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Koskela A, Törnqvist H, Somppi S, Tiira K, Kykyri VL, Hänninen L, Kujala J, Nagasawa M, Kikusui T, Kujala MV. Behavioral and emotional co-modulation during dog-owner interaction measured by heart rate variability and activity. Sci Rep 2024; 14:25201. [PMID: 39448721 PMCID: PMC11502769 DOI: 10.1038/s41598-024-76831-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 10/17/2024] [Indexed: 10/26/2024] Open
Abstract
Behavioral and physiological synchrony facilitate emotional closeness in attachment relationships. The aim of this pseudorandomized cross-over study was to investigate the emotional and physiological link, designated as co-modulation, between dogs and their owners. We measured the heart rate variability (HRV) and physical activity of dogs belonging to co-operative breeds (n = 29) and their owners during resting baselines and positive interaction tasks (Stroking, Training, Sniffing, Playing) and collected survey data on owner temperament and dog-owner relationship. Although overall HRV and activity correlated between dogs and their owners across tasks, task-specific analyses showed that HRV of dogs and owners correlated during free behaving (Pre- and Post-Baseline), whereas the activity of dogs and owners correlated during predefined interaction tasks (Stroking and Playing). Dog overall HRV was the only predictive factor for owner overall HRV, while dog height, ownership duration, owner negative affectivity, and dog-owner interaction scale predicted dog overall HRV. Thus, the characteristics of dog, owner, and the relationship modified the HRV responses in dog-owner dyads. The physiology and behavior of dogs belonging to co-operative breeds and their owners were therefore co-modulated, demonstrating physiological and emotional connection comparable to those found in attachment relationships between humans.
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Affiliation(s)
- Aija Koskela
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, PO BOX 35, 40014, Jyväskylä, Finland.
- Faculty of Veterinary Medicine, University of Helsinki, PO BOX 66, 00014, Helsinki, Finland.
| | - Heini Törnqvist
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, PO BOX 35, 40014, Jyväskylä, Finland
| | - Sanni Somppi
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, PO BOX 35, 40014, Jyväskylä, Finland
- Faculty of Veterinary Medicine, University of Helsinki, PO BOX 66, 00014, Helsinki, Finland
| | - Katriina Tiira
- Faculty of Veterinary Medicine, University of Helsinki, PO BOX 66, 00014, Helsinki, Finland
| | - Virpi-Liisa Kykyri
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, PO BOX 35, 40014, Jyväskylä, Finland
| | - Laura Hänninen
- Faculty of Veterinary Medicine, University of Helsinki, PO BOX 66, 00014, Helsinki, Finland
| | - Jan Kujala
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, PO BOX 35, 40014, Jyväskylä, Finland
| | - Miho Nagasawa
- Department of Animal Science and Biotechnology, Azabu University, 1-17-71 Fuchinobe, Chuo-Ku, Sagamihara, Kanagawa, 252-5201, Japan
| | - Takefumi Kikusui
- Department of Animal Science and Biotechnology, Azabu University, 1-17-71 Fuchinobe, Chuo-Ku, Sagamihara, Kanagawa, 252-5201, Japan
| | - Miiamaaria V Kujala
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, PO BOX 35, 40014, Jyväskylä, Finland
- Faculty of Veterinary Medicine, University of Helsinki, PO BOX 66, 00014, Helsinki, Finland
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Rietz M, Schmidt-Persson J, Gillies Banke Rasmussen M, Overgaard Sørensen S, Rath Mortensen S, Brage S, Lund Kristensen P, Grøntved A, Brønd JC. Facilitating ambulatory heart rate variability analysis using accelerometry-based classifications of body position and self-reported sleep. Physiol Meas 2024; 45:055016. [PMID: 38684167 DOI: 10.1088/1361-6579/ad450d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/29/2024] [Indexed: 05/02/2024]
Abstract
Objective.This study aimed to examine differences in heart rate variability (HRV) across accelerometer-derived position, self-reported sleep, and different summary measures (sleep, 24 h HRV) in free-living settings using open-source methodology.Approach.HRV is a biomarker of autonomic activity. As it is strongly affected by factors such as physical behaviour, stress, and sleep, ambulatory HRV analysis is challenging. Beat-to-beat heart rate (HR) and accelerometry data were collected using single-lead electrocardiography and trunk- and thigh-worn accelerometers among 160 adults participating in the SCREENS trial. HR files were processed and analysed in the RHRV R package. Start time and duration spent in physical behaviours were extracted, and time and frequency analysis for each episode was performed. Differences in HRV estimates across activities were compared using linear mixed models adjusted for age and sex with subject ID as random effect. Next, repeated-measures Bland-Altman analysis was used to compare 24 h RMSSD estimates to HRV during self-reported sleep. Sensitivity analyses evaluated the accuracy of the methodology, and the approach of employing accelerometer-determined episodes to examine activity-independent HRV was described.Main results.HRV was estimated for 31 289 episodes in 160 individuals (53.1% female) at a mean age of 41.4 years. Significant differences in HR and most markers of HRV were found across positions [Mean differences RMSSD: Sitting (Reference) - Standing (-2.63 ms) or Lying (4.53 ms)]. Moreover, ambulatory HRV differed significantly across sleep status, and poor agreement between 24 h estimates compared to sleep HRV was detected. Sensitivity analyses confirmed that removing the first and last 30 s of accelerometry-determined HR episodes was an accurate strategy to account for orthostatic effects.Significance.Ambulatory HRV differed significantly across accelerometry-assigned positions and sleep. The proposed approach for free-living HRV analysis may be an effective strategy to remove confounding by physical activity when the aim is to monitor general autonomic stress.
