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Grimsley EA, Lippincott M, Read MD, Lorch S, Farach SM, Kuo PC, Diaz JJ. Cirrhosis Increases the Rate of Failure of Nonoperative Management in Blunt Liver Injuries. Am Surg 2024:31348241241631. [PMID: 38531784 DOI: 10.1177/00031348241241631] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Pre-existing cirrhosis is associated with increased mortality in blunt liver injury. Despite widespread use of nonoperative management (NOM) for blunt liver injury, there is a relative paucity of data regarding how pre-existing cirrhosis impacts the success of NOM. Herein, we perform a retrospective cohort study using ACS TQIP 2017-2020 data to assess the relationship between cirrhosis and failure of NOM for adult patients with blunt liver injury. 37,176 patients were included (342 cirrhosis and 36,834 without cirrhosis). After propensity-score matching, patients with pre-existing cirrhosis had higher rates of failure of NOM (32.2 vs 14.1%, p < 0.01) and in-hospital mortality (36.3 vs 10.8%, p < 0.01) than patients without cirrhosis. Hesitancy to operate on patients with pre-existing cirrhosis and trauma, as well as significant underlying coagulopathy, may explain these findings.
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Affiliation(s)
- Emily A Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Michelle Lippincott
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Meagan D Read
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Steven Lorch
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sandra M Farach
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jose J Diaz
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Grimsley EA, Janjua HM, Herron T, Read MD, Lorch S, Cha JY, Farach SM, Douglas GP, Kuo PC. Patient outcomes and cost in robotic emergency general surgery. J Robot Surg 2023; 17:2937-2944. [PMID: 37856059 DOI: 10.1007/s11701-023-01739-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
The use of robotic technology in general surgery continues to increase, though its utility for emergency general surgery remains under-studied. This study explores the current trends in patient outcomes and cost of robotic emergency general surgery (REGS). The Florida Agency for Healthcare Administration database (2018-2020) was queried for adult patients undergoing intra-abdominal emergency general surgery within 24 h of admission and linked to CMS Cost Reports/Hospital Compare, American Hospital Association, and Rand Corporation Hospital datasets. Patients from the four most common REGS procedures were propensity matched to laparoscopic equivalents for hospital cost analysis. A telephone survey was performed with the top 10 REGS hospitals to identify key qualities for successful REGS programs. 181 hospitals (119 REGS, 62 non-REGS) performed 60,733 emergency surgeries. Six-percent were REGS. The most common REGS were cholecystectomy, appendectomy, inguinal and ventral hernia repairs. Before and after propensity matching, total cost for these four procedures were significantly higher than their laparoscopic equivalents, which was due to higher surgical cost as the non-operative costs did not differ. There were no differences in mortality, individual complications, or length of stay for most of the four procedures. REGS volume significantly increased each year. The survey found that 8/10 hospitals have robotic-trained staff available 24/7. Although REGS volume is increasing in Florida, cost remains significantly higher than laparoscopy. Given higher costs and lack of significantly improved outcomes, further study should be undertaken to better inform which specific patient populations would benefit from REGS.
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Affiliation(s)
- Emily A Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Haroon M Janjua
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Thomas Herron
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Meagan D Read
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Steven Lorch
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - John Y Cha
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Sandra M Farach
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Geoffrey P Douglas
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA.
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Joglekar R, DeSantis AJ, Lynch C, Lorch S. Postoperative Capnocytophaga Sputigena Presenting as Diffuse Recalcitrant Intra-abdominal Abscesses. Am Surg 2023; 89:3902-3903. [PMID: 37170816 DOI: 10.1177/00031348231175094] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Capnocytophaga sputigena is rarely implicated as the cause of postsurgical intra-abdominal abscess because it is almost exclusively found in oral flora. Despite its rarity in intra-abdominal infection, there are examples of this atypical presentation, and an awareness of this organism as a potential etiology of surgical infection is relevant for both obstetric and general surgeons. We report a case of a young female who presented just over a week after an uncomplicated C-section with complaint of abdominal discomfort and fevers. Imaging revealed multiple intra-abdominal fluid collections and cultures revealed the presence of C. sputigena. Percutaneous drainage and intravenous antibiotics were unable to provide significant source control, so she underwent surgical exploration with a multi-specialty team of obstetric and acute care surgeons. Although postsurgical pelvic abscesses are rarely due to C. sputigena, this organism has been documented to serve as a source of intra-abdominal infection.
