1
|
Aimir M, Nasser A, Rokayah J, Hardin M, Sohail M. The sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer. Med J Malaysia 2022; 77:552-557. [PMID: 36169065] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Axillary lymph node dissection (ALND), although associated with significant morbidity, has been the standard procedure for axillary staging for breast cancer in many hospitals in Malaysia. The limited resources for radioisotope tracer and nuclear medicine service, coupled with insufficient number of trained surgeons, have been the major obstacles to perform sentinel lymph node biopsy (SLNB). MATERIALS AND METHODS This study looks into the application of 1% methylene blue dye (MBD) as a single agent for SLNB and observes the outcome and any associated complication. Thirty-four patients with early breast cancer were enrolled. Two millilitres (ml) of 1% MBD was diluted with saline to a total volume of 5 ml. After induction of general anaesthesia, 3 ml of the diluted 1% MBD is injected subdermally at the upper outer quadrant of the breast followed by 5 minutes of massage. Sentinel nodes are identified as blue nodes or lymph nodes with a blue-stained lymphatic channel and were surgically removed. All patients then underwent tumour excision, either mastectomy or breast-conserving surgery, and ALND. The sentinel nodes were categorized to positive or negative for metastases and were compared with axillary lymph nodes for diagnostic value assessment. RESULTS Identification rate of sentinel nodes was 91.2%. The mean number of removed sentinel nodes was 2 (SD=1) and the mean number of axillary nodes was 16 (SD=6). Sentinel node metastasis was found in 13 (41.9%) cases. There were two false-negative cases, resulting in a sensitivity of 86.7% (95%CI: 62.1-96.3). The negative predictive value of sentinel nodes to predict axillary metastasis was 88.9% (95%CI: 67.2- 96.9). There were no complications observed. CONCLUSION Although inferior to the standard dual-tracer technique, the usage of MBD as a single agent in SLNB for early breast cancer still offers favourable accuracy and identification rate. With continuous training and improved surgeons experience, performing SLNB with blue dye alone is feasible in order to reduce the risks and morbidities associated with ALND.
Collapse
Affiliation(s)
- M Aimir
- Sarawak General Hospital, Department of Surgery, Kuching, Sarawak, Malaysia.
| | - A Nasser
- International Islamic University Malaysia, Kulliyyah of Medicine, Department of Surgery, Kuantan, Pahang, Malaysia
| | - J Rokayah
- Sarawak General Hospital, Department of Surgery, Kuching, Sarawak, Malaysia
| | - M Hardin
- Sarawak General Hospital, Department of Surgery, Kuching, Sarawak, Malaysia
| | - M Sohail
- Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences, Kota Samarahan, Sarawak, Malaysia
| |
Collapse
|
2
|
Sedhai YR, Patel NK, Mihalick V, Talasaz A, Thomas G, Denlinger BL, Damonte JI, Del Buono MG, Federmann E, Hardin M, Ibe I, Harmon M, Van Tassell B, Abbate A. Heart failure clinical trial enrollment at a rural satellite hospital. Contemp Clin Trials 2022; 115:106731. [PMID: 35283262 PMCID: PMC9647921 DOI: 10.1016/j.cct.2022.106731] [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: 12/21/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Heart failure is a clinical condition that notably affects the lives of patients in rural areas. Partnering of a rural satellite hospital with an urban academic medical center may provide geographically underrepresented populations with heart failure an opportunity to access to controlled clinical trials (CCTs). METHODS We report our experience in screening, consenting and enrolling subjects at the VCU Health Community Memorial Hospital (VCU-CMH) in rural South Hill, Virginia, that is part of the larger VCU Health network, with the lead institution being VCU Health Medical College of Virginia Hospitals (VCU-MCV), Richmond, VA. Subjects were enrolled in a clinical trial sponsored by the National Institutes of Health and assigned to treatment with an anti-inflammatory drug for heart failure or placebo. We used the electronic health record and remote guidance and oversight from the VCU-MCV resources using a close-loop communication network to work with local resources at the facility to perform screening, consenting and enrollment. RESULTS One hundred subjects with recently decompensated heart failure were screened between January 2019 and August 2021, of these 61 are enrolled to date: 52 (85%) at VCU-MCV and 9 (15%) at VCU-CMH. Of the subjects enrolled at VCU-CMH, 33% were female, 77% Black, with a mean age of 52 ± 10 years. CONCLUSION The use of a combination of virtual/remote monitoring and guidance of local resources in this trial provides an opportunity for decentralization and access of CCTs for potential novel treatment of heart failure to underrepresented individuals from rural areas. TRIAL REGISTRATION ClinicalTrials.gov: NCT03797001.
