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Kearney A, Humphreys H, Fitzgerald-Hughes D. Nutritional drinks and enteral feeds promote the growth of carbapenemase-producing Enterobacterales in conditions that simulate disposal in hospital sinks. J Hosp Infect 2023; 139:74-81. [PMID: 37271316 DOI: 10.1016/j.jhin.2023.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Studies have shown that nutritional products are discarded via handwash sinks by healthcare workers, and this practice may promote bacterial growth, including growth of pathogens such as carbapenemase-producing Enterobacterales (CPE). Outbreaks and acquisition of CPE in nosocomial settings are associated with negative outcomes for patients and hospitals. OBJECTIVES To investigate the potential growth-promoting effect of nutritional support drinks (NSDs) and enteral tube-feed products (ETFPs) on CPE. METHODS Six different CPE strains were grown in five different diluted NSDs, five different diluted ETFPs, Mueller-Hinton broth (MHB) and M9 minimal salts media to simulate discarding a small volume of nutritional product in a u-bend, already containing liquid. CPE were enumerated at 0 h, 6 h and 24 h, and compared using two-way analysis of variance and Dunett test, with confidence levels at 95%. Spearman's r was used to measure the strength of correlation between component concentrations in nutritional products and CPE growth. RESULTS All NSDs and ETFPs promoted CPE growth that exceeded both M9 (negative growth control) and MHB (positive growth control). In several cases, growth in NSDs/ETFPs was significantly greater compared with growth in MHB. CONCLUSION Nutritional products support CPE growth under in-vitro conditions. The propensity of CPE to survive in drain pipework suggests that inappropriate product disposal may further nourish established CPE in these environmental reservoirs. The growth observed in diluted NSDs and ETFPs shows that modifiable practices should be optimized to mitigate the potential risk of CPE transmission from these reservoirs.
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Affiliation(s)
- A Kearney
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - H Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - D Fitzgerald-Hughes
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin, Ireland.
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2
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O' Connor M, Mc Namara C, Doody O. Healthcare workers experiences of caring for patients colonized with Carbapenemase-Producing Enterobacterale (CPE) in an acute hospital setting - A qualitative descriptive study. Infect Dis Health 2023; 28:186-194. [PMID: 37029044 DOI: 10.1016/j.idh.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Carbapenemase-Producing Enterobacterale (CPE) is a multi-drug resistant organism, that is of growing concern within hospitals worldwide. This leads to an increased workload on healthcare workers. PURPOSE To explore the experiences of healthcare workers who care for patients colonized with CPE. METHODS A qualitative descriptive research design. Semi-structured interviews undertaken and analysed using a thematic analysis framework resulting in the identification of four main themes. RESULTS This study explores the barriers and facilitators healthcare workers encounter when caring for patients colonized with CPE and their experience of the effect that a CPE diagnosis has on the provision of patient care across four themes: education, the COVID effect, fear, and staffing/resource issues. The study is reported utilising the COREQ checklist. CONCLUSION Healthcare workers were aware of the IPC guidance and education was the main facilitator to knowledge and practice. Barriers such as poor staffing levels and the impact of COVID-19 were highlighted in relation to care provision and reducing fear associated with CPE. Healthcare workers priority is to provide safe and effective care for their patients and barriers that impact their ability to provide such care need to be addressed to ensure an optimal experience for both healthcare workers and patients.
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Affiliation(s)
- Majella O' Connor
- University of Limerick, Ireland. Clinical Nurse Manager 2 Infection Prevention and Control, University Hospital, Limerick, Ireland.
| | - Claire Mc Namara
- Department of Nursing and Midwifery, University of Limerick, Ireland.
