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In Hawaii, these natural beads were traditionally collected from the beach drift to make puka shell jewelry

In a two-way ANOVA model adjusting for hemodynamic confounding factors, changes in long-axis function observed in the overall population remained significant for mitral A a (p = 0.0014) and E a /A a ratio (p = 0.0022), and for tricuspid A a (p = 0.010) and E a /A a ratio (p = 0.019)