The diagnostic role of capnography in pulmonary embolism
Abstract The aim of this study was to evaluate the diagnostic contribution of alveolar dead space fraction (AVDSf) measured using capnography in patients admitted with suspected pulmonary embolism (PE). A total of 58 patients who were admitted to our hospital with suspected PE between October 2006 a...
Gespeichert in:
| Veröffentlicht in: | The American journal of emergency medicine 2010-05, Vol.28 (4), p.460-465 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 465 |
|---|---|
| container_issue | 4 |
| container_start_page | 460 |
| container_title | The American journal of emergency medicine |
| container_volume | 28 |
| creator | Kurt, Ozlem Kar, MD Alpar, Sibel, MD Sipit, Tugrul, MD Guven, Selma Firat, MD Erturk, Hakan, MD Demirel, Mikail Koray, MD Korkmaz, Meliha, MD Hayran, Mutlu, MD Kurt, Bahar, MD |
| description | Abstract The aim of this study was to evaluate the diagnostic contribution of alveolar dead space fraction (AVDSf) measured using capnography in patients admitted with suspected pulmonary embolism (PE). A total of 58 patients who were admitted to our hospital with suspected PE between October 2006 and January 2008 were included in this study. All patients were assessed using the Wells clinical score, capnography, computed tomographic pulmonary angiography, D-dimer measurement, lower-extremity venous Doppler ultrasonography, and V/Q scintigraphy. Forty patients (69%) had PE based on computed tomographic pulmonary angiography findings. The AVDSf value with the highest sensitivity and specificity, which was at the same time statistically significant, was 0.09. This value was consistent with the AVDSf value obtained using receiver operating characteristic analysis. In our study, the sensitivity of capnography was 70%, with a specificity of 61.1%, positive predictive value of 80%, and negative predictive value of 47.8%. The use of AVDSf in combination with any of the several scoring systems that evaluate clinical likelihood of PE and D-dimer levels resulted in higher sensitivity and specificity rates for the diagnosis of PE. |
| doi_str_mv | 10.1016/j.ajem.2009.01.031 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_733123174</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0735675709000552</els_id><sourcerecordid>2727520191</sourcerecordid><originalsourceid>FETCH-LOGICAL-c468t-1c6d88fd1ae264a9f979d711df81775e731b5ae83141113184131e6b03987de43</originalsourceid><addsrcrecordid>eNp9kl9r1TAYh4Mo7mz6BbyQgsiu2r1vkjYtyECGOmGwC-d1yEnfbqltU5NT4Xx7U87RwS52k9w8v_fPkzD2DqFAwOqiL0xPY8EBmgKwAIEv2AZLwfMaFb5kG1CizCtVqhN2GmMPgChL-ZqdcJBVxXm1YfXdA2WtM_eTjztns-AHynyXWTNP_j6Y-WGfuSmbl2H0kwn7jMatH1wc37BXnRkivT3eZ-zn1y93V9f5ze2371efb3Irq3qXo63auu5aNMQraZquUU2rENsuzahKUgK3paFaoEREgbVMB1VbEE2tWpLijJ0f6s7B_14o7vTooqVhMBP5JWolBHKBaiU_PCF7v4QpDacRBDS8lFwkih8oG3yMgTo9BzemzRKkV62616tWvWrVgDppTaH3x9LLdqT2f-SfxwR8PAImWjN0wUzWxUeO11IJWLt_OnCUlP1xFHS0jiZLrQtkd7r17vk5Lp_E7eAmlzr-oj3Fx3115Br0j_UDrO8PDQCUJRd_AXjop6w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1030925423</pqid></control><display><type>article</type><title>The diagnostic role of capnography in pulmonary embolism</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>ProQuest Central UK/Ireland</source><creator>Kurt, Ozlem Kar, MD ; Alpar, Sibel, MD ; Sipit, Tugrul, MD ; Guven, Selma Firat, MD ; Erturk, Hakan, MD ; Demirel, Mikail Koray, MD ; Korkmaz, Meliha, MD ; Hayran, Mutlu, MD ; Kurt, Bahar, MD</creator><creatorcontrib>Kurt, Ozlem Kar, MD ; Alpar, Sibel, MD ; Sipit, Tugrul, MD ; Guven, Selma Firat, MD ; Erturk, Hakan, MD ; Demirel, Mikail Koray, MD ; Korkmaz, Meliha, MD ; Hayran, Mutlu, MD ; Kurt, Bahar, MD</creatorcontrib><description>Abstract The aim of this study was to evaluate the diagnostic contribution of alveolar dead space fraction (AVDSf) measured using capnography in patients admitted with suspected pulmonary embolism (PE). A total of 58 