| | - Owen Doody
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
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3
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Halouani H, Lomont A, Jaureguy F, Carbonnelle E, Delphine S, Zahar JR. Interest of broth enrichment for rectal screening in a low carbapenemase-producing Enterobacterales (CPE) prevalence country. J Hosp Infect 2023:S0195-6701(23)00158-5. [PMID: 37286107 DOI: 10.1016/j.jhin.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Habib Halouani
- Infection Control Unit, Departement of Clinical Microbiology, AP-HP, Groupe Hospitalier Paris Seine Saint-Denis, 3009 Bobigny, France; Université Sorbonne Paris Nord and Université Paris Cité, Inserm, UMR1137- IAME, F-93000 Bobigny, France
| | - Alexandra Lomont
- Infection Control Unit, Departement of Clinical Microbiology, AP-HP, Groupe Hospitalier Paris Seine Saint-Denis, 3009 Bobigny, France; Université Sorbonne Paris Nord and Université Paris Cité, Inserm, UMR1137- IAME, F-93000 Bobigny, France
| | - Françoise Jaureguy
- Department of Clinical Microbiology, AP-HP, Groupe Hospitalier Paris Seine Saint-Denis, 93009 Bobigny, France; Université Sorbonne Paris Nord and Université Paris Cité, Inserm, UMR1137- IAME, F-93000 Bobigny, France
| | - Etienne Carbonnelle
- Department of Clinical Microbiology, AP-HP, Groupe Hospitalier Paris Seine Saint-Denis, 93009 Bobigny, France; Université Sorbonne Paris Nord and Université Paris Cité, Inserm, UMR1137- IAME, F-93000 Bobigny, France
| | - Seytre Delphine
- Infection Control Unit, Departement of Clinical Microbiology, AP-HP, Groupe Hospitalier Paris Seine Saint-Denis, 3009 Bobigny, France; Université Sorbonne Paris Nord and Université Paris Cité, Inserm, UMR1137- IAME, F-93000 Bobigny, France
| | - Jean-Ralph Zahar
- Infection Control Unit, Departement of Clinical Microbiology, AP-HP, Groupe Hospitalier Paris Seine Saint-Denis, 3009 Bobigny, France; Université Sorbonne Paris Nord and Université Paris Cité, Inserm, UMR1137- IAME, F-93000 Bobigny, France.
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Domegan L, Brehony C, Fitzpatrick F, O'Connell K, Dinesh B, Cafferkey J, Burns K. Social network and genomic analysis of an OXA-48 carbapenemase-producing Enterobacterales hospital ward outbreak in Ireland, 2018-2019. Infect Prev Pract 2023; 5:100282. [PMID: 37168234 PMCID: PMC10164899 DOI: 10.1016/j.infpip.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/28/2023] [Indexed: 05/13/2023] Open
Abstract
Background Nosocomial transmission and outbreaks of carbapenemase-producing Enterobacterales (CPE) represent a challenge to healthcare systems. In July 2018, a CPE hospital ward outbreak was declared. Our aim was to investigate transmission patterns, using social network analysis and genomics in a nosocomial CPE outbreak. Methods A retrospective descriptive analysis of all patients (cases and contacts) admitted to a ward experiencing a CPE outbreak (2018-2019) was undertaken. A case had a negative CPE admission screen, and subsequent positive test. A contact shared a multi-bed area and/or facility with a case (>4 hours). Social networks, including genomics data and ward locations, were constructed. Network metrics were analysed. Findings Forty-five cases and 844 contacts were analysed. The median age of cases was 78 years (IQR 67-83), 58% (n=26) were male and 100% had co-morbidities. The median outbreak ward length-of-stay (LOS) was 17 days (IQR 10-34). OXA-48 CPE was confirmed in all cases and from 26 environmental samples. Social networks identified clusters by time, gender and species/sequence type/plasmid. Network metrics indicated potential superspreading involving a subset of patients with behavioural issues. Conclusion Social networks elucidated high resolution transmission patterns involving two related OXA-48 plasmids, multiple species/genotypes and potential super-spreading. Interventions prevented intra-hospital spread. An older patient cohort, extended hospital LOS and frequent intra-ward bed transfers, coupled with suboptimal ward infrastructure, likely prolonged this outbreak. We recommend social network analysis contemporaneously with genomics (on case and environmental samples) for complex nosocomial outbreaks and bespoke care plans for patients with behavioural issues on outbreak wards.
