Geoclimatic Influences on Invasive Aspergillosis after Hematopoietic Stem Cell Transplantation
Background. Aspergillus species are ubiquitous. We hypothesized that climatic variables that affect airborne mold counts affect the incidence of invasive aspergillosis (IA). Methods. Patients who received hematopoietic stem cell transplants (HSCTs) in geographically and climatically diverse regions...
Gespeichert in:
| Veröffentlicht in: | Clinical infectious diseases 2010-06, Vol.50 (12), p.1588-1597 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1597 |
|---|---|
| container_issue | 12 |
| container_start_page | 1588 |
| container_title | Clinical infectious diseases |
| container_volume | 50 |
| creator | Panackal, Anil A. Li, Hong Kontoyiannis, Dimitrios P. Mori, Motomi Perego, Cheryl A. Boeckh, Michael Marr, Kieren A. |
| description | Background. Aspergillus species are ubiquitous. We hypothesized that climatic variables that affect airborne mold counts affect the incidence of invasive aspergillosis (IA). Methods. Patients who received hematopoietic stem cell transplants (HSCTs) in geographically and climatically diverse regions (Seattle, WA, and Houston, TX) were examined. Cumulative incidence function, Kaplan-Meier analysis, and Cox proportional hazards regression were performed to examine the association between IA and season. Poisson regression analysis was performed to evaluate the seasonal patterns in IA rates and association with spore counts and climate. Results. In Seattle, the 3-month incidence of IA was 4.6% (5.7% in allograft recipients and 0.8% in autograft recipients). During the 10-year study period, there was a decrease in the incidence of IA among allogeneic HSCT recipients, corresponding to decreased risks during the nonsummer months; receipt of HSCTs during the summer months was associated with an increased hazard for IA (hazard ratio, 1.87; 95% confidence interval, 1.25–2.81) after adjustment for other known risks. The person-month IA rate in Seattle was positively associated with environmental spore counts, which increased with high temperature and low precipitation. No seasonal effect on IA was observed in Houston, where total spore counts were lower and not variable by climate. Conclusions. Climatic variables differentially affect airborne spore counts and IA risk in geographically disparate centers. |
| doi_str_mv | 10.1086/652761 |
| format | Article |
| fullrecord | <record><control><sourceid>jstor_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3024009</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>25679921</jstor_id><oup_id>10.1086/652761</oup_id><sourcerecordid>25679921</sourcerecordid><originalsourceid>FETCH-LOGICAL-c540t-492fae0b36d4c7420820522a5d89f8b934d66da54a070676cab5ab13c6f791183</originalsourceid><addsrcrecordid>eNp1kV-L1DAUxYso7rrqN1CqoD5V8z_ti7CMOrPsguKOID4Y0jRdM5tJapIO-u1N6Tirgk9JOL977j25RfEQgpcQ1OwVo4gzeKs4hhTzitEG3s53QOuK1Lg-Ku7FuAEAwhrQu8URAoQCAslx8XWpvbJmK5NR5Znr7aid0rH0Lr92MpqdLk_joMOVsdZHE0vZJx3Klc4lfvBGT4WXSW_Lhba2XAfp4mClS9nRu_vFnV7aqB_sz5Pi07u368Wquni_PFucXlSKEpAq0qBeatBi1hHFCQI1AhQhSbu66eu2waRjrJOUSMAB40zJlsoWYsV63uRQ-KR4PfsOY7vVndIuBWnFEHKy8FN4acTfijPfxJXfCQwQAaDJBi_2BsF_H3VMYmuiyomk036MglNCCcJoIp_-Q278GFxOJzBhKI_HJ-j5DKngYwy6P4wCgZgWJuaFZfDxn4MfsN8bysCzPSCjkrbP_6tMvOFQTXHDpo5PZs6Pw_-bPZqZTUw-3HhQxpsGTXo16yYm_eOgy3AtGMecitXnL-L8_MP64_LyjVjgXzlNwIQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>346206779</pqid></control><display><type>article</type><title>Geoclimatic Influences on Invasive Aspergillosis after Hematopoietic Stem Cell Transplantation</title><source>MEDLINE</source><source>JSTOR Archive Collection A-Z Listing</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Panackal, Anil A. ; Li, Hong ; Kontoyiannis, Dimitrios P. ; Mori, Motomi ; Perego, Cheryl A. ; Boeckh, Michael ; Marr, Kieren A.</creator><creatorcontrib>Panackal, Anil A. ; Li, Hong ; Kontoyiannis, Dimitrios P. ; Mori, Motomi ; Perego, Cheryl A. ; Boeckh, Michael ; Marr, Kieren A.