Collapse
Affiliation(s)
- Yub Raj Sedhai
- VCU Health, Community Memorial Hospital, , South Hill, VA, United States of America
| | - Nimesh K Patel
- VCU Health, Community Memorial Hospital, , South Hill, VA, United States of America; VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Virginia Mihalick
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Azita Talasaz
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Georgia Thomas
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Bethany L Denlinger
- VCU Health, Community Memorial Hospital, , South Hill, VA, United States of America; VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Juan I Damonte
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Marco Giuseppe Del Buono
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Emily Federmann
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Mary Hardin
- VCU Health, Community Memorial Hospital, , South Hill, VA, United States of America
| | - Ikenna Ibe
- VCU Health, Community Memorial Hospital, , South Hill, VA, United States of America
| | - Mary Harmon
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Benjamin Van Tassell
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Antonio Abbate
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America.
| |
Collapse
|
3
|
Bacharier L, Maspero J, Katelaris C, Fiocchi A, Liu D, Lederer D, Hardin M. P068 DUPILUMAB REDUCES BIOMARKERS OF TYPE 2 INFLAMMATION IN CHILDREN WITH UNCONTROLLED, MODERATE-TO-SEVERE ASTHMA. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
4
|
Foley N, Hardin M, Park B, Rahaman Z, Huang S, Kelly K, Ooi H, Danter M, Wigger M, Shah A, Balsara K. Veteran Affairs Partnership Improves Access to High Volume, Quality Heart Transplant Programs. It Ain't Broke! J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.440] [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: 10/24/2022] Open
|
5
|
Feldsine PT, Jucker MT, Kaur M, Lienau AH, Kerr DE, Adamson A, Beaupre L, Bishop J, Casasola E, Cote C, Desilets S, D’lima C, Elahimanesh P, Fitzgerald S, Forgey R, Fortin J, Gohil V, Griffin J, Hardin M, Kaur D, Ketrenos J, King A, Kupski B, Luce S, Lucia L, Maeda S, Markun D, Marquez-Gonzalez M, McClendon J, McKessock J, Nelson C, Nguyen T, O’Brien C, Ramos M, Reilly S, Roa N, Schiffelbein Z, Shaffer K, Shepherd D, Sowell S, Trujillo E, Wang S, Williams K. Evaluation of the Assurance GDS® for Salmonella Method in Foods and Environmental Surfaces: Multilaboratory Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/93.1.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A multilaboratory collaborative study was conducted to compare the detection of Salmonella by the Assurance GDS® for Salmonella method and the Reference culture methods. Six foods, representing a variety of low microbial and high microbial load foods were analyzed. Seventeen laboratories in the United States and Canada participated in this study. No statistical differences (P < 0.05) were observed between the Assurance GDS for Salmonella and the Reference culture methods for any inoculation level of any food type or naturally contaminated food, except for pasta, for which the Assurance GDS method had a higher number of confirmed test portions for Salmonella compared to the Reference method.
Collapse
Affiliation(s)
| | - Markus T Jucker
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - Mandeep Kaur
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - Andrew H Lienau
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - David E Kerr
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Giaddui T, Hardin M, To D, Kremmel E, Peng C, Hann P, Richardson S, Yu Y, Harrison A, Doyle L. SU-F-T-653: Radiation Exposure from Cs-131 Permanent Seed Implants. Med Phys 2016. [DOI: 10.1118/1.4956838] [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
|
7
|
Hardin M, To D, Giaddui T, Li J, Yu Y, Harrison A. SU-F-T-386: Analysis of Three QA Methods for Predicting Dose Deviation Pass Percentage for Lung SBRT VMAT Plans. Med Phys 2016. [DOI: 10.1118/1.4956571] [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
|
8
|
Keller J, Hardin M, Giaddui T, Kremmel E, Peng C, Doyle L, Yu Y, Harrison A. SU-E-T-116: Analysis of Patient Specific VMAT QA Passing Rates with Delta4 for Matched Machines. Med Phys 2015. [DOI: 10.1118/1.4924477] [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
|
9
|
Giaddui T, Hardin M, Keller J, Kremmel E, Fu M, Peng C, Doyle L, Yu Y, Xiao Y, Harrison A. SU-E-T-115: Analysis of Patient Specific QA for VMAT by Disease Site and Planning-Delivery System Using the ScandiDos Delta4 Phantom. Med Phys 2015. [DOI: 10.1118/1.4924476] [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
|
10
|
Hardin M, Harrison A, Lockamy V, Li J, Peng C, Potrebko P, Yu Y, Doyle L, Cao J. SU-E-T-408: Evaluation of the Type and Frequency of Variations Discovered During Routine Secondary Patient Chart Review. Med Phys 2015. [DOI: 10.1118/1.4924769] [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
|
11
|
Hardin M, Wolf E, Elson H, Warnick R, Lamba M. SU-E-T-235: Monte Carlo Analysis of the Dose Enhancement in the Scalp of Patients Due to Titanium Plate Backscatter During Post-Operative Radiotherapy. Med Phys 2014. [DOI: 10.1118/1.4888566] [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
|
12
|
|
13
|
|
14
|
O'Brien A, Russo-Magno P, Karki A, Hiranniramol S, Hardin M, Kaszuba M, Sherman C, Rounds S. Effects of withdrawal of inhaled steroids in men with severe irreversible airflow obstruction. Am J Respir Crit Care Med 2001; 164:365-71. [PMID: 11500334 DOI: 10.1164/ajrccm.164.3.2002052] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [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: 11/16/2022] Open
