scholarly journals Incidence and location of residual gaps identified by a high-density grid-style catheter after PVI is confirmed by pacing the ablation lines

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Giuggia ◽  
M Volpicelli ◽  
M Mantica ◽  
MF Notarangelo ◽  
S Sundaram ◽  
...  
Keyword(s):  
De Novo ◽  
Single Case ◽  
The United States ◽  
High Density ◽  
Ablation Catheter ◽  
Average Output ◽  
True Incidence ◽  
Af Ablation ◽  
Large Patient ◽  
Ablation Line

Abstract Funding Acknowledgements Type of funding sources: None. Background The continual pursuit of more durable pulmonary vein isolation (PVI) has led ablationists to evaluate many different techniques for confirming isolation. One such technique involves using the ablation catheter to pace along the ablation lines, ensuring loss of pace capture. Initial observations from a small cohort of patients suggested that a high-density, grid style mapping catheter (HD Grid) enabling simultaneous recording of adjacent bipolar EGMs in two directions (HD Wave) may identify residual gaps that are missed when using the technique of pacing the ablation line in isolation. The true incidence of these residual gaps as identified in a large patient population has not been previously reported. Purpose To quantify in a large cohort of AF ablation patients, the presence of residual gaps identified by HD Grid which are missed by a technique of pacing along the ablation lines with the ablation catheter. Methods Self-reported data was prospectively collected in AF radiofrequency ablation procedures in which PVI was first confirmed by pacing along the ablation line followed by assessment using the HD Grid. Procedural characteristics and acute outcomes, including the incidence and location of gaps post-ablation, were analyzed. Results Data was collected in 111 AF ablation procedures performed in 18 centers across the United States and Europe. Paroxysmal (PAF), persistent (PersAF), and longstanding persistent AF (LsPersAF) accounted for 60.4%, 33.3%, and 6.3% of cases, respectively. Overall, 64.0% of ablations were de novo procedures. Following ablation, PVI was confirmed in all cases by pacing the ablation line with an average output of 9.1 ± 2.6mA and pulse width of 2.1 ± 0.5ms. Adenosine was administered in 3.6% of cases, isoproterenol in 3.6%, and a combination in 0.9%. PVI was then reassessed with HD Grid using a variety of techniques including exit block (91.0%), voltage mapping (82.0%), loss of pace capture along the ablation lines (47.7%), and entrance block (27.0%); note: total exceeds 100% as more than one technique may be used in a single case. A second dose of adenosine was administered in 2.7% of cases; isoproterenol in 2.7%. The HD Wave configuration was used in 96.4% of cases. HD Grid identified a total of 130 gaps in 65 (58.6%) patients, which were missed by pacing the ablation line (Figure 1). Conclusions In over half of the patients evaluated, the HD Grid identified residual PVI gaps that were missed when isolation was confirmed by using the ablation catheter to pace the ablation lines. These results suggest that the pacing technique, used in isolation, is not sufficient for complete gap detection. One limitation of this analysis was the use of a workflow which consistently assessed PVI with the HD Grid following confirmation of isolation by pacing the ablation lines. Despite this limitation, the rate at which residual gaps were identified is noteworthy and likely warrants additional study. Abstract Figure.

P1028Incidence and location of residual gaps identified by a high-density grid-style mapping catheter after PVI is confirmed by pacing the ablation lines

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Giuggia ◽  
M Volpicelli ◽  
N Bottoni ◽  
P Gora ◽  
M Mantica
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
De Novo ◽  
Clinical Success ◽  
The United States ◽  
Small Sample ◽  
High Density ◽  
Ablation Line ◽  
Mapping Catheter

