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Massen GM, Stone PW, Kwok HHY, Jenkins G, Allen RJ, Wain LV, Stewart I, Quint JK. Review of codelists used to define hypertension in electronic health records and development of a codelist for research. Open Heart 2024; 11:e002640. [PMID: 38626934 PMCID: PMC11029375 DOI: 10.1136/openhrt-2024-002640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND AIMS Hypertension is a leading risk factor for cardiovascular disease. Electronic health records (EHRs) are routinely collected throughout a person's care, recording all aspects of health status, including current and past conditions, prescriptions and test results. EHRs can be used for epidemiological research. However, there are nuances in the way conditions are recorded using clinical coding; it is important to understand the methods which have been applied to define exposures, covariates and outcomes to enable interpretation of study findings. This study aimed to identify codelists used to define hypertension in studies that use EHRs and generate recommended codelists to support reproducibility and consistency. ELIGIBILITY CRITERIA Studies included populations with hypertension defined within an EHR between January 2010 and August 2023 and were systematically identified using MEDLINE and Embase. A summary of the most frequently used sources and codes is described. Due to an absence of Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) codelists in the literature, a recommended SNOMED CT codelist was developed to aid consistency and standardisation of hypertension research using EHRs. FINDINGS 375 manuscripts met the study criteria and were eligible for inclusion, and 112 (29.9%) reported codelists. The International Classification of Diseases (ICD) was the most frequently used clinical terminology, 59 manuscripts provided ICD 9 codelists (53%) and 58 included ICD 10 codelists (52%). Informed by commonly used ICD and Read codes, usage recommendations were made. We derived SNOMED CT codelists informed by National Institute for Health and Care Excellence guidelines for hypertension management. It is recommended that these codelists be used to identify hypertension in EHRs using SNOMED CT codes. CONCLUSIONS Less than one-third of hypertension studies using EHRs included their codelists. Transparent methodology for codelist creation is essential for replication and will aid interpretation of study findings. We created SNOMED CT codelists to support and standardise hypertension definitions in EHR studies.
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Affiliation(s)
| | - Philip W Stone
- School of Public Health, Imperial College London, London, UK
| | - Harley H Y Kwok
- School of Public Health, Imperial College London, London, UK
| | - Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Richard J Allen
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Louise V Wain
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Iain Stewart
- National Heart and Lung Institute, Imperial College London, London, UK
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Paturle C, Huguet M, Ferreira E, Mourad JJ. From guidelines to current practices: Suboptimal hypertension management in France. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:174-180. [PMID: 38035923 DOI: 10.1016/j.jdmv.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
In France, the prevalence of hypertension is higher than 30%. Although treatment guidelines have been well established over the last twenty years, the national blood pressure control rate is below the average of high-income countries. This observational study aimed to describe the antihypertensive prescription behaviours of primary care physicians (PCPs) in France and to assess their compliance with current French guidelines, focusing on three specific prescription issues and their potential repercussions on blood pressure control: treatment initiation, treatment renewal or change and type of triple therapy. Prescription data were retrieved using the IQVIA longitudinal patient database (LPD), which delivers real-world data insights from French primary care electronic medical records (EMR). The average number of prescribed therapeutic agents was 1.9 per patient, with 39.3% monotherapy prescriptions. Treatment initiation represented 7.2% of all antihypertensive prescriptions. At treatment initiation, 22.5% of patients were prescribed dual therapy. The proportion of treatment renewal in the same therapeutic class was 74.3% while the proportion of treatment change was 18.5%. Of these, only 6.3% of patients received an additional therapy. Lastly, 35.7% of triple therapies were consistent with the recommended combinations. In conclusion, this study provides evidence of therapeutic gaps in hypertension management in France. The low blood control rate may be attributed to PCPs' therapeutic inertia and lack of knowledge of treatment guidelines. All stakeholders should commit to rapid corrective action in order to provide patients with the best care.
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Affiliation(s)
- C Paturle
- Université Paris Cité, Paris, France
| | - M Huguet
- IQVIA, Tour D2, 17 bis, place des Reflets, 92099 La Défense cedex, France
| | - E Ferreira
- IQVIA, Tour D2, 17 bis, place des Reflets, 92099 La Défense cedex, France
| | - J-J Mourad
- Service de médecine interne, hôpital Franco-Britannique, 4, rue Kléber, 92300 Levallois-Perret, France.