Abstract
Inhaled corticosteroid therapy has proven efficacy for asthmatics, but the benefit for patients with chronic obstructive pulmonary disease (COPD) is less well supported. We hypothesized that withdrawal of inhaled steroids in elderly patients with severe irreversible airway obstruction would not lead to a deterioration in respiratory function. We designed a prospective, double-blind, randomized, placebo-controlled, crossover study to follow spirometry, quality of life questionnaire, six-minute (6-min) walk test, and sputum markers of inflammation during a 6-wk placebo treatment period and a 6-wk treatment period with beclomethasone dipropionate (BDP), 336 microg/d. There were 24 men receiving BDP who entered the study; 15 completed the study. Their mean age was 66.9 +/- 1.9 yr, and mean FEV(1) was 1.61 +/- 0.1 L (47% of predicted). There was a significant decrease in the mean FEV(1 )while using the placebo inhaler (1.70 L versus 1.60 L, baseline versus placebo: 95% CI, 0.002 to 0.195; p < 0.05). There was a decrease in the mean percentage change in FEV(1) for the study subjects during the placebo treatment period as compared with the BDP treatment period (-6.28 versus 5.03%, placebo versus BDP: 95% CI, -23.38 to 0.76; p = 0.06). Six-minute walk test results and sputum analysis for cell count and differential were not significantly different during placebo and BDP treatment periods. Borg scale assessment of dyspnea after exercise was increased while using the placebo inhaler as compared with baseline, and decreased during the BDP treatment period. Chronic Respiratory Disease Questionnaire (CRQ) scores revealed no significant difference between placebo and BDP. This study has demonstrated that in elderly patients with severe irreversible airway obstruction, withdrawal of inhaled corticosteroid therapy leads to a deterioration in ventilatory function and increased exercise-induced dyspnea.
Collapse
Affiliation(s)
- A O'Brien
- Division of Pulmonary and Critical Care Medicine, Pharmacy Service, Providence Veterans' Affairs Medical Center, Rhode Island Hospital, RI 02908, USA
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Hardin M. What is the Word at Logos College? Homosocial ritual or homosexual denial in Don Delillo's End Zone? J Homosex 2000; 40:31-50. [PMID: 11195665 DOI: 10.1300/j082v40n01_02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
"What Is the Word at Logos College? Homosocial Ritual or Homosexual Denial in Don Delillo's End Zone?" investigates the homoerotic desire that, despite being culturally repressed, periodically surfaces in foothall. Given the highly closeted nature of American foothall, it is necessary to look at the puns, allusions, and interactions between the players to see how Don DeLillo has created a text that subtly exposes the homoerotics of male sport. In order to strengthen the connection between homoeroticism and football, I will show how football's invention and organization in America coincides with the construction of the homosexual subject. Football and other arenas for male-male play become enforced at the same time as desire begins to express itself; thus, football is the logical place in America to look for unresolved (and resolved) male homosexuality, and DeLillo does this skillfully.
Collapse
Affiliation(s)
- M Hardin
- Department of English, Bloomsburg University, PA 17815-1301, USA
| |
Collapse
|
16
|
Sanderson BK, Raczynski JM, Cornell CE, Hardin M, Taylor HA. Ethnic disparities in patient recall of physician recommendations of diagnostic and treatment procedures for coronary disease. Am J Epidemiol 1998; 148:741-9. [PMID: 9786229 DOI: 10.1093/oxfordjournals.aje.a009695] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 11/13/2022] Open
Abstract
Despite the proven benefits of many cardiac procedures, some are used less frequently for African Americans than for white patients with known or suspected coronary disease. This study explored differences between ethnic groups that may affect patient recall of physician recommendations of cardiac procedures. Also examined were patients' responses when asked about adhering to those recommendations. The data examined were collected from interviews with 1,333 African American and white hospital inpatients with known coronary disease admitted to the Birmingham-Black Health Seeking for Coronary Heart Disease Project (1989-1990) in Alabama. Respondents were asked to recall previous health care encounters, physician recommendations of cardiac procedures, and adherence to those recommendations. Compared with whites, fewer African American patients recalled physicians recommending some cardiac procedures. If procedure recommendations were recalled, no ethnic differences were found in patient recall of adhering to those recommendations. Predictors of recall of the recommended procedures were identified by multivariate logistic regression. Patients' knowledge of having coronary disease was the common factor that predicted their recall of all cardiac procedures. Other predictor variables included some cardiac risk factors and symptoms, socioeconomic status, and ethnicity. Although health care practice is influenced by many factors, it is important to examine variables that may lead to a reduction in ethnic disparities in coronary disease morbidity and mortality.