Abstract Background  Durable pulmonary vein isolation (PVI) is critical to the clinical success of ablation for treatment of atrial fibrillation (AF). Pacing along the ablation line (often using the ablation catheter), is one technique that is commonly used for confirmation of PVI. While this technique is common in practice, it has not been systematically evaluated against other methods for confirming PVI. A high-density grid-style mapping catheter (HD Grid) enabling simultaneous recording of adjacent bipolar EGMs in two directions (HD Wave) is now available in multiple geographies. The sensitivity of this technology for periprocedural identification of gaps in PVI lines has not previously been compared to the technique of pacing the ablation lines. Purpose  To assess the utility of a high-density grid-style catheter for confirming PVI, and to evaluate sensitivity for identification of gaps relative to a technique of pacing the ablation lines. Methods  Self-reported procedural data was prospectively collected in atrial fibrillation ablation procedures. Cases in which pulmonary vein isolation was confirmed by pacing the ablation line and subsequently assessed with HD Grid were selected for analysis. Techniques for PVI confirmation were analyzed and the incidence and location of residual gaps following PVI confirmation via pacing was quantified. Results  A total of 22 AF ablation procedures (age 60.1 ± 9.0 years, LVEF 59.3 ± 5.7%, CHADS 1.5 ± 1.4, hypertension 45.5%) across 5 centers in Italy and the United States were analyzed. De novo and repeat ablations represented 72.7% and 22.7% of cases, respectively (4.5% not reported). PVI was confirmed by pacing along the ablation line with an average output of 8.8 ± 1.9mV and pulse width of 2.2 ± 0.7ms (10mv at 2ms utilized in 59.1%). Subsequent PVI assessment was performed with HD Grid using the HD Wave configuration in all cases. PVI confirmation techniques included exit block confirmation (90.9%), voltage mapping (59.1%), loss of pace capture along ablation lines (40.9%), entrance block confirmation (18.2%), and activation mapping (4.5%); note: total exceeds 100% as more than one technique may be employed in a single case. The HD Grid identified a total of 30 gaps in 15 (68.2%) patients, which were initially missed by pacing along the ablation lines. No adenosine or isoproterenol use was documented in any case. Conclusion(s): Use of the HD Grid appears to increase substantially, the sensitivity for identifying gaps in PVI lesion sets relative to a technique of pacing the ablation line. Limitations of this analysis include small sample size and workflows which consistently assessed PVI with the HD grid following confirmation of isolation by pacing the ablation lines. Despite these limitations, the high prevalence of residual gaps is quite provocative and may warrant additional study. Abstract Figure.

scholarly journals Incidence of residual gaps identified by a high-density grid-style catheter post-cryoballoon ablation for atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
RS Gaitonde ◽  
JA Martel ◽  
A Kobori ◽  
NS Koide ◽  
GT Altemose ◽  
...  
Keyword(s):  
De Novo ◽  
Diagnostic Techniques ◽  
High Density ◽  
Cryoballoon Ablation ◽  
Single Shot ◽  
True Incidence ◽  
Density Mapping ◽  
Large Patient ◽  
Diagnostic Catheter ◽  
Mapping Catheter

