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PubMedDate not supplied

Availability of comprehensive women's health care through Department of Veterans Affairs Medical Center.

Despite increased numbers of women veterans, little is known about health services delivery to women across the Department of Veterans Affairs (VA). To assess VA availability of women's health services, we surveyed the senior clinician at each VA site serving 400 or more women veterans. We found that virtually all sites have developed arrangements, either directly or through off-site contracts, to ensure availability of comprehensive women's health care. On-site care, however, is routinely available only for basic services. Future work should evaluate cost and quality trade-offs between using non-VA sites to increase specialized service availability and using VA sites to enhance continuity of care.

Ambulatory Care↗

PubMed1996

A quality improvement team on autologous and directed-donor blood availability.

BACKGROUND: Until 1985, volunteer donors provided blood for almost all transfusions and donated blood was rarely restricted for transfusion to a specific patient. With the AIDS (Acquired Immunodeficiency Syndrome) crisis, autologous (blood from oneself) and directed (blood from families and friends) donations increased, calling for handling of far greater complexity. At the University of California at San Francisco Medical Center, the demand for special donations superseded the development of systems to meet the demand and autologous and/or directed donations were often not available when needed. After a rapid rise in incident reports and complaints from physicians, nurses, patients, and families, a quality improvement (QI) team was formed in mid-1991 to improve blood availability. METHOD: Meetings were held to analyze the processes involved in blood donation and transfusion, identify and categorize problems, develop interventions, test and implement solutions, and monitor improvements. Educational efforts were implemented throughout the medical center, recruitment for a special donations co-ordinator began, and changes were made in the blood bank's internal systems. RESULTS: In two years, with stable numbers of transfused units, the number of incident reports regarding blood availability decreased from 19 to 2 per year-an improvement that has been sustained for more than three years. The QI team continues to meet regularly to design and implement additional improvements. CONCLUSION: A QI team has improved the availability of autologous and directed-donor blood to patients and has extended the impact of the QI methodology throughout the medical center as a whole.

Academic Medical Centers↗

PubMed2002

Availability, requesting practices, and barriers to referral for high-resolution CT of the lungs: results of a survey of U.S. pulmonologists.

RATIONALE AND OBJECTIVES: The authors performed this study to assess the availability of high-resolution computed tomography (CT), current referral practices, and potential barriers to the clinical use of high-resolution CT in patients with diffuse lung disease. MATERIALS AND METHODS: The authors sent a survey to 450 pulmonologists who were members of the American College of Chest Physicians. They sought information about the availability of high-resolution CT services, explored the physicians' current requesting practices and the monthly number of referrals, and assessed the influence of six factors on the decision to refer. RESULTS: The authors received completed surveys from 230 pulmonologists (52.6%). High-resolution CT services were available to all respondents and had been used by 226 (98.3%) of them during the preceding 12 months. Two-thirds of respondents referred one to four patients per month, and one-third referred five or more. Monthly referral volume did not significantly vary among different practice types. The pulmonologists expressed a preference for hospital-based imaging facilities and routinely reviewed the images from the examinations they ordered. The most frequent reason for high-resolution CT was classification of a known interstitial process. High-resolution CT was infrequently requested to evaluate symptomatic immunocompromised patients. Confidence in the radiologist's high-resolution CT interpretation was the most important factor influencing the referral decision, and radiation dose to the patient was the least important. CONCLUSION: High-resolution CT services are widely available to and frequently requested by U.S. pulmonologists in a variety of practice settings. High-resolution CT may be underutilized in symptomatic immunocompromised patients. Radiologists should be aware that the perception of their skill in high-resolution CT interpretation is an important determinant in the pulmonologist's decision to refer.

Adult↗

PubMed2004

[The availability in Spanish public hospitals of resources for diagnosing and treating sleep apnea-hypopnea syndrome].

