scholarly journals The Evolution of Spiritual Care in the NCCN Distress Management Guidelines

2019 ◽  
Vol 17 (10) ◽  
pp. 1257-1261 ◽  
Author(s):  
George Handzo ◽  
Jill M. Bowden ◽  
Stephen King
Keyword(s):  
Spiritual Care ◽  
Improve Patient Care ◽  
Cancer Center ◽  
Care Practice ◽  
Nccn Guidelines ◽  
Care Integration ◽  
Published Evidence ◽  
Care Assessment ◽  
History Of ◽  
Healthcare Chaplaincy

Spiritual care and chaplaincy have been part of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Distress Management since the first meeting of the panel in 1997, possibly the first time this degree of spiritual care and chaplaincy care integration occurred in cancer care. Since that time, the chaplaincy care section of the guidelines, especially chaplain assessment categories derived from a spiritual care assessment, have provided a major resource for healthcare chaplaincy and have served as a model for integrating chaplaincy into the overall team practice of healthcare. However, this section of the NCCN Guidelines has not been substantially updated since it was originally written. During those 20 years, the practice of healthcare chaplaincy and the research that supports it have grown substantially. In the last year, at the request of the panel, we have updated the chaplaincy care section to fully integrate recently published evidence in spiritual care in healthcare, adding more value to this important set of guidelines. Those updates appear in the 2019 version of the NCCN Guidelines. This article discusses the history of chaplaincy involvement in the NCCN Guidelines for Distress Management and the precedent it set for the integration of chaplaincy in other efforts that followed. Integration of this section of the Guidelines into the spiritual care practice at Memorial Sloan Kettering Cancer Center is presented as an example of how these guidelines can be put into practice to improve patient care. Finally, a summary of the recent research by Drs. Kenneth Pargament and Julie Exline is presented as the foundation for the revised chaplain assessment categories and interventions.

574 A Nurse Educational Program to Promote Spiritual Care Delivery: Development and Pilot Testing

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S138-S139
Author(s):  
Tammy L Henderson ◽  
Miriam Bender ◽  
Victor C Joe ◽  
Patrick E Thompson ◽  
Mini Thomas
Keyword(s):  
Spiritual Care ◽  
Nursing Practice ◽  
Care Delivery ◽  
Essential Element ◽  
Assessment Tools ◽  
Holistic Care ◽  
Care Practice ◽  
Advanced Nursing Practice ◽  
Spiritual Assessment ◽  
Care Assessment

Abstract Introduction Spiritual Care (SC) is crucial for the holistic care of patients. Findings from a needs assessment conducted on an 8-bed burn Intensive Care Unit (ICU) (n=34, 88% response rate) revealed 90.3% of nurses believed SC was important for the overall care of their patient, but only 13% felt confident to provide the religious care. Of the respondents, 77% had come across a time when they were unable to obtain SC for their patients. The survey revealed 39% were interested in obtaining education to enhance their provision of holistic care. Based on this data, we developed and pilot tested an innovative SC educational course to examine feasibility, learning, and preliminary outcomes. Methods The IRB-approved study involved a two-hour evidence-informed class developed by a burn nurse and chaplain. The course was offered on a voluntary basis for all nurses in the critical care division (5 units overall). The class consisted of PowerPoint presentation, case studies and practice utilizing spiritual care assessment tools. Data was collected before and after the class at one- and two-months post class completion. Results Participants (n=12) were mostly female (82%), Bachelors prepared (82%), affiliated as Christian (73%) and had not had spiritual education in the past (73%). Nurses also agreed the spiritual assessment tools were useful and they were confident using them. Mean total score for Nurses’ Spiritual Care Practice increased 14% over time. Practices with the largest increases included reading/offering spiritual writings to patients (67/57%) and documentation of meeting spiritual needs (40%). The Spiritual Care Perspective scale increased 7% overall with changes in the beliefs of SC being a significant part of Advanced Nursing Practice (ANP) (10% increase), the domain of APN includes SC (15% increase) and nurses should assist a patient in using his/her spiritual resources to cope with illness (9% increase). At 2-months post training, participants felt comfortable (4.25/5.0 and confident (4.0/5.0) providing SC. Conclusions SC is an essential element of holistic nursing practice that has become even more relevant in this pandemic year. Our 2-hour educational class was considered well organized, provided relevant education and tools for use, and increased nurses confidence, comfort, and documentation of providing SC to their patients.