Collapse
Affiliation(s)
- B K Sanderson
- Department of Medicine and Center for Health Promotion, University of Alabama at Birmingham, USA
| | | | | | | | | |
Collapse
|
17
|
Abstract
The purposes of this study were to assess comprehensively the nutritional status of frail older adults living in an urban area and to identify factors associated with nutritional insufficiency. Subjects were 49 adults aged > or = 65 y followed by the Jefferson County Home Health Department. Twenty-nine percent of the women and 63% of the men had a body mass index (BMI; in kg/m2) < 24. Nineteen percent had serum albumin concentrations < 35 g/L (3.5 g/dL). More than one-half of the subjects reported symptoms of oral health problems. The key dependent variables were serum albumin concentration and BMI. In univariate analyses, a lower BMI correlated with oral symptoms, male sex, increased age, and less education. Lower serum albumin concentrations were associated with advanced age, increased dependence in Activities of Daily Living (ADL), oral symptoms, and presence of a caregiver. A stepwise multiple-regression model for BMI and serum albumin showed that predictors of low BMI were increased age, less education, difficulty in chewing, and absence of dentures. Variables in the model for lower serum albumin concentrations were sex, increased age, increased dependence in ADLs, and wearing of dentures. In a secondary analysis that controlled for age, education level, functional status, and sex, oral symptoms remained associated with lower BMI but not with lower serum albumin concentrations. This study found a high prevalence of undernutrition in urban homebound older adults and suggests that oral health disability may affect nutritional status in this population.
Collapse
Affiliation(s)
- C S Ritchie
- Division of Gerontology and Geriatric Medicine, Center for Aging, Birmingham, Al, USA.
| | | | | | | | | | | | | |
Collapse
|
18
|
Hardin M. Responsibilities and effectiveness of the juvenile court in handling dependency cases. Future Child 1996; 6:111-125. [PMID: 9117357] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The juvenile court's role in handling child abuse and neglect cases changed and expanded greatly after the passage of the federal Adoption Assistance and Child Welfare Act in 1980 and following the enactment of many similar state laws. These federal and state "permanency planning" laws require child welfare agencies to make reasonable efforts to avoid the break-up of families, where safe and practical, and direct the courts to monitor these efforts. The laws also require both agencies and courts to establish timely permanent new homes for children when preservation of families is not possible. The effectiveness of juvenile courts in fulfilling the laws' mandates has been uneven because of variations in judicial workload, court management, and relationships between the courts and the child welfare agencies. The quality of legal representation of children, parents, and agencies is often compromised by high caseloads, low status and pay, lack of experience, and rapid turnover. Courts vary in their capabilities to monitor agencies' permanency planning efforts and in their power to order specific placements and services. The proper role of the court and the agency in this regard is a matter of continuing debate. The author concludes that efforts currently under way in the states to reform the juvenile court's handling of abuse and neglect cases are cause for optimism.
Collapse
Affiliation(s)
- M Hardin
- American Bar Association Center on Children and the Law, Washington, DC, USA
| |
Collapse
|
19
|
Peterson LW, Hardin M, Nitsch MJ. The use of children's drawings in the evaluation and treatment of child sexual, emotional, and physical abuse. Arch Fam Med 1995; 4:445-52. [PMID: 7742968 DOI: 10.1001/archfami.4.5.445] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Primary care physicians can be instrumental in the initial identification of potential sexual, emotional, and physical abuse of children. We reviewed the use of children's artwork as a method of communicating individual and family functioning. A quantitative method of analyzing children's artwork provides more reliability and validity than some methods used previously. A new scoring system was developed that uses individual human figure drawings and kinetic family drawings. This scoring system was based on research with 842 children (341 positively identified as sexually molested, 252 positively not sexually molested but having emotional or behavioral problems, and 249 "normal" public school children). This system is more comprehensive than previous systems of assessment of potential abuse.
Collapse
Affiliation(s)
- L W Peterson
- Department of Pediatrics, University of Nevada School of Medicine, Reno, USA
| | | | | |
Collapse
|
20
|
Chappell P, Riddle M, Anderson G, Scahill L, Hardin M, Walker D, Cohen D, Leckman J. Enhanced stress responsivity of Tourette syndrome patients undergoing lumbar puncture. Biol Psychiatry 1994; 36:35-43. [PMID: 8080901 DOI: 10.1016/0006-3223(94)90060-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.4] [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: 01/28/2023]
Abstract
Tourette's syndrome (TS) is a complex inherited neuropsychiatric disorder that is characterized by multiple motor and phonic tics. Stress-related fluctuations in symptom severity and medication responsiveness are common, and patients often report that tics are worsened by fatigue, emotional trauma, and anxiety. We examined the effects of lumbar puncture (LP) stress on plasma adrenocorticotropin (ACTH) and cortisol, urinary catecholamines, and self- and clinician ratings of anxiety in 13 medication-free TS patients and 10 normal controls, ages 17 to 41 years. The TS patients secreted significantly more ACTH than the normal controls in response to the stress of the lumbar puncture. Compared to the controls the TS patients had significantly greater postLP mean and postLP peak ACTH levels. The TS patients also excreted significantly more norepinephrine in the 20 hr preceding the lumbar puncture and reported higher levels of anxiety before and during the procedure than the controls. In addition, urinary norepinephrine excretion of the TS patients was significantly correlated with clinician ratings of tic severity. The results were not related to current levels of depression and anxiety. Taken together, these findings suggest that a subset of TS patients may be characterized by heightened reactivity of the hypothalamic-pituitary-adrenal axis and related noradrenergic sympathetic systems.
