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Comparing Total Medical Costs between Patients Receiving Direct Oral Anticoagulants Versus Warfarin for the Treatment of Atrial Fibrillation: Evidence from the VA. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Genetic toxicology in silico protocol. Regul Toxicol Pharmacol 2019; 107:104403. [PMID: 31195068 PMCID: PMC7485926 DOI: 10.1016/j.yrtph.2019.104403] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/20/2019] [Accepted: 06/05/2019] [Indexed: 01/23/2023]
Abstract
In silico toxicology (IST) approaches to rapidly assess chemical hazard, and usage of such methods is increasing in all applications but especially for regulatory submissions, such as for assessing chemicals under REACH as well as the ICH M7 guideline for drug impurities. There are a number of obstacles to performing an IST assessment, including uncertainty in how such an assessment and associated expert review should be performed or what is fit for purpose, as well as a lack of confidence that the results will be accepted by colleagues, collaborators and regulatory authorities. To address this, a project to develop a series of IST protocols for different hazard endpoints has been initiated and this paper describes the genetic toxicity in silico (GIST) protocol. The protocol outlines a hazard assessment framework including key effects/mechanisms and their relationships to endpoints such as gene mutation and clastogenicity. IST models and data are reviewed that support the assessment of these effects/mechanisms along with defined approaches for combining the information and evaluating the confidence in the assessment. This protocol has been developed through a consortium of toxicologists, computational scientists, and regulatory scientists across several industries to support the implementation and acceptance of in silico approaches.
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Interprofessional Health Care Education at Academic Medical Centers: Using a SWOT Analysis to Develop and Implement Programming. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10766. [PMID: 30800966 PMCID: PMC6342375 DOI: 10.15766/mep_2374-8265.10766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/14/2018] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Health care is increasingly being provided by interprofessional teams. Academic medical centers (AMCs) need to offer educational experiences for trainees to work on these teams. Few resources exist to guide educational leaders in developing and implementing these experiences to meet the unique needs of their AMC. A commonly used planning tool is the strengths, weaknesses, opportunities, and threats (SWOT) analysis, which can help organizations identify issues and develop strategies that overcome barriers to program implementation. METHODS This workshop focuses on teaching participants to use a SWOT analysis to develop interprofessional learning activities. The workshop contains both a didactic component and an experiential component. The workshop was offered as a 60-minute webinar and a 120-minute in-person presentation. The additional hour during the in-person presentation was used for experiential learning activities. Eighty-four educators from a number of health professions attended the webinar, and approximately 50 medical educators attended the in-person presentation. RESULTS Participants reported satisfaction with the workshop and found its content met stated learning objectives. Participants believed they gained both the knowledge to develop a strategic plan to implement interprofessional educational programming and the ability to apply this knowledge at their AMC. Participants reported that their confidence in using strategic planning increased due to workshop participation. DISCUSSION This workshop represents a first step in helping educational leaders learn and use strategies to develop and implement interprofessional educational programming unique to their AMC. This programming is important for training future health care providers to work on interprofessional health care teams.
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In silico toxicology protocols. Regul Toxicol Pharmacol 2018; 96:1-17. [PMID: 29678766 DOI: 10.1016/j.yrtph.2018.04.014] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/16/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
Abstract
The present publication surveys several applications of in silico (i.e., computational) toxicology approaches across different industries and institutions. It highlights the need to develop standardized protocols when conducting toxicity-related predictions. This contribution articulates the information needed for protocols to support in silico predictions for major toxicological endpoints of concern (e.g., genetic toxicity, carcinogenicity, acute toxicity, reproductive toxicity, developmental toxicity) across several industries and regulatory bodies. Such novel in silico toxicology (IST) protocols, when fully developed and implemented, will ensure in silico toxicological assessments are performed and evaluated in a consistent, reproducible, and well-documented manner across industries and regulatory bodies to support wider uptake and acceptance of the approaches. The development of IST protocols is an initiative developed through a collaboration among an international consortium to reflect the state-of-the-art in in silico toxicology for hazard identification and characterization. A general outline for describing the development of such protocols is included and it is based on in silico predictions and/or available experimental data for a defined series of relevant toxicological effects or mechanisms. The publication presents a novel approach for determining the reliability of in silico predictions alongside experimental data. In addition, we discuss how to determine the level of confidence in the assessment based on the relevance and reliability of the information.