Fosaprepitant use in children and adolescents at Memorial Sloan Kettering Cancer Center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10575-10575
Author(s):  
Dazhi Liu ◽  
Krisoula Horiates ◽  
Sherry Mathew ◽  
Melissa Pozotrigo ◽  
Jennifer Thackray ◽  
...  
Keyword(s):  
Receptor Antagonist ◽  
Retrospective Chart Review ◽  
Primary Prophylaxis ◽  
Phase Iii ◽  
Cancer Center ◽  
Nccn Guidelines ◽  
History Of ◽  
Phase Iii Study ◽  
Neurokinin 1 ◽  
Type 3

10575 Background: Recent NCCN guidelines recommend the addition of a neurokinin-1(NK1) receptor antagonist (e.g. fosaprepitant) to the serotonin 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist-corticosteroid combination for controlling both acute and delayed chemotherapy induced nausea and vomiting(CINV) associated with high emetogenic chemotherapy (HEC) in adults. Fosaprepitant is bioequivalent to aprepitant and could offer benefits to patients who are unable to tolerate oral antiemetics. However, little is known about the efficacy and safety of fosaprepitant in children. Methods: This retrospective chart review included all pediatric patients less than 18 years of age who received fosaprepitant at Memorial Sloan Kettering Cancer Center from July 2011 to November 2016. Results: Thirty-one patient charts representing a total of 105 doses of fosaprepitant were reviewed. Median age was 15 (range 2-17) years. Fifty-one doses (49%) were administered for primary prophylaxis for 11 patients; 40 doses (38%) for 12 patients who had a history of severe CINV and 14 doses (13%) as rescue for CINV in 10 patients after chemotherapy. Seventy-eight of the 101 chemotherapy cycles were highly emetogenic including 39 containing cisplatin. In the first two groups, patients did not have any episodes of vomiting in 97% and 88% of chemotherapy cycles respectively after fosaprepitant therapy. Seven of 12 patients receiving fosaprepitant for > 3 episodes of breakthrough vomiting within 24 hours had no vomiting episodes during the first 24 hours post fosaprepitant administration. No fosaprepitant-related side effects were reported. Conclusions: Fosaprepitant appears to be safe and tolerable in children with cancer in whom it may provide benefit as prophylaxis and treatment of CINV. However a phase III study is warranted to formally study its role in pediatrics.

scholarly journals Vaccination strategy and anti - SARS-CoV-2 S titers in healthcare workers of the INT – IRCCS “Fondazione Pascale” Cancer Center (Naples, Italy)

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ernesta Cavalcanti ◽  
Maria Antonietta Isgrò ◽  
Domenica Rea ◽  
Lucia Di Capua ◽  
Giusy Trillò ◽  
...  
Keyword(s):  
Immune Response ◽  
Immune Responses ◽  
Healthcare Workers ◽  
Geometric Mean ◽  
Vaccination Strategy ◽  
Antibody Responses ◽  
Cancer Center ◽  
Serum Samples ◽  
Humoral Immune ◽  
History Of

