Quantification of impact of COVID-19 pandemic on cancer screening programmes – a case study from Argentina, Bangladesh, Colombia, Morocco, Sri Lanka, and Thailand

Q1Q1Pacientes con Cáncer de cuello uterinoPacientes con Cáncer de mamaIt is quite well documented that the COVID-19 pandemic disrupted cancer screening services in all countries, irrespective of their resources and healthcare settings. While quantitative estimates on reduction in volume of screening tests or diagnostic evaluation are readily available from the high-income countries, very little data are available from the low- and middle-income coun tries (LMICs). From the CanScreen5 global cancer screening data repository we identified six LMICs through purposive sampling based on the availability of cancer screening data at least for the years 2019 and 2020. These countries represented those in high human development index (HDI) cate gories (Argentina, Colombia, Sri Lanka, and Thailand) and medium HDI categories (Bangladesh and Morocco). No data were available from low HDI countries to perform similar analysis. The reduction in the volume of tests in 2020 compared to the previous year ranged from 14.1% in Bangladesh to 72.9% in Argentina (regional programme) for cervical screening, from 14.2% in Bangladesh to 49.4% in Morocco for breast cancer screening and 30.7% in Thailand for colorectal cancer screening. Number of colposcopies was reduced in 2020 compared to previous year by 88.9% in Argentina, 38.2% in Colombia, 27.4% in Bangladesh, and 52.2% in Morocco. The reduction in detection rates of CIN 2 or worse lesions ranged from 20.7% in Morocco to 45.4% in Argentina. Reduction of breast cancer detection by 19.1% was reported from Morocco. No association of the impact of pandemic could be seen with HDI categories. Quantifying the impact of service disruptions in screening and diagnostic tests will allow the programmes to strategize how to ramp up services to clear the back logs in screening and more crucially in further evaluation of screen positives. The data can be used to estimate the impact on stage distribution and avoidable mortality from these common cancers.https://orcid.org/0000-0001-7187-9946Revista Internacional - IndexadaA1N

The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial.

BACKGROUND: The prevalence of allergy-related diseases is increasing in low-income countries. Parasitic helminths, common in these settings, may be protective. We hypothesized that intensive, community-wide, anthelminthic mass drug administration (MDA) would increase allergy-related diseases, while reducing helminth-related morbidity. METHODS: In an open, cluster-randomized trial (ISRCTN47196031), we randomized 26 high-schistosomiasis-transmission fishing villages in Lake Victoria, Uganda, in a 1:1 ratio to receive community-wide intensive (quarterly single-dose praziquantel plus albendazole daily for 3 days) or standard (annual praziquantel plus 6 monthly single-dose albendazole) MDA. Primary outcomes were recent wheezing, skin prick test positivity (SPT), and allergen-specific immunoglobulin E (asIgE) after 3 years of intervention. Secondary outcomes included helminths, haemoglobin, and hepatosplenomegaly. RESULTS: The outcome survey comprised 3350 individuals. Intensive MDA had no effect on wheezing (risk ratio [RR] 1.11, 95% confidence interval [CI] 0.64-1.93), SPT (RR 1.10, 95% CI 0.85-1.42), or asIgE (RR 0.96, 95% CI 0.82-1.12). Intensive MDA reduced Schistosoma mansoni infection intensity: the prevalence from Kato Katz examinations of single stool samples from each patient was 23% versus 39% (RR 0.70, 95% CI 0.55-0.88), but the urine circulating cathodic antigen test remained positive in 85% participants in both trial arms. Hookworm prevalence was 8% versus 11% (RR 0.55, 95% CI 0.31-1.00). There were no differences in anemia or hepatospenomegaly between trial arms. CONCLUSIONS: Despite reductions in S. mansoni intensity and hookworm prevalence, intensive MDA had no effect on atopy, allergy-related diseases, or helminth-related pathology. This could be due to sustained low-intensity infections; thus, a causal link between helminths and allergy outcomes cannot be discounted. Intensive community-based MDA has a limited impact in high-schistosomiasis-transmission fishing communities, in the absence of other interventions. CLINICAL TRIALS REGISTRATION: ISRCTN47196031

Comparing one dose of HPV vaccine in girls aged 9-14 years in Tanzania (DoRIS) with one dose of HPV vaccine in historical cohorts: an immunobridging analysis of a randomised controlled trial