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P1403Targeting the vessel wall during vascular intervention with SB-030 prevents platelet activation and subsequent neointimal hyperplasia. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Effects of haemolysis, icterus and lipaemia on coagulation tests as performed on Stago STA‐Compact‐Max analyser. Int J Lab Hematol 2016; 38:375-88. [DOI: 10.1111/ijlh.12498] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/18/2016] [Indexed: 11/28/2022]
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Summary of the British Thoracic Society guidelines for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax 2011; 66:1014-5. [PMID: 22003155 DOI: 10.1136/thoraxjnl-2011-201052] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This new guideline covers the rapidly advancing field of interventional bronchoscopy using flexible bronchoscopy. It includes the use of more complex diagnostic procedures such as endobronchial ultrasound, interventions for the relief of central airway obstruction due to malignancy and the recent development of endobronchial therapies for chronic obstructive pulmonary disease and asthma. The guideline aims to help all those who undertake flexible bronchoscopy to understand more about this important area. It also aims to inform respiratory physicians and other specialists dealing with lung cancer of the procedures possible in the management and palliation of central airway obstruction. The guideline covers transbronchial needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration, electrocautery/diathermy, argon plasma coagulation and thermal laser, cryotherapy, cryoextraction, photodynamic therapy, brachytherapy, tracheobronchial stenting, electromagnetic navigation bronchoscopy, endobronchial valves for emphysema and bronchial thermoplasty for asthma.
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British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax 2011; 66 Suppl 3:iii1-21. [PMID: 21987439 DOI: 10.1136/thoraxjnl-2011-200713] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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936 poster DOSE ESCALATION STUDY USING 4D CT PLANNING IN LOCALLY ADVANCED PANCREATIC CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71058-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Effects of Phenylbutazone and Oxyphenbutazone on Hepatic Drug Metabolism in the Rat. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1985.tb14106.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Evaluating the Need for Adaptive Therapy for Conformal Bladder Radiotherapy. Clin Oncol (R Coll Radiol) 2011. [DOI: 10.1016/j.clon.2011.01.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cone Beam CT as a Quality Control Evaluation Tool for Conformal Lung Radiotherapy: What Have we Learnt about Treatment Planning and Delivery? Clin Oncol (R Coll Radiol) 2011. [DOI: 10.1016/j.clon.2011.01.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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The use of ecarin chromogenic assay and prothrombinase induced clotting time in the monitoring of lepirudin for the treatment of heparin-induced thrombocytopenia. Br J Haematol 2008; 142:466-8. [DOI: 10.1111/j.1365-2141.2008.07204.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The PIVKA II test: the first reliable coagulation test for autopsy investigations. Int J Legal Med 2003; 117:143-8. [PMID: 12799736 DOI: 10.1007/s00414-003-0362-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2002] [Accepted: 01/10/2003] [Indexed: 11/30/2022]
Abstract
To date there is no routinely used reliable diagnostic test that can be performed in the post-mortem period to investigate whether a deceased had a coagulation disorder. This paper describes a series of experiments to assess the use of an antigen-based method to investigate the vitamin K-dependent factor II function in the deceased. It illustrates that by using this approach the functional status of factor II can be investigated in the post-mortem period. The abnormal proteins that are investigated by this method appear to remain stable for at least 72 h and potentially up to at least 7 days. The method that is illustrated could thus be reliably used in the post-mortem period to identify a natural or drug-induced factor II abnormality. The potential for other protein components of the coagulation cascade to be investigated by similar antigen-based methodology is suggested.
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Shedding some light on Thismia rodwayi F. Muell. (fairy lanterns) in Tasmania: distribution, habitat and conservation status. ACTA ACUST UNITED AC 2003. [DOI: 10.26749/rstpp.137.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Monitoring for Health Hazards at Work, by Ashton and Gill, 0 632 05041 1, £27.50. ANNALS OF OCCUPATIONAL HYGIENE 2001. [DOI: 10.1016/s0003-4878(01)00009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Changes in plant biomass and nutrient removal over 3 years in a constructed wetland in Cairns, Australia. WATER SCIENCE AND TECHNOLOGY : A JOURNAL OF THE INTERNATIONAL ASSOCIATION ON WATER POLLUTION RESEARCH 2001; 44:303-310. [PMID: 11804111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The surface flow wetland in Cairns, Australia consists of 3 linear channels each 65 m long. Channels 1 and 2 are 5 m wide and Channel 3 is 15 m wide. The wetland was constructed in 1994 and band planted with emergent macrophyte species and alternating open water sections. The wetland was monitored for plant growth and nutrient removal until 1997. During that period HRT was 16 days in Channel 1 and 10 days in Channels 2 and 3; mass loading rates were 2.4 kg Total N and 2.0 kg Total P ha(-1) d(-1) in Channel 1 and 3.7 kg TN and 3.3 kg TP ha(-1) d(-1) in Channels 2 and 3. The aim of this work was to determine the proportion of nutrient removal that could be attributed to direct uptake by macrophytes and incorporated into plant biomass. Over the 3 year monitoring period reduction in total mass of nutrients was: Channel 1: 26% P, 85% N; Channel 2: 28% P, 87% N; Channel 3: 21% P, 81% N. Percentage reduction of FRP (Filterable Reactive Phosphorus) was similar to TP; NOx removal was 97-98%. Mass removal rates for TN and TP were higher in Channels 2 and 3 despite greater nutrient loading rates and shorter detention times. Total FRP removal was 23 kg P in Channel 1, 33 kg P in Channel 2 and 70 kg P in Channel 3 of which plant biomass accounted for 65%, 44% and 47% respectively. Total nitrogen removal was 92 kg in Channel 1,154 kg in Channel 2 and 386 kg in Channel 3 of which plant biomass accounted for 47%, 27% and 27% respectively. Thus, in this tropical surface flow wetland supporting a mixture of emergent macrophytes and floating duckweed, vegetation is an important mechanism for direct nutrient removal.