patients who were admitted to our hospital with suspected PE between October 2006 and January 2008 were included in this study. All patients were assessed using the Wells clinical score, capnography, computed tomographic pulmonary angiography, D-dimer measurement, lower-extremity venous Doppler ultrasonography, and V/Q scintigraphy. Forty patients (69%) had PE based on computed tomographic pulmonary angiography findings. The AVDSf value with the highest sensitivity and specificity, which was at the same time statistically significant, was 0.09. This value was consistent with the AVDSf value obtained using receiver operating characteristic analysis. In our study, the sensitivity of capnography was 70%, with a specificity of 61.1%, positive predictive value of 80%, and negative predictive value of 47.8%. The use of AVDSf in combination with any of the several scoring systems that evaluate clinical likelihood of PE and D-dimer levels resulted in higher sensitivity and specificity rates for the diagnosis of PE.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2009.01.031</identifier><identifier>PMID: 20466226</identifier><identifier>CODEN: AJEMEN</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blood clots ; Capnography ; Computed tomography ; Disease ; Emergency ; Emergency medical care ; Family medical history ; Female ; Fibrin Fibrinogen Degradation Products - analysis ; Humans ; Intensive care medicine ; Lung - diagnostic imaging ; Male ; Medical imaging ; Medical sciences ; Middle Aged ; Mortality ; Pneumology ; Predictive Value of Tests ; Pulmonary Embolism - diagnosis ; Pulmonary Embolism - diagnostic imaging ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Radiography ; ROC Curve ; Sensitivity and Specificity ; Thoracic surgery ; Tomography Scanners, X-Ray Computed ; Young Adult</subject><ispartof>The American journal of emergency medicine, 2010-05, Vol.28 (4), p.460-465</ispartof><rights>Elsevier Inc.</rights><rights>2010 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>(c) 2010 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c468t-1c6d88fd1ae264a9f979d711df81775e731b5ae83141113184131e6b03987de43</citedby><cites>FETCH-LOGICAL-c468t-1c6d88fd1ae264a9f979d711df81775e731b5ae83141113184131e6b03987de43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1030925423?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22847303$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20466226$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kurt, Ozlem Kar, MD</creatorcontrib><creatorcontrib>Alpar, Sibel, MD</creatorcontrib><creatorcontrib>Sipit, Tugrul, MD</creatorcontrib><creatorcontrib>Guven, Selma Firat, MD</creatorcontrib><creatorcontrib>Erturk, Hakan, MD</creatorcontrib><creatorcontrib>Demirel, Mikail Koray, MD</creatorcontrib><creatorcontrib>Korkmaz, Meliha, MD</creatorcontrib><creatorcontrib>Hayran, Mutlu, MD</creatorcontrib><creatorcontrib>Kurt, Bahar, MD</creatorcontrib><title>The diagnostic role of capnography in pulmonary embolism</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Abstract The aim of this study was to evaluate the diagnostic contribution of alveolar dead space fraction (AVDSf) measured using capnography in patients admitted with suspected pulmonary embolism (PE). A total of 58 patients who were admitted to our hospital with suspected PE between October 2006 and January 2008 were included in this study. All patients were assessed using the Wells clinical score, capnography, computed tomographic pulmonary angiography, D-dimer measurement, lower-extremity venous Doppler ultrasonography, and V/Q scintigraphy. Forty patients (69%) had PE based on computed tomographic pulmonary angiography findings. The AVDSf value with the highest sensitivity and specificity, which was at the same time statistically significant, was 0.09. This value was consistent with the AVDSf value obtained using receiver operating characteristic analysis. In our study, the sensitivity of capnography was 70%, with a specificity of 61.1%, positive predictive value of 80%, and negative predictive value of 47.8%. The use of AVDSf in combination with any of the several scoring systems that evaluate clinical likelihood of PE and D-dimer levels resulted in higher sensitivity and specificity rates for the diagnosis of PE.