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Lu Y, Lindaas A, Matuska K, Izurieta HS, McEvoy R, Menis M, Shi X, Steele WR, Wernecke M, Chillarige Y, Wong HL, Kelman JA, Forshee RA. Real-world Effectiveness of mRNA COVID-19 Vaccines Among US Nursing Home Residents Aged ≥65 Years in the Pre-Delta and High Delta Periods. Open Forum Infect Dis 2024; 11:ofae051. [PMID: 38505296 PMCID: PMC10950043 DOI: 10.1093/ofid/ofae051] [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: 07/14/2023] [Accepted: 01/25/2024] [Indexed: 03/21/2024] Open
Abstract
Background Long-term care residents were among the most vulnerable during the COVID-19 pandemic. We estimated vaccine effectiveness of mRNA COVID-19 vaccines in Medicare nursing home residents aged ≥65 years during pre-Delta and high Delta periods. Methods We conducted a retrospective cohort study from 13 December 2020 to 20 November 2021 using Medicare claims data. Exposures included 2 and 3 doses of Pfizer-BioNTech and Moderna COVID-19 vaccines. We used inverse probability weighting and Cox proportional hazards models to estimate absolute and relative vaccine effectiveness. Results Two-dose vaccine effectiveness against COVID-19-related death was 69.8% (95% CI, 65.9%‒73.3%) during the pre-Delta period and 55.7% (49.5%‒61.1%) during the high Delta period, without adjusting for time since vaccination. We observed substantial waning of effectiveness from 65.1% (54.2%‒73.5%) within 6 months from second-dose vaccination to 45.2% (30.6%‒56.7%) ≥6 months after second-dose vaccination in the high Delta period. Three doses provided 88.7% (73.5%‒95.2%) vaccine effectiveness against death, and the incremental benefit of 3 vs 2 doses was 74.6% (40.4%‒89.2%) during high Delta. Among beneficiaries with a prior COVID-19 infection, 3-dose vaccine effectiveness for preventing death was 78.6% (50.0%‒90.8%), and the additional protection of 3 vs 2 doses was 70.0% (30.1%‒87.1%) during high Delta. Vaccine effectiveness estimates against less severe outcomes (eg, infection) were lower. Conclusions This nationwide real-world study demonstrated that mRNA COVID-19 vaccines provided substantial protection against COVID-19-related death. Two-dose protection waned after 6 months. Third doses during the high Delta period provided significant additional protection for individuals with or without a prior COVID-19 infection.
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Affiliation(s)
- Yun Lu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Mikhail Menis
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Whitney R Steele
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Hui Lee Wong
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jeffrey A Kelman
- Center for Medicare, Centers for Medicare and Medicaid Services, Washington, DC, USA
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
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Gubernot D, Menis M, Whitaker B. Background rates for severe cutaneous reactions in the US: Contextual support for safety assessment of COVID-19 vaccines and novel biologics. Vaccine 2023; 41:6922-6929. [PMID: 37891051 DOI: 10.1016/j.vaccine.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
The global COVID-19 public health crisis has resulted in extraordinary collaboration to expeditiously develop vaccines and therapeutics. The safety of these biologics is closely monitored by the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). Novel products may have limited safety data, and although serious medical outcomes associated with vaccination are rare, knowledge of background incidence rates of medical conditions in the US population puts reported adverse events (AEs) in perspective for further study. Although relatively minor vaccination skin reactions are common, rare instances of severe delayed hypersensitivity reactions such as erythema multiforme (EM), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome may occur. To aid in the assessment of these events, we performed a literature search in PubMed and Web of Science on the background incidence of EM, SJS, SJS/TEN, and TEN in the US population and on published reports of these conditions occurring post-vaccination. The US background annual incidence rates per million individuals of all ages ranged from 5.3 to 63.0 for SJS, from 0.4 to 5.0 for TEN, and from 0.8 to 1.6 for SJS/TEN. Since these conditions may overlap, some studies reported rates for EM/SJS/TEN combined, however we did not find studies with exclusive EM incidence rates. The published literature, including studies of reports submitted to the FDA/CDC Vaccine Adverse Event Reporting System (VAERS), describes post-vaccination EM, SJS, SJS/TEN and/or TEN as rare occurrences. The vaccines most frequently associated with these conditions were measles, mumps, and rubella; diphtheria, tetanus, and pertussis; and varicella. The majority of VAERS reports of EM, SJS, SJS/TEN, or TEN occurred in children within 30 days of vaccination. This review summarizes background rates of these disorders in the general population and published AEs among vaccine recipients, to support safety surveillance of COVID-19 vaccines and other biologics.
