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Christopher M, Gonzalez R, Huynh J, Walker E, Radha Saseendrakumar B, Bowd C, Belghith A, Goldbaum MH, Fazio MA, Girkin CA, De Moraes CG, Liebmann JM, Weinreb RN, Baxter SL, Zangwill LM. Proactive Decision Support for Glaucoma Treatment: Predicting Surgical Interventions with Clinically Available Data. Bioengineering (Basel) 2024; 11:140. [PMID: 38391627 PMCID: PMC10886033 DOI: 10.3390/bioengineering11020140] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/06/2024] [Accepted: 01/27/2024] [Indexed: 02/24/2024] Open
Abstract
A longitudinal ophthalmic dataset was used to investigate multi-modal machine learning (ML) models incorporating patient demographics and history, clinical measurements, optical coherence tomography (OCT), and visual field (VF) testing in predicting glaucoma surgical interventions. The cohort included 369 patients who underwent glaucoma surgery and 592 patients who did not undergo surgery. The data types used for prediction included patient demographics, history of systemic conditions, medication history, ophthalmic measurements, 24-2 VF results, and thickness measurements from OCT imaging. The ML models were trained to predict surgical interventions and evaluated on independent data collected at a separate study site. The models were evaluated based on their ability to predict surgeries at varying lengths of time prior to surgical intervention. The highest performing predictions achieved an AUC of 0.93, 0.92, and 0.93 in predicting surgical intervention at 1 year, 2 years, and 3 years, respectively. The models were also able to achieve high sensitivity (0.89, 0.77, 0.86 at 1, 2, and 3 years, respectively) and specificity (0.85, 0.90, and 0.91 at 1, 2, and 3 years, respectively) at an 0.80 level of precision. The multi-modal models trained on a combination of data types predicted surgical interventions with high accuracy up to three years prior to surgery and could provide an important tool to predict the need for glaucoma intervention.
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Affiliation(s)
- Mark Christopher
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Ruben Gonzalez
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Justin Huynh
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Evan Walker
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Bharanidharan Radha Saseendrakumar
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Christopher Bowd
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Akram Belghith
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Michael H Goldbaum
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Massimo A Fazio
- Department of Ophthalmology and Vision Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Christopher A Girkin
- Department of Ophthalmology and Vision Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY 10032, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY 10032, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Sally L Baxter
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
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Chuter B, Huynh J, Bowd C, Walker E, Rezapour J, Brye N, Belghith A, Fazio MA, Girkin CA, De Moraes G, Liebmann JM, Weinreb RN, Zangwill LM, Christopher M. Deep Learning Identifies High-Quality Fundus Photographs and Increases Accuracy in Automated Primary Open Angle Glaucoma Detection. Transl Vis Sci Technol 2024; 13:23. [PMID: 38285462 PMCID: PMC10829806 DOI: 10.1167/tvst.13.1.23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose To develop and evaluate a deep learning (DL) model to assess fundus photograph quality, and quantitatively measure its impact on automated POAG detection in independent study populations. Methods Image quality ground truth was determined by manual review of 2815 fundus photographs of healthy and POAG eyes from the Diagnostic Innovations in Glaucoma Study and African Descent and Glaucoma Evaluation Study (DIGS/ADAGES), as well as 11,350 from the Ocular Hypertension Treatment Study (OHTS). Human experts assessed a photograph as high quality if of sufficient quality to determine POAG status and poor quality if not. A DL quality model was trained on photographs from DIGS/ADAGES and tested on OHTS. The effect of DL quality assessment on DL POAG detection was measured using area under the receiver operating characteristic (AUROC). Results The DL quality model yielded an AUROC of 0.97 for differentiating between high- and low-quality photographs; qualitative human review affirmed high model performance. Diagnostic accuracy of the DL POAG model was significantly greater (P < 0.001) in good (AUROC, 0.87; 95% CI, 0.80-0.92) compared with poor quality photographs (AUROC, 0.77; 95% CI, 0.67-0.88). Conclusions The DL quality model was able to accurately assess fundus photograph quality. Using automated quality assessment to filter out low-quality photographs increased the accuracy of a DL POAG detection model. Translational Relevance Incorporating DL quality assessment into automated review of fundus photographs can help to decrease the burden of manual review and improve accuracy for automated DL POAG detection.
