scholarly journals P0012SHOULD WE DEFINE A NEW STANDARD PRESCRIPTION OF BICARBONATE (HCO3-) IN HEMODIALYSIS (HD)?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ana Rita Valerio Alves ◽  
Cátia Figueiredo ◽  
HernÂNi Ricardo Martins GonÇAlves ◽  
Karina Lopes ◽  
Flora Sofia ◽  
...  

Abstract Background and Aims One of the aims of the regular, intermittent HD therapy prescribed for patients with end-stage chronic kidney disease, is correction of metabolic acidosis by addition of HCO3- to dialysate fluid. The KDOQI guidelines therapeutic goal is to maintain pre-dialysis HCO3-≥22mmol/L. The aim of the study was to evaluate an individualized HCO3-hemodialysis prescription as a preventing factor of metabolic changes in a HD facility and define a new standard HCO3-prescription. Method 36-month prospective study of patients on online high-flux hemodiafiltration. Every 3 months (13 time points) HCO3-, Calcium (Ca2+), Phosphorus (P+), intact Parathyroid hormone (iPTH) and protein C reactive (PCR) blood levels were analyzed. HCO3-prescription was changed using the following rules: The data collected comprised demographic information, renal disease etiology, comorbidities, HD treatment information and lab results. Categorical variables are presented as frequencies and percentages, continuous variables as means and standard deviations, or medians and interquartile ranges (IQR) for variables with skewed distributions. A p-value<0.05 was considered statistically significant. Statistical analysis was performed using SPSS version 23 for Mac OS X. Results From the 50 patients that were evaluated at Time point 0, only 24 patients completed the follow-up period. Sixteen (66.7%) were males, 54.2% (n=13) diabetic and 58.3% (n=14) hypertensives and the median age was 76 years (IQR 13). At baseline (time point 0), median pH was 7.4 (IQR 0.09) and serum HCO3-26.5 mmol/L (IQR 2.32). At time point 12, pH was 7.35 (IQR 0.12) and serum HCO3-23.25mmol/L (IQR 1.93). A repeated measures ANOVA determined that prescribed HCO3- differed with statistical significance during time (F(2.787,83.308)=39.055, p=0.001), and the post Hoc tests confirmed those assumptions between time point 1 and all the others time points, as an example the mean difference between initial prescribed HCO3-and time point 12 was 5.39mmol/L (p=0.001). Wilcoxon Sign-Rank Tests determined that throughout the analyzed period the serum HCO3- approached the reference serum HCO3- (23mmol/L) that we have defined as ideal (at time point 0, median=26.5mmol/L, Z=4.144, p=0-001; at time point 12, median 23.25mmol/L, Z=1.243, p=0.214). On the other hand, a one sample T-Test determined that the HCO3- prescription differed more in each time point from the 32mmol/L defined as standard (at time point 12, t=-2.798, p=0.01) and approached a new suggested value of 26mmol/L. However, at time point 8, 62.5% (n=15) patients had a HCO3-prescription of 28mmol/L, (t(23)=0.001,p=1) and at that time we had hypothesized that that a prescription of 28 mmol/L should be the new standard. Gender, Diabetes Mellitus, Hypertension, and renal disease etiology did not influence the HCO3- prescription neither serum HCO3-. Conclusion HCO3-prescription and serum HCO3- were not influenced by comorbidities like DM and Hypertension. Our findings suggest that the standard HCO3- prescription of 32mmol/L should be rethought, as an individualized HCO3- prescription could be beneficial for the patient. At this time, we suggest that a prescription of 26 mmol/L should be the new standard. However, the limitations of our findings include the small sample size, so further studies with larger samples should be attempted.

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ferdiye Küçük ◽  
Sibel Yıldırım ◽  
Serap Çetiner

Abstract Background The purpose of this study was to assess the cytotoxicity of various concentrations of ozonated water (OW) on human primary dental pulp cells. Methods Human primary dental pulp cells were isolated from exfoliated primary canine teeth of an 11-year-old patient with good systemic and oral health. Afterwards, cells were divided into 6 experimental groups; four groups of OW in concentrations of 2 mg/L, 4 mg/L, 8 mg/L, and 16 mg/L, untreated control group, and cell culture without cells. Cytotoxicity was evaluated after exposure for 5-min exposure using Mosmann’s Tetrazolium Toxicity (MTT) assay at 0 h and 48 h time points. Data were analyzed using a repeated measures analysis of variance and Post-hoc tests were performed using Bonferroni correction for multiple comparisons. Results All experimental groups showed proliferation at 0 h time point. However, all groups also experienced a decrease in overtime at 48 h time point (p < 0.05). At both time points 2 mg/L OW showed the highest cell viability as well as proliferation. At 0 h time point, the increase in cell viability for all experimental groups was found statistically significant when compared to positive control group (p < 0.05). At 48 h time point, although 8 mg/L and 16 mg/L OW showed statistically significant reduction in compare to 0 h time point, 2 mg/L and 4 mg/L OW groups didn’t experience any statistically significant difference (p < 0.05). Conclusion Considering our findings, due to ozonated water's induced a higher proliferation rate of dental pulp cells, indicating their biocompatibility and a possible adjuvant on irrigating agent in regenerative endodontic procedures.


