Imperial College London

Dr George Garas BSc (Hons) MBBS (Dist) PhD DIC FRCS (ORL-HNS) FEBORL-HNS (Gold Medal)

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

g.garas

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

91 results found

Spinos D, Doshi J, Garas G, 2024, Delivering a net zero National Health Service: where does otorhinolaryngology - head and neck surgery stand?, J Laryngol Otol, Vol: 138, Pages: 373-380

OBJECTIVE: The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice. METHOD: Systematic review of the literature using scientific, healthcare and general interest (public domain) databases. RESULTS: The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel. CONCLUSION: Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.

Journal article

Garas M, Bertot LC, Smith B, Delriviere L, Jacques B, Mou L, Adams L, Macquillan G, Garas G, Jeffrey G, Wallace Met al., 2023, Hepatocellular carcinoma recurrence after liver transplant: an Australian study, Publisher: WILEY, Pages: 76-76, ISSN: 0815-9319

Conference paper

Zhang G, Attree C, Adams L, Tibballs J, Garas G, Jeffrey G, Wallace M, Smith B, Macquillan Get al., 2023, Magnetic resonance cholangiopancreatography surveillance for primary sclerosing cholangitis: Making your hepatologists feel better!, Publisher: WILEY, Pages: 59-60, ISSN: 0815-9319

Conference paper

Jayabalan D, Adams LA, Huang Y, Bertot LC, De Boer B, Joseph J, Chang W, Hazeldine S, Smith B, Macquillan G, Wallace M, Garas G, Jeffrey GPet al., 2023, Long-term clinical outcomes of patients with autoimmune hepatitis and predictors of survival, Publisher: WILEY, Pages: 50-51, ISSN: 0815-9319

Conference paper

Adisa A, Bahrami-Hessari M, Bhangu A, George C, Ghosh D, Glasbey J, Haque P, Ingabire JCA, Kamarajah SK, Kudrna L, Ledda V, Li E, Lillywhite R, Mittal R, Nepogodiev D, Ntirenganya F, Picciochi M, Simões JFF, Booth L, Elliot R, Kennerton AS, Pettigrove KL, Pinney L, Richard H, Tottman R, Wheatstone P, Wolfenden JWD, Smith A, Sayed AE, Goswami AG, Malik A, McLean AL, Hassan A, Nazimi AJ, Aladna A, Abdelgawad A, Saed A, Abdelmageed A, Ghannam A, Mahmoud A, Alvi A, Ismail A, Adesunkanmi A, Ebrahim A, Al-Mallah A, Alqallaf A, Durrani A, Gabr A, Kirfi AM, Altaf A, Almutairi A, Sabbagh AJ, Ajiya A, Haddud A, Alnsour AAM, Singh A, Mittal A, Semple A, Adeniran A, Negussie A, Oladimeji A, Muhammad AB, Yassin A, Gungor A, Tarsitano A, Soibiharry A, Dyas A, Frankel A, Peckham-Cooper A, Truss A, Issaka A, Ads AM, Aderogba AA, Adeyeye A, Ademuyiwa A, Sleem A, Papa A, Cordova A, Appiah-Kubi A, Meead A, Nacion AJD, Michael A, Forneris AA, Duro A, Gonzalez AR, Altouny A, Ghazal A, Khalifa A, Ozair A, Quzli A, Haddad A, Othman AF, Yahaya AS, Elsherbiny A, Nazer A, Tarek A, Abu-Zaid A, Al-Nusairi A, Azab A, Elagili Aet al., 2023, Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries, British Journal of Surgery, Vol: 110, Pages: 804-817, ISSN: 0007-1323

BackgroundHealthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.MethodsThis study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.ResultsIn phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.ConclusionThis is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

