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  1. Article: Letter to the Editor: Obesity Definition for Muscle Outcomes in Sarcopenic Obesity: Utility of Waist Circumference Revisited.

    Lim, J P / Chew, J / Ismail, N H / Lim, W S

    The Journal of frailty & aging

    2021  Volume 10, Issue 4, Page(s) 334–336

    MeSH term(s) Body Mass Index ; Humans ; Muscles ; Obesity ; Sarcopenia/diagnosis ; Waist Circumference
    Language English
    Publishing date 2021-09-13
    Publishing country France
    Document type Letter
    ZDB-ID 2856228-8
    ISSN 2273-4309 ; 2260-1341
    ISSN (online) 2273-4309
    ISSN 2260-1341
    DOI 10.14283/jfa.2021.28
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  2. Article ; Online: Letter to the Editor: Influence of Obesity on Diagnostic Accuracy and Optimal Cutoffs for Sarcopenia Screening in Non-Frail Older Adults: A Comparison of SARC-F versus SARC-CalF.

    Lim, W S / Lim, J P / Chew, J / Tan, A W K

    The journal of nutrition, health & aging

    2020  Volume 24, Issue 8, Page(s) 914–916

    Language English
    Publishing date 2020-08-21
    Publishing country France
    Document type Journal Article
    ZDB-ID 2081921-3
    ISSN 1760-4788 ; 1279-7707
    ISSN (online) 1760-4788
    ISSN 1279-7707
    DOI 10.1007/s12603-020-1393-5
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  3. Article: Disentangling the Relationship between Frailty and Intrinsic Capacity in Healthy Community-Dwelling Older Adults: A Cluster Analysis

    Chew, Justin / Lim, J. P. / Yew, S. / Yeo, A. / Ismail, N. H. / Ding, Y. Y. / Lim, W. S.

    journal of nutrition, health & aging. 2021 Nov., v. 25, no. 9

    2021  

    Abstract: BACKGROUND: Frailty and intrinsic capacity (IC) are distinct but interrelated constructs. Uncertainty remains regarding how they are related and interact to influence health outcomes. We aim to understand the relationship between frailty and IC by ... ...

    Abstract BACKGROUND: Frailty and intrinsic capacity (IC) are distinct but interrelated constructs. Uncertainty remains regarding how they are related and interact to influence health outcomes. We aim to understand the relationship between frailty and IC by identifying subgroups based on frailty criteria and IC domains and studying one-year outcomes. METHODS: We studied 200 independent community-dwelling older adults (mean age 67.9±7.9 years, Modified Barthel Index (MBI) score 99±2.6). Frailty was defined by modified Fried criteria. Scores (range: 0–2) were assigned to individual IC domains (cognition, psychological, locomotion, and vitality) to yield a total IC score of 8. To identify subgroups, two-step cluster analysis was performed with age, frailty and IC domains. Cluster associations with one-year outcomes (frailty, muscle strength (grip strength, repeated chair stand test), physical performance (gait speed, Short Physical Performance Battery), function (MBI) and quality-of-life (EuroQol (EQ)-5D)) were examined using multiple linear regression adjusted for age, gender and education. RESULTS: Three distinct clusters were identified — Cluster 1: High IC/Robust (N=74, 37%); Cluster 2: Intermediate IC/Prefrail (N=73, 36.5%); and Cluster 3: Low IC/Prefrail-Frail (53, 26.5%). Comparing between clusters, IC domains, cognition, depressive symptoms, nutrition, strength and physical performance were least impaired in Cluster 1, intermediate in Cluster 2 and most impaired in Cluster 3. At one year, the proportion transitioning to frailty or remaining frail was highest in Cluster 3 compared to Cluster 2 and Cluster 1 (39% vs 6.9% vs 2.8%, P<0.001). Compared to Cluster 1, Cluster 3 experienced greatest declines in grip strength (β=−4.1, P<.001), MBI (β=−1.24, P=0.045) and EQ-5D utility scores (β=−0.053, P=0.005), with Cluster 2 intermediate between Cluster 1 and Cluster 3. CONCLUSIONS: Amongst independent community-dwelling older adults, IC is complementary to frailty measures through better risk-profiling of one-year outcomes amongst prefrail individuals into intermediate and high-risk groups. The intermediate group merits follow-up to ascertain longer-term prognosis.
    Keywords cluster analysis ; cognition ; education ; elderly ; exercise test ; gait ; gender ; locomotion ; muscle strength ; nutrition ; prognosis ; quality of life ; regression analysis ; uncertainty
    Language English
    Dates of publication 2021-11
    Size p. 1112-1118.
    Publishing place Springer Paris
    Document type Article
    ZDB-ID 2081921-3
    ISSN 1760-4788 ; 1279-7707
    ISSN (online) 1760-4788
    ISSN 1279-7707
    DOI 10.1007/s12603-021-1679-2
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  4. Article: Singapore Clinical Practice Guidelines For Sarcopenia: Screening, Diagnosis, Management and Prevention.

