FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2109782016> ?p ?o ?g. }

• W2109782016 endingPage "957" @default.
• W2109782016 startingPage "951" @default.
• W2109782016 abstract "Objective To assess the cost-effectiveness of two strategies of home management of under-five fevers in Ghana – treatment using antimalarials only (artesunate–amodiaquine – AAQ) and combined treatment using antimalarials and antibiotics (artesunate–amodiaquine plus amoxicillin – AAQ + AMX). Methods We assessed the costs and cost-effectiveness of AAQ and AAQ + AMX compared with a control receiving standard care. Data were collected as part of a cluster randomised controlled trial with a step-wedged design. Approximately, 12 000 children aged 2–59 months in Dangme West District in southern Ghana were covered. Community health workers delivered the interventions. Costs were analysed from societal perspective, using anaemia cases averted, under-five deaths averted and disability-adjusted life years (DALYs) averted as effectiveness measures. Results Total economic costs for the interventions were US$ 204 394.72 (AAQ) and US$ 260 931.49 (AAQ + AMX). Recurrent costs constituted 89% and 90% of the total direct costs of AAQ and AAQ + AMX, respectively. Deaths averted were 79.1 (AAQ) and 79.9 (AAQ + AMX), with DALYs averted being 2264.79 (AAQ) and 2284.57 (AAQ + AMX). The results show that cost per anaemia case averted were US$ 150.18 (AAQ) and US$ 227.49 (AAQ + AMX) and cost per death averted was US$ 2585.58 for AAQ and US$ 3272.20 for AAQ + AMX. Cost per DALY averted were US$ 90.25 (AAQ) and US$ 114.21 (AAQ + AMX). Conclusion Both AAQ and AAQ + AMX approaches were cost-effective, each averting one DALY at less than the standard US$ 150 threshold recommended by the World Health Organisation. However, AAQ was more cost-effective. Home management of under-five fevers in rural settings is cost-effective in reducing under-five mortality. Objectif: Evaluer le rapport coût-efficacité de deux stratégies de prise en charge à domicile des fièvres chez les enfants de moins de cinq au Ghana - un traitement utilisant des antipaludiques seuls (artésunate amodiaquine: AAQ) et des traitements combinés à l’aide d’antipaludiques et d’antibiotiques (artésunate amodiaquine plus amoxicilline: AAQ + AMX). Méthodes: Nous avons évalué les coûts et la rentabilité de AAQ et AAQ + AMX par rapport à un groupe témoins recevant des soins standard. Les données ont été recueillies dans le cadre d’un essai contrôlé randomisé en grappes avec un concept par étape. Environ 12.000 enfants âgés de 2 à 59 mois à Dangme West District dans le Sud du Ghana ont été couverts par l’étude. Des agents de santé communautaires ont administré les interventions. Les coûts ont été analysés selon une perspective sociétale, en utilisant comme mesures d’efficacité, les décès évités chez les enfants de moins de moins de cinq ans et les années de vie évitées, ajustées par l’incapacité (DALY). Résultats: Les coûts économiques totaux pour les interventions étaient de 204.394,72 US$ (AAQ) et 260.931,49 US$ (AAQ + AMX). Les coûts récurrents constituaient 89% et 90% du total des coûts directs pour AAQ et pour AAQ + AMX respectivement. Les décès évités étaient de 79,1 (AAQ) et 79,9 (AAQ + AMX), avec des DALY évitées atteignant 2.264,79 (AAQ) et 2.284,57 (AAQ + AMX). Les résultats montrent que le coût par décès évitéétait de 2.585,58 US$ pour AAQ et 3.272,20 US$ pour AAQ + AMX. Le coût par DALY évitée était de 90,25 US$ (AAQ) et de 114,21 US$ (AAQ + AMX). Conclusion: Les approches AAQ et AAQ + AMX étaient toutes deux rentables, chacune permettant d’éviter un DALY à moins du seuil standard de 150 US$ recommandé par l’OMS. Toutefois, AAQ était la plus rentable. La prise en charge à domicile des fièvres chez les moins de cinq ans en milieu rural est rentable en réduisant la mortalité chez les moins de cinq ans. Objetivo: Evaluar el coste-efectividad de dos estrategias de manejo domiciliario de menores de cinco años en Ghana – un tratamiento utilizando solo antimaláricos (artesunato amodiaquina – AAQ) y un tratamiento combinado utilizando antimaláricos y antibióticos (artesunato amodiaquina + amoxicilina − AAQ + AMX). Métodos: Hemos evaluado los costes y el coste-efectividad de la AAQ y AAQ + AMX comparados con un control recibiendo cuidados estándar. Se recolectaron datos como parte de un ensayo aleatorizados y controlado en conglomerados con un diseño escalonado. Se incluyeron aproximadamente 12,000 niños con edades entre los 2 y 59 meses en el distrito de Dangme del Oeste, al sur de Ghana. Las intervenciones fueron realizadas por trabajadores sanitarios comunitarios. Los costes se analizaron desde una perspectiva social, utilizando las muertes de menores de cinco años evitadas y los años de vida ajustados por discapacidad (AVADs) evitados como medidas de la efectividad. Resultados: Los costes económicos totales para las intervenciones fueron US$ 204,394.72 (AAQ) y US$ 260,931.49 (AAQ + AMX). Los costes recurrentes constituían un 89% y 90% del total de costes directos de AAQ y AAQ + AMX respectivamente. Las muertes evitadas fueron 79.1 (AAQ) y 79.9 (AAQ + AMX), con 2,264.79 (AAQ) y 2,284.57 (AAQ + AMX) AVADs evitados. Los resultados muestran que el coste por muerte evitada era de US$ 2,585.58 para AAQ y US$ 3,272.20 para AAQ + AMX. El coste por AVAD evitado era de US$ 90.25 (AAQ) y US$ 114.21 (AAQ + AMX). Conclusión: Tanto la opción de AAQ como AAQ + AMX eran coste-efectivas, cada una evitando un AVAD a menos del umbral estándar de US$ 150 recomendado por la Organización Mundial de la Salud. Sin embargo, la AAQ era más coste-efectiva. El manejo domiciliario de fiebres en menores de cinco años en zonas rurales es coste-efectivo para la reducción de la mortalidad en menores de cinco años. Access to prompt and appropriate treatment is crucial in reducing mortality in febrile children under five years. In case of malaria, current and more effective antimalarials (i.e. artemisinin-based combination therapy – ACT) and diagnostic techniques (i.e. rapid diagnostic test – RDT) have been introduced to help reduce the burden of the disease in developing countries. However, access to treatment is still a major problem hindering the control of the disease in most countries (Lubell et al. 2010). WHO recommended managing febrile conditions in children under five years old at home (WHO 2004). Home management of malaria (HMM) involves using the services of trained community volunteers who worked as community-based agents (here termed ‘community health workers’) in treating febrile children near the home with pre-packed antimalarials. By 2008, 18 African countries had taken steps to implement the approach (Ajayi et al. 2008). Currently, the implementation of HMM has expanded to other childhood fevers such as acute respiratory infections (ARIs) and diarrhoea. Studies in Africa have provided evidence of the effectiveness of home management in treating fevers (Kidane & Morrow 2000; Sirima et al. 2003). However, evidence of the cost-effectiveness of the approach is limited. There are two published studies on the cost-effectiveness of HMM in Africa (Lubell et al. 2010; Chanda et al. 2011). The Ministry of Health (MOH) of Ghana began implementing home-based care in selected districts throughout the country (MOH/NMCP 2010) in 2011 to target malaria, ARI and diarrhoea in children under five years old. The intervention will be scaled up to cover other districts in the country in subsequent years. To date, there is no (published) evidence of the cost-effectiveness of HMM in the specific Ghanaian context. Our aim was to assess the cost-effectiveness of two strategies of home management of fevers (HMF) in children under five years: treatment using antimalarials only (artesunate–amodiaquine – AAQ) and treatment using a combination of antimalarials and antibiotics (AAQ plus amoxicillin – AAQ + AMX). During a cluster randomised controlled trial, the two strategies – AAQ and AAQ + AMX – were implemented, and the impact of each strategy on morbidity and all-cause mortality in children under age five was assessed. The study was conducted between January 2006 and December 2009 in the Dangme West District, one of the rural districts of the Greater Accra Region, Ghana with an area of ca. 1700 km2. Approximately, 12% of the district’s total population of 109 459 consists of children under age five (Nonvignon et al. 2010). The district experiences an all-year malaria transmission with peaks during the rainy seasons in April and October (M. A. Chinbuah, P. A. Kager, M. Abbey, M. Gyapong, E. Awini, J. Nonvignon, M. Adjuik, M. Aikins, F. Pagnoni, J. O. Gyapong, in preparation). Residents are predominantly farmers and fishermen. The home management trial was a cluster controlled trial with the interventions introduced in a step-wedge manner. At the beginning of the trial, all clusters belonged to the control arm until they were randomised to either of the two intervention arms at different time periods. During the control period, no intervention was put in place; febrile children 2–59 months continued to seek standard care at health facilities, over-the-counter and other sources previously used. In clusters belonging to the AAQ (antimalarial only) arm, febrile children 2–59 months received artesunate–amodiaquine when taken to community health workers (CHWs) by their caregivers and diagnosed of having uncomplicated fever. In clusters belonging to the AAQ + AMX (antimalarial plus antibiotic) arm, febrile children received artesunate–amodiaquine plus amoxicillin when diagnosed of fever by