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and the resulting disease, coronavirus disease 2019 (COVID-19), have spread to millions of people globally, requiring the development of billions of different vaccine doses. The SARS-CoV-2 spike mRNA vaccine (named BNT162b2/Pfizer), authorized by the FDA, has shown high efficacy in preventing SARS-CoV-2 infection after administration of two doses in individuals 16 years of age and older. In the present study, we retrospectively evaluated the differences in the SARS-CoV-2 humoral immune response after vaccine administration in the two different cohorts of workers at the INT - IRCCS “Fondazione Pascale” Cancer Center (Naples, Italy): previously infected to SARS-CoV-2 subjects and not infected to SARS-CoV-2 subjects. Methods We determined specific anti-RBD (receptor-binding domain) titers against trimeric spike glycoprotein (S) of SARS-CoV-2 by Roche Elecsys Anti-SARS-CoV-2 S immunoassay in serum samples of 35 healthcare workers with a previous documented history of SARS-CoV-2 infection and 158 healthcare workers without, after 1 and 2 doses of vaccine, respectively. Moreover, geometric mean titers and relative fold changes (FC) were calculated. Results Both previously infected and not infected to SARS-CoV-2 subjects developed significant immune responses to SARS-CoV-2 after the administration of 1 and 2 doses of vaccine, respectively. Anti-S antibody responses to the first dose of vaccine were significantly higher in previously SARS-CoV-2-infected subjects in comparison to titers of not infected subjects after the first as well as the second dose of vaccine. Fold changes for subjects previously infected to SARS-CoV-2 was very modest, given the high basal antibody titer, as well as the upper limit of 2500.0 BAU/mL imposed by the Roche methods. Conversely, for naïve subjects, mean fold change following the first dose was low ($$ \overline{x} $$ x ¯ =1.6), reaching 3.8 FC in 72 subjects (45.6%) following the second dose. Conclusions The results showed that, as early as the first dose, SARS-CoV-2-infected individuals developed a remarkable and statistically significant immune response in comparison to those who did not contract the virus previously, suggesting the possibility of administering only one dose in previously SARS-CoV-2-infected subjects. FC for previously infected subjects should not be taken into account for the generally high pre-vaccination values. Conversely, FC for not infected subjects, after the second dose, were = 3.8 in > 45.0% of vaccinees, and ≤ 3.1 in 19.0%, the latter showing a potential susceptibility to further SARS-CoV-2 infection.

scholarly journals SUN-934 A Rare Case of Hyperparathyroidism - Parathyroid Carcinoma, Atypical Adenoma, or Both?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Petra Krutilova ◽  
Harjyot Sandhu ◽  
Michael Salim ◽  
Janice L Gilden ◽  
Paula Butler
Keyword(s):  
Parathyroid Carcinoma ◽  
Rare Case ◽  
Parathyroid Tissue ◽  
Needle Aspiration ◽  
Mitotic Rate ◽  
Fluid Replacement ◽  
Cancer Center ◽  
Subtotal Parathyroidectomy ◽  
History Of ◽  
The Right

Abstract Introduction: Parathyroid carcinoma (PC) is a rare endocrine malignancy. It accounts for <1% cases of primary hyperparathyroidism (PHPT). We present a rare case of concurrent PC and atypical parathyroid adenoma (PA). Case presentation: A 72-year-old woman presented with 1-week history of generalized weakness, confusion, and auditory hallucinations. Her medical history was significant for PHPT known for 5 years, CAD and CHF. The patient appeared mildly volume depleted and was tachycardic (105/min). The rest of her physical exam was unremarkable. Calcium (Ca) was 15.1 mg/dL (8.4–10.2 mg/dL) and intact PTH 451.9 pg/mL (12–88 pg/mL). Her condition improved with aggressive fluid replacement, pamidronate, and cinacalcet. A sestamibi scan revealed increased uptake of bilateral parathyroid tissue. Fine needle aspiration (FNA) revealed PA. Surgical treatment was postponed for control of cardiac comorbidities. One month later, she presented again with symptomatic hypercalcemia. Her Ca was 16.1 md/dL and PTH 761.5 pg/mL. Initial medical management was followed by subtotal parathyroidectomy – three masses were removed (one on the right and two on the left). Final pathology revealed PC within the left parathyroid, the others were consistent with hypercellular parathyroid tissue. One month later, the patient underwent left hemithyroidectomy, right parathyroidectomy, and central neck dissection. PTH level dropped to 2.4 pg/mL and Ca level was 7.6 mg/dL after surgery. She was discharged home on Ca and vitamin D supplements. Pathology was sent to a referral cancer center and revealed PC vs. atypical PA within the right parathyroid. Discussion: PC is a rare endocrine malignancy. Further, there are not many cases of synchronous PC and PA or multifocal PC. Diagnosing PC preoperatively is challenging since it shares overlapping characteristics with PA. Patients with malignancy commonly present with larger tumor size, higher level of Ca (>14.6 mg/dL), and PTH (5-fold higher than the upper limit of normal). Our patient had a history of multiple admissions due to symptomatic HC. She had no palpable neck masses on exam. Her initial FNA was consistent with PA. Hence, we presumed that her hypercalcemia was caused by PA. Establishing a definitive diagnosis of PC by frozen sections intraoperatively is difficult. Histopathologic findings of atypical cells, high mitotic rate, and cellular invasions can suggest the diagnosis, though they are often negative. Even postoperatively, pathologists often disagree on cytologic interpretation. However, differentiating PA and PC is important since earlier and more aggressive treatment is needed to reduce the morbidity and mortality in case of malignancy.