Collapse
Affiliation(s)
- P Chappell
- Yale Child Study Center, New Haven, CT 06510-8009
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Slattery ML, Dyer A, Jacobs DR, Hilner JE, Caan BJ, Bild DE, Liu K, McDonald A, van Horn L, Hardin M. Response. J Clin Epidemiol 1994. [DOI: 10.1016/0895-4356(94)90168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Slattery ML, Dyer A, Jacobs DR, Hilner JE, Caan BJ, Bild DE, Liu K, McDonald A, Van Horn L, Hardin M. A comparison of two methods to ascertain dietary intake: the CARDIA Study. J Clin Epidemiol 1994; 47:701-11. [PMID: 7722583 DOI: 10.1016/0895-4356(94)90166-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 01/26/2023]
Abstract
Data on dietary intake were collected in the Coronary Artery Risk Development in Young Adults (CARDIA) Study at the baseline examination in 1985-86 and again at the second examination 2 years later. At baseline, a diet history questionnaire developed for the CARDIA study was used; at the second exam the NCI (Block) food frequency questionnaire was used. The purpose of the present report is to compare the estimated nutrient intakes obtained with the two instruments; to compare correlations of nutrient intakes obtained at the two exams with those observed for other lifestyle and physiological variables also measured 2 years apart; and to assess ability to test hypotheses relating 2-year changes in risk factors to between-exam differences in reported nutrient intakes. Mean levels of reported intake were generally greater for both blacks and whites on the CARDIA diet history than on the Block food frequency. Rank order correlations of reported nutrient intakes between the two questionnaires indicated greater consistency between instruments for whites (r's ranging between 0.35 and 0.52) than for blacks (r's ranging between 0.29 and 0.45). Correlations over time for nutrients were smaller than those observed for body size measures and lipid levels but were similar in magnitude to those for blood pressure, physical activity, and life events. At both exams, total caloric intake was positively associated with physical activity (range of r's for CARDIA were 0.07 for white women to 0.23 for black men, the range of r's for Block were 0.06 for women to 0.11 for white men). Using data from the two examinations, 2-year changes in total plasma cholesterol were significantly related to 2 year changes in Keys scores. The results of this comparison are useful in that they show similarities and differences between two instruments developed to gather dietary intake data. The study also illustrates the need to monitor young adults during a time when rapid changes occur in many lifestyle and physiologic factors.
Collapse
Affiliation(s)
- M L Slattery
- Department of Family and Preventive Medicine, University of Utah Medical Center, Salt Lake City, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Raczynski JM, Taylor H, Cutter G, Hardin M, Rappaport N, Oberman A. Diagnoses, symptoms, and attribution of symptoms among black and white inpatients admitted for coronary heart disease. Am J Public Health 1994; 84:951-6. [PMID: 8203692 PMCID: PMC1614965 DOI: 10.2105/ajph.84.6.951] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.2] [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: 01/29/2023]
Abstract
OBJECTIVES This study examined health care-seeking behaviors to elucidate factors that contribute to differences in patterns of coronary heart disease between African Americans and Whites. The prevalence of diagnosed coronary heart disease, patients' perceptions of symptoms and attribution of symptoms, and predictors of painful symptoms and attribution of cardiac symptoms were examined. METHODS The study involved 2416 patients admitted with diagnoses of coronary artery disease, ischemic heart disease, or myocardial infarction or to rule out myocardial infarction. Structured interview questions were used to obtain demographic information, symptoms precipitating admission, and patients' attribution of their symptoms. Discharge diagnoses were obtained from hospital records. RESULTS Acute myocardial infarction, unstable angina, nonacute ischemic heart disease, and atherosclerosis were more frequent in White patients. For Blacks, the odds of reporting painful symptoms were only 64% of the odds found for Whites when other factors were controlled, and the odds of attributing symptoms to cardiac origins were almost 50% lower for Blacks than for Whites. CONCLUSIONS The tendency of Blacks to report fewer painful symptoms and to attribute their symptoms to noncardiac origins may contribute to differences in care-seeking and in medical management of heart disease in Blacks.