2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0024
Author(s):  
Manuel Schubert ◽  
Tariq Awan ◽  
Aaron Sciascia ◽  
Emily Pacheco ◽  
Jennifer DeMink ◽  
...  

Objectives: There has been a rise in elbow ulnar collateral ligament (UCL) injuries in youth pitchers over recent years. With forearm flexor-pronator mass fatigue, the dynamic stability provided could be diminished placing greater stress on the UCL. Pitch count limits have been instituted in an attempt to help curtail this rise in throwing injuries, especially in youth athletes. In order to provide more objective data regarding current pitch count limits for youth pitchers, the purpose of this pilot study was to evaluate for potential fatigue of the flexor-pronator mass by assessing changes in medial elbow laxity, noninvasively characterizing changes in muscle glycogen storage within the forearm flexor-pronator mass, and evaluating changes in subjective fatigue, strength, range of motion (ROM), pitching velocity, and accuracy with increasing number of pitches thrown by 10-year-old pitchers up to their recommended 75 pitch count limit. Methods: After appropriate power analysis, male pitchers 10 years of age were recruited for the study (n=22). Pitchers threw a total of 75 pitches divided into sets of 25 pitches, with standardized periods of rest in between throws and sets to best simulate a game. Bilateral medial elbow laxity was measured by applying 10 decanewtons of valgus force with a standardized stress device and utilizing ultrasound imaging (Figures 1A-B) prior to pitching and after each pitching set. The change in medial ulnohumeral joint distance (Figure 1C) after stress was applied was calculated from baseline without stress. Relative changes in muscle glycogen storage, detected as changes in echogenicity, within the flexor carpi radialis (FCR) and the flexor digitorum superficialis (FDS)/flexor carpi ulnaris (FCU) muscles were measured non-invasively with ultrasound-based software (Figures 1D-E) and recorded as fuel percentile. Repeated measures analysis of variance and post-hoc testing were used to determine statistical significance (alpha=0.05). Results: There were no significant differences in medial elbow laxity between arms or time points. There was a trend for similar decline in FCR fuel percentile values between each arm, indicating relative decreases in glycogen storage bilaterally. However, only the throwing arm demonstrated a statistically significant decline in fuel percentile from baseline to after 75 pitches (p=0.05). There were no statistically significant differences across time points for FDS/FCU fuel percentile values. Fatigue measurements for both arms were significantly higher at all time points compared to baseline (p≤0.03). Grip strength of the dominant arm after 75 pitches was significantly decreased compared to after 25 pitches (p=0.02). There were no statistically significant changes in other strength measurements, ROM, velocity, or accuracy between all time points. Conclusions: By the recommended 75 pitch count limit in 10-year-olds, subjective fatigue and a decrease in grip strength had occurred. Furthermore, relative glycogen storage of the flexor-pronator mass of the throwing arm decreased between pitching 50 to 75 pitches, but without an increase in medial elbow gapping. This study provides a foundation and raises questions for further objective testing of physiologic changes that occur throughout increasing pitching to better guide pitch count limits and ensure the safety of young athletes


2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S162-S163
Author(s):  
Jennifer B Radics-Johnson ◽  
Daniel W Chacon ◽  
Li Zhang

Abstract Introduction Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child. Methods A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value&lt; 0.5. Results Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32). There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?” Conclusions In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.


2015 ◽  
Vol 33 (10) ◽  
pp. 1171-1179 ◽  
Author(s):  
Lari Wenzel ◽  
Kathryn Osann ◽  
Susie Hsieh ◽  
Jo A. Tucker ◽  
Bradley J. Monk ◽  
...  