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Affiliation(s)
- Diane Gubernot
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
| | - Mikhail Menis
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
| | - Barbee Whitaker
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
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Lu Y, Jiao Y, Graham DJ, Wu Y, Wang J, Menis M, Chillarige Y, Wernecke M, Kelman J, Forshee RA, Izurieta HS. Risk factors for COVID-19 deaths among elderly nursing home Medicare beneficiaries in the pre-vaccine period. J Infect Dis 2021; 225:567-577. [PMID: 34618896 DOI: 10.1093/infdis/jiab515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evaluate pre-vaccine pandemic period COVID-19 death risk factors among nursing home (NH) residents. METHODS Retrospective cohort study covering Medicare fee-for-service beneficiaries ages ≥65 residing in U.S. NHs. We estimated adjusted hazard ratios (HRs) using multivariate Cox proportional hazards regressions. RESULTS Among 608,251 elderly NH residents, 57,398 (9.4%) died of COVID-related illness April 1 to December 22, 2020. About 46.9% (26,893) of these COVID-19 deaths occurred without prior COVID-19 hospitalizations. We observed a consistently increasing age trend for COVID-19 deaths. Racial/ethnic minorities generally shared a similarly high risk of NH COVID-19 deaths with Whites. NH facility characteristics including for-profit ownership and low health inspection ratings were associated with higher death risk. Resident characteristics, including male (HR 1.69), end-stage renal disease (HR 1.42), cognitive impairment (HR 1.34), and immunocompromised status (HR 1.20) were important death risk factors. Other individual-level characteristics were less predictive of death than they were in community-dwelling population. CONCLUSIONS Low NH health inspection ratings and private ownership contributed to COVID-19 death risks. Nearly half of NH COVID-19 deaths occurred without prior COVID-19 hospitalization and older residents were less likely to get hospitalized with COVID-19. No substantial differences were observed by race/ethnicity and socioeconomic status for NH COVID-19 deaths.
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Affiliation(s)
- Yun Lu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - David J Graham
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Yue Wu
- Acumen LLC, Burlingame, CA, USA
| | | | - Mikhail Menis
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Jeffrey Kelman
- Centers for Medicare and Medicaid Services, Washington DC, USA
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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Izurieta HS, Graham DJ, Jiao Y, Hu M, Lu Y, Wu Y, Chillarige Y, Wernecke M, Menis M, Pratt D, Kelman J, Forshee R. Natural History of Coronavirus Disease 2019: Risk Factors for Hospitalizations and Deaths Among >26 Million US Medicare Beneficiaries. J Infect Dis 2021; 223:945-956. [PMID: 33325510 PMCID: PMC7799044 DOI: 10.1093/infdis/jiaa767] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The current study was performed to evaluate risk factors for severe coronavirus disease 2019 (COVID-19) outcomes among Medicare beneficiaries during the pandemic's early phase. METHODS In a retrospective cohort study covering Medicare fee-for-service beneficiaries, we separated out elderly residents in nursing homes (NHs) and those with end-stage renal disease (ESRD) from the primary study population of individuals age ≥65 years. Outcomes included COVID-19 hospital encounters and COVID-19-associated deaths. We estimated adjusted odds ratios (ORs) using logistic regression. RESULTS We analyzed 25 333 329 elderly non-NH beneficiaries without ESRD, 653 966 elderly NH residents, and 292 302 patients with ESRD. COVID-related death rates (per 10 000) were much higher among elderly NH residents (275.7) and patients with ESRD (60.8) than in the primary study population (5.0). Regression-adjusted clinical predictors of death among the primary population included immunocompromised status (OR, 1.43), frailty index conditions such as cognitive impairment (3.16), and other comorbid conditions, including congestive heart failure (1.30). Demographic-related risk factors included male sex (OR, 1.77), older age (3.09 for 80- vs 65-year-olds), Medicaid dual-eligibility status (2.17), and racial/ethnic minority. Compared with whites, ORs were higher for blacks (2.47), Hispanics (3.11), and Native Americans (5.82). Results for COVID-19 hospital encounters were consistent. CONCLUSIONS Frailty, comorbid conditions, and race/ethnicity were strong risk factors for COVID-19 hospitalization and death among the US elderly.
