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Gathuya Z, Nabukenya MT, Aaron O, Gray R, Evans FM. Children's Anaesthesia and perioperative care challenges, and innovations. Semin Pediatr Surg 2023; 32:151355. [PMID: 38043262 DOI: 10.1016/j.sempedsurg.2023.151355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The 2015 Sustainable Development Goals emphasise good health to all with reduced inequalities, and surgical and anaesthesia care is essential to achieve these. https://sdgs.un.org/goals. However, it has been estimated that 1.7 billion children do not have access to safe anaesthesia and surgery when needed and this disproportionately affects children in low- and middle-income countries (1). It is alarming that 1 in 10 individuals in LMICs do not have access to safe surgical care. Both safe surgery and anaesthesia are essential for ensuring that individuals receive proper medical attention. Economically viable public health initiatives that can avert many disability-adjusted years are needed. (2-4) Morbidity and mortality from surgical disease and anaesthesia care remain high in low-income countries, unlike in high-income countries. The incidence of severe anaesthesia-related critical events and perioperative cardiac arrest is between three and ten times more in LMICs than in HICs (5-7) A baseline POMR that is 100 times higher in LMICs compared to HICs is reported. (8) This perioperative morbidity and mortality gap is more evident in neonates and younger age groups, especially in children with congenital abnormalities. The challenges facing providers of anaesthesia and perioperative care are multifactorial and include but are not limited to the inadequate workforce, inadequate and inappropriate infrastructure, lack of adequate and appropriately sized equipment, including monitors, and safe monitoring capacity, supply chain challenges for medicines and reusable consumables, unreliable supply of oxygen and blood products, lack of data and research for policy formulation, inadequate resource allocation from governments and lack of safety culture among other things. In paediatrics, this is further multiplied by the variability in the sizes of the patients, from neonates to older children (9).
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Affiliation(s)
- Z Gathuya
- Department of Anesthesia, The Nairobi Hospital, Nairobi, Kenya.
| | - M T Nabukenya
- Department of Anesthesia, Makerere University College of Health Sciences, Uganda
| | - O Aaron
- Department of Anesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - R Gray
- Division of Paediatric Anaesthesia, Division of Global Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, 27St Michaels Rd, Tamboerskloof, Cape Town, 8001, South Africa
| | - F M Evans
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Powell WF, Echeto-Cerrato MA, Gathuya Z, Gray RM, Hodges S, Nabukenya MT, Newton MW, Rai E, Evans FM. Delivery of Safe Pediatric Anesthesia Care in the First 8000 days: Realities, Challenges, and Solutions in Low- and Middle-Income Countries. World J Surg 2023; 47:3429-3435. [PMID: 37891383 DOI: 10.1007/s00268-023-07229-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Worldwide, perioperative mortality has declined over the past 50 years, but the reduction is skewed toward high-income countries (HICs). Currently, pediatric perioperative mortality is much higher in low- and middle-income countries (LMICs) compared to HICs, despite studied cohorts being predominantly low-risk. These disparities must be studied and addressed. METHODS A narrative review of the literature was undertaken to identify contributing factors and potential knowledge gaps. Interventions aimed at alleviating the outcomes disparities are discussed, and recommendations are made for future directions. RESULTS AND CONCLUSIONS There is a lack of adequately trained pediatric anesthesia providers in LMICs, and the number must be bolstered by making such training available. Essential anesthesia medications and equipment, in pediatric-appropriate sizes, are often not available; neither are essential infrastructure items. Perioperative staff are underprepared for emergent situations that may arise and simulation training may help to ameliorate this. The global anesthesia community has implemented several solutions to address these issues. The World Federation of Societies of Anaesthesiologists (WFSA) and Global Initiative for Children's Surgery have published standards that outline essential items for the provision of safe perioperative pediatric care. Several short educational courses have been developed and introduced in LMICs that either specifically address pediatric patients, or contain a pediatric component. The WFSA also maintains a collection of discrete tutorials for educational purposes. Finally, in Africa, large-scale, prospective data collection is underway to examine pediatric perioperative outcomes. More work needs to be done, though, to improve perioperative outcomes for pediatric patients in LMICs.