BACKGROUND: Human papillomavirus (HPV) vaccines are given as a two-dose schedule in children aged 9-14 years, or as three doses in older individuals. We compared antibody responses after one dose of HPV vaccine in the Dose Reduction Immunobridging and Safety Study (DoRIS), a randomised trial of different HPV vaccine schedules in Tanzania, to those from two observational HPV vaccine trials that found high efficacy of one dose up to 11 years against HPV16 and HPV18 (Costa Rica Vaccine Trial [CVT] and Institutional Agency for Research on Cancer [IARC] India trial). METHODS: In this immunobridging analysis of an open-label randomised controlled trial, girls were recruited from 54 government schools in Mwanza, Tanzania, into the DoRIS trial. Girls were eligible if they were aged 9-14 years, healthy, and HIV negative. Participants were randomly assigned (1:1:1:1:1:1), using permutated block sizes of 12, 18, and 24, to one, two, or three doses of the 2-valent vaccine (Cervarix, GSK Biologicals, Rixensart, Belgium) or the 9-valent vaccine (Gardasil 9, Sanofi Pasteur MSD, Lyon, France). For this immunobridging analysis, the primary objective was to compare geometric mean concentrations (GMCs) at 24 months after one dose in the per-protocol population compared with in historical cohorts: the one-dose 2-valent vaccine group in DoRIS was compared with recipients of the 2-valent vaccine Cervarix from CVT and the one-dose 9-valent vaccine group in DoRIS was compared with recipients of the 4-valent vaccine Gardasil (Merck Sharp & Dohme, Whitehouse Station, NJ, USA) from the IARC India trial. Samples were tested together with virus-like particle ELISA for HPV16 and HPV18 IgG antibodies. Non-inferiority of GMC ratios (DoRIS trial vs historical cohort) was predefined as when the lower bound of the 95% CI was greater than 0·50. This study is registered with ClinicalTrials.gov, NCT02834637. FINDINGS: Between Feb 23, 2017, and Jan 6, 2018, we screened 1002 girls for eligibility, of whom 930 were enrolled into DoRIS and 155 each were assigned to one dose, two doses, or three doses of 2-valent vaccine, or one dose, two doses, or three doses of 9-valent vaccine. 154 (99%) participants in the one-dose 2-valent vaccine group (median age 10 years [IQR 9-12]) and 152 (98%) in the one-dose 9-valent vaccine group (median age 10 years [IQR 9-12]) were vaccinated and attended the 24 month visit, and so were included in the analysis. 115 one-dose recipients from the CVT (median age 21 years [19-23]) and 139 one-dose recipients from the IARC India trial (median age 14 years [13-16]) were included in the analysis. At 24 months after vaccination, GMCs for HPV16 IgG antibodies were 22·9 international units (IU) per mL (95% CI 19·9-26·4; n=148) for the DoRIS 2-valent vaccine group versus 17·7 IU/mL (13·9-22·5; n=97) for the CVT (GMC ratio 1·30 [95% CI 1·00-1·68]) and 13·7 IU/mL (11·9-15·8; n=145) for the DoRIS 9-valent vaccine group versus 6·7 IU/mL (5·5-8·2; n=131) for the IARC India trial (GMC ratio 2·05 [1·61-2·61]). GMCs for HPV18 IgG antibodies were 9·9 IU/mL (95% CI 8·5-11·5: n=141) for the DoRIS 2-valent vaccine group versus 8·0 IU/mL (6·4-10·0; n=97) for the CVT trial (GMC ratio 1·23 [95% CI 0·95-1·60]) and 5·7 IU/mL (4·9-6·8; n=136) for the DoRIS 9-valent vaccine group versus 2·2 IU/mL (1·9-2·7; n=129) for the IARC India trial (GMC ratio 2·12 [1·59-2·83]). Non-inferiority of antibody GMCs was met for each vaccine for both HPV16 and HPV18. INTERPRETATION: One dose of HPV vaccine in young girls might provide sufficient protection against persistent HPV infection. A one-dose schedule would reduce costs, simplify vaccine delivery, and expand access to the vaccine. FUNDING: UK Department for International Development/UK Medical Research Council/Wellcome Trust Joint Global Health Trials Scheme, The Bill & Melinda Gates Foundation, and the US National Cancer Institute. TRANSLATION: For the KiSwahili translation of the abstract see Supplementary Materials section

