Category: General Interest

Categories : Diseases, Syndromes and Conditions General InterestTags :

Study Reveals Mediaeval Plague Victims Buried With Care and Attention

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Photo by Peter Kvetny on Unsplash

Mediaeval plague victims in the UK were mostly buried with care and attention, according to a new study from Cambridge University. 

In the mid-14th century, Europe was devastated by the Black Death which killed between 40 and 60 per cent of the population. For centuries afterward, waves of plague would continue to strike the region.

Due to the rapid onset of death in the absence of antibiotic treatment (less than a week for bubonic plague and under 48h for pneumonic plague), the disease leaves no visible evidence on the skeleton, so until now archaeologists have been unable to identify individuals who died of plague unless they were buried in mass graves.

Although it has been long believed that most plague victims in fact received an individual burial, this has been impossible to confirm until now.

By studying DNA extracted from the teeth of individuals who died at this time, researchers from the Wellcome Trust-funded After the Plague project, based at the Department of Archaeology, University of Cambridge, have identified the presence of Yersinia Pestis, the bacterial pathogen that causes plague. The study is available to read online in the European Journal of Archaeology.

These include people who received normal individual burials at a parish cemetery and friary in Cambridge and in the nearby village of Clopton.

Lead author Craig Cessford of the University of Cambridge explained: “These individual burials show that even during plague outbreaks individual people were being buried with considerable care and attention. This is shown particularly at the friary where at least three such individuals were buried within the chapter house. The Cambridge Archaeological Unit conducted excavations on this site on behalf of the University in 2016-2017.”

The individual at the parish of All Saints by the Castle in Cambridge was also buried with care; this stand in contrast to the apocalyptic language used to describe the abandonment of this church in 1365 when it was reported that the church was partly in ruins and ‘the bones of dead bodies are exposed to beasts’.”

The study also shows that some plague victims in Cambridge did, as expected, receive mass burials.

Yersinia Pestis was also identified in several parishioners from St Bene’t’s, who were found buried together in a large trench in the churchyard excavated by the Cambridge Archaeological Unit on behalf of Corpus Christi College.

Soon afterwards, this part of the churchyard was transferred to Corpus Christi College, which was founded by the St Bene’t’s parish guild to commemorate the dead including the victims of the Black Death. For centuries, the members of the College would walk over the mass burial every day on the way to the parish church.

Cessford concluded, “Our work demonstrates that it is now possible to identify individuals who died from plague and received individual burials. This greatly improves our understanding of the plague and shows that even in incredibly traumatic times during past pandemics people tried very hard to bury the deceased with as much care as possible.”

Source: University of Cambridge

Journal information: “Beyond Plague Pits: Using Genetics to Identify Responses to Plague in Medieval Cambridgeshire” – Craig Cessford, Christiana L. Scheib, Meriam Guellil, Marcel Keller, Craig Alexander, Sarah A. Inskip and John E. Robb. European Journal of Archaeology, https://doi.org/10.1017/eaa.2021.19

Categories : Cancer General InterestTags :

CNN Anchor Christiane Amanpour Reveals Her Ovarian Cancer Diagnosis

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Photo by Obi Onyeador on Unsplash

CNN anchor Christiane Amanpour told viewers on Monday that she has been diagnosed with ovarian cancer.

The 63 year-old international news veteran told viewers she had had “major successful surgery to remove it” and will now undergo several months of chemotherapy, adding that she was “very confident”.

Amanpour, who works in CNN’s London studio, said she feels “fortunate to have health insurance through work and incredible doctors who are treating me in a country underpinned by, of course, the brilliant NHS,” referencing the UK’s National Health Service.

After four weeks off, she said in Monday’s announcement, “I’m telling you this in the interest of transparency but in truth really mostly as a shoutout to early diagnosis.” Pointing out “millions of women around the world”, she added that she wanted to “urge women to educate themselves on this disease; to get all the regular screenings and scans that you can; to always listen to your bodies; and of course to ensure that your legitimate medical concerns are not dismissed or diminished.”

Amanpour has decades of experience reporting around the world, covering a wide range of conflicts and crises.

Ovarian cancer is the leading cause of death in women diagnosed with gynaecological cancers. It is also the fifth most frequent cause of death in women, in general. The symptoms, such as bloated, swollen or painful stomach, are easily mistaken for less serious health problems, making diagnosis difficult. Most cases are only diagnosed at an advanced stage, leading to poor outcomes. Existing screening tests unfortunately have a low predictive value.