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Affiliation(s)
- Marlene Rietz
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Division of Clinical Physiology, Department for Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Schmidt-Persson
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Applied Research in Child and Adult Health, Department of Midwifery, Physiotherapy, Occupational Therapy, and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Martin Gillies Banke Rasmussen
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Sarah Overgaard Sørensen
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Sofie Rath Mortensen
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Søren Brage
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Peter Lund Kristensen
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Anders Grøntved
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Jan Christian Brønd
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
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Frasch MG. Heart Rate Variability Code: Does It Exist and Can We Hack It? Bioengineering (Basel) 2023; 10:822. [PMID: 37508849 PMCID: PMC10375964 DOI: 10.3390/bioengineering10070822] [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] [Received: 04/26/2023] [Revised: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
A code is generally defined as a system of signals or symbols for communication. Experimental evidence is synthesized for the presence and utility of such communication in heart rate variability (HRV) with particular attention to fetal HRV: HRV contains signatures of information flow between the organs and of response to physiological or pathophysiological stimuli as signatures of states (or syndromes). HRV exhibits features of time structure, phase space structure, specificity with respect to (organ) target and pathophysiological syndromes, and universality with respect to species independence. Together, these features form a spatiotemporal structure, a phase space, that can be conceived of as a manifold of a yet-to-be-fully understood dynamic complexity. The objective of this article is to synthesize physiological evidence supporting the existence of HRV code: hereby, the process-specific subsets of HRV measures indirectly map the phase space traversal reflecting the specific information contained in the code required for the body to regulate the physiological responses to those processes. The following physiological examples of HRV code are reviewed, which are reflected in specific changes to HRV properties across the signal-analytical domains and across physiological states and conditions: the fetal systemic inflammatory response, organ-specific inflammatory responses (brain and gut), chronic hypoxia and intrinsic (heart) HRV (iHRV), allostatic load (physiological stress due to surgery), and vagotomy (bilateral cervical denervation). Future studies are proposed to test these observations in more depth, and the author refers the interested reader to the referenced publications for a detailed study of the HRV measures involved. While being exemplified mostly in the studies of fetal HRV, the presented framework promises more specific fetal, postnatal, and adult HRV biomarkers of health and disease, which can be obtained non-invasively and continuously.
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Affiliation(s)
- Martin Gerbert Frasch
- Department of Obstetrics and Gynecology and Institute on Human Development and Disability, University of Washington School of Medicine, Seattle, WA 98195, USA
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Somppi S, Törnqvist H, Koskela A, Vehkaoja A, Tiira K, Väätäjä H, Surakka V, Vainio O, Kujala MV. Dog-Owner Relationship, Owner Interpretations and Dog Personality Are Connected with the Emotional Reactivity of Dogs. Animals (Basel) 2022; 12:1338. [PMID: 35681804 PMCID: PMC9179432 DOI: 10.3390/ani12111338] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
We evaluated the effect of the dog-owner relationship on dogs' emotional reactivity, quantified with heart rate variability (HRV), behavioral changes, physical activity and dog owner interpretations. Twenty nine adult dogs encountered five different emotional situations (i.e., stroking, a feeding toy, separation from the owner, reunion with the owner, a sudden appearance of a novel object). The results showed that both negative and positive situations provoked signs of heightened arousal in dogs. During negative situations, owners' ratings about the heightened emotional arousal correlated with lower HRV, higher physical activity and more behaviors that typically index arousal and fear. The three factors of The Monash Dog-Owner Relationship Scale (MDORS) were reflected in the dogs' heart rate variability and behaviors: the Emotional Closeness factor was related to increased HRV (p = 0.009), suggesting this aspect is associated with the secure base effect, and the Shared Activities factor showed a trend toward lower HRV (p = 0.067) along with more owner-directed behaviors reflecting attachment related arousal. In contrast, the Perceived Costs factor was related to higher HRV (p = 0.009) along with less fear and less owner-directed behaviors, which may reflect the dog's more independent personality. In conclusion, dogs' emotional reactivity and the dog-owner relationship modulate each other, depending on the aspect of the relationship and dogs' individual responsivity.