Evaluation of Visual Screening in Prevention of Cervical and Oral Cancer in India

Kohdunkaulan syöpä ja suusyöpä ovat merkittäviä kansanterveysongelmia Intiassa. Kehitysmaaoloissa länsimaissa yleisesti käytetty kohdunkaulan solunäytteisiin (ns. PAPA-koe) perustuva seulontamenetelmä ei kalleutensa vuoksi tule kyseeseen. Siksi on kehitetty menetelmiä, joissa silmämääräisen tarkastelun perusteella voidaan todeta epäilyttävältä näyttäviä muutoksia kohdunkaulassa ja suun limakalvolla. Nämä menetelmät ovat yksinkertaisia eivätkä vaadi lääkärinkoulutusta seulojilta. Intiassa köyhin väestönosa jää usein kokonaan ilman terveydenhuollon palveluja. Hinnaltaan edulliset seulontamenetelmät ovat todellinen mahdollisuus ehkäistä syöpää tilanteessa, jossa syövän hoito on hintansa vuoksi useimmille ihmisille käytännössä mahdotonta. Silmämääräisen tarkastelun jälkeen kohdunkaulan muutokset hoidetaan yksinkertaisilla menetelmillä saman tien, jolloin varsinkin maaseudun asukkaat saavat hoidon eivätkä jää menemättä uudelle käynnille mahdollisesti kaukaisellekin klinikalle. Tutkimuksen tavoitteena oli selvittää erilaisissa tutkimusasetelmissa useiden eri seulontamenetelmien vaikutusta kohdunkaulan syövän ennalta ehkäisyn keinoina ja selvittää näiden organisoitujen seulontaohjelmien vaikutusta kohdunkaulan syövästä ja suusyövästä aiheutuvaan kuolleisuuteen Intiassa. Tutkimuksissa verrattiin vaikutuksia seulonta- ja vertailuryhmissä. Eri tutkimusryhmien koot vaihtelivat 58 000:n ja 190 000:n henkilön välillä. Tutkimukset suoritettiin Dingdigulissa Tamil Nadun osavaltiossa ja Trivandrumissa, Keralassa. Tutkimustulokset osoittivat, että silmämääräiset seulontamenetelmät toimivat toistettuina ja järjestelmällisesti toteutettuina erinomaisesti kehittyvien maiden olosuhteissa. Kohdunkaulan syövän ilmaantuvuus pieneni 25% ja kuolleisuus peräti 35% yhdessä tutkimusosiossa. Myös suusyövän aiheuttamassa kuolleisuudessa havaittiin 20%:n vähenemä. Asiallisesti järjestettyinä silmämääräisiin menetelmiin perustuvat seulontaohjelmat vaikuttavat kuolleisuutta vähentävästi ja niitä voidaan soveltaa muuallakin kehittyvien maiden olosuhteissa. Tutkimukset koordinoi WHO:n Kansainvälinen syöväntutkimuskeskus (International Agency for Research on Cancer, Lyon, Ranska) yhteistyössä paikallisten intialaisten tutkijoiden kanssa. Tutkimukset rahoitti yhdysvaltalainen Bill ja Melinda Gatesin säätiö. Väitöskirjatyön ohjaajina toimivat tohtori Rengaswamy Sankaranarayanan, Head of Screening Group, Pathogenesis and Prevention Cluster, International Agency for Research on Cancer, Lyon, Ranska ja professori Risto Sankila, Terveystieteen laitos, Tampereen yliopisto ja Suomen Syöpärekisteri, Helsinki.Globally, India has the greatest relative burden of cancers of the cervix and oral cavity in terms of absolute numbers, and numbers of these two cancers summed together form the biggest part of the cancers in the country. With well organized screening programmes, screening for precancerous lesion of these two cancers and giving appropriate treatment to individuals with these lesions, would be beneficial in reducing the number of cancers and cancer deaths in the country. Pap smear, which has been seen to be an effective cervical cancer screening technique in the developed world, is resource demanding, requiring a laboratory infrastructure, quality assurance for the different steps involved and a system to report the test results to women. For this reason, implementation of Pap smear screening in India, as in other low/medium resourced countries, has met challenges and difficulties, leading to the evaluation of alternative, simple, safe, acceptable, affordable and inexpensive visual inspection techniques for detecting cervical precancer lesions and preventing cervical cancer. Furthermore, oral visual inspection is an oral cancer screening method which is cheap, can be easily applied by a wide range of medical personnel and, hence, is suitable for India and other developing countries. The main aim of this study was to assess the validity of these visual inspection techniques and to evaluate what impact they would have on reducing the incidence of and/or mortality from cervical and oral cancers when used in organized screening programmes, especially in low/medium resourced settings. The test performance of five cervical cancer screening methods, visual inspection with acetic acid (VIA), visual inspection with Lugol s iodine (VILI), VIA with magnification (VIAM), conventional Pap smear and Human papilomavirus (HPV) testing, were simultaneously evaluated in more than 58,000 women aged 25 to 64 from eleven urban settings in India (6 centres) and five African countries (5 centres), all centres following the same protocol. These studies were carried out by the International Agency for Research on Cancer (IARC) as part