1
|
Pryde SJ, Williams O, O'Hare MP, Murdock C, Pedlow K. Exploring access to community neurorehabilitation for people with progressive neurological conditions: a qualitative study. Disabil Rehabil 2024:1-14. [PMID: 38632940 DOI: 10.1080/09638288.2024.2338198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Community neurorehabilitation enables people with progressive neurological conditions (PNCs) to manage their symptoms to live an active, fulfilling life; however, it is not accessible to all. This study explored the factors influencing access to community neurorehabilitation in Northern Ireland from the perspective of people with PNCs and their carers. METHODS Eleven people living with a PNC and three carers took part in virtual focus groups. Data was thematically analysed using the framework method. RESULTS Access to neurorehabilitation was described as a staged journey, driven by people with PNCs, and impacted by interactions with others. Four themes were identified: the person in the driving seat, describing the value of person-centred care and the need for proactivity; the traffic lights, depicting the role and influence of health care professionals (HCPs); the need for direction; and roadworks and roadblocks, identifying additional barriers to access. In addition, six fundamentals of good access were identified. CONCLUSIONS This study adds depth to our understanding of the complexity, and the roles and needs of people with PNCs and HCPs, in accessing community neurorehabilitation. Further research is needed to determine how best to empower people to access rehabilitation.
Collapse
Affiliation(s)
- Shona J Pryde
- School of Health Sciences, Ulster University, Londonderry, UK
- Physiotherapy Department, Belfast Health and Social Care Trust, Belfast, UK
| | | | | | - Carolyn Murdock
- School of Health Sciences, Ulster University, Londonderry, UK
| | - Katy Pedlow
- School of Health Sciences, Ulster University, Londonderry, UK
| |
Collapse
|
2
|
Hilger A, Dunne-Platero K. The experiences of speech pathology referral and communicative participation in adults with cerebellar ataxia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:849-860. [PMID: 36562755 DOI: 10.1080/17549507.2022.2134455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The purpose of this study was to identify potential barriers to speech pathology referral in ataxia, as well as potential factors influencing satisfaction with speech pathology and communicative participation. METHOD An online survey study included questions about participant demographics, referral and access to speech pathology, satisfaction with speech pathology, and communicative participation via the Communicative Participation Item Bank (CPIB). RESULTS We analysed 118 eligible responses from individuals with ataxia. Results from Bayesian regression models indicated that the overall referral rate to speech pathology was 64% for the respondents with a speech impairment, predicted by lower income, less education, and greater self-perceived speech severity. Additionally, sex, self-perceived speech severity, and length of speech impairment predicted more restricted communicative participation. For the respondents who were referred for speech pathology, overall satisfaction with speech pathology was neutral to high but most individuals reported little to no improvement in their speech. CONCLUSION Referral rate to speech pathology was low given that dysarthria and dysphagia are highly likely to occur in ataxia. Considerations should be made for perceived speech severity, sex, and length of speech impairment in evaluating communicative participation. Lastly, there is a vital need for evidence-based treatment for ataxic dysarthria.