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Affiliation(s)
- Benton Chuter
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Justin Huynh
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Evan Walker
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Jasmin Rezapour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
- Department of Ophthalmology, University Medical Center Mainz, Germany
| | - Nicole Brye
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Massimo A. Fazio
- School of Medicine, Callahan Eye Hospital, University of Alabama-Birmingham, Birmingham, Alabama, United States
| | - Christopher A. Girkin
- School of Medicine, Callahan Eye Hospital, University of Alabama-Birmingham, Birmingham, Alabama, United States
| | - Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Jeffrey M. Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Mark Christopher
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
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Huynh J, Cho M, Kim E, Ren M, Amaya-Chanaga C, Vogel A. P-78 Post hoc analysis in patients with unresectable hepatocellular carcinoma who progressed to Child-Pugh B liver function in the phase 3 REFLECT study of lenvatinib vs sorafenib. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Huynh J, McIntyre W, Um K, Reza S, Belley-Côté E, Healey J. LONG-TERM RISK OF STROKE AFTER AN EPISODE OF ATRIAL FIBRILLATION OCCURRING TRANSIENTLY WITH STRESS FOLLOWING NON-CARDIAC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.209] [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: 10/28/2022] Open
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Zullo AR, Lou U, Cabral SE, Huynh J, Berard-Collins CM. Overuse and underuse of pegfilgrastim for primary prophylaxis of febrile neutropenia. J Oncol Pharm Pract 2018; 25:1357-1365. [PMID: 30124123 DOI: 10.1177/1078155218792698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/16/2022]
Abstract
INTRODUCTION Guidelines recommend pegfilgrastim for primary prophylaxis of febrile neutropenia after highly myelosuppressive chemotherapy. While deviations from guidelines could result in overuse and increased costs, underuse is also a concern and could compromise quality of care. Our objectives were to evaluate guideline adherence and quantify the extent to which physician heterogeneity may influence pegfilgrastim use. METHODS We randomly sampled 550 patients from a retrospective cohort of those who received infusions at an academic cancer center between 1 September 2013 and 1 September 2014. Electronic medical and drug dispensing records provided information on patient characteristics, chemotherapy characteristics, prescribing physician, and pegfilgrastim administration. RESULTS We included 154 patients treated by 25 physicians. About half of patients were male and mean age was 61.3 years. Forty (26.1%) patients had no febrile neutropenia risk factors, 62 (40.5%) had one, and 51 (33.3%) had two or more. Thirty patients (19.5%) received pegfilgrastim, of which 12 (40%) received palliative chemotherapy. Nine (60%) of 15 patients on a regimen with a febrile neutropenia risk ≥ 20% received pegfilgrastim. Pegfilgrastim use significantly varied by cancer type (p < 0.01), chemotherapy regimen (p < 0.001), and regimen febrile neutropenia risk (p < 0.001). Multivariable analysis reaffirmed the association between chemotherapy regimen febrile neutropenia risk ≥ 20% and pegfilgrastim use (odds ratio (OR) = 10.1, 95% confidence interval (CI): 1.6-62.7) and suggested that 31% (95% CI: 8%-71%) of the variation in use was attributable to physician characteristics. CONCLUSION Pegfilgrastim was potentially overused for palliative chemotherapy and underused for chemotherapy regimens with febrile neutropenia risk ≥ 20%. Successful interventions to modify prescribing practices likely require an understanding of the relationship between specific physician characteristics and pegfilgrastim use.
