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Article ; Online: Fibcare

Yamada, Akihiro / Tamura, Takahiro / Imaizumi, Takahiro / Kubo, Yoko / Nishiwaki, Kimitoshi

2023 Volume 85, Issue 2, Page(s) 310–318

Abstract: Central laboratory measurements are time consuming, while rapid fibrinogen level measurements within the operating room improve transfusion strategies. We aimed to clarify the correlation between fibrinogen concentrations (measured using ... ...

Abstract	Central laboratory measurements are time consuming, while rapid fibrinogen level measurements within the operating room improve transfusion strategies. We aimed to clarify the correlation between fibrinogen concentrations (measured using Fibcare
MeSH term(s)	Humans ; Cardiopulmonary Bypass ; Hypothermia ; Retrospective Studies ; Blood Coagulation Tests/methods ; Fibrinogen/analysis
Chemical Substances	Fibrinogen (9001-32-5)
Language	English
Publishing date	2023-06-09
Publishing country	Japan
Document type	Journal Article
ZDB-ID	193148-9
ISSN	2186-3326 ; 0027-7622
ISSN (online)	2186-3326
ISSN	0027-7622
DOI	10.18999/nagjms.85.2.310
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Ua VI Zs.181: Show issues

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Article ; Online: Caregiver Burdens, Health Risks, Coping and Interventions among Caregivers of Dementia Patients: A Review of the Literature.

Goto, Yasuyuki / Morita, Kohei / Suematsu, Mina / Imaizumi, Takahiro / Suzuki, Yusuke

Internal medicine (Tokyo, Japan)

2023 Volume 62, Issue 22, Page(s) 3277–3282

Abstract: Over 55 million people reportedly suffer from dementia worldwide. In Japan, it is estimated that 1 in 5 people over 65 years old will have dementia by 2025, of which more than 20% will live with symptoms that require home/nursing care. Given the lack of ... ...

Abstract	Over 55 million people reportedly suffer from dementia worldwide. In Japan, it is estimated that 1 in 5 people over 65 years old will have dementia by 2025, of which more than 20% will live with symptoms that require home/nursing care. Given the lack of effective medical treatments for dementia, informal caregivers play essential roles in allowing dementia patients to live with dignity. Our review focusing on caregiver burden showed that this burden has not been sufficiently addressed, despite having negative effects on caregivers' health, employment, and finances. It is important to consider non-pharmacological interventions that contribute to effective coping strategies for mitigating the caregiver burden. Online communication tools may be a viable intervention measure to educate caregivers on the importance of sharing resilient coping strategies to reduce their stress so that they can continue to provide care for their loved ones.
MeSH term(s)	Humans ; Aged ; Caregivers ; Caregiver Burden ; Adaptation, Psychological ; Dementia/therapy
Language	English
Publishing date	2023-03-01
Publishing country	Japan
Document type	Review ; Journal Article
ZDB-ID	32371-8
ISSN	1349-7235 ; 0021-5120 ; 0918-2918
ISSN (online)	1349-7235
ISSN	0021-5120 ; 0918-2918
DOI	10.2169/internalmedicine.0911-22
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Zs.A 240: Show issues

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Article ; Online: Impact of guideline recommendation for novel surgical procedures on surgeons' decisions: a time series analysis of gastric cancer surgeries from a nationwide cohort study.

Honda, Michitaka / Yasunaga, Hideo / Michihata, Nobuaki / Miyakawa, Teppei / Kumazawa, Ryosuke / Matsui, Hiroki / Imaizumi, Takahiro

International journal of surgery (London, England)

2023 Volume 109, Issue 3, Page(s) 316–322

Abstract: Background: Since two Japanese guidelines, for gastric cancer treatment and for minimally invasive surgery, were simultaneously revised in 2014, laparoscopic distal gastrectomy has been a standard procedure for clinical stage I gastric cancer.: ... ...

