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Salmiranta E, Areskoug Josefsson K, Ockander M, Augutis M, Masterson D. The voice of caregivers of children and adolescents with spinal cord injuries: A scoping review. J Spinal Cord Med 2024; 47:315-326. [PMID: 36745084 PMCID: PMC11044720 DOI: 10.1080/10790268.2022.2164455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
CONTEXT Participation in SCI research with caregivers of children and adolescents with spinal cord injury (SCI) can occur in a range of different ways. This review explores the extent to which caregivers' participation is connected to what might be called a voice. OBJECTIVES To explore the voice of caregivers by collating available research with the participation of caregivers of children and adolescents with SCI, and synthesizing how the research has been conducted. METHODS The databases CINAHL, ERIC, MEDLINE, PsycInfo, and Scopus were searched for articles published between January 2008 and March 2022. Descriptive and narrative information was extracted and factors describing how caregivers participated were identified using an inductive approach. RESULTS Twenty-nine articles were identified, of which 28 had affiliations connected to the USA, and 25 to Shriners Hospitals for Children. In most of the articles, the caregivers were invited to participate in the research to complete or develop measures. Information from the caregivers was often captured using close-structured questions and summarized quantitatively with little or no exploration of the perspectives of the caregivers. CONCLUSION The voice of caregivers of children and adolescents with SCI in research is limited by representativeness, the pre-determined emphasis, a lack of involvement in the process, and the reported narrative. By reflecting on voice, caregivers can have their experiences and perspectives acted upon to a greater extent to bring change, ultimately leading to improved care and health for children and adolescents with SCI.
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Affiliation(s)
- Elin Salmiranta
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Kristina Areskoug Josefsson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Faculty of Health Science, University West, Trollhättan, Sweden
- Department for Behavioural Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Marlene Ockander
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Marika Augutis
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Solna, Sweden
| | - Daniel Masterson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Meng YF, Zhang JW, Tong AN, Tang HH, Bai JZ, Wang FY, Liu SJ, Lyu Z, Chen SZ, Liu JS, Hong Y. Prognosis of traumatic spinal cord injury in children: Follow-up of 86 patients. Chin J Traumatol 2023; 26:14-19. [PMID: 35691771 PMCID: PMC9912184 DOI: 10.1016/j.cjtee.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The long-term situation of children with spinal cord injury (SCI) was investigated, and suggestions for helping them better return to the society were provided. METHODS SCI patients less than 18 years old hospitalized in Beijing Boai Hospital from January 2011 to December 2020 were retrospectively analyzed. Information including motor function, complications, characteristic changes, self-care abilities, school attendance and social participation were collected by telephone interview and electronic questionnaire. All the answers were statistically analyzed. RESULTS A total of 86 cases were enrolled, 77 girls and 9 boys, with a median injury age of 6 years and 2 months. The follow-up time was 3-130 months. The main cause of trauma in these children was sport injury (66.3%), the thoracic spinal cord was involved the most (91.9%), and complete SCIs accounted for the majority (76.7%). In terms of complications, children with complete SCIs were more likely to have urinary incontinence, constipation and characteristic changes (p < 0.05); whereas the incomplete SCIs often have spasticity (p < 0.05). As to the daily living abilities, children with incomplete lumbar SCIs were more capable to accomplish personal hygiene, transfer, and bathing independently than those with complete injuries, or cervical/thoracic SCIs, respectively (p < 0.05). Moreover, children older than 9 years care more able to dress and transfer independently than the youngers (p < 0.05). Wheelchair users accounted for 84.9% and more than half of them were able to propel wheelchair independently, and those who move passively in wheelchairs were mostly introverted kids (p < 0.05). Almost all (93.8%) children with incomplete injuries were able to walk independently. Most (79.1%) children continued to attending school, and 41.9% participated in interest classes. Unfortunately, 67.4% of the children spent less time playing with their peers than before the injury. CONCLUSION SCIs impair physical structures and function of children, affect their independence in daily living, and restrict school attendance and social interaction. Comprehensive rehabilitation after injury is a systematic work. Medical staff and caregivers should not only pay attention to neurological function, but also help them improve self-care abilities. It is also important to balance rehabilitation training and school work and social participation.