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Affiliation(s)
- Sanni Somppi
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, FI-00014 Helsinki, Finland; (H.T.); (A.K.); (K.T.); (O.V.); (M.V.K.)
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland
| | - Heini Törnqvist
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, FI-00014 Helsinki, Finland; (H.T.); (A.K.); (K.T.); (O.V.); (M.V.K.)
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland
| | - Aija Koskela
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, FI-00014 Helsinki, Finland; (H.T.); (A.K.); (K.T.); (O.V.); (M.V.K.)
| | - Antti Vehkaoja
- Faculty of Medicine and Health Technology, Tampere University, P.O. Box 692, FI-33101 Tampere, Finland;
| | - Katriina Tiira
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, FI-00014 Helsinki, Finland; (H.T.); (A.K.); (K.T.); (O.V.); (M.V.K.)
| | - Heli Väätäjä
- Research Group for Emotions, Sociality, and Computing, Faculty of Information Technology and Communication Sciences, Tampere University, P.O. Box 100, FI-33014 Tampere, Finland;
- Master School, Lapland University of Applied Sciences, Jokiväylä 11 B, FI-96300 Rovaniemi, Finland;
| | - Veikko Surakka
- Master School, Lapland University of Applied Sciences, Jokiväylä 11 B, FI-96300 Rovaniemi, Finland;
| | - Outi Vainio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, FI-00014 Helsinki, Finland; (H.T.); (A.K.); (K.T.); (O.V.); (M.V.K.)
| | - Miiamaaria V. Kujala
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, FI-00014 Helsinki, Finland; (H.T.); (A.K.); (K.T.); (O.V.); (M.V.K.)
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O. Box 12200, FI-00076 Aalto, Finland
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Kitajima K, Oishi K, Kojima T, Uenishi S, Yasunaka Y, Sakai K, Kumagai H, Hirooka H. An Assessment of Stress Status in Fattening Steers by Monitoring Heart Rate Variability: A Case of Dietary Vitamin A Restriction. FRONTIERS IN ANIMAL SCIENCE 2022. [DOI: 10.3389/fanim.2021.799289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Heart rate variability (HRV), heart beat-to-beat variations, is a measure of cardiac autonomic functions, and HRV monitoring using sensor technology can be a non-invasive way to assess stress of animals. The objective of this study was to investigate the effect of dietary vitamin A (VA) restriction to enhance beef quality on the physiological status of fattening steers by HRV analysis. Six Japanese Black steers were equally allocated into VA-restricted (RES) and VA-supplemented (SUP) groups. The RES steers were fed VA-restricted diets from 11 to 20 months of age. The inter-beat intervals and blood VA concentration were measured at 18 and 24 months of age. HRV parameters in time, frequency, and non-linear domains were calculated using the inter-beat intervals. Blood VA concentration was significantly lower in RES steers than in SUP steers at 18 months of age (P < 0.05) but did not differ between the groups at 24 months of age. The HRV analysis indicated greater sympathetic and lower parasympathetic activities in RES steers than in SUP steers (P < 0.05). However, there were significant interactions of the group and age on HRV parameters (P < 0.05), indicating that although RES steers at 18 months of age might suffer from slight stress, the response could recover to a level similar to SUP steers at 24 months of age by the increase in blood VA concentration.
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Twiss SD, Brannan N, Shuert CR, Bishop AM, Pomeroy PP, Moss S. An external telemetry system for recording resting heart rate variability and heart rate in free-ranging large wild mammals. PLoS One 2021; 16:e0252013. [PMID: 34086713 PMCID: PMC8177659 DOI: 10.1371/journal.pone.0252013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/09/2021] [Indexed: 11/30/2022] Open
Abstract
Measures of heart rate variability (and heart rate more generally) are providing powerful insights into the physiological drivers of behaviour. Resting heart rate variability (HRV) can be used as an indicator of individual differences in temperament and reactivity to physical and psychological stress. There is increasing interest in deriving such measures from free ranging wild animals, where individuals are exposed to the natural and anthropogenic stressors of life. We describe a robust, externally mounted heart rate monitor for use in wild mammals, deployed here on wild breeding adult female grey seals (Halichoerus grypus), that delivers millisecond precise measures of inter beat intervals (IBIs), allowing computation of resting HRV parameters. Based on Firstbeat™ heart rate belts, our system allows for remote, continuous recording of IBI data from over 30 individuals simultaneously at ranges of up to 200m. We assessed the accuracy of the IBI data provided by the Firstbeat™ system using concurrent IBI data derived from in-field electrocardiogram (ECG) recordings. Bland-Altmann analyses demonstrated high correspondence between the two sets of IBI data, with a mean difference of 0.87±0.16ms. We used generalized additive mixed-effects models to examine the impact of the default Firstbeat™ software artefact correction procedure upon the generation of anomalous data (flats and stairs). Artefact correction and individual activity were major causes of flats and stairs. We used simulations and models to assess the impact of these errors on estimates of resting HRV and to inform criteria for subsampling relatively error free IBI traces. These analyses allowed us to establish stringent filtering procedures to remove traces with excessive numbers of artefacts, including flats and stairs. Even with strict criteria for removing potentially erroneous data, the abundance of data yielded by the Firstbeat™ system provides the potential to extract robust estimates of resting HRV. We discuss the advantages and limitations of our system for applications beyond the study system described here.
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Affiliation(s)
- Sean D. Twiss
- Department of Biosciences, Durham University, Durham, United Kingdom
- * E-mail:
| | - Naomi Brannan
- Department of Biosciences, Durham University, Durham, United Kingdom
| | | | - Amanda M. Bishop
- Department of Biosciences, Durham University, Durham, United Kingdom
| | - Patrick. P. Pomeroy
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St. Andrews, St. Andrews, United Kingdom
| | - Simon Moss
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St. Andrews, St. Andrews, United Kingdom
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Kitajima K, Oishi K, Miwa M, Anzai H, Setoguchi A, Yasunaka Y, Himeno Y, Kumagai H, Hirooka H. Effects of Heat Stress on Heart Rate Variability in Free-Moving Sheep and Goats Assessed With Correction for Physical Activity. Front Vet Sci 2021; 8:658763. [PMID: 34141733 PMCID: PMC8203806 DOI: 10.3389/fvets.2021.658763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/27/2021] [Indexed: 01/31/2023] Open
Abstract
Heart rate variability (HRV) is the heart beat-to-beat variation under control of the cardiovascular function of animals. Under stressed conditions, cardiac activity is generally regulated with an upregulated sympathetic tone and withdrawal of vagal tone; thus, HRV monitoring can be a non-invasive technique to assess stress level in animals especially related to animal welfare. Among several stress-induced factors, heat stress is one of the most serious causes of physiological damage to animals. The aim of this study was to assess the effects of heat stress on HRV in small ruminants under free-moving conditions. In three experimental periods (June, August, and October), inter-beat intervals in sheep and goats (three for each) in two consecutive days were measured. HRV parameters were calculated from the inter-beat interval data by three types of analyses: time domain, frequency domain, and non-linear analyses. The temperature–humidity index (THI) was used as an indicator of heat stress, and vectorial dynamic body acceleration (VeDBA) was calculated to quantify the physical activity of the animals tested. First, we investigated correlations of THI and VeDBA with HRV parameters; subsequently, THI was divided into five categories according to the values obtained (≤ 65, 65–70, 70–75, 75–80, and >80), and the effects of the THI categories on HRV parameters were investigated with and without correcting for the effects of physical activity based on the VeDBA. The results indicated that HRV significantly decreased with increasing THI and VeDBA. For non-linear HRV parameters that were corrected for the effects of physical activity, it was suggested that there would be a threshold of THI around 80 that strongly affected HRV; high heat stress can affect the autonomic balance of animals non-linearly by inducing the sympathetic nervous system. In conclusion, to assess psychophysiological conditions of unrestrained animals by HRV analysis, the confounding effect of physical activity on HRV should be minimized for a more precise interpretation of the results.
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Affiliation(s)
- Kaho Kitajima
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
| | - Kazato Oishi
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
| | - Masafumi Miwa
- Division of Grassland Farming, Institute of Livestock and Grassland Science, National Agriculture and Food Research Organization, Tochigi, Japan
| | - Hiroki Anzai
- Department of Animal and Grassland Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Akira Setoguchi
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
| | - Yudai Yasunaka
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
| | - Yukiko Himeno
- Department of Bioinformatics, College of Life Sciences, Ritsumeikan University, Shiga, Japan
| | - Hajime Kumagai
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
| | - Hiroyuki Hirooka
- Laboratory of Animal Husbandry Resources, Division of Applied Biosciences, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
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A novel accelerometry approach combining information on classified behaviors and quantified physical activity for assessing health status of cattle: a preliminary study. Appl Anim Behav Sci 2021. [DOI: 10.1016/j.applanim.2021.105220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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