Collapse
Affiliation(s)
- Allison Hilger
- Department of Speech, Language, and Hearing Sciences, University of Colorado, Boulder, CO, USA
| | - Kylie Dunne-Platero
- Department of Speech, Language, and Hearing Sciences, University of Colorado, Boulder, CO, USA
| |
Collapse
|
3
|
Vallortigara J, Greenfield J, Hunt B, Hoffman D, Reinhard C, Graessner H, Federico A, Quoidbach V, Morris S, Giunti P. Patient pathways for rare diseases in Europe: ataxia as an example. Orphanet J Rare Dis 2023; 18:328. [PMID: 37848998 PMCID: PMC10583310 DOI: 10.1186/s13023-023-02907-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/04/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Progressive ataxias are rare and complex neurological disorders that represent a challenge for the clinicians to diagnose and manage them. This study explored the patient pathways of individuals attending specialist ataxia centres (SAC) compared with non-specialist settings. We investigated specifically how diagnosis was reached, the access to healthcare services, treatments, and care satisfaction. The focus of this study was on early intervention, coordination of treatment to understand the care provision in different countries. METHODS A patient survey was done in the UK, Germany and Italy to gather information about diagnosis and management of the ataxias in specialist (SAC) and non-specialist settings, utilisation of other primary and secondary health care services, and patients' satisfaction of received treatment. RESULTS Patients gave positive feedback about the role of SAC in understanding their condition, ways to manage their ataxia (p < 0.001; UK) and delivering care adapted to their needs (p < 0.001; UK), in coordinating referrals to other healthcare specialists, and in offering opportunities to take part in research studies. Similar barriers for patients were identified in accessing the SACs among the selected countries, UK, Germany, and Italy. CONCLUSIONS This study provides crucial information about the ataxia patients care pathways in three European countries. Overall, the results showed a trend in patients' satisfaction being better in SAC compared to non-SAC. The outcomes can be used now for policy recommendations on how to improve treatment and care for people with these very rare and complex neurological diseases across Europe.
Collapse
Affiliation(s)
- Julie Vallortigara
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square House, Queen Square, London, WC1N 3BG, UK
| | | | | | | | - Carola Reinhard
- Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Holm Graessner
- Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Italy and European Academy of Neurology, Siena, Italy
| | | | - Steve Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paola Giunti
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square House, Queen Square, London, WC1N 3BG, UK.
| |
Collapse
|
4
|
Rouco Axpe I, Loyola Irulegui A, Ruiz de la Peña B, Izarzugaza Iturrizar E. Hereditary cerebellar ataxias and hereditary spastic paraplegias: experience of disease from the patient's perspective. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:736-738. [PMID: 34294581 DOI: 10.1016/j.nrleng.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/23/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- I Rouco Axpe
- Consulta de Ataxias y Paraparesias Espásticas Hereditarias, Servicio de Neurología, Hospital Universitario de Cruces, Instituto de Investigación Sanitaria Biocruces, Barakaldo-Bizkaia, Spain.
| | - A Loyola Irulegui
- Subdirección de Innovación y Calidad, Hospital Universitario de Cruces, Barakaldo-Bizkaia, Spain
| | - B Ruiz de la Peña
- Subdirección de Innovación y Calidad, Hospital Universitario de Cruces, Barakaldo-Bizkaia, Spain
| | - E Izarzugaza Iturrizar
- Unidad de Innovación, Instituto de Investigación Sanitaria Biocruces, Baracaldo, Vizcaya, Spain
| |
Collapse
|
5
|
Rouco Axpe I, Loyola Irulegui A, Ruiz de la Peña B, Izarzugaza Iturrizar E. Ataxias and Hereditary Spastic Paraplegias: experience of disease from patient view. Neurologia 2021; 36:S0213-4853(21)00039-6. [PMID: 33810891 DOI: 10.1016/j.nrl.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- I Rouco Axpe
- Consulta de Ataxias y Paraparesias Espásticas Hereditarias, Servicio de Neurología, Hospital Universitario de Cruces, Instituto de Investigación Sanitaria Biocruces, Baracaldo, Vizcaya, España.
