Validation of the Rowlands Universal Dementia Assessment Scale (RUDAS) to detect major neurocognitive disorder among elderly people in Ethiopia, 2020
The Rowland Universal Dementia Assessment Scale (RUDAS) is currently widely used for research and clinical purposes in many countries. However, its applicability and validity have not been evaluated in the Ethiopian context so far. Therefore, we designed this study to assess the reliability and vali...
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| description | The Rowland Universal Dementia Assessment Scale (RUDAS) is currently widely used for research and clinical purposes in many countries. However, its applicability and validity have not been evaluated in the Ethiopian context so far. Therefore, we designed this study to assess the reliability and validity of Rowland Universal Dementia Assessment Scale to detect major neurocognitive disorder among older people in Ethiopia.
An institution-based cross-sectional study was conducted among selected older people residing in Macedonia institutional care center, Addis Ababa, Ethiopia. The gold standard diagnosis was determined using the Diagnostic and Statistical Manual of Mental Disorders criteria for major neurocognitive disorders. Stata v16 statistical software was used for data analysis. Receivers operating curve analysis, correlations, linear regression, and independent t-test were performed with statistically significant associations declared at a p-value of |
| doi_str_mv | 10.1371/journal.pone.0262483 |
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An institution-based cross-sectional study was conducted among selected older people residing in Macedonia institutional care center, Addis Ababa, Ethiopia. The gold standard diagnosis was determined using the Diagnostic and Statistical Manual of Mental Disorders criteria for major neurocognitive disorders. Stata v16 statistical software was used for data analysis. Receivers operating curve analysis, correlations, linear regression, and independent t-test were performed with statistically significant associations declared at a p-value of <0.05. Inter-rater, internal consistency reliabilities, content, criterion and construct validities were also determined.
A total of 116 individuals participated in the study with a 100% response rate. Most (52.7%) of the participants were male and the mean age in years was 69.9± 8. The Cronbach's alpha for RUDAS was 0.7 with an intra-class correlation coefficient value of 0.9. RUDAS has an area under the receivers operating curve of 0.87 with an optimal cutoff value of ≤ 22. At this cutoff point, RUDAS has sensitivity and specificity of 92.3 and 75.3 with positive and negative likelihood ratios as well as positive and negative predictive values of 3.7, 0.1, 65.5%, and 91.5%, respectively. There has also been a significant difference in the mean scores of RUDAS among the two diagnostic groups showing good construct validity.
The Rowland Universal Dementia Assessment Scale has been demonstrated to be a valid and reliable tool to detect major neurocognitive disorder. Policy makers and professionals can incorporate the tool in clinical and research practices in developing countries.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0262483</identifier><identifier>PMID: 35051198</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged, 80 and over ; Biology and Life Sciences ; Cognition ; Cognitive ability ; Correlation ; Correlation coefficient ; Correlation coefficients ; Cross-Sectional Studies ; Cutoffs ; Data analysis ; Degeneration ; Dementia ; Dementia - diagnosis ; Dementia disorders ; Developing countries ; Diagnostic tests ; Ethiopia ; Female ; Funding ; Geriatric Assessment ; Humans ; LDCs ; Likelihood ratio ; Linguistics ; Low income groups ; Male ; Medical examination ; Medicine and Health Sciences ; Mental depression ; Mental disorders ; Middle Aged ; Multiculturalism & pluralism ; Nervous system ; Neurocognitive Disorders - diagnosis ; Neuropsychological Tests ; Older people ; Population ; Psychiatry ; Receivers ; Reliability analysis ; Reproducibility of Results ; Sample size ; Sensitivity and Specificity ; Social Sciences ; Sociodemographics ; Software ; Statistical analysis ; Statistics ; Supervision</subject><ispartof>PloS one, 2022-01, Vol.17 (1), p.e0262483-e0262483</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Daniel 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>2022 Daniel et al 2022 Daniel et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c593t-ee0a78207280def2efb7a6a3ada10dce4b6ee01a8618a3279391a7e7f7de1af03</citedby><cites>FETCH-LOGICAL-c593t-ee0a78207280def2efb7a6a3ada10dce4b6ee01a8618a3279391a7e7f7de1af03</cites><orcidid>0000-0002-4112-1509</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775314/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775314/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,2914,23846,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35051198$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>De Rosa, Salvatore</contributor><creatorcontrib>Daniel, Beniam</creatorcontrib><creatorcontrib>Agenagnew, Liyew</creatorcontrib><creatorcontrib>Workicho, Abdulhalik</creatorcontrib><creatorcontrib>Abera, Mubarek</creatorcontrib><title>Validation of the Rowlands Universal Dementia Assessment Scale (RUDAS) to detect major neurocognitive disorder among elderly people in Ethiopia, 2020</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The Rowland Universal Dementia Assessment Scale (RUDAS) is currently widely used for research and clinical purposes in many countries. However, its applicability and validity have not been evaluated in the Ethiopian context so far. Therefore, we designed this study to assess the reliability and validity of Rowland Universal Dementia Assessment Scale to detect major neurocognitive disorder among older people in Ethiopia.
