Re-Infection Outcomes Following One- And Two-Stage Surgical Revision of Infected Knee Prosthesis: A Systematic Review and Meta-Analysis
Periprosthetic joint infection (PJI) is a serious complication of total knee arthroplasty. Two-stage revision is the most widely used technique and considered as the most effective for treating periprosthetic knee infection. The one-stage revision strategy is an emerging alternative option, however,...
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| description | Periprosthetic joint infection (PJI) is a serious complication of total knee arthroplasty. Two-stage revision is the most widely used technique and considered as the most effective for treating periprosthetic knee infection. The one-stage revision strategy is an emerging alternative option, however, its performance in comparison to the two-stage strategy is unclear. We therefore sought to ask if there was a difference in re-infection rates and other clinical outcomes when comparing the one-stage to the two-stage revision strategy.
Our first objective was to compare re-infection (new and recurrent infections) rates for one- and two-stage revision surgery for periprosthetic knee infection. Our second objective was to compare between the two revision strategies, clinical outcomes as measured by postoperative Knee Society Knee score, Knee Society Function score, Hospital for Special Surgery knee score, WOMAC score, and range of motion.
Systematic review and meta-analysis.
MEDLINE, EMBASE, Web of Science, Cochrane Library, reference lists of relevant studies to August 2015, and correspondence with investigators.
Longitudinal (prospective or retrospective cohort) studies conducted in generally unselected patients with periprosthetic knee infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision surgery. No clinical trials comparing both revision strategies were identified.
Two independent investigators extracted data and discrepancies were resolved by consensus with a third investigator. Re-infection rates from 10 one-stage studies (423 participants) and 108 two-stage studies (5,129 participants) were meta-analysed using random-effect models after arcsine transformation.
The rate (95% confidence intervals) of re-infection was 7.6% (3.4-13.1) in one-stage studies. The corresponding re-infection rate for two-stage revision was 8.8% (7.2-10.6). In subgroup analyses, re-infection rates remained generally similar for several study-level and clinically relevant characteristics. Postoperative clinical outcomes of knee scores and range of motion were similar for both revision strategies.
Potential bias owing to the limited number of one-stage revision studies and inability to explore heterogeneity in greater detail.
Available evidence from aggregate published data suggest the one-stage revision strategy may be as effective as the two-stage revision strategy in treating infected knee prostheses in gen |
| doi_str_mv | 10.1371/journal.pone.0151537 |
| format | Article |
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Our first objective was to compare re-infection (new and recurrent infections) rates for one- and two-stage revision surgery for periprosthetic knee infection. Our second objective was to compare between the two revision strategies, clinical outcomes as measured by postoperative Knee Society Knee score, Knee Society Function score, Hospital for Special Surgery knee score, WOMAC score, and range of motion.
Systematic review and meta-analysis.
MEDLINE, EMBASE, Web of Science, Cochrane Library, reference lists of relevant studies to August 2015, and correspondence with investigators.
Longitudinal (prospective or retrospective cohort) studies conducted in generally unselected patients with periprosthetic knee infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision surgery. No clinical trials comparing both revision strategies were identified.
Two independent investigators extracted data and discrepancies were resolved by consensus with a third investigator. Re-infection rates from 10 one-stage studies (423 participants) and 108 two-stage studies (5,129 participants) were meta-analysed using random-effect models after arcsine transformation.
The rate (95% confidence intervals) of re-infection was 7.6% (3.4-13.1) in one-stage studies. The corresponding re-infection rate for two-stage revision was 8.8% (7.2-10.6). In subgroup analyses, re-infection rates remained generally similar for several study-level and clinically relevant characteristics. Postoperative clinical outcomes of knee scores and range of motion were similar for both revision strategies.
Potential bias owing to the limited number of one-stage revision studies and inability to explore heterogeneity in greater detail.
Available evidence from aggregate published data suggest the one-stage revision strategy may be as effective as the two-stage revision strategy in treating infected knee prostheses in generally unselected patients. Further investigation is warranted.