| | - A Loyola Irulegui
- Unidad de Innovación y Calidad, Instituto de Investigación Sanitaria Biocruces, Baracaldo, Vizcaya, España
| | - B Ruiz de la Peña
- Unidad de Innovación y Calidad, Instituto de Investigación Sanitaria Biocruces, Baracaldo, Vizcaya, España
| | - E Izarzugaza Iturrizar
- Unidad de Innovación y Calidad, Instituto de Investigación Sanitaria Biocruces, Baracaldo, Vizcaya, España
| |
Collapse
|
6
|
Staying Strong Toolbox: Co-design of a physical activity and lifestyle program for Aboriginal families with Machado-Joseph disease in the Top End of Australia. PLoS One 2021; 16:e0244311. [PMID: 33544709 PMCID: PMC7864457 DOI: 10.1371/journal.pone.0244311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022] Open
Abstract
Physical activity has positive health implications for individuals living with neurodegenerative diseases. The success of physical activity programs, particularly in culturally and linguistically diverse populations, is typically dependent on their alignment with the culture, lifestyle and environmental context of those involved. Aboriginal families living in remote communities in the Top End of Australia invited researchers to collaborate with them to co-design a physical activity and lifestyle program to keep individuals with Machado-Joseph disease (MJD) walking and moving around. The knowledge of Aboriginal families living with MJD, combined with findings from worldwide MJD research, formed the foundation for the co-design. An experience-based co-design (EBCD) approach, drawing from Indigenous and Participatory methodologies, was used. An expert panel of individuals with lived experience of MJD participated in a series of co-design phases. Prearranged and spontaneous co-design meetings were led by local community researchers within each phase. Data was collected using a culturally responsive ethnographic approach and analysed thematically. Sixteen panel members worked to develop the ‘Staying Strong Toolbox’ to cater for individuals with MJD who are ‘walking strong’; or ‘wobbly’; or ‘in a wheelchair’. Based on the ‘Staying Strong Framework’, the Toolbox was developed as a spiral bound A3 book designed to guide the user to select from a range of activities to keep them walking and moving around and to identify those activities most important to them to work on. The ‘Staying Strong Toolbox’ is a community driven, evidence based resource for a physical activity and lifestyle program for Aboriginal families with MJD. The Toolbox provides a guide for health professionals and support workers to deliver person-centred support to Aboriginal families with MJD, and that can be modified for use by other families with MJD or people with other forms of ataxia around the world.
Collapse
|
7
|
Lacorte E, Bellomo G, Nuovo S, Corbo M, Vanacore N, Piscopo P. The Use of New Mobile and Gaming Technologies for the Assessment and Rehabilitation of People with Ataxia: a Systematic Review and Meta-analysis. THE CEREBELLUM 2020; 20:361-373. [PMID: 33190189 PMCID: PMC8213672 DOI: 10.1007/s12311-020-01210-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 11/24/2022]
Abstract
There are no currently available disease-modifying pharmacological treatments for most of the chronic hereditary ataxias; thus, effective rehabilitative strategies are crucial to help improve symptoms and therefore the quality of life. We propose to gather all available evidence on the use of video games, exergames, and apps for tablet and smartphone for the rehabilitation, diagnosis, and assessment of people with ataxias. Relevant literature published up to June 8, 2020, was retrieved searching the databases PubMed, ISI Web of Science, and the Cochrane Database. Data were extracted using a standardized form, and their methodological quality was assessed using RoB and QUADAS-2. Six studies of 434 retrieved articles met the predefined inclusion/exclusion criteria. Two of them were diagnostic, while 4 were experimental studies. Studies included participants ranging from 9 to 28 in trials and 70 to 248 in diagnostic studies. Although we found a small number of trials and of low methodological quality, all of them reported an improvement of motor outcomes and quality of life as measured by specific scales, including the SARA, BBS, DHI, and SF-36 scores. The main reason for such low quality in trials was that most of them were small and uncontrolled, thus non-randomized and unblinded. As video games, exergames, serious games, and apps were proven to be safe, feasible, and at least as effective as traditional rehabilitation, further and more high-quality studies should be carried out on the use of these promising technologies in people with different types of ataxia.
Collapse
Affiliation(s)
- Eleonora Lacorte
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Guido Bellomo
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Sara Nuovo
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico (CCP), Milan, Italy
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Paola Piscopo
- Department of Neuroscience, Italian National Institute of Health, Viale Regina Elena, 00161, Rome, Italy.
