Patterns in place of cancer death in the State of Qatar: a population-based study
International studies show that most people prefer to die at home; however, hospitals remain the most common place of death (PoD). This study aims to investigate the patterns in PoD and the associated factors, which are crucial for end-of-life cancer care enhancement. This retrospective, population-...
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| description | International studies show that most people prefer to die at home; however, hospitals remain the most common place of death (PoD). This study aims to investigate the patterns in PoD and the associated factors, which are crucial for end-of-life cancer care enhancement.
This retrospective, population-based study analyzed all registered cancer deaths in Qatar between January 1, 2006 and December 31, 2012 (n = 1,224). The main outcome measures were patient characteristics: age, gender, nationality, cancer diagnosis, year of death, and PoD. Time trends for age-standardized proportions of death in individual PoDs were evaluated using chi-square analysis. Odds ratio (OR) were determined for variables associated with the most preferred (acute palliative care unit [APCU] and hematology/oncology ward) versus least preferred (ICU and general medicine ward) PoDs in Qatar, stratified by nationality.
The hematology/oncology ward was the most common PoD (32.4%; 95% CI 26.7-35.3%) followed by ICU (31.4%; 95% CI 28.7-34.3%), APCU (26.9%; 95% CI 24.3-29.6%), and general medicine ward (9.2%; 95% CI 7.6-11.1%). APCU trended upward (+0.057/year; p |
| doi_str_mv | 10.1371/journal.pone.0109615 |
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This retrospective, population-based study analyzed all registered cancer deaths in Qatar between January 1, 2006 and December 31, 2012 (n = 1,224). The main outcome measures were patient characteristics: age, gender, nationality, cancer diagnosis, year of death, and PoD. Time trends for age-standardized proportions of death in individual PoDs were evaluated using chi-square analysis. Odds ratio (OR) were determined for variables associated with the most preferred (acute palliative care unit [APCU] and hematology/oncology ward) versus least preferred (ICU and general medicine ward) PoDs in Qatar, stratified by nationality.
The hematology/oncology ward was the most common PoD (32.4%; 95% CI 26.7-35.3%) followed by ICU (31.4%; 95% CI 28.7-34.3%), APCU (26.9%; 95% CI 24.3-29.6%), and general medicine ward (9.2%; 95% CI 7.6-11.1%). APCU trended upward (+0.057/year; p<0.001), while the hematology/oncology ward trended downward (-0.055/year; p<0.001). No statistically significant changes occurred in the other PoDs; home deaths remained low (0.4%; 95% Cl 0.38-0.42). Qataris who died from liver cancer (OR 0.23) and aged 65 or older (OR 0.64) were less likely to die in the APCU or hematology/oncology ward (p<0.05). Non-Qataris who died from pancreatic cancer (OR 3.12) and female (OR 2.05) were more likely to die in the APCU or hematology/oncology ward (p<0.05). Both Qataris and non-Qataris who died from hematologic malignancy (OR 0.18 and 0.41, respectively) were more likely to die in the ICU or general medicine ward (p<0.05).