CHWs. In each arm, the treatment first dose was observed. A detailed description of the study design and interventions are reported elsewhere (M. A. Chinbuah, P. A. Kager, M. Abbey, M. Gyapong, E. Awini, J. Nonvignon, M. Adjuik, M. Aikins, F. Pagnoni, J. O. Gyapong, in preparation). The study populations were all children 2–59 months, their caregivers and CHWs in the study district. By the end of the trial, 660 CHWs had been trained and worked. Data on recurrent and capital costs were obtained from the programme records kept at the Dodowa Health Research Centre (DHRC). CHWs also recorded the number of children treated and the drugs given. In addition, some CHWs were trained to record the caregivers’ travel time and the CHW’s time spent on treatment and with field supervisors. Numbers of deaths were obtained from the mortality records of the trial and the demographic surveillance system at the DHRC. The number of anaemia cases was determined during biannual cross-sectional surveys undertaken during the trial by taking the blood samples from surveyed children using a haemocue. Costing was done from the societal perspective, which considered households costs (transport, food and related expenses) and health system costs. Financial costs (actual financial expenses) and economic costs were estimated and are reported in the results. Direct and indirect costs are reported. Direct costs. Direct costs had capital and recurrent components. Capital costs included vehicles and equipment that were annualised using the useful life of items and the recommended discount rate of 3% (Gold et al. 1996). The useful life of capital was estimated on the basis of the discussion with the accountant and the stores manager at the DHRC. The capital items were vehicles, motorcycles and helmets, television sets, flip chart stands, generators, digital camera, DVD players, VCDs and extension equipment. Recurrent costs included medical supplies (e.g. drugs), stationery supplies, allowances and salaries of staff involved in programme activities, and cost of vehicle operation and maintenance. Market rental price was used for building spaces. Capital costs and recurrent costs were summed up to obtain the total costs for each study year. These costs were then apportioned to the two study arms using the proportion of CHWs and number of communities under each study arm. However, the cost of drugs that were specific to a particular study arm was allocated to the respective study arm. Indirect costs. Indirect costs constitute productivity losses. This included the time of CHWs (who were not remunerated) volunteered to the trial. Also, the productive losses to caregivers (travel and treatment time) were included. Indirect costs were analysed using the average local agricultural labour wage per day. Costs in the local currency (Ghana Cedis) for each year were adjusted to 2009 (final year) cost using the consumer price indices (CPIs) for health goods for the respective years. These values were then converted into a United States dollar equivalent using the 2009 average interbank exchange rate of 1.42 Ghana Cedis to 1.00 dollar (as quoted by the Bank of Ghana). The calculation of costs was done on a Microsoft Excel (2007) spreadsheet. Anaemia cases averted, deaths averted and disability-adjusted life years (DALYs) averted were the effectiveness measures. The number of deaths observed during the trial period were 181 (control), 72 (AAQ) and 57 (AAQ + AMX). Records of these deaths were obtained from the trial records and the Health and Demographic Surveillance System (HDSS), which is a biannual census that obtains data on vital events such as deaths, births and pregnancies. However, for the purpose of estimating the cost-effectiveness of the trial interventions, the indirect standardization method (Kirkwood & Sterne 2005, pp. 268 & 269) was used to calculate the expected number of deaths in AAQ and AAQ + AMX with the control as the reference population. The method made use of the observed age-specific deaths and person years in each study arm. The expected deaths in AAQ and AAQ + AMX were estimated to be 101.9 and 101.3, respectively. Originally developed in 1990, DALYs are a measure of the burden of diseases and are expressed as number of years of life lost to illness and years lived with disability (YLD). Years of life lost (YLL) is a component of DALY and constitutes the majority of the burden of fever (especially malaria). Using life expectancy at a mean age of death of 65.4 years (Ghana Statistical Service 2011), no age weighting and a discount rate of 3% (Murray & Lopez 1996a,b), each death was estimated to be equivalent to 28.6 YLLs. The differences between the effects (i.e. anaemia cases, deaths and DALYs) under each study arm and those under the control constituted the