Journal article

Medas F, Dobrinja C, Al-Suhaimi EA, Altmeier J, Anajar S, Arikan AE, Azaryan I, Bains L, Basili G, Bolukbasi H, Bononi M, Borumandi F, Bozan MB, Brenta G, Brunaud L, Brunner M, Buemi A, Canu GL, Cappellacci F, Cartwright B, Fuste IC, Cavalheiro B, Cavallaro G, Chala A, Chan SYB, Chaplin J, Cheema MS, Chiapponi C, Chiofalo MG, Chrysos E, D'Amore A, de Cillia M, De Crea C, de Manzini N, de Matos LL, De Pasquale L, Del Rio P, Demarchi MS, Dhiwakar M, Donatini G, Dora JM, D'Orazi V, Gamgaram VKD, Eismontas V, Kabiri EH, El Malki HO, Elzahaby I, Enciu O, Eskander A, Feroci F, Figueroa-Bohorquez D, Filis D, Francois G, Frias-Fernandez P, Gamboa-Dominguez A, Genc V, Giordano D, Gomez-Pedraza A, Graceffa G, Griffin J, Guerreiro SC, Gupta K, Gupta KK, Gurrado A, Hajiioannou J, Hakala T, Harahap WA, Hargitai L, Hartl D, Hellmann A, Hlozek J, Hoang VT, Iacobone M, Innaro N, Ioannidis O, Jang JHI, Xavier-Junior JC, Jovanovic M, Kaderli RM, Kakamad F, Kaliszewski K, Karamanliev M, Katoh H, Kosec A, Kovacevic B, Kowalski LP, Kralik R, Yadav SK, Kumorova A, Lampridis S, Lasithiotakis K, Leclere J-C, Leong EKF, Leow MK-S, Lim JY, Lino-Silva LS, Liu SYW, Llorach NP, Lombardi CP, Lopez-Gomez J, Lori E, Quintanilla-Dieck L, Lucchini R, Madani A, Manatakis D, Markovic I, Materazzi G, Mazeh H, Mercante G, Meyer-Rochow GY, Mihaljevic O, Miller JA, Minuto M, Monacelli M, Mulita F, Mullineris B, Munoz-de-Nova JL, Girardi FM, Nader S, Napadon T, Nastos C, Offi C, Ronen O, Oragano L, Orois A, Pan Y, Panagiotidis E, Panchangam RB, Papavramidis T, Parida PK, Paspala A, Perez OV, Petrovic S, Raffaelli M, Ramacciotti CF, Gimenez TR, Vazquez AR, Roh J-L, Rossi L, Sanabria A, Santeerapharp A, Semenov A, Seneviratne S, Serdar A, Sheahan P, Sheppard SC, Slotcavage RL, Smaxwil C, Kim SY, Sorrenti S, Spartalis E, Sriphrapradang C, Testini M, Turk Y, Tzikos G, Vabalayte K, Vargas-Osorio K, Sebastian R, Renteria V, Velazquez-Fernandez D, Vithana SMP, Yucel L, Yulian ED, Zahradnikova P, Zarogoulidis P Zet al., 2023, Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study, LANCET DIABETES & ENDOCRINOLOGY, Vol: 11, Pages: 402-413, ISSN: 2213-8587

Journal article

De M, Gupta K, Garas G, Siddiq S, Idle M, Germaine Set al., 2022, Role of the PuraBond haemostatic agent in Trans oral Robotic surgery - A case series, 4th International Symposium on HPV Infection in Head and Neck Cancer - Latest Advances in Biomarker-Driven Management, Publisher: ELSEVIER, ISSN: 1368-8375

Conference paper

Gupta KK, Garas G, Wilkes J, De Met al., 2022, Synchronous mucoepidermoid carcinoma and papillary microcarcinomas of the thyroid gland, BMJ CASE REPORTS, Vol: 15

Journal article

Garas G, Roland NJ, Lancaster J, Zammit M, Manon VA, Davies K, Jones TM, De M, Holsinger FC, Prestwich RJD, Fleming JCet al., 2022, Novel Strategies for Managing Retropharyngeal Lymph Node Metastases in Head and Neck and Thyroid Cancer with Transoral Robotic Surgery (TORS), ANNALS OF SURGICAL ONCOLOGY, Vol: 29, Pages: 7881-7890, ISSN: 1068-9265

Journal article

Garas G, Roland NJ, Lancaster J, Zammit M, Manon VA, Davies K, Jones TM, De M, Holsinger FC, Prestwich RJD, Fleming JCet al., 2022, ASO Visual Abstract: Novel Strategies for Managing Retropharyngeal Lymph Node Metastases in Head and Neck and Thyroid Cancer with TransOral Robotic Surgery (TORS), ANNALS OF SURGICAL ONCOLOGY, Vol: 29, Pages: 7893-7894, ISSN: 1068-9265

Journal article

Gupta KK, Garas G, Idle M, Germain S, De Met al., 2022, Evaluating the role of the self-assembling topical haemostat PuraBond? in Transoral Robotic Surgery (TORS) for oropharyngeal cancer: A case series, ANNALS OF MEDICINE AND SURGERY, Vol: 80, ISSN: 2049-0801

Journal article

Al Ani M, Garas G, Hollingshead J, Cheetham D, Athanasiou T, Patel Vet al., 2022, Which electronic health record system should we use? A systematic review, Medical Principles and Practice, Vol: 31, Pages: 342-351, ISSN: 1011-7571