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Affiliation(s)
- Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - David J Graham
- Center for Drugs Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Yixin Jiao
- Acumen, LLC, Burlingame, California, USA
| | - Mao Hu
- Acumen, LLC, Burlingame, California, USA
| | - Yun Lu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Yue Wu
- Acumen, LLC, Burlingame, California, USA
| | | | | | - Mikhail Menis
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Douglas Pratt
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jeffrey Kelman
- Centers for Medicare $ Medicaid Services, Washington, DC, USA
| | - Richard Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
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Menis M, Whitaker BI, Wernecke M, Jiao Y, Eder A, Kumar S, Xu W, Liao J, Wei Y, MaCurdy TE, Kelman JA, Anderson SA, Forshee RA. Babesiosis Occurrence Among United States Medicare Beneficiaries, Ages 65 and Older, During 2006-2017: Overall and by State and County of Residence. Open Forum Infect Dis 2020; 8:ofaa608. [PMID: 33598501 DOI: 10.1093/ofid/ofaa608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background Human babesiosis is a mild-to-severe parasitic infection that poses health concerns especially in older and other at-risk populations. The study objective was to assess babesiosis occurrence among US Medicare beneficiaries, ages 65 and older, during 2006-2017. Methods Our retrospective claims-based study used Medicare databases. Babesiosis cases were identified using recorded diagnosis codes. The study estimated rates (per 100 000 beneficiary-years) overall, by year, diagnosis month, demographics, and state and county of residence. Results Nationwide, 19 469 beneficiaries had babesiosis recorded, at a rate of 6 per 100 000 person-years, ranging from 4 in 2006 to 9 in 2017 (P < .05). The highest babesiosis rates by state were in the following: Massachusetts (62), Rhode Island (61), Connecticut (51), New York (30), and New Jersey (19). The highest rates by county were in the following: Nantucket, Massachusetts (1089); Dukes, Massachusetts (236); Barnstable, Massachusetts (213); and Dutchess, New York (205). Increasing rates, from 2006 through 2017 (P < .05), were identified in multiple states, including states previously considered nonendemic. New Hampshire, Maine, Vermont, Pennsylvania, and Delaware saw rates increase by several times. Conclusions Our 12-year study shows substantially increasing babesiosis diagnosis trends, with highest rates in well established endemic states. It also suggests expansion of babesiosis infections in other states and highlights the utility of real-world evidence.
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Affiliation(s)
- Mikhail Menis
- Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | | | - Anne Eder
- Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sanjai Kumar
- Food and Drug Administration, Silver Spring, Maryland, USA
| | - Wenjie Xu
- Acumen LLC, Burlingame, California, USA
| | | | - Yuqin Wei
- Acumen LLC, Burlingame, California, USA
| | - Thomas E MaCurdy
- Acumen LLC, Burlingame, California, USA.,Stanford University, Stanford, California, USA
| | - Jeffrey A Kelman
- Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
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Simonetti A, Ezzeldin H, Menis M, McKean S, Izurieta H, Anderson SA, Forshee RA. Modeling the potential impact on the US blood supply of transfusing critically ill patients with fresher stored red blood cells. PLoS One 2017; 12:e0174033. [PMID: 28319164 PMCID: PMC5358863 DOI: 10.1371/journal.pone.0174033] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/02/2017] [Indexed: 01/09/2023] Open
Abstract
Background Although some studies have suggested that transfusion recipients may have better medical outcomes if transfused with red blood cell units stored for a short time, the overall body of evidence shows mixed results. It is important to understand how using fresher stored red blood cell units for certain patient groups may affect blood availability. Methods Based on the Stock-and-Flow simulation model of the US blood supply developed by Simonetti et al. 2014, we evaluated a newly implemented allocation method of preferentially transfusing fresher stored red blood cell units to a subset of high-risk group of critically ill patients and its potential impact on supply. Results Simulation results showed that, depending on the scenario, the US blood total supply might be reduced between 2-42%, when compared to the standard of care in transfusion medicine practice. Among our simulated scenarios, we observed that the number of expired red blood cell units modulated the supply levels. The age threshold of the required red blood cell units was inversely correlated with both the supply levels and the number of transfused units that failed to meet that age threshold. Conclusion To our knowledge, this study represents the first attempt to develop a comprehensive framework to evaluate the impact of preferentially transfusing fresher stored red blood cells to the higher-risk critically ill patients on supply. Model results show the difficulties to identify an optimal scenario.