PROSPERO 2015: CRD42015017327.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0151537</identifier><identifier>PMID: 26967645</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Antibiotics ; Arthroplasty (knee) ; Biology and Life Sciences ; Biomedical materials ; Clinical outcomes ; Clinical trials ; Confidence intervals ; Data processing ; Financial analysis ; Hospital costs ; Humans ; Infection ; Infections ; Joint diseases ; Joint surgery ; Knee ; Knee prostheses ; Knee Prosthesis - adverse effects ; Medical ethics ; Medical research ; Medicine and Health Sciences ; Meta-analysis ; Patients ; Physical Sciences ; Prospero protein ; Prostheses ; Prosthesis-Related Infections - surgery ; Prosthetics ; Recurrence ; Recurrent infection ; Reoperation - methods ; Research and Analysis Methods ; Risk factors ; Strategy ; Studies ; Surgery ; Surgical implants ; Systematic review ; Transformation ; Treatment outcome</subject><ispartof>PloS one, 2016-03, Vol.11 (3), p.e0151537-e0151537</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Kunutsor 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>2016 Kunutsor et al 2016 Kunutsor et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-8e89a35b94fc03882aa28c5445e5b2562d7b79d32554808c3ece57cb345ecbca3</citedby><cites>FETCH-LOGICAL-c758t-8e89a35b94fc03882aa28c5445e5b2562d7b79d32554808c3ece57cb345ecbca3</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/PMC4788419/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788419/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26967645$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kunutsor, Setor K</creatorcontrib><creatorcontrib>Whitehouse, Michael R</creatorcontrib><creatorcontrib>Lenguerrand, Erik</creatorcontrib><creatorcontrib>Blom, Ashley W</creatorcontrib><creatorcontrib>Beswick, Andrew D</creatorcontrib><creatorcontrib>INFORM Team</creatorcontrib><title>Re-Infection Outcomes Following One- And Two-Stage Surgical Revision of Infected Knee Prosthesis: A Systematic Review and Meta-Analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Periprosthetic joint infection (PJI) is a serious complication of total knee arthroplasty. Two-stage revision is the most widely used technique and considered as the most effective for treating periprosthetic knee infection. The one-stage revision strategy is an emerging alternative option, however, its performance in comparison to the two-stage strategy is unclear. We therefore sought to ask if there was a difference in re-infection rates and other clinical outcomes when comparing the one-stage to the two-stage revision strategy.
Our first objective was to compare re-infection (new and recurrent infections) rates for one- and two-stage revision surgery for periprosthetic knee infection. Our second objective was to compare between the two revision strategies, clinical outcomes as measured by postoperative Knee Society Knee score, Knee Society Function score, Hospital for Special Surgery knee score, WOMAC score, and range of motion.
Systematic review and meta-analysis.
MEDLINE, EMBASE, Web of Science, Cochrane Library, reference lists of relevant studies to August 2015, and correspondence with investigators.
Longitudinal (prospective or retrospective cohort) studies conducted in generally unselected patients with periprosthetic knee infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision surgery. No clinical trials comparing both revision strategies were identified.
Two independent investigators extracted data and discrepancies were resolved by consensus with a third investigator. Re-infection rates from 10 one-stage studies (423 participants) and 108 two-stage studies (5,129 participants) were meta-analysed using random-effect models after arcsine transformation.
The rate (95% confidence intervals) of re-infection was 7.6% (3.4-13.1) in one-stage studies. The corresponding re-infection rate for two-stage revision was 8.8% (7.2-10.6). In subgroup analyses, re-infection rates remained generally similar for several study-level and clinically relevant characteristics. Postoperative clinical outcomes of knee scores and range of motion were similar for both revision strategies.
Potential bias owing to the limited number of one-stage revision studies and inability to explore heterogeneity in greater detail.
Available evidence from aggregate published data suggest the one-stage revision strategy may be as effective as the two-stage revision strategy in treating infected knee prostheses in generally unselected patients. Further investigation is warranted.