The UK government had intended to introduce a comprehensive EHRs system in England by 2020. These EHRs would run across primary, secondary, and social care linking data in a single digital platform. This systematic review's objectives were to identify studies that compare EHRs in terms of direct comparison between systems and evaluate them using System and Software Quality Requirements and Evaluation (SQuaRE) ISO/IEC 25010. A systematic review was performed by searching EMBASE and Ovid MEDLINE databases between 1974 and April 2021. All original studies that appraised EHR systems and their providers were included. The main outcome measures were EHR system comparison and SQuaRE's eight characteristics: functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability. A total of 724 studies were identified using the search criteria. After review of titles and abstracts, this was filtered down to 40 studies as per exclusion and inclusion criteria set out in our study selection. Seven studies compared more than one EHR. The following number of studies looked at the various aspects of the SQuaRE respectively. Nineteen studies addressed functional suitability, n=18 performance efficiency, n=12 compatibility, n=25 usability, n=6 reliability, n=2 security, n=16 maintainability, and n=13 portability. Epic was the most studied EHR system and one of the most implemented vendors in the USA market, and one of the top ten in UK. It is difficult to assess which is the most advantageous EHR system currently available when looking at them in accordance with SQuaRE's eight characteristics for software evaluation.

Journal article

COVIDSurg Collaborative, GlobalSurg Collaborative, 2022, SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study, Anaesthesia, Vol: 77, Pages: 28-39, ISSN: 0003-2409

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no his

Journal article

Garas G, Mallick AS, O'Donoghue G, 2021, Comment on "Tracheotomy in Ventilated Patients With COVID-19'', ANNALS OF SURGERY, Vol: 274, Pages: E777-E778, ISSN: 0003-4932

Journal article

COVIDSurg Collaborative, GlobalSurg Collaborative, Shalhoub J, 2021, Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study, Anaesthesia, ISSN: 0003-2409

Journal article

Garas G, Darzi A, Athanasiou T, Lancaster Jet al., 2021, Stapler closure versus manual closure in total laryngectomy for laryngeal cancer: A systematic review and meta-analysis, CLINICAL OTOLARYNGOLOGY, Vol: 46, Pages: 918-918, ISSN: 1749-4478

Journal article

COVIDSurg Collaborative, GlobalSurg Collaborative, 2021, Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study, Anaesthesia, Vol: 76, Pages: 748-758, ISSN: 0003-2409

Peri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1% (3.3–4.8), 3.9% (2.6–5.1) and 3.6% (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS‐CoV‐2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5% (0.9–2.1%)). After a ≥ 7 week delay in undertaking surgery following SARS‐CoV‐2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0%), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS‐CoV‐2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

Journal article

Patel VM, Haunschild R, Bornmann L, Garas Get al., 2021, A call for governments to pause Twitter censorship: using Twitter data as social-spatial sensors of COVID-19/SARS-CoV-2 research diffusion, SCIENTOMETRICS, Vol: 126, Pages: 3193-3207, ISSN: 0138-9130

Journal article

COVIDSurg Collaborative, GlobalSurg Collaborative, 2021, SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study., British Journal of Surgery, ISSN: 0007-1323

Journal article

Ellis M, Garas G, Hardman J, Khan M, Mehanna H, Smith ME, Tikka T, Ubayasiri K, Williams Ret al., 2021, Post-Treatment Head and Neck Cancer Care: National Audit and Analysis of Current Practice in the United Kingdom, CLINICAL OTOLARYNGOLOGY, Vol: 46, Pages: 284-294, ISSN: 1749-4478

Journal article

Bonduelle Q, Garas G, Ramakrishnan Y, 2021, A rare cause of diplopia: Solitary extramedullary plasmacytoma of the skull base, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 103, Pages: E38-E41, ISSN: 0035-8843

Journal article

Kumar N, Garas G, Swift AC, O'Donoghue GMet al., 2020, Recognizing and Mitigating the Threat Posed by COVID-19 to Otolaryngologists: A UK Perspective, LARYNGOSCOPE, Vol: 130, Pages: E524-E524, ISSN: 0023-852X

Journal article

Stubington TJ, Mallick AS, Garas G, Stubington E, Reddy C, Mansuri MSet al., 2020, Tracheotomy in COVID-19 patients: Optimizing patient selection and identifying prognostic indicators, HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK, Vol: 42, Pages: 1386-1391, ISSN: 1043-3074

Journal article

Garas G, Cingolani I, Patel V, Panzarasa P, Alderson D, Darzi A, Athanasiou Tet al., 2020, Surgical innovation in the era of global surgery: a network analysis, Annals of Surgery, Vol: 271, Pages: 868-874, ISSN: 0003-4932

