Toward quantitative neuroimaging biomarkers for Friedreich's ataxia at 7 Tesla: Susceptibility mapping, diffusion imaging, R2 and R1 relaxometry

Friedreich's ataxia (FRDA) is a rare genetic disorder leading to degenerative processes. So far, no effective treatment has been found. Therefore, it is important to assist the development of medication with imaging biomarkers reflecting disease status and progress. Ten FRDA patients (mean age...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Journal of neuroscience research 2020-11, Vol.98 (11), p.2219-2231
Hauptverfasser: Straub, Sina, Mangesius, Stephanie, Emmerich, Julian, Indelicato, Elisabetta, Nachbauer, Wolfgang, Degenhardt, Katja S., Ladd, Mark E., Boesch, Sylvia, Gizewski, Elke R.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 2231
container_issue 11
container_start_page 2219
container_title Journal of neuroscience research
container_volume 98
creator Straub, Sina
Mangesius, Stephanie
Emmerich, Julian
Indelicato, Elisabetta
Nachbauer, Wolfgang
Degenhardt, Katja S.
Ladd, Mark E.
Boesch, Sylvia
Gizewski, Elke R.
description Friedreich's ataxia (FRDA) is a rare genetic disorder leading to degenerative processes. So far, no effective treatment has been found. Therefore, it is important to assist the development of medication with imaging biomarkers reflecting disease status and progress. Ten FRDA patients (mean age 37 ± 14 years; four female) and 10 age‐ and sex‐matched controls were included. Acquisition of magnetic resonance imaging (MRI) data for quantitative susceptibility mapping, R1, R2 relaxometry and diffusion imaging was performed at 7 Tesla. Results of volume of interest (VOI)‐based analyses of the quantitative data were compared with a voxel‐based morphometry (VBM) evaluation. Differences between patients and controls were assessed using the analysis of covariance (ANCOVA; p 
doi_str_mv 10.1002/jnr.24701
format Article
fullrecord <record><control><sourceid>proquest_wiley</sourceid><recordid>TN_cdi_proquest_miscellaneous_2429786264</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2448003478</sourcerecordid><originalsourceid>FETCH-LOGICAL-p2061-861b6ccf3930b4c2d350e48d5086c55bcba2d8bdeb838e6892b2b18048683c3d3</originalsourceid><addsrcrecordid>eNpdkctu2zAQRYmiBeo6XfQPCGSRLKx4-BBFZRcEcR4wWsB11wIpUikdSZRJKYn_op9c5rHK6s7i4OAOLkI_CJwRALrc9eGM8gLIJzQjUBYZz3nxGc2ACcg4EPoVfYtxBwBlmbMZ-rf1TyoYvJ9UP7pRje7R4t5OwbtO3bv-HmvnOxUebIi48QGvgrMmWFf_PYlYjerZqRS4wFsbW3WOf0-xtsPotGvdeMCdGoZkWWDjmmaKzvf4XbzAG4pVb_CG4GBb9ew7O4bDEfrSqDba7-85R39WV9vLm2z96_r28mKdDRQEyaQgWtR1w0oGmtfUsBwslyYHKeo817VW1EhtrJZMWiFLqqkmErgUktXMsDk6ffMOwe8nG8eqc6l526re-ilWlNOykIIKntDjD-jOT6FP7RLFJQDjhUzU8o16cq09VENIf4ZDRaB6GaZKw1Svw1R3PzevB_sPEfaD7A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2448003478</pqid></control><display><type>article</type><title>Toward quantitative neuroimaging biomarkers for Friedreich's ataxia at 7 Tesla: Susceptibility mapping, diffusion imaging, R2 and R1 relaxometry</title><source>Access via Wiley Online Library</source><creator>Straub, Sina ; Mangesius, Stephanie ; Emmerich, Julian ; Indelicato, Elisabetta ; Nachbauer, Wolfgang ; Degenhardt, Katja S. ; Ladd, Mark E. ; Boesch, Sylvia ; Gizewski, Elke R.</creator><creatorcontrib>Straub, Sina ; Mangesius, Stephanie ; Emmerich, Julian ; Indelicato, Elisabetta ; Nachbauer, Wolfgang ; Degenhardt, Katja S. ; Ladd, Mark E. ; Boesch, Sylvia ; Gizewski, Elke R.</creatorcontrib><description>Friedreich's ataxia (FRDA) is a rare genetic disorder leading to degenerative processes. So far, no effective treatment has been found. Therefore, it is important to assist the development of medication with imaging biomarkers reflecting disease status and progress. Ten FRDA patients (mean age 37 ± 14 years; four female) and 10 age‐ and sex‐matched controls were included. Acquisition of magnetic resonance imaging (MRI) data for quantitative susceptibility mapping, R1, R2 relaxometry and diffusion imaging was performed at 7 Tesla. Results of volume of interest (VOI)‐based analyses of the quantitative data were compared with a voxel‐based morphometry (VBM) evaluation. Differences between