INTRODUCTION AND OBJECTIVE: Sleep apnea-hypopnea syndrome is associated with an overall deterioration in the patients health and affects between 1 and 2 million people in Spain. The objective of the present study was to evaluate the diagnostic and therapeutic resources available in Spain for dealing with this problem in terms of both infrastructure and human resources. METHODS: We selected 461 general hospitals, 457 (99.1%) of which answered a questionnaire in the course of a telephone interview. RESULTS: At the time of response, 219 hospitals (47.5%) reported performing sleep studies. Conventional polysomnography was available in 53% of those hospitals, respiratory polygraphy was used in 42%, and oximetry in 5%. In 47% of the hospitals, continuous positive airway pressure was titrated empirically in most cases; the number of patients being treated with CPAP was 109,752, that is, 269 per 100,000 population in Spain. CONCLUSIONS: The level of resources available for diagnosing and treating sleep apnea-hypopnea syndrome, although improving, is clearly still inadequate. Currently, only 0.49 polysomnograph and 0.72 polygraph machines are available per 100,000 population, whereas 1 and 3 machines, respectively, are deemed necessary. Only 5% to 10% of the affected population has been diagnosed, and in 47% of the hospitals interviewed continuous positive airway pressure is not properly titrated. These results should be a clarion call to the health authorities to take the appropriate steps to address this health problem.

Health Care Surveys↗

PubMed2006

Enhancement effect study of some organic acids on the calcium availability of vegetables: application of the dynamic in vitro simulated gastrointestinal digestion method with continuous-flow dialysis.

The effect of added organic acids on the calcium availability of vegetables was investigated using the dialysis profiles obtained from an in vitro simulated gastrointestinal digestion with continuous-flow dialysis method. Citric acid was the most effective enhancer followed by tartaric, malic, and ascorbic acids. For amaranth, which has a low calcium availability (5.4%), a significant increase of availability was observed with increasing concentrations of all acids studied. With the continuous-flow dialysis approach, organic acids could be observed to promote the dialyzability even at an elevated intestinal pH. An enhancement effect from added organic acids was not clearly observed for Chinese kale, which itself contains a high amount of available calcium (52.9%).

Ascorbic Acid↗

PubMed2000

Effects of thermal processing and storage on available lysine and furfural compounds contents of infant formulas.

The Maillard reaction-related effects that thermal treatments during the manufacturing process and storage (at 20 and 37 degrees C) have on powdered adapted and follow-up milk-based infant formulas were estimated by measuring the available lysine and furfural compounds contents of raw cow milk used in manufacturing, intermediate products and formulas. A fluorimetric method was used to measure the available lysine contents, and free and total furfural compounds were determined by HPLC. Statistically significant losses in available lysine (about 20%) in the infant formulas with respect to raw milk were found. The storage period did not affect the available lysine contents of adapted formulas but reduced (16%) the contents of the follow-up ones (from 6.61 to 5.33 g/100 g of protein). No furfural compounds were detected in raw milk, and free and total furyl methyl ketone (FMC) and methylfurfural (MF) were not observed in the analyzed samples. After 6 months of storage, an increase in free hydroxymethylfurfural (HMF) (from 0.34 to 0.77 mg/100 g of protein) and furfural (F) (from nondetectable to 0.1 mg/100 g of protein) in adapted formulas and free HMF (from 1.84 to 2.62 mg/100 g of protein) in follow-up formulas was observed.

Food Handling↗

PubMed2000

Assistance programs available for medications commonly used in transplant patients.

Pharmaceutical manufacturers have programs available to supply medications to indigent patients at little or no cost. Enrolling needy patients into these programs should increase patient compliance to medications, minimize patient and institution financial burdens, and decrease adverse events associated with medication noncompliance. However, access to assistance programs by patients in need is limited if physicians and other health care providers are unaware of the existence of such programs or not informed of each program's enrollment process. The literature is void of a manuscript describing assistance programs available for commonly prescribed medications used in transplant patients. This article offers a concise summary of medication assistance programs available through the pharmaceutical industry to assist in the procurement of medications that are commonly prescribed for the transplant population, including immunosuppressants, antibacterials, gastrointestinal, cardiovascular, and hypoglycemic agents. This article should be used by health care professionals as a guide to the availability and requirements of medication assistance programs.

Anti-Bacterial Agents↗

PubMed2005

Reactivity to alcohol cues: isolating the role of perceived availability.