OBJECTIVE: To present a novel network-based framework for the study of collaboration in surgery and demonstrate how this can be used in practice to help build and nurture collaborations that foster innovation. BACKGROUND: Surgical innovation is a social process that originates from complex interactions among diverse participants. This has led to the emergence of numerous surgical collaboration networks. What is still needed is a rigorous investigation of these networks and of the relative benefits of various collaboration structures for research and innovation. METHODS: Network analysis of the real-world innovation network in robotic surgery. Hierarchical mixed-effect models were estimated to assess associations between network measures, research impact and innovation, controlling for the geographical diversity of collaborators, institutional categories, and whether collaborators belonged to industry or academia. RESULTS: The network comprised of 1700 organizations and 6000 links. The ability to reach many others along few steps in the network (closeness centrality), forging a geographically diverse international profile (network entropy), and collaboration with industry were all shown to be positively associated with research impact and innovation. Closed structures (clustering coefficient), in which collaborators also collaborate with each other, were found to have a negative association with innovation (P < 0.05 for all associations). CONCLUSIONS: In the era of global surgery and increasing complexity of surgical innovation, this study highlights the importance of establishing open networks spanning geographical boundaries. Network analysis offers a valuable framework for assisting surgeons in their efforts to forge and sustain collaborations with the highest potential of maximizing innovation and patient care.

Journal article

Rocke J, Mclaren O, Hardman J, Garas G, Smith ME, Ishii H, Constable J, Tikka T, Wie Liu Z, Williams Ret al., 2020, The role of allied healthcare professionals in head and neck cancer surveillance: A systematic review, CLINICAL OTOLARYNGOLOGY, Vol: 45, Pages: 83-98, ISSN: 1749-4478

Journal article

Garas G, Darzi A, Athanasiou T, 2019, Comment on: Relationship between surgeons and industry, British Journal of Surgery, Vol: 106, Pages: 1560-1560, ISSN: 0007-1323

Journal article

Garas G, Cingolani I, Patel V, Panzarasa P, Darzi A, Athanasiou Tet al., 2019, Evaluating the implications of Brexit for research collaboration and policy: A network analysis and simulation study, BMJ Open, Vol: 9, Pages: 1-11, ISSN: 2044-6055

Objective To evaluate the role of the European Union (EU) as a research collaborator in the United Kingdom (UK)’s success as a global leader in healthcare research and innovation and quantify the impact that Brexit may have. Design Network and regression analysis of scientific collaboration, followed by simulation models based on alternative scenarios. Setting International real world collaboration network among all countries involved in robotic surgical research and innovation.Participants 772 organisations from industry and academia nested within 56 countries and connected through 2,397 collaboration links.Main outcome measures Research impact measured through citations, innovation value measured through the innovation index, and an array of attributes of social networks to measure brokerage and geographical entropy at national and international levels.Results Globally, the UK ranks third in robotic surgical innovation, and the EU constitutes its prime collaborator. Brokerage opportunities and collaborators’ geographical diversity are associated with a country’s research impact (c=211.320 and 244.527, respectively;p-value<0·01) and innovation (c=18.819 and 30.850, respectively;p-value<0·01). Replacing EU collaborators with United States (US)’ ones is the only strategy that could benefit the UK, but on the condition that US collaborators are chosen among the top-performing ones, which is likely to be very difficult and costly, at least in the short term. Conclusions This study suggests what has long been argued, namely that the UK-EU research partnership has been mutually beneficial and that its continuation represents the best possible outcome for both negotiating parties. However, the uncertainties raised by Brexit necessitate looking beyond the EU for potential research partners. In the short-term, the UK’s best strategy might be to try and maintain its academic links with the EU. In the longer-term, strategic r

Journal article

Mallick AS, Garas G, McGlashan J, 2019, Presbylaryngis: a state-of-the-art review, CURRENT OPINION IN OTOLARYNGOLOGY & HEAD AND NECK SURGERY, Vol: 27, Pages: 168-177, ISSN: 1068-9508

Journal article

Garas G, Cingolani I, Panzarasa P, Darzi A, Athanasiou Tet al., 2019, Correction: Beyond IDEAL: the importance of surgical innovation metrics, The Lancet, Vol: 393, Pages: 746-746, ISSN: 0140-6736

Garas G, Cingolani I, Panzarasa P, Darzi A, Athanasiou T. Beyond IDEAL: the importance of surgical innovation metrics. Lancet 2019; 393: 315—In this Correspondence, the affiliations should read “Department of Surgery and Cancer, St Mary's Hospital (GG, AD, TA), and Centre for Health Policy (IC), Imperial College London, London W2 1NY, UK; and School of Business and Management, Queen Mary University of London, London, UK (PP)”. This correction has been made as of Feb 21, 2019.

Journal article

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