Standard care treatment includes surgery and platinum-based chemotherapy; however, anti-angiogenic bevacizumab and Poly(ADP-ribose) polymerase (PARP) inhibitors are gaining ground in the treatment of this disease.

Source: BBC News

Categories : General Interest Healthcare Politics and RegulationsTags :

Meet the Two Women in the Running for SA’s Top Medical Job

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Photo by Markus Winkler on Unsplash

Health Minister Dr Zweli Mkhize is in hot water over alleged procurement fraud for a R150 million COVID contract, and is widely expected to step down shortly.

President Cyril Ramaphosa is reportedly weighing up two candidates to replace Dr Mkhize as health minister.

The candidates are the former Gauteng health MEC Dr Gwen Ramokgopa, (who took over following the Life Esidimeni tragedy) and Dr Nkosazana Dlamini-Zuma, who, as Health Minister saw the overhaul of the country’s apartheid-era healthcare systems.

As an anti-Apartheid activist, Dr Ramokgopa held various leadership positions. She qualified as a medical doctor (MBChB) in 1989 and obtained her Master’s in Public Health (MPH) in 2007. She worked as a Medical Officer at the Dr George Mukhari (then Ga-Rankuwa) Hospital until 1992.

Having served once as the Gauteng health MEC in 1999,  Dr Ramokgopa took on the role deputy health minister from 2010 to 2014. She succeeded Qedani Mahlangu as Gauteng health MEC following the shameful Life Esidimeni tragedy involving the deaths of at least 94 mental health patients released from private mental healthcare facilities to 27 unlicensed facilities. In a  statement, she vowed to tackle waste and corruption.

Dr Nkosazana Dlamini-Zuma completed her MBChB at the University of Bristol in 1978, and took part in underground ANC activities. During Mandela’s presidency, she was appointed Minister of Health, and courted controversy by voicing support for Virodene, an ‘HIV cure’ which attracted heavy criticism and which was never approved.

She then served as Minister of Foreign Affairs from 1999 to 2009, and then Minister of Home Affairs to 2012, where she turned around a department mired by mismanagement. Despite stubborn resistance from French-speaking nations, she was elected the African Union’s (AU) Chairperson from 2012 to 2017 and was praised for focusing on gender issues. After this, she began vying for the ANC presidency as an MP. In 2019, she was appointed Minister of Cooperative Governance and Traditional Affairs.

During South Africa’s lockdown, she memorably rose to internet fame for using “zol” to refer to cannabis when giving reasons for the tobacco ban.

Categories : General Interest Obstetrics & GynaecologyTags :

South African Woman Gives Birth to 10 Babies in World First

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Photo by William Fortunato from Pexels

In a world first, a Gauteng woman has given birth to 10 babies. It was only last month when Malian woman Halima Cissé had set the record when she gave birth to nine children in Morocco.

Gosiame Thamara Sithole, 37, delivered her seven boys and three girls by Caesarean section at 29 weeks along last night at a Pretoria hospital, according to her husband Teboho Tsotetsi. 

While such large numbers are usually a result of fertility treatment, Sithole had told the Pretoria News that her pregnancy was natural. She already has a pair of six-year-old twins.

Sithole said in an interview that she was shocked and fascinated by the pregnancy.

The retail store manager was told she had sextuplets, before that was revised to octuplets and finally decuplets because two foetuses were hidden in the fallopian tubes.

“I am shocked by my pregnancy. It was tough at the beginning. I was sick. It was hard for me. It’s still tough but I am used to it now. I don’t feel the pain anymore, but it’s still a bit tough. I just pray for God to help me deliver all my children in a healthy condition, and for me and my children to come out alive. I would be pleased about it,” Sithole said.

At first, she was dubious when the doctors informed her she was pregnant with octuplets.

“I didn’t believe it. I doubted it. I was convinced that if it was more, it would be twins or triplets, not more than that. When the doctor told me, I took time to believe it. Even when I saw the scans I didn’t believe it. But, as time went by, I realised it was indeed true. I battled to sleep at night though.”

Sithole had worried a great deal about her unborn children.

“How would they fit in the womb? Would they survive? What if they came out conjoined at the head, in the stomachs or hands? Like, what would happen? I asked myself all these questions until the doctor assured me that my womb was starting to expand inside. God made a miracle and my children stayed in the womb without any complications.”

