Medicine and Health Sciences Commons^™

Genetic And Non-Genetic Factors Affecting The Expression Of Covid-19-Relevant Genes In The Large Airway Epithelium, Silva Kasela, Victor E Ortega, Molly Martorella, Suresh Garudadri, Jenna Nguyen, Elizabeth Ampleford, Anu Pasanen, Srilaxmi Nerella, Kristina L Buschur, Igor Z Barjaktarevic, R Graham Barr, Eugene R Bleecker, Russell P Bowler, Alejandro P Comellas, Christopher B Cooper, David J Couper, Gerard J Criner, Jeffrey L Curtis, Meilan K Han, Nadia N Hansel, Eric A Hoffman, Robert J Kaner, Jerry A Krishnan, Fernando J Martinez, Merry-Lynn N Mcdonald, Deborah A Meyers, Robert Paine, Stephen P Peters, Mario Castro, Loren C Denlinger, Serpil C Erzurum, John V Fahy, Elliot Israel, Nizar N Jarjour, Bruce D Levy, Xingnan Li, Wendy C Moore, Sally E Wenzel, Charles Langelier, Prescott G Woodruff, Tuuli Lappalainen, Stephanie A Christenson

Faculty, Staff and Student Publications

BACKGROUND: The large airway epithelial barrier provides one of the first lines of defense against respiratory viruses, including SARS-CoV-2 that causes COVID-19. Substantial inter-individual variability in individual disease courses is hypothesized to be partially mediated by the differential regulation of the genes that interact with the SARS-CoV-2 virus or are involved in the subsequent host response. Here, we comprehensively investigated non-genetic and genetic factors influencing COVID-19-relevant bronchial epithelial gene expression.

METHODS: We analyzed RNA-sequencing data from bronchial epithelial brushings obtained from uninfected individuals. We related ACE2 gene expression to host and environmental factors in the SPIROMICS cohort of smokers with …

The Prevalence Of Hyperpalatable Baby Foods And Exposure During Infancy: A Preliminary Investigation., Kai Ling Kong, Tera L. Fazzino, Kaitlyn M. Rohde, Katherine S. Morris

Manuscripts, Articles, Book Chapters and Other Papers

Objective: To characterize the prevalence of hyperpalatable foods (HPF) among baby foods in the U.S. and examine the prevalence of HPF exposure and consumption from both baby food and adult food sources among infants aged 9-15 months.

Methods: A U.S. baby food database as well as baby foods from three 24-h dietary recalls of 147 infants were used to identify baby foods as HPF per previous publication. HPF exposure was defined as intake of any HPF during the 3-day measurement period. To determine the extent of HFP consumption, % kilocalorie (kcal) intake from HPF was characterized.

Results: Only 12% of …

Obesity Bias: Bachelor Of Science Nursing Student Perceptions, Ashlyn Nicole Beasley

Honors College Theses

The National Institutes of Health identifies that one in three adults is obese. Obesity is defined as a body mass index (BMI) of 30 and above. Patients with obesity may deny themselves healthcare due to the mistreatment and mistrust they may develop within the healthcare system. If the prejudice against obese patients is addressed, it could prevent future issues for patients and healthcare providers. Not only can bias against obese patients lead to injury, but it can also lead worsening conditions. When a patient perceives the stigma of a weight bias from a caregiver, it can cause them to withdraw …

Dosing Recommendations For Vancomycin In Children And Adolescents With Varying Levels Of Obesity And Renal Dysfunction: A Population Pharmacokinetic Study In 1892 Children Aged 1–18 Years, Cornelis Smit, Sebastiaan C. Goulooze, Roger J. M. Brüggemann, Catherine M. Sherwin, Catherijne A. J. Knibbe

Pediatrics Faculty Publications

Vancomycin is an effective but potentially nephrotoxic antibiotic commonly used for severe infections. Dosing guidelines for vancomycin in obese children and adolescents with or without renal impairment are currently lacking. This study describes the pharmacokinetics of vancomycin in a large pediatric cohort with varying degrees of obesity and renal function to design practical dosing guidelines for this population. A multi-center retrospective population pharmacokinetic study was conducted using data from patients aged 1−18 years who received >1 dose of vancomycin and had ≥1 vancomycin concentration measured between January 2006 and December 2012. Besides pharmacokinetic data, age, gender, body weight, creatinine clearance …