patients and controls were assessed using the analysis of covariance (ANCOVA; p &lt; 0.01) with age and sex as covariates, effect size of group differences, and correlations with disease characteristics with Spearman correlation coefficient. For the VBM analysis, a statistical threshold of 0.001 for uncorrected and 0.05 for corrected p‐values was used. Statistically significant differences between FRDA patients and controls were found in five out of twelve investigated structures, and statistically significant correlations with disease characteristics were revealed. Moreover, VBM revealed significant white matter atrophy within regions of the brainstem, and the cerebellum. These regions overlapped partially with brain regions for which significant differences between healthy controls and patients were found in the VOI‐based quantitative MRI evaluation. It was shown that two independent analyses provided overlapping results. Moreover, positive results on correlations with disease characteristics were found, indicating that these quantitative MRI parameters could provide more detailed information and assist the search for effective treatments. Quantitative 7 Tesla MRI (susceptibility, relaxation, fractional anisotropy) found differences between ten Friedreich's ataxia patients and matched healthy controls in eight structures of brainstem and cerebellum which correlated with disease characteristics. Voxel‐based morphometry revealed white matter atrophy in partially overlapping volumes of interest (VOI) used for the VOI‐based evaluation. *Statistically significant differences between patients and controls; middle cerebellar peduncle (MCP), pontine crossing tract (PCT), corticospinal tract (CS), medial lemniscus (ML), inferior cerebellar peduncle (ICP), superior cerebellar peduncle (SCP), cerebral peduncle (CP), posterior thalamic radiation (PTR), sagittal stratum (SS), dentate nuclei (DN), red nuclei (RN), substantia nigra (SN).</description><identifier>ISSN: 0360-4012</identifier><identifier>EISSN: 1097-4547</identifier><identifier>DOI: 10.1002/jnr.24701</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc</publisher><subject>Age ; Ataxia ; Atrophy ; Biomarkers ; Brain mapping ; Brain stem ; brainstem ; Cerebellum ; Correlation analysis ; Correlation coefficient ; Correlation coefficients ; Covariance ; diffusion imaging ; Evaluation ; fiber tracts ; Friedreich's ataxia ; Genetic disorders ; Magnetic permeability ; Magnetic resonance imaging ; Mapping ; Medical imaging ; midbrain ; Morphometry ; MR relaxometry ; Neuroimaging ; nuclei ; quantitative MRI ; quantitative susceptibility mapping ; Sex ; Statistical analysis ; Statistical significance ; Substantia alba</subject><ispartof>Journal of neuroscience research, 2020-11, Vol.98 (11), p.2219-2231</ispartof><rights>2020 The Authors. Journal of Neuroscience Research published by Wiley Periodicals LLC</rights><rights>Copyright Wiley Subscription Services, Inc. Nov 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0002-9167-8778 ; 0000-0003-0217-8630 ; 0000-0001-6859-8377 ; 0000-0001-5870-8472 ; 0000-0001-5790-2724</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjnr.24701$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjnr.24701$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids></links><search><creatorcontrib>Straub, Sina</creatorcontrib><creatorcontrib>Mangesius, Stephanie</creatorcontrib><creatorcontrib>Emmerich, Julian</creatorcontrib><creatorcontrib>Indelicato, Elisabetta</creatorcontrib><creatorcontrib>Nachbauer, Wolfgang</creatorcontrib><creatorcontrib>Degenhardt, Katja S.</creatorcontrib><creatorcontrib>Ladd, Mark E.</creatorcontrib><creatorcontrib>Boesch, Sylvia</creatorcontrib><creatorcontrib>Gizewski, Elke R.