Collapse
Affiliation(s)
- J M Raczynski
- School of Medicine, University of Alabama at Birmingham
| | | | | | | | | | | |
Collapse
|
24
|
Fontanini G, Macchiarini P, Pepe S, Ruggiero A, Hardin M, Bigini D, Vignati S, Pingitore R, Angeletti CA. The expression of proliferating cell nuclear antigen in paraffin sections of peripheral, node-negative non-small cell lung cancer. Cancer 1992; 70:1520-7. [PMID: 1355398 DOI: 10.1002/1097-0142(19920915)70:6<1520::aid-cncr2820700613>3.0.co;2-k] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.9] [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: 01/24/2023]
Abstract
Cell proliferation of 40 peripheral, node-negative non-small cell lung cancers (NSCLC) treated with surgery alone was investigated by immunohistochemical analysis with the monoclonal antibody (MoAb) PC10, which recognizes a proliferating cell nuclear antigen (PCNA) in formalin-fixed and paraffin-embedded material. Results were correlated with DNA ploidy and S-phase fraction (SPF) analyzed by DNA flow cytometric study. Mitotic count (MC) was analyzed by light microscopic study and histopathologic features. PCNA immunoreactivity was seen in all samples and confined to the nuclei of cancer, but not to the surrounding, tumor-negative cells; its frequency ranged from 0-70% (median, 15%), and tumors expressed either a low (0-25%, n = 25) or intermediate (26-75%, n = 15) proliferative activity. There was no relationship between PCNA immunoreactivity and tumor stage or among size, histologic type, and mitotic count (MC). Tumors with intratumoral blood vessel invasion (BVI) showed a significantly higher (P less than 0.005) PCNA immunoreactivity than BVI-negative tumors. PCNA scores were significantly higher (P less than 0.005) in DNA aneuploid (n = 22) than in DNA diploid (n = 18) tumors and correlated significantly with the SPF of DNA aneuploid tumors (r = 0.825, P less than 0.0001), but not with diploid tumors (r = 0.002, P = 0.9). Intermediate proliferating tumors had a significantly higher (P less than 0.01) MC than their counterparts. In univariate analysis, significant predictors of survival were tumor classification (T1 versus T2), tumor size (less than or equal to 2.6 cm versus more than 2.6 cm), BVI (BVI-negative versus BVI-positive), MC (less than or equal to 8 versus more than 8), and PCNA immunoreactivity (low versus intermediate). DNA ploidy and SPF did not influence survival significantly. Only PCNA immunoreactivity retained its independent level of significance (P = 0.02) by multivariate analysis. It was concluded that PCNA immunostaining is a simple and clinically useful method for estimating cell proliferation in formalin-fixed, paraffin-embedded tissue of resected peripheral, node-negative NSCLC.
Collapse
Affiliation(s)
- G Fontanini
- Institute of Pathological Anatomy and Histology, University of Pisa, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Scahill L, Ort S, Hardin M. Genetic epidemiology in child psychiatric nursing. Tourette's Syndrome as a model. J Child Adolesc Psychiatr Ment Health Nurs 1991; 4:154-61. [PMID: 1748960 DOI: 10.1111/j.1744-6171.1991.tb00514.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent discoveries in the field of molecular biology and increased attention to genetic epidemiology have stimulated renewed interest in the genetics of psychiatric disorders. Tourette's syndrome, a neuropsychiatric disorder characterized by motor and phonic tics, is used as a model to describe the research strategies employed in the genetic epidemiology of child psychiatric disorders. The relevance of genetic research findings to child psychiatric nursing is also discussed.
Collapse
|
26
|
Macchiarini P, Hardin M, Angeletti CA. Long-term evaluation of intrapleural bacillus Calmette-Guerin with or without adjuvant chemotherapy in completely resected stages II and III non-small-cell lung cancer. Am J Clin Oncol 1991; 14:291-7. [PMID: 1650528 DOI: 10.1097/00000421-199108000-00004] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Between January 1979 and December 1980, 52 patients with completely resected stages II and III non-small-cell lung cancer (NSCLC) were randomly assigned to receive either adjuvant chemotherapy (cyclophosphamide, doxorubicin, and vincristine--CAV) plus intrapleural bacillus Calmette-Guerin (BCG) (n = 26) or adjuvant CAV alone (n = 26). Careful intraoperative staging was performed in all patients, and stratification for histology (squamous versus nonsquamous) and stage (II or III) ensured a balanced randomization for these factors. With a median follow-up time of 111 months, overall 10-year and median survival were 21% and 20 months (range 2-127 + months), respectively. Thirty-four (95%) patients relapsed in extrathoracic sites, and five (5%) developed loco-regional recurrence; their overall median disease-free interval (DFI) was 10 months (range 1-73 months). There was a 9% and 2.5 month difference in survival (p = .76) and disease-free interval (p = .67), respectively, favoring the BCG arm. There were no significant differences in the sites and patterns of first recurrence comparing the two treatment arms. In conclusion, there is no suggestion of a significant therapeutic advantage from intrapleural BCG in conjunction with adjuvant chemotherapy for completely resected stages II and III NSCLC.