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite advances in cardiac ablation technologies and the introduction of single-shot ablation devices such as the cryoballoon, the ability to consistently achieve complete and durable PVI remains elusive. While this is often attributed to PV reconnections that develop after the index procedure, recent data has suggested that traditional diagnostic techniques and technologies may in fact fail to identify gaps that remain upon completion of the index ablation. Initial observations in a small cohort of patients suggested that these residual gaps could be detected by a high-density, grid-style mapping catheter (HD Grid) post-cryoballoon ablation (CBA). The true incidence of these residual gaps as identified in a large patient population has not been previously reported. Purpose To quantify in a large cohort of CBA procedures, the presence of residual gaps identified by HD Grid which are missed by standard techniques of PVI confirmation using a 3.3F circular mapping catheter (CMC). Methods Self-reported data was prospectively collected in CBA procedures in which PVI was first confirmed using CMC followed by assessment using the HD Grid. Procedural characteristics and acute outcomes, including the incidence and location of residual gaps were analyzed. Results Data was collected in 150 CBA procedures performed in 24 centers across the US, Europe and Japan. De novo and repeat ablations represented 78.7% and 12.0% of cases, respectively (9.3% NR). A left common PV was present and ablated in 5.3%; right common in 0.7%. The CMC was used to confirm isolation in all cases using a variety of techniques including voltage mapping (73.3%), exit block (54.7%), and entrance block (29.3%); note: total exceeds 100% as >1 technique may be used in a single case. PVI was then reassessed with HD Grid, enabling a direct comparison of the two technologies. The HD Wave configuration, measuring simultaneous orthogonal bipoles, was used in 94.0% of cases. HD Grid identified a total of 119 gaps in 41 (27.3%) patients, which were missed by the CMC (Figure 1). Conclusions Assessment of PVI using the HD Grid identified residual PV conduction gaps that were missed by the CMC and standard diagnostic techniques in over a quarter of the patients evaluated. One limitation of this analysis is that the technique(s) used for confirmation of PVI were left to the discretion of the operator. Additionally, this analysis includes only workflows in which PVI was confirmed with HD Grid after confirmation using the CMC. Considering the prevalence of residual gaps observed, it is reasonable to interpret that new diagnostic catheter technologies could be critical in the pursuit of more complete and durable PVI, potentially impacting long-term clinical outcomes. Further study on other high-density mapping catheter configurations would be warranted before extrapolating these results to different technologies. Abstract Figure.

P1061Incidence and location of PVI gaps identified post-cryoballoon ablation for atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Z Eldadah ◽  
C Jons ◽  
Z Hollis ◽  
L Dekker ◽  
S Mathew ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Single Case ◽  
The United States ◽  
Small Sample ◽  
High Density ◽  
Cryoballoon Ablation ◽  
Density Mapping ◽  
Diagnostic Catheter ◽  
Mapping Catheter

Abstract Background  Successful delivery of continuous and durable pulmonary vein isolation (PVI) lesion sets is recognized as being critical to long-term clinical outcomes following ablation for atrial fibrillation (AF). Confirmation of PVI following cryoballoon ablation is commonly achieved using a 3.3F circular mapping catheter (CMC) which can be delivered through the central lumen of the cryoballoon, but other diagnostic tools may be used alone or in conjunction with the 3.3F CMC. A high-density, grid-style mapping catheter is now available in multiple geographies; use in cryoballoon ablation procedures and associated outcomes has not been previously reported. Purpose  To evaluate diagnostic catheter usage patterns in cryoablation procedures and identify associated trends in procedural characteristics and acute outcomes. Methods  Self-reported procedural data was prospectively collected in AF cryoablation cases utilizing various diagnostic catheter tools, including the 3.3F CMC and high-density, grid-style mapping catheter (HD Grid). Procedural characteristics and acute outcomes, including the incidence and location of gaps post-ablation, were recorded and analyzed. Results  Data was collected in 23 cryoablation procedures performed in 7 centers across the United States and Europe. De novo and repeat ablations represented 65.2% and 21.7% of cases, respectively (13.0% not reported). 3D mapping was employed in 95.7% of cases. A left common pulmonary vein was present and ablated in 8.7% (2/23). The 28mm cryoballoon was utilized in all cases, with a single case using both a 23mm and 28mm cryoballoon. The 3.3F CMC was used to confirm isolation in all cases using a variety of techniques: voltage mapping (60.9%), exit block (56.5%), entrance block (30.4%), propagation mapping (4.3%), and activation mapping (4.3%); note: total exceeds 100% as more than one technique may be employed in a single case. In 18 cases, PVI was confirmed using a 3.3F CMC followed by secondary confirmation with HD Grid, enabling a direct comparison of the two technologies. The HD Grid identified a total of 12 gaps in 4 (22.2%) patients, which were missed by the 3.3F CMC (Figure 1). No adenosine or isoproterenol use was documented in any case. Conclusion(s): The 3.3F CMC is routinely used to confirm PVI following cryoballoon ablation for atrial fibrillation, but it may fail to identify gaps in some patients. Subsequent assessment of PVI using the HD Grid identified residual gaps in nearly a quarter of patients, suggesting that sensitivity for gap detection may be improved with this tool. Limitations of this analysis include the small sample size and workflows which consistently assessed PVI with the high-density mapping catheter after confirming isolation with the 3.3F CMC. Despite these limitations, the incidence of residual gaps observed is noteworthy and may warrant additional study. Abstract Figure.