Perceived availability of a substance has been proposed to play a role in cue reactivity by both traditional classical conditioning models and S. T. Tiffany's (1990) cognitive processing model (CPM) of substance use. This study investigated the role of availability information on alcohol cue reactivity. Subjects were 134 heavy drinkers in a 2 x 2 between-subjects design, crossing cues (alcohol vs. neutral) and availability information (availability vs. unavailability). The results indicated significant main effects for cue type, with alcohol cues eliciting greater reactivity on multiple measures, and an interaction effect on the Alcohol Urge Questionnaire (M. J. Bohn, D. D. Krahn, & B. B. Staehler, 1995), such that exposure to alcohol cues in conjunction with unavailability information elicited a greater urge. This was largely a result of changes in self-reported craving and was interpreted as consistent with the CPM. Alternative methodologies and limitations are discussed.

Adult↗

PubMed2005

Choice and availability of takeaway and restaurant food is not related to the prevalence of adult obesity in rural communities in Australia.

OBJECTIVES: To establish whether choice and availability of takeaway and restaurant food consumption are associated with increased obesity. DESIGN: Crossroads Undiagnosed Disease Study: a cross-sectional study undertaken between June 2001 and March 2003. SETTING: A regional centre and six shire capitals of variables size in rural Victoria, Australia. PARTICIPANTS: In total, 1454 residents of randomly selected households. MEASUREMENTS: Obesity (by body mass index (BMI) or waist circumference), weekly recreational activity, self-reported frequency of takeaway consumption, number of local takeaway and restaurant food outlets in the area. RESULTS: The prevalence of obesity ranged from 25.5-30.8% and was higher than the general Australian population among both men and women. Those in the regional centre were less likely than those in large and small shire capitals to participate in recreational activity of 150 min or more (39.7 vs 48.4%, 46.0% respectively, P=0.023) and yet reported better access to facilities and amenities for physical activity. Recreational activity of > or =150 min/week was associated with 0.75 (0.58-0.97) fold less risk of obesity. BMI was unrelated to takeaway consumption. Waist circumference was significantly lower among those eating no takeaways, but similar whether takeaways were consumed <1/month or > or =1/week. Increased takeaway consumption was associated with increased consumption of higher fat preparations of dairy and meat products. Availability of takeaway outlets and restaurants was unrelated to obesity. CONCLUSION: The obesity epidemic exists among those without significant consumption of or availability to takeaway foods. In a setting of easy availability of food, the obesity epidemic relates strongly to reduced physical activity, but not to consumption of takeaway food.

Age Factors↗

PubMed2003

Central muscarinic acetylcholine receptor availability in patients treated with clozapine.

Clozapine is the prototypical atypical antipsychotic. In vitro, clozapine antagonizes a broad range of receptors, including dopamine, serotonin and muscarinic acetylcholine receptors. In vivo, receptor occupancy studies have shown moderate dopamine D(2) receptor blockade as well as high serotonin 5HT(2) receptor blockade for clozapine. Using [I-123]IQNB SPECT, we explored the influence of clozapine on muscarinic receptors in vivo. Eight schizophrenia patients underwent a total of 12 [I-123]IQNB SPECT scans after treatment with low to moderate doses of clozapine (mean 210 mg/day, range 50-450 mg/day). Muscarinic receptor availability was determined for basal ganglia, cortex, thalamus, and pons. A group of 12 age- and sex-matched unmedicated schizophrenia patients was used for comparison. Compared to unmedicated patients, [I-123]IQNB binding was lower in all regions in subjects treated with clozapine and decreased with increasing dose. In patients treated with a daily clozapine dose of at least 200 mg (mean 275+/-88 mg/day), these differences were highly significant (p <0.003) with mean reductions of muscarinic receptor availability of 45% for basal ganglia, 58% for cortex, 66% for pons, and 79% for thalamus. These preliminary data indicate that reduction of muscarinic receptor availability by clozapine can be measured in vivo and that moderate daily doses are associated with moderate to high reductions of muscarinic receptor availability. These results may explain, at least in part, the lack of extrapyramidal side effects as well as some side effects seen with clozapine.

Adult↗

PubMed2002

Powered liposuction: an evaluation of currently available instrumentation.

