Metropolitan General Hospital Research Articles

How is spiritual care/pastoral care understood and provided in general hospitals in Victoria, Australia? – Staff perspectives

ABSTRACT There is strong movement worldwide towards the professionalisation of spiritual care in the healthcare system, accompanied by appropriate education pathways, defining of best-practice care models, and evidence-based practice. The aim of the study reported here was to explore the understanding and expectations of healthcare service staff, across the spectrum of staffing levels, in relation to the provision of spiritual care in their facility. It utilised semi-structured interviews with 32 staff members from three large metropolitan general hospitals in Victoria Australia. Interviews were audio-recorded, transcribed and thematically analysed. Overall, it was considered that spiritual care is an integral part of whole person care; more resources and in-house education of other staff are needed; and referral systems could be improved to better serve patient, family and staff spiritual care needs. Responses of clinical staff able to make referrals were compared with those of non-clinical staff who cannot make referrals. Spiritual care was regarded as important by all staff, but those who could make referrals were more likely to make specific improvement suggestions. Outcomes of this study are similar to others which have investigated these issues.

Marian K. Shaughnessy, DNP, RN

Marian K. Shaughnessy was a nationally known nurse leader and philanthropist. She was the founder of the Marian K. Shaughnessy Nurse Leadership Academy at the Frances Payne Bolton School of Nursing, Case Western Reserve University where she served as an adjunct professor. Dr. Shaughnessy held leadership board positions in a wide number of Cleveland non-profits and was a member of the board of University Hospitals Medical Center of Cleveland and served as vice-chair of the Quality and Professional Committee and a member of the Clinical Council, University Hospital Medical Group. She also served on the Advisory Committee for Notre Dame School of Nursing in South Euclid, OH. She helped launch the national Nurses on Boards Coalition for the American Nurses Foundation in order to present a nursing perspective to America's boardrooms. Her nursing career included leadership positions and consulting in perioperative care delivery at the Cleveland Clinic Foundation and Lakewood Hospital, and Critical Care at Cleveland Metropolitan General Hospital. She was a member of the American Nurses Association, Association of Operating Room Nurses, Association of Nurse Executives and Sigma Theta Tau. This interview was conducted in September, 2019. She will be missed.

Affecting Variables on Subjective Memory Impairment in the Elderly with Benign Prostatic Hyperplasia

본 연구는 전립선비대증을 가진 노인을 대상으로 주관적 기억장애에 영향을 미치는 요인을 파악하는 것을 목적으로 하였다. 연구대상은 일 광역시 두 개 종합병원 비뇨기과 외래에서 전립선비대증을 진단받은 노인 179명이며, 하부요로증상, 수면장애, 일상생활 수행능력에 따른 주관적 기억장애의 차이를 파악하기 위하여 t-test, one-way ANOVA를 실시하였고, Scheff&eacute; test로 사후검정을 하였다. 또한, 제 변수와의 상관관계는 Pearson’s correlation-coefficient로 분석하였고, 주관적 기억장애에 영향을 미치는 요인은 stepwise multiple regression으로 분석하였다. 본 연구결과 하부요로증상(β=,52, p<.001), 일상생활 수행능력(β=.18, p=.005)이 주관적 기억장애와 관련 있으며, 두 변수는 주관적 기억장애를 30.0% 설명하였다. 이 연구결과를 바탕으로 다음과 같은 점을 논의하였다. 첫째, 전립선비대증에 의한 하부요로증상은 주관적 기억장애의 위험성을 증가시킬 수 있다. 둘째, 하부요로증상 치료가 미뤄지는 이유는 연령이 증가할수록 하부요로증상을 노화에 따른 자연스런 생리현상으로 인식하기 때문이다. 셋째, 하부요로증상을 예방하기 위하여 조기 검진과 시기적절한 중재가 권고된다. 이를 바탕으로 전립선비대증을 가진 노인의 하부요로증상을 완화시킬 수 있는 간호중재 프로그램 개발과 주관적 기억장애를 사정, 평가, 중재할 수 있는 간호사 양성을 위한 교육 프로그램 개발을 제언한다.This study aimed to investigate variables affecting subjective memory impairment in the elderly with benign prostatic hyperplasia. We used 179 survey data collected from the urology department of two metropolitan general hospitals. The subjects were patients with benign prostatic hyperplasia. T-test, one-way analysis of variance, and Scheff&eacute;’s test were performed to identify differences among variables. Pearson’s correlation-coefficient and stepwise multiple regression were used to identify variables that affect subjective memory impairment. This study revealed that lower urinary tract symptom and activities of daily living were statistically significant variables, with an explanatory power of 30.0%. The lower urinary tract symptom was due to the benign prostatic hyperplasia increasing the risk of subjective memory impairment. Treatment of the lower urinary tract symptom was delayed because as the elderly got older, they increasingly recognized benign prostatic hyperplasia as a reasonable symptom. Timely intervention and early screening are necessary to prevent lower urinary tract symptom. Finally, programs to reduce the incidence of lower urinary tract symptom and educate nurses to assess, evaluate, perform intervention for subjective memory impairment should be developed.