</creatorcontrib><description>Background. Aspergillus species are ubiquitous. We hypothesized that climatic variables that affect airborne mold counts affect the incidence of invasive aspergillosis (IA). Methods. Patients who received hematopoietic stem cell transplants (HSCTs) in geographically and climatically diverse regions (Seattle, WA, and Houston, TX) were examined. Cumulative incidence function, Kaplan-Meier analysis, and Cox proportional hazards regression were performed to examine the association between IA and season. Poisson regression analysis was performed to evaluate the seasonal patterns in IA rates and association with spore counts and climate. Results. In Seattle, the 3-month incidence of IA was 4.6% (5.7% in allograft recipients and 0.8% in autograft recipients). During the 10-year study period, there was a decrease in the incidence of IA among allogeneic HSCT recipients, corresponding to decreased risks during the nonsummer months; receipt of HSCTs during the summer months was associated with an increased hazard for IA (hazard ratio, 1.87; 95% confidence interval, 1.25–2.81) after adjustment for other known risks. The person-month IA rate in Seattle was positively associated with environmental spore counts, which increased with high temperature and low precipitation. No seasonal effect on IA was observed in Houston, where total spore counts were lower and not variable by climate. Conclusions. Climatic variables differentially affect airborne spore counts and IA risk in geographically disparate centers.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/652761</identifier><identifier>PMID: 20450414</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Oxford: The University of Chicago Press</publisher><subject>Adolescent ; Adult ; Air Microbiology ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; ARTICLES AND COMMENTARIES ; Aspergillosis ; Aspergillosis - epidemiology ; Aspergillus ; Aspergillus - isolation & purification ; Biological and medical sciences ; Bone marrow, stem cells transplantation. Graft versus host reaction ; Climate ; Climate models ; Environmental disorders ; Environmental Monitoring ; Epidemiological Monitoring ; Female ; Fungal infections ; Hematopoietic Stem Cell Transplantation ; HLA antigens ; Human mycoses ; Humans ; Infections ; Infectious diseases ; Male ; Medical sciences ; Microbial colony count ; Middle Aged ; Miscellaneous mycoses ; Mold ; Mycoses ; Poisson distribution ; Risk factors ; Seasons ; Spores - isolation & purification ; Stem cells ; Texas - epidemiology ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy ; Transplantation ; Transplants & implants ; Washington - epidemiology ; Weather ; Young Adult</subject><ispartof>Clinical infectious diseases, 2010-06, Vol.50 (12), p.1588-1597</ispartof><rights>2010 Infectious Diseases Society of America</rights><rights>2010 by the Infectious Diseases Society of America 2010</rights><rights>2015 INIST-CNRS</rights><rights>Copyright University of Chicago, acting through its Press Jun 15, 2010</rights><rights>2010 by the Infectious Diseases Society of America. All rights reserved. 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c540t-492fae0b36d4c7420820522a5d89f8b934d66da54a070676cab5ab13c6f791183</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/25679921$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/25679921$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,780,784,803,885,27924,27925,58017,58250</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22853969$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20450414$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Panackal, Anil A.</creatorcontrib><creatorcontrib>Li, Hong</creatorcontrib><creatorcontrib>Kontoyiannis, Dimitrios P.</creatorcontrib><creatorcontrib>Mori, Motomi</creatorcontrib><creatorcontrib>Perego, Cheryl A.</creatorcontrib><creatorcontrib>Boeckh, Michael</creatorcontrib><creatorcontrib>Marr, Kieren A.</creatorcontrib><title>Geoclimatic Influences on Invasive Aspergillosis after Hematopoietic Stem Cell Transplantation</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>Background. Aspergillus species are ubiquitous. We hypothesized that climatic variables that affect airborne mold counts affect the incidence of invasive aspergillosis (IA). Methods. Patients who received hematopoietic stem cell transplants (HSCTs) in geographically and climatically diverse regions (Seattle, WA, and Houston, TX) were examined. Cumulative incidence function, Kaplan-Meier analysis, and Cox proportional hazards regression were performed to examine the association between IA and season. Poisson regression analysis was performed to evaluate the seasonal patterns in IA rates and association with spore counts and climate. Results. In Seattle, the 3-month incidence of IA was 4.6% (5.7% in allograft recipients and 0.8% in autograft recipients). During the 10-year study period, there was a decrease in the incidence of IA among allogeneic HSCT recipients, corresponding to decreased risks during the nonsummer months; receipt of HSCTs during the summer months was associated with an increased hazard for IA (hazard ratio, 1.87; 95% confidence interval, 1.25–2.81) after adjustment for other known risks. The person-month IA rate in Seattle was positively associated with environmental spore counts, which increased with high temperature and low precipitation. No seasonal effect on IA was observed in Houston, where total spore counts were lower and not variable by climate. Conclusions. Climatic variables differentially affect airborne spore counts and IA risk in geographically disparate centers.