An institution-based cross-sectional study was conducted among selected older people residing in Macedonia institutional care center, Addis Ababa, Ethiopia. The gold standard diagnosis was determined using the Diagnostic and Statistical Manual of Mental Disorders criteria for major neurocognitive disorders. Stata v16 statistical software was used for data analysis. Receivers operating curve analysis, correlations, linear regression, and independent t-test were performed with statistically significant associations declared at a p-value of <0.05. Inter-rater, internal consistency reliabilities, content, criterion and construct validities were also determined.
A total of 116 individuals participated in the study with a 100% response rate. Most (52.7%) of the participants were male and the mean age in years was 69.9± 8. The Cronbach's alpha for RUDAS was 0.7 with an intra-class correlation coefficient value of 0.9. RUDAS has an area under the receivers operating curve of 0.87 with an optimal cutoff value of ≤ 22. At this cutoff point, RUDAS has sensitivity and specificity of 92.3 and 75.3 with positive and negative likelihood ratios as well as positive and negative predictive values of 3.7, 0.1, 65.5%, and 91.5%, respectively. There has also been a significant difference in the mean scores of RUDAS among the two diagnostic groups showing good construct validity.
The Rowland Universal Dementia Assessment Scale has been demonstrated to be a valid and reliable tool to detect major neurocognitive disorder. Policy makers and professionals can incorporate the tool in clinical and research practices in developing countries.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biology and Life Sciences</subject><subject>Cognition</subject><subject>Cognitive ability</subject><subject>Correlation</subject><subject>Correlation coefficient</subject><subject>Correlation coefficients</subject><subject>Cross-Sectional Studies</subject><subject>Cutoffs</subject><subject>Data analysis</subject><subject>Degeneration</subject><subject>Dementia</subject><subject>Dementia - diagnosis</subject><subject>Dementia disorders</subject><subject>Developing countries</subject><subject>Diagnostic tests</subject><subject>Ethiopia</subject><subject>Female</subject><subject>Funding</subject><subject>Geriatric Assessment</subject><subject>Humans</subject><subject>LDCs</subject><subject>Likelihood ratio</subject><subject>Linguistics</subject><subject>Low income groups</subject><subject>Male</subject><subject>Medical examination</subject><subject>Medicine and Health Sciences</subject><subject>Mental depression</subject><subject>Mental disorders</subject><subject>Middle Aged</subject><subject>Multiculturalism & pluralism</subject><subject>Nervous system</subject><subject>Neurocognitive Disorders - diagnosis</subject><subject>Neuropsychological Tests</subject><subject>Older people</subject><subject>Population</subject><subject>Psychiatry</subject><subject>Receivers</subject><subject>Reliability analysis</subject><subject>Reproducibility of Results</subject><subject>Sample size</subject><subject>Sensitivity and Specificity</subject><subject>Social Sciences</subject><subject>Sociodemographics</subject><subject>Software</subject><subject>Statistical analysis</subject><subject>Statistics</subject><subject>Supervision</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</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>eNptUl1rFDEUHUSxtfoPRAO-VHDXfMxMMi_C0lYtFITW-hruJjfbLDPJmsxW-kP8v2a729JKyUNubs499-tU1VtGp0xI9nkZ1ylAP13FgFPKW14r8azaZ53gk5ZT8fyBvVe9ynlJaSNU276s9kRDG8Y6tV_9_QW9tzD6GEh0ZLxCch7_9BBsJpfBX2PK0JNjHDCMHsgsZ8x58yAXBnokh-eXx7OLj2SMxOKIZiQDLGMiAdcpmrgIfiwkxPock8VEYIhhQbAvdn9DVhhXhcQHcjJe-bjy8Ilwyunr6oWDPuOb3X1QXX49-Xn0fXL249vp0exsYppOjBNEClJxKrmiFh1HN5fQggALjFqD9bwtEAaqZQoEl53oGEiUTlpk4Kg4qN5veVd9zHo30azLMFnbcqGagjjdImyEpV4lP0C60RG8vnXEtNCQRm961LID23BruGNN7Wo3F065ujUUrFWsMYXryy7bej5gqS-MCfpHpI9_gr_Si3itlZSNYHUhONwRpPh7jXnUg88G-7IujOvbujmXsus2nX34D_p0dzvUouxS--BiyWs2pHrWqq5TLW1UQU2fQJVjcfCmyM_54n8UUG8DTIo5J3T3PTKqN-K9K0ZvxKt34i1h7x7O5z7oTq3iH8Ix7l0</recordid><startdate>20220101</startdate><enddate>20220101</enddate><creator>Daniel, Beniam</creator><creator>Agenagnew, Liyew</creator><creator>Workicho, Abdulhalik</creator><creator>Abera, Mubarek</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>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>COVID</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><orcidid>https://orcid.org/0000-0002-4112-1509</orcidid></search><sort><creationdate>20220101</creationdate><title>Validation