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Affiliation(s)
- Yu-Fei Meng
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China
| | - Jun-Wei Zhang
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - An-Ni Tong
- Department of Rehabilitation Medicine, Beijing Haidian Hospital, Beijing, 100080, China
| | - He-Hu Tang
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Jin-Zhu Bai
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Fang-Yong Wang
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Shu-Jia Liu
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Zhen Lyu
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Shi-Zheng Chen
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Jie-Sheng Liu
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China,Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Yi Hong
- School of Rehabilitation, Capital Medical University, Beijing, 100068, China; Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, 100068, China.
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Zebracki K, Hwang M, Vogel LC, Mulcahey MJ, Varni JW. PedsQL™ Spinal Cord Injury Module: Reliability and Validity. Top Spinal Cord Inj Rehabil 2022; 28:64-77. [PMID: 35145336 PMCID: PMC8791414 DOI: 10.46292/sci21-00057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The objective was to report on the initial measurement properties of the Pediatric Quality of Life Inventory™ (PedsQL™) Spinal Cord Injury (SCI) Module in youth with SCI from the youth and parent perspectives. METHODS PedsQL™ SCI Module and PedsQL™ 4.0 Generic Core Scales SF15 were completed in a multisite national study by 166 youth ages 8 to 25 years and 128 parents of youth ages 5 to 23 years. Data from the PedsQL™ Generic Core Scales were compared with an age- and sex-matched healthy control sample. Factor analysis was conducted to determine the factor structure of the items. RESULTS In addition to a Total Scale Score, nine unidimensional scales were derived measuring daily activities, mobility, bladder function, bowel function, pressure injury, pain interference, social participation, worry bladder bowel, and worry social. The PedsQL™ SCI Module evidenced excellent reliability for Total Scale Scores (youth self-report, α = 0.93; parent proxy-report, α = 0.93) and acceptable reliability for the nine individual scales (youth self-report, α = 0.71-0.83; parent proxy-report, α = 0.67-0.87). Intercorrelations with the Generic Core Scales supported construct validity with medium to large effect sizes (most ps < .001). Factor analysis supported the unidimensionality of the nine individual scales. PedsQL™ Generic Core Scales comparisons to healthy controls demonstrated significantly impaired generic health-related quality of life in youth with SCI with large effect sizes. CONCLUSION The PedsQL™ SCI Module Scales demonstrated acceptable measurement properties and may be utilized as standardized scales to assess SCI-specific concerns and problems in clinical research and practice in youth with SCI.
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Affiliation(s)
- Kathy Zebracki
- Shriners Children’s Chicago, Illinois
,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Lawrence C. Vogel
- Shriners Children’s Chicago, Illinois
,Rush Medical College, Chicago, Illinois
| | - MJ Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Department of Physical Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James W. Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas
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Grampurohit N, Bell A, Duff SV, Mulcahey MJ, Thielen CC, Kaplan G, Marino RJ. Highlighting gaps in spinal cord injury research in activity-based interventions for the upper extremity: A scoping review. NeuroRehabilitation 2021; 49:23-38. [PMID: 33967071 DOI: 10.3233/nre-210042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited. OBJECTIVE To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI. METHODS The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTSeeker with the criteria: non-invasive activity-based interventions delivered at least three times/week for two weeks, upper extremity functional outcomes, age 13 years or older, English language, and neurological disorders three months post onset/injury. RESULTS The search yielded 172 studies. There were seven studies with SCI, all in adults. Activity-based interventions in SCI included task-specific training and gaming, with and without electrical stimulation, and a robotic exoskeleton. The other populations found in the review included studies in stroke, cerebral palsy, and multiple sclerosis. Thirty-four different interventions were reported in other populations. In comparison to the extensive stroke research, work in SCI was not found for high-intensity interventions using virtual reality, brain stimulation, rehabilitation devices, and applications to the home and telerehab settings. CONCLUSION The results highlight critical gaps within upper extremity high-intensity activity-based research in SCI.