Abstract	Background: Since two Japanese guidelines, for gastric cancer treatment and for minimally invasive surgery, were simultaneously revised in 2014, laparoscopic distal gastrectomy has been a standard procedure for clinical stage I gastric cancer. Materials and methods: We evaluated the impact of this revision on surgeons' decision-making using a nationwide inpatient database in Japan. We described the time trends in the proportion of laparoscopic surgery from January 2011 to December 2018. We performed an interrupted time series analysis; the exposure time point was August 2014, and the main outcome was the change in slope before and after the revision of the guidelines. We performed a subgroup analysis of hospital volume and the odds ratio (OR) for postoperative complications according to exposure. Results: A total of 64 910 patients who underwent subtotal gastrectomy for stage I disease were identified. During the study period, the proportion of laparoscopic surgery showed a consistent increase from 47.4 to 81.2%. After the revision, the slope of the increase was rather slow; the OR [95% CI] was 0.601 [0.548-0.654] before the revision and 0.219 [0.176-0.260] after the revision. The adjusted ORs were 0.642 [0.575-0.709] before the revision and 0.240 [0.187-0.294] after the revision. Conclusion: The revision of the guidelines recommending laparoscopic surgery had little impact on surgeons' decisions regarding the choice of procedure.
MeSH term(s)	Humans ; Stomach Neoplasms/surgery ; Cohort Studies ; Time Factors ; Surgeons ; Postoperative Complications/surgery ; Gastrectomy/methods ; Laparoscopy/methods ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2023-03-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1097/JS9.0000000000000179
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Zs.A 6502: Show issues

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Article ; Online: Clinical Value of Troponin Levels to Cardiac Function and Prognosis in Patients with Fulminant Myocarditis.

Shibata, Naoki / Kondo, Toru / Okumura, Takahiro / Imaizumi, Takahiro / Dohi, Kaoru / Izawa, Hideo / Ohte, Nobuyuki / Amano, Tetsuya / Murohara, Toyoaki

International heart journal

2024 Volume 65, Issue 2, Page(s) 218–229

Abstract: Troponin (Tn) is a biomarker related to myocardial necrosis and is elevated in patients with myocarditis. This study aimed to investigate the association between cardiac Tn levels and the course of cardiac function, and prognosis in patients with ... ...

Abstract	Troponin (Tn) is a biomarker related to myocardial necrosis and is elevated in patients with myocarditis. This study aimed to investigate the association between cardiac Tn levels and the course of cardiac function, and prognosis in patients with fulminant myocarditis (FM) receiving percutaneous mechanical circulatory support (MCS).We used data from a multicenter retrospective registry, CHANGE PUMP 2, which included 216 patients with FM who required MCS. Among them, 141 patients whose Tn levels were available were analyzed. The patients were divided into low and high Tn groups according to the median values of TnT and TnI.The median age was 54 years, and 59.6% were male. The TnT and TnI on day 1 (at MCS initiation) were 3.8 (1.4-10.0) and 21.4 (8.4-68.8) ng/mL. While the left ventricular ejection fraction (LVEF) was similar on day 1 (25.0% versus 24.5%), the low Tn group showed better LVEF improvement on day 7 than the high Tn group (45.0% versus 25.3%, P < 0.001). LVEF at 1 year after admission was higher in the low Tn group (65.0% versus 59.7%, P = 0.039). The low Tn group had a better 90-day composite endpoint in death, durable left ventricular assist device implantation, and heart transplantation compared to the high Tn group (hazard ratio 0.47, 95% CI 0.23-0.95).Tn levels were associated with short- and long-term cardiac recovery and adverse outcomes in patients with FM receiving MCS due to cardiogenic shock.
MeSH term(s)	Female ; Humans ; Male ; Middle Aged ; Heart-Assist Devices ; Myocarditis/diagnosis ; Prognosis ; Retrospective Studies ; Shock, Cardiogenic ; Stroke Volume ; Treatment Outcome ; Troponin ; Ventricular Function, Left ; Multicenter Studies as Topic
Chemical Substances	Troponin
Language	English
Publishing date	2024-03-12
Publishing country	Japan
Document type	Journal Article
ZDB-ID	2187806-7
ISSN	1349-3299 ; 1349-2365
ISSN (online)	1349-3299
ISSN	1349-2365
DOI	10.1536/ihj.23-589
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Zs.A 211: Show issues

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Article ; Online: Machine learning models predict delayed hyponatremia post-transsphenoidal surgery using clinically available features.