BACKGROUND: Over the past several years, powered liposuction instruments have become available to the dermatologic surgeon. These instruments all move the cannula forward and backward 2-12 mm with rapidity. This motion simulates the standard human movement of the cannula and facilitates movement through the tissue. Powered liposuction may help to prevent surgeon fatigue and has recently been shown to aid in the efficacy of fat removal. OBJECTIVE: To compare and contrast currently available powered liposuction instruments, to obtain objective engineering data on the instruments, and to compare the instruments when used on actual liposuction cases. METHODS: Five currently available powered liposuction systems were evaluated by the author. Each instrument was used with a 3 mm dual side port cannula on patients undergoing tumescent liposuction. An independent engineering firm, who collected objective measurements such as weight, stroke force, temperature, and vibration measurements on the instruments, evaluated the units. Noise measurements were obtained. RESULTS: Each of the five systems showed advantages and disadvantages. Important issues were the size and weight of the units, as well as whether they were driven electrically or pneumatically. Stroke force is variable (range 9.5-30 pounds). The noise of the units ranged between 60 and 87 dB. Vibration measurements varied from instrument to instrument. Units produced a variable amount of heat ranging from 77 degrees F to 102 degrees F. Most instruments are autoclavable, and one system is disposable. Build quality and reliability varied with the instrument. CONCLUSION: Instruments for powered liposuction have emerged in the last 2 years, with each instrument having distinct advantages and disadvantages. This article reviews five currently available powered liposuction instruments and presents objective measurements as well as the author's experience using the instruments.

Abdomen↗

PubMed2001

Availability of on-site catheterization and clinical outcomes in patients receiving fibrinolysis for ST-elevation myocardial infarction.

AIMS: To compare management and clinical outcomes in hospitals stratified by the availability of on-site catheterization in InTIME-II, a multicentre trial comparing alteplase with lanoteplase for acute myocardial infarction. METHODS AND RESULTS: We studied 15,078 patients enrolled in 35 countries and 855 hospitals. Thirty-one percent of hospitals had 24-h, 25% day-only, and 44% no on-site catheterization facilities. Rates of cardiac angiography (57%, 38%, 26%) and revascularization (37%, 21%, 17%) were higher in hospitals with increasing access to on-site facilities(P<0.0001). The presence of a 24-h on-site facility was the strongest predictor of angiography during the index admission (odds ratio 4.17, 95% CI 3.85-4.54). There were no major differences in patient outcomes at 30 days when hospitals were stratified by availability of on-site catheterization. Adjusted 1-year mortality was similar between groups of hospitals (odds ratio for day-only 0.94 [0.80-1.09] and odds ratio for no availability 0.95 [0.83-1.10] compared to hospitals with 24-h facilities). CONCLUSIONS: There is a marked variation in procedure use by the availability of on-site catheterization with no major differences in patient outcomes. There is a need for additional randomized trials in the current era to address both the appropriate selection of patients and timing of invasive procedures in ST-elevation acute myocardial infarction.

Adolescent↗

PubMed2003

Oxygen availability during orthotopic liver transplantation.

Studies have stressed the role of adequate tissue oxygenation in the light of an optimal patient outcome and allograft viability in liver transplantation. The practice of monitoring conventional hemodynamic parameters during liver transplantation could be complemented by parameters assessing real oxygen availability. In the present prospective study, real arterial available oxygen content (CavlO(2)) and its extraction ratio (O(2)ERavl) were calculated. These parameters include the effect of changes in oxyhemoglobin dissociation curve (ODC; expressed by P(50)) on oxygen availability, under the different circumstances occurring during liver transplantation. Sixteen adult cirrhotic patients were studied during orthotopic liver transplantation with the use of venovenous bypass. Classic hemodynamic measurements using a Swan-Ganz thermodilution catheter and arterial and mixed venous blood gas analysis were performed, and P(50), oxygen delivery index (DO(2 ind)), oxygen consumption index (VO(2 ind)), oxygen extraction ratio (O(2)ER), CavlO(2), and O(2)ERavl were calculated. Statistical analysis was performed using ANOVA for repeated measures and Spearman correlation coefficient matrix among the six variables (DO(2 ind), VO(2 ind), O(2)ER, P(50), CavlO(2), and O(2)ERavl) taken two at a time at every phase. Parameter P(50) changed from 25.98 +/- 1.10 to 23.15 +/- 2.24 (at the end of operation). A leftward shift of the ODC was observed. The results showed positive association between P(50) and CavlO(2) after the removal of the native liver, and a weak and inconsistent relation of DO(2 ind) with any of the other study variables. The intraoperative changes in P(50) values, which represent a shift of the ODC to the left, may reflect a more accurate estimation of O(2) release to the tissues, than the hemoglobin, Pao(2) and Sao(2) alone. Besides conventional hemodynamic parameters, P(50), which includes the effect of alterations in ODC on oxygen availability, could be of value in monitoring the systemic oxygenation during liver transplantation.

Adult↗

PubMedDate not supplied

[Size and shape of commercially available polyethylene particles for in-vitro and in-vivo-experiments].

AIM: The longevity of total hip arthroplasty is sometimes limited by osteolysis and aseptic loosening. Aseptic loosening may be caused by the biologic reaction to polyethylene wear particles. Particles of less than 1 micro m diameter are of particular importance. These particles are not easily available for experimental use. METHOD: We performed a morphologic analysis of commercially available, very small polyethylene particles (Ceridust(R)) in order to determine the specific size distribution. We measured 1 978 particles. Size analysis was performed using an electron microscope. Particle size was described as the equivalent circle diameter (ECD). Particle morphology was described as feret ratio. In addition, Ceridust(R) particles were compared to different particles stemming from a hip simulator experiment. RESULTS: More than 35 % of the particles were less than 1 micro m in size. The particle size was 1.75 micro m +/- 1.43 micro m (median 1.42 micro m). The minimum was 0.06 micro m, the maximum was 11.06 micro m. The feret ratio was 0.58 +/- 0.17 (median 0.63). The minimum was 0.07, the maximum was 0.93. The majority of Ceridust(R) particles had a rough surface. Compared to polyethylene particles stemming from a hip simulator experiment, Ceridust(R) particles had a rougher surface, were less longitudinal, and had a more even size distribution. CONCLUSIONS: The pure, commercially available polyethylene particles analyzed here are suitable for in vitro and in vivo experiments due to their easy availability, minor costs, and large fraction of very small particles.

Biocompatible Materials↗

PubMed2006

[Impact of a PACS/RIS-integrated speech recognition system on radiology reporting time and report availability].

PURPOSE: Quantification of the impact of a PACS/RIS-integrated speech recognition system (SRS) on the time expenditure for radiology reporting and on hospital-wide report availability (RA) in a university institution. MATERIAL AND METHODS: In a prospective pilot study, the following parameters were assessed for 669 radiographic examinations (CR): 1. time requirement per report dictation (TED: dictation time (s)/number of images [examination] x number of words [report]) with either a combination of PACS/tape-based dictation (TD: analog dictation device/mini-cassette/transcription) or PACS/RIS/speech recognition system (RR: remote recognition/transcription and OR: online recognition/self-correction by radiologist), respectively, and 2. the Report Turnaround Time (RTT) as the time interval from the entry of the first image into the PACS to the available RIS/HIS report. Two equal time periods were chosen retrospectively from the RIS database: 11/2002 - 2/2003 (only TD) and 11/2003 - 2/2004 (only RR or OR with speech recognition system [SRS]). The mid-term (> or = 24 h, 24 h intervals) and short-term (< 24 h, 1 h intervals) RA after examination completion were calculated for all modalities and for CR, CT, MR and XA/DS separately. The relative increase in the mid-term RA (RIMRA: related to total number of examinations in each time period) and increase in the short-term RA (ISRA: ratio of available reports during the 1st to 24th hour) were calculated. RESULTS: Prospectively, there was a significant difference between TD/RR/OR (n = 151/257/261) regarding mean TED (0.44/0.54/0.62 s [per word and image]) and mean RTT (10.47/6.65/1.27 h), respectively. Retrospectively, 37 898/39 680 reports were computed from the RIS database for the time periods of 11/2002 - 2/2003 and 11/2003 - 2/2004. For CR/CT there was a shift of the short-term RA to the first 6 hours after examination completion (mean cumulative RA 20 % higher) with a more than three-fold increase in the total number of available reports within 24 hours (all modalities). The RIMRA for CR/CT/MR was 3.1/5.8/4.0 in the first 24 hours, and 2.0 for XA/DS in the second 24-hour interval. CONCLUSION: In comparison to tape-based dictation, an SRS results in a significantly higher primary time expenditure and a modified report dictation workflow. In a university institution, a PACS/RIS-integrated SRS achieves a marked improvement in both short- and mid-term RA which eventually results in an improvement in patient care.

Efficiency, Organizational↗

PubMed2003

Atropine availability as an antidote for nerve agent casualties: validated rapid reformulation of high-concentration atropine from bulk powder.

STUDY OBJECTIVE: Atropine is the preferred antidote for immediate management of toxicity associated with nerve agents or other cholinergic syndromes. A large-scale exposure to a nerve agent or organophosphate insecticide might result in many victims presenting for care within a short period of time. This situation would require the prompt availability of a large amount of atropine to provide treatment. Antidote stocks at many hospitals are inadequate to meet this demand. Atropine that is commercially available comes supplied at concentrations of either 0.4 mg/mL or 1 mg/mL, thereby requiring intravenous administration because of the volume necessary to administer the commonly recommended initial dose of 2 to 6 mg. Moderately ill victims may not require an intravenous line for other care, and in the setting of overwhelmed resources, intramuscular administration is faster and easier to perform. METHODS: To facilitate the delivery of larger atropine doses, we developed a method of fortifying existing injectable atropine with bulk pharmaceutical-grade atropine powder to a concentration of 2 mg/mL, thereby increasing the amount available and facilitating its intramuscular administration. An independent analysis of the resulting formulation was undertaken to assess its potency, absence of pyrogens, and stability. RESULTS: The amount of atropine initially present varied by less than +/-5%, within the range allowed by the US Pharmacopeia for the original product. The product was pyrogen free and maintained its potency at refrigeration temperature for at least 8 weeks after preparation and at room temperature for 4 weeks. Once all materials were available, the compounding of this preparation required about 1 hour to complete. CONCLUSION: Existing atropine stocks can be readily augmented by fortification with powdered atropine accurately and inexpensively. Common pharmaceutical guidelines recommend refrigeration for compounded products such as this if not completely used within 28 days.

Adult↗

PubMed2000

The effect of a rapid change in availability of epidural analgesia on the cesarean delivery rate: a meta-analysis.

OBJECTIVE: This study was undertaken to quantitatively estimate the effect of a rapid introduction or withdrawal of on-demand epidural analgesia on the cesarean delivery rate. STUDY DESIGN: MEDLINE and meeting abstracts were searched for studies reporting the cesarean delivery rate immediately before and after a rapid change in the availability of epidural analgesia. Nine studies reporting data on 37,753 patients were selected. Meta-analysis was performed to estimate the means and 95% confidence intervals for the changes in rates of total cesarean deliveries, cesarean deliveries among nulliparous women, cesarean deliveries for dystocia, and operative vaginal deliveries. RESULTS: There was no significant change in the overall cesarean delivery rate with an increase in the availability of epidural analgesia. Similarly, the rates of cesarean deliveries among nulliparous patients, of cesarean deliveries for dystocia, and of operative vaginal deliveries did not significantly differ between periods of high and low epidural analgesia availability. CONCLUSION: A rapid change in the availability of epidural analgesia is not associated with any increase in the cesarean delivery rate.

Analgesia, Epidural↗

PubMed2004

Population effects of growth hormone transgenic coho salmon depend on food availability and genotype by environment interactions.

Environmental risk assessment of genetically modified organisms requires determination of their fitness and invasiveness relative to conspecifics and other ecosystem members. Cultured growth hormone transgenic coho salmon (Oncorhynchus kisutch) have enhanced feeding capacity and growth, which can result in large enhancements in body size (>7-fold) relative to nontransgenic salmon, but in nature, the ability to compete for available food is a key factor determining survival fitness and invasiveness of a genotype. When transgenic and nontransgenic salmon were cohabitated and competed for different levels of food, transgenic salmon consistently outgrew nontransgenic fish and could affect the growth of nontransgenic cohorts except when food availability was high. When food abundance was low, dominant individuals emerged, invariably transgenic, that directed strong agonistic and cannibalistic behavior to cohorts and dominated the acquisition of limited food resources. When food availability was low, all groups containing transgenic salmon experienced population crashes or complete extinctions, whereas groups containing only nontransgenic salmon had good (72.0 +/- 4.3% SE) survival, and their population biomass continued to increase. Thus, effects of growth hormone transgenic salmon on experimental populations were primarily mediated by an interaction between food availability and population structure. These data, while indicative of forces which may act on natural populations, also underscore the importance of genotype by environment interactions in influencing risk assessment data for genetically modified organisms and suggest that, for species such as salmon which are derived from large complex ecosystems, considerable caution is warranted in applying data from individual studies.

Animals↗