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Affiliation(s)
- Lisa Domegan
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
- Corresponding author. Address: Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland.
| | - Carina Brehony
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland
- European Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
| | - Fidelma Fitzpatrick
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland
| | - Karina O'Connell
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland
| | - Binu Dinesh
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland
| | - Jacqueline Cafferkey
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland
| | - Karen Burns
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland
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Büchler AC, Shahab SN, Severin JA, Vos MC, Voor In 't Holt AF. Outbreak investigations after identifying carbapenem-resistant Pseudomonas aeruginosa: a systematic review. Antimicrob Resist Infect Control 2023; 12:28. [PMID: 37013661 PMCID: PMC10068724 DOI: 10.1186/s13756-023-01223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/23/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a serious cause of healthcare-associated infections. Part of the infection prevention and control measures are outbreak investigations (OI) of patients, healthcare workers (HCW), and the environment after identifying a CRPA in order to identify carriers and environmental reservoirs, so that targeted actions can be taken to prevent further transmission. However, little is known on when and how to perform such OI. Therefore, this systematic review aims to summarize OI performed after detection of CRPA in the endemic and epidemic hospital setting. MAIN TEXT Articles related to our research question were identified through a literature research in multiple databases (Embase, Medline Ovid, Cochrane, Scopus, Cinahl, Web of Science, and Google Scholar) until January 12, 2022 (Prospero registration number CRD42020194165). Hundred-twenty-six studies were included. In both the endemic and the epidemic setting, a median number of two out of seven predefined components of OI were identified. In the endemic setting, the most frequent component of OI was screening of the environment (28 studies, 62.2%). In the epidemic setting, screening of the environment (72 studies, 88.9%), and screening of patients during hospitalization (30 studies, 37%) were most frequently performed. Only 19 out of 126 studies (15.1%) reported screening of contact patients, and 37 studies reported screening of healthcare workers (HCW, 29.4%). CONCLUSION Due to probable underreporting of OI in the literature, the available evidence for the usefulness of the individual components of OI is scarce. This could lead to inhomogeneous performance of OI after detection of CRPA in the healthcare setting, and with this, potential under- or overscreening. While we could show evidence for the usefulness for environmental screening in order to identify the mode of transmission, evidence for HCW screening is scarce and might not lead to the identification of modes of transmission. Further studies are needed to better understand CI in different settings and, finally, develop guidance on when and how to best perform OI.
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Affiliation(s)
- Andrea C Büchler
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Selvi N Shahab
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Clinical Microbiology, Dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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O'Connor M, McNamara C, Doody O. Healthcare workers' experiences of caring for patients colonized with carbapenemase-producing Enterobacterales (CPE) in an acute hospital setting - a scoping review. J Hosp Infect 2023; 131:181-189. [PMID: 36347399 DOI: 10.1016/j.jhin.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Abstract
Carbapenemase-producing Enterobacterales (CPE) is an increasing public health concern; these bacteria are highly transmissible in hospital environments and the number of patients with these multidrug-resistant bacteria is rising. Healthcare workers caring for patients colonized with CPE offer insight into care delivery and processes in the hospital setting. The aim of this review was to explore healthcare workers' experiences of caring for patients colonized with CPE. A scoping review method was employed and seven electronic databases (CINAHL, Academic Search Complete, Cochrane, Embase, Medline, Web of Science and Scopus) and four grey literature databases (Open Grey, Grey Literature Report, Clinical trials. gov and WHO International Clinical Trials Registry Platform) were searched using specific search terms and inclusion/exclusion criteria. A PRISMA flow diagram was used to illustrate the process of article selection and thematic analysis used to form themes. Three studies met the criteria to be included in this review. Two main themes were identified from analysing the articles: 'Safeguarding' and 'Power of Knowledge'. The desire to protect themselves, their families and patients was evident from the studies. Healthcare workers were aware of the importance on infection prevention and control measures such as hand hygiene, in preventing the transmission of CPE, however barriers to these were identified, such as time constraints. In conclusion, healthcare workers have negative associations when it comes to caring for patients with CPE. Very little research has been conducted in the area and there is an opportunity to further explore the experience of healthcare workers caring for patients with CPE to identify opportunities for improvement and support of staff.