Fuse, Yutaro / Takeuchi, Kazuhito / Nishiwaki, Hiroshi / Imaizumi, Takahiro / Nagata, Yuichi / Ohno, Kinji / Saito, Ryuta

Pituitary

2023 Volume 26, Issue 2, Page(s) 237–249

Abstract: Purpose: Delayed hyponatremia (DHN), a unique complication, is the leading cause of unexpected readmission after pituitary surgery. Therefore, this study aimed to develop tools for predicting postoperative DHN in patients undergoing endoscopic ... ...

Abstract	Purpose: Delayed hyponatremia (DHN), a unique complication, is the leading cause of unexpected readmission after pituitary surgery. Therefore, this study aimed to develop tools for predicting postoperative DHN in patients undergoing endoscopic transsphenoidal surgery (eTSS) for pituitary neuroendocrine tumors (PitNETs). Methods: This was a single-center, retrospective study involving 193 patients with PitNETs who underwent eTSS. The objective variable was DHN, defined as serum sodium levels < 135 mmol/L at ≥ 1 time between post operative days 3 and 9. We trained four machine learning models to predict this objective variable using the clinical variables available preoperatively and on the first postoperative day. The clinical variables included patient characteristics, pituitary-related hormone levels, blood test results, radiological findings, and postoperative complications. Results: The random forest (RF) model demonstrated the highest (0.759 ± 0.039) area under the curve of the receiver operating characteristic curve (ROC-AUC), followed by the support vector machine (0.747 ± 0.034), the light gradient boosting machine (LGBM: 0.738 ± 0.026), and the logistic regression (0.710 ± 0.028). The highest accuracy (0.746 ± 0.029) was observed in the LGBM model. The best-performing RF model was based on 24 features, nine of which were clinically available preoperatively. Conclusions: The proposed machine learning models with pre- and post-resection features predicted DHN after the resection of PitNETs.
MeSH term(s)	Humans ; Hyponatremia/etiology ; Retrospective Studies ; Adenoma/surgery ; Pituitary Neoplasms/surgery ; Pituitary Neoplasms/complications ; Machine Learning
Language	English
Publishing date	2023-03-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1385151-2
ISSN	1573-7403 ; 1386-341X
ISSN (online)	1573-7403
ISSN	1386-341X
DOI	10.1007/s11102-023-01311-w
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Zs.A 6139: Show issues

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Article ; Online: Development and validation of machine learning models to predict postoperative infarction in moyamoya disease.

Fuse, Yutaro / Ishii, Kazuki / Kanamori, Fumiaki / Oyama, Shintaro / Imaizumi, Takahiro / Araki, Yoshio / Yokoyama, Kinya / Takasu, Syuntaro / Seki, Yukio / Saito, Ryuta

Journal of neurosurgery

2024 , Page(s) 1–9

Abstract: Objective: Cerebral infarction is a common complication in patients undergoing revascularization surgery for moyamoya disease (MMD). Although previous statistical evaluations have identified several risk factors for postoperative brain ischemia, the ... ...

Abstract	Objective: Cerebral infarction is a common complication in patients undergoing revascularization surgery for moyamoya disease (MMD). Although previous statistical evaluations have identified several risk factors for postoperative brain ischemia, the ability to predict its occurrence based on these limited predictors remains inadequately explored. This study aimed to assess the feasibility of machine learning algorithms for predicting cerebral infarction after revascularization surgery in patients with MMD. Methods: This retrospective study was conducted across two centers and harnessed data from 512 patients with MMD who had undergone revascularization surgery. The patient cohort was partitioned into internal and external datasets. Using perioperative clinical data from the internal cohort, three distinct machine learning algorithms-namely the support vector machine, random forest, and light gradient-boosting machine models-were trained and cross-validated to predict the occurrence of postoperative cerebral infarction. Predictive performance validity was subsequently assessed using an external dataset. Shapley additive explanations (SHAP) analysis was conducted to augment the prediction model's transparency and to quantify the impact of each input variable on shaping both the aggregate and individual patient predictions. Results: In the cohort of 512 patients, 33 (6.4%) experienced postrevascularization cerebral infarction. The cross-validation outcomes revealed that, among the three models, the support vector machine model achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at mean ± SD 0.785 ± 0.052. Notably, during external validation, the light gradient-boosting machine model exhibited the highest accuracy at 0.903 and the largest ROC-AUC at 0.710. The top-performing prediction model utilized five input variables: postoperative serum gamma-glutamyl transpeptidase value, positive posterior cerebral artery (PCA) involvement on preoperative MRA, infarction as the rationale for surgery, presence of an infarction scar on preoperative MRI, and preoperative modified Rankin Scale score. Furthermore, the SHAP analysis identified presence of PCA involvement, infarction as the rationale for surgery, and presence of an infarction scar on preoperative MRI as positive influences on postoperative cerebral infarction. Conclusions: This study indicates the usefulness of employing machine learning techniques with routine perioperative data to predict the occurrence of cerebral infarction after revascularization procedures in patients with MMD.
Language	English
Publishing date	2024-04-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
DOI	10.3171/2024.1.JNS232173
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Article ; Online: Predictive Models for Palliative Care Needs of Advanced Cancer Patients Receiving Chemotherapy.