of the Alliance for Cervical Cancer Prevention (ACCP) supported by the Bill & Melinda Gates Foundation (Seattle, Washington, USA) to advance cervical cancer prevention in low/medium resourced countries. The test accuracy of VIA and VILI in detecting high grade cervical disease was found to be similar or even better than that of conventional Pap smear. In order to evaluate whether a single lifetime VIA screening and treatment of detected cervical intraepithelial neoplasia by cryotherapy and excision under field conditions, all provided by trained nurses, can lead to reduced cervical cancer incidence and mortality among women offered screening compared to a similar group of women receiving the existing standard health care, IARC in collaboration with the Christian Fellowship Community Health Centre, a rural hospital and a cancer centre in the Dindigul District of Tamil Nadu State in South India, organized a large randomized controlled trial involving about 80,000 women aged 30-59 years. In this trial, 57 municipal administrative units (49,300 women) were randomly allocated to the intervention group and 56 to the control group (31,000 women). Women (31,300 in number) in the intervention group were then offered VIA, and VIA positive women were colposcopied and/or biopsied by the nurse during the same screening visit followed by immediate treatment with cryotherapy, when appropriate. Women with lesions not eligible for cryotherapy were referred for loop electrosurgical excision procedure (LEEP) and those with suspected invasive cancer were referred for further investigations and treatment. After seven years from the beginning of screening, there was a 25% reduction in the number of cervical cancer cases, and a 35% reduction in the number of cervical cancer deaths among women offered VIA screening compared to those not offered screening. In conclusion, this trial showed that VIA screening could reduce the cervical cancer burden. In a similar randomized oral cancer screening trial, carried out by IARC in collaboration with the Regional Cancer Centre, Trivandrum, Kerala, India, 13 municipal administrative units, involving about 191,800 apparently healthy individuals of 35 years and above, were randomly allocated to two groups. The intervention group (with about 96,500 individuals) received three rounds of oral visual inspection at 3-year intervals provided by trained health workers, whereas the control group received the standard health care. The aim of this trial was to assess if oral visual screening would ultimately lead to a reduction in oral cancer mortality in the intervention group compared to the control group. Nine years from the initiation of screening, a 21% reduction in oral cancer mortality was observed in the intervention group compared to the control group which did not reach statistical significance. However, a statistically significant 33% reduction in mortality was observed among tobacco and/or alcohol users compared to similar control subjects. In summary, evidence from this Indian study shows that oral visual screening can reduce mortality in high-risk individuals. In a nested case-control study using data from the Trivandrum oral cancer screening trial it was shown that individuals chewing paan, smoking bidi and/or drinking alcohol heavily were more likely to catch oral cancer compared to those not having the habits. Big differences in risk estimates among men and women chewing paan were observed with a 3-fold increased risk of oral cancer for male chewers compared to an 11-fold increased risk among female chewers, both groups compared to their corresponding never chewers. Effects of chewing paan with or without tobacco on oral cancer risk were elevated for both sexes. A 2-fold increased risk of oral cancer was observed among male bidi smokers. The risk of catching oral cancer increased with increasing frequency and duration of chewing and alcohol drinking, as well as with increasing duration of bidi smoking. These results further show that cessation of tobacco use and moderation of alcohol use in combination with early diagnosis remain the key elements in oral cancer prevention and control. India, like many low and medium resourced countries, is hit hard by the burden of cervical and oral cancers. It has a limited health budget, cancer treatment facilities are not universally available and life-prolonging therapies are often unavailable. Nevertheless, it is of great importance to prevent those cancers (such as cervical and oral cancer) that can be prevented. Based on the evidence discussed in this dissertation, specific priorities should be given to primary prevention initiatives aimed at taking action against tobacco and heavy alcohol consumption and intensified action against cancers of the cervix and oral cavity through screening