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Affiliation(s)
- Andrew R Zullo
- 1 Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA.,2 Department of Health Services, Policy, and Practice, Brown University, Providence, RI, USA.,3 Department of Epidemiology, Brown University, Providence, RI, USA.,4 Providence Veterans Affairs Medical Center, Center of Innovation in Long-Term Services and Supports, Providence, RI, USA
| | - Uvette Lou
- 5 Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah E Cabral
- 1 Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
| | - Justin Huynh
- 1 Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
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Skrepnik T, Goldbaum D, Suszko J, Famoso J, Hurley J, Binks J, Stea B, Huynh J. Does Immunotherapy Influence the Risk of Developing Radiation Necrosis After Radiosurgery of Brain Metastases? Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Peters RM, Shivakumar N, Xu R, Javaherian K, Sink E, Patel K, Brown A, Huynh J, Blanchard M, Ross W, Byrd J. Assessing the Utility of a Novel SMS- and Phone-Based System for Blood Pressure Control in Hypertensive Patients: Feasibility Study. JMIR Cardio 2017; 1:e2. [PMID: 31758763 PMCID: PMC6857956 DOI: 10.2196/cardio.7915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/24/2017] [Revised: 06/14/2017] [Accepted: 06/27/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although hypertension (HTN) is a major modifiable risk factor for arterial damage, blood pressure (BP) remains poorly controlled in the hypertensive population. Telemedicine is a promising adjunct intervention that may complement traditional therapies and improve adherence rates; however, current approaches have multiple barriers to entry, including the use of relatively expensive Bluetooth devices or the dependence on smart phone utilization, which tend to exclude low-income and more elderly populations. OBJECTIVE The aim of this study was to design and implement a new phone call- and short message service text messaging-based intervention, Epharmix's EpxHypertension, in a quality improvement project that demonstrates the feasibility of this system for BP control in a family medicine setting. METHODS We recruited 174 patients from a community clinic in St Louis from a database of patients diagnosed with HTN. An automated call or text messaging system was used to monitor patient-reported BPs. If determined to be elevated, physicians were notified by an email, text, or electronic medical record alert. Mean systolic BPs (SBPs) and diastolic BPs (DBPs) were compared at the beginning and end of 12 weeks. RESULTS After 12 weeks on the system, patients with a baseline SBP of 140 mm Hg or higher reduced SBP by 10.8 mm Hg (95% CI -14.5 to -7.2, P<.001) and DBP by 6.6 mm Hg (95% CI -9.9 to -3.4, P=.002), but no significant changes were observed in overall BPs and BPs in the group with baseline SBP less than 140 mm Hg. CONCLUSIONS EpxHypertension provides a viable means to control HTN in patients with high baseline BPs despite previous therapy. This community implementation study demonstrates the feasibility of implementing EpxHypertension across a primary care setting without the need for smartphones or Bluetooth-linked BP cuffs. Future studies should evaluate its effectiveness in a randomized control trial compared with standard of care.
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Affiliation(s)
| | - Nishkala Shivakumar
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Ran Xu
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Kavon Javaherian
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Eric Sink
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Kunjan Patel
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Angela Brown
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | | | - Melvin Blanchard
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Will Ross
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Jonathan Byrd
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Peters RM, Lui M, Patel K, Tian L, Javaherian K, Sink E, Xu R, Xu Z, Aung W, Zhou L, Huynh J, Polites G, Blanchard M, Som A, Ross W, Bernal-Mizrachi C. Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation. JMIR Diabetes 2017; 2:e15. [PMID: 30291063 PMCID: PMC6238836 DOI: 10.2196/diabetes.7910] [Citation(s) in RCA: 9] [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: 04/24/2017] [Revised: 05/30/2017] [Accepted: 06/16/2017] [Indexed: 01/10/2023] Open
Abstract
Background Type II diabetes mellitus (T2DM) presents a major disease burden in the United States. Outpatient glycemic control among patients with T2DM remains difficult. Telemedicine shows great potential as an adjunct therapy to aid in glycemic control in real-world settings. Objective We aimed to explore the effectiveness of EpxDiabetes, a novel digital health intervention, in improving hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) among patients with uncontrolled diabetes. Methods We recruited 396 patients from a community clinic in St. Louis, Missouri, from a database of patients diagnosed with T2DM and with a most recent HbA1c >7% as part of a quality improvement project. An automated call or text-messaging system was used to monitor patient-reported FBG. If determined to be elevated, care managers were notified by email, text, or electronic medical record alert. Participants self-reported their FBG data by replying to EpxDiabetes automated phone calls or text messages. Data were subsequently analyzed, triaged, and shared with providers to enable appropriate follow-up and care plan adjustments. Absolute HbA1c reduction, patient engagement, and absolute patient-reported FBG reduction were examined at approximately 6 months post implementation. Results EpxDiabetes had an average 95.6% patient response rate to messages at least once per month and an average 71.1% response rate to messages at least once per week. Subsequent HbA1c drop with EpxDiabetes use over 4 months was -1.15% (95% CI -1.58 to -0.71) for patients with HbA1c >8% at baseline compared to the change in HbA1c over 4 months prior to the implementation of EpxDiabetes of only -0.005 points (95% CI -0.28 to 0.27), P=.0018. Conclusions EpxDiabetes may help reduce HbA1c in patients with high HbA1c baselines (>8%). The intervention demonstrates high patient engagement sustainable for at least 6 months.