Kawashima, Arisa / Furukawa, Taiki / Imaizumi, Takahiro / Morohashi, Akemi / Hara, Mariko / Yamada, Satomi / Hama, Masayo / Kawaguchi, Aya / Sato, Kazuki

Journal of pain and symptom management

2024 Volume 67, Issue 4, Page(s) 306–316.e6

Abstract: Context: Early palliative care is recommended within eight-week of diagnosing advanced cancer. Although guidelines suggest routine screening to identify cancer patients who could benefit from palliative care, implementing screening can be challenging ... ...

Abstract	Context: Early palliative care is recommended within eight-week of diagnosing advanced cancer. Although guidelines suggest routine screening to identify cancer patients who could benefit from palliative care, implementing screening can be challenging due to understaffing and time constraints. Objectives: To develop and evaluate machine learning models for predicting specialist palliative care needs in advanced cancer patients undergoing chemotherapy, and to investigate if predictive models could substitute screening tools. Methods: We conducted a retrospective cohort study using supervised machine learning. The study included patients aged 18 or older, diagnosed with metastatic or stage IV cancer, who underwent chemotherapy and distress screening at a designated cancer hospital in Japan from April 1, 2018, to March 31, 2023. Specialist palliative care needs were assessed based on distress screening scores and expert evaluations. Data sources were hospital's cancer registry, health claims database, and nursing admission records. The predictive model was developed using XGBoost, a machine learning algorithm. Results: Out of the 1878 included patients, 561 were analyzed. Among them, 114 (20.3%) exhibited needs for specialist palliative care. After under-sampling to address data imbalance, the models achieved an Area Under the Curve (AUC) of 0.89 with 95.8% sensitivity and a specificity of 71.9%. After feature selection, the model retained five variables, including the patient-reported pain score, and showcased an 0.82 AUC. Conclusion: Our models could forecast specialist palliative care needs for advanced cancer patients on chemotherapy. Using five variables as predictors could replace screening tools and has the potential to contribute to earlier palliative care.
MeSH term(s)	Humans ; Palliative Care ; Retrospective Studies ; Neoplasms/drug therapy ; Patients ; Machine Learning
Language	English
Publishing date	2024-01-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	639142-4
ISSN	1873-6513 ; 0885-3924
ISSN (online)	1873-6513
ISSN	0885-3924
DOI	10.1016/j.jpainsymman.2024.01.009
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Zs.A 2252: Show issues

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Article ; Online: Relationship between peak aortic jet velocity and progression of aortic stenosis in patients undergoing hemodialysis.

Kurasawa, Shimon / Imaizumi, Takahiro / Kondo, Toru / Hishida, Manabu / Okazaki, Masaki / Nishibori, Nobuhiro / Takeda, Yuki / Kasuga, Hirotake / Maruyama, Shoichi

International journal of cardiology

2024 Volume 402, Page(s) 131822

Abstract: Background: The natural history of aortic stenosis (AS) progression, especially before severe AS development, is not well documented. We aimed to investigate the time course of peak aortic jet velocity (Vmax) and AS progression risk according to ... ...