A high percentage of cancer deaths in Qatar occur in hospital. As home was the preferred PoD for most people, effective home care and hospice programs are needed to improve end-of-life cancer care.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0109615</identifier><identifier>PMID: 25536076</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Age ; Aged ; Aged, 80 and over ; Analysis ; Blood cancer ; Cancer ; Cancer research ; Confidence Intervals ; Death ; Demography ; Fatalities ; Female ; Health care policy ; Health Care Surveys ; Hematology ; Home Care Services - statistics & numerical data ; Hospitals ; Hospitals - statistics & numerical data ; Humans ; International studies ; Internationality ; Investigations ; Liver ; Liver cancer ; Male ; Malignancy ; Medical diagnosis ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Neoplasms - epidemiology ; Neoplasms - mortality ; Odds Ratio ; Palliative care ; Pancreatic cancer ; Patients ; Population ; Population studies ; Population-based studies ; Public Sector - statistics & numerical data ; Qatar - epidemiology ; Statistical analysis ; Statistical tests ; Studies ; United Nations ; Young Adult</subject><ispartof>PloS one, 2014-12, Vol.9 (12), p.e109615-e109615</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Mohsen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Mohsen et al 2014 Mohsen et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-6ef13cbbd8f5c4b53edd94369a39ba0d552b03a40a66fb4b78f26076f17292c83</citedby><cites>FETCH-LOGICAL-c692t-6ef13cbbd8f5c4b53edd94369a39ba0d552b03a40a66fb4b78f26076f17292c83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275179/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275179/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25536076$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Guo, Nancy Lan</contributor><creatorcontrib>Mohsen, Hassan</creatorcontrib><creatorcontrib>Haddad, Pascale</creatorcontrib><creatorcontrib>Allam, Ayman</creatorcontrib><creatorcontrib>Hassan, Azza</creatorcontrib><title>Patterns in place of cancer death in the State of Qatar: a population-based study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>International studies show that most people prefer to die at home; however, hospitals remain the most common place of death (PoD). This study aims to investigate the patterns in PoD and the associated factors, which are crucial for end-of-life cancer care enhancement.
This retrospective, population-based study analyzed all registered cancer deaths in Qatar between January 1, 2006 and December 31, 2012 (n = 1,224). The main outcome measures were patient characteristics: age, gender, nationality, cancer diagnosis, year of death, and PoD. Time trends for age-standardized proportions of death in individual PoDs were evaluated using chi-square analysis. Odds ratio (OR) were determined for variables associated with the most preferred (acute palliative care unit [APCU] and hematology/oncology ward) versus least preferred (ICU and general medicine ward) PoDs in Qatar, stratified by nationality.
The hematology/oncology ward was the most common PoD (32.4%; 95% CI 26.7-35.3%) followed by ICU (31.4%; 95% CI 28.7-34.3%), APCU (26.9%; 95% CI 24.3-29.6%), and general medicine ward (9.2%; 95% CI 7.6-11.1%). APCU trended upward (+0.057/year; p<0.001), while the hematology/oncology ward trended downward (-0.055/year; p<0.001). No statistically significant changes occurred in the other PoDs; home deaths remained low (0.4%; 95% Cl 0.38-0.42). Qataris who died from liver cancer (OR 0.23) and aged 65 or older (OR 0.64) were less likely to die in the APCU or hematology/oncology ward (p<0.05). Non-Qataris who died from pancreatic cancer (OR 3.12) and female (OR 2.05) were more likely to die in the APCU or hematology/oncology ward (p<0.05). Both Qataris and non-Qataris who died from hematologic malignancy (OR 0.18 and 0.41, respectively) were more likely to die in the ICU or general medicine ward (p<0.05).
