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Neurosurgery 81:620-626, 2017. Surgical resection of brainstem cavernous malformations (BSCMs) is challenging, and patient selection and timing of intervention remain controversial.. OBJECTIVE: To evaluate the impact of surgical timing and predictors of neurological outcome after surgical resection of BSCMs.. METHODS: Consecutive adult patients (≥18 years) with BSCMs undergoing surgical resection between 1985 and 2014 by the senior author (RFS)were retrospectively reviewed. Patient demographics, lesion characteristics, imaging results, surgical approach, and perioperative and long-term neurological morbidity were analyzed.. RESULTS: Data were analyzed for a total of 397 adult patients (160, 40% male).On univariate analysis, a greater proportion of patients treated within 6 weeks of hemorrhage had an improved Glasgow Outcome Scale score (P = .06). On logistic regression analysis, patients treated within 6weeks of hemorrhage experienced improved clinical outcomes (odds ratio = 1.73; 95% ...
Results The reliability of the QOLIBRI-OS was good (Cronbachs α=0.86, test-retest reliability =0.81) and similar in participants with higher and lower cognitive performance. Factor analysis indicated that the scale is unidimensional. Rasch analysis also showed a satisfactory fit with this model. The QOLIBRI-OS correlates highly with the total score from the full QOLIBRI scale (r=0.87). Moderate to strong relationships were found among the QOLIBRI-OS and the Extended Glasgow Outcome Scale, Short-Form-36, and Hospital Anxiety and Depression scale (r=0.54 to -0.76). The QOLIBRI-OS showed good construct validity in the TBI group. ...
Two class III publications met the inclusion criteria for this topic and provide evidence to support the recommendations (1, 2). The recommendations on the use of advanced neuromonitoring in this chapter are for patients with no contraindications for neuromonitoring such as coagulopathy (brain oxygenation) and for patients who do not have a diagnosis of brain death.. In 2009, a study by Figaji et al (1) reported the relationship between PbtO2 and long-term outcome in 52 children with severe TBI. Patients with compromised PbtO2 were treated to a threshold ≥20 mm Hg. Overall mortality was nearly 10%. After considering other conventional predictors, authors reported that PbtO2 ,5 mm Hg for ,1 hr or ,10 mm Hg for ,2 hrs were associated with a significantly increased risk of unfavorable outcome (Glasgow Outcome Scale and Pediatric Cerebral Performance Category scores) and mortality, independent of other factors that were also significant (e.g., ICP, cerebral perfusion pressure, Glasgow Come Scale, ...
RESULTS: One patient had neurofibromatosis (NF) type 1, and five patients had NF2. Tumors were most commonly located in the convexity (n=6) and parasagittal or falcine (n=6). Gross total resection was performed in 70.4% of cases. WHO grade I tumors accounted for 56% of all cases, whereas high-grade meningiomas accounted for 44% (33% grade II, 11% grade III). The mean follow-up duration was 10.3 ± 7.7 years. Three patients (13%) died during follow-up, and 76.2% of the patients had favorable outcome (Glasgow Outcome Scale > 3) during the last follow-up assessment. Ten patients (43.5%) had relapse. In univariate analysis, low histological grade (p=0.030) and gross total resection (p=0.024) were associated with favorable outcome. The 10-year overall survival rate was 86%.. CONCLUSION: Meningiomas in the pediatric age group are surgically treatable tumors with fairly good outcomes. However, relapses are common even for low-grade tumors; therefore, long-term surveillance and aggressive treatment ...
Ten years after Schuldiners passing, members of Cynic, Cormorant, Exhumed, Charred Walls of the Damned, Baroness and more write about their favorite Death songs.
OBJECTIVE: To examine predefined risk factors and outcome of seizures in community-acquired bacterial meningitis (CABM).. DESIGN: Observational cohort studies SETTING: Denmark PARTICIPANTS: In the derivation cohort, we retrospectively included all adults (,15 years of age) with CABM in North Denmark Region from 1998 to 2014 and at Hvidovre and Hillerød hospitals from 2003 to 2014. In the validation cohort, we prospectively included all adults (,18 years of age) with CABM treated at all departments of infectious diseases in Denmark from 2015 to 2017.. PRIMARY AND SECONDARY OUTCOME MEASURES: In the derivation cohort, we used modified Poisson regression to compute adjusted relative risks (RRs) with 95% confidence intervals for predefined risk factors for seizures during CABM as well as for risks of death and unfavourable outcome assessed by the Glasgow Outcome Scale score (1-4). Next, results were validated in the validation cohort.. RESULTS: In the derivation cohort (n=358), risk factors for ...