    Lim, W S / Cheong, C Y / Lim, J P / Tan, M M Y / Chia, J Q / Malik, N A / Tay, L

    The Journal of frailty & aging

    2022  Volume 11, Issue 4, Page(s) 348–369

    Abstract: Objectives: To present the local evidence and final recommendations of the Clinical Practice Guidelines workgroup convened by the Chapter of Geriatricians and the Society for Geriatric Medicine Singapore. The aim is to develop contextualized evidence- ... ...

    Abstract Objectives: To present the local evidence and final recommendations of the Clinical Practice Guidelines workgroup convened by the Chapter of Geriatricians and the Society for Geriatric Medicine Singapore. The aim is to develop contextualized evidence-based recommendations that facilitate adoption of the Asian Working Group for Sarcopenia (AWGS) 2019 consensus into current practice in Singapore.
    Methods: The workgroup drew upon the AWGS'2019 consensus, updated literature review of Singapore studies till 31 Dec 2020, and evidence from recent systematic reviews. From 40 local studies included for data extraction, we constructed evidence tables organized as: definition and epidemiology; diagnosis and evaluation; and treatment and intervention. Twenty recommendations - case-finding, diagnosis, treatment, prevention, research - were developed, and graded for strength and quality using the GRADE approach. Consensus from an expert panel(N=23) was achieved after two rounds of the modified Delphi process.
    Results: The local prevalence of sarcopenia among community-dwelling older adults ranged from 13.6% to 25%. Most studies adopted the AWGS'2019 and AWGS'2014 criteria. Reported case finding tools include SARC-F, calf circumference (CC) and SARC-CalF. Gender-specific AWGS cut-offs for appendicular skeletal mass were used to define low muscle mass. Different protocols and dynamometers were used to assess handgrip strength, whilst gait speed and 5-times chair stand were commonly used to assess physical performance.
    Recommendations: We conditionally recommend a case-finding approach in at-risk older adults using validated case-finding tools. Screen-positive individuals should be assessed for 'possible sarcopenia' and underlying causes. For diagnosis, we conditionally recommend using the AWGS'2019 algorithm, and dual-energy X-ray absorptiometry when necessary to determine low lean mass for a confirmatory diagnosis of sarcopenia. For treatment, we strongly recommend resistance-based exercises and conditionally recommend a quality protein-rich diet/protein supplementation, with Vitamin D supplementation for insufficiency (<30 micrograms/L). For prevention, we recommend regular resistance-based physical activity and adequate protein intake (≥1.0g/kg bodyweight). We encourage more research to address local evidence gaps.
    MeSH term(s) Humans ; Aged ; Sarcopenia/diagnosis ; Sarcopenia/epidemiology ; Sarcopenia/prevention & control ; Hand Strength ; Singapore/epidemiology ; Muscle Strength/physiology ; Walking Speed ; Mass Screening/methods ; Geriatric Assessment/methods
    Language English
    Publishing date 2022-11-01
    Publishing country France
    Document type Review ; Journal Article
    ZDB-ID 2856228-8
    ISSN 2273-4309 ; 2260-1341
    ISSN (online) 2273-4309
    ISSN 2260-1341
    DOI 10.14283/jfa.2022.59
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  5. Article: Yubi-Wakka Test for Sarcopenia Screening in the Community: Comparative Agreement, Diagnostic Performance and Validity with Calf Circumference Measurements.

