Alleman  

Langman  

ANNA CE

Using Teamwork for Effective Management of CKD and Mineral and Bone Disorders

Craig B. Langman, MD and Kim Alleman, MS, RN, FNP-BC, CNN
(ANNA Fall Symposium, Chicago, IL. September, 2008.) 1.25 CNE
Langman: How has FGF23 changed the way we look at phosphate and vitamin D hydroxylation in CKD? Is FGF23 a risk marker for mortality? If so, can it be reduced by lowering serum phosphate? How effective are various P-binders? How does serum phosphate relate to survival and vascular calcification? What did Treat to Goal, the Takei study, and RIND show with respect to calcification and P-binders? How does treatment with P-binders affect calcification in predialysis patients? What are the nontraditional effects of sevelamer, and how might these impact on calcification? How is bone remodeling linked to vascular calcification? How do P-binders compare re mortality? How might vitamin D deficiency affect mortality in CKD? How prevalent are low levels of 25-D and 1,25-D? How might vitamin D affect cardiovascular function? What do observational studies show re Vitamin D treatment and survival in CKD?
Alleman: What are the goals of treatment in CKD-MBD? What are our current target lab values? How well or how poorly are we doing in achieving these targets? How can we put together an effective collaborative approach to manage CKD-MBD? What are the team members and what are their roles? What are useful methods to promote collaboration? (more...)


Schira

Free CE

Managing Anemia in Chronic Kidney Disease: The Benefits to Patients

Mary Schira, PhD, RN, ACNP, BC, CNN-P
(ANNA Fall Symposium, Chicago, IL. September, 2008.) 1.25 CNE
Schira: How does anemia develop as kidney function decreases? What are the various functions of red blood cells? What are the causes of anemia in CKD? Where does erythropoietin come from? When does it work in the lifespan of the RBC? How does inflammation affect erythropoiesis? What are the symptoms of anemia? How does KDOQI guide us to evaluate patients for anemia? What do RBC indices tell us? How does anemia lead to increased costs? What are KDOQI therapy targets? What are potential benefits of treating anemia? What are the potential risks of overtreatment? What patient factors affect anemia diagnosis and treatment? (more...)


Schmidt

Senft

Free CE

What You Can Teach Your Team About Chronic Kidney Disease-Related Mineral Bone Disorder (CKD-MBD)

Rebecca Schmidt, DO, FACP, FASN and Sharon Senft, RN-C, FNP
(ANNA National Symposium, Philadelphia, PA. April, 2008.) 1.5 CNE
Dr. Schmidt and Ms. Senft: Part One: What is happening to the prevalence of CKD? What is the incidence by race and ethnicity? What are the associated conditions? How many millions have CKD? Are they aware of it? Who is at greatest risk? What did we find in West Virginia? What can we learn from the case of a young diabetic with CKD? Part Two: What is this young patient's likely outcome? His mortality risk? What is the risk for hospitalization due to congestive heart failure? Expected remaining lifetime? How do serum calcium and serum phosphorus relate to mortality risk? What about the coronary artery calcification score? How can one assess vascular calcification? Part Three: How can we optimize outcome by intervening early in CKD- related mineral bone disorder? How can we achieve optimal bone health and minimize risk for vascular calcification? How do we manage a case with high serum phosphorus and high serum calcium? What about a case with high phosphorus and low serum calcium? When do we combine binders? What are the challenges in managing hyperphosphatemia? What is the calcium balance associated with various calcium baths? What are the advantages and disadvantages of each class of phosphate binders? What are their comparative efficacies? What is sevelamer carbonate and why might it be an improved binder? What can you teach your team about CKD-related bone mineral disorder (CKD-MBD)? (more...)


Qunibi

Szczech

Free CE

New Perspectives on the Progression of Coronary Artery Calcification and Patient Outcomes in Chronic Kidney Disease

Wajeh Qunibi, MD, FACP and Lynda Szczech, MD, MSCE
(ANNA National Symposium, Philadelphia, PA. April, 2008.) 1.5 CE
Qunibi: How do the various phosphate binders compare in terms or their ability to control serum phosphorus in the real world? What are the population attributable risks to elevated serum phosphorus, calcium, and PTH? What is the evidence that calcium-based phosphate binder dose is linked to calcification, and to what extent might this be operating through hyperphosphatemia in noncompliant patients? What did the CARE-2 study show? What were the mortality outcomes results in RIND and DCOR? What do the 2003 KDOQI bone disease guidelines recommend regarding phosphate binders and what might be the economic implication of these recommendations? Szczech: What are the statistical issues involved when examining observational association of laboratory values (e.g. serum calcium, phosphorus, and PTH) vs. mortality? What characterizes patients with high serum phosphate? High serum calcium? What do time varying analyses of change in these values show? Are there any clinically relevant differences between calcium carbonate and calcium acetate? Which calcium-based binder types were used in the various trials -- RIND, Treat to Goal, DCOR, and CARE-2? What are the potential pitfalls of looking at intermediate outcomes in trials of phosphate binders? (more...)

Free ANNA CE via HDCN
What You Can Teach Your Team About Chronic Kidney Disease-Related Mineral Bone Disorder (CKD-MBD).
(Rebecca Schmidt, DO, FACP, FASN and Sharon Senft, RN-C, FNP)
ANNA National Symposium, April, 2008.
(Posted: 09/30/2008. Expires: 09/30/2010)

1.25 hr
Stabilizing Hemoglobin Levels: What’s New in IV Iron and Anemia Management?
(Steven Fishbane, MD; Suzann VanBuskirk, BSN, RN, CNN, and Kristin Larson, RN, ANP, GNP, CNN)
ANNA National Symposium, April, 2008.
(Posted: 09/15/2008. Expires: 09/15/2010)

1.5 hr
New Perspectives on the Progression of Coronary Artery Calcification and Patient Outcomes in Chronic Kidney Disease
(Wajeh Qunibi, MD, FACP and Lynda Szczech, MD, MSCE)
ANNA National Symposium, April, 2008.
(Posted: 01/15/2008. Expires: 08/12/2010)
1.5 hr
Chronic Kidney Disease - Mineral Bone Disorder
(Jose A.L. Arruda, MD, FACP; Jennifer L. Snavely, CRNP-BC, MSN, CNN)
ANNA Fall Symposium, October, 2007.
(Posted: 01/15/2008. Expires: 01/15/2010)
1.25 hr
Updating Practices in an Evolving IV Iron and Anemia Environment: Practical Solutions. A New Anemia Treatment Paradigm in Favor of the Patient
(Andrea Easom, MA, MNSc, APN, BC, CNN-NP; Peter Juergensen, PA-C; Richard Amerling, MD)
ANNA National Symposium, April, 2007.
(Posted: 09/25/2007. Expires: 11/15/2009)
1.25 hr
Achieving and Maintaining a Phosphate Balance in the Patient With CKD
(Terran Mathers, DNS, RN)
ANNA National Symposium, April, 2007.
(Posted: 09/25/2007. Expires: 09/25/2009)
1.25 hr
Standards: The Basis of Care to Manage the Patient with Complications of Chronic Kidney Disease Leading to Cardiovascular Disease
(Sally Burrows-Hudson, MS, RN, CNN; Carol Headley, DNSc, RN, CNN; and Sally Campoy, MS, APRN, BC)
ANNA National Symposium, April, 2007.
(Posted: 09/13/2007. Expires: 09/13/2009)
1.25 hr
Updated: October 31, 2016 (Oct31)
Oct31 ASN Kidney Week 2016 abstract book link (PDF, 50 mB file)
Oct05 FDA warns about hepatitis B reactivation with direct acting hepatitis C antivirals.
Jul28 Good Staph. in the nose makes novel peptide antibiotic that kills bad Staph.
Jul23 Hemodialysis University Chicago, Sept. 9-10 (up to 12 CME/CEUs)
Jul23 Cyanobacteria becoming a widespread problem in U.S. lakes
Jul12 Dr. Fred Coe videos on urine calcium supersaturation in stone disease.
Jun30 FDA issues warning about Shiga-toxin producing E. Coli found in flour
May29 Nicotinamide riboside protects mice from effects of diabetes.
May29 Smoking increases risk of CKD progression in African Americans
May24 CRIC study shows a high urinary sodium excretion in CKD linked to higher CV risk.
May20 SPRINT shows lower than 120 BP systolic target in elderly results in improved outcomes
Apr27 Tetraspanin-7 as an antibody target for type 1 diabete
Apr13 New bacteria called Elizabethkingia affecting Midwest patients.
Mar30 AC6 gene therapy improves cardiac function in patients with heart failure.
Mar17 Updated CKD booklet for professionals released
Industry Advances Emphasis
archive

Infectious Diseases Exposure Risks in Dialysis Units (Preston) NANT 2009
Hemodialysis Procedures & Complications (Dittrich) NANT 2009
Hemodialysis Access / Heparinization (Meetz,) NANT 2009
Stages of CKD: What Happens Before Dialysis (Go) NANT 2009
Infection Control: New Challenges Under the New Conditions (R. Patel) CFC 2008
An Overview of Adherence Health Care Therapies (Kammerer) ADC 2008
Strategies to Improve Adherence (Finkelstein) ADC 2008
Prevention of Volume Overload and Cardiovascular Complications (Mehrotra) ADC 2008
HD Patient Education on the Run (Dickenson) ADC 2008
Case Studies and Discussion (Kammerer) ADC 2008
Minimizing Use, Yet Maximizing Benefit (Schwab) ADC 2008
PD Patient Identification, Education and Recruitment (Requ) ADC 2008
Predictors of Non-Adherence in Dialysis Patients (Russell) ADC 2008
PQRI: The Decision Making Process (Raskin) RPA 2008
Creating Innovation Out of Conformity: Implementing Clinical Practice Guidelines (Goldman) RPA 2008
PQRI: The Decision Making Process (Przybyla) RPA 2008
PQRI: The Decision Making Process (Simonton) RPA 2008
Preserving Residual Renal Function: Does It Matter? (Burrows) ADC 2008
Prevention of Depression (Kimmel) ADC 2008
Louis Diamond Lecture: Is Decision Support Software Worth the Investment? (Graber) RPA 2008
How to Teach Patients to Self-Cannulate (Leitch) ADC 2008
How Culture Affects Food Choices and Dietary Adherence (Grant) ADC 2008
Drug Anaphylaxis - Immediate Hypersensitivity Reactions (IHR) to Radiocontrast Media (RCM) (Abreo) ASDIN 2008
HIT and heparin alternatives in the access center (Q. Urbanes) ASDIN 2008
Debate Part II CKD Stage V in the aged population (>70 yrs): dialysis or (low protein) diet? (Brunori) RRI 2008
Debate Part II - Guidelines have improved patient care and outcomes vs. guidelines have done more harm than good (Amerling) RRI 2008
Debate Part I - Guidelines have improved patient care and outcomes vs. guidelines have done more harm than good (Levin) RRI 2008
Debate Part I CKD Stage V in the aged population (>70 yrs): dialysis or (low protein) diet? (Misra) RRI 2008
Debate Part II CKD Stage V in the aged population (>70 yrs): dialysis or (low protein) diet? (Brunori) RRI 2008
Reproduction and Fertility (B. McKay) ASN Renal Week 2007
Frailty in CKD (G. Shlipak) ASN Renal Week 2007
Quality of Life and Symptoms in Elderly ESRD Patients (D. Weisbord) ASN Renal Week 2007
Physical Functioning in ESRD: Clinical Significance of Deficits and Impact of Interventions (Painter) ASN Renal Week 2007
Update on Immunizations (Blumberg) ASN Renal Week 2007
Non-Adherence in Hemodialysis: Does it Affect Outcome? (E. Leggat) ASN Renal Week 2007
Focus on Quality Care - THe CMS Perspective (M. Straube) ASN Renal Week 2007
Treating the Disruptive Dialysis Patient: A Practical, Medical, and Ethical Approach (H. Moss) ASN Renal Week 2007
Vascular Access: A Multidisciplinary Approach to AV Fistula Access Care ADC 2007 - MP3 audiofile
Future of Hemodialysis Access ADC 2007 - MP3 audiofile
Intradialytic Hypotension: Causes, Consequences and Management (Sulowicz) ADC 2007
Physical Examination: The Free Procedure to Evaluate the AVF (Work) ADC 2007
Adherence and Outcomes: What Are the Data? (G. Blake) ADC 2007
Clinical Nursing Assessment of the Dialysis Patient, Continued (Schira) ADC 2007
Federal Regulations: Nursing Clinical Assessment and Patient Care Plan (Payne) ADC 2007
Empowering Patients to Self Cannulate (Brouwer) ADC 2007
AVF Cannulation Techniques (Brouwer) ADC 2007
Clinical Nursing Assessment of the Dialysis Patient (Schira) ADC 2007
Care Plan for a PD Patient (Zorzanello) ADC 2007
Care Plan for an HD Patient (F. Patrick) ADC 2007
AVF Problems and Interventions (Asif) ADC 2007
Creation and Survival of AV Fistulas (Besarab) ADC 2007
Sodium is a Uremic Toxin:The "Lag Phenomenon" Finally Explained (Twardowski) ADC 2007
ASDIN 3rd Annual Meeting (Part 7 and Nursing Breakout Session) (Besarab, Schon, Ash : Copelan, Holland, Merrill, Brouwer, White, Litchfield) ASDIN 2007 - handouts only
Overview of catheter lock solutions (Allon) ASN 2006 - Slide/audio
The Controversy Over Sodium Modeling: Should We Use It or Not? (Henning) NNJ 2006 (pdf)
The Buttonhole Technique for Arteriovenous Fistula Cannulation (Ball) NNJ 2006 (pdfs)
Perceptions of Incorporating Spirituality into Their Care: A Phenomenological Study of Female Patients on Hemodialysis (Tanyi, Stehle-Werner) NNJ 2006 (pdf)
Explaining and Correcting PD Underutilization (Madhukar Misra, MD; John Burkart, MD; Allen R. Nissenson, MD, FACP; Irum Shahab, MD; Martin Schreiber, MD; Rajnish Mehrotra, MD, MBBS; Dimitrios G. Oreopoulos, MD, PhD, FRCPC, FACP; Martin Schreiber, MD) ADC 2006 (audiofiles)
Emerging Dialysis Techniques (Derrick Latos, MD; Robert S. Lockridge, Jr., MD) ADC 2006 (audiofiles)
Nursing Home Dialysis: A Primer (Stephen Korbet, MD; Steven Bucher, CPA, MBA) ADC 2006 (audiofiles)
Annual Dialysis Conference, 2006 (various authors) ADC 2006 (audiofiles)
Anemia in the PD Patient (Michael V. Rocco, MD, MS, FACP; Allen R. Nissenson, MD, FACP; Chaim Charytan, MD; David B. Van Wyck, MD) ADC 2006 (audio only)
RRI - International Conference on Dialysis, 2006 (various authors) RRI 2006 (handouts)
More talks of interest to nurses...

Prediction, Progression, and Outcomes of Chronic Kidney Disease in Older Adults (Workshop Summary) JASN (Jun 2009)
Atrial Fibrillation and Heart Failure: Treatment Considerations for a Dual Epidemic (Anter et al) Circulation (May 2009)
Oral Phosphate Binders (Hutchison et al) Kidney Int May 2009
Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies (Law MR et al) BMJ (May 2009)
Citrate- vs. acetate-based dialysate in bicarbonate haemodialysis: consequences on haemodynamics, coagulation, acid-base status, and electrolytes (Gabutti et al) BMC Nephrol (March 2009)
A patient's guide to taking coumadin/warfarin Circulation (Mar 2009 )
Pregnancy and the kidney J Am Soc Nephrol (Jan 2009)
Transplant center regulations: ASTS vs. CMS Am J Transplant (Dec 2008)
Low-molecular-weight heparin for routine hemodialysis Hemodial Int (Oct 2008)
Balkan Nephropathy: Evolution of Our Knowledge (Bamias and Boletis) Am J Kidney Dis (Sep 2008)
Spurious Hyperphosphatemia in Patients on Hemodialysis With Catheters (Schiller et al) Am J Kidney Dis (Sep 2008)
Routine reporting of estimated glomerular filtration rate: not ready for prime time (Glassock and Winearls) Nature Clin Pract Nephrol (Aug 2008)
Oral estrogen therapy in postmenopausal women is associated with loss of kidney function Kidney Int - Aug - 08
Treating elderly people with diabetes and stages 3 and 4 chronic kidney disease CJASN (Jul 2008)
Dyslipidemia in CKD: An approach to pathogenesis and treatment. (Tsimihodimos) (Am J Nephrol Jul 2008)
Resistant hypertension: diagnosis, evaluation, and treatment Circulation (Jul 2008)
Dietary sodium and cardiovascular and renal disease risk factors: dark horse or phantom entry? (McCarron DA) NDT Jul 08
Reimbursement and economic factors influencing dialysis modality choice around the world (Just PM et al) NDT - Jul - 08
Formula-Based Estimates of the GFR: Equations Variable and Uncertain (Delanaye and Cohen) Nephron-Clin-Practice (Jul 2008)
Exercise in Dialysis Patients: A Review (Johansen K) Hemodial Int - Jul - 08
Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: A Scientific Statement From American Heart Association (Kumanyika SK et al) Circulation Jul 08
Should patients with venous thromboembolism be screened for thrombophilia? Am J Med (Jun 2008)
Urinalysis: core curriculum 2008 Am J Kidney Dis (Jun 2008)
Comparative mortality of hemodialysis patients at for-profit and not-for-profit dialysis facilities in the United States, 1998 to 2003: A retrospective analysis BMC Nephrology (Jun 2008)
Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med (Jun 2008)
Large artery stiffening with weight gain in humans: role of visceral fat accumulation Hypertens (Jun 2008)
Contaminated heparin associated with adverse clinical events and activation of the contact system N Engl J Med (Jun 2008)
Lipid abnormalities and cardiovascular risk in renal disease J Am Soc Nephrol (Jun 2008)
Debate: Weight loss and blood pressure control (Pro) vs. Dietary therapy for obesity: an emperor with no clothes (Con) Hypertens (Jun 2008)
Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med (May 2008)
Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care Diabet Care (May 2008)
Staging of chronic kidney disease: time for a course correction J Am Soc Nephrol (May 2008)
Prevention of heart failure: a scientific statement from the American Heart Association Councils Circulation (May 2008)
Glucose in the dialysate: Historical perspective and possible implications? Hemodial Int (Apr 2008)
Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of- hospital sudden cardiac arrest: An AHA Science Advisory Circulation (Apr 2008)
Lipoprotein management in patients with cardiometabolic risk: Consensus statement from the American Diabetes Association and the American College of Cardiology Foundation Diabet Care (Apr 2008)
Atherosclerotic renal artery stenosis: overtreated but underrated? J Am Soc Nephrol (Apr 2008)
Nephrogenic systemic fibrosis: early recognition and treatment Semin Dial (Apr 2008)
Revisiting the dialysate sodium prescription as a tool for better blood pressure and interdialytic weight gain management in hemodialysis patients Clin J Am Soc Nephrol (Mar 2008
Effect of the Italian smoking ban on population rates of acute coronary events Circulation (Mar 2008)
Hyperglycemia and acute coronary syndrome: A Scientific Statement From the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism Circulation (Mar 2008)
Changes in the potassium content of different potato varieties after cooking J Ren Nutr (Mar 2008)
Achieving blood pressure targets during dialysis improves control but increases intradialytic hypotension Kidney Int (Mar 2008)
National Institutes of Health State-of-the-Science Conference Statement: Prevention of fecal and urinary incontinence in adults Ann Intern Med (Mar 2008)
Systematic Review: Randomized, controlled trials of nonsurgical treatments for urinary incontinence in women Ann Intern Med (Mar 2008)
Protein restriction and body composition in renal disease J Ren Nutr (Mar 2008)
Primary care-based disease management of chronic kidney disease (CKD), based on estimated glomerular filtration rate (eGFR) reporting, improves patient outcomes Nephrol Dial Transplant (Feb 2008)
Beta-blockade in chronic dialysis patients Semin Dial (Feb 2008)
The impact of population-based identification of chronic kidney disease using estimated glomerular filtration rate (eGFR) reporting Nephrol Dial Transplant (Feb 2008)
Mechanisms of vascular calcification in chronic kidney disease J Am Soc Nephrol (Feb 2008)
The optimal hemoglobin in dialysis patients -- a critical review Semin Dial (Feb 2008)
Dermatological disease in patients with CKD Am J Kidney Dis (Feb 2008)
A meta-analysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection Am J Kidney Dis (Feb 2008)
Does warfarin safely prevent clotting of hemodialysis catheters?. a review of efficacy and safety Semin Dial (Feb 2008)
Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study Brit Med J (Feb 2008)
Low birth weight is associated with chronic kidney disease only in men Kidney Int (Feb 2008)
Mechanisms of disease: erythropoietin resistance in patients with both heart and kidney failure Nature Clin Pract Nephrol (Jan 2008)
Recent advances in the prevention and management of intradialytic hypotension J Am Soc Nephrol (Jan 2008)
Battleground: chronic kidney disorders mineral and bone disease - calcium obsession, vitamin F, and binder confusion Clin J Am Soc Nephrol (Jan 2008)
More Frequent Hemodialysis: Back to the Future? (Rocco MV) Adv Chronic Kidney Dis (Jul 2007)
Hidden Phosphorus: Where Do We Go From Here? (Murphy-Gutekunst L) J Ren Nutr (Jul 07)
Primary Prevention of Cardiovascular Disease in Nursing Practice: Focus on Children and Youth: A Scientific Statement From the American Heart Association Committee on Atherosclerosis, Hypertension, and Obesity in Youth of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity, and Metabolism (Hayman LL et al) Circulation (Jul 07)
A different approach to resistant hypertension (Hirsch S) Cleveland Clinic J Med (Jun 07)
Gadolinium use in patients with kidney disease: A cause for concern Semin Dial 05-07
Essentials of anticoagulation in hemodial Hemodial Int 04-07
Hypomagnesemia in patients with type 2 diabetes (Pham et al) CJASN (03-2007)
A case of nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis NCPN (02-2007)
Clinical aspects of iron use in the anemia of kidney disease JASN 02-07
Starting a home hemodialysis program (Moran, Kraus) Semin Dial (02-2007)
Major Difficulties the US Nephrologist Faces in Providing Adequate Dialysis (Diaz-Buxo and Crawford-Bonadio) Blood Purification 01-07
Pathogenesis and prevention of bone loss in patients who have kidney disease and receive long-term immunosuppression. JASN (01-07)
Calcific uremic arteriolopathy: advances in pathogenesis and treatment Semin Dial 04-07
Core Curriculum: Chronic Kidney Disease (Lederer, Ouseph) Am-J-Kidney-Dis 01-2007
Fluid balance, dry weight, and blood pressure in dialysis Hemodial Int 01-07
Tube feeding in advanced dementia. The metabolic perspective. (Hoffer) Br Med J 12-06
Physical Activity Intervention Studies: What We Know and What We Need to Know (AHA) Circulation 12-06
Advanced glycation end products and nephrotoxicity of high-protein diets (Uribarri, Tuttle) CJASN 11-06
Should dialysis patients ever receive warfarin and for what reasons? (Bennett) CJASN 11-06
Dialysis facility design - Part IV: Color, sound, and materials (Steven B. Bower) Dial Transplant 11-06
Obesity: Growing Impact on CKD (McGill, Furth, Kaskel) Adv Chronic Kidney Dis 10-06
Review of dialysate calcium concentration in hemodialysis (Toussaint, Cooney, Kerr) Hemodial Int 10-06
Dialysis facility design - part III: How to outfit an existing building for use as a dialysis clinic (Steven B. Bower) Dial Transplant 10-06
Dialysis facility design - part II: Minimize costly plan changes (Steven B. Bower) Dial Transplant 09-06
Dialysis facility design - part I: Developing a strategic and financial plan (Steven B. Bower) Dial Transplant 08-06

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