Purpose Survivors of cervical cancer experience quality-of-life (QOL) disruptions that persist years after treatment. This study examines the effect of a psychosocial telephone counseling (PTC) intervention on QOL domains and associations with biomarkers. Patients and Methods We conducted a randomized clinical trial in survivors of cervical cancer, who were ≥ 9 and less than 30 months from diagnosis (n = 204), to compare PTC to usual care (UC). PTC included five weekly sessions and a 1-month booster. Patient-reported outcomes (PROs) and biospecimens were collected at baseline and 4 and 9 months after enrollment. Changes in PROs over time and associations with longitudinal change in cytokines as categorical variables were analyzed using multivariable analysis of variance for repeated measures. Results Participant mean age was 43 years; 40% of women were Hispanic, and 51% were non-Hispanic white. Adjusting for age and baseline scores, participants receiving PTC had significantly improved depression and improved gynecologic and cancer-specific concerns at 4 months compared with UC participants (all P < .05); significant differences in gynecologic and cancer-specific concerns (P < .05) were sustained at 9 months. Longitudinal change in overall QOL and anxiety did not reach statistical significance. Participants with decreasing interleukin (IL) -4, IL-5, IL-10, and IL-13 had significantly greater improvement in QOL than those with increasing cytokine levels. Conclusion This trial confirms that PTC benefits mood and QOL cancer-specific and gynecologic concerns for a multiethnic underserved population of survivors of cancer. The improvement in PROs with decreases in T-helper type 2 and counter-regulatory cytokines supports a potential biobehavioral pathway relevant to cancer survivorship.


2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 609-609
Author(s):  
John Apolzan ◽  
Jennifer Rood ◽  
Robbie Beyl ◽  
Shengping Yang ◽  
Frank Greenway ◽  
...  

Abstract Objectives Assess the effects of the amino acid arginine on growth hormone (GH), other metabolites, and mood. Arginine is reported to increase GH, but the mechanism is not known. It was hypothesized prolactin mediated this effect since it is similar in structure to GH and, like GH, is secreted by the pituitary gland. Methods Thirty physically active healthy young males (18–39 y; 18.5–25 kg/m2) were enrolled in a randomized, double-blind, placebo-controlled, crossover trial. Two days prior and 1 day following each treatment a standardized diet was provided that maintained arginine at 3–5 g/d. Arginine or placebo treatments in the form of a beverage were consumed after an overnight fast. Treatment conditions were separated by at least a one week washout period. The beverages contained either 10 g of arginine or 0 g (placebo). Blood was collected at baseline and 1.5, 3.0, and 24 hr post treatment. Plasma GH, prolactin, amino acids, glucose, insulin, triacylglycerols, thyroid hormones, sex hormone binding globulin (SHBG), testosterone, cortisol, and dehydroepiandrosterone (DHEA) were assessed. The Profile of Mood States (POMS) was administered at the same time as blood draws. Repeated measures ANOVAs were used to estimate treatment effects at each time point. Results Arginine increased plasma arginine at 1.5, 3.0, and 24 hr (P ≤ 0.001) and GH at 24 hr (P ˂ 0.05) but not other time points. Arginine increased glucose and insulin at the 1.5 and 3.0 hr (P ˂ 0.05) but not 24 hr. Arginine did not affect any other dependent measure (P &gt; 0.05) including prolactin. When only individuals with detectable levels of GH (responders; n = 16) were analyzed separately, arginine increased GH at the 1.5 (P ˂ 0.05) but not the 3.0 or 24 hr time points. Among the responders, arginine also increased thyroid stimulating hormone (TSH) at the 24 hr time point (P ˂ 0.05) but not the 1.5 and 3.0 hr time points. Conclusions Arginine supplementation modestly increased growth hormone. Despite their similar structures, prolactin secretion was not elevated following arginine supplementation, thus another mechanism is responsible for growth hormone secretion. Funding Sources DoD and NIH P30DK072476. Views expressed are those of the authors and do not reflect official policy of the Army, DoD, or US Government.


2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0026
Author(s):  
John Y. Kwon ◽  
Timilien Wusu ◽  
Jorge Briceno ◽  
Philip Kaiser ◽  
Patrick Cronin ◽  
...  