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Affiliation(s)
| | - Matt Lui
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Kunjan Patel
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Lewis Tian
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Kavon Javaherian
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Eric Sink
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Ran Xu
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Zhuchen Xu
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Wint Aung
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Li Zhou
- John Cochrane Division, VA Medical Center, St. Louis, MO, United States
| | - Justin Huynh
- Division of Internal Medicine, Mercy Clinic, St. Louis, MO, United States
| | - Gregory Polites
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Melvin Blanchard
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Avik Som
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States.,Epharmix, Inc, St. Louis, MO, United States
| | - Will Ross
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Carlos Bernal-Mizrachi
- Division of Endocrinology, St. Louis VA Medical Service, St. Louis, MO, United States.,Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Dostal J, Dudzak R, Pisarczyk T, Pfeifer M, Huynh J, Chodukowski T, Kalinowska Z, Krousky E, Skala J, Hrebicek J, Medrik T, Golasowski J, Juha L, Ullschmied J. Synchronizing single-shot high-energy iodine photodissociation laser PALS and high-repetition-rate femtosecond Ti:sapphire laser system. Rev Sci Instrum 2017; 88:045109. [PMID: 28456257 DOI: 10.1063/1.4979810] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A system of precise pulse synchronization between a single-shot large-scale laser exploiting an acousto-optical modulator and a femtosecond high repetition rate laser is reported in this article. This opto-electronical system has been developed for synchronization of the sub-nanosecond kJ-class iodine photodissociation laser system (Prague Asterix Laser System-PALS) with the femtosecond 25-TW Ti:sapphire (Ti:Sa) laser operating at a repetition rate 1 kHz or 10 Hz depending on the required energy level of output pulses. At 1 kHz synchronization regime, a single femtosecond pulse of duration about 45 fs and a small energy less than 1 mJ are exploited as a probe beam for irradiation of a three-frame interferometer, while at 10 Hz repetition rate a single femtosecond pulse with higher energy about 7-10 mJ is exploited as a probe beam for irradiation of a two-channel polaro-interferometer. The synchronization accuracy ±100 ps between the PALS and the Ti:Sa laser pulses has been achieved in both regimes of synchronization. The femtosecond interferograms of laser-produced plasmas obtained by the three-frame interferometer and the femtosecond polarimetric images obtained by the two-frame polaro-interferometer confirm the full usefulness and correct functionality of the proposed method of synchronization.