</creatorcontrib><title>Toward quantitative neuroimaging biomarkers for Friedreich's ataxia at 7 Tesla: Susceptibility mapping, diffusion imaging, R2 and R1 relaxometry</title><title>Journal of neuroscience research</title><description>Friedreich's ataxia (FRDA) is a rare genetic disorder leading to degenerative processes. So far, no effective treatment has been found. Therefore, it is important to assist the development of medication with imaging biomarkers reflecting disease status and progress. Ten FRDA patients (mean age 37 ± 14 years; four female) and 10 age‐ and sex‐matched controls were included. Acquisition of magnetic resonance imaging (MRI) data for quantitative susceptibility mapping, R1, R2 relaxometry and diffusion imaging was performed at 7 Tesla. Results of volume of interest (VOI)‐based analyses of the quantitative data were compared with a voxel‐based morphometry (VBM) evaluation. Differences between patients and controls were assessed using the analysis of covariance (ANCOVA; p &lt; 0.01) with age and sex as covariates, effect size of group differences, and correlations with disease characteristics with Spearman correlation coefficient. For the VBM analysis, a statistical threshold of 0.001 for uncorrected and 0.05 for corrected p‐values was used. Statistically significant differences between FRDA patients and controls were found in five out of twelve investigated structures, and statistically significant correlations with disease characteristics were revealed. Moreover, VBM revealed significant white matter atrophy within regions of the brainstem, and the cerebellum. These regions overlapped partially with brain regions for which significant differences between healthy controls and patients were found in the VOI‐based quantitative MRI evaluation. It was shown that two independent analyses provided overlapping results. Moreover, positive results on correlations with disease characteristics were found, indicating that these quantitative MRI parameters could provide more detailed information and assist the search for effective treatments. Quantitative 7 Tesla MRI (susceptibility, relaxation, fractional anisotropy) found differences between ten Friedreich's ataxia patients and matched healthy controls in eight structures of brainstem and cerebellum which correlated with disease characteristics. Voxel‐based morphometry revealed white matter atrophy in partially overlapping volumes of interest (VOI) used for the VOI‐based evaluation. *Statistically significant differences between patients and controls; middle cerebellar peduncle (MCP), pontine crossing tract (PCT), corticospinal tract (CS), medial lemniscus (ML), inferior cerebellar peduncle (ICP), superior cerebellar peduncle (SCP), cerebral peduncle (CP), posterior thalamic radiation (PTR), sagittal stratum (SS), dentate nuclei (DN), red nuclei (RN), substantia nigra (SN).</description><subject>Age</subject><subject>Ataxia</subject><subject>Atrophy</subject><subject>Biomarkers</subject><subject>Brain mapping</subject><subject>Brain stem</subject><subject>brainstem</subject><subject>Cerebellum</subject><subject>Correlation analysis</subject><subject>Correlation coefficient</subject><subject>Correlation coefficients</subject><subject>Covariance</subject><subject>diffusion imaging</subject><subject>Evaluation</subject><subject>fiber tracts</subject><subject>Friedreich's ataxia</subject><subject>Genetic disorders</subject><subject>Magnetic permeability</subject><subject>Magnetic resonance imaging</subject><subject>Mapping</subject><subject>Medical imaging</subject><subject>midbrain</subject><subject>Morphometry</subject><subject>MR relaxometry</subject><subject>Neuroimaging</subject><subject>nuclei</subject><subject>quantitative MRI</subject><subject>quantitative susceptibility mapping</subject><subject>Sex</subject><subject>Statistical analysis</subject><subject>Statistical significance</subject><subject>Substantia alba</subject><issn>0360-4012</issn><issn>1097-4547</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><recordid>eNpdkctu2zAQRYmiBeo6XfQPCGSRLKx4-BBFZRcEcR4wWsB11wIpUikdSZRJKYn_op9c5rHK6s7i4OAOLkI_CJwRALrc9eGM8gLIJzQjUBYZz3nxGc2ACcg4EPoVfYtxBwBlmbMZ-rf1TyoYvJ9UP7pRje7R4t5OwbtO3bv-HmvnOxUebIi48QGvgrMmWFf_PYlYjerZqRS4wFsbW3WOf0-xtsPotGvdeMCdGoZkWWDjmmaKzvf4XbzAG4pVb_CG4GBb9ew7O4bDEfrSqDba7-85R39WV9vLm2z96_r28mKdDRQEyaQgWtR1w0oGmtfUsBwslyYHKeo817VW1EhtrJZMWiFLqqkmErgUktXMsDk6ffMOwe8nG8eqc6l526re-ilWlNOykIIKntDjD-jOT6FP7RLFJQDjhUzU8o16cq09VENIf4ZDRaB6GaZKw1Svw1R3PzevB_sPEfaD7A</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Straub, Sina</creator><creator>Mangesius, Stephanie</creator><creator>Emmerich, Julian</creator><creator>Indelicato, Elisabetta</creator><creator>Nachbauer, Wolfgang</creator><creator>Degenhardt, Katja S.