AN ANALYSIS OF OPERATING PHYSICIAN AND PATIENT RADIATION EXPOSURE DURING RADIAL CORONARY ANGIOPLASTIES.

The objective of this study was to evaluate radiation exposure levels in conjunction with operator dose implemented, patient vascular characteristics, and other technical angiographic parameters. In total, 756 radial coronary angioplasties were evaluated in a major metropolitan general hospital in Tabriz, Iran. The classification of coronary lesions was based on the ACC/AHA system. One interventional cardiologist performed all of the procedures using a single angiography unit. The mean kerma-area product and mean cumulative dose for all cases was 5081 μGy m2 and 814.44 mGy, respectively. Average times of 26.16 and 9.1 min were recorded for the overall procedure and fluoroscopy, respectively. A strong correlation was demonstrated between types of lesions, number of stents and vessels treated in relation to physician radiation exposure. It was determined that operator radiation exposure levels for percutaneous coronary interventions lesions (complex) were higher than that of simple and moderate lesions. In addition, operator radiation exposure levels increased with the treatment of more coronary vessels and implementation of additional stents.

From Hypothermia to Cephalosomatic Anastomoses: The Legacy of Robert White (1926-2010) at Case Western Reserve University of Cleveland.

Dr. Robert J. White (1926-2010) was an eminent neurosurgeon and bioethicist, renowned for his classic work in hypothermia and pioneering mammalian head transplant experiments. He founded the Division of Neurosurgery at the Cleveland Metropolitan General Hospital (currently MetroHealth Medical Center, a level 1 trauma county hospital) and became the youngest full professor at the Case Western Reserve University in Cleveland, Ohio. With over 500 research articles to his credit, he founded the Brain Research Laboratory at what was then the Cleveland Metropolitan General Hospital, which was also home to future leaders in neurosurgery, neurosciences, and allied specialties. He transferred a healthy monkey head onto a surgically beheaded monkey body under deep hypothermic conditions drawing both laurels and criticisms alike. Despite a largely controversial neurosurgical research career, his original contributions to deep hypothermia have found profound clinical applications in modern trauma and vascular neurosurgery. The new fusogens and myelorrhaphy methods being tried in Europe hold promise for a future of reanastomosing 2 homologous or heterologous tracts in the neuraxis.

Radiation exposure levels according to vascular access sites during PCI : Aprospective controlled study.

We previously showed that using the radial artery access site as opposed to the femoral artery site decreases the radiation exposure of patients during coronary artery interventions. The objective of this study was to compare radiation exposure levels of the operating physician during coronary interventions when incorporating both radial and femoral artery approaches. The study assessed all coronary angioplasties performed in amajor metropolitan general hospital. The study design was prospective and observational, in which we measured the radiation exposure of the patient and the operator. Measurements of radiation levels were made using an electronic personal dosimeter (Diamentor® E2-DAP) at the radial and at the femoral artery access sites. Aninterventional cardiologist operator performed all the percutaneous coronary interventions (PCI) using asingle-plane angiography unit via both femoral and radial artery approaches. Data from 252 PCIs were recorded. The mean physician radiation exposure levels from the femoral access site and the right radial access site were 40.5± 20.2 µSv and 47.5± 26.5 µSv, respectively (p< 0.02). There was astrong correlation between physician and patient radiation exposure levels. However, there was no correlation between patient body mass index and radiation exposure levels. We found significantly higher physician radiation exposure levels with the radial artery than with the femoral artery access site.