Abstract	Background: The natural history of aortic stenosis (AS) progression, especially before severe AS development, is not well documented. We aimed to investigate the time course of peak aortic jet velocity (Vmax) and AS progression risk according to baseline Vmax, particularly whether there is a Vmax threshold. Methods: In a retrospective multicenter cohort study of patients on hemodialysis with aortic valve calcification, we investigated the time series of Vmax and the relationship between the baseline Vmax and progression to severe AS by analyzing longitudinal echocardiographic data. Results: Among 758 included patients (mean age, 71 years; 65% male), patients with Vmax <1.5, 1.5-1.9, 2.0-2.4, 2.5-2.9, and 3.0-3.9 m/s were 395 (52%), 216 (29%), 85 (11%), 39 (5.1%), and 23 (3.0%), respectively. The Vmax slope was gradual (mean 0.05-0.07 m/s/year) at Vmax <2 m/s, but steeper (mean 0.13-0.21 m/s/year) at Vmax ≥2 m/s. During a median 3.2-year follow-up, 52 (6.9%) patients developed severe AS. While patients with Vmax <2 m/s rarely developed severe AS, the risk of those with Vmax ≥2 m/s increased remarkably with an increasing baseline Vmax; the adjusted incidence rates in patients with Vmax <1.5, 1.5-1.9, 2.0-2.4, 2.5-2.9, and 3.0-3.9 m/s were 0.59, 0.57, 4.25, 13.8, and 56.1 per 100 person-years, respectively; the adjusted hazard ratio per 0.2 m/s increase in the baseline Vmax was 1.49 (95% confidence interval: 1.32-1.68) when Vmax ≥2 m/s. Conclusions: The risk of progression to severe AS increased with the baseline Vmax primarily at ≥2 m/s; a Vmax threshold of 2 m/s was observed.
MeSH term(s)	Humans ; Male ; Aged ; Female ; Cohort Studies ; Retrospective Studies ; Severity of Illness Index ; Aortic Valve Stenosis/diagnostic imaging ; Aortic Valve Stenosis/epidemiology ; Aortic Valve/diagnostic imaging ; Renal Dialysis/adverse effects
Language	English
Publishing date	2024-02-01
Publishing country	Netherlands
Document type	Multicenter Study ; Journal Article
ZDB-ID	779519-1
ISSN	1874-1754 ; 0167-5273
ISSN (online)	1874-1754
ISSN	0167-5273
DOI	10.1016/j.ijcard.2024.131822
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Zs.A 1673: Show issues

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Article ; Online: Risk factors for cefmetazole-non-susceptible bacteremia in acute cholangitis.

Onishi, Katsuhiro / Morioka, Hiroshi / Imaizumi, Takahiro / Tsuchimoto, Daisuke / Nishio, Mitsuru / Komiyama, Takuma

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy

2023 Volume 30, Issue 5, Page(s) 423–428

Abstract: Introduction: Cefmetazole (CMZ), an antibiotic with limited international distribution, is recommended by the Tokyo Guidelines 2018 (TG18) for non-severe cases of acute cholangitis (AC). However, the risk factors for CMZ-non-susceptible (CMZ-NS) ... ...