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Affiliation(s)
- William Francis Powell
- Department of Anesthesiology, Harvard Medical School, Mass Eye and Ear243 Charles Street, Boston, MA, 02114, USA.
| | - Maria Alejandra Echeto-Cerrato
- Department of Anesthesiology and Pediatrics, Hospital del Valle North Blvd, 8Th Street NE, San Pedro Sula, Honduras, 21101
| | | | - Rebecca Mary Gray
- Division of Paediatric Anaesthesia, Division of Global Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, 27 St Michaels Rd, Tamboerskloof, Cape Town, 8001, Republic of South Africa
| | | | - Mary T Nabukenya
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Upper Mulago Hill Rd, Kampala, Uganda
| | - Mark W Newton
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ekta Rai
- Department of Anaesthesiology, Christian Medical College, Vellore, India, 632004
| | - Faye M Evans
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Vaz Ferreira R, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Navas Leon FJ, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Correction: Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002414. [PMID: 37708095 PMCID: PMC10501557 DOI: 10.1371/journal.pgph.0002414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
[This corrects the article DOI: 10.1371/journal.pgph.0002102.].
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Gray R, Desalu R, Gathuya Z, Ndikontar Kwinji R, Nabukenya MT, Newton M, Osazuwa M, Sarpong P, Evans FM. The narrative must change: Ethical research tenets do not change when you cross borders. Paediatr Anaesth 2023; 33:773-774. [PMID: 37313641 DOI: 10.1111/pan.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Rebecca Gray
- Division of Paediatric Anaesthesia, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Ronke Desalu
- Department of Anaesthesia, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria
- Department of Anaesthesia, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Raymond Ndikontar Kwinji
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
- Department of Anesthesia and Intensive Care, Yaounde Gyneco Obstetric and Pediatric Hospital, Yaounde, Cameroon
| | - Mary T Nabukenya
- Department of Anaesthesia, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mark Newton
- Department of Anesthesiology and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Maryrose Osazuwa
- Department of Anaesthesia, National Hospital Abuja, Abuja, Nigeria
| | - Pokua Sarpong
- Department of Anaesthesia, Korle Bu Teaching Hospital, Accra, Ghana
| | - Faye M Evans
- The Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Ferreira RV, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Leon FJN, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002102. [PMID: 37450426 PMCID: PMC10348592 DOI: 10.1371/journal.pgph.0002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023]
Abstract
Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field. A task force was set up using snowball sampling to recruit a broad group of content and context experts in global surgical and perioperative care. A draft set of competencies was revised through the modified Delphi process with two rounds of anonymous input. A threshold of 80% consensus was used to determine whether a competency or sub-competency learning objective was relevant to the skillset needed within academic global surgery and perioperative care. A diverse task force recruited experts from 22 countries to participate in both rounds of the Delphi process. Of the n = 59 respondents completing both rounds of iterative polling, 63% were from low- or middle-income countries. After two rounds of anonymous feedback, participants reached consensus on nine core competencies and 31 sub-competency objectives. The greatest consensus pertained to competency in ethics and professionalism in global surgery (100%) with emphasis on justice, equity, and decolonization across multiple competencies. This Delphi process, with input from experts worldwide, identified nine competencies which can be used to develop standardized academic global surgery and perioperative care curricula worldwide. Further work needs to be done to validate these competencies and establish assessments to ensure that they are taught effectively.
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Affiliation(s)
- Natalie Pawlak
- Tufts University, Boston, Massachusetts, United States of America
| | - Christine Dart
- Virginia Commonwealth University, Richmond, Virginia, United States of America
| | | | - Emmanuel Ameh
- National Hospital Division of Paediatric Surgery, Abuja, Nigeria
| | - Abebe Bekele
- University of Global Health Equity, Butaro, Rwanda
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Maria F. Jimenez
- Department of Surgery, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogota, Colombia
| | | | - Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Nobhojit Roy
- The George Institute for Global Health, New Delhi, India
| | - Girma Terfera
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Adesoji O. Ademuyiwa
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, United Kingdom
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | | | | | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children’s Hospital, Montreal, Canada
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Emmanuel Bua
- Busitema University Mbale Hospital, Mbale, Uganda
| | - Leticia Nunes Campos
- Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Pernambuco, Brasil
| | - Chris Dodgion
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Michalina Drejza
- Specialty Trainee in Obstetrics and Gynaecology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Marcel E. Durieux
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Dhruva Ghosh
- NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, India
| | | | - Walter D. Johnson
- Loma Linda University, Loma Linda, California, United States of America
| | | | | | - Kristin L. Long
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Jana B. A. Macleod
- Kenyatta University, Nairobi, Kenya
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Anshul Mahajan