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Air Microbiology</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>ARTICLES AND COMMENTARIES</subject><subject>Aspergillosis</subject><subject>Aspergillosis - epidemiology</subject><subject>Aspergillus</subject><subject>Aspergillus - isolation & purification</subject><subject>Biological and medical sciences</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Climate</subject><subject>Climate models</subject><subject>Environmental disorders</subject><subject>Environmental Monitoring</subject><subject>Epidemiological Monitoring</subject><subject>Female</subject><subject>Fungal infections</subject><subject>Hematopoietic Stem Cell Transplantation</subject><subject>HLA antigens</subject><subject>Human mycoses</subject><subject>Humans</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Microbial colony count</subject><subject>Middle Aged</subject><subject>Miscellaneous mycoses</subject><subject>Mold</subject><subject>Mycoses</subject><subject>Poisson distribution</subject><subject>Risk factors</subject><subject>Seasons</subject><subject>Spores - isolation & purification</subject><subject>Stem cells</subject><subject>Texas - epidemiology</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>Washington - epidemiology</subject><subject>Weather</subject><subject>Young Adult</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kV-L1DAUxYso7rrqN1CqoD5V8z_ti7CMOrPsguKOID4Y0jRdM5tJapIO-u1N6Tirgk9JOL977j25RfEQgpcQ1OwVo4gzeKs4hhTzitEG3s53QOuK1Lg-Ku7FuAEAwhrQu8URAoQCAslx8XWpvbJmK5NR5Znr7aid0rH0Lr92MpqdLk_joMOVsdZHE0vZJx3Klc4lfvBGT4WXSW_Lhba2XAfp4mClS9nRu_vFnV7aqB_sz5Pi07u368Wquni_PFucXlSKEpAq0qBeatBi1hHFCQI1AhQhSbu66eu2waRjrJOUSMAB40zJlsoWYsV63uRQ-KR4PfsOY7vVndIuBWnFEHKy8FN4acTfijPfxJXfCQwQAaDJBi_2BsF_H3VMYmuiyomk036MglNCCcJoIp_-Q278GFxOJzBhKI_HJ-j5DKngYwy6P4wCgZgWJuaFZfDxn4MfsN8bysCzPSCjkrbP_6tMvOFQTXHDpo5PZs6Pw_-bPZqZTUw-3HhQxpsGTXo16yYm_eOgy3AtGMecitXnL-L8_MP64_LyjVjgXzlNwIQ</recordid><startdate>20100615</startdate><enddate>20100615</enddate><creator>Panackal, Anil A.</creator><creator>Li, Hong</creator><creator>Kontoyiannis, Dimitrios P.</creator><creator>Mori, Motomi</creator><creator>Perego, Cheryl A.</creator><creator>Boeckh, Michael</creator><creator>Marr, Kieren A.</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><general>Oxford University Press</general><scope>BSCLL</scope><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>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7QO</scope><scope>5PM</scope></search><sort><creationdate>20100615</creationdate><title>Geoclimatic Influences on Invasive Aspergillosis after Hematopoietic Stem Cell Transplantation</title><author>Panackal, Anil A. ; Li, Hong ; Kontoyiannis, Dimitrios P. ; Mori, Motomi ; Perego, Cheryl A. ; Boeckh, Michael ; Marr, Kieren A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c540t-492fae0b36d4c7420820522a5d89f8b934d66da54a070676cab5ab13c6f791183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Air Microbiology</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>ARTICLES AND COMMENTARIES</topic><topic>Aspergillosis</topic><topic>Aspergillosis - epidemiology</topic><topic>Aspergillus</topic><topic>Aspergillus - isolation & purification</topic><topic>Biological and medical sciences</topic><topic>Bone marrow, stem cells transplantation. Graft versus host reaction</topic><topic>Climate</topic><topic>Climate models</topic><topic>Environmental disorders</topic><topic>Environmental Monitoring</topic><topic>Epidemiological Monitoring</topic><topic>Female</topic><topic>Fungal infections</topic><topic>Hematopoietic Stem Cell Transplantation</topic><topic>HLA antigens</topic><topic>Human mycoses</topic><topic>Humans</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Microbial colony count</topic><topic>Middle Aged</topic><topic>Miscellaneous mycoses</topic><topic>Mold</topic><topic>Mycoses</topic><topic>Poisson distribution</topic><topic>Risk factors</topic><topic>Seasons</topic><topic>Spores - isolation & purification</topic><topic>Stem cells</topic><topic>Texas - epidemiology</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><topic>Washington - epidemiology</topic><topic>Weather</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Panackal, Anil A.</creatorcontrib><creatorcontrib>Li, Hong</creatorcontrib><creatorcontrib>Kontoyiannis, Dimitrios P.