final effects (i.e. anaemia cases averted, deaths averted and DALYs averted) used in the cost-effectiveness analysis. The anaemia cases were 2289 (control), 928 (AAQ) and 1142 (AAQ + AMX). The anaemia cases were not standardised because prevalence was assessed by determining the proportion of surveyed children with haemoglobin levels lower than 11 mg/dl. Cost-effectiveness ratios (CERs) were estimated for AAQ and AAQ + AMX, in each case using the control as the comparator. Cost per death averted for each intervention arm was compared to the threshold guideline used by the WHO Commission on Macroeconomics and Health (also used by WHO-CHOICE) that an intervention is ‘highly cost-effective’ if CER is less than three times gross domestic product (GDP) per capita, ‘cost-effective’ if CER is between one and three times three times GDP per capita and ‘not cost-effective’ if CER is greater than three times GDP per capita (WHO 2001). The World Bank estimated Ghana’s GDP per capita for 2009 to be US$ 1098 (data.worldbank.org/indicator/NY.GDP. PCAP.CD). Cost per DALY averted was also compared to the threshold guideline that an intervention is ‘highly attractive’ if cost per DALY is below US$ 25–30 and ‘attractive’ if cost per DALY is below US$ 150 (WHO 1996). First, a one-way sensitivity analysis was performed using a lower (2%) and a higher discount rate (5%) and varying the useful life of vehicles (to 8 years instead of 5 years) used in calculating capital cost. The national daily minimum wage rate was also used in place of the local daily wage rate in estimating indirect cost. Further, other drugs (arthemeter-lumefantrine and co-trimoxazole), which are also recommended by the MOH, were used in the sensitivity analysis. During the trial, CHWs served as volunteers who were not remunerated for their services. However, as part of the sensitivity analysis, it was assumed that CHWs were given allowances equal to their indirect costs. Further, an assumption of higher (50%) attrition rates (reported by Olang’o 2010 in Nigeria) among CHWs was also used. In addition, assumptions of mortality rates being 10% lower and between 1% and 20% higher than the observed rates were used alternatively. Finally, a multi-way sensitivity analysis was performed varying multiple parameters at the same time. The ethics committees of Ghana Health Service and the WHO granted ethical clearance for the study. The total financial costs of the study arms were US$ 99 690.32 for AAQ (Table 1a) and US$ 138 321.21 for AAQ + AMX (Table 1b). Recurrent costs constituted 84% (AAQ) and 86% (AAQ + AMX) of the total financial costs. The total financial cost of the interventions per 1000 population was US$ 7431.26 for AAQ (Table 1a) and US$ 9796.81 for AAQ + AMX (Table 1b). Table 1 also present the annual financial costs and annual financial costs per 1000 population. The total direct economic costs of the study interventions were US$ 154 411.12 and US$ 203 172.75 for AAQ (Table 2a) and AAQ + AMX (Table 2b), respectively. Recurrent costs accounted for 89% (AAQ) and 90% (AAQ + AMX) of the direct economic costs. The total indirect costs of the interventions to CHWs and caregivers were US$49 983.59 for AAQ (Table 2a) and US$57 758.74 for AAQ + AMX (Table 2b). Further, the total economic costs for the study interventions were estimated to be US$204 394.72 for AAQ (Table 2a) and US$260 931.49 for AAQ + AMX (Table 2b). Figure 1 shows that 24% of the total economic cost of AAQ was indirect costs. For AAQ + AMX, 22% of the total economic costs were indirect costs (Figure 2). Total economic cost of AAQ study arm. Total economic cost of AAQ + AMX study arm. Anaemia cases averted by AAQ were 1361 and by AAQ + AMX, 1147. The deaths averted by AAQ and AAQ + AMX were calculated as 79.1 and 79.7, respectively. These translate into 2264.79 DALYs averted for the AAQ arm and 2284.57 for the AAQ + AMX arm. The cost-effectiveness ratios are presented in Table 3. The cost per anaemia case averted was US$ 150.18 (AAQ) and US$ 227.49 (AAQ + AMX). Cost per death averted was US$ 2585.58 for AAQ and US$ 3272.20 for AAQ + AMX, while the cost per DALY averted was US$ 90.25 for AAQ and US$ 114.21 for AAQ + AMX. The results of the one-way and multi-way sensitivity analyses indicate that the costs and cost-effectiveness estimates were not sensitive to changes in most of the parameters used, with the exception of changes in mortality rates. While lower mortality rates enhanced the cost-effectiveness of both interventions, a 1% increase in the mortality rates renders AAQ + AMX not cost-effective. On the contrary, AAQ remains cost-effective even if mortality rates increase by between 1% and 16%. Any higher percentage increase in the mortality rate would render AAQ not cost-effective. The study results indicate that HMF