| |
Collapse
|
8
|
Carr JJ, Lalara J, Lalara G, O’Hare G, Massey L, Kenny N, Pope KE, Clough AR, Lowell A, Barker RN. 'Staying strong on the inside and outside' to keep walking and moving around: Perspectives from Aboriginal people with Machado Joseph Disease and their families from the Groote Eylandt Archipelago, Australia. PLoS One 2019; 14:e0212953. [PMID: 30856185 PMCID: PMC6411155 DOI: 10.1371/journal.pone.0212953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/12/2019] [Indexed: 11/22/2022] Open
Abstract
Machado Joseph Disease (MJD) (spinocerebellar ataxia 3) is a hereditary neurodegenerative disease causing progressive ataxia and loss of mobility. It is the most common spinocerebellar ataxia worldwide. Among Aboriginal families of Groote Eylandt and related communities across Australia's Top End, MJD is estimated to be more prevalent than anywhere else in the world. This study explored lived experiences of individuals and families with MJD to determine what is important and what works best to keep walking and moving around. A collaborative qualitative exploratory study, drawing from constructivist grounded theory methods, was undertaken for data collection and analysis. Semi-structured in-depth interviews were conducted with individuals with MJD (n = 8) and their family members (n = 4) from the Groote Eylandt Archipelago where ~1500 Aboriginal people (Warnumamalya) live. Interviews were led by Warnumamalya community research partners in participants' preferred language(s). Participants described their experience of living with MJD, from 'knowing about MJD', 'protecting yourself from MJD' and 'adjusting to life with MJD'. While the specific importance of walking and moving around differed widely between participants, all perceived that walking and moving around enabled them to do what mattered most to them in life. 'Staying strong on the inside and outside' (physically, mentally, emotionally, spiritually) was perceived to work best to keep walking and moving around as long as possible. A framework that included personal and environmental strategies for staying strong emerged: 'Exercising your body', 'having something important to do', 'keeping yourself happy', 'searching for good medicine', 'families helping each other' and 'going country'. This study, the first to explore lived experiences of MJD in Australia, highlights the importance of maintaining mobility as long as possible. Strategies perceived to work best address physical and psychosocial needs in an integrated manner. Services supporting families with MJD need flexibility to provide individualised, responsive and holistic care.
Collapse
Affiliation(s)
- Jennifer J. Carr
- College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia
| | - Joyce Lalara
- Machado Joseph Disease Foundation, Alyangula, Northern Territory, Australia
| | - Gayangwa Lalara
- Machado Joseph Disease Foundation, Alyangula, Northern Territory, Australia
| | - Gloria O’Hare
- Machado Joseph Disease Foundation, Alyangula, Northern Territory, Australia
| | - Libby Massey
- Machado Joseph Disease Foundation, Alyangula, Northern Territory, Australia
| | - Nick Kenny
- Machado Joseph Disease Foundation, Alyangula, Northern Territory, Australia
| | - Kate E. Pope
- Machado Joseph Disease Foundation, Alyangula, Northern Territory, Australia
| | - Alan R. Clough
- Community-based Health Promotion and Prevention Studies Group, College of Public Health, Medical and Veterinary Sciences and Australian Institute of Tropical Health and Medicine, James Cook University Cairns, Australia
| | - Anne Lowell
- Northern Institute, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ruth N. Barker
- College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia
| |
Collapse
|
9
|
de Silva R, Greenfield J, Cook A, Bonney H, Vallortigara J, Hunt B, Giunti P. Guidelines on the diagnosis and management of the progressive ataxias. Orphanet J Rare Dis 2019; 14:51. [PMID: 30786918 PMCID: PMC6381619 DOI: 10.1186/s13023-019-1013-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/29/2019] [Indexed: 11/26/2022] Open
Abstract
