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Rebus D, Iskander A, Deonarine F, Almas A, Rattigan D, Henn P, Fadahunsi KP, O'Donoghue J. Compliance of Type 2 Diabetes Applications to International Guidelines: Protocol for a Quantitative App Assessment. JMIR Res Protoc 2024; 13:e48781. [PMID: 38294861 PMCID: PMC10867742 DOI: 10.2196/48781] [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] [Received: 05/10/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Diabetes is among the most common chronic conditions people live with across the world. While it can be managed to a substantial degree, it can result in significant complications. As such, easy access to accurate tools to aid diabetes management is useful in minimizing these complications. Mobile apps are highly accessible and widely used, but there is a gap in the literature examining their compliance with medical guidelines. OBJECTIVE The aims of this study are to develop the Analysis of Diabetes Apps (ADA) checklist to evaluate apps' compliance to guidelines set by the International Diabetes Federation (IDF) on the treatment and management of type 2 diabetes; to assess type 2 diabetes apps in the Apple App Store and the Android Google Play Store, and their compliance with international guidelines using the ADA framework; and to compare the novel ADA checklist against both the Mobile App Rating Scale (MARS) tool kit and app ratings for each store. METHODS We will develop a checklist based on the "IDF Clinical Practice Recommendations for Managing Type 2 Diabetes in Primary Care." Type 2 diabetes apps will be scraped from 6 countries' app stores using web scraping tools. These countries include Australia, Brazil, India, Nigeria, the United States, and the United Kingdom, which were selected based on the largest population of English-speaking people in each continent. The apps will be searched on the web-based scraper using the search terms "blood sugar," "diabetes," "glucose level," "insulin," "sugar level," and "type 2 diabetes." Apps will be excluded if they are paid or are not in English. The apps will be assessed using the ADA checklist to evaluate their compliance to the international diabetes guidelines. Once scored, the results will be analyzed with descriptive statistics. The most popular apps will be further analyzed using the MARS tool kit. The ADA checklist scores will then be compared to both the MARS tool kit score and app ratings for each store. RESULTS The ADA checklist developed based on the IDF guidelines focuses on general information, risk factors, diagnosis, pharmacology, lifestyle modification, glycemic recommendations, and medications. The initial stress testing of the protocol resulted in 173 included apps. This will vary in the final search as the app stores are constantly changing. CONCLUSIONS The protocol presents the development of a checklist to investigate the compliance of type 2 diabetes apps with international guidelines. The checklist will hopefully form the basis of a scoring system for future research on compliance of mobile apps with international guidelines. High standardization of the ADA checklist will make it a robust tool for people with diabetes and their health care providers alike in assessing type 2 diabetes apps in the future. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48781.
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Affiliation(s)
- David Rebus
- Faculty of Medicine, University College Cork, Cork, Ireland
| | | | | | - Asad Almas
- Faculty of Medicine, University College Cork, Cork, Ireland
| | - Darren Rattigan
- Department of Medicine, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Patrick Henn
- ASSERT Centre, University College Cork, Cork, Ireland
| | - Kayode Philip Fadahunsi
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - John O'Donoghue
- ASSERT Centre, University College Cork, Cork, Ireland
- Malawi eHealth Research Centre, University College Cork, Cork, Ireland
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Iskander A, Jairam T, Wang C, Kendzerska T, Murray BJ, Boulos MI. Corrigendum to "Normal multiple sleep latency test values in adults: A systematic review and meta-analysis" [Sleep Med 109 (2023) 143-148]. Sleep Med 2023; 110:179. [PMID: 37611489 DOI: 10.1016/j.sleep.2023.08.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Andrew Iskander
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Trevor Jairam
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christine Wang
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Iskander A, Jairam T, Wang C, Murray BJ, Boulos MI. Normal multiple sleep latency test values in adults: A systematic review and meta-analysis. Sleep Med 2023; 109:143-148. [PMID: 37442016 DOI: 10.1016/j.sleep.2023.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
Sleep latency is a measure of time it takes to enter sleep. Very short sleep latencies are indicative of excessive daytime sleepiness and pathological sleep conditions such as narcolepsy. The normal range of mean sleep latency calculated from the multiple sleep latency test in healthy adults is not well-established. We provide a review of normative mean sleep latency values on the multiple sleep latency test by synthesizing data from 110 healthy adult cohorts. We also examine the impact of demographic variables such as age, sex, body mass index, sleep architecture and sleep-disordered breathing as well as methodological variables such as sleep onset definitions and multiple sleep latency test protocols. The average mean sleep latency was 11.7 min (95% CI: 10.8-12.6; 95% PI: 5.2-18.2) for cohorts evaluated using the earlier definition of sleep onset and 11.8 min (95% CI: 10.7-12.8; 95% PI: 7.2-16.3) for those evaluated using the later definition. There were no significant associations between mean sleep latency and demographic or methodological variables. A negative association of -0.29 per one unit increase (95% CI: -0.55 to -0.04) was found between mean sleep latency and apnea-hypopnea index on prior night polysomnography. Establishing updated ranges for mean sleep latency among healthy adults may guide clinical decision-making surrounding sleep pathologies and inform future research into the associations between patient variables, daytime sleepiness, and sleep pathologies.