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Affiliation(s)
- M O'Connor
- Infection Prevention and Control, University Hospital, Limerick, Ireland
| | - C McNamara
- Department of Nursing and Midwifery, University of Limerick, Ireland
| | - O Doody
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
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7
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O'Connell N, Gasior S, Slevin B, Power L, Barrett S, Bhutta S, Minihan B, Powell J, Dunne C. Microbial epidemiology and clinical risk factors of carbapenemase-producing Enterobacterales amongst Irish patients from first detection in 2009 until 2020. Infect Prev Pract 2022; 4:100230. [PMID: 35935263 PMCID: PMC9352914 DOI: 10.1016/j.infpip.2022.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Carbapenemase producing Enterobacterales (CPE) are major public health threats. Aim To review microbial epidemiology of CPE, as well as clinical risk factors and infections, amongst CPE positive patients over 12 years in an Irish tertiary hospital. Methods Retrospective observational study of data extracted from a laboratory CPE database, electronic healthcare records and manual review of patient charts. Common risk factors, treatment regimens for all CPE related infections, and clinical outcomes were ascertained. Findings Among CPE strains isolated from 460 patients, Klebsiella pneumoniae carbapenemase (KPC) was the carbapenemase most frequently detected, accounting for 87.4% (459) of all CPE enzymes. Citrobacter species 177 (33.7%) were the most common species harbouring this enzyme. 428 CPE positive patients (93%) were identified in the acute hospital setting; the most common risk factor for CPE acquisition was history of hospitalisation, observed in 305 (66%) cases. Thirty patients (6.5%) had confirmed infections post-acquisition, of which four were bloodstream infections. There were 19 subsequent episodes of non CPE-related bacteraemia in this cohort. All causal mortality at 30 days was 41 patients (8.9%). However, clinical review determined that CPE was an indirect associative factor in 8 patient deaths. Conclusions In this tertiary hospital setting, microbial epidemiology is changing; with both OXA-48 enzymes and KPC-producing Citrobacter species becoming more prevalent. Whilst the burden of CPE related infections, especially bacteraemia, was low over the study period, it remains critical that basic infection prevention and control practices are adhered to lest the observed changes in epidemiology result in an increase in clinical manifestations.
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Affiliation(s)
- N.H. O'Connell
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - S. Gasior
- School of Medicine, University of Limerick, Limerick, Ireland
| | - B. Slevin
- Department of Infection Prevention and Control, ULHG, Limerick, Ireland
| | - L. Power
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
| | - S. Barrett
- Department of Pharmacy, ULHG, Limerick, Ireland
| | - S.I. Bhutta
- Department of Gastroenterology, ULHG, Limerick, Ireland
| | - B. Minihan
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
| | - J. Powell
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - C.P. Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
- Corresponding author. Address: Foundation Chair and Director of Research, School of Medicine, University of Limerick, Ireland. Tel.: +35361234703.
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Murphy C, Duffy F, McCormick F, O'Donnell S, Fitzpatrick F, Humphreys H. Workload for infection prevention and control teams in preventing nosocomial tuberculosis. An underestimated burden. J Hosp Infect 2022; 129:115-116. [PMID: 35961479 DOI: 10.1016/j.jhin.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 10/31/2022]
Affiliation(s)
- C Murphy
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - F Duffy
- Infection Prevention and Control Department, Beaumont Hospital, Dublin, Ireland
| | - F McCormick
- Infection Prevention and Control Department, Beaumont Hospital, Dublin, Ireland
| | - S O'Donnell
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - F Fitzpatrick
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - H Humphreys
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Dublin, Ireland
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van der Schoor AS, Boyle M, Voor in ‘t holt AF, Vos MC, Humphreys H. Environmental sampling practices of innate hospital surfaces. A need for guidance and consensus? A survey conducted by the ESCMID Study Group for Nosocomial Infections (ESGNI). J Hosp Infect 2022. [DOI: 10.1016/j.jhin.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022]
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