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Affiliation(s)
- J Dostal
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - R Dudzak
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - T Pisarczyk
- Institute of Plasma Physics and Laser Microfusion, Ul. Hery 23, 01-497 Warsaw, Poland
| | - M Pfeifer
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - J Huynh
- Institute of Physics of the Czech Academy of Sciences, Na Slovance 2, 182 21 Prague, Czech Republic
| | - T Chodukowski
- Institute of Plasma Physics and Laser Microfusion, Ul. Hery 23, 01-497 Warsaw, Poland
| | - Z Kalinowska
- Institute of Plasma Physics and Laser Microfusion, Ul. Hery 23, 01-497 Warsaw, Poland
| | - E Krousky
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - J Skala
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - J Hrebicek
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - T Medrik
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - J Golasowski
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - L Juha
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - J Ullschmied
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
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Rezende LF, Huynh J, Kramer K, Cranmer M, Schlager L, Pugh-Yi R, Friedman S. Abstract P5-10-03: XRAYS (eXamining Relevance of Articles to Young Survivors) program survey of information needs and media use by young breast cancer survivors and young women at high risk for breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-10-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Women age 45 or under with breast cancer, or who are at high risk for breast cancer, have distinct health risks and needs when compared to their older counterparts. Young women with breast cancer or at high risk for breast cancer need evidence-based, high-quality information to help them make informed decisions about their specific health needs. Interpreting media reports on research findings, including determining the study implications for younger women is often challenging. To help women better understand media coverage of new research, Facing Our Risk of Cancer Empowered (FORCE) developed the CDC-funded XRAYS (eXamining Relevance of Articles to Young Survivors) program. To assure that the XRAYS program is responsive to the community's needs, FORCE launched a survey to assess where young women turn for information about breast cancer and to identify their information needs. The survey examines: how frequently women visit various media sources and health- or cancer-related websites for information on breast cancer screening, treatment, surgery, prevention, genetics, or survivorship; how much the women trust these information sources; whether they have ever tried to share media articles with their health care team and how the team received the information; and at what point(s) during the process of screening, diagnosis, treatment, survivorship and/or risk management respondents actively seek out information from the media. FORCE launched the survey nationally through its network of 50 outreach groups, partner organizations that serve young breast cancer survivors, and via a social media campaign targeting women age 45 and under with, or at high risk for breast cancer. The survey was open March 15 - June 30, 2015. We will report results from over 800 women, age 45 or younger, including those with breast cancer, who have previously had breast cancer, or who are at high risk for breast cancer. Analysis will determine response frequencies and whether information needs and utilization correlate with key demographic variables such as race/ethnicity, education, and income level. We will use correlation and multiple regression analysis to assess patterns in the types of information needed and channels where information is sought. These results will ensure XRAYS materials and dissemination efforts are efficient and responsive to the young breast cancer population's needs, and will inform the broader medical, media and patient advocacy communities about the distinct information needs of this group.
Citation Format: Rezende LF, Huynh J, Kramer K, Cranmer M, Schlager L, Pugh-Yi R, Friedman S. XRAYS (eXamining Relevance of Articles to Young Survivors) program survey of information needs and media use by young breast cancer survivors and young women at high risk for breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-10-03.
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Affiliation(s)
- LF Rezende
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - J Huynh
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - K Kramer
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - M Cranmer
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - L Schlager
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - R Pugh-Yi
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - S Friedman
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
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12
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Kim Y, Huynh J, Ley M, Gonzalez V. SU-E-T-325: Dosimetric Impact Due to FlexiShield in Electronic Brachytherapy (eBx) of Breast IORT: A Phantom Study. Med Phys 2015. [DOI: 10.1118/1.4924686] [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: 11/07/2022] Open
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Huynh J, Obaid H. Right thigh pain. Atypical femoral fracture (AFF). Skeletal Radiol 2015; 44:715-6, 763-4. [PMID: 25547953 DOI: 10.1007/s00256-014-2087-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J Huynh
- Royal University Hospital, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, Canada,
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Anselmi L, Huynh J, Duraffourd C, Jaramillo I, Vegezzi G, Saccani F, Boschetti E, Brecha N, De Giorgio R, Sternini C. Activation of μ opioid receptors modulates inflammation in acute experimental colitis. Neurogastroenterol Motil 2015; 27:509-23. [PMID: 25690069 PMCID: PMC4405133 DOI: 10.1111/nmo.12521] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 02/20/2014] [Accepted: 12/31/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND μ opioid receptors (μORs) are expressed by neurons and inflammatory cells, and mediate immune response. We tested whether activation of peripheral μORs ameliorates the acute and delayed phase of colitis. METHODS C57BL/6J mice were treated with 3% dextran sodium sulfate (DSS) in water, 5 days with or without the peripherally acting μOR agonist, [D-Ala2, N-Me-Phe4, Gly5-ol]-Enkephalin (DAMGO) or with DAMGO+μOR antagonist at day 2-5, then euthanized. Other mice received DSS followed by water for 4 weeks, or DSS with DAMGO starting at day 2 of DSS for 2 or 3 weeks followed by water, then euthanized at 4 weeks. Disease activity index (DAI), histological damage, and myeloperoxidase assay (MPO), as index of neutrophil infiltration, were evaluated. Cytokines and μOR mRNAs were measured with RT-PCR, and nuclear factor-kB (NF-kB), the antiapoptotic factor Bcl-xL, and caspase 3 and 7 with Western blot. KEY RESULTS DSS induced acute colitis with elevated DAI, tissue damage, apoptosis and increased MPO, cytokines, μOR mRNA, and NF-kB. DAMGO significantly reduced DAI, inflammatory indexes, cytokines, caspases, and NF-kB, and upregulated Bcl-xL, effects prevented by μOR antagonist. In DSS mice plus 4 weeks of water, DAI, NF-kB, and μOR were normal, whereas MPO, histological damage, and cytokines were still elevated; DAMGO did not reduce inflammation, and did not upregulate Bcl-xL. CONCLUSIONS & INFERENCES μOR activation ameliorated the acute but not the delayed phase of DSS colitis by reducing cytokines, likely through activation of the antiapoptotic factor, Bcl-xL, and suppression of NF-kB, a potentiator of inflammation.