Collapse
Affiliation(s)
- P Macchiarini
- Service of Thoracic Surgery, University of Pisa, Italy
| | | | | |
Collapse
|
27
|
Abstract
Between 1975 and 1988, 37 patients with resectable non-small cell lung cancer (NSCLC) and synchronous (within 1 month, n = 10) or metachronous (n = 27) solitary brain metastasis (SBM) underwent combined excision of their lesions. Overall 5-year and median survival were 30% and 27 months (range, 3 to 125+ months), respectively. Twenty-seven patients had a relapse, and their median disease-free interval (DFI) was 17.5 months (range, 1 to 108 months). The most frequent (78%, n = 20) site of first recurrence locally was either the ipsilateral thorax (n = 14) or brain (n = 6). In univariate analysis, age, primary tumor and lymph node status; tumor histology, size, and side; type of pulmonary resection; side and location of SBM; and onset of presentation did not affect survival and DFI. By contrast, the interval (less than or equal to versus greater than 12 months) between the two operations significantly affected survival (P = 0.0096) and DFI (P = 0.046). The DFI was also affected by the administration of adjuvant chemotherapy (AC) for the primary tumor (P = 0.02). Using the Cox model, AC was the most independent predictor of DFI. These data support the inclusion of surgery in the therapeutic armamentarium for patients with NSCLC and SBM.
Collapse
Affiliation(s)
- P Macchiarini
- Service of Thoracic Surgery, University of Pisa, Italy
| | | | | | | | | |
Collapse
|
28
|
Macchiarini P, Hardin M, Basolo F, Bruno J, Chella A, Angeletti CA. Surgery plus adjuvant chemotherapy for T1-3N0M0 small-cell lung cancer. Rationale for current approach. Am J Clin Oncol 1991; 14:218-24. [PMID: 1851603 DOI: 10.1097/00000421-199106000-00008] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [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: 12/29/2022]
Abstract
Between January 1980 and December 1986, 42 patients with histological confirmed small-cell lung cancer (SCLC) staged pathologically as T1-3N0M0 disease entered a prospective study of surgery plus adjuvant chemotherapy including six courses of i.v. cyclophosphamide (1 g/m2, day 1), epirubicin (60 mg/m2, day 1), and etoposide (120 mg/m2, days 1, 3, and 5), at 3-week intervals. No thoracic or prophylactic cranial irradiation was given. With a 52.5-month median follow-up, estimated 5-year survival was 36% and median survival was 32.7 months (range, 5-100+) for all patients. Seven patients (17%) are currently alive and disease-free at 63 to 100 months. In univariate analysis, baseline characteristics significantly influencing survival and disease-free interval (DFI) were the tumor stage (T1 and T2 versus T3), tumor histology (oat and intermediate versus combined cell type), and type of resection (lobectomy versus pneumonectomy). However, in multivariate analysis, only the tumor stage (T1-2 versus T3) maintained its level of significance. There was a significant correlation (p less than 0.0001) between the pathological tumor size (maximum tumor diameter [(MTD) cm] and survival and DFI; once the MTD (less than versus greater than median value, 3.9 cm) was included in univariate and multivariate analysis, the tumor stage no longer appeared to maintain its level of significance. Treatment was generally well-tolerated and toxicity was acceptable. This study demonstrates the effectiveness of surgery and adjuvant chemotherapy in yielding impressive long-term survival for T1 and T2N0M0 SCLC and provides evidence that the MTD can be used as a powerful and independent prognostic factor for stratification of patients in further trials.
Collapse
Affiliation(s)
- P Macchiarini
- Service of Thoracic Surgery, University of Pisa, Italy
| | | | | | | | | | | |
Collapse
|
29
|
Macchiarini P, Hardin M, Basolo F, Bruno J, Angeletti CA. Adjuvant chemotherapy for T1-2NOMO small cell lung cancer: single-agent or combination chemotherapy? Cancer Invest 1991; 9:19-25. [PMID: 1849442 DOI: 10.3109/07357909109032796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In an attempt to address the schedule of adjuvant chemotherapy in surgically resected T1 or T2NOMO small cell lung cancer, 12 patients were randomized to receive 6 courses of either single-agent (high-dose epirubicin) or combination (cyclophosphamide, epirubicin, and etoposide) chemotherapy, at 3-week intervals. No thoracic radiotherapy was administered while prophylactic cranial irradiation (30 Gy/10 fractions/2 weeks) was given. With a 25-month median followup, overall estimated 2-year and median survival were 83% and 26.5 months (range 16-34+), respectively. Ten patients are currently alive and disease free. No significant difference in 2-year survival was observed between the two adjuvant treatment modalities and median survival was 28 months (range 13-34+) for combination and 21 months (range 14-29+) for single-agent chemotherapy. Although at high doses, epirubicin resulted in a moderate clinical and histological cardiotoxicity and a remarkably reduced incidence of severe (WHO grades 3 and 4) treatment-related morbidity compared with the combination regimen. These preliminary results suggest that comparable survival and reduced toxicity might be expected with an active single-agent as adjuvant chemotherapy in T1 or T2NOMO small cell lung cancer.
