchrony when pacing both ventricles rather than left ventricle alone. Europace 2020. [DOI: 10.1093/europace/euaa162.193] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Abbott
Introduction
Automatic adjustment of atrioventricular delay (AVD) with SyncAV has been shown to improve electrical synchronization when pacing one or two sites in the left ventricle together with the right ventricle. However, it is unknown if the same benefit can be gained by using SyncAV while pacing only the left ventricle without right ventricular pacing.
Purpose
Evaluate the acute improvement in electrical synchrony provided by SyncAV with and without MultiPoint Pacing (MPP) during biventricular (BiV) and LV only pacing.
Methods
Patients with LBBB and QRS duration (QRSd) ≥ 150 ms scheduled for CRT-P/D device implantation with quadripolar LV lead were enrolled in this prospective study. QRSd was measured post-implant from 12-lead surface electrograms by blinded experts during the following pacing configurations: intrinsic conduction, conventional BiV (BiV = RV + LV1), MPP (MPP = RV + LV1 + LV2), LV-only single-site (LVSS = LV1 only), and LV-only MPP (LVMPP = LV1 + LV2). For each pacing mode, SyncAV was enabled (e.g. BiV + SyncAV) with the patient-tailored SyncAV offset that minimized QRSd. As an additional reference, QRSd during BiV was also measured using the nominal static AVD (paced/sensed AVD = 140/110 ms). BiV and LVSS pacing used the latest activating LV cathode, whereas MPP and LVMPP used the two LV cathodes with the widest possible separation (>30mm). All configurations used the minimum programmable RV-LV and LV1-LV2 delays.
Results
Thirty-five patients (78% male, 33% ischemic, 26% ejection fraction, 165 ms intrinsic QRSd) completed device implant and QRSd assessment. Relative to intrinsic conduction, BiV with nominal AVD reduced the QRSd by 17.5% (p < 0.001 vs intrinsic). Enabling SyncAV with a patient-optimized offset significantly improved QRSd reduction. BiV + SyncAV reduced QRSd by 25.2% (p < 0.001 vs. BiV). The greatest QRSd reduction of 28.9% was achieved by MPP + SyncAV (p < 0.01 vs. BiV + SyncAV). Single- and multi-site LV-only pacing reduced QRSd significantly less than corresponding biventricular modes. LVSS + SyncAV reduced QRSd by 22.5% (p < 0.05 vs. BiV + SyncAV), and LVMPP + SyncAV reduced QRSd by 24.3% (p < 0.05 vs. MPP + SyncAV). As a percent of PR interval, optimal SyncAV offsets were similar for BiV + SyncAV (median: 13%, mean: 17%) vs. MPP + SyncAV (median: 13%, mean 16%, p = 0.35 vs. BiV + SyncAV), and similar for LVSS + SyncAV (median: 20%, mean: 28%) and LVMPP + SyncAV (median: 23%, mean: 26%, p = 0.35 vs. LVSS + SyncAV), but were significantly higher for LV-only settings vs. corresponding BiV/MPP settings (p < 0.01 for both pairs). Conclusion: Greater improvement in electrical synchrony using SyncAV was observed when right ventricular pacing was included with left ventricular pacing. Additional benefit was gained by the addition of a second left ventricular pacing site with MPP in combination with SyncAV in both biventricular and LV only pacing modes.
Abstract Figure.
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Affiliation(s)
- B Thibault
- Montreal Heart Institute, Montreal, Canada
| | - A Chow
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Mangual
- Abbott, Sylmar, United States of America
| | - N Badie
- Abbott, Sylmar, United States of America
| | - P Waddingham
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | | | - T Betts
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - L Calo
- Polyclinic Casilino of Rome, Rome, Italy
| | - F Leyva
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
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Gerontitis D, Wardley J, Chapman M, Zegard A, Sammut E, Bates M, Waddingham P, Diab I, Chow A, Leyva F, Turley A, Williams I, Ullah W. P5681Improved electrical performance/stability of a novel active fixation coronary sinus lead compared to passive fixation leads: a multi-centre study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0623] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
A novel active fixation coronary sinus (CS) lead, Attain Stability, has been released in a bipolar and quadripolar configuration, with the hypothesis it will improve targeted lead positioning and stability independent of vessel anatomy.
Purpose
To compare implant procedure parameters and electrical performance/stability of a novel active fixation lead with passive fixation CS leads.
Methods
This was a retrospective study involving 6 major UK cardiac centres. Patients who received active leads were compared with passive lead recipients in a 1:2 ratio. The primary outcome was total lead displacements (combined macro/micro-displacements, defined as displacements requiring repositioning procedures, or an increase in threshold≥0.5 volts or pulse width≥0.5msec, or a change in pacing polarity). Multivariate analysis was performed to establish predictors of the primary outcome, assessing fixation mechanism (active or passive), number of poles (quad or bipolar), contributing hospital and follow-up duration.