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surgery</subject><subject>Prosthetics</subject><subject>Recurrence</subject><subject>Recurrent infection</subject><subject>Reoperation - methods</subject><subject>Research and Analysis Methods</subject><subject>Risk factors</subject><subject>Strategy</subject><subject>Studies</subject><subject>Surgery</subject><subject>Surgical implants</subject><subject>Systematic review</subject><subject>Transformation</subject><subject>Treatment outcome</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk91u0zAYhiMEYqNwBwgsISE4SEliO3Z2gFRNDCqGitrBqeU4X1JXSVxiZ6VXwG3jttnUoh2gHDiyn_e1v78geBlH4xiz-MPK9F0r6_HatDCOYhpTzB4F53GGkzBNIvz46P8seGbtKooo5mn6NDhL0ixlKaHnwZ85hNO2BOW0adGsd8o0YNGVqWuz0W2FZi2EaNIW6GZjwoWTFaBF31VayRrN4Vbbnc6U6GACBfraAqDvnbFuCVbbCzRBi6110Ein1V4CGyS94TdwMpz4ELYeex48KWVt4cWwjoIfV59uLr-E17PP08vJdagY5S7kwDOJaZ6RUkWY80TKhCtKCAWaJzRNCpazrMAJpYRHXGFQQJnKsQdUriQeBa8PvuvaWDHk0IqYsYSQLI25J6YHojByJdadbmS3FUZqsd8wXSVk50OpQRQqz8scypJKIKqkPE7zhMRpyXMpIWPe6-NwW583UChoXSfrE9PTk1YvRWVuBWGcE1--UfBuMOjMrx6sE422CupatmD6_bsx8dVk2KNv_kEfjm6gKukD0G1p_L1qZyomhGLCYkIjT40foPxXQKOVb7hS-_0TwfsTgWcc_HaV7K0V08X8_9nZz1P27RG7BFm7pTV1v-tWewqSA6h859kOyvskx5HYzctdNsRuXsQwL1726rhA96K7AcF_ARZKEWE</recordid><startdate>20160311</startdate><enddate>20160311</enddate><creator>Kunutsor, Setor K</creator><creator>Whitehouse, Michael R</creator><creator>Lenguerrand, Erik</creator><creator>Blom, Ashley W</creator><creator>Beswick, Andrew D</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>AEUYN</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>20160311</creationdate><title>Re-Infection Outcomes Following One- And Two-Stage Surgical Revision of Infected Knee Prosthesis: A Systematic Review and Meta-Analysis</title><author>Kunutsor, Setor K ; Whitehouse, Michael R ; Lenguerrand, Erik ; Blom, Ashley W ; Beswick, Andrew D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c758t-8e89a35b94fc03882aa28c5445e5b2562d7b79d32554808c3ece57cb345ecbca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Analysis</topic><topic>Antibiotics</topic><topic>Arthroplasty (knee)</topic><topic>Biology and Life Sciences</topic><topic>Biomedical materials</topic><topic>Clinical outcomes</topic><topic>Clinical trials</topic><topic>Confidence intervals</topic><topic>Data processing</topic><topic>Financial analysis</topic><topic>Hospital costs</topic><topic>Humans</topic><topic>Infection</topic><topic>Infections</topic><topic>Joint diseases</topic><topic>Joint surgery</topic><topic>Knee</topic><topic>Knee prostheses</topic><topic>Knee Prosthesis - adverse effects</topic><topic>Medical ethics</topic><topic>Medical research</topic><topic>Medicine and Health Sciences</topic><topic>Meta-analysis</topic><topic>Patients</topic><topic>Physical Sciences</topic><topic>Prospero protein</topic><topic>Prostheses</topic><topic>Prosthesis-Related Infections - surgery</topic><topic>Prosthetics</topic><topic>Recurrence</topic><topic>Recurrent infection</topic><topic>Reoperation - methods</topic><topic>Research and Analysis Methods</topic><topic>Risk factors</topic><topic>Strategy</topic><topic>Studies</topic><topic>Surgery</topic><topic>Surgical implants</topic><topic>Systematic review</topic><topic>Transformation</topic><topic>Treatment outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kunutsor, Setor K</creatorcontrib><creatorcontrib>Whitehouse, Michael R</creatorcontrib><creatorcontrib>Lenguerrand, Erik</creatorcontrib><creatorcontrib>Blom, Ashley W</creatorcontrib><creatorcontrib>Beswick, Andrew D</creatorcontrib><creatorcontrib>INFORM Team</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 One Sustainability</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>Kunutsor, Setor K</au><au>Whitehouse, Michael R</au><au>Lenguerrand, Erik</au><au>Blom, Ashley W</au><au>Beswick, Andrew D</au><aucorp>INFORM Team</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Re-Infection Outcomes Following One- And Two-Stage Surgical Revision of Infected Knee Prosthesis: A Systematic Review and Meta-Analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-03-11</date><risdate>2016</risdate><volume>11</volume><issue>3</issue><spage>e0151537</spage><epage>e0151537</epage><pages>e0151537-e0151537</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Periprosthetic joint infection (PJI) is a serious complication of total knee arthroplasty. Two-stage revision is the most widely used technique and considered as the most effective for treating periprosthetic knee infection. The one-stage revision strategy is an emerging alternative option, however, its performance in comparison to the two-stage strategy is unclear. We therefore sought to ask if there was a difference in re-infection rates and other clinical outcomes when comparing the one-stage to the two-stage revision strategy.