scholarly journals Rare Treatments for Rare Dyslipidemias: New Perspectives in the Treatment of Homozygous Familial Hypercholesterolemia (HoFH) and Familial Chylomicronemia Syndrome (FCS)

2021 ◽  
Vol 23 (11) ◽  
Author(s):  
Laura D’Erasmo ◽  
Simone Bini ◽  
Marcello Arca
Keyword(s):  
Familial Hypercholesterolemia ◽  
Treatment Options ◽  
New Drugs ◽  
Lipid Lowering ◽  
Homozygous Familial Hypercholesterolemia ◽  
Published Evidence ◽  
Novel Drugs ◽  
Life Threatening ◽  
History Of ◽  
Definition Of

Abstract Purpose of Review This review aims to summarize the most recent published literature concerning lomitapide and volanesorsen that are approved for the use in HoFH and FCS patients, respectively. Moreover, it will briefly revise the published evidence on novel, non-approved treatments that are under evaluation for the management of these rare forms of dyslipidemias Recent Findings The definition of rare dyslipidemias identifies a large number of severe disorders of lipid metabolism of genetic origin. Among them were homozygous familial hypercholesterolemia (HoFH) (OMIM #143890) and familial chylomicronemia syndrome (FCS) (OMIM #238600), which are characterized by a markedly impaired cholesterol- and triglyceride-containing lipoproteins metabolism. They are being particularly associated with poor health outcomes and quality of life. Considering the severity of these diseases, common lipid-lowering drugs are often ineffective or do not allow to achieve the recommended lipid targets to prevent the development of complications. Nowadays, several new drugs have been found to effectively treat HoFH and FCS with an acceptable safety profile. Summary Treating patients with HoFH and FCS remains very challenging. However, novel treatment options are emerging and might be considered in addition to conventional therapy for managing these diseases. These novel drugs will possibly change the natural history of these two rare and life-threatening diseases.

scholarly journals Acute Lymphoblastic Leukemia, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology

2021 ◽  
Vol 19 (9) ◽  
pp. 1079-1109
Author(s):  
Patrick A. Brown ◽  
Bijal Shah ◽  
Anjali Advani ◽  
Patricia Aoun ◽  
Michael W. Boyer ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Supportive Care ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Treatment Strategies ◽  
Adolescent And Young Adult ◽  
Cancer Center ◽  
Nccn Guidelines ◽  
Treatment Regimens

The NCCN Guidelines for Acute Lymphoblastic Leukemia (ALL) focus on the classification of ALL subtypes based on immunophenotype and cytogenetic/molecular markers; risk assessment and stratification for risk-adapted therapy; treatment strategies for Philadelphia chromosome (Ph)-positive and Ph-negative ALL for both adolescent and young adult and adult patients; and supportive care considerations. Given the complexity of ALL treatment regimens and the required supportive care measures, the NCCN ALL Panel recommends that patients be treated at a specialized cancer center with expertise in the management of ALL This portion of the Guidelines focuses on the management of Ph-positive and Ph-negative ALL in adolescents and young adults, and management in relapsed settings.

Clinical and Laboratory Management of the Prothrombin G20210A Mutation

2002 ◽  
Vol 126 (11) ◽  
pp. 1319-1325 ◽  
Author(s):  
Ronald C. McGlennen ◽  
Nigel S. Key
Keyword(s):  
Significant Risk ◽  
Factor V Leiden ◽  
Initial Assessment ◽  
Prothrombin G20210a ◽  
Factor V Leiden Mutation ◽  
Published Evidence ◽  
G20210a Mutation ◽  
Key Points ◽  
Prothrombin Mutation ◽  
History Of