Category: Ankle Introduction/Purpose: There is limited evidence that removal of syndesmotic implants is beneficial. Despite this, many surgeons advocate removal based on previous studies suggesting improved ankle dorsiflexion. Methodologic difficulties make the validity and applicability of previous works questionable. The purpose of this study was to examine the effect of ankle dorsiflexion after syndesmotic implant removal using radiographic measurements of ankle dorsiflexion before and after screw removal utilizing a standardized, applied load. Methods: All patients undergoing isolated syndesmotic implant removal were consented for participation. Ankle dorsiflexion was measured radiographically at three different time points: (I) immediately before implant removal intraoperatively, (II) immediately after implant removal intraoperatively and (III) approximately three months after implant removal. A standardized dorsiflexion torque force of 33.4 newton-meter (Nm) was applied to the ankle by a research assistant using a tensiometer at these time points and a perfect lateral radiograph of the ankle was obtained. Four reviewers independently measured ankle dorsiflexion on randomized, deidentified and blinded images using a digital measurement tool. Chi-square tests were used for categorical variables. Paired T-test or analysis of variance (ANOVA) with repeated measures was used for continuous variables. Intra-class correlation coefficients (ICC) were calculated using a 2-way random effects model and the absolute agreement definition. Results: 29 patients met inclusion criteria and were enrolled in the study. There were 11 men (38%) and 18 women (62%). The mean, and standard deviation, age was 50.3 ± 16.9 years (range 19-80). The mean ankle dorsiflexion pre-operatively, post-op and at 3 month follow up was 13.7°± 6.6°, 13.3°±7.3° and 11.8°±11.3°, respectively (p=0.466). For subsequent analysis, 5 patients were excluded due to potential cofounding effect of retained suture button devices. Analysis of the remaining 24 patients demonstrated similar results with no statistically significant difference in ankle dorsiflexion at all three time points. Conclusion: Removal of syndesmotic screws does not improve ankle dorsiflexion motion and should not be used as an indication for screw removal.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9029-9029
Author(s):  
Timothy Burnight ◽  
Christopher G. Wood ◽  
Nizar M. Tannir ◽  
Eric Jonasch ◽  
Louis L. Pisters ◽  
...  

9029 Background: Most previous research examining the efficacy of brief expressive writing interventions have used small sample sizes and followed people for no more than 3 months. We conducted a large randomized trial to examine an expressive writing intervention for patients with renal cell carcinoma and followed them for 10 months after the end of the writing sessions. Methods: Two hundred patients with RCC were randomly assigned to either write their deepest thoughts and feelings about their cancer (EW) or to write about neutral topics (NW) on four separate occasions over 10 days for a maximum of 20 minutes at each writing session. Patients completed the MD Anderson Symptom Inventory (MDASI), Brief Fatigue Inventory, SF-36, IES, CES-D, and PSQI at baseline and then again 1, 4, and 10 months after the writing sessions. Results: The mean age of the participants was 58 (range 34-82 years), 41% were women, and staging data were 39% stage I, 15% stage II, 19% stage III, and 27% stage IV. The groups were well balanced on all demographic and medical characteristics. Examination of group differences 1 month after the writing sessions, controlling for the respective baseline measure, revealed decreased IES scores for the EW group (intrusive thoughts: EW, 5.0 v NW, 7.2; p<.02; avoidance behaviors: EW, 6.3 v NW, 8.7; p<.07). By 4 months after the intervention, the EW group reported higher levels of SF-36 Social Functioning scores (EW: 52.6 v NW: 49.7; p<.04). At the 10 month time point, the EW group reported fewer cancer-related symptoms (EW: 20.8 v NW: 30.8; p<.04), higher levels of SF-36 Role Physical scores (EW: 69.6 v NW: 54.0; p<.02), and fewer sleep disturbances (subscale of the PSQI; EW: 1.4 v NW: 1.6; p<.05). Means for the other SF-36 subscales at 10 months were in the expected, but did not reach statistical significance. There were no group differences for CES-D or fatigue scores at any time point. Mediation analyses revealed that IES scores at 1 month mediated the effects of EW on cancer-related symptoms (F= 1.85, p<.06) at the 10 month follow up. Conclusions: These findings indicate expressive writing leads to short-term reduction in intrusive thoughts about the cancer experience and results in long-term improvement in aspects of quality of life.


2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 679-679
Author(s):  
Olalekan O. Oluwole ◽  
William Wu ◽  
Steven N. Wolff ◽  
Kenneth R. Hande