Collapse
Affiliation(s)
- P Macchiarini
- Service of Thoracic Surgery, University of Pisa, Italy
| | | | | | | | | |
Collapse
|
30
|
Dykens E, Leckman J, Riddle M, Hardin M, Schwartz S, Cohen D. Intellectual, academic, and adaptive functioning of Tourette syndrome children with and without attention deficit disorder. J Abnorm Child Psychol 1990; 18:607-15. [PMID: 2074343 DOI: 10.1007/bf01342750] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.0] [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: 12/30/2022]
Abstract
The intellectual, academic, and adaptive strengths and weaknesses of 30, medication-free children (M = 10.5 years) with Tourette syndrome (TS) were assessed with a battery of standardized psychoeducational measures and the Vineland Adaptive Behavior Scales. Results indicated significant relative weaknesses in mental and written arithmetic, and relative strengths in reading achievement and abstract, logical thinking. Socialization skills emerged as a significant weakness in adaptive functioning. Comparisons between TS children with attention deficit disorder with hyperactivity (ADD-H) (n = 19) weakness in both groups in all areas assessed, but significantly lower performance IQs in TS subjects with ADD-H. These findings are discussed in relation to future research with TS children.
Collapse
Affiliation(s)
- E Dykens
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut 16510
| | | | | | | | | | | |
Collapse
|
31
|
Alcala A, Evans M, Flynn K, Hardin M, McElhiney B, Shaw P, Westfall J. Weighting performance made our merit raises fairer. MLO Med Lab Obs 1990; 22:35-7, 40. [PMID: 10106706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- A Alcala
- Presbyterian Hospital, Charlotte, NC
| | | | | | | | | | | | | |
Collapse
|
32
|
Meredith R, Plott G, Brezovich I, Khazaeli M, Russell C, Wheeler R, Saleh M, Simpson T, Haynes A, Allen L, Orr R, Baker T, Spencer S, Hardin M, Salter M, LoBuglio A. Comparative dosimetry with repeat courses of 131I-labeled murine or mouse/human chimeric monoclonal antibodies. Int J Radiat Oncol Biol Phys 1990. [DOI: 10.1016/0360-3016(90)90894-p] [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: 10/20/2022]
|
33
|
Leckman JF, Riddle MA, Berrettini WH, Anderson GM, Hardin M, Chappell P, Bissette G, Nemeroff CB, Goodman WK, Cohen DJ. Elevated CSF dynorphin A [1-8] in Tourette's syndrome. Life Sci 1988; 43:2015-23. [PMID: 2463450 DOI: 10.1016/0024-3205(88)90575-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [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: 01/01/2023]
Abstract
A recent neuropathological study has reported decreased levels of dynorphin A immunoreactivity in striato-pallidal fibers in the brain of a patient with severe Gilles de la Tourette's syndrome (TS). This observation, taken with the neuroanatomic distribution of dynorphin and its broad range of motor and behavioral effects, has led to speculation concerning its role in the pathobiology of TS. We report on the presence of elevated concentrations of dynorphin A [1-8] in the CSF of 7 TS patients, aged 20 to 45 years. The increase in CSF dynorphin was found to be associated with the severity of the obsessive compulsive symptoms but not with tic severity in these patients. Although CSF studies lack the precision necessary to address questions of selective involvement of neuronal system in specific CNS locations, these findings suggest that endogenous opioids are involved in the pathobiology of TS and related disorders. Tourette's syndrome (TS) is a chronic neuropsychiatric disorder of childhood onset that is characterized by multiple motor and phonic tics that wax and wane in severity and an array of behavioral problems including some forms of obsessive compulsive disorder (OCD) (1). Once thought to be a rare condition, the prevalence of TS is now estimated to be one case per 1,000 boys and one case per 10,000 girls, and milder variants of the syndrome are likely to occur in a sizeable percentage of the population (2). Although the etiology of TS remains unknown, the vertical transmission of TS within families follows a pattern consistent with an autosomal dominant form of inheritance (3,4). Neurobiologic and pharmacological data have implicated central monoaminergic and neuropeptidergic systems in the pathophysiology of TS, and basal ganglia structures remain the prime candidates as the neuroanatomical origin for TS and related conditions (1). Endogenous opioids, including dynorphin and met-enkephalin are concentrated in structures of the basal ganglia (5), are known to interact with central dopaminergic neurons (6, 7), and may play an important role in the control of motor functions (8). Post-mortem brain studies have directly implicated opioids in the pathophysiology of Parkinson's disease (9), Huntington's disease (10), and most recently in TS (11). The neuropathological study of Haber et al. (11) reported decreased levels of dynorphin A [1-17] immunoreactivity in striatal fibers projecting to the globus pallidus in the brain of a patient with severe TS. This ovservation, taken with the neuroanatomic distribution of dynorphin and its broad range of motor and behavioral effects, has led to speculation concerning its role in the pathobiology of TS.(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
Affiliation(s)
- J F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT 06510
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hardin M. Court review: making it work. Child Welfare 1983; 62:367-371. [PMID: 6884123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Is periodic court review an effective apparatus for achieving permanency for children? The author details its benefits and pitfalls, and discusses how to work for improvements in the review process.
Collapse
|
35
|
Hardin M. Health fair: a community project. Weather Vane 1974; 43:9, 11, 17. [PMID: 4497370] [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: 01/10/2023]
|