</creator><creator>Ladd, Mark E.</creator><creator>Boesch, Sylvia</creator><creator>Gizewski, Elke R.</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>7QG</scope><scope>7QP</scope><scope>7QR</scope><scope>7TK</scope><scope>7U7</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9167-8778</orcidid><orcidid>https://orcid.org/0000-0003-0217-8630</orcidid><orcidid>https://orcid.org/0000-0001-6859-8377</orcidid><orcidid>https://orcid.org/0000-0001-5870-8472</orcidid><orcidid>https://orcid.org/0000-0001-5790-2724</orcidid></search><sort><creationdate>202011</creationdate><title>Toward quantitative neuroimaging biomarkers for Friedreich's ataxia at 7 Tesla: Susceptibility mapping, diffusion imaging, R2 and R1 relaxometry</title><author>Straub, Sina ; Mangesius, Stephanie ; Emmerich, Julian ; Indelicato, Elisabetta ; Nachbauer, Wolfgang ; Degenhardt, Katja S. ; Ladd, Mark E. ; Boesch, Sylvia ; Gizewski, Elke R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p2061-861b6ccf3930b4c2d350e48d5086c55bcba2d8bdeb838e6892b2b18048683c3d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age</topic><topic>Ataxia</topic><topic>Atrophy</topic><topic>Biomarkers</topic><topic>Brain mapping</topic><topic>Brain stem</topic><topic>brainstem</topic><topic>Cerebellum</topic><topic>Correlation analysis</topic><topic>Correlation coefficient</topic><topic>Correlation coefficients</topic><topic>Covariance</topic><topic>diffusion imaging</topic><topic>Evaluation</topic><topic>fiber tracts</topic><topic>Friedreich's ataxia</topic><topic>Genetic disorders</topic><topic>Magnetic permeability</topic><topic>Magnetic resonance imaging</topic><topic>Mapping</topic><topic>Medical imaging</topic><topic>midbrain</topic><topic>Morphometry</topic><topic>MR relaxometry</topic><topic>Neuroimaging</topic><topic>nuclei</topic><topic>quantitative MRI</topic><topic>quantitative susceptibility mapping</topic><topic>Sex</topic><topic>Statistical analysis</topic><topic>Statistical significance</topic><topic>Substantia alba</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Straub, Sina</creatorcontrib><creatorcontrib>Mangesius, Stephanie</creatorcontrib><creatorcontrib>Emmerich, Julian</creatorcontrib><creatorcontrib>Indelicato, Elisabetta</creatorcontrib><creatorcontrib>Nachbauer, Wolfgang</creatorcontrib><creatorcontrib>Degenhardt, Katja S.</creatorcontrib><creatorcontrib>Ladd, Mark E.</creatorcontrib><creatorcontrib>Boesch, Sylvia</creatorcontrib><creatorcontrib>Gizewski, Elke R.</creatorcontrib><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Animal Behavior Abstracts</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neuroscience research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Straub, Sina</au><au>Mangesius, Stephanie</au><au>Emmerich, Julian</au><au>Indelicato, Elisabetta</au><au>Nachbauer, Wolfgang</au><au>Degenhardt, Katja S.</au><au>Ladd, Mark E.</au><au>Boesch, Sylvia</au><au>Gizewski, Elke R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Toward quantitative neuroimaging biomarkers for Friedreich's ataxia at 7 Tesla: Susceptibility mapping, diffusion imaging, R2 and R1 relaxometry</atitle><jtitle>Journal of neuroscience research</jtitle><date>2020-11</date><risdate>2020</risdate><volume>98</volume><issue>11</issue><spage>2219</spage><epage>2231</epage><pages>2219-2231</pages><issn>0360-4012</issn><eissn>1097-4547</eissn><abstract>Friedreich's ataxia (FRDA) is a rare genetic disorder leading to degenerative processes. So far, no effective treatment has been found. Therefore, it is important to assist the development of medication with imaging biomarkers reflecting disease status and progress. Ten FRDA patients (mean age 37 ± 14 years; four female) and 10 age‐ and sex‐matched controls were included. Acquisition of magnetic resonance imaging (MRI) data for quantitative susceptibility mapping, R1, R2 relaxometry and diffusion imaging was