A high percentage of cancer deaths in Qatar occur in hospital. As home was the preferred PoD for most people, effective home care and hospice programs are needed to improve end-of-life cancer care.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Blood cancer</subject><subject>Cancer</subject><subject>Cancer research</subject><subject>Confidence Intervals</subject><subject>Death</subject><subject>Demography</subject><subject>Fatalities</subject><subject>Female</subject><subject>Health care policy</subject><subject>Health Care Surveys</subject><subject>Hematology</subject><subject>Home Care Services - statistics & numerical data</subject><subject>Hospitals</subject><subject>Hospitals - statistics & numerical data</subject><subject>Humans</subject><subject>International studies</subject><subject>Internationality</subject><subject>Investigations</subject><subject>Liver</subject><subject>Liver cancer</subject><subject>Male</subject><subject>Malignancy</subject><subject>Medical diagnosis</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neoplasms - epidemiology</subject><subject>Neoplasms - mortality</subject><subject>Odds Ratio</subject><subject>Palliative care</subject><subject>Pancreatic cancer</subject><subject>Patients</subject><subject>Population</subject><subject>Population studies</subject><subject>Population-based studies</subject><subject>Public Sector - statistics & numerical data</subject><subject>Qatar - epidemiology</subject><subject>Statistical analysis</subject><subject>Statistical tests</subject><subject>Studies</subject><subject>United Nations</subject><subject>Young Adult</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNkstu1DAUhi0EomXgDRBEQkKwmMGOHSdhgVRVXEaqVEqBrXXiy0wqTxxsB9G3x-mk1QR1gbJw5POd_1z8I_Sc4BWhJXl35QbfgV31rtMrTHDNSfEAHZOa5kueY_rw4P8IPQnhCuOCVpw_Rkd5UVCOS36MLr5CjNp3IWu7rLcgdeZMJqGT2mdKQ9yOgbjV2WWEeBO8gAj-fQZZ7_rBQmxdt2wgaJWFOKjrp-iRARv0s-lcoB-fPn4__bI8O_-8Pj05W0pe53HJtSFUNo2qTCFZU1CtVM0or4HWDWBVFHmDKTAMnJuGNWVl8rFlQ8q8zmVFF-jlXre3LohpG0EQzjDGJUmzL9B6TygHV6L37Q78tXDQipsL5zcCfGyl1YJjhQ0BqlilWaoGjSprSQpGFeFKQtL6MFUbmp1WUnfRg52JziNduxUb91uwvCxIOTbzZhLw7tegQxS7NkhtLXTaDfu-WYV5eqMFevUPev90E7WBNEDbGZfqylFUnDBSkZxTPFKre6j0Kb1rZbKOadP9LOHtLCExUf-JGxhCEOvLb__Pnv-cs68P2K0GG7fB2WG0T5iDbA9K70Lw2twtmWAxOv92G2J0vpicn9JeHD7QXdKt1elfpbj8qQ</recordid><startdate>20141223</startdate><enddate>20141223</enddate><creator>Mohsen, Hassan</creator><creator>Haddad, Pascale</creator><creator>Allam, Ayman</creator><creator>Hassan, Azza</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20141223</creationdate><title>Patterns in place of cancer death in the State of Qatar: a population-based study</title><author>Mohsen, Hassan ; Haddad, Pascale ; Allam, Ayman ; Hassan, Azza</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-6ef13cbbd8f5c4b53edd94369a39ba0d552b03a40a66fb4b78f26076f17292c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Blood cancer</topic><topic>Cancer</topic><topic>Cancer research</topic><topic>Confidence Intervals</topic><topic>Death</topic><topic>Demography</topic><topic>Fatalities</topic><topic>Female</topic><topic>Health care policy</topic><topic>Health Care Surveys</topic><topic>Hematology</topic><topic>Home Care Services - statistics & numerical data</topic><topic>Hospitals</topic><topic>Hospitals - statistics & numerical data</topic><topic>Humans</topic><topic>International studies</topic><topic>Internationality</topic><topic>Investigations</topic><topic>Liver</topic><topic>Liver cancer</topic><topic>Male</topic><topic>Malignancy</topic><topic>Medical diagnosis</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neoplasms - epidemiology</topic><topic>Neoplasms - mortality</topic><topic>Odds Ratio</topic><topic>Palliative care</topic><topic>Pancreatic cancer</topic><topic>Patients</topic><topic>Population</topic><topic>Population studies</topic><topic>Population-based studies</topic><topic>Public Sector - statistics & numerical data</topic><topic>Qatar - epidemiology</topic><topic>Statistical analysis</topic><topic>Statistical tests</topic><topic>Studies</topic><topic>United Nations</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mohsen, Hassan</creatorcontrib><creatorcontrib>Haddad, Pascale</creatorcontrib><creatorcontrib>Allam, Ayman</creatorcontrib><creatorcontrib>Hassan, Azza</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mohsen, Hassan</au><au>Haddad, Pascale</au><au>Allam, Ayman</au><au>Hassan, Azza</au><au>Guo, Nancy Lan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patterns in place of cancer death in the State of Qatar: a population-based study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-12-23</date><risdate>2014</risdate><volume>9</volume><issue>12</issue><spage>e109615</spage><epage>e109615</epage><pages>e109615-e109615</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>International studies show that most people prefer to die at home; however, hospitals remain the most common place of death (PoD). This study aims to investigate the patterns in PoD and the associated factors, which are crucial for end-of-life cancer care enhancement.