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Affiliation(s)
- Andrew Iskander
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Trevor Jairam
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christine Wang
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Naguib M, Elsayed M, Khouzam RN, Iskander A. Percutaneous Closure of Post-Infarct Left Ventricular Pseudoaneurysm; A Review of Literature. Curr Probl Cardiol 2023; 48:101743. [PMID: 37084993 DOI: 10.1016/j.cpcardiol.2023.101743] [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] [Received: 04/08/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
Left ventricular pseudoaneurysm is a well-known complication of myocardial infarction and open-heart surgery and has recently been described as succeeding transapical transcatheter aortic valve replacement (TAVR). While surgical intervention is the conventional therapeutic approach, transcatheter closure can be considered in patients at high risk for surgical procedures. In this article, we present a post-myocardial infarction pseudoaneurysm for which closure was done via retrograde left ventricular (LV) access using an Amplatzer Septal Occluder, and provide a review of recent literature focusing on indications and outcomes of the different percutaneous techniques and devices.
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Affiliation(s)
- M Naguib
- Bachelor of Medicine and Bachelor of Surgery and Bachelor of Obstetrics, Roayl college of Surgeons in Ireland & North Lincolnshire and Goole NHS Trust Junior doctor.
| | - M Elsayed
- Bachelor of Medicine and Bachelor of Surgery and Bachelor of Obstetrics, Roayl college of Surgeons in Ireland & Southport at Osmskirk district hospital NHS Junior doctor
| | - R N Khouzam
- Consultant Interventional Cardiologist, Methodist Health Care
| | - A Iskander
- Doctor of Medicine, Consultant Interventional Cardiologist, St. Joseph's Hospital Cardiology Associates, St. Joseph's Health Hospital
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Oydanich M, Tutwiler V, Naftalovich R, Iskander A. Clarification on viscosity vs. viscoelasticity. Anaesthesiol Intensive Ther 2023; 55:313-314. [PMID: 38084579 PMCID: PMC10691457 DOI: 10.5114/ait.2023.132522] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Marko Oydanich
- Department of Anesthesiology, Rutgers – New Jersey Medical School, Newark, NJ, United States
| | - Valerie Tutwiler
- Department of Biomedical Engineering, Rutgers School of Engineering, New Brunswick, NJ, United States
| | - Rotem Naftalovich
- Department of Anesthesiology, Rutgers – New Jersey Medical School, Newark, NJ, United States
- Medical Corps of the U.S. Army, Fort Sam Houston, Texas, United States
| | - Andrew Iskander
- Department of Anesthesiology, Newark Beth Israel Medical Center, Newark, NJ, United States
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Iskander A, Bilgi C, Naftalovich R, Hacihaliloglu I, Berkman T, Naftalovich D, Pahlevan N. The Rheology of the Carotid Sinus: A Path Toward Bioinspired Intervention. Front Bioeng Biotechnol 2021; 9:678048. [PMID: 34178967 PMCID: PMC8222608 DOI: 10.3389/fbioe.2021.678048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/08/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022] Open
Abstract
The association between blood viscosity and pathological conditions involving a number of organ systems is well known. However, how the body measures and maintains appropriate blood viscosity is not well-described. The literature endorsing the function of the carotid sinus as a site of baroreception can be traced back to some of the earliest descriptions of digital pressure on the neck producing a drop in blood delivery to the brain. For the last 30 years, improved computational fluid dynamic (CFD) simulations of blood flow within the carotid sinus have demonstrated a more nuanced understanding of the changes in the region as it relates to changes in conventional metrics of cardiovascular function, including blood pressure. We suggest that the unique flow patterns within the carotid sinus may make it an ideal site to transduce flow data that can, in turn, enable real-time measurement of blood viscosity. The recent characterization of the PIEZO receptor family in the sinus vessel wall may provide a biological basis for this characterization. When coupled with other biomarkers of cardiovascular performance and descriptions of the blood rheology unique to the sinus region, this represents a novel venue for bioinspired design that may enable end-users to manipulate and optimize blood flow.
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Affiliation(s)
- Andrew Iskander
- Department of Anesthesiology, Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Coskun Bilgi
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Rotem Naftalovich
- Department of Anesthesiology, New Jersey Medical School, University Hospital, Rutgers University, Newark, NJ, United States.,Medical Corps of the U.S. Army, U.S. Army Medical Department, Fort Sam Houston, San Antonio, TX, United States
| | - Ilker Hacihaliloglu
- Department of Biomedical Engineering, Rutgers School of Engineering, Rutgers University, Piscataway, NJ, United States
| | - Tolga Berkman
- Department of Anesthesiology, New Jersey Medical School, University Hospital, Rutgers University, Newark, NJ, United States
| | - Daniel Naftalovich
- Department of Computational and Mathematical Sciences, California Institute of Technology, Pasadena, CA, United States.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Niema Pahlevan
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Cummins MR, Del Fiol G, Crouch BI, Ranade-Kharkar P, Khalifa A, Iskander A, Mann D, Hoffman M, Thornton S, Allen TL, Bennett H. Enabling health information exchange at a US Poison Control Center. J Am Med Inform Assoc 2020; 27:1000-1006. [PMID: 32483587 PMCID: PMC7647288 DOI: 10.1093/jamia/ocaa055] [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: 09/23/2019] [Revised: 02/27/2020] [Accepted: 04/27/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this project was to enable poison control center (PCC) participation in standards-based health information exchange (HIE). Previously, PCC participation was not possible due to software noncompliance with HIE standards, lack of informatics infrastructure, and the need to integrate HIE processes into workflow. MATERIALS AND METHODS We adapted the Health Level Seven Consolidated Clinical Document Architecture (C-CDA) consultation note for the PCC use case. We used rapid prototyping to determine requirements for an HIE dashboard for use by PCCs and developed software called SNOWHITE that enables poison center HIE in tandem with a poisoning information system. RESULTS We successfully implemented the process and software at the PCC and began sending outbound C-CDAs from the Utah PCC on February 15, 2017; we began receiving inbound C-CDAs on October 30, 2018. DISCUSSION With the creation of SNOWHITE and initiation of an HIE process for sending outgoing C-CDA consultation notes from the Utah Poison Control Center, we accomplished the first participation of PCCs in standards-based HIE in the US. We faced several challenges that are also likely to be present at PCCs in other states, including the lack of a robust set of patient identifiers to support automated patient identity matching, challenges in emergency department computerized workflow integration, and the need to build HIE software for PCCs. CONCLUSION As a multi-disciplinary, multi-organizational team, we successfully developed both a process and the informatics tools necessary to enable PCC participation in standards-based HIE and implemented the process at the Utah PCC.
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Affiliation(s)
- Mollie R Cummins
- University of Utah College of Nursing, Salt Lake City, Utah, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Barbara I Crouch
- Utah Poison Control Center, University of Utah, Salt Lake City, Utah, USA
| | | | - Aly Khalifa
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Andrew Iskander
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Darren Mann
- Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Matt Hoffman
- Medical Informatics, Utah Health Information Network, Murray, Utah, USA
| | - Sid Thornton
- Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Todd L Allen
- Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Heather Bennett
- Utah Poison Control Center, University of Utah, Salt Lake City, Utah, USA
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Ho J, Fong CK, Iskander A, Towns S, Steinbeck K. Digital psychosocial assessment: An efficient and effective screening tool. J Paediatr Child Health 2020; 56:521-531. [PMID: 31883286 DOI: 10.1111/jpc.14675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/11/2019] [Accepted: 10/14/2019] [Indexed: 11/30/2022]
Abstract
AIM A large proportion of young people with chronic health conditions are surviving into adulthood. They face the same challenges as their healthy peers and are at increased risk of mental health problems. Psychosocial assessment is a crucial aspect of clinical care. Interviews using the internationally used and accepted HEEADSSS (home environment, education/employment, eating, peer-related activities, drugs, sexuality, suicide/depression, and safety) framework require trained clinicians, rapid interpersonal engagement, time and manual documentation. HEEADSSS-derived digital self-report surveys can be initiated by non-trained staff. This study compares the utility and information recorded using both methods. METHODS A retrospective analysis comparing documentation from HEEADSSS guided face-to-face interview and a digital survey tool was conducted using 146 records collected by the Trapeze transition service across the two locations of the Sydney Children's Hospital Network (NSW, Australia) between 2013 and 2016. A panel of four experts used an iterative process to identify 29 data verification points, falling into seven categories. Wilcoxon signed-rank tests were used to compare category scores. RESULTS The digital survey took an average of 15 min and showed a significantly higher rate of disclosure across all psychosocial categories, particularly in the sensitive areas of emotions, drug use, sex and safety, compared to electronic medical record documentation of interview. CONCLUSIONS Digital survey provided a time-efficient psychosocial screening tool that was self-administered, able to be introduced by non-trained staff, had a consistent record of responses, and elicited a substantially higher disclosure rate for important areas of strength and risk that may otherwise be avoided or not recorded.
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Affiliation(s)
- Jane Ho
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Trapeze, Centre for Adolescent and Young Adult Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Cameron K Fong
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Trapeze, Centre for Adolescent and Young Adult Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Andrew Iskander
- Trapeze, Centre for Adolescent and Young Adult Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Susan Towns
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Adolescent Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
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Windle S, Dehghani P, Roy N, Old W, Grondin F, Bata I, Iskander A, Lauzon C, Srivastava N, Clarke A, Cassavar D, Dion D, Haught H, Mehta S, Baril J, Lambert C, Madan M, Abramson B, Eisenberg M. SUSTAINED SMOKING ABSTINENCE 12 MONTHS AFTER ACUTE CORONARY SYNDROME: FOLLOW-UP FROM A RANDOMIZED CONTROLLED TRIAL OF VARENICLINE IN HOSPITALIZED PATIENTS. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Shaaban S, Alsulami M, Arbab SA, Ara R, Shankar A, Iskander A, Angara K, Jain M, Bagher-Ebadian H, Achyut BR, Arbab AS. Targeting Bone Marrow to Potentiate the Anti-Tumor Effect of Tyrosine Kinase Inhibitor in Preclinical Rat Model of Human Glioblastoma. ACTA ACUST UNITED AC 2016; 12:69-81. [PMID: 27429653 DOI: 10.3923/ijcr.2016.69.81] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Antiangiogenic agents caused paradoxical increase in pro-growth and pro-angiogenic factors and caused tumor growth in glioblastoma (GBM). It is hypothesized that paradoxical increase in pro-angiogenic factors would mobilize Bone Marrow Derived Cells (BMDCs) to the treated tumor and cause refractory tumor growth. The purposes of the studies were to determine whether whole body irradiation (WBIR) or a CXCR4 antagonist (AMD3100) will potentiate the effect of vatalanib (a VEGFR2 tyrosine kinase inhibitor) and prevent the refractory growth of GBM. Human GBM were grown orthotopically in three groups of rats (control, pretreated with WBIR and AMD3100) and randomly selected for vehicle or vatalanib treatments for 2 weeks. Then all animals underwent Magnetic Resonance Imaging (MRI) followed by euthanasia and histochemical analysis. Tumor volume and different vascular parameters (plasma volume (vp), forward transfer constant (Ktrans), back flow constant (kep), extravascular extracellular space volume (ve) were determined from MRI. In control group, vatalanib treatment increased the tumor growth significantly compared to that of vehicle treatment but by preventing the mobilization of BMDCs and interaction of CXCR4-SDF-1 using WBIR and ADM3100, respectively, paradoxical growth of tumor was controlled. Pretreatment with WBIR or AMD3100 also decreased tumor cell migration, despite the fact that ADM3100 increased the accumulation of M1 and M2 macrophages in the tumors. Vatalanib also increased Ktrans and ve in control animals but both of the vascular parameters were decreased when the animals were pretreated with WBIR and AMD3100. In conclusion, depleting bone marrow cells or CXCR4 interaction can potentiate the effect of vatalanib.
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Affiliation(s)
- S Shaaban
- Laboratory of Tumor Angiogenesis, Department of Biochemistry and Molecular Biology, Cancer Center, Georgia Regents University, Augusta, GA, 30912, USA
| | - M Alsulami
- Laboratory of Tumor Angiogenesis, Department of Biochemistry and Molecular Biology, Cancer Center, Georgia Regents University, Augusta, GA, 30912, USA
| | - S A Arbab
- Laboratory of Tumor Angiogenesis, Department of Biochemistry and Molecular Biology, Cancer Center, Georgia Regents University, Augusta, GA, 30912, USA
| | - R Ara
- Laboratory of Tumor Angiogenesis, Department of Biochemistry and Molecular Biology, Cancer Center, Georgia Regents University, Augusta, GA, 30912, USA
| | - A Shankar
- Laboratory of Tumor Angiogenesis, Department of Biochemistry and Molecular Biology, Cancer Center, Georgia Regents University, Augusta, GA, 30912, USA
| | - A Iskander
- Laboratory of Tumor Angiogenesis, Department of Biochemistry and Molecular Biology, Cancer Center, Georgia Regents University, Augusta, GA, 30912, USA
| | - K Angara
- Laboratory of Tumor Angiogenesis, Department of Biochemistry and Molecular Biology, Cancer Center, Georgia Regents University, Augusta, GA, 30912, USA
| | - M Jain
- Laboratory of Tumor Angiogenesis, Department of Biochemistry and Molecular Biology, Cancer Center, Georgia Regents University, Augusta, GA, 30912, USA
| | - H Bagher-Ebadian
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA
| | - B R Achyut
- Laboratory of Tumor Angiogenesis, Department of Biochemistry and Molecular Biology, Cancer Center, Georgia Regents University, Augusta, GA, 30912, USA
| | - A S Arbab
- Laboratory of Tumor Angiogenesis, Department of Biochemistry and Molecular Biology, Cancer Center, Georgia Regents University, Augusta, GA, 30912, USA
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Carpenter CP, Iskander A, Hausdorff M, Stock JA. Fluid Management in Pediatric Urology: A Review of the Literature and Call for a Change in Practice. Urol Pract 2015; 2:373-378. [PMID: 37559316 DOI: 10.1016/j.urpr.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/26/2022]
Abstract
INTRODUCTION We investigate the intravenous fluid ordering practices of pediatric urologists. We also provide evidence for the use of isotonic fluids and, thus, establish a new standard for the field. METHODS An online questionnaire was distributed via the listserve of the American Academy of Pediatrics Section on Urology. For 3 patient scenarios the respondents were asked to select which intravenous fluid they would prescribe and which infusion rate they would choose. Fluid choices were listed as lactated Ringer solution, normal saline, 0.45% normal saline, 5% dextrose in lactated Ringer solution, 5% dextrose in 0.45% normal saline, none and other (with write-in option). Infusion rate choices were listed as maintenance (defined according to the Holliday-Segar 4-2-1 nomogram), ½x maintenance, 1.5x maintenance, 2x maintenance and other (with write-in option). A final question probed physician reason(s) for selections. RESULTS The survey had a 35% response rate. The majority of respondents use 5% dextrose in 0.45% normal saline, and the most common infusion rate is 1.5x maintenance. Additionally, choices for fluid use and infusion rate were based on a combination of physician training and personal experience. Only 13% of respondents stated that they routinely avoid isotonic fluids. A PubMed® literature search demonstrated that the general pediatric and surgical specialty literature discourages hypotonic fluids and favors the judicious use of isotonic hydration and dextrose. CONCLUSIONS A change in pediatric urology needs to occur such that isotonic fluids at maintenance rate become the standard, with the addition of dextrose and/or increasing of rate only for carefully selected patients.
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Affiliation(s)
- Christina P Carpenter
- Department of Surgery, Division of Urology, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Andrew Iskander
- Department of Anesthesiology, St. Barnabas Medical Center, St. Barnabas Health Care System, Livingston, New Jersey
| | - Mark Hausdorff
- Department of Anesthesiology, St. Barnabas Medical Center, St. Barnabas Health Care System, Livingston, New Jersey
| | - Jeffrey A Stock
- Department of Surgery, Division of Urology, Children's Hospital of New Jersey, St. Barnabas Health Care System, Newark, New Jersey
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12
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Fiol GD, Curtis C, Cimino JJ, Iskander A, Kalluri AS, Jing X, Hulse NC, Long J, Overby CL, Schardt C, Douglas DM. Disseminating context-specific access to online knowledge resources within electronic health record systems. Stud Health Technol Inform 2013; 192:672-676. [PMID: 23920641 PMCID: PMC3870015] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Clinicians' patient care information needs are frequent and largely unmet. Online knowledge resources are available that can help clinicians meet these information needs. Yet, significant barriers limit the use of these resources within the clinical workflow. Infobuttons are clinical decision support tools that use the clinical context (e.g., institution, user, patient) within electronic health record (EHR) systems to anticipate clinicians' questions and provide automated links to relevant information in knowledge resources. This paper describes OpenInfobutton (www.openinfobutton.org): a standards-based, open source Web service that was designed to disseminate infobutton capabilities in multiple EHR systems and healthcare organizations. OpenInfobutton has been successfully integrated with 38 knowledge resources at 5 large healthcare organizations in the United States. We describe the OpenInfobutton architecture, knowledge resource integration, and experiences at five large healthcare organizations.
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Affiliation(s)
- Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | - James J. Cimino
- Laboratory for Informatics Development, National Institutes of Health (NIH) Clinicial Center, Bethesda, MD, USA
| | - Andrew Iskander
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Aditya S.D. Kalluri
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Xia Jing
- Laboratory for Informatics Development, National Institutes of Health (NIH) Clinicial Center, Bethesda, MD, USA
| | - Nathan C. Hulse
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Jie Long
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Casey L. Overby
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
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Yoo GH, Subramanian G, Boinpally RR, Iskander A, Shehadeh N, Oliver J, Ezzat W, Piechocki MP, Ensley JF, Lin HS, Shibuya TY, Polin L, Parchment RE. An in vivo evaluation of docetaxel delivered intratumorally in head and neck squamous cell carcinoma. ACTA ACUST UNITED AC 2005; 131:418-29. [PMID: 15897421 DOI: 10.1001/archotol.131.5.418] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/14/2022]
Abstract
OBJECTIVE To identify activity and biological mechanisms of intratumoral (IT) docetaxel on head and neck squamous cell carcinoma (HNSCC). METHODS Docetaxel IT therapy was tested in xenograft models of 2 HNSCC lines, HN30 and HN12. The overall and disease-free survival rates, tumor growth, and toxic effects were measured. The pharmacokinetic profiles of docetaxel in plasma and tumor were compared after IT and intravenous (IV) administration. Comparisons between common and supradoses of docetaxel with regard to expression of regulators in the cell cycle, apoptosis, and signal transduction pathways were determined using Western blot analysis. RESULTS In the HN30 and HN12 xenograft models, IT docetaxel improved overall as well as disease-free survival and reversed tumor growth. The only toxic effects noted were local (alopecia and skin breakdown). Skin breakdown resolved in all cases. At equivalent dosing levels, IT docetaxel achieved a 26-fold higher peak tumor concentration and 24-fold longer tumor exposure than IV treatment. Furthermore, limited plasma exposure was noted with IT docetaxel. Supradose levels of docetaxel produced distinct protein expression patterns for regulators of the cell cycle (cyclins A and B, p21, and p27), apoptosis (cleaved caspase-3 and cleaved PARP), and signal transduction (EGFR, pEGFR, pc-Jun, and pERK) in HNSCC, which supports a distinctive mechanism of action for supradose docetaxel levels. Since levels of cleaved caspase-3 and PARP, markers of apoptosis, were only elevated with lower doses, the observed cell death at supradose levels was probably due to necrosis. CONCLUSIONS Injections of IT docetaxel at usual and supradoses are associated with a pharmacokinetic profile and biological mechanism distinct from those observed with usual IV doses. It is calculated that IT therapy in men will increase peak concentrations of docetaxel in tumors by 1000-fold over the conventional IV dose used clinically. These preclinical results support further testing of IT docetaxel in HNSCC.
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Affiliation(s)
- George H Yoo
- Department of Otolaryngology-Head and Neck Surgery, Division of Hematology/Oncology, Wayne State University, Detroit, MI 48201, USA
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Kaufman MR, Westreich R, Ammar SM, Amirali A, Iskander A, Lawson W. Autologous Cartilage Grafts Enhanced by a Novel Transplant Medium Using Fibrin Sealant and Fibroblast Growth Factor. ACTA ACUST UNITED AC 2004; 6:94-100. [PMID: 15023796 DOI: 10.1001/archfaci.6.2.94] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To introduce and assess a system for the delivery of fibroblast growth factor to autologous cartilage grafts using fibrin sealant and analyze whether this "enhancement" results in reduced rates of cartilage resorption and greater preservation of normal architectural features compared with "unenhanced" cartilage grafts. METHODS Auricular cartilage segments measuring 1 cm(2) were harvested from 12 New Zealand white rabbits, morselized, and implanted into the subcutaneous dorsum of the upper back for 3 months. The conditions included (1) cartilage alone; (2) cartilage + fibrin sealant; (3/4) cartilage + acidic or basic fibroblast growth factor (aFGF or bFGF); and (5/6) cartilage + fibrin sealant + aFGF or bFGF. Subsequent to graft harvest, gross and microscopic assessments were performed to assess size, structural integrity, and architectural features, with comparisons performed between each of the conditions. RESULTS The mean areas of the harvested cartilage grafts treated with fibrin sealant + aFGF or bFGF were 1.23 cm(2) and 1.19 cm(2), respectively, while the corresponding value for the untreated (ie, cartilage alone) specimens was 1.03 cm(2). The percentage of decrease in size was 45% for the untreated specimens and 0% for the specimens treated with fibrin sealant + aFGF or fibrin sealant + bFGF. Cartilage treated with fibrin sealant + bFGF had the greatest quantity of elastin fibers of the 6 conditions. Cartilage grafts treated with fibrin sealant alone demonstrated the most intense ground substance staining on a computerized measure of pixel intensity. CONCLUSIONS Our findings demonstrated significant improvements in graft quality using fibroblast growth factor and fibrin sealant or even fibrin sealant alone. These findings may justify changes in how cartilage grafts are prepared and delivered for facial augmentation procedures to reduce graft resorption and maintain the structural integrity of the cartilage. Further trials will be performed to elucidate the optimal growth factor concentrations for maximum structural and architectural benefits.
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Affiliation(s)
- Matthew R Kaufman
- Department of Otolaryngology--Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY, USA.
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Abstract
There are currently no descriptions of neonatal tongue anatomy. Therefore, there have been no reports on the morphological differences between it and the adult tongue that would suggest its suitability for suckling. Serial coronal sections of a neonatal tongue were used to create a 3-dimensional model that was compared to that of the adult tongue. Compared to the adult human tongue, the neonatal tongue was found to contain 1) considerably less fat and soft tissue; 2) a thinner mucosa; 3) relatively enlarged extrinsic musculature; 4) a less-developed superior longitudinal muscle, resulting in a flat dorsal surface; and 5) attachments between the extrinsic muscles and the transverse muscle group that have not been identified in the adult tongue. The particular structure of the neonatal tongue suggests how the neonatal tongue is specialized for suckling.
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Affiliation(s)
- Andrew Iskander
- Dept of Otolaryngology, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
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16
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Abstract
Extensive tracheal defects may pose a life-threatening dilemma. Although tracheal transplantation may represent a reconstructive solution, very little is known regarding the immunobiology and behavior of tracheal allografts. The objective of this study was to assess the pattern and kinetics of re-epithelialization of orthotopic tracheal allografts in immunosuppressed recipients. Thirty-eight age-matched mice were randomly assigned to five experimental groups. BALB/c donor tracheal segments were orthotopically transplanted into either syngeneic BALB/c or MHC mismatched allogeneic C57BL/6 recipients with and without immunosuppression. On post-transplant days 7, 14, 28, 48, and 62, animals from each group were evaluated by serial histology, electron microscopy, and serial immunohistochemical analysis for mucosal phenotype, re-epithelialization pattern, and lymphocyte subpopulations. Nonimmunosuppressed recipients underwent recipient-derived basal cell re-epithelialization by Day 48, with differentiation into a sparse population of ciliated columnar epithelium by Day 62, whereas immunosuppressed recipients underwent basal cell re-epithelialization 28 d after transplantation and differentiation into a dense population of ciliated columnar epithelium by Day 48. The re-epithelialization process occurred in a definable pattern that was significantly enhanced with the addition of immunosuppression. Orthotopic tracheal transplants undergo progressive re-epithelialization with recipient-derived basal cells that differentiate into ciliated columnar epithelium in a definable pattern that is enhanced with the addition of immunosuppression.
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Affiliation(s)
- Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA.