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Affiliation(s)
- Arianna Simonetti
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
- * E-mail:
| | - Hussein Ezzeldin
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Mikhail Menis
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | | | - Hector Izurieta
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Steven A. Anderson
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Richard A. Forshee
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
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Menis M, Forshee RA, Anderson SA, McKean S, Gondalia R, Warnock R, Johnson C, Mintz PD, Worrall CM, Kelman JA, Izurieta HS. Febrile non-haemolytic transfusion reaction occurrence and potential risk factors among the U.S. elderly transfused in the inpatient setting, as recorded in Medicare databases during 2011-2012. Vox Sang 2014; 108:251-61. [DOI: 10.1111/vox.12215] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/25/2014] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Menis
- Food and Drug Administration; Silver Spring MD USA
| | | | | | | | | | | | | | - P. D. Mintz
- Food and Drug Administration; Silver Spring MD USA
| | - C. M. Worrall
- Centers for Medicare & Medicaid Services; Baltimore MD USA
| | - J. A. Kelman
- Centers for Medicare & Medicaid Services; Baltimore MD USA
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Ekezue BF, Sridhar G, Izurieta HS, Forshee RA, Selvam N, Ovanesov MV, Jain N, Mintz PD, Anderson SA, Menis M. Clotting Factor (Cf) Product Use And Same-Day Risk For Thrombotic Adverse Events (Tes), As Recorded In Large Health Care Database During 2008-2013 Study Period. Value Health 2014; 17:A473. [PMID: 27201359 DOI: 10.1016/j.jval.2014.08.1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - G Sridhar
- HealthCore Inc., Alexandria, VA, USA
| | - H S Izurieta
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - R A Forshee
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - N Selvam
- HealthCore Inc., Alexandria, VA, USA
| | - M V Ovanesov
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - N Jain
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - P D Mintz
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - S A Anderson
- U. S. Federal Drug Administration, Silver Spring, MD, USA
| | - M Menis
- U. S. Federal Drug Administration, Silver Spring, MD, USA
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Menis M, Forshee RA, Anderson SA, McKean S, Gondalia R, Warnock R, Johnson C, Mintz PD, Worrall CM, Kelman JA, Izurieta HS. Posttransfusion purpura occurrence and potential risk factors among the inpatient US elderly, as recorded in large Medicare databases during 2011 through 2012. Transfusion 2014; 55:284-95. [DOI: 10.1111/trf.12782] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/28/2014] [Accepted: 06/01/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Mikhail Menis
- Food and Drug Administration; Silver Spring Maryland
| | | | | | | | | | | | | | - Paul D. Mintz
- Food and Drug Administration; Silver Spring Maryland
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Sridhar G, Ekezue BF, Izurieta HS, Selvam N, Ovanesov MV, Divan HA, Liang Y, Golding B, Forshee RA, Anderson SA, Menis M. Immune globulins and same-day thrombotic events as recorded in a large health care database during 2008 to 2012. Transfusion 2014; 54:2553-65. [DOI: 10.1111/trf.12663] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/03/2014] [Accepted: 02/25/2014] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Hector S. Izurieta
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | | | - Mikhail V. Ovanesov
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | | | - Yideng Liang
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Basil Golding
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Richard A. Forshee
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Steven A. Anderson
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Mikhail Menis
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