The effect of post-injury erythropoietin administration on mortality and Glasgow outcome scales of patients with traumatic brain injury: A metaanalysis., Faye B Garciano, Perry N N
This prospective consecutive double-blinded randomized study investigated the effect of prostacyclin on pressure reactivity (PR) in severe traumatic brain injured patients. Other aims were to describe PR over time and its relation to outcome. Blunt head trauma patients, Glasgow coma scale a parts per thousand currency sign8, age 15-70 years were included and randomized to prostacyclin treatment (n = 23) or placebo (n = 25). Outcome was assessed using the extended Glasgow outcome scale (GOSE) at 3 months. PR was calculated as the regression coefficient between the hourly mean values of ICP versus MAP. Pressure active/stable was defined as PR a parts per thousand currency sign0. Mean PR over 96 h (PRtot) was 0.077 +/- A 0.168, in the prostacyclin group 0.030 +/- A 0.153 and in the placebo group 0.120 +/- A 0.173 (p , 0.02). There was a larger portion of pressure-active/stable patients in the prostacyclin group than in the placebo group (p , 0.05). Intra-individual changes over time were common. ...
The Glasgow Outcome Score attempts to objectively assess outcomes of brain injury by degree of recovery. It makes use of five categories. The first version was developed in 1975 by Jennett and Bond. An alternative quantification of outcomes in common use is the Modified Rankin Scale. 1. Death Severe injury or death without recovery of consciousness 2. Persistent vegetative state Severe damage with…
Outcome after sever brain damage. 1. Dead. 2. Persistent vegetative state (no obvious cortical function). 3. Severe disability (conscious but disabled). 4. Moderate disability (disabled but independent). 5. Good recovery (return to normal activities wvwn with minor neuro or psychological deficits). Reference: http://www.nervous-system-diseases.com/glasgow-outcome-scale.html. ...
Content for ASHAs Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Pediatric Traumatic Brain Injury page. ...
About: Predicting Seizures In The Acute Stage Of Pediatric Traumatic Brain Injury. Blog by a compassionate yet aggressive San Francisco Injury Attorney.
The current Brain Trauma Foundation recommendation for antiseizure prophylaxis is phenytoin during the first 7 days after traumatic brain injury (TBI) 93 adult patients (43 [46%] No phenytoin group vs. 50 [54%] phenytoin group). The two groups were well matched. Contrary to expectation, more seizures occurred in the PP group as compared with the NP group; however, this did not reach significance (PP vs. NP, 2 [4%] vs. 1 [2.3%], p = 1). There was no significant difference in the two groups (PP vs. NP) as far as disposition are concerned, mortality caused by head injury (4 [8%] vs. 3 [7%], p = 1), discharge home (16 [32%] vs. 17 [40%], p = 0.7), and discharge to rehabilitation (30 [60%] vs. 23 [53%], p = 0.9). However, with PP, there was a significantly longer hospital stay (PP vs. NP, 36 vs. 25 days, p = 0.04) and significantly worse functional outcome at discharge based on Glasgow Outcome Scale (GOS) score (PP vs. NP, 2.9 vs. 3.4, p , 0.01) and modified Rankin Scale score (2.3 ± 1.7 vs. 3.1 ± ...
The 5-point Glasgow Outcome Scale (GOS), or its extended 8-point version (GOS-E) was used as the primary outcome measure in 21 of the 30 studies (70 percent), and was the only outcome measure used in six of those studies (Table 2). Four of the remaining studies used the GOS as a secondary outcome measure, and two used an outcome assessment that is structured similarly to the GOS in the pediatric populations (Pediatric Cerebral Performance Category). Three studies used other means of measuring outcome. While GOS or GOS-E accurately captures global phenomena, it may fail to assess subtle differences in outcomes over a wide range of functioning. We speculate that clinical trials for brain injury will have a better probability of success when there are means of detecting and classifying brain injury appropriately, according to its pathophysiology as patients enter a trial and more sensitive outcome measures to assess recovery as patients leave a trial are utilized.. Multimodal algorithmic assessment ...