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Affiliation(s)
- Namrata Grampurohit
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alison Bell
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Susan V Duff
- Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA, USA
| | - M J Mulcahey
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Gary Kaplan
- Scott Memorial Library, Academic Commons, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ralph J Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Carlstrom LP, Graffeo CS, Perry A, Klinkner DB, Daniels DJ. An arrow that missed the mark: a pediatric case report of remarkable neurologic improvement following penetrating spinal cord injury. Childs Nerv Syst 2021; 37:1771-1778. [PMID: 32754869 DOI: 10.1007/s00381-020-04842-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/28/2020] [Indexed: 11/25/2022]
Abstract
Penetrating spinal cord injuries are rare in children but result in devastating impacts on long-term morbidity and mortality-with little known about the recovery capacity in this age group. We present the case of an eight-year-old child who sustained a penetrating injury through the right anterior thorax. Thoracic CT showed the arrow tip extending through the spinal canal at T6. Neurologic examination revealed no motor or sensory function below T6. The arrow was surgically removed without complications through an anterior-only approach. MRI on post-operative day (POD) 4 showed focal T2 hyperintensity at the T6 spinal cord. Patient was discharged on POD33 with an American Spinal Injury Association (ASIA)-D score and trace voluntary control over bowel and bladder function. Remarkably, four months later, he had near normal bowel and bladder function, with near-intact lower extremity strength and self-sustained ambulation. Follow-up imaging revealed hemicord formation at the level of injury. We review our case of penetrating spinal cord injury in a child and similar reports in the literature. Penetrating thoracic spinal cord trauma portends poor clinical outcomes, particularly when employing available adult prognostic spinal cord injury scoring metrics. Incomplete spinal cord injury, and often-associated spinal shock, can mimic a complete injury-as in our patient, which improved to near-complete motor and sensory restoration of function and resulted in the formation of a split hemicord. This case represents a unique penetrating spinal cord injury with remarkable neurologic recovery, which would advocate against definitive early prognostication in the pediatric population.
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Affiliation(s)
- Lucas P Carlstrom
- Department of Neurological Surgery, Pediatric Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Christopher S Graffeo
- Department of Neurological Surgery, Pediatric Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Avital Perry
- Department of Neurological Surgery, Pediatric Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - David J Daniels
- Department of Neurological Surgery, Pediatric Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA.
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Calhoun Thielen C, Slavin MD, Ni P, Mulcahey MJ. Development and initial validation of ability levels to interpret pediatric spinal cord injury activity measure and pediatric measure of participation scores. J Pediatr Rehabil Med 2021; 14:463-476. [PMID: 34250956 DOI: 10.3233/prm-200774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To develop ability levels and descriptions to interpret Pediatric Spinal Cord Injury Activity Measure (PEDI-SCI AM) and Pediatric Measure of Participation (PMoP) scores. METHODS Mixed-methods approach to 1.) create item maps using PEDI-SCI AM and PMoP calibration data; 2.) employ bookmarking methods and an iterative consensus process including semi-structured interviews, focus groups and surveys to establish PEDI-SCI AM and PMoP level score cut-points and descriptions; 3.) use calibration sample data to examine mean score differences across levels [analyses of variance (ANOVAs)] and assess the sample distribution (%) across levels; 4.) repeat in a separate validation sample; 5.) develop level descriptions. Throughout the mixed methods approach, the sample participants include children with spinal cord injury (SCI), parents of children with SCI, and professionals who work with children with SCI. RESULTS Four or five ability levels were identified for each PEDI-SCI AM and PMoP domain along with descriptions for each level. ANOVA results revealed significant overall differences for level mean scores and pairwise comparisons (p < 0.05). Consensus (>80%) was achieved for all PEDI-SCI AM and some PMoP level descriptions. CONCLUSION PEDI-SCI AM and PMoP score cut-points identify different levels of activity and participation among children with SCI. These levels and descriptions provide clinical relevance for PEDI-SCI and PMoP numeric scores.