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Affiliation(s)
- Ria Joglekar
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Anthony J DeSantis
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Catherine Lynch
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Steven Lorch
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Barry TM, Wang CQ, Lorch S. Submucosal Lipoma : A Rare Cause of Colonic Intussusception. Am Surg 2020; 86:1586-1587. [PMID: 32866034 DOI: 10.1177/0003134820940287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Chloe Q Wang
- 7831 Division of Trauma and Acute Care Surgery, Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Steven Lorch
- 7831 Division of Trauma and Acute Care Surgery, Department of Surgery, University of South Florida, Tampa, FL, USA
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Phibbs C, Lorch S, Schmitt S, Main E, Kozhimannil K, Leonard S, Phibbs C. Racial/Ethnic Disparities in Costs, Length of Stay, and Severity of Severe Maternal Morbidity. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- C. Phibbs
- Loyola Marymount University Los Angeles CA United States
| | - S. Lorch
- Leonard Davis Institute of Health Economics Philadelphia PA United States
| | - S. Schmitt
- Stanford University Palo Alto CA United States
| | - E. Main
- California Maternal Quality Care Collaborative Stanford University School of Medicine Stanford CA United States
| | - K. Kozhimannil
- Department of Health Policy & Management School of Public Health University of Minnesota Minneapolis MN United States
| | - S. Leonard
- Stanford University School of Medicine Stanford CA United States
| | - C. Phibbs
- Stanford University & Palo Alto VA Menlo Park CA United States
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Phibbs C, Leonard S, Kozhimannil K, Main E, Phibbs C, Schmitt S, Lorch S. Expanding the Estimate of the Costs of Severe Maternal Morbidity to Include Readmissions, Physician Fees, and Infant Costs. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- C. Phibbs
- Stanford University & Palo Alto VA Menlo Park CA United States
| | - S. Leonard
- Stanford University School of Medicine Stanford CA United States
| | - K. Kozhimannil
- Department of Health Policy & Management School of Public Health University of Minnesota Minneapolis MN United States
| | - E. Main
- California Maternal Quality Care Collaborative Stanford University School of Medicine Stanford CA United States
| | - C. Phibbs
- Loyola Marymount University Los Angeles CA United States
| | - S. Schmitt
- Stanford University Palo Alto CA United States
| | - S. Lorch
- Leonard Davis Institute of Health Economics Philadelphia PA United States
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Myers S, Lorch S, Passarella M, Carr B. 186 Pediatric Readiness of Hospitals Initially Caring for Severely Ill or Injured Children. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.192] [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: 11/25/2022]
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Heer K, Behringer D, Piermattei A, Bässler C, Brandl R, Fady B, Jehl H, Liepelt S, Lorch S, Piotti A, Vendramin G, Weller M, Ziegenhagen B, Büntgen U, Opgenoorth L. Linking dendroecology and association genetics in natural populations: Stress responses archived in tree rings associate with SNP genotypes in silver fir (Abies albaMill.). Mol Ecol 2018; 27:1428-1438. [DOI: 10.1111/mec.14538] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/08/2018] [Indexed: 01/07/2023]
Affiliation(s)
- K. Heer
- Faculty of Biology, Conservation Biology; Philipps-University Marburg; Marburg Germany
- Department of Ecology; Faculty of Biology; Philipps-University Marburg; Marburg Germany
| | - D. Behringer
- Faculty of Biology, Conservation Biology; Philipps-University Marburg; Marburg Germany
| | - A. Piermattei
- Department of Geography; University of Cambridge; Cambridge UK
- Department of Agricultural, Food and Environmental Sciences; Marche Polytechnic University; Ancona Italy
- Dendro Science; Swiss Federal Research Institute WSL; Birmensdorf Switzerland
| | - C. Bässler
- Bavarian Forest National Park; Grafenau Germany
| | - R. Brandl
- Department of Ecology; Faculty of Biology; Philipps-University Marburg; Marburg Germany
| | - B. Fady
- INRA; UR Ecologie des Forêts Méditerranéennes; Avignon France
| | - H. Jehl
- Bavarian Forest National Park; Grafenau Germany
| | - S. Liepelt
- Faculty of Biology, Conservation Biology; Philipps-University Marburg; Marburg Germany
| | - S. Lorch
- Department of Ecology; Faculty of Biology; Philipps-University Marburg; Marburg Germany
| | - A. Piotti
- National Research Council; Institute of Biosciences and Bioresources; Firenze Italy
| | - G.G. Vendramin
- National Research Council; Institute of Biosciences and Bioresources; Firenze Italy
| | - M. Weller
- Department of Ecology; Faculty of Biology; Philipps-University Marburg; Marburg Germany
| | - B. Ziegenhagen
- Faculty of Biology, Conservation Biology; Philipps-University Marburg; Marburg Germany
| | - U. Büntgen
- Department of Geography; University of Cambridge; Cambridge UK
- Dendro Science; Swiss Federal Research Institute WSL; Birmensdorf Switzerland
- CzechGlobe, Global Change Research Institute CAS and Masaryk University; Brno Czech Republic
| | - L. Opgenoorth
- Department of Ecology; Faculty of Biology; Philipps-University Marburg; Marburg Germany
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Ratcliff J, Lorch S, Pancholy B, Jimenez E. Bronchotomy for Extraction of Voice Prosthesis After Total Laryngectomy: A Case Report and Review of the Literature. Chest 2016. [DOI: 10.1016/j.chest.2016.02.049] [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: 11/27/2022] Open