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blood clots</subject><subject>Capnography</subject><subject>Computed tomography</subject><subject>Disease</subject><subject>Emergency</subject><subject>Emergency medical care</subject><subject>Family medical history</subject><subject>Female</subject><subject>Fibrin Fibrinogen Degradation Products - analysis</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Lung - diagnostic imaging</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pneumology</subject><subject>Predictive Value of Tests</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Pulmonary Embolism - diagnostic imaging</subject><subject>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</subject><subject>Radiography</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Thoracic surgery</subject><subject>Tomography Scanners, X-Ray Computed</subject><subject>Young Adult</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kl9r1TAYh4Mo7mz6BbyQgsiu2r1vkjYtyECGOmGwC-d1yEnfbqltU5NT4Xx7U87RwS52k9w8v_fPkzD2DqFAwOqiL0xPY8EBmgKwAIEv2AZLwfMaFb5kG1CizCtVqhN2GmMPgChL-ZqdcJBVxXm1YfXdA2WtM_eTjztns-AHynyXWTNP_j6Y-WGfuSmbl2H0kwn7jMatH1wc37BXnRkivT3eZ-zn1y93V9f5ze2371efb3Irq3qXo63auu5aNMQraZquUU2rENsuzahKUgK3paFaoEREgbVMB1VbEE2tWpLijJ0f6s7B_14o7vTooqVhMBP5JWolBHKBaiU_PCF7v4QpDacRBDS8lFwkih8oG3yMgTo9BzemzRKkV62616tWvWrVgDppTaH3x9LLdqT2f-SfxwR8PAImWjN0wUzWxUeO11IJWLt_OnCUlP1xFHS0jiZLrQtkd7r17vk5Lp_E7eAmlzr-oj3Fx3115Br0j_UDrO8PDQCUJRd_AXjop6w</recordid><startdate>20100501</startdate><enddate>20100501</enddate><creator>Kurt, Ozlem Kar, MD</creator><creator>Alpar, Sibel, MD</creator><creator>Sipit, Tugrul, MD</creator><creator>Guven, Selma Firat, MD</creator><creator>Erturk, Hakan, MD</creator><creator>Demirel, Mikail Koray, MD</creator><creator>Korkmaz, Meliha, MD</creator><creator>Hayran, Mutlu, MD</creator><creator>Kurt, Bahar, MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><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>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20100501</creationdate><title>The diagnostic role of capnography in pulmonary embolism</title><author>Kurt, Ozlem Kar, MD ; Alpar, Sibel, MD ; Sipit, Tugrul, MD ; Guven, Selma Firat, MD ; Erturk, Hakan, MD ; Demirel, Mikail Koray, MD ; Korkmaz, Meliha, MD ; Hayran, Mutlu, MD ; Kurt, Bahar, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c468t-1c6d88fd1ae264a9f979d711df81775e731b5ae83141113184131e6b03987de43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood clots</topic><topic>Capnography</topic><topic>Computed tomography</topic><topic>Disease</topic><topic>Emergency</topic><topic>Emergency medical care</topic><topic>Family medical history</topic><topic>Female</topic><topic>Fibrin Fibrinogen Degradation Products - analysis</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Lung - diagnostic imaging</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Pneumology</topic><topic>Predictive Value of Tests</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Pulmonary Embolism - diagnostic imaging</topic><topic>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</topic><topic>Radiography</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Thoracic surgery</topic><topic>Tomography Scanners, X-Ray Computed</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kurt, Ozlem Kar, MD</creatorcontrib><creatorcontrib>Alpar, Sibel, MD</creatorcontrib><creatorcontrib>Sipit, Tugrul, MD</creatorcontrib><creatorcontrib>Guven, Selma Firat, MD</creatorcontrib><creatorcontrib>Erturk, Hakan, MD</creatorcontrib><creatorcontrib>Demirel, Mikail