in children under age five using antimalarials plus antibiotics is financially and economically more expensive than using antimalarials only. This result was mainly attributable to the additional drugs used in treating the combined group and the different numbers of children treated and CHWs in the study arms. Further, a greater portion of the costs were recurrent, which indicates that the home management trial used more recurrent inputs than capital inputs. The study findings also indicate that a substantial portion (more than one-fifth) of the total economic cost of each study arm was indirect costs. Thus, the contribution of indirect costs to the total economic cost of home management programmes must not be overlooked. The use of the provider perspective in analysing costs and cost-effectiveness of home management interventions is likely to lead to important costs being ignored, because the provider perspective excludes indirect costs to caregivers. Using the recommended threshold criteria, AAQ and AAQ + AMX are both cost-effective compared to standard practice even though the difference in deaths between AAQ and AAQ + AMX was not statistically significant. However, the results show that AAQ represents a more attractive use of society’s resources. This is because while AAQ + AMX averts more deaths and DALYs than AAQ, it does so at a higher economic cost to society. The findings of this study confirm the findings of other studies that home management of childhood illnesses is cost-effective (Goodman et al. 2006; Conteh et al. 2010; Lubell et al. 2010; Tozan et al. 2010; Chanda et al. 2011). This is the first study in Ghana and the third in sub-Saharan Africa – after Chanda et al. (2011) and Lubell et al. (2010)– to provide evidence that the delivery of pre-packed antimalarials (specifically ACTs) through the home management approach recommended by WHO is cost-effective. However, our study is the first to provide evidence that treatment of fevers in children under age five near the home using pre-packed antimalarials in combination with antibiotics is also a cost-effective way of reducing the burden of fevers and under five mortality in low-income countries, especially in sub-Saharan Africa. The cost-effectiveness of child health interventions is important in determining which interventions should be scaled up or have increased resources devoted to them. Nevertheless, decisions to scale up or not to scale up given child health interventions are in some cases also dependent on other factors, such as the value a policymaker places on a child’s life in the specific context. It is worth noting that our study was undertaken in a rural setting and that its findings may not be applicable to urban settings. We used special dispersible amoxicillin tablets produced by a local pharmaceutical company for different age groups and these drugs were more expensive than currently marketed pills. Thus, the total cost would have been differed if the market price had been used. In conclusion, we emphasise the point that given the resource constraints in delivering child health interventions through the formal health-facility settings in developing countries, home management strategies could be used to complement service delivery through health facilities, especially in rural settings. These two ways – delivery through health facilities and home management strategies – together will accelerate progress towards meeting the Millennium Development Goal of reducing child mortality. The study received technical and financial support from the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, the Knowledge Enriches Programme of the Netherlands Organization for the Advancement of Tropical Research, WOTRO (NWO) and the African Doctoral Dissertation Research Fellowship, a collaborative programme of IDRC and African Population and Health Research Centre. We further acknowledge contributions from the community health workers, staff of Dodowa Health Research Centre (especially the malaria–pneumonia team), Dr. Evelyn Ansah, Director of Health Services, Dangme West District, Professor Piet A. Kager, Amsterdam Medical Centre, and Professor Bart van den Borne, University of Maastricht, the Netherlands. We also acknowledge technical inputs from Dr. Catherine Goodman of the London School of Hygiene and Tropical Medicine." @default.
• W2109782016 created "2016-06-24" @default.
• W2109782016 creator A5009210238 @default.
• W2109782016 creator A5035477752 @default.
• W2109782016 creator A5053573268 @default.
• W2109782016 creator A5066960718 @default.
• W2109782016 creator A5070665712 @default.
• W2109782016 creator A5071011495 @default.
• W2109782016 creator A5077525484 @default.
• W2109782016 date "2012-05-30" @default.
• W2109782016 modified "2023-09-25" @default.