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Raventós B, Fernández-Bertolín S, Aragón M, Voss EA, Blacketer C, Méndez-Boo L, Recalde M, Roel E, Pistillo A, Reyes C, van Sandijk S, Halvorsen L, Rijnbeek PR, Burn E, Duarte-Salles T. Transforming the Information System for Research in Primary Care (SIDIAP) in Catalonia to the OMOP Common Data Model and Its Use for COVID-19 Research. Clin Epidemiol 2023; 15:969-986. [PMID: 37724311 PMCID: PMC10505380 DOI: 10.2147/clep.s419481] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/03/2023] [Indexed: 09/20/2023] Open
Abstract
Purpose The primary aim of this work was to convert the Information System for Research in Primary Care (SIDIAP) from Catalonia, Spain, to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). Our second aim was to provide a descriptive analysis of COVID-19-related outcomes among the general population. Patients and Methods We mapped patient-level data from SIDIAP to the OMOP CDM and we performed more than 3,400 data quality checks to assess its readiness for research. We established a general population cohort as of the 1st March 2020 and identified outpatient COVID-19 diagnoses or tested positive for, hospitalised with, admitted to intensive care units (ICU) with, died with, or vaccinated against COVID-19 up to 30th June 2022. Results After verifying the high quality of the transformed dataset, we included 5,870,274 individuals in the general population cohort. Of those, 604,472 had either an outpatient COVID-19 diagnosis or positive test result, 58,991 had a hospitalisation, 5,642 had an ICU admission, and 11,233 died with COVID-19. A total of 4,584,515 received a COVID-19 vaccine. People who were hospitalised or died were more commonly older, male, and with more comorbidities. Those admitted to ICU with COVID-19 were generally younger and more often male than those hospitalised and those who died. Conclusion We successfully transformed SIDIAP to the OMOP CDM. From this dataset, a general population cohort of 5.9 million individuals was identified and their COVID-19-related outcomes over time were described. The transformed SIDIAP database is a valuable resource that can enable distributed network research in COVID-19 and beyond.
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Affiliation(s)
- Berta Raventós
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Sergio Fernández-Bertolín
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - María Aragón
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Erica A Voss
- Janssen Pharmaceutical Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA
| | - Clair Blacketer
- Janssen Pharmaceutical Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA
| | - Leonardo Méndez-Boo
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Spain
| | - Martina Recalde
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Elena Roel
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Andrea Pistillo
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlen Reyes
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | | | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA
| | - Edward Burn
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
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Wang M, Mi H, Li N, Shi Q, Sun W, He T, Lin J, Jin W, Gao X, Hu B, Su C, Pan J. Association between the overall burden of comorbidity and Ct values among the older patients with Omicron infection: Mediated by inflammation. Front Immunol 2023; 14:1145044. [PMID: 36999038 PMCID: PMC10043200 DOI: 10.3389/fimmu.2023.1145044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/02/2023] [Indexed: 03/15/2023] Open
Abstract
ObjectivesTo investigate the associations between the overall burden of comorbidity, inflammatory indicators in plasma and Ct values among the elderly with COVID-19.MethodsWe conducted a retrospective observational study. The results of each nucleic acid test of during hospitalization were obtained. Linear regression models assessed the associations between the overall burden of comorbidity, inflammatory indicators in plasma and Ct values among the elderly. A causal mediation analysis was performed to assess the mediation effects of inflammatory indicators on the association between the overall burden of comorbidity and Ct values.ResultsA total of 767 COVID-19 patients aged ≥ 60 years were included between April 2022 and May 2022. Patients with a high burden of comorbidity had significantly lower Ct values of the ORF gene than subjects with a low burden of comorbidity (median, 24.81 VS 26.58, P < 0.05). Linear regression models showed that a high burden of comorbidity was significantly associated with higher inflammatory responses, including white blood cell count, neutrophil count and C-reactive protein. Also, white blood cell count, neutrophil count, C-reactive protein and the overall burden of comorbidity assessed by age-adjusted Charlson comorbidity index were independent risk factors for the Ct values. A mediation analysis detected the mediation effect of white blood cells on the association between the burden of comorbidity and Ct values, with the indirect effect estimates of 0.381 (95% CI: 0.166, 0.632, P < 0.001). Similarly, the indirect effect of C-reactive protein was -0.307 (95% CI: -0.645, -0.064, P = 0.034). White blood cells and C-reactive protein significantly mediated the relationship between the burden of comorbidity and Ct values by 29.56% and 18.13% of the total effect size, respectively.ConclusionsInflammation mediated the association between the overall burden of comorbidity and Ct values among elderly with COVID-19, which suggests that combined immunomodulatory therapies could reduce the Ct values for such patients with a high burden of comorbidity.