Koray, MD</creatorcontrib><creatorcontrib>Korkmaz, Meliha, MD</creatorcontrib><creatorcontrib>Hayran, Mutlu, MD</creatorcontrib><creatorcontrib>Kurt, Bahar, MD</creatorcontrib><collection>Pascal-Francis</collection><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>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kurt, Ozlem Kar, MD</au><au>Alpar, Sibel, MD</au><au>Sipit, Tugrul, MD</au><au>Guven, Selma Firat, MD</au><au>Erturk, Hakan, MD</au><au>Demirel, Mikail Koray, MD</au><au>Korkmaz, Meliha, MD</au><au>Hayran, Mutlu, MD</au><au>Kurt, Bahar, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The diagnostic role of capnography in pulmonary embolism</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2010-05-01</date><risdate>2010</risdate><volume>28</volume><issue>4</issue><spage>460</spage><epage>465</epage><pages>460-465</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><coden>AJEMEN</coden><abstract>Abstract The aim of this study was to evaluate the diagnostic contribution of alveolar dead space fraction (AVDSf) measured using capnography in patients admitted with suspected pulmonary embolism (PE). A total of 58 patients who were admitted to our hospital with suspected PE between October 2006 and January 2008 were included in this study. All patients were assessed using the Wells clinical score, capnography, computed tomographic pulmonary angiography, D-dimer measurement, lower-extremity venous Doppler ultrasonography, and V/Q scintigraphy. Forty patients (69%) had PE based on computed tomographic pulmonary angiography findings. The AVDSf value with the highest sensitivity and specificity, which was at the same time statistically significant, was 0.09. This value was consistent with the AVDSf value obtained using receiver operating characteristic analysis. In our study, the sensitivity of capnography was 70%, with a specificity of 61.1%, positive predictive value of 80%, and negative predictive value of 47.8%. The use of AVDSf in combination with any of the several scoring systems that evaluate clinical likelihood of PE and D-dimer levels resulted in higher sensitivity and specificity rates for the diagnosis of PE.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20466226</pmid><doi>10.1016/j.ajem.2009.01.031</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0735-6757 |
| ispartof | The American journal of emergency medicine, 2010-05, Vol.28 (4), p.460-465 |
| issn | 0735-6757 1532-8171 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_733123174 |
| source | MEDLINE; Elsevier ScienceDirect Journals; ProQuest Central UK/Ireland |
| subjects | Adult Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood clots Capnography Computed tomography Disease Emergency Emergency medical care Family medical history Female Fibrin Fibrinogen Degradation Products - analysis Humans Intensive care medicine Lung - diagnostic imaging Male Medical imaging Medical sciences Middle Aged Mortality Pneumology Predictive Value of Tests Pulmonary Embolism - diagnosis Pulmonary Embolism - diagnostic imaging Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Radiography ROC Curve Sensitivity and Specificity Thoracic surgery Tomography Scanners, X-Ray Computed Young Adult |
| title | The diagnostic role of capnography in pulmonary embolism |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-18T13%3A47%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20diagnostic%20role%20of%20capnography%20in%20pulmonary%20embolism&rft.jtitle=The%20American%20journal%20of%20emergency%20medicine&rft.au=Kurt,%20Ozlem%20Kar,%20MD&rft.date=2010-05-01&rft.volume=28&rft.issue=4&rft.spage=460&rft.epage=465&rft.pages=460-465&rft.issn=0735-6757&rft.eissn=1532-8171&rft.coden=AJEMEN&rft_id=info:doi/10.1016/j.ajem.2009.01.031&rft_dat=%3Cproquest_cross%3E2727520191%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1030925423&rft_id=info:pmid/20466226&rft_els_id=S0735675709000552&rfr_iscdi=true |