Primary objective : During childhood, the central nervous system is in a state of rapid development which can be interrupted by a traumatic brain injury (TBI). This study aimed to describe if and how TBI during childhood influences health and life situation, 5-8 years later.. Research design : A case-control retrospective design was employed for the assessment of 61 adolescents and young adults with a mild, moderate or severe TBI and 229 matched controls from a normative group (16-24 years).. Methods and procedures : SF-36 (Short Form 36 health survey) and a self-reported questionnaire measuring life situation were distributed to youths suffering TBI 5-8 years ago. Forty-five youths (74%) completed the questionnaires.. Main outcomes and results : Participants with a TBI stated lower self-estimated health compared with the normative group.. Remaining self-reported symptoms were physical and cognitive. Negative effects of TBI influencing school results, leisure activities and thoughts about future ...
Health State Preference Weights for the Glasgow Outcome Scale Following Traumatic Brain Injury: A Systematic Review and Mapping Study
Kessler Foundation researchers conducted a pilot study to determine ways to assess social communication difficulties in children with impaired social functioning caused by moderate-to-severe traumatic brain injury (TBI). ...
Signs and symptoms of TBI vary, depending on the site and extent of injury to the brain, the age at which the injury occurred, premorbid abilities, and functional domains affected (e.g., physical, cognitive, language, sensory). The effects of TBI can be temporary or permanent, and no two children present with the same pattern. Some young children with TBI may demonstrate relatively typical developmental progression after the initial stages of recovery. Others continue to have long-term difficulty learning new information and negotiating more complex social interactions due to impairments in cognitive functions (Anderson, Godfrey, Rosenfeld, & Catroppa, 2012; Turkstra, Politis, & Forsyth, 2015). The functional impact of TBI in children can differ from that in adults because the pediatric brain is still developing. For example, sensory systems and the frontal lobes of the brain continue to develop past late adolescence (S. J. Taylor, Barker, Heavey, & McHale, 2013). Therefore, some children may ...
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This is a two-arm, parallel, double-blind randomized prospective clinical trial. The subjects will be asked to provide informed consent, and then undergo screening for enrollment criteria at the first visit (-5 weeks). The subjects who are eligible, and provide informed consent will return for Visit 2 baseline data (-4 weeks), and then begin the unblinded niacin-ER titration. Specifically, subjects will receive a starting dose of niacin-ER of 500 mg per day, which will be increased in 500 mg increments every week up to a dose of 2000 mg per day. Subjects will need to tolerate at least 1500 mg per day of niacin-ER in order to remain in the study and be randomized. Thus subjects who are unable to tolerate the 2000 mg daily dose of niacin-ER will be taken back to 1500 mg per day for one week and then randomized. Subjects who develop prohibitive side effects at doses less than 1500 mg per day will be discontinued from the study. All subjects who are able to take the target dose of niacin-ER will ...
This is a two-arm, parallel, double-blind randomized prospective clinical trial. The subjects will be asked to provide informed consent, and then undergo screening for enrollment criteria at the first visit (-5 weeks). The subjects who are eligible, and provide informed consent will return for Visit 2 baseline data (-4 weeks), and then begin the unblinded niacin-ER titration. Specifically, subjects will receive a starting dose of niacin-ER of 500 mg per day, which will be increased in 500 mg increments every week up to a dose of 2000 mg per day. Subjects will need to tolerate at least 1500 mg per day of niacin-ER in order to remain in the study and be randomized. Thus subjects who are unable to tolerate the 2000 mg daily dose of niacin-ER will be taken back to 1500 mg per day for one week and then randomized. Subjects who develop prohibitive side effects at doses less than 1500 mg per day will be discontinued from the study. All subjects who are able to take the target dose of niacin-ER will ...
ARCA aims to boost participation by easing stringent enrollment criteria in a study investigating Gencaro in heart failure patients with a favorable response genotype.