Comparative Analysis of Financial Performance between Metropolitan General Hospitals and Non-metropolitan General Hospitals

Comparative Analysis of Financial Performance between Metropolitan General Hospitals and Non-metropolitan General Hospitals

Frailty and adverse outcomes: impact of multiple bed moves for older inpatients.

A consequence of pressure on hospitals to accommodate care needs of older patients is "boarding" or out-lying from their home ward. This may have greater adverse effects on older inpatients who are frail. A retrospective matched cohort study was conducted in an outer metropolitan general hospital. Randomly selected patients hospitalized between July 2012 and June 2013 under the care of an Older Person Evaluation Review and Assessment (OPERA) team (n = 300) were age and sex matched with patients under the care of general physicians (n = 300). Frequency of boarding and number of bed moves were recorded for all patients. For patients who had three or more moves, adverse outcomes were compared between the two groups. A higher proportion of OPERA patients (n = 143; 47.7%) were out-lied from medical wards compared with 94 (31.3%) General Medicine patients (p < 0.001). Three or more bed moves were recorded for 67 (22.3%) OPERA and 24 (8%) General Medicine patients (p < 0.001). Of those with multiple moves, OPERA patients were more likely to have pre-morbid cognitive impairment (p = 0.005), to be moderately to severely frail (p = 0.016) and to suffer acute delirium and falls during admission (p = 0.03), compared with General Medicine patients. OPERA patients were also more at risk of adverse outcomes such as increased dependence, discharge to residential care or death (p = 0.023). Compared with age- and sex-matched General Medicine patients, OPERA patients were more likely to undergo multiple bed moves and out-lying, which may have contributed to negative outcomes for these patients.

Major depression in hospitalized Argentine general medical patients: Prevalence and risk factors

BackgroundDepression is not uncommon among medically hospitalized patients, though reported prevalence has varied widely, often in samples involving elderly patients with particular illnesses. Accordingly, we evaluated risk of major depression in three metropolitan general hospitals in Buenos Aires, in subjects with a range of medical disorders and ages, comparing several standard screening methods to expert clinical examinations. MethodsConsecutively hospitalized general medical patients were evaluated over a six-months. Excluded were subjects under age 18 and those unable to participate in assessments because of illness, medication, sensory or speech impairment, or lack of language fluency, or scored <25 on the Mini Mental State Examination (MMSE). Consenting participants were examined for DSM-IV-TR major depression by psychiatrists guided by MINI examinations, compared with other standard screening methods. Risk factors were assessed by preliminary bivariate analyses followed by multivariate logistic regression modeling. ResultsOverall prevalence of major depression in 257 subjects was 27% by psychiatric examination. The rate was most similar (25%) with the Hospital Anxiety & Depression Scale (HADS), and much higher with the Beck Depression Inventory-II (BDI, 44%) and Patient Health Questionnaire (PHQ, 56%). Factors associated independently with depression by multivariate modeling included: prior psychotropic-drug treatment, female sex, more children, and heavy smoking. Depression was associated most with neoplastic, urological, and infectious disorders, least with pulmonary, neurological, and hematologic conditions. LimitationsModest numbers limited power to test for associations of depression with specific medical conditions. ConclusionsMajor depression was identified in over one-quarter of Argentine, general medical inpatients, with marked differences among screening methods. Several risk factors were identified. The findings encourage assertive identification of depression in hospitalized medical patients using valid, reliable, and cost-effective means of improving their care.