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Affiliation(s)
- L. Anselmi
- CURE Digestive Diseases Research Center, Digestive Diseases
Division, David Geffen School of Medicine, Los Angeles, California 90095, USA,Department of Medicine, University of California Los Angeles,
David Geffen School of Medicine, Los Angeles, California 90095, USA
| | - J. Huynh
- CURE Digestive Diseases Research Center, Digestive Diseases
Division, David Geffen School of Medicine, Los Angeles, California 90095, USA,Department of Medicine, University of California Los Angeles,
David Geffen School of Medicine, Los Angeles, California 90095, USA
| | - C. Duraffourd
- CURE Digestive Diseases Research Center, Digestive Diseases
Division, David Geffen School of Medicine, Los Angeles, California 90095, USA,Department of Medicine, University of California Los Angeles,
David Geffen School of Medicine, Los Angeles, California 90095, USA,Department of Neurobiology, University of California Los Angeles,
David Geffen School of Medicine, Los Angeles, California 90095, USA
| | - I. Jaramillo
- CURE Digestive Diseases Research Center, Digestive Diseases
Division, David Geffen School of Medicine, Los Angeles, California 90095, USA,Department of Medicine, University of California Los Angeles,
David Geffen School of Medicine, Los Angeles, California 90095, USA
| | - G. Vegezzi
- CURE Digestive Diseases Research Center, Digestive Diseases
Division, David Geffen School of Medicine, Los Angeles, California 90095, USA,Department of Medicine, University of California Los Angeles,
David Geffen School of Medicine, Los Angeles, California 90095, USA
| | - F Saccani
- CURE Digestive Diseases Research Center, Digestive Diseases
Division, David Geffen School of Medicine, Los Angeles, California 90095, USA,Department of Medicine, University of California Los Angeles,
David Geffen School of Medicine, Los Angeles, California 90095, USA
| | - E. Boschetti
- Department of Medical and Surgical Sciences, Centro di Ricerca
Biomedica Applicata (C.R.B.A.), University of Bologna, Italy, St. Orsola-Malpighi Hospital,
Bologna, Italy
| | - N.C. Brecha
- CURE Digestive Diseases Research Center, Digestive Diseases
Division, David Geffen School of Medicine, Los Angeles, California 90095, USA,Department of Medicine, University of California Los Angeles,
David Geffen School of Medicine, Los Angeles, California 90095, USA,Department of Neurobiology, University of California Los Angeles,
David Geffen School of Medicine, Los Angeles, California 90095, USA,Veteran Administration Greater Los Angeles Health System, Los
Angeles, California 90073, USA
| | - R. De Giorgio
- Department of Medical and Surgical Sciences, Centro di Ricerca
Biomedica Applicata (C.R.B.A.), University of Bologna, Italy, St. Orsola-Malpighi Hospital,
Bologna, Italy
| | - C Sternini
- CURE Digestive Diseases Research Center, Digestive Diseases
Division, David Geffen School of Medicine, Los Angeles, California 90095, USA,Department of Medicine, University of California Los Angeles,
David Geffen School of Medicine, Los Angeles, California 90095, USA,Department of Neurobiology, University of California Los Angeles,
David Geffen School of Medicine, Los Angeles, California 90095, USA,Veteran Administration Greater Los Angeles Health System, Los
Angeles, California 90073, USA,Corresponding author: Catia Sternini, MD, CURE/DDRC,
Division of Digestive Diseases, David Geffen School of Medicine UCLA, 650 C. Young Dr.
South, CHS 44-146, Los Angeles, CA 90095, USA, ,
Tel:+1-310-825-6526
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Chao C, Page JH, Yang SJ, Rodriguez R, Huynh J, Chia VM. History of chronic comorbidity and risk of chemotherapy-induced febrile neutropenia in cancer patients not receiving G-CSF prophylaxis. Ann Oncol 2014; 25:1821-1829. [PMID: 24915871 DOI: 10.1093/annonc/mdu203] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 11/14/2022] Open
Abstract
BACKGROUND Chemotherapy-induced febrile neutropenia (FN) is a clinically important complication that affects patient outcome by delaying chemotherapy doses or reducing dose intensity. Risk of FN depends on chemotherapy- and patient-level factors. We sought to determine the effects of chronic comorbidities on risk of FN. DESIGN We conducted a cohort study to examine the association between a variety of chronic comorbidities and risk of FN in patients diagnosed with six types of cancer (non-Hodgkin lymphoma and breast, colorectal, lung, ovary, and gastric cancer) from 2000 to 2009 who were treated with chemotherapy at Kaiser Permanente Southern California, a large managed care organization. We excluded those patients who received primary prophylactic granulocyte colony-stimulating factor. History of comorbidities and FN events were identified using electronic medical records. Cox models adjusting for propensity score, stratified by cancer type, were used to determine the association between comorbid conditions and FN. Models that additionally adjusted for cancer stage, baseline neutrophil count, chemotherapy regimen, and dose reduction were also evaluated. RESULTS A total of 19 160 patients with mean age of 60 years were included; 963 (5.0%) developed FN in the first chemotherapy cycle. Chronic obstructive pulmonary disease [hazard ratio (HR) = 1.30 (1.07-1.57)], congestive heart failure [HR = 1.43 (1.00-1.98)], HIV infection [HR = 3.40 (1.90-5.63)], autoimmune disease [HR = 2.01 (1.10-3.33)], peptic ulcer disease [HR = 1.57 (1.05-2.26)], renal disease [HR = 1.60 (1.21-2.09)], and thyroid disorder [HR = 1.32 (1.06-1.64)] were all associated with a significantly increased FN risk. CONCLUSIONS These results provide evidence that history of several chronic comorbidities increases risk of FN, which should be considered when managing patients during chemotherapy.
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Affiliation(s)
- C Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
| | - J H Page
- Center for Observational Research, Amgen, Inc., Thousand Oaks
| | - S-J Yang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - R Rodriguez
- Department of Hematology Oncology, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles
| | - J Huynh
- Department of Hematology and Oncology, Harbor-UCLA Medical Center, Los Angeles, USA
| | - V M Chia
- Center for Observational Research, Amgen, Inc., Thousand Oaks
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Abstract
The Pathway Evaluation Program is a resource that provides profiles of 42 different medical specialities, including diagnostic radiology. It is widely used by medical students. The portrait of radiologic practice it presents is a sobering one and has the potential to deflect top students from careers in radiology. Radiologic educators and practicing radiologists need to understand its findings to improve educational experience and enhance professional fulfillment in the field.