Diabetes And Cancer: Metabolic Association, Therapeutic Challenges, And The Role Of Natural Products, Wamidh H. Talib, Asma Ismail Mahmod, Sara Feras Abuarab, Eliza Hasen, Amer A. Munaim, Shatha Khaled Haif, Amani Marwan Ayyash, Samar Khater, Intisar Hadi Al-Yasari, Lina T. Al Kury

All Works

Cancer is considered the second leading cause of death worldwide and in 2018 it was responsible for approximately 9.6 million deaths. Globally, about one in six deaths are caused by cancer. A strong correlation was found between diabetes mellitus and carcinogenesis with the most evident correlation was with type 2 diabetes mellitus (T2DM). Research has proven that elevated blood glucose levels take part in cell proliferation and cancer cell progression. However, limited studies were conducted to evaluate the efficiency of conventional therapies in diabetic cancer patients. In this review, the correlation between cancer and diabetes will be discussed and the …

Effect Of Sesamol On Neurobiochemical Changes In Diet Induced (Dio) Obesity Model Of Zebra Fish (Danio Rerio), Rashmii K.S.

Kasturba Medical College, Mangalore Theses and Dissertations

No abstract provided.

Advertising To Children And The Long-Term Effects Of Obesity On Health Equity, Joirdon Karl Nicholas

Honor’s College Freeman Research Journal

America spends more money on health than people anywhere else in the world and ranks 11th in the world of developed nations in terms of performance. Americans live shorter less healthier lives and the trends are not improving especially in minority communities. In my research, Americans are focused on the wrong things when they think about health. Health is not defined by seeing a physician or taking medicines. Health should be defined as life circumstances, from the cultures we come from, and the neighborhoods we live in. Advertising to children that leads to obesity has generational impact especially in minority …

Association Between Obesity And Histological Tumor Budding In Patients With Nonmetastatic Colon Cancer, Tong Gan, Kurt B. Schaberg, Daheng He, Akila Mansour, Harit Kapoor, Chi Wang, B. Mark Evers, Therese J. Bocklage

Surgery Faculty Publications

Importance: Obesity is associated with increased risk of colorectal cancer (CRC) and a more aggressive disease course. Tumor budding (TB) is an important prognostic factor for CRC, but its association with obesity is unknown.

Objective: To evaluate the association of TB with obesity and other prognostic factors in colon cancer.

Design, Setting, and Participants: This cohort study involved a histological review of colon cancer specimens obtained during 7 years (January 2008 to December 2015) at the University of Kentucky Medical Center; data analysis was conducted from February 2020 to January 2021. Specimens came from 200 patients with stage I to …

Prevalence Of Liver Cirrhosis And Its Association With Obesity Among Hispanics And Mexican Americans: An Evidence Synthesis, Alexa Perlick, Abaigeal Thompson, Colton Wayne, Angel Rendon, Jose Campo Maldonado

MEDI 9331 Scholarly Activities Clinical Years

INTRODUCTION

The obesity epidemic is a growing public health concern. In addition to the already known complications and comorbidities associated with obesity, data suggest that obesity is an independent risk factor for the development of liver disease.^1,2 However, there is a paucity of data regarding the clinical correlation of obesity and cirrhosis in a predominantly Hispanic population of South Texas. The aim of this systematic literature review is to investigate the prevalence of cirrhosis stratified by obesity in Hispanic populations.

MATERIALS AND METHODS

PubMed was used to perform a thorough literature search. The terms liver cirrhosis and obesity were …

Stakeholder Perspectives And Sustainability Of An Integrated Care Model For The Prevention And Management Of Obesity: The Childhood Obesity Research Demonstration (Cord) Project, Rebecca E Lee, Nathan H Parker, Allen M Hallett, Dennis Kao, Maria J Modelska, Hanadi S Rifai, Erica G Soltero, Daniel P O'Connor