performed at 7 Tesla. Results of volume of interest (VOI)‐based analyses of the quantitative data were compared with a voxel‐based morphometry (VBM) evaluation. Differences between patients and controls were assessed using the analysis of covariance (ANCOVA; p &lt; 0.01) with age and sex as covariates, effect size of group differences, and correlations with disease characteristics with Spearman correlation coefficient. For the VBM analysis, a statistical threshold of 0.001 for uncorrected and 0.05 for corrected p‐values was used. Statistically significant differences between FRDA patients and controls were found in five out of twelve investigated structures, and statistically significant correlations with disease characteristics were revealed. Moreover, VBM revealed significant white matter atrophy within regions of the brainstem, and the cerebellum. These regions overlapped partially with brain regions for which significant differences between healthy controls and patients were found in the VOI‐based quantitative MRI evaluation. It was shown that two independent analyses provided overlapping results. Moreover, positive results on correlations with disease characteristics were found, indicating that these quantitative MRI parameters could provide more detailed information and assist the search for effective treatments. Quantitative 7 Tesla MRI (susceptibility, relaxation, fractional anisotropy) found differences between ten Friedreich's ataxia patients and matched healthy controls in eight structures of brainstem and cerebellum which correlated with disease characteristics. Voxel‐based morphometry revealed white matter atrophy in partially overlapping volumes of interest (VOI) used for the VOI‐based evaluation. *Statistically significant differences between patients and controls; middle cerebellar peduncle (MCP), pontine crossing tract (PCT), corticospinal tract (CS), medial lemniscus (ML), inferior cerebellar peduncle (ICP), superior cerebellar peduncle (SCP), cerebral peduncle (CP), posterior thalamic radiation (PTR), sagittal stratum (SS), dentate nuclei (DN), red nuclei (RN), substantia nigra (SN).</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1002/jnr.24701</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-9167-8778</orcidid><orcidid>https://orcid.org/0000-0003-0217-8630</orcidid><orcidid>https://orcid.org/0000-0001-6859-8377</orcidid><orcidid>https://orcid.org/0000-0001-5870-8472</orcidid><orcidid>https://orcid.org/0000-0001-5790-2724</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0360-4012
ispartof Journal of neuroscience research, 2020-11, Vol.98 (11), p.2219-2231
issn 0360-4012
1097-4547
language eng
recordid cdi_proquest_miscellaneous_2429786264
source Access via Wiley Online Library
subjects Age
Ataxia
Atrophy
Biomarkers
Brain mapping
Brain stem
brainstem
Cerebellum
Correlation analysis
Correlation coefficient
Correlation coefficients
Covariance
diffusion imaging
Evaluation
fiber tracts
Friedreich's ataxia
Genetic disorders
Magnetic permeability
Magnetic resonance imaging
Mapping
Medical imaging
midbrain
Morphometry
MR relaxometry
Neuroimaging
nuclei
quantitative MRI
quantitative susceptibility mapping
Sex
Statistical analysis
Statistical significance
Substantia alba
title Toward quantitative neuroimaging biomarkers for Friedreich's ataxia at 7 Tesla: Susceptibility mapping, diffusion imaging, R2 and R1 relaxometry
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-03T21%3A43%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_wiley&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Toward%20quantitative%20neuroimaging%20biomarkers%20for%20Friedreich's%20ataxia%20at%207%20Tesla:%20Susceptibility%20mapping,%20diffusion%20imaging,%20R2%20and%20R1%20relaxometry&rft.jtitle=Journal%20of%20neuroscience%20research&rft.au=Straub,%20Sina&rft.date=2020-11&rft.volume=98&rft.issue=11&rft.spage=2219&rft.epage=2231&rft.pages=2219-2231&rft.issn=0360-4012&rft.eissn=1097-4547&rft_id=info:doi/10.1002/jnr.24701&rft_dat=%3Cproquest_wiley%3E2448003478%3C/proquest_wiley%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2448003478&rft_id=info:pmid/&rfr_iscdi=true