Survey of Clinical Characteristics and the State and Respiratory Care in COPD Patients Admitted to Metropolitan General Hospital in Japan

Survey of Clinical Characteristics and the State and Respiratory Care in COPD Patients Admitted to Metropolitan General Hospital in Japan

Factors Associated With Older Patients' Engagement in Exercise After Hospital Discharge

Hill A-M, Hoffmann T, McPhail S, Beer C, Hill KD, Brauer SG, Haines TP. Factors associated with older patients' engagement in exercise after hospital discharge. Objectives To identify factors that are associated with older patients' engagement in exercise in the 6 months after hospital discharge. Design A prospective observational study using qualitative and quantitative evaluation. Setting Follow-up of hospital patients in their home setting after discharge from a metropolitan general hospital. Participants Participants (N=343) were older patients (mean age ± SD, 79.4±8.5y) discharged from medical, surgical, and rehabilitation wards and followed up for 6 months after discharge. Interventions Not applicable. Main Outcome Measures Self-perceived awareness and risk of falls measured at discharge with a survey that addressed elements of the Health Belief Model. Engagement and self-reported barriers to engagement in exercise measured at 6 months after discharge using a telephone survey. Results Six months after discharge, 305 participants remained in the study, of whom 109 (35.7%) were engaging in a structured exercise program. Multivariable logistic regression analysis demonstrated participants were more likely to be engaging in exercise if they perceived they were at risk of serious injury from a fall (odds ratio [OR] =.61; 95% confidence interval [CI], .48–.78; P<.001), if exercise was recommended by the hospital physiotherapist (OR=1.93; 95% CI, 1.03–3.59; P=.04), and if they lived with a partner (OR=1.97; 95% CI, 1.18–3.28; P=.009). Barriers to exercise identified by 168 participants (55%) included low self-efficacy, low motivation, medical problems such as pain, and impediments to program delivery. Conclusions Older patients have low levels of engagement in exercise after hospital discharge. Researchers should design exercise programs that address identified barriers and facilitators, and provide education to enhance motivation and self-efficacy to exercise in this population.

Current Concepts in the Management of Tuberculosis

Tuberculosis (TB) poses a serious threat to public health throughout the world but disproportionately afflicts low-income nations. Persons in close contact with a patient with active pulmonary TB and those from endemic regions of the world are at highest risk of primary infection, whereas patients with compromised immune systems are at highest risk of reactivation of latent TB infection (LTBI). Tuberculosis can affect any organ system. Clinical manifestations vary accordingly but often include fever, night sweats, and weight loss. Positive results on either a tuberculin skin test or an interferon-γ release assay in the absence of active TB establish a diagnosis of LTBI. A combination of epidemiological, clinical, radiographic, microbiological, and histopathologic features is used to establish the diagnosis of active TB. Patients with suspected active pulmonary TB should submit 3 sputum specimens for acid-fast bacilli smears and culture, with nucleic acid amplification testing performed on at least 1 specimen. For patients with LTBI, treatment with isoniazid for 9 months is preferred. Patients with active TB should be treated with multiple agents to achieve bacterial clearance, to reduce the risk of transmission, and to prevent the emergence of drug resistance. Directly observed therapy is recommended for the treatment of active TB. Health care professionals should collaborate, when possible, with local and state public health departments to care for patients with TB. Patients with drug-resistant TB or coinfection with human immunodeficiency virus should be treated in collaboration with TB specialists. Public health measures to prevent the spread of TB include appropriate respiratory isolation of patients with active pulmonary TB, contact investigation, and reduction of the LTBI burden.

Betty Q. Banker, MD (1921–2010)

Betty Q. Banker, a pioneer in neuropathology, died on February 7, 2010, at the age of 88 years. Betty was born in New York City in 1921 and raised by her mother in Freeport, Long Island, under difficult circumstances. Supported by a scholarship, she earned a bachelor degree from Ithaca College and became a high school teacher. She soon decided to take a medical degree. After graduation from Albany Medical College, she interned at the Boston University Hospital. In 1950, she was a neurology resident at the Boston City Hospital under the tutelage of Dr Derek Denny-Brown, and in 1953, she became a neuropathology resident at the Massachusetts General Hospital under the direction of Dr Raymond Adams. From 1955 to 1957, she again worked with Denny-Brown, examining the effects of denervation on normal and dystrophic muscle. In 1957, Betty was appointed Neuropathologist at the Children's Hospital Medical Center in Boston and became an Associate in Neuropathology at the Harvard Medical School. In the same year, she married Maurice Victor, a neurologist at the Massachusetts General Hospital. In 1962, Betty and Maurice moved to the Cleveland Metropolitan General Hospital, where Betty became the director of the Division of Neuropathology and Maurice the director of the Neurology Service; both were appointed professors in their respective fields at Western Reserve (now Case Western) University. In 1986, Betty and …