This retrospective, population-based study analyzed all registered cancer deaths in Qatar between January 1, 2006 and December 31, 2012 (n = 1,224). The main outcome measures were patient characteristics: age, gender, nationality, cancer diagnosis, year of death, and PoD. Time trends for age-standardized proportions of death in individual PoDs were evaluated using chi-square analysis. Odds ratio (OR) were determined for variables associated with the most preferred (acute palliative care unit [APCU] and hematology/oncology ward) versus least preferred (ICU and general medicine ward) PoDs in Qatar, stratified by nationality.
The hematology/oncology ward was the most common PoD (32.4%; 95% CI 26.7-35.3%) followed by ICU (31.4%; 95% CI 28.7-34.3%), APCU (26.9%; 95% CI 24.3-29.6%), and general medicine ward (9.2%; 95% CI 7.6-11.1%). APCU trended upward (+0.057/year; p<0.001), while the hematology/oncology ward trended downward (-0.055/year; p<0.001). No statistically significant changes occurred in the other PoDs; home deaths remained low (0.4%; 95% Cl 0.38-0.42). Qataris who died from liver cancer (OR 0.23) and aged 65 or older (OR 0.64) were less likely to die in the APCU or hematology/oncology ward (p<0.05). Non-Qataris who died from pancreatic cancer (OR 3.12) and female (OR 2.05) were more likely to die in the APCU or hematology/oncology ward (p<0.05). Both Qataris and non-Qataris who died from hematologic malignancy (OR 0.18 and 0.41, respectively) were more likely to die in the ICU or general medicine ward (p<0.05).
A high percentage of cancer deaths in Qatar occur in hospital. As home was the preferred PoD for most people, effective home care and hospice programs are needed to improve end-of-life cancer care.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25536076</pmid><doi>10.1371/journal.pone.0109615</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2014-12, Vol.9 (12), p.e109615-e109615 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1640007119 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adolescent Adult Age Aged Aged, 80 and over Analysis Blood cancer Cancer Cancer research Confidence Intervals Death Demography Fatalities Female Health care policy Health Care Surveys Hematology Home Care Services - statistics & numerical data Hospitals Hospitals - statistics & numerical data Humans International studies Internationality Investigations Liver Liver cancer Male Malignancy Medical diagnosis Medicine Medicine and Health Sciences Middle Aged Mortality Neoplasms - epidemiology Neoplasms - mortality Odds Ratio Palliative care Pancreatic cancer Patients Population Population studies Population-based studies Public Sector - statistics & numerical data Qatar - epidemiology Statistical analysis Statistical tests Studies United Nations Young Adult |
| title | Patterns in place of cancer death in the State of Qatar: a population-based study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T01%3A03%3A00IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Patterns%20in%20place%20of%20cancer%20death%20in%20the%20State%20of%20Qatar:%20a%20population-based%20study&rft.jtitle=PloS%20one&rft.au=Mohsen,%20Hassan&rft.date=2014-12-23&rft.volume=9&rft.issue=12&rft.spage=e109615&rft.epage=e109615&rft.pages=e109615-e109615&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0109615&rft_dat=%3Cgale_plos_%3EA418126309%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1640007119&rft_id=info:pmid/25536076&rft_galeid=A418126309&rft_doaj_id=oai_doaj_org_article_60d0f1a3d48e4b4babd79c1543d16dca&rfr_iscdi=true |