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Menis M, Anderson SA, Forshee RA, McKean S, Johnson C, Warnock R, Gondalia R, Mintz PD, Holness L, Worrall CM, Kelman JA, Izurieta HS. Transfusion-related acute lung injury and potential risk factors among the inpatient US elderly as recorded in Medicare claims data, during 2007 through 2011. Transfusion 2014; 54:2182-93. [PMID: 24673344 DOI: 10.1111/trf.12626] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/17/2014] [Accepted: 01/23/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a serious complication leading to pulmonary edema and respiratory failure. This study's objective was to assess TRALI occurrence and potential risk factors among inpatient US elderly Medicare beneficiaries, ages 65 and older, during 2007 through 2011. STUDY DESIGN AND METHODS This retrospective claims-based study utilized large Medicare administrative databases. Transfusions were identified by recorded procedure and revenue center codes. TRALI was ascertained via ICD-9-CM diagnosis code. The study evaluated TRALI rates among the inpatient elderly overall and by calendar year, age, sex, race, blood components, and units transfused. Logistic regression analyses were used to assess potential risk factors. RESULTS Of 11,378,264 inpatient transfusion stays for elderly Medicare beneficiaries, 2556 had a recorded TRALI diagnosis code, an overall rate of 22.46 per 100,000 stays. TRALI rates were higher for platelet (PLT)- and plasma-containing transfusions and increased by year and number of units transfused (p < 0.0001). Significantly higher odds of TRALI were also found for persons ages 65 to 79 years versus more than 79 years (OR, 1.19; 95% confidence interval CI, 1.09-1.29), females versus males (OR, 1.26; 95% CI, 1.16-1.38), white versus nonwhite (OR, 1.43; 95% CI, 1.27-1.66), and with 6-month histories of postinflammatory pulmonary fibrosis (OR, 1.89; 95% CI, 1.52-2.20), tobacco use (OR, 1.16; 95% CI, 1.00-1.26), and other diseases. CONCLUSION Our study among the elderly suggests TRALI to be a severe event and identifies a substantially increased TRALI occurrence with greater number of units and with PLT- or plasma-containing transfusions. The study also suggests importance of underlying health conditions, prior recipient alloimmunization, and nonimmune mechanism in TRALI development among the elderly.
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Menis M, Sridhar G, Selvam N, Ovanesov MV, Divan HA, Liang Y, Scott D, Golding B, Forshee R, Ball R, Anderson SA, Izurieta HS. Hyperimmune globulins and same-day thrombotic adverse events as recorded in a large healthcare database during 2008-2011. Am J Hematol 2013; 88:1035-40. [PMID: 23907744 DOI: 10.1002/ajh.23559] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/28/2013] [Accepted: 07/22/2013] [Indexed: 11/09/2022]
Abstract
Thrombotic events (TEs) are rare serious complications following administration of hyperimmune globulin (HIG) products. Our retrospective claims-based study assessed occurrence of same-day TEs following administration of HIGs during 2008-2011 and examined potential risk factors using HealthCore's Integrated Research Database (HIRD(SM) ) and laboratory testing of products' procoagulant Factor XIa activity by U.S. Food and Drug Administration. Multivariable regression was used to estimate same-day TE risk for different products. Of 101,956 individuals exposed to 23 different HIG product groups, 86 (0.84 per 1,000 persons) had a TE diagnosis code (DC) recorded on the same day as HIG administration. Unadjusted same-day TE DC rates (per 1,000 persons) ranged from 0.4 to 148.9 for different products. GamaSTAN S/D IG >10 cc had statistically significantly higher same-day TE DC risk compared to Tetanus IG (OR = 57.57; 95% CI = 19.72-168.10). Increased TE risk was also observed with older age (≥45 years), prior thrombotic events, and hypercoagulable state(s). Laboratory investigation identified elevated Factor XIa activity for GamaSTAN S/D, HepaGam B, HyperHep B S/D, WinRho SDF, HyperRHO S/D full dose, and HyperTET S/D. Our study, for the first time, identified increase in the same-day TE DC risk with GamaSTAN S/D IG >10 cc and suggests potentially elevated TE risk with other HIGs.