The Ontology for Biomedical Investigations (OBI) aims to represent all elements of investigations such as assays, instruments or subject enrollment criteria. This tutorial will provide training on how to use OBI in specific applications and contribute to OBI development. The application use cases will cover various biological and medical investigations of interest to different communities, such as those performing functional genomics or clinical investigations. While going through these use cases, we will discuss: OBI design principles and the underlying Basic Formal Ontology, the Minimum Information to Reference an External Ontology Term (MIREOT) methodology, how to use the Quick Term Template (QTT), how to submit term requests, and how to generate an OBI view for specific applications. This tutorial will start with a general overview of OBI followed by a presentation of practical applications leading to a hands-on session where attendees can practice using tools and applying principles ...
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Geisterzug Gose Quinced is a Sour - Gose style beer brewed by Freigeist Bierkultur in Stolberg, Germany. Score: 90 with 70 ratings and reviews. Last update: 08-13-2020.
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Amber Cowan, 28, works at a hospital in Glasgow and claims managers told her to get her affairs in order before starting her first night shift on a COVID-19 ward.
Various Authors Anarchism in Glasgow (Interview) 14/8/87 Transcribed in November 1993 from a not-always-clear cassette tape. A formerly inaudible section...
Geraint Bevan (Member of programme committee), 8 Aug 2012 → 5 Jun 2013. Activity: Conference participation › Participation in conference ...
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OBJECTIVE: Accurate and consistent outcome assessment is essential to randomized clinical trials. We aimed to explore observer variation in the assessment of outcome in a recently completed trial of dexanabinol in head injury and to consider steps to reduce such variation. METHODS: Eight hundred sixty-one patients with severe traumatic brain injury who were admitted to 86 centers were included in a multicenter, placebo-controlled, Phase III trial. Outcome was assessed at 3 and 6 months postinjury using the extended Glasgow Outcome Scale; standardized assessment was facilitated by the use of a structured interview. Before initiation of trial centers, outcome ratings were obtained for sample cases to establish initial levels of agreement. Training sessions in outcome assessment were held, and problems in assigning outcome were investigated. During the trial, a process of central review was established to monitor performance. Interobserver variation was analyzed using the κ statistic. RESULTS: ...
TY - JOUR. T1 - Increased adenosine in cerebrospinal fluid after severe traumatic brain injury in infants and children. T2 - Association with severity of injury and excitotoxicity. AU - Robertson, Courtney. AU - Bell, M. J.. AU - Kochanek, P. M.. AU - Adelson, P. D.. AU - Ruppel, R. A.. AU - Carcillo, J. A.. AU - Wisniewski, S. R.. AU - Mi, Z.. AU - Janesko, K. L.. AU - Clark, R. S B. AU - Marion, D. W.. AU - Graham, S. H.. AU - Jackson, E. K.. PY - 2001. Y1 - 2001. N2 - Objectives: To measure adenosine concentration in the cerebrospinal fluid of infants and children after severe traumatic brain injury and to evaluate the contribution of patient age, Glasgow Coma Scale score, mechanism of injury, Glasgow Outcome Score, and time after injury to cerebrospinal fluid adenosine concentrations. To evaluate the relationship between cerebrospinal fluid adenosine and glutamate concentrations in this population. Design: Prospective survey. Setting: Pediatric intensive care unit in a university-based ...
Objective : Removal of blood from subarachnoid space with a lumbar drainage (LD) may decrease development of cerebral vasospasm. We evaluated the effectiveness of a LD for a clinical vasospasm and outcomes after clipping of aneurysmal subarachnoid hemorrhage (SAH). Methods : Between July 2008 and July 2013, 234 patients were included in this study. The LD group consisted of 126 patients, 108 patients in the non LD group. We investigated outcomes as follow : 1) clinical vasospasm, 2) angioplasty, 3) cerebral infarction, 4) Glasgow outcome scale (GOS) score at discharge, 5) GOS score at 6-month follow-up, and 6) mortality. Results : Clinical vasospasm occurred in 19% of the LD group and 42% of the non LD group (p,0.001):Angioplasty was performed in 17% of the LD group and 38% of the non LD group (p=0.001). Cerebral infarctions were detected in 29% and 54% of each group respectively (p,0.001). The proportion of GOS score 5 at 6 month follow-up in the LD group was 69%, and it was 58% in the non LD ...