    Piodena-Aportadera, M R B / Lau, S / Tan, C N / Chew, J / Lim, J P / Ismail, N H / Ding, Y Y / Lim, W S

    The Journal of frailty & aging

    2023  Volume 13, Issue 2, Page(s) 98–107

    Abstract: Background: Screening tools such as calf circumference (CC) and Yubi-wakka (finger-ring) test have been recognized as effective tools by Asian Working Group for Sarcopenia 2019 (AWGS'19) for sarcopenia screening but their comparative agreement, ... ...

    Abstract Background: Screening tools such as calf circumference (CC) and Yubi-wakka (finger-ring) test have been recognized as effective tools by Asian Working Group for Sarcopenia 2019 (AWGS'19) for sarcopenia screening but their comparative agreement, diagnostic performance and validity are unclear.
    Objectives: This study aims to determine: (i)agreement between calf and finger-ring circumference, (ii)diagnostic performance for low muscle mass and AWGS'19 sarcopenia diagnosis, (iii)correlation with muscle mass, strength, and physical performance, and (iv)association with frailty, life space mobility and physical activity.
    Methods: We studied 187 healthy community-dwelling older adults (mean age=66.8+7.0years) from the GERILABS-2 study. CC was measured via (i) both calves in sitting and standing positions, and (ii) Yubi-wakka test by encircling the thickest part of the non-dominant calf with index fingers and thumbs of both hands. We performed Cohen's kappa to check for agreement, area under receiver operating characteristic curve (AUC) to compare diagnostic performance, partial correlations adjusted for age and gender to compare convergent validity, and logistic regression to determine predictive validity for outcome measures.
    Results: Sarcopenia prevalence was 24.0% (AWGS'19). Yubi-wakka identified 16.6% of participants as screen-positive ("smaller"), showing moderate agreement only with non-dominant sitting CC measurements (k=0.421,p<0.001) and having lower diagnostic performance in determining low muscle mass (AUC=0.591 vs 0.855-0.870,p<0.001; sensitivity=57.1% vs 75.5-90.8%; specificity=58.4% vs 70.8-80.9%) and sarcopenia diagnosis (AUC=0.581 vs 0.788-0.818,p<0.001; sensitivity=55.6% vs 57.5-71.8%; specificity=74.4% vs 75.6-88.9%) compared to CC measurements. Yubi-wakka correlated significantly with muscle mass, grip strength and knee extension but not physical performance. When adjusted for age, gender and hypertension, Yubi-wakka was significantly associated with frailty (OR=3.96,95%CI:1.09-14.38), life space mobility (OR=2.38,95%CI:1.08-5.24) and physical activity (OR=2.50,95%CI:1.07-5.86).
    Discussion and conclusions: Yubi-wakka provides a self-administered, low-cost and practicable community screening tool for sarcopenia. Our study affirmed the convergent and predictive validity of Yubi-wakka, albeit with lower sensitivity and specificity in diagnostic performance compared to CC measurements.
    MeSH term(s) Humans ; Aged ; Frailty ; Sarcopenia/diagnosis ; Sarcopenia/epidemiology ; Knee Joint ; Exercise ; Hand Strength
    Language English
    Publishing date 2023-12-26
    Publishing country France
    Document type Journal Article
    ZDB-ID 2856228-8
    ISSN 2273-4309 ; 2260-1341
    ISSN (online) 2273-4309
    ISSN 2260-1341
    DOI 10.14283/jfa.2024.25
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  6. Article: Muscle Strength Definitions Matter: Prevalence of Sarcopenia and Predictive Validity for Adverse Outcomes Using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) Criteria

    Chew, Justin / Yeo, A / Yew, S / Lim, J. P / Tay, L / Ding, Y. Y / Lim, W. S

    journal of nutrition, health & aging. 2020 June, v. 24, no. 6

    2020  

    Abstract: BACKGROUND: EWGSOP2 criteria for sarcopenia recommends the use of either handgrip strength (GS) or 5-times repeated chair stand test (RCS) as a muscle strength measure. We aim to compare the impact of different muscle strength definitions on sarcopenia ... ...

    Abstract BACKGROUND: EWGSOP2 criteria for sarcopenia recommends the use of either handgrip strength (GS) or 5-times repeated chair stand test (RCS) as a muscle strength measure. We aim to compare the impact of different muscle strength definitions on sarcopenia prevalence and predictive validity for 2-year outcomes, using the EWGSOP2 clinical algorithm. METHODS: We studied 200 community-dwelling older adults, comparing sarcopenia prevalence using three muscle strength definitions: 1) maximum GS (Asian Working Group cutoffs); 2) RCS-1 (standard cutoff >15s); and 3) RCS-2 (ROC-derived cutoff >12.5s). Two-year outcomes include: 1) Incident frailty (modified Fried criteria); 2) Physical performance [Short Physical Performance Battery (SPPB) score <10]; and 3) Quality of life [EuroQol-5 dimension (EQ-5D) <25th percentile]. We performed logistic regression on 2-year outcomes adjusted for age, gender, cognition and mood. RESULTS: Prevalence of confirmed sarcopenia was 14.5%, 4% and 9% for GS, RCS-1 and RCS-2 respectively. For 2-year outcomes (N=183), RCS-2 predicted incident frailty (OR: 5.7, 95% CI 1.4–22.8, p=0.013), low SPPB (OR: 4.4, 95% CI 1.4–13.1, p=0.009), and trended towards predicting low QOL (OR: 2.1, 95% CI 0.9–4.9, p=0.095). In contrast, GS and RCS-1 did not predict frailty nor low QOL, but predicted low SPPB only (GS: OR 3.8, 95% CI 1.3–10.6, p=0.01; RCS-1: OR: 8.8, 95% CI 2.2–35.0, p=0.002). CONCLUSIONS: Sarcopenia prevalence varies with muscle strength definitions, with GS being significantly higher vis-á-vis RCS definitions. Our results also support the use of population-specific over standard cutoffs for RCS to obtain intermediate estimates of sarcopenia prevalence and the best predictive validity for two-year outcomes.
    Keywords algorithms ; cognition ; emotions ; exercise test ; gender ; hand strength ; nutrition ; people ; physical activity ; quality of life ; regression analysis ; sarcopenia
    Language English
    Dates of publication 2020-06
    Size p. 614-618.
    Publishing place Springer Paris
    Document type Article
    Note NAL-AP-2-clean
    ZDB-ID 2081921-3
    ISSN 1760-4788 ; 1279-7707
    ISSN (online) 1760-4788
    ISSN 1279-7707
    DOI 10.1007/s12603-020-1371-y
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  7. Article: Social Frailty and Executive Function: Association with Geriatric Syndromes, Life Space and Quality of Life in Healthy Community-Dwelling Older Adults.

    Ong, M / Pek, K / Tan, C N / Chew, J / Lim, J P / Yew, S / Yeo, A / Lim, W S

    The Journal of frailty & aging

    2021  Volume 11, Issue 2, Page(s) 206–213

    Abstract: Background: Despite emerging evidence about the association between social frailty and cognitive impairment, little is known about the role of executive function in this interplay, and whether the co-existence of social frailty and cognitive impairment ... ...

    Abstract Background: Despite emerging evidence about the association between social frailty and cognitive impairment, little is known about the role of executive function in this interplay, and whether the co-existence of social frailty and cognitive impairment predisposes to adverse health outcomes in healthy community-dwelling older adults.
    Objectives: We aim to examine independent associations between social frailty with the MMSE and FAB, and to determine if having both social frailty and cognitive impairment is associated with worse health outcomes than either or neither condition.
    Methods: We studied 229 cognitively intact and functionally independent community-dwelling older adults (mean age= 67.2±7.43). Outcome measures comprise physical activity; physical performance and frailty; geriatric syndromes; life space and quality of life. We compared Chinese Mini Mental State Examination (CMMSE) and Chinese Frontal Assessment Battery (FAB) scores across the socially non-frail, socially pre-frail and socially frail. Participants were further recategorized into three subgroups (neither, either or both) based on presence of social frailty and cognitive impairment. Cognitive impairment was defined as a score below the educational adjusted cut-offs in either CMMSE or FAB. We performed logistic regression adjusted for significant covariates and mood to examine association with outcomes across the three subgroups.
    Results: Compared with CMMSE, Chinese FAB scores significantly decreased across the social frailty spectrum (p<0.001), suggesting strong association between executive function with social frailty. We derived three subgroups relative to relationship with socially frailty and executive dysfunction: (i) Neither, N=140(61.1%), (ii) Either, N=79(34.5%), and (iii) Both, N=10(4.4%). Compared with neither or either subgroups, having both social frailty and executive dysfunction was associated with anorexia (OR=4.79, 95% CI= 1.04-22.02), near falls and falls (OR= 5.23, 95% CI= 1.10-24.90), lower life-space mobility (odds ratio, OR=9.80, 95% CI=2.07-46.31) and poorer quality of life (OR= 13.2, 95% CI= 2.38-73.4).
    Conclusion: Our results explicated the association of executive dysfunction with social frailty, and their synergistic relationship independent of mood with geriatric syndromes, decreased life space and poorer quality of life. In light of the current COVID-19 pandemic, the association between social frailty and executive dysfunction merits further study as a possible target for early intervention in relatively healthy older adults.
    MeSH term(s) Aged ; COVID-19 ; Cognitive Dysfunction/epidemiology ; Cognitive Dysfunction/psychology ; Cross-Sectional Studies ; Executive Function ; Frail Elderly/psychology ; Frailty/diagnosis ; Frailty/epidemiology ; Frailty/psychology ; Geriatric Assessment/methods ; Humans ; Independent Living/psychology ; Pandemics ; Quality of Life/psychology ; Syndrome
    Language English
    Publishing date 2021-08-06
    Publishing country France
    Document type Journal Article
    ZDB-ID 2856228-8
    ISSN 2273-4309 ; 2260-1341
    ISSN (online) 2273-4309
    ISSN 2260-1341
    DOI 10.14283/jfa.2021.43
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  8. Article ; Online: Letter to the Editor: COVID-19 Pandemic Control Measures: Impact on Social Frailty and Health Outcomes in Non-Frail Community-Dwelling Older Adults.

    Pek, K / Tan, C N / Yew, S / Yeo, A / Lim, J P / Chew, J / Lim, W S

    The journal of nutrition, health & aging

    2021  Volume 25, Issue 6, Page(s) 816–818

    Language English
    Publishing date 2021-06-09
    Publishing country France
    Document type Journal Article
    ZDB-ID 2081921-3
    ISSN 1760-4788 ; 1279-7707
    ISSN (online) 1760-4788
    ISSN 1279-7707
    DOI 10.1007/s12603-021-1635-1
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  9. Article ; Online: Disentangling the Relationship between Frailty and Intrinsic Capacity in Healthy Community-Dwelling Older Adults: A Cluster Analysis.

    Chew, J / Lim, J P / Yew, S / Yeo, A / Ismail, N H / Ding, Y Y / Lim, W S

    The journal of nutrition, health & aging

    2021  Volume 25, Issue 9, Page(s) 1112–1118

    Abstract: Background: Frailty and intrinsic capacity (IC) are distinct but interrelated constructs. Uncertainty remains regarding how they are related and interact to influence health outcomes. We aim to understand the relationship between frailty and IC by ... ...

    Abstract Background: Frailty and intrinsic capacity (IC) are distinct but interrelated constructs. Uncertainty remains regarding how they are related and interact to influence health outcomes. We aim to understand the relationship between frailty and IC by identifying subgroups based on frailty criteria and IC domains and studying one-year outcomes.
    Methods: We studied 200 independent community-dwelling older adults (mean age 67.9±7.9 years, Modified Barthel Index (MBI) score 99±2.6). Frailty was defined by modified Fried criteria. Scores (range: 0-2) were assigned to individual IC domains (cognition, psychological, locomotion, and vitality) to yield a total IC score of 8. To identify subgroups, two-step cluster analysis was performed with age, frailty and IC domains. Cluster associations with one-year outcomes (frailty, muscle strength (grip strength, repeated chair stand test), physical performance (gait speed, Short Physical Performance Battery), function (MBI) and quality-of-life (EuroQol (EQ)-5D)) were examined using multiple linear regression adjusted for age, gender and education.
    Results: Three distinct clusters were identified - Cluster 1: High IC/Robust (N=74, 37%); Cluster 2: Intermediate IC/Prefrail (N=73, 36.5%); and Cluster 3: Low IC/Prefrail-Frail (53, 26.5%). Comparing between clusters, IC domains, cognition, depressive symptoms, nutrition, strength and physical performance were least impaired in Cluster 1, intermediate in Cluster 2 and most impaired in Cluster 3. At one year, the proportion transitioning to frailty or remaining frail was highest in Cluster 3 compared to Cluster 2 and Cluster 1 (39% vs 6.9% vs 2.8%, P<0.001). Compared to Cluster 1, Cluster 3 experienced greatest declines in grip strength (β=-4.1, P<.001), MBI (β=-1.24, P=0.045) and EQ-5D utility scores (β=-0.053, P=0.005), with Cluster 2 intermediate between Cluster 1 and Cluster 3.
    Conclusions: Amongst independent community-dwelling older adults, IC is complementary to frailty measures through better risk-profiling of one-year outcomes amongst prefrail individuals into intermediate and high-risk groups. The intermediate group merits follow-up to ascertain longer-term prognosis.
    MeSH term(s) Aged ; Cluster Analysis ; Frail Elderly/psychology ; Frailty/diagnosis ; Geriatric Assessment ; Hand Strength/physiology ; Humans ; Independent Living
    Language English
    Publishing date 2021-10-24
    Publishing country France
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2081921-3
    ISSN 1760-4788 ; 1279-7707
    ISSN (online) 1760-4788
    ISSN 1279-7707
    DOI 10.1007/s12603-021-1679-2
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  10. Article: Obesity Definitions in Sarcopenic Obesity: Differences in Prevalence, Agreement and Association with Muscle Function.

    Khor, E Q / Lim, J P / Tay, L / Yeo, A / Yew, S / Ding, Y Y / Lim, W S

    The Journal of frailty & aging

    2020  Volume 9, Issue 1, Page(s) 37–43

    Abstract: Background: Sarcopenic obesity (SO) is associated with poorer physical performance in the elderly and will increase in relevance with population ageing and the obesity epidemic. The lack of a consensus definition for SO has resulted in variability in ... ...

    Abstract Background: Sarcopenic obesity (SO) is associated with poorer physical performance in the elderly and will increase in relevance with population ageing and the obesity epidemic. The lack of a consensus definition for SO has resulted in variability in its reported prevalence, poor inter-definitional agreement, and disagreement on its impact on physical performance, impeding further development in the field. While sarcopenia definitions have been compared, the impact of obesity definitions in SO has been less well-studied.
    Objectives: To compare 3 widely-adopted definitions of obesity in terms of SO prevalence, inter-definitional agreement, and association with muscle function.
    Design: Cross-sectional.
    Setting: GERILABS study, Singapore Participants: 200 community-dwelling, functionally-independent older adults.
    Measurements: We utilized three commonly-used definitions of obesity: body mass index (BMI), waist circumference (WC) and DXA-derived fat mass percentage (FM%). Sarcopenia was defined using Asian Working Group for Sarcopenia criteria. For muscle function, we assessed handgrip strength, gait speed and Short Physical Performance Battery (SPPB). Subjects were classified into 4 body composition phenotypes (normal, obese, sarcopenic and SO), and outcomes were compared between groups.
    Results: The prevalence rate for SO was lowest for BMI (0.5%) compared to FM% (10.0%) and WC (10.5%). Inter-definitional agreement was lowest between BMI and WC (κ=0.364), and at best moderate between FM% and WC (κ=0.583). SO performed the worst amongst body composition phenotypes in handgrip strength, gait speed and SPPB (all p<0.01) only when defined using WC. In regression analyses, SO was associated with decreased SPPB scores (β=-0.261, p=0.001) only for the WC definition.
    Conclusion: There is large variation in the prevalence of SO across different obesity definitions, with low-to-moderate agreement between them. Our results corroborate recent evidence that WC, and thus central obesity, is best associated with poorer muscle function in SO. Thus, WC should be further explored in defining obesity for accurate and early characterization of SO among older adults in Asian populations.
    MeSH term(s) Aged ; Cross-Sectional Studies ; Humans ; Muscle Strength/physiology ; Obesity/epidemiology ; Obesity/physiopathology ; Prevalence ; Reproducibility of Results ; Sarcopenia/epidemiology ; Sarcopenia/physiopathology ; Terminology as Topic
    Language English
    Publishing date 2020-03-09
    Publishing country France
    Document type Journal Article
    ZDB-ID 2856228-8
    ISSN 2273-4309 ; 2260-1341
    ISSN (online) 2273-4309
    ISSN 2260-1341
    DOI 10.14283/jfa.2019.28
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