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Affiliation(s)
- Mikhail Menis
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | | | | | - Mikhail V. Ovanesov
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | | | - Yideng Liang
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Dorothy Scott
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Basil Golding
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Richard Forshee
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Robert Ball
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Steven A. Anderson
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Hector S. Izurieta
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
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Menis M, Anderson SA, Forshee RA, McKean S, Johnson C, Holness L, Warnock R, Gondalia R, Worrall CM, Kelman JA, Ball R, Izurieta HS. Transfusion-associated circulatory overload (TACO) and potential risk factors among the inpatient US elderly as recorded in Medicare administrative databases during 2011. Vox Sang 2013; 106:144-52. [DOI: 10.1111/vox.12070] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/05/2013] [Accepted: 06/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- M. Menis
- Food and Drug Administration; Rockville MD USA
| | | | | | | | | | - L. Holness
- Food and Drug Administration; Rockville MD USA
| | | | | | - C. M. Worrall
- Centers for Medicare & Medicaid Services; Baltimore MD USA
| | - J. A. Kelman
- Centers for Medicare & Medicaid Services; Baltimore MD USA
| | - R. Ball
- Food and Drug Administration; Rockville MD USA
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Menis M, Anderson SA, Izurieta HS, Kumar S, Burwen DR, Gibbs J, Kropp G, Erten T, Macurdy TE, Worrall CM, Kelman JA, Walderhaug MO. Babesiosis among elderly Medicare beneficiaries, United States, 2006-2008. Emerg Infect Dis 2012; 18:128-31. [PMID: 22257500 PMCID: PMC3310092 DOI: 10.3201/eid1801.110305] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We used administrative databases to assess babesiosis among elderly persons in the United States by year, sex, age, race, state of residence, and diagnosis months during 2006–2008. The highest babesiosis rates were in Connecticut, Rhode Island, New York, and Massachusetts, and findings suggested babesiosis expansion to other states.
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Affiliation(s)
- Mikhail Menis
- Food and Drug Administration, Rockville, MD 20852, USA.
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15
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Daniel GW, Menis M, Sridhar G, Scott D, Wallace AE, Ovanesov MV, Golding B, Anderson SA, Epstein J, Martin D, Ball R, Izurieta HS. Immune globulins and thrombotic adverse events as recorded in a large administrative database in 2008 through 2010. Transfusion 2012; 52:2113-21. [DOI: 10.1111/j.1537-2995.2012.03589.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Menis M, Izurieta HS, Anderson SA, Kropp G, Holness L, Gibbs J, Erten T, Worrall CM, MaCurdy TE, Kelman JA, Ball R. Outpatient transfusions and occurrence of serious noninfectious transfusion-related complications among US elderly, 2007-2008: utility of large administrative databases in blood safety research. Transfusion 2012; 52:1968-76. [DOI: 10.1111/j.1537-2995.2011.03535.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [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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Abstract
BACKGROUND Our study characterizes blood use in the ambulatory setting by US elderly Medicare beneficiaries during 2001. As the US population ages and delivery of health care in outpatient settings is on the rise, ambulatory blood utilization is expected to increase. There is currently a lack of broad population-based studies detailing ambulatory blood utilization patterns among the US elderly. STUDY DESIGN AND METHODS This descriptive cross-sectional study of ambulatory blood utilization in institutional outpatient settings used Medicare administrative data (5% sample of enrollees) for calendar year 2001. Blood use was identified by either the presence of recorded blood units or the procedure code(s) for transfusion of whole blood or red blood cells. RESULTS Among 1,368,368 elderly Medicare beneficiaries analyzed, 7054 (0.52%) had blood transfusion in institutional outpatient settings, and 34,186 (2.50%) had blood transfusion in the inpatient setting. Of 10,705 institutional outpatient claims with blood use quantified in this cohort of elderly Medicare beneficiaries, the top 10 principal diagnoses using the largest quantities of blood accounted for 66.3% of total blood units transfused. Nine of these 10 principal diagnoses were either for anemias (51%) or neoplasms (13%) and accounted for 64% of total blood units transfused. CONCLUSION Our study suggests that most of the ambulatory blood utilization among US elderly is for diagnoses of anemias and neoplasms rather than procedures. Our population-based study provides valuable information on ambulatory blood utilization patterns which may be used to better understand the reasons for transfusion in the ambulatory setting as blood use is expected to grow.