</creatorcontrib><creatorcontrib>Mori, Motomi</creatorcontrib><creatorcontrib>Perego, Cheryl A.</creatorcontrib><creatorcontrib>Boeckh, Michael</creatorcontrib><creatorcontrib>Marr, Kieren A.</creatorcontrib><collection>Istex</collection><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>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Biotechnology Research Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Panackal, Anil A.</au><au>Li, Hong</au><au>Kontoyiannis, Dimitrios P.</au><au>Mori, Motomi</au><au>Perego, Cheryl A.</au><au>Boeckh, Michael</au><au>Marr, Kieren A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Geoclimatic Influences on Invasive Aspergillosis after Hematopoietic Stem Cell Transplantation</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2010-06-15</date><risdate>2010</risdate><volume>50</volume><issue>12</issue><spage>1588</spage><epage>1597</epage><pages>1588-1597</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Background. Aspergillus species are ubiquitous. We hypothesized that climatic variables that affect airborne mold counts affect the incidence of invasive aspergillosis (IA). Methods. Patients who received hematopoietic stem cell transplants (HSCTs) in geographically and climatically diverse regions (Seattle, WA, and Houston, TX) were examined. Cumulative incidence function, Kaplan-Meier analysis, and Cox proportional hazards regression were performed to examine the association between IA and season. Poisson regression analysis was performed to evaluate the seasonal patterns in IA rates and association with spore counts and climate. Results. In Seattle, the 3-month incidence of IA was 4.6% (5.7% in allograft recipients and 0.8% in autograft recipients). During the 10-year study period, there was a decrease in the incidence of IA among allogeneic HSCT recipients, corresponding to decreased risks during the nonsummer months; receipt of HSCTs during the summer months was associated with an increased hazard for IA (hazard ratio, 1.87; 95% confidence interval, 1.25–2.81) after adjustment for other known risks. The person-month IA rate in Seattle was positively associated with environmental spore counts, which increased with high temperature and low precipitation. No seasonal effect on IA was observed in Houston, where total spore counts were lower and not variable by climate. Conclusions. Climatic variables differentially affect airborne spore counts and IA risk in geographically disparate centers.</abstract><cop>Oxford</cop><pub>The University of Chicago Press</pub><pmid>20450414</pmid><doi>10.1086/652761</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1058-4838 |
| ispartof | Clinical infectious diseases, 2010-06, Vol.50 (12), p.1588-1597 |
| issn | 1058-4838 1537-6591 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3024009 |
| source | MEDLINE; JSTOR Archive Collection A-Z Listing; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Air Microbiology Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ARTICLES AND COMMENTARIES Aspergillosis Aspergillosis - epidemiology Aspergillus Aspergillus - isolation & purification Biological and medical sciences Bone marrow, stem cells transplantation. Graft versus host reaction Climate Climate models Environmental disorders Environmental Monitoring Epidemiological Monitoring Female Fungal infections Hematopoietic Stem Cell Transplantation HLA antigens Human mycoses Humans Infections Infectious diseases Male Medical sciences Microbial colony count Middle Aged Miscellaneous mycoses Mold Mycoses Poisson distribution Risk factors Seasons Spores - isolation & purification Stem cells Texas - epidemiology Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation Transplants & implants Washington - epidemiology Weather Young Adult |
| title | Geoclimatic Influences on Invasive Aspergillosis after Hematopoietic Stem Cell Transplantation |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T10%3A52%3A34IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-jstor_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Geoclimatic%20Influences%20on%20Invasive%20Aspergillosis%20after%20Hematopoietic%20Stem%20Cell%20Transplantation&rft.jtitle=Clinical%20infectious%20diseases&rft.au=Panackal,%20Anil%20A.&rft.date=2010-06-15&rft.volume=50&rft.issue=12&rft.spage=1588&rft.epage=1597&rft.pages=1588-1597&rft.issn=1058-4838&rft.eissn=1537-6591&rft.coden=CIDIEL&rft_id=info:doi/10.1086/652761&rft_dat=%3Cjstor_pubme%3E25679921%3C/jstor_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=346206779&rft_id=info:pmid/20450414&rft_jstor_id=25679921&rft_oup_id=10.1086/652761&rfr_iscdi=true |