Feasibility and effectiveness of cotrimoxazole prophylaxis for HIV-1-infected adults attending an HIV/AIDS clinic in Uganda.

BACKGROUND: Cotrimoxazole is recommended for prevention of opportunistic infections in symptomatic HIV patients in sub-Saharan Africa. METHODS: We examined the feasibility and effectiveness of daily cotrimoxazole prophylaxis in a well-established cohort of HIV-infected adults attending clinics in Entebbe, Uganda. We compared mortality and morbidity rates for 12 months before and after the introduction of cotrimoxazole. RESULTS: Between August 2000 and February 2002, 94% of cohort members were enrolled onto cotrimoxazole prophylaxis. Revisits were scheduled every 4 weeks to replenish pills; patients attended 61% of revisits. The main reasons for nonenrollment and defaulting were lack of transport, being away from home, and sickness. Drug-related adverse events, mainly itching and rash, were seen in 4% of participants. Although bacterial resistance rate to cotrimoxazole was high, the adjusted mortality incidence rate ratio was significantly reduced after the introduction of cotrimoxazole (0.76; 95% confidence interval, 0.60-0.96; P = 0.020). Overall febrile events and morbidity rates were unchanged after the introduction of cotrimoxazole, but the incidence of malaria was reduced (incidence rate ratio, 0.31; 95% confidence interval, 0.13-0.72). CONCLUSIONS: Cotrimoxazole prophylaxis can be introduced into routine HIV clinic activities and is associated with a reduction in overall mortality and malaria morbidity, even in an area with high bacterial resistance. These results reinforce the need for large-scale provision of cotrimoxazole prophylaxis for all HIV-positive patients in developing countries

Correlação da mortalidade por câncer do colo do útero com fertilidade, acesso a cuidados de saúde e indicadores socioeconômicos

The present study aimed to examine which development indicators are correlated with cervical cancer (CC) mortality rates in Brazil. Methods This was an ecological study that correlated mortality rates and indicators, such as human development index (HDI), gross domestic product (GDP) per capita, illiteracy rate, fertility rate, screening coverage, proportion of private health insurance use, density of physicians, and density of radiotherapy centers. The mortality rates were obtained from the Brazilian national registry, while the indicators were based on official reports from the Ministry of Health. Univariate and multivariate linear regression was used. Results Among the states of Brazil, the average age-specific CC mortality rate from 2008 to 2012 varied from 4.6 to 22.9 per 100,000 women/year. In the univariate analysis, HDI, proportion of private health insurance use, density of physicians, and density of radiotherapy centers were inversely correlated with the mortality rates. Fertility rate was positively correlated with the mortality rates. In the multivariate analysis, only fertility rate was significantly associated with the CC mortality rate (coefficient of correlation: 9.38; 95% confidence interval [CI]: 5.16-13.59). Conclusion A decrease in the fertility rate, as expected when the level of development of the regions increases, is related to a decrease in the mortality rate of CC. The results of the present study can help to better monitor the quality assessment of CC programs both among and within countries414249255sem informaçãoO presente estudo teve como objetivo examinar quais indicadores de desenvolvimento estão correlacionados com as taxas de mortalidade por câncer do colo do útero no Brasil. Métodos Este foi um estudo ecológico que correlacionou as taxas de mortalidade com indicadores como índice de desenvolvimento humano (IDH), produto interno bruto (PIB) per capita, taxa de analfabetismo, taxa de fertilidade, cobertura do rastreamento, proporção do uso do seguro privado de saúde, densidade de médicos e densidade de centros de radioterapia. A fonte das taxas de mortalidade foi o registro nacional, enquanto que os indicadores foram baseados em relatórios oficiais do Ministério da Saúde. Foi utilizada regressão linear univariada e multivariada. Resultados Entre os estados, a taxa média de mortalidade específica por idade por câncer do colo do útero de 2008 a 2012 variou de 4.6 a 22.9 por 100.000 mulheres/ano. Na análise univariada, foram inversamente correlacionadas com as taxas de mortalidade: IDH, proporção do uso do seguro privado de saúde, densidade de médicos e densidade de centros de radioterapia. A taxa de fertilidade foi positivamente correlacionada com a mortalidade. Na análise multivariada, apenas a taxa de fertilidade foi significativamente associada à taxa de mortalidade por câncer do colo do útero (coeficiente de correlação: 9,38; índice de confiança [IC] 95%: 5,16–13,59). Conclusão A diminuição da taxa de fertilidade, como esperado quando o nível de desenvolvimento das regiões aumenta, está relacionada a uma diminuição da taxa de mortalidade por câncer do colo do útero. Os resultados do presente estudo podem ajudar a monitorar melhor a avaliação da qualidade dos programas de câncer do colo do útero nos países tanto interna quanto externamentesem informaçã