Background: The outcomes of the grade V subarachnoid hemorrhage (SAH) patients have been dismal. Considering rapid advancement in techniques and devices in endovascular treatment (EVT), however, the outcomes of grade V SAH patients treated endovascularly may have been improved chronologically.. Methods: A single-center, retrospective study was conducted to evaluate whether the outcomes of World Federation of Neurosurgical Societies (WFNS) grade V SAH patients treated endovascularly were improved chronologically during the last 15 years (January 2000- December 2014). Coiling has been the first-line treatment for WFNS grade V SAH patients in our institution since 2000, and 115 patients who underwent EVT were trichotomized based on the admission year: 2000-04 (n=44), 2005-09 (n=37), and 2010-14 (n=34). Demographics and the outcomes were compared among the three groups. The outcomes at discharge were evaluated with the Glasgow Outcome Scale (GOS) score, and GOS 4/5 were defined as favorable ...
From the age of five through adulthood, trauma is the leading cause of death, and many traumatic injuries involve brain injury. Fortunately, the majority of traumatic brain injuries are mild, but nevertheless, some children will experience a severe traumatic brain injury.
Abstract Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children worldwide. This study was conducted to report the presentation, management, outcomes and prognostic indicators in a large series of patients from a tertiary care centre in a developing country. It is a review of prospectively collected data of paediatric patients with TBI admitted at our centre between July 2010 and December 2013. A total of 291 patients with a mean age of 7.2±5.0 years were dichotomised into survivors and non-survivors, and variables were compared between the two groups. The mean post-resuscitation Glasgow coma scale (GCS) score was 11.6±3.9, mean Marshall Score was 2.26±0.95 and the mean revised trauma score at presentation was 10.58±1.7. Younger age, lower GCS score after resuscitation, lower revised trauma score, absent cisterns on imaging, associated subarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) and a lower Marshall score were associated with higher
The overall aim of the research presented here was to expand the knowledge on metabolic course and nutritional outcome in patients with severe traumatic brain injury and to analyze the use and accuracy of different methods of assessment.. Study I, a systematic review of 30 articles demonstrated consistent data on increased metabolic rate, of catabolism and of upper gastrointestinal intolerance in the majority of the patients during early post injury period. Data also indicated a tendency of less morbidity and mortality in early fed patients.. Study II, a retrospective survey, based on medical records of 64 patients from three regions in Sweden, showed that the majority of patients regained their independence in eating within six months post injury. However, energy intake was set at a low level and 68 % of the patients developed malnutrition with 10 to 29 % loss of initial body mass during the first and second month post injury.. Study III, a questionnaire based study addressed to 74 care units ...
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Emotive, Cognitive and Motor Rehabilitation Post Severe Traumatic Brain Injury A New Convergent Approach Grigore Burdea, Bryan Rabin, Aurélien Chaperon Tele-Rehabilitation Institute Rutgers University
cebo group (15 percent vs. 25 percent; relative risk, cebo died. Adjuvant treatment with dexamethasone 0.59; 95 percent confidence interval, 0.37 to 0.94; P= did not have a significant beneficial effect on neuro- 0.03) (Table 2); the absolute reduction in the risk of logic sequelae, including hearing loss. During admis- an unfavorable outcome was 10 percent. Predictors sion, audiologic examination was performed in 28 pa- of an unfavorable outcome were coma on admission tients, 14 of whom had severe hearing loss (60 dB or (P=0.002), hypotension (P=0.03), and meningitis more in one or both ears). At eight weeks, 27 patients due to S. pneumoniae (P=0.02). The benefit of dex- had hearing loss. The distribution of scores on the amethasone remained substantial in an analysis adjust- Glasgow Outcome Scale is shown in Table 3. The low- ed for other risk factors (adjusted odds ratio, 0.45; P= er mortality in the dexamethasone group did not re- 0.02). Among the patients with pneumococcal men- sult in an ...
1:00 p.m. - 5:00 p.m.. The World Federation for the Treatment of Opioid Dependence (WFTOD) was founded during the EUROPAD meeting of July 2007 in Ljubljana, Slovenia. All of the member nations, which included the member countries of EUROPAD and all of the member states within AATOD, agreed to a charter for the World Federation.. 1:00 p.m.-1:15 p.m. ...
Glasgow Coma Scale Score A Frequent method used to Assess the severity of a Traumatic brain injury is the Glasgow Coma Scale (GCS) score.) The GCS score ranges from 3 to 15. Its founded on the individuals best verbal response, ability to follow orders, and eye opening. A rating of 3 means that a individual doesnt have any eye opening, isnt creating a noises or speaking, and isnt responding even to annoyance (and so isnt following orders). This reflects an extremely severe TBI. Someone with a rating of 15 has their eyes open, is after orders, and is speaking (even to the extent of being oriented). By definition of a GCS score of 8 or under reflects a serious TBI, a score of 9-12 a moderate TBI, along with a score of 13-15 a moderate TBI. The very first GCS score is usually done in the roadside from the EMTs. In several cases, moderately to seriously injured men and women are intubated (a tube is put down the throat and to the air passage to the lungs) in the scene of the harm to guarantee ...
Pediatric traumatic brain injury (TBI) is a major cause of death and disability. While the damage caused by the primary injury may not be alterable by treatment, the effects of the secondary injury-subsequent metabolic, humoral and cellular derangements-can be modified. By ensuring good hemodynamics, gas exchange and intracranial pressure control, physicians can improve outcomes. However, the appearance of vasospasm and subsequent ischemia has been demonstrated in up to 45% of adults with TBI (depending on the criteria used to define vasospasm) and has been associated with worse outcomes. In a recent study, OBrien et al sought to evaluate the prevalence, time to onset and duration of vasospasm in children with moderate to severe TBI. For their single center, prospective, observational study, the authors enrolled 69 children with TBI (35 subjects had moderate TBI and 34 had severe TBI).. They found that vasospasm occurs in a sizeable number of children with moderate and severe TBI. However, ...
Our study shows the potential of multifactorial Random Forest models using qEEG parameters to predict outcome in patients with moderate to severe TBI.
Engineering an intracellular pathway for major histocompatibility complex class II presentation of antigens. Proceedings of the National Academy of Sciences of the United States of America. 1995 ...
Background. Most acute febrile illnesses (AFI) are usually not associated with a specific diagnosis because of limitations of available diagnostics. This study reports on the frequency of EBV viremia and viral load in children and adults presenting with febrile illness in hospitals in Kenya.. Methodology/Principal Findings. A pathogen surveillance study was conducted on patients presenting with AFI (N = 796) at outpatient departments in 8 hospitals located in diverse regions of Kenya. Enrollment criterion to the study was fever without a readily diagnosable infection. All the patients had AFI not attributable to the common causes of fever in Kenyan hospitals, such as malaria or rickettsiae, leptospira, brucella and salmonella and they were hence categorized as having AFI of unknown etiology. EBV was detected in blood using quantitative TaqMan-based qPCR targeting a highly conserved BALF5 gene. The overall frequency of EBV viremia in this population was 29.2%, with significantly higher proportion ...
He didnt meet enrollment criteria due to the hematologic abnormalities. The pancytopenia was thought to be consistent with considerable marrow involvement. No clinically significant hematologic toxic effects had been observed in the medical trials of GDC-0449 up to that time. Because of the lack of alternative therapies and the preclinical evidence that hedgehog signaling might be critical in medulloblastoma, a protocol deviation was proposed to allow this patient to be treated with GDC-0449. On April 18 The process deviation was accepted by the institutional review board at Johns Hopkins University, 2008, and the patient provided written informed consent.The workouts were often difficult, but the rewards were fairly incredible actually. Hill uncovered the experiments results: FITNESS TEST RESULTS Push-ups: from 13 to 30 Sit-ups: from 30 to 42 One-mile run: from 10:10 to 8:45 - - improved by 1:25 FITNESS RESULTS Body composition: 21.3 % to 19.9 % - - nearly 2 % loss of body fat Aerobic ...
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