P441Targeted ablation of residual luminal pulmonary vein potentials through high density mapping: preliminary results from the CHARISMA registry

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Solimene ◽  
F M Cauti ◽  
G Zucchelli ◽  
V Schillaci ◽  
P Rossi ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
De Novo ◽  
Low Voltage ◽  
Complete Characterization ◽  
High Density ◽  
Analysis Tool ◽  
Temporal Consistency ◽  
Af Ablation ◽  
Density Mapping

Abstract Background A high incidence of pulmonary vein (PV) reconnection has been reported in patients (pts) with clinical recurrences of AF. Low-voltage activity beyond PVs (e.g. antral activity) may contribute to ablation failures in the long term. Detailed characterization of PV antra through high density mapping (HDM) and automated algorithm is still lacking.  Purpose to characterize PV gaps and the low-voltage activity in tissue such as the PV antra during and after ablation of PVs in AF pts.  Methods Consecutive pts undergoing AF ablation from the CHARISMA registry with complete characterization of residual PV antral activity were included. A complete map of the left atrium and PVs was performed prior and after ablation through the Rhythmia HDM system. A novel map analysis tool (Lumipoint - LM -) that automatically identifies split potentials and continuous activation was used sequentially on each PV component, in order to assess the presence of gaps (PVG) and residual potential within the antral scar (RAP, defined as any low voltage high frequency fractionated signal propagating within the antral scar without conduction into the vein) and characterize electrical propagation. After ablation we reassessed with repeat voltage and propagation maps that electrical quiescence was achieved. Ablation endpoint was PV isolation.  Results Thirty-six cases of AF ablation were analyzed (11 de novo, 25 redo). A total of 36 PVG in 13 (36%) patients were detected after remap (1 case of de novo) or initial map of redo patients (12 cases). A total of 34 RAP in 20 cases (56%) were found: 4 (36%) cases of de novo (all after ablation and remap) and 16 (64%) cases of redo (all after initial map). In 7 (19%) cases we found at least one RAP in pts with complete absence of PV conduction. 100% of PVG (n = 36) and 89% of RAP (n = 29) were fully detected though a first pass automated annotation. In 5 RAPs (11%) an additional temporal consistency of low-voltage signal relative to neighboring activation was needed due to the very low voltage EGM (≤0.1 mV). PVGs were more common at right PV sites (n = 26, 72%) and anterior PV sites (n = 20, 55.6%) whereas RAPs were detected more frequently at left PV sites (n = 20, 59%) and anterior PV sites (n = 21, 62%). RAP showed a lower median voltage compared with PVG (0.22[0.2-0.3]mV for RAP vs 0.97[0.6-1.3]mV for PVG, p < 0.0001) whereas the median number of EGM peaks were higher (6.5[5-8] for RAP vs 3[2-4] for PVG, p < 0.0001). No complications during the procedures were reported. The acute procedural success was 100%, with all PVs successfully isolated and RAPs completely abolished in all study pts.  Conclusion In our preliminary experience, local vulnerabilities in antral lesion sets were commonly discernible using HDM system both in de novo or redo patients when no PV conduction was present. The applied workflow seemed to be useful to quickly pinpoint and accelerate the search of local PV activity or concealed low-voltage activity.