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Affiliation(s)
- Mikhail Menis
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, MD 20852, USA.
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Abstract
BACKGROUND Our objective was to characterize inpatient blood use by the US elderly population during 2001. As the US population ages the demand for blood is expected to grow. There have been no comprehensive studies, however, detailing blood use by the elderly in the United States. STUDY DESIGN AND METHODS A descriptive cross-sectional study of blood utilization was conducted with the 5 percent Medicare Provider Analysis and Review (MedPAR) data file obtained from the Centers for Medicare and Medicaid Services (CMS). Each record of the file represented a billing record of an inpatient stay. Blood use was identified by either a nonzero blood pints furnished quantity or a procedure code for transfusion of whole blood or red blood cells (RBCs). RESULTS Among 635,700 stays, 43,220 (6.8%) recorded transfusion of whole blood or RBCs. Blood use prevalence was approximately 4.5 times higher for stays with at least one medical procedure compared to stays without procedures. Of 15,579 stays with number of blood pints furnished recorded, the top 20 principal procedures with the largest quantities of blood accounted for about 56 percent of total blood pints furnished; however, these procedures represented only about 19 percent of all stays. CONCLUSION Our study shows a strong association between medical procedures and blood use among inpatient stays for the elderly. Some of the highest blood utilization occurred with surgical procedures. More precise information on blood utilization may serve as the basis for estimating risks associated with blood transfusion and may inform decisions that maintain an adequate supply of blood.
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Affiliation(s)
- Steven A Anderson
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland 20852-1448, USA.
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Steinberger EK, Menis M, Kozlovsky B, Langenberg P, Zhan M, Israel E, Hopkins A, Dwyer DM, Groves C. Body mass index and up-to-date colorectal cancer screening among Marylanders aged 50 years and older. Prev Chronic Dis 2006; 3:A88. [PMID: 16776889 PMCID: PMC1636718] [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] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Overweight and obese individuals are at increased risk for developing and dying from colorectal cancer. Studies suggest that overweight and obese women are more likely to avoid or delay cancer screening. Our objective was to determine whether overweight or obese adults aged 50 years and older living in Maryland in 2002 were less likely to be up-to-date with colorectal cancer screening than normal and underweight adults. METHODS The relationship between body mass index and colorectal cancer screening was evaluated based on responses from 3436 participants aged 50 years and older to the Maryland Cancer Survey 2002, a population-based random-digit-dial telephone survey. The survey contains self-reported information on colorectal cancer screening, height, weight, and potential confounders. Logistic regression was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for age, sex, race, employment, marital status, education, area of residence, and health-care-related variables. RESULTS Overall, 64.9% of Marylanders aged 50 and older were up-to-date with colorectal cancer screening. Compared with normal and underweight individuals, overweight individuals had similar odds of being up-to-date with colorectal cancer screening (OR, 1.05; 95% CI, 0.83-1.33). Obese individuals had slightly lower odds, but this difference was not statistically significant (OR, 0.84; 95% CI, 0.65-1.09). Recommendation by a health care provider for colorectal cancer screening was strongly associated with up-to-date colorectal cancer screening (OR, 36.7; 95% CI, 28.7-47.0). CONCLUSION Our study shows no statistically significant association between body mass index levels and up-to-date colorectal cancer screening. We recommend that physicians and other health care providers increase up-to-date colorectal cancer screening rates in the population by referring their patients for appropriate screening.