The progressive ataxias are a group of rare and complicated neurological disorders, knowledge of which is often poor among healthcare professionals (HCPs). The patient support group Ataxia UK, recognising the lack of awareness of this group of conditions, has developed medical guidelines for the diagnosis and management of ataxia. Although ataxia can be a symptom of many common conditions, the focus here is on the progressive ataxias, and include hereditary ataxia (e.g. spinocerebellar ataxia (SCA), Friedreich’s ataxia (FRDA)), idiopathic sporadic cerebellar ataxia, and specific neurodegenerative disorders in which ataxia is the dominant symptom (e.g. cerebellar variant of multiple systems atrophy (MSA-C)). Over 100 different disorders can lead to ataxia, so diagnosis can be challenging. Although there are no disease-modifying treatments for most of these entities, many aspects of the conditions are treatable, and their identification by HCPs is vital. The early diagnosis and management of the (currently) few reversible causes are also of paramount importance. More than 30 UK health professionals with experience in the field contributed to the guidelines, their input reflecting their respective clinical expertise in various aspects of ataxia diagnosis and management. They reviewed the published literature in their fields, and provided summaries on “best” practice, including the grading of evidence available for interventions, using the Guideline International Network (GIN) criteria, in the relevant sections. A Guideline Development Group, consisting of ataxia specialist neurologists and representatives of Ataxia UK (including patients and carers), reviewed all sections, produced recommendations with levels of evidence, and discussed modifications (where necessary) with contributors until consensus was reached. Where no specific published data existed, recommendations were based on data related to similar conditions (e.g. multiple sclerosis) and/or expert opinion. The guidelines aim to assist HCPs when caring for patients with progressive ataxia, indicate evidence-based (where it exists) and best practice, and act overall as a useful resource for clinicians involved in managing ataxic patients. They do, however, also highlight the urgent need to develop effective disease-modifying treatments, and, given the large number of recommendations based on “good practice points”, emphasise the need for further research to provide evidence for effective symptomatic therapies. These guidelines are aimed predominantly at HCPs in secondary care (such as general neurologists, clinical geneticists, physiotherapists, speech and language therapists, occupational therapists, etc.) who provide care for individuals with progressive ataxia and their families, and not ataxia specialists. It is a useful, practical tool to forward to HCPs at the time referrals are made for on-going care, for example in the community.
Collapse
Affiliation(s)
- Rajith de Silva
- Department of Neurology, Essex Centre for Neurological Sciences, Queen's Hospital, Romford, RM7 0AG, UK
| | | | - Arron Cook
- Ataxia Centre, Department of Molecular Neurosciences, UCL Queen Sqaure Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | | | | | - Barry Hunt
- Ataxia UK, 12 Broadbent Close, London, N6 5JW, UK
| | - Paola Giunti
- Ataxia Centre, Department of Molecular Neurosciences, UCL Queen Sqaure Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
| |
Collapse
|
10
|
Payne K, Gavan SP, Wright SJ, Thompson AJ. Cost-effectiveness analyses of genetic and genomic diagnostic tests. Nat Rev Genet 2018; 19:235-246. [PMID: 29353875 DOI: 10.1038/nrg.2017.108] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Developments in next-generation sequencing technologies have driven the clinical application of diagnostic tests that interrogate the whole genome, which offer the chance to diagnose rare inherited diseases or inform the targeting of therapies. New genomic diagnostic tests compete with traditional approaches to diagnosis, including the genetic testing of single genes and other clinical strategies, for finite health-care budgets. In this context, decision analytic model-based cost-effectiveness analysis is a useful method to help evaluate the costs versus consequences of introducing new health-care interventions. This Perspective presents key methodological, technical, practical and organizational challenges that must be considered by decision-makers responsible for the allocation of health-care resources to obtain robust and timely information about the relative cost-effectiveness of the increasing numbers of emerging genomic tests.
Collapse
Affiliation(s)
- Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, M13 9PL, UK
| | - Sean P Gavan
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, M13 9PL, UK
| | - Stuart J Wright
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, M13 9PL, UK
| | - Alexander J Thompson
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, M13 9PL, UK
| |
Collapse
|
11
|
Cassidy E, Naylor S, Reynolds F. The meanings of physiotherapy and exercise for people living with progressive cerebellar ataxia: an interpretative phenomenological analysis. Disabil Rehabil 2017; 40:894-904. [DOI: 10.1080/09638288.2016.1277400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elizabeth Cassidy
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Sandra Naylor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Frances Reynolds
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| |
Collapse
|