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Alpha motoneurons are present in normal numbers but with reduced soma size in neurotrophin-3 knockout mice. Neurosci Lett 1999; 272:107-10. [PMID: 10507553 DOI: 10.1016/s0304-3940(99)00587-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neurotrophin-3 (NT-3) is essential for survival of proprioceptive and mechanoreceptor neurons, but its role in motoneuron development in vivo has seemed slight. Recent evidence however has suggested that NT-3 may be involved in motoneuron maturation. Here, we quantitatively assess the number and state of development of motoneurons within the lumbar lateral motor column (LLMC) of newborn NT-3 (-/-), (+/-) and (+/+) mutant mice. We find that the number of alpha motoneurons in the LLMC is the same in all genotypes, but soma size is significantly reduced in (-/-) mutants. This suggests that NT-3 is not required for normal production and survival of alpha motoneurons, but is essential for their full maturation and/or maintenance. We also confirm a previous report that gamma motoneurons are absent in NT-3 (-/-) mice.
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Gramicidin channel controversy--the structure in a lipid environment. NATURE STRUCTURAL BIOLOGY 1999; 6:609; discussion 611-2. [PMID: 10404209 DOI: 10.1038/10648] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Implementing programs for chronic illness management: the case of hypertension services. THE JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT 1997; 23:593-601. [PMID: 9407263 DOI: 10.1016/s1070-3241(16)30342-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This article describes the process by which HealthSystem Minnesota (a vertically integrated health care organization), functioning in a competitive managed care environment, has been implementing a hypertension services program. The program involves a team approach to care, with emphasis on patient participation in treatment; decentralized care delivery by nurse coordinators at primary care practice sites; ongoing training and education for patients and providers; and the continuous monitoring and evaluation of patient outcomes and satisfaction. JOB-LEVEL ISSUES: A variety of issues, such as the role and responsibilities of the nurse coordinator, became evident as the program moved towards operational status at four primary care practice sites, which prolonged the implementation period. PROCESS-LEVEL ISSUES: Issues relating to work process changes were more complicated to resolve and required, in some cases, changes in the proposed model. The most significant process-level issues related to educating physicians about the program to secure their participation and support. ORGANIZATION-LEVEL ISSUES: Such issues, which were the most difficult for program implementors to anticipate and resolve, included an organizational culture that emphasized decision making autonomy at primary practice sites. In part, the difficulty encountered in resolving organization-level issues reflected the implementors' lack of awareness of the strength or complexity of the environmental pressures facing the organization, as well as a lack of sensitivity to nuances relating to organizational culture. MOVING AHEAD Two groups of hypertensive patients--at the implementation and comparison sites--will be compared with respect to satisfaction with care, clinical outcomes, and costs. Expansion of the model to patients with other chronic conditions is under consideration.
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A rational approach to hypertension treatment in the older patient. Geriatrics (Basel) 1992; 47:24-8, 33-8. [PMID: 1358761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
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[Alma Woolley, dean of the School of Nursing of Georgetown University. Nursing, a humanistic bond between people and technology. Interview by Rosalía Rodríguez García]. REVISTA DE ENFERMERIA (BARCELONA, SPAIN) 1988; 11:71-2. [PMID: 3353642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
This paper outlines the main failings of the National Health Service in respect of its purchase and use of clinical and laboratory equipment. It emphasizes the need for proper inventories and demonstrates how they can aid the more efficient use of equipment by ensuring that all purchases within a Health District are co-ordinated and that named officers are responsible for individual pieces of equipment.
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Confirmation of a New Species of Small Dasyurid Marsupial by Electrophoretic Analysis of Enzymes and Proteins. AUST J ZOOL 1983. [DOI: 10.1071/zo9830743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Eight species of dasyurid marsupials have been typed for the electrophoretic mobility of 18 of their enzymes and proteins. The species were the Ningbing antechinus (Pseudantechinus sp.), Pseudantechinus macdonnellensis (formerly Antechinus macdonnellensis), Parantechinus apicalis (formerly Antechinus apicalis), Parantechinus bilarni (formerly Antechinus bilarni), Antechinus stuartii, Dasykaluta rosamondae (formerly Antechinus rosamondae), Dasycercus cristicauda and Planigale maculata. The results show that the Ningbing antechinus is a probable new species. The data suggest that its nearest relative is Dasycercus cristicauda. Analysis of the results by calculation of a modified x2 and an approximation to Nei's genetic distance indicates that all species have been the product of one radiation, possibly in the late Miocene or early Pliocene. Two races of P. macdonnellensis probably exist, separable by their transferrin types.
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Inactivitis. Am J Nurs 1966; 66:2661-3. [PMID: 5178862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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