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Utidjian LH, Hogan A, Michel J, Localio AR, Karavite D, Song L, Ramos MJ, Fiks AG, Lorch S, Grundmeier RW. Clinical Decision Support and Palivizumab: A Means to Protect from Respiratory Syncytial Virus. Appl Clin Inform 2015; 6:769-84. [PMID: 26767069 DOI: 10.4338/aci-2015-08-ra-0096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/08/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Palivizumab can reduce hospitalizations due to respiratory syncytial virus (RSV), but many eligible infants fail to receive the full 5-dose series. The efficacy of clinical decision support (CDS) in fostering palivizumab receipt has not been studied. We sought a comprehensive solution for identifying eligible patients and addressing barriers to palivizumab administration. METHODS We developed workflow and CDS tools targeting patient identification and palivizumab administration. We randomized 10 practices to receive palivizumab-focused CDS and 10 to receive comprehensive CDS for premature infants in a 3-year longitudinal cluster-randomized trial with 2 baseline and 1 intervention RSV seasons. RESULTS There were 356 children eligible to receive palivizumab, with 194 in the palivizumab-focused group and 162 in the comprehensive CDS group. The proportion of doses administered to children in the palivizumab-focused intervention group increased from 68.4% and 65.5% in the two baseline seasons to 84.7% in the intervention season. In the comprehensive intervention group, proportions of doses administered declined during the baseline seasons (from 71.9% to 62.4%) with partial recovery to 67.9% during the intervention season. The palivizumab-focused group improved by 19.2 percentage points in the intervention season compared to the prior baseline season (p < 0.001), while the comprehensive intervention group only improved 5.5 percentage points (p = 0.288). The difference in change between study groups was significant (p = 0.05). CONCLUSIONS Workflow and CDS tools integrated in an EHR may increase the administration of palivizumab. The support focused on palivizumab, rather than comprehensive intervention, was more effective at improving palivizumab administration.
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Affiliation(s)
- L H Utidjian
- Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biomedical and Health, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A Hogan
- Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania
| | - J Michel
- Department of Biomedical and Health, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - A R Localio
- Departments of Biostatics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania
| | - D Karavite
- Department of Biomedical and Health, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - L Song
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - M J Ramos
- Department of Biomedical and Health, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - A G Fiks
- Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biomedical and Health, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - S Lorch
- Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania
| | - R W Grundmeier
- Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biomedical and Health, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Molinaro T, Haynes K, Lorch S, Barnhart K. A large general practice database can be used to estimate the incidence of behavioral disorders in children conceived after assisted reproduction, and the results are reassuring. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.813] [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: 10/21/2022]
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13
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Rao PS, Lorch S. Cardiac function after percutaneous closure of patent foramen ovale. J Invasive Cardiol 2007; 19:255-6. [PMID: 17541125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- P Syamasundar Rao
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas/Houston Medical School, Houston, Texas 77030, USA.
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Abstract
Two functions of home care, assistance to improve disabled and aged patients' mobility and function, and self-care that includes treatment, screening-monitoring, exercise assistance, and information exchange, are described, as are the technologies used for these functions. Social and economic pressures as well as professional rationales that expand the use of technologies at home are noted, as is their impact on the site of care and on the patient-doctor relationship.
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Lorch S. Technology and the work of the doctor outside the hospital. Int J Technol Assess Health Care 1988; 5:43-52. [PMID: 10292541 DOI: 10.1017/s0266462300005936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article examines the ends to which technology are employed in the office practice of medicine. It argues that the types of decisions technology supports are of greater impact on how medicine is practiced over the long view than the actual technologies themselves. The more relevant the technologies are to the effectiveness of diagnosis and treatment, the more they drive the practice of medicine toward a standard endeavor. Similarly, technologies that make existing tests and procedures more efficient often reduce the skill level that is needed to provide care. The results of these forces coupled with the increasing administrative, economic, and regulating pressures lead to a diminished role for physicians unless a conscious effort is made to introduce technologies that enhance their unique and discretionary work with patients.
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Quarton GC, McGuire MT, Lorch S. Man-machine natural language exchanges based on selected features of unrestricted input. I. The development of the time-shared computer as a research tool in studying dyadic communication. J Psychiatr Res 1967; 5:165-77. [PMID: 6056818 DOI: 10.1016/0022-3956(67)90029-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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McGuire MT, Lorch S, Quarton GC. Man-machine natural language exchanges based on selected features of unrestricted input. II. The use of the time-shared computer as a research tool in studying dyadic communication. J Psychiatr Res 1967; 5:177-91. [PMID: 6056819 DOI: 10.1016/0022-3956(67)90030-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Hardy HL, Rabe EW, Lorch S. United States, Beryllium Case Registry (1952-1966). Review of its methods and utility. J Occup Med 1967; 9:271-6. [PMID: 6026373] [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: 01/18/2023]
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