Abstract	Introduction: Cefmetazole (CMZ), an antibiotic with limited international distribution, is recommended by the Tokyo Guidelines 2018 (TG18) for non-severe cases of acute cholangitis (AC). However, the risk factors for CMZ-non-susceptible (CMZ-NS) bacteremia in AC remain unclear. Here, we aimed to investigate the risk factors for CMZ-NS bacteremia and evaluate mortality in patients with AC. Methods: This single-center, retrospective, observational study included all patients diagnosed with definite bacteremic AC, based on TG18, from April 2019 to March 2023. Risk factors for CMZ-NS bacteremia were analyzed by univariate, and age- and sex-adjusted, logistic regression analyses. Mortality was compared by cause of obstruction, CMZ-susceptible/CMZ-NS bacteremia, and initial treatment. Results: In total, 165 patients were enrolled. CMZ-NS bacteremia was diagnosed in 46 (27.9 %) patients. Histories of diabetes mellitus, hepato-biliary-pancreatic cancer, malignant biliary obstruction, and endoscopic sphincterotomy were identified as significant factors associated with the risk of CMZ-NS bacteremia. Thirteen patients died within 30 days of hospital admission. The mortality of patients with AC and malignant biliary obstruction was statistically higher than that of patients with bile duct stones. No patients with AC and bile duct stones died in the group with CMZ-NS bacteremia and inappropriate initial antibiotics. Conclusions: In AC, a history of diabetes mellitus, hepato-biliary-pancreatic cancer, malignant biliary obstruction, and endoscopic sphincterotomy are associated with an increased risk of CMZ-NS bacteremia. Therefore, the choice of empiric therapy for AC should be based on the etiology and patient background, rather than on the severity.
MeSH term(s)	Humans ; Anti-Bacterial Agents/therapeutic use ; Cefmetazole ; Cholangitis/complications ; Cholangitis/drug therapy ; Cholestasis ; Diabetes Mellitus ; Pancreatic Neoplasms/complications ; Retrospective Studies ; Risk Factors ; Male ; Female
Chemical Substances	Anti-Bacterial Agents ; Cefmetazole (3J962UJT8H)
Language	English
Publishing date	2023-11-18
Publishing country	Netherlands
Document type	Observational Study ; Journal Article
ZDB-ID	1355399-9
ISSN	1437-7780 ; 1341-321X
ISSN (online)	1437-7780
ISSN	1341-321X
DOI	10.1016/j.jiac.2023.11.015
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Zs.A 5236: Show issues

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Article ; Online: Prevalence and Risk Factors of Insomnia and Sleep-aid Use in Emergency Physicians in Japan: Secondary Analysis of a Nationwide Survey.

Chiba, Takuyo / Hagiwara, Yusuke / Hifumi, Toru / Kuroda, Yasuhiro / Ikeda, Shunya / Khoujah, Danya / Imaizumi, Takahiro / Shiga, Takashi

The western journal of emergency medicine

2023 Volume 24, Issue 2, Page(s) 331–339

Abstract: Introduction: Emergency physicians (EP) are suspected to have a high prevalence of insomnia and sleep-aid use. Most prior studies about sleep-aid use in EPs have been limited by low response rates. In this study our aim was to investigate the prevalence ...

Abstract	Introduction: Emergency physicians (EP) are suspected to have a high prevalence of insomnia and sleep-aid use. Most prior studies about sleep-aid use in EPs have been limited by low response rates. In this study our aim was to investigate the prevalence of insomnia and sleep-aid use among early-career Japanese EPs and assess the factors associated with insomnia and sleep-aid use. Methods: We collected anonymous, voluntary, survey-based data regarding chronic insomnia and sleep-aid use from board-eligible EPs taking the initial Japanese Association of Acute Medicine board certification exam in 2019 and 2020. We describe the prevalence of insomnia and sleep-aid use and analyzed demographic and job-related factors using multivariable logistic regression analysis. Results: The response rate was 89.71% (732 of 816). The prevalence of chronic insomnia and sleep-aid use was 24.89% (95% CI 21.78-28.29%) and 23.77% (95% CI 20.69-27.15%), respectively. Factors associated with chronic insomnia were long working hours (odds ratio [OR] 1.02, 1.01-1.03, per one-hour/week), and "stress factor" (OR 1.46, 1.13-1.90). Factors associated with sleep-aid use were male gender (OR 1.71, 1.03-2.86), unmarried status (OR 2.38, 1.39-4.10), and "stress factor" (OR 1.48, 1.13-1.94). The "stress factor" was mostly influenced by stressors in dealing with patients/families and co-workers, concern about medical malpractice, and fatigue. Conclusions: Early-career EPs in Japan have a high prevalence of chronic insomnia and sleep-aid use. Long working hours and stress were associated with chronic insomnia, while male gender, unmarried status, and stress were associated with the use of sleep aids.
MeSH term(s)	Humans ; Male ; Female ; Sleep Initiation and Maintenance Disorders/epidemiology ; Prevalence ; Japan/epidemiology ; Surveys and Questionnaires ; Risk Factors ; Sleep ; Physicians
Language	English
Publishing date	2023-02-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.2022.12.57910
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