Tsotetsi, who is unemployed, also said he was shocked when he heard the news.

“I could not believe it. I felt like one of God’s chosen children. I felt blessed to be given these kinds of blessings when many people out there need children. It’s a miracle which I appreciate. I had to go do my own research on whether a person could really conceive eight children. It was a new thing. I knew about twins, triplets and even quadruplets,” Tsotetsi said.

“But after I found out that these things do happen, and saw my wife’s medical records, I got even more excited. I can’t wait to have them in my arms.”

Professor Dini Mawela, deputy head of the school of medicine at the Sefako Makgatho Health Sciences University, said Sithole’s case was rare and usually the result of fertility treatments. Because it was a “high risk” situation, the children will spend the next few months in an incubator, she said. Termed ‘grand multiparity‘, such pregnancies can be risky, and a pregnancy with 10 babies is of course unprecedented.  

“It’s quite a unique situation. I don’t know how often it happens. It’s extremely high risk (pregnancy). It’s a highly complex and high-risk situation. The danger is that, because there is not enough space in the womb for the children, the tendency is that they will be small. What would happen is that they would take them out pre-term because there is a risk if they keep them longer in there. The babies will come out small, chances of survival compromised. But all this depends on how long she carried them for.”

Source: IOL

Categories : General Interest Neurodegenerative DiseasesTags :

A Neurologist Confronts His Alzheimer’s Disease

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Image by valelopardo from Pixabay

Neurologist Daniel Gibbs, MD, PhD, related his experiences of having been diagnosed with Alzheimer’s disease and taking part in clinical trials of possible treatments for it.

“I’m fascinated by this disease that, for my entire career as a scientist and a neurologist, I could only observe from the outside,” Dr Gibbs wrote in his new book, A Tattoo on my Brain: A Neurologist’s Personal Battle against Alzheimer’s Disease. “Now I’ve got a front-row seat — or rather, I’m in the ring with the tiger.”

Dr Gibbs stumbled upon his diagnosis accidentally, when he and his wife tested their DNA to learn about their ancestry that he discovered he had two copies of the APOE4 allele, the most common genetic risk factor for Alzheimer’s disease.

Because he had an early diagnosis, Dr Gibbs has volunteered to participate in several Alzheimer’s clinical trials in recent years, including one for aducanumab, the controversial Alzheimer’s treatment the FDA is expected to decide upon in June.

During a trial of aducanumab, he developed a serious amyloid-related imaging abnormality (ARIA) involving both brain oedema and intracerebral haemorrhage, which he recovered from. Dr Gibbs went on to co-author a case report about the clinical course and treatment of his complication. In the wake of much controversy, aducanumab has today received FDA approval.

MedPage Today interviewed Dr Gibbs on his experiences and perspectives since his Alzheimer’s diagnosis.

Dr Gibbs said that “as a patient and as a neurologist” it is a coping mechanism which gives hime “a huge advantage” to be able to look at the disease through his two “masks”. “Looking at it from the neurologist scientist’s point of view is a lot less threatening and is intellectually very satisfying. I enjoy reading and writing about it,” he said.

Regarding his future, he said: “One of the messages I try to get across in the book is that you need to plan for the future while you are still cognitively intact, and make very clearly known what you want done when you’re unable to give instructions about your care. I’ve done that. My family knows, my doctor knows: I don’t want anything done if I can’t participate in making decisions.” 

Dr Gibbs said he was excited to volunteer for the aducanumab study partly because of the way aducanumab was discovered; a reverse-engineered antibody found in cognitively normal aged people. Another reason was the more aggressive nature of the trial. He explained the meaning of “tattoo on my brain” alluded to in the title of his book, an adverse effect of the experimental drug.

“For me, a ‘tattoo on my brain’ has two forms. In the ARIA — the amyloid-related imaging abnormality complication I had from aducanumab — there was both leakage of fluid causing swelling in my brain and leakage of blood, microhaemorrhages. Those went away, as did the swelling in my brain, but they left behind this haemosiderin, this iron-containing pigment which is not dissimilar to tattoo ink, if you will.

“I haven’t had a recent MRI scan, but at least the last one I looked at a year or two ago still showed those little dots of hemosiderin. In a literal sense, that is the tattoo on my brain. In the figurative sense, the tattoo is a symbol of a kind of coming out of the closet and showing something that you’re not ashamed of.” 