Results
736 patients were included (241 with active leads, 495 with passive leads). There were no group differences in the baseline characteristics with respect to age, gender, EF, NYHA class, and co-morbidities, P>0.05 for all. The primary endpoint rate was 31% (74/241) in the active and 43% (213/495) in the passive fixation group (P=0.002). 6 patients in the active group and 14 in the passive group required CS lead repositioning procedures. The results of the multivariate analysis are presented in the Table. The use of active leads was associated with a significant reduction in lead displacements, odds ratio 0.62 (95% CI 0.43–0.9), P=0.012. There were differences in favour of passive compared with active leads in procedure duration, 120 [96–149] minutes vs 128 [105–155] minutes (P=0.011), and fluoroscopy time, 17 [11–26] minutes vs 18.5 [13–27] minutes (P=0.028). The median duration of follow up was similar (active vs passive): 31 [17–47] weeks vs 34 [16–71] weeks, (P=0.052).
Odds Ratio (95% Confidence Interval) P-value Active fixation CS lead 0.62 (0.43–0.9) 0.012 Quadripolar (rather than Bipolar) lead 1.26 (0.75–2.11) 0.376 Follow-up Duration (weeks) 1.005 (1.001–1.008) 0.025 Also included in the model: contributing hospital, which was significant.
Conclusion
In this large, multi-centre study, active fixation Attain Stability CS leads demonstrated superior electrical performance/stability compared with passive fixation leads, with minimal increases in implant procedure and fluoroscopy times.
Acknowledgement/Funding
None
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Affiliation(s)
- D Gerontitis
- University Hospital Southampton NHS Foundation Trust, Cardiology Department, Southampton, United Kingdom
| | - J Wardley
- Norfolk and Norwich University Hospital, Department of Cardiology, Norwich, United Kingdom
| | - M Chapman
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - A Zegard
- Aston University, Aston Medical Research Institute, Aston Medical School, Birmingham, United Kingdom
| | - E Sammut
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - M Bates
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - P Waddingham
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - I Diab
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - A Chow
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - F Leyva
- Aston University, Aston Medical Research Institute, Aston Medical School, Birmingham, United Kingdom
| | - A Turley
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - I Williams
- Norfolk and Norwich University Hospital, Department of Cardiology, Norwich, United Kingdom
| | - W Ullah
- University Hospital Southampton NHS Foundation Trust, Cardiology Department, Southampton, United Kingdom
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Craven MP, Goodwin R, Rawsthorne M, Butler D, Waddingham P, Brown S, Jamieson M. Try to see it my way: exploring the co-design of visual presentations of wellbeing through a workshop process. Perspect Public Health 2019; 139:153-161. [PMID: 30955447 PMCID: PMC6595544 DOI: 10.1177/1757913919835231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/07/2023]
Abstract
AIMS A 10-month project funded by the NewMind network sought to develop the specification of a visualisation toolbox that could be applied on digital platforms (web- or app-based) to support adults with lived experience of mental health difficulties to present and track their personal wellbeing in a multi-media format. METHODS A participant co-design methodology, Double Diamond from the Design Council (Great Britain), was used consisting of four phases: Discover - a set of literature and app searches of wellbeing and health visualisation material; Define - an initial workshop with participants with lived experience of mental health problems to discuss wellbeing and visualisation techniques and to share personal visualisations; Develop - a second workshop to add detail to personal visualisations, for example, forms of media to be employed, degree of control over sharing; and Deliver - to disseminate the learning from the exercise. RESULTS Two design workshops were held in December 2017 and April 2018 with 13 and 12 experts-by-experience involved, respectively, including two peer researchers (co-authors) and two individual-carer dyads in each workshop, with over 50% of those being present in both workshops. A total of 20 detailed visualisations were produced, the majority focusing on highly personal and detailed presentations of wellbeing. DISCUSSION While participants concurred on a range of typical dimensions of wellbeing, the individual visualisations generated were in contrast to the techniques currently employed by existing digital wellbeing apps and there was a great diversity in preference for different visualisation types. Participants considered personal visualisations to be useful as self-administered interventions or as a step towards seeking help, as well as being tools for self-appraisal. CONCLUSION The results suggest that an authoring approach using existing apps may provide the high degree of flexibility required. Training on such tools, delivered via a module on a recovery college course, could be offered.
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Affiliation(s)
- M P Craven
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Triumph Road, Nottingham NG7 2TU, UK.,Bioengineering Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - R Goodwin
- The Oliver Zangwill Centre, Cambridgeshire Community Services NHS Trust, Ely, UK
| | - M Rawsthorne
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Institute of Mental Health, Nottingham, UK
| | - D Butler
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Nottingham, UK
| | - P Waddingham
- The Oliver Zangwill Centre, Cambridgeshire Community Services NHS Trust, Ely, UK
| | - S Brown
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Nottingham, UK.,Division of Psychiatry and Applied Psychology, University of Nottingham, Jubilee Campus, Nottingham, UK
| | - M Jamieson
- Institute of Health and Wellbeing, Administration Building, Gartnavel Royal Hospital, Glasgow, UK
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