679 Background: 5-fluorouracil (5-FU), a synthetic fluoropyrimidine, is a critical component of chemotherapy in many cancers. Its metabolites inhibit Thymidylate Synthetase (TS) causing cessation of DNA synthesis and are misincorporated into DNA and RNA causing ineffective DNA repair and faulty mRNA splicing. The rate limiting step in the catabolism of 5-FU is by the Dihydropyrimidine Dehydrogenase enzyme (DPD) which catabolizes over 80% of 5-FU. Patients with near total DPD enzymatic deficiency develop life threatening toxicity after a single administration and those with less severe deficiency will have delayed elimination of 5-FU and slowly accumulate active metabolites leading to toxicities. Methods: We conducted a pilot retrospective cohort study of African American (AA) and Caucasian patients treated for colorectal cancer over a 9 year period, 2000 – 2008, in this IRB approved study. The primary outcome of interest was the rate of development of grade 3 or 4 neutropenia (Absolute Neutrophil Count <1000/uL = grade 3 and <500/uL = grade 4). Descriptive and univariate analysis were done. To test for differences between AA and Caucasians, we computed independent t-test for continuous and Fisher’s exact test for categorical variables. Relative Risk (RR) and p-values were computed. All statistics were done with SPSS v19 software. Results: There were 66 evaluable patients (40 men, 26 women), 40 AA, 24 Caucasians and 2 of other races. Thirty-eight patients (15 Caucasians and 23 AA) received 5-FU containing chemotherapy. The two groups were comparable in baseline characteristics. AA were more likely to develop grade 3-4 hematological toxicity. Nine of 23 AA (39.1%) and one of 15 Caucasians (6.7%) developed grade 3-4 hematological toxicity. RR 8.56, 95% confidence interval 0.95 – 421.06 (p-value of 0.0561) Conclusions: These results suggest that AA were more likely than Caucasians to have severe hematologic toxicity with the use of 5-FU containing chemotherapy. This difference did not meet statistical significance due to small sample size and few numbers of events in the Caucasian arm. A larger prospective study is needed to further evaluate the observed difference.


2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 62-62
Author(s):  
Sydney Banton ◽  
Julia G Pezzali ◽  
Renan Antunes Donadelli ◽  
Marica Bakovic ◽  
Katharine M Wood ◽  
...  

Abstract Grain-free pet foods have been sold for over a decade and comprise more than 40% of dog and cat diets sold today. Grain-free diets replace grain ingredients with pulse ingredients, which are high in lysine but low in methionine and cysteine, the precursor amino acids to taurine synthesis in the dog. The objective of this study was to evaluate the postprandial response of plasma methionine and taurine and whole blood taurine concentrations of dogs fed a grain-free diet without supplementation (CON) or with methionine (MET), taurine (TAU) or creatine, carnitine and choline (CCC) supplementation. Eight Beagles were pair housed and fed one of the four experimental diets for seven days in a 4x4 Latin Square Design. On the morning of d 7, cephalic catheters were placed and one fasted sample (0 min) and nine post-meal blood samples (15, 30, 60, 90, 120, 180, 240, 300 and 360 min) were collected. Data were analyzed as repeated measures using the PROC GLIMMIX function in SAS (Version 9.4). Dogs supplemented with MET had significantly higher plasma methionine concentrations from 30 to 360 minutes post-meal compared to dogs on CON, TAU and CCC treatments (P &lt; 0.05). However, no differences were observed in plasma methionine concentrations between CON, TAU and CCC treatments at any time point (P &gt; 0.05). Plasma taurine concentrations were significantly higher across time points in all treatment groups compared to CON (P &lt; 0.05). Whole blood taurine concentrations tended to be higher across time points in MET and TAU treatment groups compared to CCC (P = 0.0513). Overall, MET, TAU and CCC supplementation increased plasma taurine concentrations compared to CON, but only MET supplementation increased plasma methionine concentrations from 30 to 360 minutes post-meal.


2018 ◽  
Vol 10 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Hammed I. Adebisi ◽  
Adodo S. Monikhe ◽  
Agwubike E. Okey

Summary Study aim: This study investigated the alterations in gait velocity and grip strength of stroke survivors following a structured therapeutic exercise programme (STEP). Material and methods: This was a pre-test, post-test experimental study of the effectiveness of a 12-week STEP on gait veloc­ity and grip strength of stroke survivors. A total of 30 hemiparetic stroke survivors participated in the study. The instrument for this study was an adaptation of a training protocol for the training and assessment of gait velocity and grip strength. The participants underwent a 12-week STEP of a frequency of 3 times per week and the training programme focused on exercises aimed at improving the gait velocity and grip strength of the participants. The gait velocity and grip strength were measured before and after the training. Data generated were analysed using descriptive statistics of mean and standard deviation to sum­marize the profile of the participants. The analysis of variance for repeated measures (ANOVA) was used to test the hypotheses. Statistical significance was accepted for a p value of <0.05. Results: The outcome of this study showed that the STEP had significant (p < 0.05) effects on the gait velocity and grip strength of stroke survivors. Meanwhile, there was no significant (p > 0.05) effect of haemorrhagic and ischaemic groups of stroke sur­vivors on gait velocity and grip strength.Conclusion: It was therefore concluded that the use of the STEP can substantially improve the gait velocity and grip strength of stroke survivors.


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