The book, he said, is about people with early disease and the children of people with Alzheimer’s disease because they’re at risk. The aim is to “loosen up the conversation” so that interventions such as lifestyle changes can take place.

He suspects that the first disease-modifying drugs will be effective in early stages, which are going to be really hard studies to do. Recruiting participants without cognitive impairment but the pathology of  of Alzheimer’s disease is extremely difficult.
Finally, he offered some advice on dealing with Alzheimer’s.

“What I would recommend is for everybody to start doing things that are good for them. A heart-healthy diet is good for you in so many ways. It’s hard to say that’s not a good idea, although we’re a country of hamburger-loving people. And exercise — I don’t know how you overcome that bar of convincing people if you want to be a healthy 70- or 80-year-old, you have to exercise and get a good diet. And good sleep.”

Source:MedPage Today

Categories : General Interest NeurologyTags :

Researchers Discover that Humans can Readily Develop Echolocation Ability

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Photo by Pawel Czerwinski on Unsplash

The ability for humans to sense their surrounding space with reflected sounds might sound like a superhero’s ability, but it is a skill that is developed by some blind people, who use clicks as a form of echolocation.

Echolocation is an ability known in dolphins, whales and bat species, which occurs when such animals emit a sound that reflects off objects in the environment, returning echoes that provide information about the surrounding space.

Existing research has shown that some blind people may use click-based echolocation to judge spaces and improve their navigation skills. Armed with this information, a team of researchers led by Dr Lore Thaler explored how people acquire this skill.

Over the course of a 10-week training programme, the team investigated how blindness and age affect learning of click-based echolocation. They also studied how learning this skill affects the daily lives of people who are blind.

Both blind and sighted people between 21 and 79 years of age participated in this study, which provided a training course of 10 weeks. Blind participants also took part in a 3-month follow up survey assessing how the training affected their daily life.

Both sighted and blind people improved considerably on all measures, and in some cases performed as well as expert echolocators did at the end of training. A surprising result was that a few sighted people even performed better than those who were blind.

However, neither age nor blindness limited participants’ rate of learning or in their ability to apply their echolocation skills to novel, untrained tasks.

Furthermore, in the follow up survey, all participants who were blind reported improved mobility, and 83% reported better independence and wellbeing.

Age or vision not a limitation

Overall, the results suggest that the ability to learn click-based echolocation is not strongly limited by age or level of vision. This has positive implications for the rehabilitation of people with vision loss or in the early stages of progressive vision loss.

Click-based echolocation is not presently taught as part of mobility training and rehabilitation for blind people. There is also the possibility that some people are reluctant to use click-based echolocation due to a perceived stigma around  the click sounds in social environments.

Despite this, the results indicate that both blind people who use echolocation and people new to echolocation are confident to use it in social situations, indicating that the perceived stigma is likely less than believed.

Source: Durham University

Journal information: Human click-based echolocation: Effects of blindness and age, and real-life implications in a 10-week training program, PLOS ONE (2021)

Categories : Gender General InterestTags :

Reviewing 50 Years of Progress in Women’s Health

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Woman receiving a mammogram. Photo by National Cancer Institute on Unsplash

As abortion comes under threat in the United States, a perspective article looks back at the progress made in women’s health, seeing significant improvements in areas like equitable access to health care and survivorship.

However, the article’s authors argue there is still a long road ahead, despite all of the progress.

The United States, for example, still has the highest rate of maternal death among high-income countries, particularly among African American women.

As the United States Supreme Court prepares to hear a Mississippi abortion case challenging the landmark 1973 Roe v. Wade decision, some experts are questioning whether the progress made in women’s health may be winding back.

Cynthia A Stuenkel, MD, clinical professor of medicine at University of California San Diego School of Medicine, and JoAnn E Manson, MD, DrPH, professor of epidemiology at Harvard TH Chan School Of Public Health, review 50 years of progress in women’s health in a perspective article published online in New England Journal of Medicine.

“Reproductive justice is broader than the pro-choice movement and encompasses equity and accessibility of reproductive health care, as well as enhanced pathways to parenthood,” wrote the authors.