The Medical Emergency Team system: A two hospital comparison

To compare activity and outcomes of a mature Medical Emergency Team (MET) in two hospitals. SETTING AND POPULATIONS: A Tertiary Referral Hospital (TRH) and a Metropolitan General Hospital (MGH) who combined have approximately 82,000 admissions annually with 38,000 patients meeting the eligibility criteria. The population included all admissions to the two hospitals aged 15 years and over with a stay>1 day (12 months period). Admissions that had a MET call originating in general wards were defined as Admissions Associated with a MET call (AAMET). A retrospective analysis of MET call audit forms, a Death Review database, and routinely collected hospital data for the period 1st October 2004 to 30th September 2005, inclusive. Chronic morbidity was calculated as a Charlson Index (CI) score over previous visits and admissions using ICD10 & ICD9 diagnosis and procedure codes. There were 633 and 349 AAMETs. The incidence rates (MET calls/1000 admissions) were 37.6 and 34.1. They were associated with being elderly; males; higher CI scores; surgical admissions, Emergency Department (ED) admissions, and longer length of stay (LOS). A systolic BP<90mm Hg, and "worried" were the most frequent MET call criteria. There were 27 (4.3%) and 9 (2.6%) deaths following a MET call, of these 17 and 5 had Cardiac Arrest (CA) as the reason for the call. Death occurred for 192 and 54 AAMETs, only 38 (20%) and 14 (26%) were Do Not Attempt Resuscitation (DNAR) deaths. One hundred and forty-seven (23.2%) and eighty-seven (24.9%) AAMETs had a MET call within 24h of transfer from a critical care area; the proportions of transfers differed significantly between the two hospitals. A well established MET system identified similar AAMET populations from two different hospital populations. Sick, elderly, and surgical rather than medical patients were associated with MET activity in both hospitals. Further research is needed to estimate the impact of increased monitoring and interventions on patient outcomes, and the role of MET teams in end of life decision-making.

Time course of systolic and diastolic blood pressure decreases during the preintubation period of anesthesia induction: modeling with a logistic function

Study Objective To investigate whether systolic (SBP) and diastolic blood pressure (DBP) decreases during the preintubation period could be expressed as 4-parameter logistic and cubic functions giving S-shaped curves. Design Prospective, clinical study. Setting Operating room of a metropolitan general hospital. Patients Seven ASA physical status I and II patients scheduled for elective spinal surgery during general anesthesia. Interventions Anesthesia was induced with fentanyl, propofol, and vecuronium injection followed by inhalation of sevoflurane. Measurements The SBP and DBP data were recorded at all beats from fentanyl injection to direct laryngoscopy. The respective changes were analyzed using a logistic function: P( t) = p L + ( q L − p L)/(1 + exp{[4 m L/( q L − p L)][ k L − t]}) and a cubic function: P( t) = at 3 + bt 2 + ct + d, where parameter p L is the upper asymptote, q L is the lower asymptote, m L is the slope at the inflection point, and k L is the time to the inflection point and where a, b, and c are coefficients, and d are constants. Goodness of fit of the two functions was compared using a correlation coefficient and residual mean squares. Each parameter was compared with the corresponding observed data. Main Results Logistic correlation coefficient values for SBP and DBP decreases were larger than the cubic correlation coefficient values (0.990 [ Z transformation: 2.64 ± 0.32] vs 0.981 [ Z: 2.32 ± 0.37] and 0.977 [ Z: 2.22 ± 0.33] vs 0.967 [ Z: 2.05 ± 0.34], respectively; P < 0.05). Logistic residual mean squares values for SBP and DBP decreases were smaller than cubic residual mean squares values (20.6 vs 41.0 and 9.2 vs 13.7 mmHg 2, respectively; P < 0.05). There were significant correlations between p L and SBP or DBP after anesthesia induction, between q L and SBP or DBP before endotracheal intubation, and between k L and time to maximal rate of the SBP or DBP decrease (d P/d t min), but no significant correlation between m L and d P/d t min for SBP or DBP. Conclusions Time courses of SBP and DBP decreases during the preintubation period of anesthesia induction are modeled effectively by a logistic function.

Branched-chain amino acids as nutritional therapy in liver disease: dearth or surfeit?