Abstract Objective.—To make recommendations regarding the appropriate evaluation for the prothrombin G20210A mutation, as reflected by published evidence and the consensus opinion of recognized experts in the field. Data Sources.—Review of the medical literature, primarily since 1996. Data Extraction and Synthesis.—After an initial assessment of the literature, key points defining the condition, and review of the clinical study design, a draft manuscript was prepared and circulated to every participant in the College of American Pathologists Conference on Diagnostic Issues in Thrombophilia before the meeting. Each of the key points and associated recommendations were then presented for discussion at the conference. Recommendations were accepted if a consensus of 70% of experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—Consensus was reached on several recommendations concerning the criteria for testing for the prothrombin G20210A mutation and for the method of testing. First, a major point of consensus was that the prothrombin G20210A mutation is a significant risk factor for venous thromboembolism (VTE) and that testing should be considered in the initial evaluation of suspected inherited thrombophilia. Second, although several analytic methods are commonly used for genetic testing for the prothrombin mutation, all are generally robust and reliable. The recommendations for testing for the prothrombin mutation parallel those for the factor V Leiden mutation and include patients with a history of recurrent VTE, a first episode of VTE before the age of 50 years, a history of an unprovoked VTE at any age, thromboses in unusual anatomic sites, or an affected first-degree relative with VTE. A history of VTE related to pregnancy or estrogen use and unexplained pregnancy loss during the second or third trimesters were also considered to be indications for testing. Other scenarios remain controversial or not recommended, including general population screening.

Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18816-e18816
Author(s):  
Cesar Simbaqueba ◽  
Omar Mamlouk ◽  
Kodwo Dickson ◽  
Josiah Halm ◽  
Sreedhar Mandayam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Hazard Model ◽  
Cancer Center ◽  
Icu Admission ◽  
Significant Difference ◽  
History Of

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

Identification of Women at Risk for Hereditary Breast and Ovarian Cancer in A Sample of 1000 Slovenian Women: A Comparison of Guidelines

2020 ◽  
Author(s):  
Urška Kotnik ◽  
Borut Peterlin ◽  
Luca Lovrecic
Keyword(s):  
Ovarian Cancer ◽  
At Risk ◽  
Family History ◽  
High Risk ◽  
Breast And Ovarian Cancer ◽  
Nccn Guidelines ◽  
Family History Of Cancer ◽  
Slovenian Population ◽  
History Of ◽  
History Of Cancer

Abstract Background: An important number of breast and ovarian cancer cases is due to a strong genetic predisposition. The main tool for identifying individuals at risk is recognizing a suggestive family history of cancer. We present a prospective study on applying three selected clinical guidelines to a cohort of 1000 Slovenian women to determine the prevalence of at-risk women according to each of the guidelines and analyze the differences amongst the guidelines.Methods: Personal and family history of cancer was collected for 1000 Slovenian women. Guidelines by three organizations: National Comprehensive Cancer Network (NCCN), American College of Medical Genetics in cooperation with National Society of Genetic Counselors (ACMG/NSGC), and Society of Gynecologic Oncology (SGO) were applied to the cohort. The number of women identified, the characteristics of the high-risk population, and the agreement between the guidelines were explored. Results: NCCN guidelines identify 16.7 % of women, ACMG/NSGC guidelines identify 7.1 % of women, and SGO guidelines identify 7.0 % of women from the Slovenian population, while 6.2 % of women are identified by all three guidelines as having high-risk for hereditary breast and ovarian cancer.Conclusions: We identified 17.4 % of women from the Slovenian population as being at an increased risk for breast and ovarian cancer based on their personal and family history of cancer using all of the guidelines. There are important differences between the guidelines. NCCN guidelines are the most inclusive, identifying more than twice the amount of women as high-risk for hereditary breast and ovarian cancer as compared to the AGMG/NSCG and SGO guidelines in the Slovenian population.

Surgical Palliative Care

2019 ◽  
pp. 1-12
Author(s):  
Geoffrey P. Dunn
Keyword(s):  
Twentieth Century ◽  
Palliative Care ◽  
Surgical Intervention ◽  
Homo Sapiens ◽  
Surgical Skills ◽  
Care Practice ◽  
History Of Surgery ◽  
Human Response ◽  
History Of

Attention to suffering through the comfort and nonabandonment of the sick and injured is an instinctive human response that provides the framework of current palliative care practice. This component of our socialization is so profound it probably pre-dates our Homo sapiens identity. Trauma to humans was a likely stimulus for the development and refinement of this empathic capacity, raising the possibility that someone using rudimentary surgical skills introduced palliative care to civilization long before a surgeon coined the term palliative care in the twentieth century. Many palliative interventions ultimately became cures. The history of surgery repetitively shows that when the first priority for surgical intervention is the response to suffering, the cures will follow, but the reverse is not necessarily true.

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