of the Rowlands Universal Dementia Assessment Scale (RUDAS) to detect major neurocognitive disorder among elderly people in Ethiopia, 2020</title><author>Daniel, Beniam ; Agenagnew, Liyew ; Workicho, Abdulhalik ; Abera, Mubarek</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c593t-ee0a78207280def2efb7a6a3ada10dce4b6ee01a8618a3279391a7e7f7de1af03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biology and Life Sciences</topic><topic>Cognition</topic><topic>Cognitive ability</topic><topic>Correlation</topic><topic>Correlation coefficient</topic><topic>Correlation coefficients</topic><topic>Cross-Sectional Studies</topic><topic>Cutoffs</topic><topic>Data analysis</topic><topic>Degeneration</topic><topic>Dementia</topic><topic>Dementia - diagnosis</topic><topic>Dementia disorders</topic><topic>Developing countries</topic><topic>Diagnostic tests</topic><topic>Ethiopia</topic><topic>Female</topic><topic>Funding</topic><topic>Geriatric Assessment</topic><topic>Humans</topic><topic>LDCs</topic><topic>Likelihood ratio</topic><topic>Linguistics</topic><topic>Low income groups</topic><topic>Male</topic><topic>Medical examination</topic><topic>Medicine and Health Sciences</topic><topic>Mental depression</topic><topic>Mental disorders</topic><topic>Middle Aged</topic><topic>Multiculturalism & pluralism</topic><topic>Nervous system</topic><topic>Neurocognitive Disorders - diagnosis</topic><topic>Neuropsychological Tests</topic><topic>Older people</topic><topic>Population</topic><topic>Psychiatry</topic><topic>Receivers</topic><topic>Reliability analysis</topic><topic>Reproducibility of Results</topic><topic>Sample size</topic><topic>Sensitivity and Specificity</topic><topic>Social Sciences</topic><topic>Sociodemographics</topic><topic>Software</topic><topic>Statistical analysis</topic><topic>Statistics</topic><topic>Supervision</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Daniel, Beniam</creatorcontrib><creatorcontrib>Agenagnew, Liyew</creatorcontrib><creatorcontrib>Workicho, Abdulhalik</creatorcontrib><creatorcontrib>Abera, Mubarek</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>ProQuest Nursing and Allied Health Journals</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>ProQuest Health and Medical</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 (ProQuest)</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</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>Daniel, Beniam</au><au>Agenagnew, Liyew</au><au>Workicho, Abdulhalik</au><au>Abera, Mubarek</au><au>De Rosa, Salvatore</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Validation of the Rowlands Universal Dementia Assessment Scale (RUDAS) to detect major neurocognitive disorder among elderly people in Ethiopia, 2020</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2022-01-01</date><risdate>2022</risdate><volume>17</volume><issue>1</issue><spage>e0262483</spage><epage>e0262483</epage><pages>e0262483-e0262483</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The Rowland Universal Dementia Assessment Scale (RUDAS) is currently widely used for research and clinical purposes in many countries. However, its applicability and validity have not been evaluated in the Ethiopian context so far. Therefore, we designed this study to assess the reliability and validity of Rowland Universal Dementia Assessment Scale to detect major neurocognitive disorder among older people in Ethiopia.