• W2109782016 title "Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District" @default.
• W2109782016 cites W1969124734 @default.
• W2109782016 cites W2083637310 @default.
• W2109782016 cites W2114869964 @default.
• W2109782016 cites W2124536724 @default.
• W2109782016 cites W2144120311 @default.
• W2109782016 cites W2156631386 @default.
• W2109782016 cites W2157843711 @default.
• W2109782016 cites W2169668999 @default.
• W2109782016 doi "https://doi.org/10.1111/j.1365-3156.2012.03018.x" @default.
• W2109782016 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/22643324" @default.
• W2109782016 hasPublicationYear "2012" @default.
• W2109782016 type Work @default.
• W2109782016 sameAs 2109782016 @default.
• W2109782016 citedByCount "32" @default.
• W2109782016 countsByYear W21097820162013 @default.
• W2109782016 countsByYear W21097820162014 @default.
• W2109782016 countsByYear W21097820162015 @default.
• W2109782016 countsByYear W21097820162016 @default.
• W2109782016 countsByYear W21097820162017 @default.
• W2109782016 countsByYear W21097820162019 @default.
• W2109782016 countsByYear W21097820162020 @default.
• W2109782016 countsByYear W21097820162021 @default.
• W2109782016 countsByYear W21097820162022 @default.
• W2109782016 crossrefType "journal-article" @default.
• W2109782016 hasAuthorship W2109782016A5009210238 @default.
• W2109782016 hasAuthorship W2109782016A5035477752 @default.
• W2109782016 hasAuthorship W2109782016A5053573268 @default.
• W2109782016 hasAuthorship W2109782016A5066960718 @default.
• W2109782016 hasAuthorship W2109782016A5070665712 @default.
• W2109782016 hasAuthorship W2109782016A5071011495 @default.
• W2109782016 hasAuthorship W2109782016A5077525484 @default.
• W2109782016 hasBestOaLocation W21097820161 @default.
• W2109782016 hasConcept C144024400 @default.
• W2109782016 hasConcept C162324750 @default.
• W2109782016 hasConcept C205649164 @default.
• W2109782016 hasConcept C2908647359 @default.
• W2109782016 hasConcept C2992044688 @default.
• W2109782016 hasConcept C2994082534 @default.
• W2109782016 hasConcept C45355965 @default.
• W2109782016 hasConcept C50522688 @default.
• W2109782016 hasConcept C71924100 @default.
• W2109782016 hasConcept C83864248 @default.
• W2109782016 hasConcept C99454951 @default.
• W2109782016 hasConceptScore W2109782016C144024400 @default.
• W2109782016 hasConceptScore W2109782016C162324750 @default.
• W2109782016 hasConceptScore W2109782016C205649164 @default.
• W2109782016 hasConceptScore W2109782016C2908647359 @default.
• W2109782016 hasConceptScore W2109782016C2992044688 @default.
• W2109782016 hasConceptScore W2109782016C2994082534 @default.
• W2109782016 hasConceptScore W2109782016C45355965 @default.
• W2109782016 hasConceptScore W2109782016C50522688 @default.
• W2109782016 hasConceptScore W2109782016C71924100 @default.
• W2109782016 hasConceptScore W2109782016C83864248 @default.
• W2109782016 hasConceptScore W2109782016C99454951 @default.
• W2109782016 hasIssue "8" @default.
• W2109782016 hasLocation W21097820161 @default.
• W2109782016 hasLocation W21097820162 @default.
• W2109782016 hasOpenAccess W2109782016 @default.
• W2109782016 hasPrimaryLocation W21097820161 @default.
• W2109782016 hasRelatedWork W2517575795 @default.
• W2109782016 hasRelatedWork W2748952813 @default.
• W2109782016 hasRelatedWork W2899084033 @default.
• W2109782016 hasRelatedWork W2910919925 @default.
• W2109782016 hasRelatedWork W3157139564 @default.
• W2109782016 hasRelatedWork W3178151984 @default.
• W2109782016 hasRelatedWork W3203386426 @default.
• W2109782016 hasRelatedWork W4231571219 @default.
• W2109782016 hasRelatedWork W2291893536 @default.
• W2109782016 hasRelatedWork W3095557100 @default.
• W2109782016 hasVolume "17" @default.
• W2109782016 isParatext "false" @default.
• W2109782016 isRetracted "false" @default.
• W2109782016 magId "2109782016" @default.
• W2109782016 workType "article" @default.