Our first objective was to compare re-infection (new and recurrent infections) rates for one- and two-stage revision surgery for periprosthetic knee infection. Our second objective was to compare between the two revision strategies, clinical outcomes as measured by postoperative Knee Society Knee score, Knee Society Function score, Hospital for Special Surgery knee score, WOMAC score, and range of motion.
Systematic review and meta-analysis.
MEDLINE, EMBASE, Web of Science, Cochrane Library, reference lists of relevant studies to August 2015, and correspondence with investigators.
Longitudinal (prospective or retrospective cohort) studies conducted in generally unselected patients with periprosthetic knee infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision surgery. No clinical trials comparing both revision strategies were identified.
Two independent investigators extracted data and discrepancies were resolved by consensus with a third investigator. Re-infection rates from 10 one-stage studies (423 participants) and 108 two-stage studies (5,129 participants) were meta-analysed using random-effect models after arcsine transformation.
The rate (95% confidence intervals) of re-infection was 7.6% (3.4-13.1) in one-stage studies. The corresponding re-infection rate for two-stage revision was 8.8% (7.2-10.6). In subgroup analyses, re-infection rates remained generally similar for several study-level and clinically relevant characteristics. Postoperative clinical outcomes of knee scores and range of motion were similar for both revision strategies.
Potential bias owing to the limited number of one-stage revision studies and inability to explore heterogeneity in greater detail.
Available evidence from aggregate published data suggest the one-stage revision strategy may be as effective as the two-stage revision strategy in treating infected knee prostheses in generally unselected patients. Further investigation is warranted.
PROSPERO 2015: CRD42015017327.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26967645</pmid><doi>10.1371/journal.pone.0151537</doi><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_1772449618 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Analysis Antibiotics Arthroplasty (knee) Biology and Life Sciences Biomedical materials Clinical outcomes Clinical trials Confidence intervals Data processing Financial analysis Hospital costs Humans Infection Infections Joint diseases Joint surgery Knee Knee prostheses Knee Prosthesis - adverse effects Medical ethics Medical research Medicine and Health Sciences Meta-analysis Patients Physical Sciences Prospero protein Prostheses Prosthesis-Related Infections - surgery Prosthetics Recurrence Recurrent infection Reoperation - methods Research and Analysis Methods Risk factors Strategy Studies Surgery Surgical implants Systematic review Transformation Treatment outcome |
| title | Re-Infection Outcomes Following One- And Two-Stage Surgical Revision of Infected Knee Prosthesis: A Systematic Review and Meta-Analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-06T22%3A59%3A57IST&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=Re-Infection%20Outcomes%20Following%20One-%20And%20Two-Stage%20Surgical%20Revision%20of%20Infected%20Knee%20Prosthesis:%20A%20Systematic%20Review%20and%20Meta-Analysis&rft.jtitle=PloS%20one&rft.au=Kunutsor,%20Setor%20K&rft.aucorp=INFORM%20Team&rft.date=2016-03-11&rft.volume=11&rft.issue=3&rft.spage=e0151537&rft.epage=e0151537&rft.pages=e0151537-e0151537&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0151537&rft_dat=%3Cgale_plos_%3EA453471450%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=1772449618&rft_id=info:pmid/26967645&rft_galeid=A453471450&rft_doaj_id=oai_doaj_org_article_dcbbfbeff5ae4cf5816b2416f8baae97&rfr_iscdi=true |