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Lindenmayer JP, Volavka J, Lieberman J, Sheitman B, Citrome L, Chakos M, Czobor P, Parker B, Iskander A. Olanzapine for schizophrenia refractory to typical and atypical antipsychotics: an open-label, prospective trial. J Clin Psychopharmacol 2001; 21:448-53. [PMID: 11476131 DOI: 10.1097/00004714-200108000-00014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The role of olanzapine in treatment-resistant schizophrenia is still unresolved. This article presents an open-label, prospective, 14-week trial with olanzapine in patients with schizophrenia and schizoaffective disorder selected for unambiguous resistance to either clozapine or risperidone and to typical antipsychotics. Forty-three inpatients (mean age, 41.6 years; mean duration of illness, 21.7 years) were enrolled and treated after cross-titration from their previous antipsychotic treatment with olanzapine 10 to 40 mg daily without any concomitant antipsychotic medication. Patients were evaluated with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions Scale, and the Extrapyramidal Symptom Rating Scale. The change with olanzapine treatment was associated with a PANSS total score improvement of 3.7 (SD = 15.6; not significant). There was a significant improvement for the PANSS cognitive and depression/anxiety factors, whereas the PANSS excitement factor worsened. The improvement rate was superior in patients receiving olanzapine doses higher than 20 mg. A total of 16.7% of patients reached response criteria set forth by a previous study. There was a significant decrease in extrapyramidal side effects (t = 2.04; p < 0.05) and statistically significant, yet modest, weight gain. These results indicate that olanzapine is only modestly effective in these severely treatment-resistant patients with schizophrenia. However, a trial with olanzapine can be recommended in these patients before moving to augmentation strategies, given the lack of proven alternatives and the observation that 16.7% of patients reached the response criteria.
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Affiliation(s)
- J P Lindenmayer
- Psychopharmacology Research Unit, Manhattan Psychiatric Unit, Manhattan Psychiatric Center, Wards Island, New York 10035, USA.
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Lindenmayer JP, Iskander A, Park M, Apergi FS, Czobor P, Smith R, Allen D. Clinical and neurocognitive effects of clozapine and risperidone in treatment-refractory schizophrenic patients: a prospective study. J Clin Psychiatry 1998; 59:521-7. [PMID: 9818633 DOI: 10.4088/jcp.v59n1005] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Few controlled studies have compared the efficacy of clozapine and risperidone in treatment-refractory schizophrenic patients. The present study investigates the efficacy of both clozapine and risperidone on psychopathologic and neurocognitive measures in a prospective 12-week open-label trial in treatment-refractory schizophrenic patients from state psychiatric hospitals. METHOD Thirty-five DSM-IV schizophrenic patients with a documented history of nonresponse to typical neuroleptics were treated with either clozapine or risperidone. Response was assessed every 2 weeks by independent raters with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI) scale, neurologic rating scales, and plasma drug levels. Neurocognitive tests were administered at baseline and week 12. RESULTS Both clozapine and risperidone brought about significant (p < .003) overall improvement in psychopathology. However, clozapine was numerically superior to risperidone on PANSS total scores and PANSS positive, negative, excitement, and cognitive factors. Extrapyramidal side effects were minimal for clozapine, whereas some were present for risperidone. Patients taking risperidone improved significantly in the beginning stages of the study and remained stable thereafter. Patients taking clozapine showed a gradual improvement that occurred over the entire length of the trial. Neurocognitive measures showed minimal improvement and did not differentiate between the 2 medication groups. CONCLUSION Both clozapine and risperidone were comparably effective across a wide spectrum of psychopathologic measures. While the efficacy of clozapine was only numerically superior to that of risperidone, it was associated with fewer extrapyramidal side effects and with progressive improvement over the 12-week treatment period, suggesting that in longer trials clozapine may prove to be superior to risperidone in neuroleptic-refractory patients.
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Affiliation(s)
- J P Lindenmayer
- Psychopharmacology Research Unit, Manhattan Psychiatric Center, New York, NY 10035, USA
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Rutenfranz J, Lederle-Schenk U, Iskander A. Leistungsver�nderungen w�hrend des �bungsverlaufes bei Montaget�tigkeiten in Abh�ngigkeit von der Anfangsleistung. Eur J Appl Physiol 1972. [DOI: 10.1007/bf00699122] [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: 10/26/2022]
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Rutenfranz J, Iskander A. [Influence of different working and practice conditions in the early stages of learning on the acquisition of a simple sensorimotor skull]. Int Z Angew Physiol 1969; 27:356-69. [PMID: 5403933] [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: 01/15/2023]
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Rutenfranz J, Iskander A. Untersuchungen �ber den Einflu� verschiedener Arbeits- und �bungsbedingungen in fr�hen Lernstadien auf das Erlernen einer einfachen sensumotorischen Leistung. Eur J Appl Physiol 1969. [DOI: 10.1007/bf00698537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rutenfranz J, Iskander A. [On the effect of intervals on the acquisition of simple sensorimotor skills]. Int Z Angew Physiol 1966; 22:207-35. [PMID: 5988913] [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: 01/17/2023]
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