Children’s Nutrition Research Center Staff Publications

Although reliable strategies exist to promote healthy habits that reduce childhood obesity, the sustainability of these strategies remains an ongoing public health challenge. This study aimed to identify factors experienced in a large, multisite project aimed at reducing childhood obesity that might contribute to project sustainability. Hypothesized constructs underpinning sustainability included replicability, continuation of benefits, institutionalization, and community capacity. Key informants (n = 27) completed 60 min, in-depth interviews, which were audio recorded and transcribed. Transcripts were first coded using a combined deductive and inductive approach. Four major themes emerged (with numerous subthemes): developing partnerships, challenges to the sustainability …

Mobilizing Rural Communities To Create Systemic Changes To Reduce Health Disparities, Denise Everson, Amanda Tedrow, Al Parker Edd

National Youth Advocacy & Resilience Conference

USG institutions are creating strategies to enhance community capacity in addressing health inequities, "closing the gap" between suggested optimal development models and helping prepare a visioning masterplan in rural communities.

Heterogeneous Contributions Of Change In Population Distribution Of Body Mass Index To Change In Obesity And Underweight, Ncd Risk Factor Collaboration (Ncd-Risc), Maria Lc Iurilli, Bin Zhou, James E. Bennett, Rodrigo M. Carrillo-Larco, Marisa K. Sophiea, Andrea Rodriguez-Martinez, Honor Bixby, Bethlehem D. Solomon, Zulfiqar Ahmed Bhutta

Woman and Child Health

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape …

Impact Of Pediatric Obesity On Diurnal Blood Pressure Assessment And Cardiovascular Risk Markers, Margaret O. Murphy, Hong Huang, John A. Bauer, Aric Schadler, Majd Makhoul, Jody L. Clasey, Aftab S. Chishti, Stefan G. Kiessling

Pediatrics Faculty Publications

Background: The prevalence of hypertension is increasing particularly among obese children and adolescents. Obese children and adolescents with hypertension are likely to remain hypertensive as they reach adulthood and hypertension is linked to an increased risk for cardiovascular disease. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has become one of the most important tools in diagnosing hypertension in children and adolescents and circadian patterns of blood pressure may be important disease-risk predictors.

Methods: A retrospective chart review was conducted in patients aged 6–21 years who underwent 24-h ABPM at Kentucky Children's Hospital (KCH) from August 2012 through June 2017. Exclusion criteria …

Does Better A1c Control Worsen Osteoarthritis? An Electronic Health Record Cross-Sectional Study, Sarah C. Cattaneo

USF Tampa Graduate Theses and Dissertations

Obesity is a major risk factor for osteoarthritis (OA). There is evidence that diabetes also increases risk. Our hypothesis is that A1C is a predictor of OA severity. The aim is to investigate the association between A1C, BMI, and knee and hip OA severity. This is a cross-sectional study within the Veterans Health Administration (VHA) database containing 818 patients with diagnosed diabetes. Patients at one VHA facility with recorded diabetes in fiscal year 2020 were identified. A1C and BMI data was obtained from the electronic health record. Chart reviews were performed to collect data on imaging reports of weight-bearing joints …

Evaluation Of A Health Education Intervention For Rural Preschool And Kindergarten Children In The Southeastern United States: A Cluster Randomized Trial, Holli H. Seitz, Julie C. Parker, Heather L. Hanna, Ginger C. Hooge

Journal of Human Sciences and Extension

This research employed a matched-pairs randomized field experiment design to evaluate a classroom-based health education intervention for pre-Kindergarten and Kindergarten children in a rural region of the southeastern United States. Schools were matched on demographic characteristics, then one school from each pair was randomly assigned to the treatment group and one to the delayed treatment group. The intervention included a field trip experience and an integrated curriculum designed to increase knowledge about nutrition, physical activity, and sleep. Staff conducted individual assessments of changes in knowledge with a random sample of children from each classroom (252 children from treatment classrooms; 251 …

Inspire : Vol 4, Issue 3, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message from the Chair
• Medicine at National and International Forums
• Outstanding Women In Medicine OWIM 2021 Session
• 17th Neurology Certificate Course 2021 – Virtual Session
• Welcome to AKU Karachi - Dr Saleem Abdul Karim!
• Virtual Education Grand Rounds (EGR)
• In-depth- featuring Dr Saira Bukhari
• Featured Faculty: Dr. Sarwar Siddiqui “...You do not need to be an extraordinary genius to achieve scholastic success. Dream big…”
• Publications