Divergence in the epidemiological estimates of traumatic brain injury in the United States: comparison of two national databases

2020 ◽  
pp. 1-10
Author(s):  
Brittany M. Stopa ◽  
Maya Harary ◽  
Ray Jhun ◽  
Arun Job ◽  
Saef Izzy ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Data Bank ◽  
The United States ◽  
National Sample ◽  
Population Based ◽  
Weighted Estimates ◽  
True Incidence ◽  
Ed Visits

OBJECTIVETraumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown.METHODSThe National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project’s National (“Nationwide” before 2012) Inpatient Sample and National Emergency Department Sample.RESULTSIn the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013.CONCLUSIONSThe databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.

scholarly journals A Bibliometric Insight of Genetic Factors in ASD: Emerging Trends and New Developments

2020 ◽  
Vol 11 (1) ◽  
pp. 33
Author(s):  
Kang Wang ◽  
Weicheng Duan ◽  
Yijie Duan ◽  
Yuxin Yu ◽  
Xiuyi Chen ◽  
...  
Keyword(s):  
Genetic Factors ◽  
De Novo ◽  
Rapid Development ◽  
The United States ◽  
Research Area ◽  
Scientific Output ◽  
Autism Spectrum ◽  
De Novo Mutations ◽  
Emerging Trends ◽  
Genetic Abnormalities

Autism spectrum disorder (ASD) cases have increased rapidly in recent decades, which is associated with various genetic abnormalities. To provide a better understanding of the genetic factors in ASD, we assessed the global scientific output of the related studies. A total of 2944 studies published between 1997 and 2018 were included by systematic retrieval from the Web of Science (WoS) database, whose scientific landscapes were drawn and the tendencies and research frontiers were explored through bibliometric methods. The United States has been acting as a leading explorer of the field worldwide in recent years. The rapid development of high-throughput technologies and bioinformatics transferred the research method from the traditional classic method to a big data-based pipeline. As a consequence, the focused research area and tendency were also changed, as the contribution of de novo mutations in ASD has been a research hotspot in the past several years and probably will remain one into the near future, which is consistent with the current opinions of the major etiology of ASD. Therefore, more attention and financial support should be paid to the deciphering of the de novo mutations in ASD. Meanwhile, the effective cooperation of multi-research centers and scientists in different fields should be advocated in the next step of scientific research undertaken.

E-voting adoption in many countries: A literature review

2021 ◽  
pp. 205789112110405
Author(s):  
Ikhsan Darmawan
Keyword(s):  
United States ◽  
Systematic Review ◽  
Literature Review ◽  
Single Case ◽  
Research Question ◽  
The United States ◽  
Single Case Study ◽  
Academic Publications ◽  
Research Questions

Although the number of countries that have adopted e-voting has decreased lately, the number of academic publications on e-voting adoption has increased in the last two years. To date, there is no coherent narrative in the existing literature that explains the progress of the research on e-voting adoption. This article aims to answer the following research question: “How has research on the topic of e-voting adoption progressed over the last 15 years?” The article provides a semi-systematic review of 78 studies that were conducted from 2005 to 2020. In this article, I argue that although the studies on e-voting adoption are dominated by a single case study, by research in the United States, and by the positivist paradigm, scholars have employed the term “e-voting adoption” diversely and the research on e-voting adoption has evolved to address more specific research questions. Recommendations for the future agenda of research on e-voting adoption are also discussed.