An institution-based cross-sectional study was conducted among selected older people residing in Macedonia institutional care center, Addis Ababa, Ethiopia. The gold standard diagnosis was determined using the Diagnostic and Statistical Manual of Mental Disorders criteria for major neurocognitive disorders. Stata v16 statistical software was used for data analysis. Receivers operating curve analysis, correlations, linear regression, and independent t-test were performed with statistically significant associations declared at a p-value of <0.05. Inter-rater, internal consistency reliabilities, content, criterion and construct validities were also determined.
A total of 116 individuals participated in the study with a 100% response rate. Most (52.7%) of the participants were male and the mean age in years was 69.9± 8. The Cronbach's alpha for RUDAS was 0.7 with an intra-class correlation coefficient value of 0.9. RUDAS has an area under the receivers operating curve of 0.87 with an optimal cutoff value of ≤ 22. At this cutoff point, RUDAS has sensitivity and specificity of 92.3 and 75.3 with positive and negative likelihood ratios as well as positive and negative predictive values of 3.7, 0.1, 65.5%, and 91.5%, respectively. There has also been a significant difference in the mean scores of RUDAS among the two diagnostic groups showing good construct validity.
The Rowland Universal Dementia Assessment Scale has been demonstrated to be a valid and reliable tool to detect major neurocognitive disorder. Policy makers and professionals can incorporate the tool in clinical and research practices in developing countries.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>35051198</pmid><doi>10.1371/journal.pone.0262483</doi><orcidid>https://orcid.org/0000-0002-4112-1509</orcidid><oa>free_for_read</oa></addata></record> |
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| issn | 1932-6203 1932-6203 |
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| 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 | Aged Aged, 80 and over Biology and Life Sciences Cognition Cognitive ability Correlation Correlation coefficient Correlation coefficients Cross-Sectional Studies Cutoffs Data analysis Degeneration Dementia Dementia - diagnosis Dementia disorders Developing countries Diagnostic tests Ethiopia Female Funding Geriatric Assessment Humans LDCs Likelihood ratio Linguistics Low income groups Male Medical examination Medicine and Health Sciences Mental depression Mental disorders Middle Aged Multiculturalism & pluralism Nervous system Neurocognitive Disorders - diagnosis Neuropsychological Tests Older people Population Psychiatry Receivers Reliability analysis Reproducibility of Results Sample size Sensitivity and Specificity Social Sciences Sociodemographics Software Statistical analysis Statistics Supervision |
| title | Validation of the Rowlands Universal Dementia Assessment Scale (RUDAS) to detect major neurocognitive disorder among elderly people in Ethiopia, 2020 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-25T02%3A32%3A18IST&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=Validation%20of%20the%20Rowlands%20Universal%20Dementia%20Assessment%20Scale%20(RUDAS)%20to%20detect%20major%20neurocognitive%20disorder%20among%20elderly%20people%20in%20Ethiopia,%202020&rft.jtitle=PloS%20one&rft.au=Daniel,%20Beniam&rft.date=2022-01-01&rft.volume=17&rft.issue=1&rft.spage=e0262483&rft.epage=e0262483&rft.pages=e0262483-e0262483&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0262483&rft_dat=%3Cgale_plos_%3EA689986058%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=2621662385&rft_id=info:pmid/35051198&rft_galeid=A689986058&rft_doaj_id=oai_doaj_org_article_79ad52dc2f154f4fb3f8f46c0add815c&rfr_iscdi=true |