- Global Surgery Fellow, WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs’, Mumbai, India
| | - Rebecca G. Maine
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | | | - Craig D. McClain
- Department of Anesthesiology, Critical Care and Pain Medicine, Program in Global Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | | | - Peter M. Nthumba
- Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Benedict C. Nwomeh
- Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | | | - Norgrove Penny
- Branch for Global Surgical Care, University of British Columbia, Vancouver, Canada
| | | | - Jennifer Rickard
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lina Roa
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lubna Samad
- Interactive Research and Development (IRD) Global, Singapore, Singapore
| | | | - Martin Smith
- University of the Witwatersrand, Johannesburg, South Africa
| | - Nichole Starr
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Richard J. Stewart
- Global Initiative for Children’s Surgery, Portland, Oregon, United States of America
| | - John L. Tarpley
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Vanderbilt University, Nashville, Tennessee, United States of America
| | | | | | - Thomas G. Weiser
- Department of Surgery, Stanford University, Palo Alto, California, United States of America
| | | | - Elliot Wollner
- Peter MacCallum Cancer Center and University of California, San Francisco, San Francisco, California, United States of America
| | - Sudha Jayaraman
- Department of Surgery, Center for Global Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, United States of America
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Abbas A, Samad L, Ozgediz D, Ademuyiwa A, Ameh EA, Banu T, Botelho F, Espineda B, Gathuya Z, Lakhoo K, Olubunmi LA, Madhuri V, Millano L, Nabulindo S, Shehata S, Wong K, Butler MW. Online action planning forums to develop a roadmap to mitigate the impact of COVID-19 on the delivery of global children’s surgical care. Pediatr Surg Int 2021; 37:1221-1233. [PMID: 33880597 PMCID: PMC8057944 DOI: 10.1007/s00383-021-04903-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE We aimed to understand the challenges facing children's surgical care providers globally and realistic interventions to mitigate the catastrophic impact of COVID-19 on children's surgery. METHODS Two online Action Planning Forums (APFs) were organized by the Global Initiative for Children's Surgery (GICS) with a geographically diverse panel representing four children's surgical, anesthesia, and nursing subspecialties. Qualitative analysis was performed to identify codes, themes, and subthemes. RESULTS The most frequently reported challenges were delayed access to care for children; fear among the public and patients; unavailability of appropriate personal protective equipment (PPE); diversion of resources toward COVID-19 care; and interruption in student and trainee hands-on education. To address these challenges, panelists recommended human resource and funding support to minimize backlog; setting up international, multi-center studies for systematic data collection specifically for children; providing online educational opportunities for trainees and students in the form of large and small group discussions; developing best practice guidelines; and, most importantly, adapting solutions to local needs. CONCLUSION Identification of key challenges and interventions to mitigate the impact of the COVID-19 pandemic on global children's surgery via an objective, targeted needs assessment serves as an essential first step. Key interventions in these areas are underway.
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Affiliation(s)
- Alizeh Abbas
- Center for Essential Surgical and Acute Care, Global Health Directorate, Indus Health Network, Woodcraft Building, Plot 3 and 3A, Sector 47, Korangi Creek Road, Karachi, Pakistan
| | - Lubna Samad
- Center for Essential Surgical and Acute Care, Global Health Directorate, Indus Health Network, Woodcraft Building, Plot 3 and 3A, Sector 47, Korangi Creek Road, Karachi, Pakistan
| | - Doruk Ozgediz
- University of California, San Francisco, San Francisco, CA USA
| | - Adesoji Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Emmanuel A. Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | - Fabio Botelho
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Beda Espineda
- Philippines Children’s Medical Center, Quezon City, The Philippines
| | | | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Vrisha Madhuri
- Department of Paediatric Orthopaedics, Christian Medical College and Hospital, Vellore, India
| | - Leecarlo Millano
- Pediatric Surgery Division, Tarakan General Hospital, Jakarta, Indonesia
| | - Susane Nabulindo
- Department of Anaesthesia, University of Nairobi, Nairobi, Kenya
| | - Sameh Shehata
- Department of Pediatric Surgery, University of Alexandria, Alexandria, Egypt
| | - Kenneth Wong
- Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong
| | - Marilyn W. Butler
- Division of Pediatric Surgery, Oregon Health and Science University, 501 N. Graham Street, Suite 300, Portland, OR 97227 USA
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Nthumba PM, Newton MW, Gathuya Z. Global surgery in the 21st century: The voice from Africa - We need a new model. Paediatr Anaesth 2021; 31:510-512. [PMID: 33844377 DOI: 10.1111/pan.14162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Peter Muli Nthumba
- AIC Kijabe Hospital, Kijabe, Kenya.,Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark W Newton
- AIC Kijabe Hospital, Kijabe, Kenya.,Departments of Anesthesiology and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zipporah Gathuya
- Department of Anesthesiology, The Nairobi Hospital, Nairobi, Kenya
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Gathuya Z, Bosenberg A. Anaesthesia and Rubinstein-Taybi syndrome. Southern African Journal of Anaesthesia and Analgesia 2005. [DOI: 10.1080/22201173.2005.10872414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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