C1q Complement/Tumor Necrosis Factor-Associated Proteins In Cardiovascular Disease And Covid-19, Yaoli Xie, Zhijun Meng, Jia Gao, Caihong Liu, Jing Wang, Rui Guo, Jianli Zhao, Bernard Lopez, Theodore Christopher, Daniel Lee, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

With continually improving treatment strategies and patient care, the overall mortality of cardiovascular disease (CVD) has been significantly reduced. However, this success is a double-edged sword, as many patients who survive cardiovascular complications will progress towards a chronic disorder over time. A family of adiponectin paralogs designated as C1q complement/tumor necrosis factor (TNF)-associated proteins (CTRPs) has been found to play a role in the development of CVD. CTRPs, which are comprised of 15 members, CTRP1 to CTRP15, are secreted from different organs/tissues and exhibit diverse functions, have attracted increasing attention because of their roles in maintaining inner homeostasis by regulating …

The Association Between Overnight Fasting And Body Mass Index In Older Adults: The Interaction Between Duration And Timing, Qian Xiao, Cici Bauer, Tracy Layne, Mary Playdon

Faculty, Staff and Student Publications

BACKGROUND: Circadian rhythms play an important role in the regulation of eating and fasting, and mistimed dietary intakes may be detrimental to metabolic health. Extended overnight fasting has been proposed as a strategy to better align the eating-fasting cycle with the internal circadian clock, and both observational and experimental studies have linked longer overnight fasting with lower body weight. However, it remains unclear if the timing of overnight fasting modifies the relationship between fasting duration and weight outcomes.

METHODS: The current study included 495 men and 499 women age 50-74 years. Dietary intake over 12 months was assessed by 24-h …

Deficiency Of Stat1 In Cd11c+ Cells Alters Adipose Tissue Inflammation And Improves Metabolic Dysfunctions In Mice Fed A High-Fat Diet, Antu Antony, Zeqin Lian, Xiaoyuan Dai Perrard, Jerry Perrard, Hua Liu, Aaron R Cox, Pradip Saha, Lothar Hennighausen, Sean M Hartig, Christie M Ballantyne, Huaizhu Wu

Faculty, Staff and Students Publications

CD11c+ macrophages/dendritic cells (MDCs) are increased and display the classically activated M1-like phenotype in obese adipose tissue (AT) and may contribute to AT inflammation and insulin resistance. Stat1 is a key transcription factor for MDC polarization into the M1-like phenotype. Here, we examined the role of Stat1 in obesity-induced AT MDC polarization and inflammation and insulin resistance using mice with specific knockout of Stat1 in MDCs (cKO). Stat1 was upregulated and phosphorylated, indicating activation, early and persistently in AT and AT MDCs of wild-type mice fed a high-fat diet (HFD). Compared with littermate controls, cKO mice fed an HFD (16 …

Impact Of Obesity On Day-Night Differences In Cardiac Metabolism, Sobuj Mia, Ravi Sonkar, Lamario Williams, Mary N Latimer, Isabelle Frayne Robillard, Abhinav Diwan, Stuart J Frank, Christine Des Rosiers, Martin E Young

2020-Current year OA Pubs

An intrinsic property of the heart is an ability to rapidly and coordinately adjust flux through metabolic pathways in response to physiologic stimuli (termed metabolic flexibility). Cardiac metabolism also fluctuates across the 24-hours day, in association with diurnal sleep-wake and fasting-feeding cycles. Although loss of metabolic flexibility has been proposed to play a causal role in the pathogenesis of cardiac disease, it is currently unknown whether day-night variations in cardiac metabolism are altered during disease states. Here, we tested the hypothesis that diet-induced obesity disrupts cardiac "diurnal metabolic flexibility", which is normalized by time-of-day-restricted feeding. Chronic high fat feeding (20-wk)-induced …

Association Between Height And Hypertension Among Us Adults: Analyses Of National Health And Nutrition Examination Survey 2007-18, Rajat Das Gupta, Maxwell Akonde, Ibrahim Hossain Sajal, Gulam Muhammed Al Kibria

Publications

Background

Previous studies that investigated association of height with prevalence and control of hypertension found mixed results. This cross-sectional study explored these associations among US adults (≥20 years).

Methods

The National Health and Nutrition Examination Survey (NHANES) 2007–18 data was analyzed. Height was measured in meters and was converted into centimeters (cm) and was further divided into quartiles: Q1 (135.3–159.2 cm), Q2 (159.3–166.2 cm), Q3 (166.3–173.6 cm), Q4 (173.7–204.5 cm). Hypertension definition of the ‘2017 American College of Cardiology/American Heart Association Guideline’ was used. Logistic regression analyses were conducted to find out the association between the dependent variable and the …

Metabolic Flexibility Across The Spectrum Of Glycemic Regulation In Youth, Fida Bacha, Sara Klinepeter Bartz, Maurice Puyau, Anne Adolph, Susan Sharma

Children’s Nutrition Research Center Staff Publications

BACKGROUNDMetabolic flexibility (MF) refers to the relative ability to utilize lipid and carbohydrate substrates and to transition between them. It is not clear whether MF is impaired in obese youth and what the determining factors are.METHODSWe investigated the determinants of MF (increased respiratory exchange ratio [ΔRER] under insulin-stimulated conditions) in pubertal youth (n = 104; 15.6 ± 1.8 years) with obesity across the spectrum of glucose tolerance compared with normal weight (NW) controls, including body composition (fat-free mass [FFM], %body fat), visceral adipose fat (VAT) (MRI), glycemia, and insulin sensitivity (IS) [3-hour hyperinsulinemic-euglycemic clamp with measurement of lipolysis ([2H5] glycerol), …

Marcellus Shale Natural Gas Development Increased Income For Rural Pennsylvania Families, But Youth Obesity Rates Remained High, Molly A. Martin

Population Health Research Brief Series

A new study finds that despite increased income due to MarcellusShale, childhood obesity in rural PA remain unchanged.

F-Wave Parameters And Body Mass Index In Carpal Tunnel Syndrome, Philip Adebayo, Rose E. Mwakabatika

Faculty of Health Sciences, East Africa

Background

Severe carpal tunnel syndrome (CTS) readily lends itself to both clinical and electrophysiological recognition. The uncertainty sometimes is in identifying and quantifying motor involvement in mild and, perhaps, in moderate CTS. Our study aimed to evaluate F responses in mild and moderate CTS and determine the contribution of BMI to the F-wave parameters.

Methods A retrospective review of the clinical and electrophysiological data of patients with CTS seen at the clinical neurophysiology laboratory of Aga Khan Hospital, Dar es Salaam, between 1 August 2017 and 31 July 2019 was retrieved. Carpal tunnel syndrome was graded according to the electrophysiological …

Vertical Sleeve Gastrectomy Confers Metabolic Improvements By Reducing Intestinal Bile Acids And Lipid Absorption In Mice, Lili Ding, Eryun Zhang, Qiaoling Yang, Lihua Jin, Kyle M Sousa, Bingning Dong, Yangmeng Wang, Jui Tu, Xiaoxiao Ma, Jingyan Tian, Hongli Zhang, Zhipeng Fang, Ana Guan, Yixin Zhang, Zhengtao Wang, David D Moore, Li Yang, Wendong Huang

Faculty, Staff and Students Publications

Vertical sleeve gastrectomy (VSG) is a highly effective bariatric surgery that sustainably treats obesity and type 2 diabetes (T2D). However, the underlying mechanisms governing its metabolic benefits remain unclear. In this study, we have used four different genetically modified mouse lines to understand the link between bile acid circulation and metabolic effects of VSG. Instead of directly activating the nuclear bile acid receptor farnesoid X receptor (Fxr) in the liver or intestine, VSG reduces intestinal levels of bile acids, thereby decreasing fat absorption in the intestine. Given the rising popularity of bariatric surgeries to treat obesity and associated T2D, the …

Macrophage-Derived Thrombospondin 1 Promotes Obesity-Associated Non-Alcoholic Fatty Liver Disease, Taesik Gwag, Raja Gopal Reddy Mooli, Dong Li, Sangderk Lee, Eun Young Lee, Shuxia Wang

Pharmacology and Nutritional Sciences Faculty Publications

Background

Thrombospondin 1 (TSP1) is a multifunctional matricellular protein. We previously showed that TSP1 has an important role in obesity-associated metabolic complications, including inflammation, insulin resistance, cardiovascular, and renal disease. However, its contribution to obesity-associated non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD or NASH) remains largely unknown; thus, we aimed to determine its role.