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Godwin M, Muirhead M, Huynh J, Helt B, Grimmer J. Prevalence of gestational diabetes mellitus among Swampy Cree women in Moose Factory, James Bay. CMAJ 1999; 160:1299-302. [PMID: 10333831 PMCID: PMC1230311] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Although high rates of gestational diabetes mellitus have been documented in native populations, few studies have examined rates of the disease among native Indians in Canada. The authors conducted a study to estimate the prevalence of gestational diabetes among Swampy Cree women, to identify factors predictive of the occurrence of gestational diabetes, and to identify delivery and infant outcomes related to the presence of the disease. METHODS Information on Swampy Cree women who gave birth at Weeneebayko Hospital, Moose Factory, James Bay, Ont., between 1987 and 1995 was obtained from medical charts. Patients with and without gestational diabetes were compared. Logistic regression analysis was used to identify independent predictors of gestational diabetes. Delivery and infant outcomes that occurred secondary to gestational diabetes were also identified by means of logistic regression. RESULTS A total of 1401 deliveries occurred at Weeneebayko Hospital over the study period, of which 1298 were included in the study. Gestational diabetes was diagnosed in 110 (8.5% [95% confidence interval (CI) 6.9%-9.9%]) of the 1298 pregnancies. Factors predictive of gestational diabetes were age 35 years or more (relative risk [RR] 4.1, 95% CI 1.5-11.7), a history of gestational diabetes in a previous pregnancy (RR 6.4, 95% CI 3.5-11.7), diastolic blood pressure of 80 mm Hg or higher at the first prenatal visit (RR 1.7, 95% CI 1.1-2.8), weight greater than 80 kg at the first prenatal visit (RR 4.9, 95% CI 1.8-12.9) and having a first-degree relative with diabetes (RR 3.0, 95% CI 1.4-6.1). The only delivery outcome independently associated with the presence of gestational diabetes was an increased likelihood of needing assisted delivery (forceps or vacuum extraction) (RR 2.8, 95% CI 1.1-7.0). Shoulder dystocia was indirectly associated with gestational diabetes owing to increased infant birth weight. Infant outcomes associated with the presence of gestational diabetes were birth weight greater than 4500 g (RR 2.4, 95% CI 1.4-3.8), hyperbilirubinemia (RR 2.9, 95% CI 1.4-6.1), hypoglycemia (RR 7.3, 95% CI 3.7-14.4) and hypocalcemia (RR 8.9, 95% CI 2.3-33.7). INTERPRETATION Gestational diabetes occurred in a significant minority of Swampy Cree women and was associated with a number of adverse outcomes.
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Affiliation(s)
- M Godwin
- Department of Family Medicine, Queen's University, Kingston, Ont.
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Guo F, Huynh J, Dmitrienko GI, Viswanatha T, Clarke AJ. The role of the non-conserved residue at position 104 of class A beta-lactamases in susceptibility to mechanism-based inhibitors. Biochim Biophys Acta 1999; 1431:132-47. [PMID: 10209286 DOI: 10.1016/s0167-4838(99)00048-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of the non-conserved amino acid residue at position 104 of the class A beta-lactamases, which comprises a highly conserved sequence of amino acids at the active sites of these enzymes, in both the hydrolysis of beta-lactam substrates and inactivation by mechanism-based inhibitors was investigated. Site-directed mutagenesis was performed on the penPC gene encoding the Bacillus cereus 569/H beta-lactamase I to replace Asp104 with the corresponding Staphylococcus aureus PC1 residue Ala104. Kinetic data obtained with the purified Asp104Ala B. cereus 569/H beta-lactamase I was compared to that obtained from the wild-type B. cereus and S. aureus enzymes. Replacement of amino acid residue 104 had little effect on the Michaelis parameters for the hydrolysis of both S- and A-type penicillins. Relative to wild-type enzyme, the Asp104Ala beta-lactamase I had 2-fold higher Km values for benzylpenicillin and methicillin, but negligible difference in Km for ampicillin and oxacillin. However, kcat values were also slightly increased resulting in little change in catalytic efficiency, kcat/Km. In contrast, the Asp104Ala beta-lactamase I became more like the S. aureus enzyme in its response to the mechanism-based inhibitors clavulanic acid and 6-beta-(trifluoromethane sulfonyl)amido-penicillanic acid sulfone with respect to both response to the inhibitors and subsequent enzymatic properties. Based on the known three-dimensional structures of the Bacillus licheniformis 749/C, Escherichia coli TEM and S. aureus PC1 beta-lactamases, a model for the role of the non-conserved residue at position 104 in the process of inactivation by mechanism-based inhibitors is proposed.
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Affiliation(s)
- F Guo
- Guelph-Waterloo Centre for Graduate Work in Chemistry, Department of Chemistry, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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