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Affiliation(s)
- Eileen K Steinberger
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Howard Hall
| | | | - Bernard Kozlovsky
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Pat Langenberg
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Min Zhan
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Ebenezer Israel
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Annette Hopkins
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Diane M Dwyer
- Center for Cancer Surveillance and Control, Maryland Department of Health and Mental Hygiene, Baltimore, Md
| | - Carmela Groves
- Center for Cancer Surveillance and Control, Maryland Department of Health and Mental Hygiene, Baltimore, Md
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Zuckerman IH, Menis M, McNally DL, Layne BA, Mullins CD. Intervention for Decreasing Excessive Acetaminophen use in Pennsylvania Medicaid Recipients. Am J Health Syst Pharm 2004; 61:2410-4. [PMID: 15581265 DOI: 10.1093/ajhp/61.22.2410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ilene H Zuckerman
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore 21201, USA
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Carter-Pokras O, O'Neill MJF, Cheanvechai V, Menis M, Fan T, Solera A. Providing linguistically appropriate services to persons with limited English proficiency: a needs and resources investigation. Am J Manag Care 2004; 10 Spec No:SP29-36. [PMID: 15481434] [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: 04/30/2023]
Abstract
Increasing numbers of persons in the United States cannot speak, read, write, or understand the English language at a level that permits them to interact effectively. These limitations can hamper encounters between patients and healthcare providers, often leading to misunderstandings as to diagnosis and treatment, which in turn may result in poor patient compliance, unsatisfactory outcomes, and increased costs. A questionnaire was developed and distributed to clinical practice managers at the University of Maryland School of Medicine to assess the needs for language interpretation services and resources among clinical faculty providing healthcare to persons with limited English proficiency (LEP). Literature review, search of key Web sites, and consultation with national experts on issues pertaining to language access, health services, and reimbursement strategies also were done. Then, recommendations regarding the costs and benefits of language interpretation in healthcare settings were developed. Because recipients of federal financial assistance from the Department of Health and Human Services must provide meaningful access to persons with LEP at no cost to the client, there are clear benefits to providing language interpretation. Providers and managers should be made aware of interpretation service options and cost-saving strategies.
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Affiliation(s)
- Olivia Carter-Pokras
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore, MD 21201-1596, USA.
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Panizzo R, Menis M, Antoci B. [Melanoblastoma of the meninges. Immunohistochemical and ultrastructural study of a case]. Pathologica 1990; 82:447-57. [PMID: 2284147] [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: 12/31/2022] Open
Abstract
Primary diffuse melanoblastomatosis of the leptomeninges is an uncommon disease and are not associated with any specific clinical or radiologic features. Diagnosis is usually post-mortem and first regard the interpretation of malignant melanoblastomatosis as a primary neoplasm; the situation is complicated by the fact that a primary melanoma, in this site, may metastasize to extraneural organs and a detailed dissection of the entire body, including the orbital contents, aims to reveal no primary tumor outside the nervous system. Differential diagnosis is V.S. others pigmented tumors of the C.N.S. Electronmicroscopic and immunohistochemical analysis were performed and confirmed the diagnosis.
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Affiliation(s)
- R Panizzo
- Istituto di anatomia ed istologia patologica, Ospedale Civile di Udine
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Risaliti A, Pizzolitto S, Menis M, Tomada PF, Cinque A, Melchior C, Rocco M. [Lobular carcinoma of the breast with neuroendocrine differentiation. Study of a case]. G Ital Oncol 1989; 9:100-4. [PMID: 2767728] [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: 01/02/2023]
Abstract
A breast tumor with morphologic features of neuroendocrine differentiation and containing large amounts of estrogen receptor protein was associated with areas of typical infiltrating lobular carcinoma. The neuroendocrine areas were argyrophilic, NSE positive and ultrastructurally did not show dense granules. Results of flow cytometric analysis revealed aneuploid nuclear DNA.
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Englaro GC, De Biasi F, Antoci B, Menis M, Scott C, Toso C, Morassut M. [Comparison and correlation of various methods for the determination of steroid receptors in 761 cases of female breast carcinoma]. Pathologica 1987; 79:33-43. [PMID: 3441409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Menis M, Toso C, Rocco M, Pizzolitto S, Antoci B. [Comparison and correlations of results obtained in the study of steroid receptors using fluorescent histochemical and radiometric methods in 300 cases of breast neoplasms]. Pathologica 1985; 77:299-303. [PMID: 3008069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Toso C, Menis M, Pizzolitto S, Rocco M, Antoci B. [Methods of the determination of steroid receptors in breast neoplasms]. Pathologica 1985; 77:231-5. [PMID: 3913890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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