HepatologyVolume 3, Issue 2 p. 269-271 ArticleFree Access Branched-Chain Amino Acids as Nutritional Therapy in Liver Disease: Dearth or Surfeit? Arthur J. McCullough M.D., Arthur J. McCullough M.D. Division of Gastroenterology Cleveland Metropolitan General Hospital Case Western Reserve University Cleveland, Ohio 44109Search for more papers by this authorKevin D. Mullen M.D., Kevin D. Mullen M.D. Division of Gastroenterology Cleveland Metropolitan General Hospital Case Western Reserve University Cleveland, Ohio 44109Search for more papers by this authorAnthony S. Tavill M.D., Corresponding Author Anthony S. Tavill M.D. Division of Gastroenterology Cleveland Metropolitan General Hospital Case Western Reserve University Cleveland, Ohio 44109Anthony S. Tavill, M.D., Division of Gastroenterology, Cleveland Metropolitan General Hospital, 3395 Scranton Road, Cleveland, Ohio 44109.===Search for more papers by this author Arthur J. McCullough M.D., Arthur J. McCullough M.D. Division of Gastroenterology Cleveland Metropolitan General Hospital Case Western Reserve University Cleveland, Ohio 44109Search for more papers by this authorKevin D. Mullen M.D., Kevin D. Mullen M.D. Division of Gastroenterology Cleveland Metropolitan General Hospital Case Western Reserve University Cleveland, Ohio 44109Search for more papers by this authorAnthony S. Tavill M.D., Corresponding Author Anthony S. Tavill M.D. Division of Gastroenterology Cleveland Metropolitan General Hospital Case Western Reserve University Cleveland, Ohio 44109Anthony S. Tavill, M.D., Division of Gastroenterology, Cleveland Metropolitan General Hospital, 3395 Scranton Road, Cleveland, Ohio 44109.===Search for more papers by this author First published: 1983 https://doi.org/10.1002/hep.1840030223Citations: 10AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume3, Issue21983Pages 269-271 ReferencesRelatedInformation

Diet Manuals to Practice Manuals: The Evolution of Nutrition Care

Although the role of nutrition as a therapy for the sick has been recognized for centuries, the science of nutrition is a relatively young discipline. The first modern attempt to document and standardize appropriate nutrition care was the diet manual. The evolution from "diet manual" to "practice manual" is less a change in purpose than an expansion of scope. This paper reviews the history of diet manuals in the United States, focusing on the evolution of nutrition therapy and the transformation of diet manuals into practice manuals for nutrition care providers. Included is a practice-oriented summary of 7 diet manuals published by Cleveland Metropolitan General Hospital in Cleveland from 1939 to 1984, when the hospital began using nationally distributed practice manuals. These manuals exemplify changes in the practice of medicine and in the role of nutrition providers on the healthcare team. A review of the evolution of clinical decision-making as documented in diet and practice manuals reflects increasing rigor in referencing scientific evidence. Nutrition therapies that seem quaint to us now reflect the traditional origins of many medical practices that persist today. Knowledge of this history should motivate us to critically evaluate the research base that supports all aspects of nutrition therapy, develop protocols to assess practices that remain unexamined, and embrace the discipline of evidence-based practice.

Myotonic Dystrophy and Pain Management of a Patient Undergoing Total Abdominal Hysterectomy in a Metropolitan General Hospital

Patients with myotonic dystrophy presenting for surgery are exposed to the adverse effects of anaesthetics, especially if the condition has not been diagnosed. Respiratory depression due to increased sensitivity to anaesthetic and opioid drugs is of major concern in patients undergoing major surgery. Meticulous pre- and postoperative management, including pain management, is necessary to avoid morbidity and mortality.

Tuberculous aneurysm of the abdominal aorta

Journal Article Tuberculous aneurysm of the abdominal aorta Get access I Penn I Penn Johannesburg Present address: Department of Surgery, Cleveland Metropolitan General Hospital, Cleveland, 9, Ohio, U.S.A. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 50, Issue 221, November 1962, Pages 288–290, https://doi.org/10.1002/bjs.18005022108 Published: 06 December 2005

Conversation with Robert L. DuPont

Conversation with Robert L. DuPont