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Affiliation(s)
- Meixia Wang
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, Fujian, China
| | - Hongfei Mi
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, Fujian, China
| | - Na Li
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qingfeng Shi
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Sun
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tingjuan He
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, Fujian, China
| | - Jiabing Lin
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenting Jin
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodong Gao
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bijie Hu
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chenghao Su
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, Fujian, China
| | - Jue Pan
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, Fujian, China
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Jue Pan,
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Barone A, Billeci M, D'Amore S, De Prisco M, De Simone G, Ermini E, Freda V, Iannotta F, Luciani A, Pistone L, Rifici LM, Saia VM, Spennato G, Subosco F, Vellucci L, D'Urso G, Galletta D, Fornaro M, Iasevoli F, de Bartolomeis A. The effects of sustained COVID-19 emergency and restrictions on the mental health of subjects with serious mental illness: A prospective study. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:154-167. [PMID: 35615854 PMCID: PMC9347680 DOI: 10.1002/jcop.22886] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/13/2022] [Accepted: 05/13/2022] [Indexed: 05/16/2023]
Abstract
Few longitudinal studies have so far investigated the impact of sustained COVID-19 among people with pre-existing psychiatric disorders. We conducted a prospective study involving people with serious mental illness (n = 114) and healthy controls (n = 41) to assess changes in the Perceived Stress Scale, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, and Specific Psychotic Experiences Questionnaire scores 18 months after the COVID-19 pandemic outset. Subjects underwent interviews with a mental health professional in April 2020 and at the end of the local third wave (October 2021). A significant increase in perceived stress was found in healthy controls, especially females. Psychiatric patients showed a significant worsening of anxiety symptoms compared to baseline records (t = -2.3, p = 0.036). Patients who rejected vaccination had significantly higher paranoia scores compared to those willing to get vaccinated (U = 649.5, z = -2.02, p = 0.04). These findings indicate that COVID-19's sustained emergency may cause enduring consequences on mental health, soliciting further investigations.
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Affiliation(s)
- Annarita Barone
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Sofia D'Amore
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Giuseppe De Simone
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Eleonora Ermini
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Vittorio Freda
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Federica Iannotta
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Adalgisa Luciani
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Luca Pistone
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Lorenza M. Rifici
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Viviana M. Saia
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Giancarlo Spennato
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Francesco Subosco
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Licia Vellucci
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Giordano D'Urso
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Diana Galletta
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Felice Iasevoli
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
- UNESCO Chair on Health Education & Sustainable Development at University of Naples “Federico II”School of MedicineNaplesItaly
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Ying CQ, Lin XQ, Lv L, Chen Y, Jiang JJ, Zhang Y, Tung TH, Zhu JS. Intentions of Patients with Hypertension to Receive a Booster Dose of the COVID-19 Vaccine: A Cross-Sectional Survey in Taizhou, China. Vaccines (Basel) 2022; 10:vaccines10101635. [PMID: 36298500 PMCID: PMC9608070 DOI: 10.3390/vaccines10101635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
COVID-19 patients with hypertension have increased hospital complications and mortality rates. Moreover, these patients also have lower antibody titers after receiving the coronavirus disease (COVID-19) vaccine. Therefore, patients with hypertension should receive a COVID-19 vaccine booster. To promote the uptake of COVID-19 vaccine booster among hypertensive patients, this study investigated patients’ willingness and factors that influence patients with hypertension to receive the COVID-19 vaccine booster. From July 2021 to August, 410 patients with hypertension were surveyed. Overall, 76.8% of patients were willing to receive the COVID-19 vaccine booster, as 82.7% of patients without comorbidities and 72.7% of patients with comorbidities were willing to receive the vaccine booster. The main factors that influenced the willingness of patients with hypertension to receive a booster dose were the preventive effect of the vaccine (χ2 = 52.827, p < 0.05), vaccine safety (χ2 = 42.423, p < 0.05), vaccine knowledge (χ2 = 7.831, p < 0.05), presence of comorbidities (χ2 = 4.862, p < 0.05), disease control (χ2 = 5.039, p < 0.05), and antihypertensive treatments (χ2 = 12.565, p < 0.05). This study’s findings highlight the need to promote knowledge about booster vaccination among patients and health management. These measures would improve patients’ willingness and knowledge about the vaccine and their health status, which are the main factors that influence patients’ intention to receive booster vaccines.
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Affiliation(s)
- Chen-Qian Ying
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Xiao-Qing Lin
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Li Lv
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai 317000, China
| | - Yan Chen
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Jian-Jun Jiang
- Department of Cardiovascular Diseases, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai 317000, China
| | - Yun Zhang
- Department of Cardiovascular Diseases, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai 317000, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
- Correspondence: (T.-H.T.); (J.-S.Z.)
| | - Jian-Sheng Zhu
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
- Correspondence: (T.-H.T.); (J.-S.Z.)
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