Abstract P193: High Density Lipoprotein is Superior to Triglyceride as a Biomarker of Physiologic Stress in African Immigrants: The Africans in America Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Rafeal L Baker ◽  
Jean N Utumatwishima ◽  
Stephanie T Chung ◽  
Anne E Sumner
Keyword(s):  
High Density Lipoprotein ◽  
Allostatic Load ◽  
Density Lipoprotein ◽  
African Immigrants ◽  
Cardiac Risk ◽  
The United States ◽  
High Density ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Introduction: For Africans living in the United States, the extent to which stress-induced physiologic dysfunction varies by reason for immigration is unknown. Allostatic load score (ALS) is used to assess physiologic stress. ALS has biomarkers in 3 domains: cardiovascular, metabolic and immune. However, there are many ALS equations and the number of biomarkers in each domain varies. In the cardiac domain of ALS, equations use either triglyceride (TG) or high density lipoprotein (HDL). A specific problem for African descent populations is that HDL may be superior to TG as a marker of insulin resistance and cardiac risk. Objective: Our primary goal in 95 African immigrants (71% male, age 42±10, (mean±SD), range 22-62y) was to determine if ALS varied by reason for immigration. Our secondary goal was to evaluate 4 different ALS equations to determine if there was a difference in ALS performance depending on whether HDL or TG was the included biomarker. Methods and Results: For all 4 equations, the reasons for immigration from lowest to highest ALS were: family reunification, lottery for self and immediate family, marriage, asylum, work and study (Figure 1). As the first 3 reasons for immigration promoted family unity, they were grouped together (Group 1). The Africans who came for other reasons were grouped together (Group 2). Equations 1 and 2 included HDL as a biomarker. For these equations, ALS in Group 1 vs. Group 2 were: 1.7±1.3 vs. 2.8±1.7, P <0.01 and 1.4±1.2 vs. 2.3±1.7, P <0.01 resp. Equations 3 and 4 used TG. For these two equations ALS in Group 1 vs. Group 2 were: 2.2±1.6 vs. 2.9±2.0, P =0.08 and 2.1±1.4 vs. 2.9±2.0, P =0.03 resp. In Equations 1 and 2, when HDL was replaced by TG, the significant difference in ALS between groups declined. In Equations 3 and 4, when TG was replaced by HDL, the significant difference in ALS between groups increased. Conclusions: ALS varies by reason for immigration and is easier to detect in ALS equations which use HDL rather than TG.

Sanctioned to Survive: How Foreign Firms Perform when Economic Sanctions Affect their Business Relationships—A Study of Contemporary Economic Sanction Actions and their Impact

2017 ◽  
Vol 16 (5) ◽  
pp. 501-538
Author(s):  
Blaine Stout
Keyword(s):  
Single Case ◽  
Economic Sanctions ◽  
The United States ◽  
Study Strategies ◽  
Foreign Firms ◽  
Case Study Methodology ◽  
Exxon Mobil ◽  
Historical Accounts ◽  
The Impact

Abstract The intent of this study is to examine the effects of economic sanctions on companies with significant fdi operating in the sanctioned country. Using case study methodology, we consider the impact of sanctions imposed on the Russian Federation (rf) by the United States of America for its intrusion into the sovereign rights of Ukraine. Past sanction events in South Africa and pre-rf formation are reviewed. Two measurable frameworks are developed to study strategies based on ‘divestment and non-divestment’ (Malone and Goodin 1997) dimensions and coupled with variables related to ‘direct and indirect’ effects on financial performance, forgone potential, (Losman 1988) and foreign direct investment (Biglaiser and Lektzian 2011). This research also relies on the historical accounts of Hufbauer et al. (2007) for the compilation of facts related to economic sanctions. Through literature review, the study asks: 1) Strategically, how does a company respond to the economic sanctions imposed by its home country on the sanctioned country in which it has significant fdi? 2) Financially, how do economic sanctions affect the company’s performance and fdi? and 3) Organizationally, how do economic sanctions affect the relationships with those recipient companies of fdi? The study focus is on the energy industry in which the rf economy relies upon for 40 percent of its sustainability and the company of focus is Exxon Mobil (xom). The author readily acknowledges that a single case study may not provide the degree of conclusiveness found in a cross-case study format. However, the outcome of the study does provide a template for use in future case reviews.

Sign in / Sign up

Export Citation Format

Share Document