Comparative accuracy of Pap smear and HPV screening in Ubon Ratchathani in Thailand

We evaluate the potential for using high-risk human papillomavirus (hr-HPV) testing-based screening for cervical intraepithelial neoplasia (CIN) in routine health services in Thailand; its accuracy in comparison to that of conventional cytology (CC); and the utility of HPV16/18 positive results and liquid-based cytology (LBC) triage for HPV-positive women in the detection of high-grade CIN. Women aged 30â60 years in Ubon Ratchathani province, Thailand were screened with CC and hr-HPV testing and those abnormal on either tests were referred for colposcopy and/or directed biopsies. The final diagnosis using COBAS was based on histology or colposcopy when histology was not available. Estimation of test accuracy parameters was done using latent class analysis using Bayesian models. Of the 5004 women were enrolled, 20 (0.4%) had abnormal CC and 174 (3.5%) women were HPV-positive. Among 185 women abnormal on CC or HPV-positive, 176 (95.1%) underwent colposcopy, of whom 101 (57.4%) had abnormal colposcopy findings. Ninety-seven women with abnormal and 69 with normal colposcopy had biopsies performed. All 21 women with histological CIN2 or worse had hr-HPV and none were abnormal on CC. The estimated sensitivity, specificity and positive predictive value were respectively 71.8%, 97.0% and 13.0% of HPV testing; 53%, 98.7% and 20.3% for triage of HPV-positive women with LBC; and 70.4%, 98.2% and 16.9% when test positivity was taken as HPV16/18 irrespective of LBC result or positive for hr-HPV non 16/18 types and LBC triage. Our study findings indicate poor performance of cytology screening and demonstrate the potential and utility of using HPV testing in public health services in Thailand as well as the utility of primary HPV testing and LBC triage in screening for cervical neoplasia. Keywords: Cervix cancer, Early detection, HPV screening, Cytology screening, Accurac

Survival of Patients With Cervical Cancer in Rural India

Background: Patients’ survival after diagnosis of cervical cancer is indirectly influenced by socio-economic factors. We evaluated this survival and its socio-economic determinants in a rural population in south India. Methods: We assessed 165 women diagnosed with cervical cancer from the routine care control arm of a randomized screening trial conducted in rural south India. Kaplan-Meier curves were plotted to illustrate the observed survival of cancer patients. The effect of socio-economic factors was assessed using Cox proportional hazards regression analysis. Results: The 5-year observed survival was 32.5%, ranging from 9% for stage IV to 78% for stage I cancers. Women with poor socio-economic status (SES) had up to a 70% higher risk of death. Higher household income was significantly associated with poorer survival. However, most women in the higher income group were married women and housewives, hence with no personal income. Conclusion: Cervical cancer survival was disappointingly low in these rural populations of India and stage of disease at diagnosis was the strongest determinant. A higher household income is not always associated with women being empowered in terms of seeking healthcare. The study findings further stress the importance of strengthening prevention and screening opportunities to women in rural populations.Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal