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Article ; Online: Precision Medicine in Rheumatology: The Promise of Ultrasound-Guided Synovial Biopsy, Barriers to Its Implementation in the United States, and Proposed Solutions.

Horowitz, Diane Lewis / Mandelin, Arthur M / Tabechian, Darren / Ben-Artzi, Ami

2024

Abstract: Purpose of review: In the clinical evaluation of inflammatory arthritis and the research into its pathogenesis, there is a growing role for the direct analysis of synovial tissue. Over the years, various biopsy techniques have been used to obtain human ... ...

Abstract	Purpose of review: In the clinical evaluation of inflammatory arthritis and the research into its pathogenesis, there is a growing role for the direct analysis of synovial tissue. Over the years, various biopsy techniques have been used to obtain human synovial tissue samples, and there have been progressive improvements in the safety, tolerability, and utility of the procedure. Recent findings: The latest advancement in synovial tissue biopsy techniques is the use of ultrasound imaging to guide the biopsy device, along with evolution in the characteristics of the device itself. While ultrasound guided synovial biopsy (UGSB) has taken a strong foothold in Europe, the procedure is still relatively new to the United States of America (USA). In this paper, we describe the expansion of UGSB in the USA, elucidate the challenges faced by rheumatologists developing UGSB programs in the USA, and describe several strategies for overcoming these challenges.
Language	English
Publishing date	2024-02-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057357-1
ISSN	1534-6307 ; 1523-3774
ISSN (online)	1534-6307
ISSN	1523-3774
DOI	10.1007/s11926-024-01138-9
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Article ; Online: Best practices for ultrasound-guided synovial biopsy in the United States.

Ben-Artzi, Ami / Horowitz, Diane L / Mandelin, Arthur M / Tabechian, Darren

Best practice & research. Clinical rheumatology

2023 Volume 37, Issue 1, Page(s) 101834

Abstract: The target organ in many forms of inflammatory arthritis is the synovium. However, synovial tissue has historically been perceived as either difficult to obtain or of little practical value. Ultrasound-guided synovial biopsy [UGSB] is a safe and well- ... ...

Abstract	The target organ in many forms of inflammatory arthritis is the synovium. However, synovial tissue has historically been perceived as either difficult to obtain or of little practical value. Ultrasound-guided synovial biopsy [UGSB] is a safe and well-tolerated bedside procedure that is established in Europe and rapidly growing in popularity in the United States. The technique can be mastered by rheumatologists who are already experienced in ultrasound-guided procedures such as joint aspirations. The USGB procedure allows the proceduralist to access small, medium, and large joints and is inexpensive and less invasive compared to surgical alternatives. The relative ease of obtaining this tissue, along with recent research suggesting that synovium may have more clinical and investigational utility than previously thought, has led clinicians and researchers to a new appreciation of the role of synovial biopsy in both the clinical and research setting. In this manuscript, the authors present recommendations on best practices for ultrasound-guided synovial biopsy in the United States, based on our initial training with well-established experts overseas and our own subsequent collective experience in performing numerous synovial biopsies in the United States over the past 7 years for both clinical and research indications. We envision a future where UGSB is more frequently incorporated in the standard diagnostic workup of arthritis and drives novel research initiatives.
MeSH term(s)	Humans ; United States ; Ultrasonography ; Synovial Membrane/diagnostic imaging ; Synovial Membrane/pathology ; Arthritis/diagnostic imaging ; Image-Guided Biopsy/methods ; Biopsy ; Ultrasonography, Interventional
Language	English
Publishing date	2023-05-30
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2052323-3
ISSN	1532-1770 ; 1521-6942
ISSN (online)	1532-1770
ISSN	1521-6942
DOI	10.1016/j.berh.2023.101834
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Article: Clonal associations of lymphocyte subsets and functional states revealed by single cell antigen receptor profiling of T and B cells in rheumatoid arthritis synovium.

bioRxiv : the preprint server for biology

2023

Abstract: Rheumatoid arthritis (RA) is an autoimmune disease initiated by antigen-specific T cells and B cells, which promote synovial inflammation through a complex set of interactions with innate immune and stromal cells. To better understand the phenotypes and ... ...

Abstract	Rheumatoid arthritis (RA) is an autoimmune disease initiated by antigen-specific T cells and B cells, which promote synovial inflammation through a complex set of interactions with innate immune and stromal cells. To better understand the phenotypes and clonal relationships of synovial T and B cells, we performed single-cell RNA and repertoire sequencing on paired synovial tissue and peripheral blood samples from 12 donors with seropositive RA ranging from early to chronic disease. Paired transcriptomic-repertoire analyses highlighted 3 clonally distinct CD4 T cells populations that were enriched in RA synovium: T peripheral helper (Tph) and T follicular helper (Tfh) cells, CCL5+ T cells, and T regulatory cells (Tregs). Among these cells, Tph cells showed a unique transcriptomic signature of recent T cell receptor (TCR) activation, and clonally expanded Tph cells expressed an elevated transcriptomic effector signature compared to non-expanded Tph cells. CD8 T cells showed higher oligoclonality than CD4 T cells, and the largest CD8 T cell clones in synovium were highly enriched in
Language	English
Publishing date	2023-03-21
Publishing country	United States
Document type	Preprint
DOI	10.1101/2023.03.18.533282
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Article ; Online: Activated Peripheral Blood B Cells in Rheumatoid Arthritis and Their Relationship to Anti-Tumor Necrosis Factor Treatment and Response: A Randomized Clinical Trial of the Effects of Anti-Tumor Necrosis Factor on B Cells.

Meednu, Nida / Barnard, Jennifer / Callahan, Kelly / Coca, Andreea / Marston, Bethany / Thiele, Ralf / Tabechian, Darren / Bolster, Marcy / Curtis, Jeffrey / Mackay, Meggan / Graf, Jonathan / Keating, Richard / Smith, Edwin / Boyle, Karen / Keyes-Elstein, Lynette / Welch, Beverly / Goldmuntz, Ellen / Anolik, Jennifer H

Arthritis & rheumatology (Hoboken, N.J.)

2021 Volume 74, Issue 2, Page(s) 200–211

Abstract: Objective: B cells can become activated in germinal center (GC) reactions in secondary lymphoid tissue and in ectopic GCs in rheumatoid arthritis (RA) synovium that may be tumor necrosis factor (TNF) and lymphotoxin (LT) dependent. This study was ... ...

Abstract	Objective: B cells can become activated in germinal center (GC) reactions in secondary lymphoid tissue and in ectopic GCs in rheumatoid arthritis (RA) synovium that may be tumor necrosis factor (TNF) and lymphotoxin (LT) dependent. This study was undertaken to characterize the peripheral B cell compartment longitudinally during anti-TNF therapy in RA. Methods: Participants were randomized in a 2:1 ratio to receive standard dosing regimens of etanercept (n = 43) or adalimumab (n = 20) for 24 weeks. Eligible participants met the American College of Rheumatology 1987 criteria for RA, had clinically active disease (Disease Activity Score in 28 joints >4.4), and were receiving stable doses of methotrexate. The primary mechanistic end point was the change in switched memory B cell fraction from baseline to week 12 in each treatment group. Results: B cell subsets remained surprisingly stable over the course of the study regardless of treatment group, with no significant change in memory B cells. Blockade of TNF and LT with etanercept compared to blockade of TNF alone with adalimumab did not translate into significant differences in clinical response. The frequencies of multiple activated B cell populations, including CD21- double-negative memory and activated naive B cells, were higher in RA nonresponders at all time points, and CD95+ activated B cell frequencies were increased in patients receiving anti-TNF treatment in the nonresponder group. In contrast, frequencies of transitional B cells-a putative regulatory subset-were lower in the nonresponders. Conclusion: Overall, our results support the notion that peripheral blood B cell subsets are remarkably stable in RA and not differentially impacted by dual blockade of TNF and LT with etanercept or single blockade of TNF with adalimumab. Activated B cells do associate with a less robust response.
MeSH term(s)	Adalimumab/pharmacology ; Adalimumab/therapeutic use ; Adult ; Aged ; Antirheumatic Agents/pharmacology ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/blood ; Arthritis, Rheumatoid/drug therapy ; Arthritis, Rheumatoid/immunology ; B-Lymphocytes/drug effects ; B-Lymphocytes/physiology ; Etanercept/pharmacology ; Etanercept/therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Single-Blind Method ; Tumor Necrosis Factor Inhibitors/pharmacology ; Tumor Necrosis Factor Inhibitors/therapeutic use
Chemical Substances	Antirheumatic Agents ; Tumor Necrosis Factor Inhibitors ; Adalimumab (FYS6T7F842) ; Etanercept (OP401G7OJC)
Language	English
Publishing date	2021-12-27
Publishing country	United States
Document type	Clinical Trial, Phase IV ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2756371-6
ISSN	2326-5205 ; 2326-5191
ISSN (online)	2326-5205
ISSN	2326-5191
DOI	10.1002/art.41941
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Article ; Online: Severe long-standing dysimmune sensory neuronopathy responsive to etanercept.

Figueroa, Juan J / Tabechian, Darren / Herrmann, David N

Journal of clinical neuromuscular disease

2008 Volume 9, Issue 4, Page(s) 415–420

Abstract: Sensory neuronopathy in association with connective tissue disease is a disabling disorder for which there is no well-established therapy. Various immunosuppressive agents, plasmapheresis, and intravenous immunoglobulin have shown only anecdotal or ... ...

Abstract	Sensory neuronopathy in association with connective tissue disease is a disabling disorder for which there is no well-established therapy. Various immunosuppressive agents, plasmapheresis, and intravenous immunoglobulin have shown only anecdotal or modest beneficial effects. Tumor necrosis factor alpha is a proinflammatory cytokine that mediates TH1-cell inflammatory responses and is a plausible contributor to dorsal root ganglion injury in sensory neuronopathy. We describe a patient with severe painful and ataxic sensory neuronopathy in association with systemic lupus erythematosus, who showed marked and sustained improvement on etanercept, a tumor necrosis factor alpha inhibitor, despite a chronic and progressive course that was refractory to several immunomodulatory interventions. We review the therapeutic potential of tumor necrosis factor alpha blockade in immune-mediated neuropathies and the reported neurologic complications from its use, most notably central and peripheral demyelination.
MeSH term(s)	Adult ; Ataxia/drug therapy ; Ataxia/etiology ; Ataxia/immunology ; Ataxia/pathology ; Athetosis/complications ; Athetosis/drug therapy ; Athetosis/immunology ; Athetosis/pathology ; Chronic Disease ; Electromyography ; Etanercept ; Female ; Humans ; Immunoglobulin G/therapeutic use ; Immunologic Factors/therapeutic use ; Lupus Erythematosus, Systemic/complications ; Lupus Erythematosus, Systemic/immunology ; Neural Conduction ; Neurons, Afferent/immunology ; Neurons, Afferent/pathology ; Paresthesia/drug therapy ; Paresthesia/etiology ; Paresthesia/immunology ; Paresthesia/pathology ; Peripheral Nervous System Diseases/complications ; Peripheral Nervous System Diseases/drug therapy ; Peripheral Nervous System Diseases/immunology ; Peripheral Nervous System Diseases/pathology ; Receptors, Tumor Necrosis Factor/therapeutic use ; Recombinant Fusion Proteins/therapeutic use ; Treatment Outcome
Chemical Substances	Immunoglobulin G ; Immunologic Factors ; Receptors, Tumor Necrosis Factor ; Recombinant Fusion Proteins ; Etanercept (OP401G7OJC)
Language	English
Publishing date	2008-06
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1454947-5
ISSN	1537-1611 ; 1522-0443
ISSN (online)	1537-1611
ISSN	1522-0443
DOI	10.1097/CND.0b013e3181659999
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Article: Deep immunophenotyping reveals circulating activated lymphocytes in individuals at risk for rheumatoid arthritis.

Inamo, Jun / Keegan, Joshua / Griffith, Alec / Ghosh, Tusharkanti / Horisberger, Alice / Howard, Kaitlyn / Pulford, John / Murzin, Ekaterina / Hancock, Brandon / Jonsson, Anna Helena / Seifert, Jennifer / Feser, Marie L / Norris, Jill M / Cao, Ye / Apruzzese, William / Louis Bridges, S / Bykerk, Vivian / Goodman, Susan / Donlin, Laura /

Firestein, Gary S / Perlman, Harris / Bathon, Joan M / Hughes, Laura B / Tabechian, Darren / Filer, Andrew / Pitzalis, Costantino / Anolik, Jennifer H / Moreland, Larry / Guthridge, Joel M / James, Judith A / Brenner, Michael B / Raychaudhuri, Soumya / Sparks, Jeffrey A / Michael Holers, V / Deane, Kevin D / Lederer, James A / Rao, Deepak A / Zhang, Fan

bioRxiv : the preprint server for biology

2023

Abstract: Rheumatoid arthritis (RA) is a systemic autoimmune disease with currently no universally highly effective prevention strategies. Identifying pathogenic immune phenotypes in 'At-Risk' populations prior to clinical disease onset is crucial to establishing ... ...

Abstract	Rheumatoid arthritis (RA) is a systemic autoimmune disease with currently no universally highly effective prevention strategies. Identifying pathogenic immune phenotypes in 'At-Risk' populations prior to clinical disease onset is crucial to establishing effective prevention strategies. Here, we applied mass cytometry to deeply characterize the immunophenotypes in blood from At-Risk individuals identified through the presence of serum antibodies to citrullinated protein antigens (ACPA) and/or first-degree relative (FDR) status (n=52), as compared to established RA (n=67), and healthy controls (n=48). We identified significant cell expansions in At-Risk individuals compared with controls, including CCR2+CD4+ T cells, T peripheral helper (Tph) cells, type 1 T helper cells, and CXCR5+CD8+ T cells. We also found that CD15+ classical monocytes were specifically expanded in ACPA-negative FDRs, and an activated PAX5
Language	English
Publishing date	2023-07-04
Publishing country	United States
Document type	Preprint
DOI	10.1101/2023.07.03.547507
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Article ; Online: Deconstruction of rheumatoid arthritis synovium defines inflammatory subtypes.

Zhang, Fan / Jonsson, Anna Helena / Nathan, Aparna / Millard, Nghia / Curtis, Michelle / Xiao, Qian / Gutierrez-Arcelus, Maria / Apruzzese, William / Watts, Gerald F M / Weisenfeld, Dana / Nayar, Saba / Rangel-Moreno, Javier / Meednu, Nida / Marks, Kathryne E / Mantel, Ian / Kang, Joyce B / Rumker, Laurie / Mears, Joseph / Slowikowski, Kamil /

Weinand, Kathryn / Orange, Dana E / Geraldino-Pardilla, Laura / Deane, Kevin D / Tabechian, Darren / Ceponis, Arnoldas / Firestein, Gary S / Maybury, Mark / Sahbudin, Ilfita / Ben-Artzi, Ami / Mandelin, Arthur M / Nerviani, Alessandra / Lewis, Myles J / Rivellese, Felice / Pitzalis, Costantino / Hughes, Laura B / Horowitz, Diane / DiCarlo, Edward / Gravallese, Ellen M / Boyce, Brendan F / Moreland, Larry W / Goodman, Susan M / Perlman, Harris / Holers, V Michael / Liao, Katherine P / Filer, Andrew / Bykerk, Vivian P / Wei, Kevin / Rao, Deepak A / Donlin, Laura T / Anolik, Jennifer H / Brenner, Michael B / Raychaudhuri, Soumya

Nature

2023 Volume 623, Issue 7987, Page(s) 616–624

Abstract: Rheumatoid arthritis is a prototypical autoimmune disease that causes joint inflammation and ... ...

Abstract	Rheumatoid arthritis is a prototypical autoimmune disease that causes joint inflammation and destruction
MeSH term(s)	Humans ; Arthritis, Rheumatoid/complications ; Arthritis, Rheumatoid/genetics ; Arthritis, Rheumatoid/immunology ; Arthritis, Rheumatoid/pathology ; Cytokines/metabolism ; Inflammation/complications ; Inflammation/genetics ; Inflammation/immunology ; Inflammation/pathology ; Synovial Membrane/pathology ; T-Lymphocytes/immunology ; B-Lymphocytes/immunology ; Genetic Predisposition to Disease/genetics ; Phenotype ; Single-Cell Gene Expression Analysis
Chemical Substances	Cytokines
Language	English
Publishing date	2023-11-08
Publishing country	England
Document type	Journal Article
ZDB-ID	120714-3
ISSN	1476-4687 ; 0028-0836
ISSN (online)	1476-4687
ISSN	0028-0836
DOI	10.1038/s41586-023-06708-y
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Article: Cardiac tamponade: an uncommon presentation of hypertensive scleroderma renal crisis.

Pattanaik, Debendra / Tabechian, Darren / Varnis, Charlene

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

2004 Volume 10, Issue 3, Page(s) 125–129

Abstract: Cardiac tamponade is an extremely rare manifestation of systemic sclerosis and has been reported to be a risk factor for the subsequent development of renal failure. We report the case of a 37-year-old man with recently diagnosed scleroderma who ... ...

Abstract	Cardiac tamponade is an extremely rare manifestation of systemic sclerosis and has been reported to be a risk factor for the subsequent development of renal failure. We report the case of a 37-year-old man with recently diagnosed scleroderma who presented with chest pain and shortness of breath. He was found to have scleroderma renal crisis as well as cardiac tamponade. He responded hemodynamically to emergent pericardiocentesis and blood pressure control with angiotensin-converting enzyme inhibitors. However, the renal function deteriorated further leading to development of end-stage renal disease and required chronic hemodialysis.Although pericardial effusions are common in scleroderma, cardiac tamponade is rare. Coexistent hypertension and cardiac tamponade in scleroderma have not been described previously. Elevated systemic blood pressure can accompany and should not be used to exclude the diagnosis of cardiac tamponade. We emphasize the importance of pericardial disease as an uncommon but important cause of chest pain in patients with scleroderma.
Language	English
Publishing date	2004-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1283266-2
ISSN	1076-1608
ISSN	1076-1608
DOI	10.1097/01.rhu.0000128872.29252.b2
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Article ; Online: Divergent gene activation in peripheral blood and tissues of patients with rheumatoid arthritis, psoriatic arthritis and psoriasis following infliximab therapy.

Rosenberg, Alexander / Fan, Hongtao / Chiu, Yahui G / Bolce, Rebecca / Tabechian, Darren / Barrett, Rick / Moorehead, Sharon / Baribaud, Frédéric / Liu, Hao / Peffer, Nancy / Shealy, David / Schwarz, Edward M / Ritchlin, Christopher T

PloS one

2014 Volume 9, Issue 10, Page(s) e110657

Abstract: Objective: The immune inflammatory disorders rheumatoid arthritis (RA), psoriatic arthritis (PsA) and psoriasis (Ps) share common pathologic features and show responsiveness to anti-tumor necrosis factor (TNF) agents yet they are phenotypically distinct. ...

Abstract	Objective: The immune inflammatory disorders rheumatoid arthritis (RA), psoriatic arthritis (PsA) and psoriasis (Ps) share common pathologic features and show responsiveness to anti-tumor necrosis factor (TNF) agents yet they are phenotypically distinct. The aim of this study was to examine if anti-TNF therapy is associated with divergent gene expression profiles in circulating cells and target tissues of patients with these diseases. Methods: Peripheral blood CD14+ and CD14- cells were isolated from 9 RA, 12 PsA and 10 Ps patients before and after infliximab (IFX) treatment. Paired synovial (n=3, RA, PsA) and skin biopsies (n=5, Ps) were also collected. Gene expression was analyzed by microarrays. Results: 26 out of 31 subjects responded to IFX. The transcriptional response of CD14+ cells to IFX was unique for the three diseases, with little overlap (<25%) in significantly changed gene lists (with PsA having the largest number of changed genes). In Ps, altered gene expression was more pronounced in lesional skin (relative to paired, healthy skin) compared to blood (relative to healthy controls). Marked suppression of up-regulated genes in affected skin was noted 2 weeks after therapy but the expression patterns differed from uninvolved skin. Divergent patterns of expression were noted between the blood cells and skin or synovial tissues in individual patients. Functions that promote cell differentiation, proliferation and apoptosis in all three diseases were enriched. RA was enriched in functions in CD14- cells, PsA in CD14+ cells and Ps in both CD14+ and CD14- cells, however, the specific functions showed little overlap in the 3 disorders. Conclusion: Divergent patterns of altered gene expression are observed in RA, PsA and Ps patients in blood cells and target organs in IFX responders. Differential gene expression profiles in the blood do not correlate with those in target organs.
MeSH term(s)	Adult ; Arthritis, Psoriatic/genetics ; Arthritis, Psoriatic/pathology ; Arthritis, Rheumatoid/genetics ; Arthritis, Rheumatoid/pathology ; Gene Expression Regulation/drug effects ; Genetic Variation ; Humans ; Infliximab/adverse effects ; Middle Aged ; Protein Biosynthesis ; Psoriasis/chemically induced ; Psoriasis/drug therapy ; Psoriasis/genetics ; Psoriasis/pathology ; Tumor Necrosis Factor-alpha/antagonists & inhibitors
Chemical Substances	Tumor Necrosis Factor-alpha ; Infliximab (B72HH48FLU)
Language	English
Publishing date	2014-10-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0110657
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Article ; Online: Musculoskeletal ultrasound objective structured clinical examination: an assessment of the test.

Kissin, Eugene Y / Grayson, Peter C / Cannella, Amy C / Demarco, Paul J / Evangelisto, Amy / Goyal, Janak / Al Haj, Rany / Higgs, Jay / Malone, Daniel G / Nishio, Midori J / Tabechian, Darren / Kaeley, Gurjit S

Arthritis care & research

2014 Volume 66, Issue 1, Page(s) 2–6

Abstract: Objective: To determine the reliability and validity of an objective structured clinical examination (OSCE) for musculoskeletal ultrasound (MSUS).: Methods: A 9-station OSCE was administered to 35 rheumatology fellows trained in MSUS and to 3 expert ... ...

Abstract	Objective: To determine the reliability and validity of an objective structured clinical examination (OSCE) for musculoskeletal ultrasound (MSUS). Methods: A 9-station OSCE was administered to 35 rheumatology fellows trained in MSUS and to 3 expert faculty (controls). Participants were unaware of joint health (5 diseased/4 healthy). Faculty assessors (n = 9) graded image quality with predefined checklists and a 0-5 global rating, blinded to who performed the study. Interrater reliability, correlation between a written multiple choice question examination (MCQ) and OSCE performance, and comparison of fellow OSCE results with those of the faculty were measured to determine OSCE reliability, concurrent validity, and construct validity. Results: Assessors' interrater reliability was good (intraclass correlation coefficient [ICC] 0.7). Score reliability was good in the normal wrist and ankle stations (ICC 0.7) and moderate in the abnormal wrist and ankle stations (ICC 0.4). MCQ grades significantly correlated with OSCE grades (r = 0.52, P < 0.01). The fellows in the bottom quartile of the MCQ scored 3.07 on the OSCE, significantly worse than the top quartile fellows (3.32) and the faculty (3.29; P < 0.01). Scores also significantly discriminated bottom quartile fellows from faculty in the normal wrist and ankle stations (3.38 versus 3.78; P < 0.01), but not in the abnormal stations (3.37 versus 3.49; P = 0.08). Conclusion: MSUS OSCE is a reliable and valid method for evaluation of MSUS skill. Normal joint assessment stations are more reliable than abnormal joint assessment stations and better discriminate poorly performing fellows from faculty. Therefore, MSUS OSCE with normal joints can be used for the assessment of MSUS skill competency.
MeSH term(s)	Ankle Joint/diagnostic imaging ; Clinical Competence ; Education, Medical, Continuing/methods ; Educational Measurement/methods ; Humans ; Musculoskeletal Diseases/diagnosis ; Musculoskeletal Diseases/diagnostic imaging ; Musculoskeletal System/diagnostic imaging ; Observer Variation ; Reproducibility of Results ; Rheumatology/education ; Ultrasonography/methods ; Wrist Joint/diagnostic imaging
Language	English
Publishing date	2014-01
Publishing country	United States
Document type	Evaluation Studies ; Journal Article
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.22105
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