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Affiliation(s)
- Christina Calhoun Thielen
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mary D Slavin
- Health Outcomes Unit, Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Pengsheng Ni
- Biostatistics & Epidemiology Data Analytic Center, Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - M J Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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Hwang M, Zebracki K, Vogel LC, Mulcahey MJ, Varni JW. Development of the Pediatric Quality of Life Inventory™ Spinal Cord Injury (PedsQL™ SCI) module: qualitative methods. Spinal Cord 2020; 58:1134-1142. [DOI: 10.1038/s41393-020-0450-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
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Tracking Spinal Cord Injury Functional Outcomes Across the Lifespan: Validation of Linking Coefficients. Arch Phys Med Rehabil 2019; 100:1924-1931. [DOI: 10.1016/j.apmr.2019.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/26/2019] [Accepted: 05/04/2019] [Indexed: 11/18/2022]
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Behrman AL, Trimble SA, Argetsinger LC, Roberts MT, Mulcahey MJ, Clayton L, Gregg ME, Lorenz D, Ardolino EM. Interrater Reliability of the Pediatric Neuromuscular Recovery Scale for Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2019; 25:121-131. [PMID: 31068744 DOI: 10.1310/sci2502-121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: In synergy with the mounting scientific evidence for the capacity of recovery after spinal cord injury (SCI) and training, new evidence-based therapies advancing neuromuscular recovery are emerging. There is a parallel need for outcome instruments that specifically address recovery. The Pediatric Neuromuscular Recovery Scale (Pediatric NRS) is one example with established content validity to assess neuromuscular capacity within task performance. Objective: The objective of this study was to determine interrater reliability of the Pediatric NRS to classify motor capacity in children after SCI. Methods: Pediatric physicians (3), occupational therapists (5), and physical therapists (6) received standardized training in scoring the scale, then rated video assessments of 32 children post SCI, 2-12 years of age, 78% non-ambulatory. Interrater reliability was analyzed using Kendall coefficient of concordance for individual Pediatric NRS items and overall score. Results: The interrater reliability coefficient was determined to be near 1 for the overall Pediatric NRS score (ICC = 0.966; 95% CI, 0.89-0.98). Twelve of 16 individual items exhibited high concordance coefficients (Kendall's W ≥ 0.8) and four items demonstrated concordance coefficients, < 0.8 and > 0.69. Interrater reliability was equivalent among groups defined by age and neurological level, but lower among non-ambulatory individuals. Conclusion: Strong interrater reliability was demonstrated by pediatric clinicians who scored children with SCI using the Pediatric NRS.
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Affiliation(s)
- Andrea L Behrman
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Shelley A Trimble
- Spinal Cord Medicine Program, Frazier Rehab Institute, Louisville, Kentucky
| | | | | | - M J Mulcahey
- Jefferson College of Rehabilitation Science, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lisa Clayton
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky.,Kosair Charities Center for Pediatric NeuroRecovery, University of Louisville, Louisville, Kentucky
| | - Mary E Gregg
- Department of Biostatistics, University of Louisville, Louisville, Kentucky
| | - Doug Lorenz
- Department of Biostatistics, University of Louisville, Louisville, Kentucky
| | - Elizabeth M Ardolino
- Doctor of Physical Therapy Program - Austin, University of St. Augustine for Health Sciences, Austin, Texas
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Recommendations for the National Institute for Neurologic Disorders and Stroke spinal cord injury common data elements for children and youth with SCI. Spinal Cord 2016; 55:331-340. [PMID: 27845358 DOI: 10.1038/sc.2016.139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/22/2016] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN In 2014, the adult spinal cord injury (SCI) common data element (CDE) recommendations were made available. This project was a review of the adult SCI CDE for relevance to children and youth with SCI. OBJECTIVES The objective of this study was to review the National Institute of Neurologic Disorders and Stroke (NINDS) adult SCI CDEs for relevance to children and youth with SCI. SETTING International. METHODS The pediatric working group consisted of international members with varied fields of expertise related to pediatric SCI. The group convened biweekly meetings for 6 months in 2015. All of the adult SCI CDEs were reviewed, evaluated and modified/created for four age groups: 0-5 years, 6-12 years, 13-15 years and 16-18 years. Whenever possible, results of published research studies were used to guide recommendations. In the absence of empirical support, grey literature and international content expert consensus were garnered. Existing pediatric NINDS CDEs and new CDEs were developed in areas where adult recommendations were not appropriate. After internal working group review of domain recommendations, these pediatric CDEs were vetted during a public review from November through December 2015. RESULTS Version 1.0 of the pediatric SCI CDEs was posted in February 2016. CONCLUSION The pediatric SCI CDEs are incorporated directly into the NINDS SCI CDE sets and can be found at https://commondataelements.ninds.nih.gov.
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Mulcahey MJ, Slavin MD, Ni P, Vogel LC, Thielen CC, Coster WJ, Jette AM. The Pediatric Measure of Participation (PMoP) short forms. Spinal Cord 2016; 54:1183-1187. [DOI: 10.1038/sc.2016.68] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/14/2016] [Accepted: 03/30/2016] [Indexed: 11/09/2022]
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