Methods

High-fat diet or AMLN (amylin liver NASH) diet-induced obese and insulin-resistant NAFLD/NASH mouse models were utilised, in addition to tissue-specific Tsp1-knockout mice, to determine the contribution of different cellular sources of obesity-induced TSP1 to NAFLD/NASH development.

Results

Liver TSP1 levels were increased in experimental obese …

Rationale And Design Of The Baylor Infant Twin Study-A Study Assessing Obesity-Related Risk Factors From Infancy, Shabnam R Momin, Mackenzie K Senn, Scott Buckley, Neil R M Buist, Manisha Gandhi, Amy B Hair, Sheryl O Hughes, Kelly R Hodges, William C Lange, Maria A Papaioannou, Mimi Phan, Robert A Waterland, Alexis C Wood

Children’s Nutrition Research Center Staff Publications

Background: Early childhood (0-3 years) is a critical period for obesity prevention, when tendencies in eating behaviors and physical activity are established. Yet, little is understood about how the environment shapes children's genetic predisposition for these behaviors during this time. The Baylor Infant Twin Study (BITS) is a two phase study, initiated to study obesity risk factors from infancy. Data collection has been completed for Phase 1 in which three sub-studies pilot central measures for Phase 2. A novel infant temperament assessment, based on observations made by trained researchers was piloted in Behavior Observation Pilot Protocol (BOPP) study, a new …

Intestinal Stem Cell-Derived Enteroids From Morbidly Obese Patients Preserve Obesity-Related Phenotypes: Elevated Glucose Absorption And Gluconeogenesis, Nesrin M Hasan, Kelli F Johnson, Jianyi Yin, Nicholas W Baetz, Lea Fayad, Vadim Sherman, Sarah E Blutt, Mary K Estes, Vivek Kumbhari, Nicholas C Zachos, Olga Kovbasnjuk

Faculty, Staff and Students Publications

OBJECTIVE: The mechanisms behind the efficacy of bariatric surgery (BS) for treating obesity and type 2 diabetes, particularly with respect to the influence of the small bowel, remain poorly understood. In vitro and animal models are suboptimal with respect to their ability to replicate the human intestinal epithelium under conditions induced by obesity. Human enteroids have the potential to accelerate the development of less invasive anti-obesity therapeutics if they can recapitulate the pathophysiology of obesity. Our aim was to determine whether adult stem cell-derived enteroids preserve obesity-characteristic patient-specific abnormalities in carbohydrate absorption and metabolism.

METHODS: We established 24 enteroid lines …

Development Of A Mind Body Program For Obese Knee Osteoarthritis Patients With Comorbid Depression, Cale A. Jacobs, Ryan A. Mace, Jonathan Greenberg, Paula J. Popok, Mira Reichman, Christian Lattermann, Jessica L. Burris, Eric A. Macklin, Ana-Maria Vranceanu

Orthopaedic Surgery and Sports Medicine Faculty Publications

Knee osteoarthritis (OA) is the most common joint disorder in the U.S. and a leading cause of disability. Depression and obesity are highly comorbid among knee OA patients, and the combination of obesity and depression is associated with decreased physical activity, higher pain and disability, and more rapid cartilage degradation. Depression, obesity and OA exacerbate one another and share a common pathophysiology involving systemic inflammation and pro-inflammatory cytokines, reflecting a complex mind-body interaction. Current treatments for knee OA offer little to no benefit over placebo, and do not emphasize mind-body practices or physical activity to target the underlying pathophysiology. Mind-body …

A Mixed Methods Evaluation Of An Intensive Therapeutic Lifestyle Change Program For Nurses With Obesity, Theresa L. Free

DNP Research Projects

No abstract provided.