In addition to Roe v. Wade, they authors reviewed advances in reproductive health including:

  • The 1972 US Supreme Court ruling on Eisenstadt vs Baird ensuring unmarried persons equal access to contraception
  • The 2010 Affordable Care Act in the US made contraceptives an insured preventive health benefit
  • The Reproductive technology advances, including in vitro fertilisation, genetic testing and fertility preservation by cancer specialists

Advances in women’s health encompass more than reproduction, the authors wrote. As interest and focus has expanded to all stages of a woman’s life, science has begun to catch up to the specialised needs of women and sex-specific risk factors for chronic diseases that disproportionately affect women’s health, such as autoimmune diseases, mental health, osteoporosis and coronary heart disease.

  • Progress in breast cancer care and prevention resulted in a five-year overall survival rate of 90%
  • The human papillomavirus (HPV) vaccine reduced cervical cancer mortality fell by 50%

“Moving forward, it will be essential to recognise and study intersectional health disparities, including disparities based on sex, race, ethnicity, gender identity, sexual orientation, income and disability status. Overcoming these challenges and addressing these inequities will contribute to improved health for everyone,” wrote the authors.

Source: News-Medical.Net

Journal information: Stuenkel, C. A., et al. (2021) Women’s Health — Traversing Medicine and Public Policy. New England Journal of Medicine. doi.org/10.1056/NEJMp2105292.

Categories : COVID General InterestTags :

French President Macron in SA for Talks on COVID

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French President Emmanuel Macron arrived in South Africa today for talks with President Cyril Ramaphosa on a range of issues including possible technological assistance to aid South Africa’s response to the COVID pandemic.

On the agenda of the visit is the economic, health, research and manufacturing responses to the COVID pandemic.

Arriving from Rwanda, where he acknowledged France’s role in the 1994 genocide, Macron held talks in Pretoria with President Ramaphosa, whom he met last week in Paris at a summit on African economies.

The pair were also due to attend an event to support vaccine production on the continent, sponsored by the European Union, the United States and the World Bank. 

So far South Africa is the country worst hit by COVID on the continent as far available monitoring can determine, and has vaccinated just 1 percent of its population of 59 million people.

South Africa’s immunisation efforts have been hampered by delayed procurement, and then selling off its AstraZeneca vaccines obtained via Covax to other African countries after trial results showed drastically reduced effectiveness against the local B.1.351 variant. Rollout of the replacement Johnson & Johnson vaccine was paused for two weeks in April due to blood clot fears.

Now, along with India, South Africa is campaigning for a waiver of intellectual property rights on COVID vaccines, so that each country may produce its own doses. This effort has met with stiff resistance so far.

Macron has voiced support for a technology transfer to enable vaccine production sites to be set up in poorer countries.

Visit long delayed

Macron’s visit to South Africa has been long delayed due to the COVID pandemic.
The initial purpose for the trip had been to discuss multilateral cooperation with South Africa, an important G20 partner which is also a regular guest at G7 summits.

According to Foreign Policy, the French leader will also seek to establish greater influence in a region that is experiencing greater instability, marked by recent insurgencies in Mozambique.   

Jihadist attacks forced French energy giant Total to suspend work on a multi-billion euro gas project in Cabo Delgado province after a nearby town was targeted.

Before he returns to France, he will pay a visit to the Nelson Mandela Foundation, whose main missions are the fight against AIDS and education in rural areas.

Source: RFI

Categories : General Interest Mental HealthTags :

Rough Night? Perhaps Skip the Coffee, Study Suggests

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Photo by Toa Heftiba on Unsplash

Depending on coffee to get through the day after a night of poor sleep isn’t always the answer, suggests a new study from Michigan State University.

Researchers from MSU’s Sleep and Learning Lab, led by psychology associate professor Kimberly Fenn, assessed the effectiveness of caffeine in counteracting the negative effects of sleep deprivation on cognition. It turned out that caffeine only helps up to a point.

The study assessed the impact of caffeine following a night of sleep deprivation. The study recruited over 275 participants who were asked to complete a simple attention task as well as a more challenging ‘placekeeping’ task where tasks had to be completed in a specific order without skipping or repeating steps.

Asst Prof Fenn’s study is the first to investigate the effect of caffeine on placekeeping after a period of sleep deprivation.

“We found that sleep deprivation impaired performance on both types of tasks and that having caffeine helped people successfully achieve the easier task,”  said Asst Prof Fenn. “However, it had little effect on performance on the placekeeping task for most participants.”

She added: “Caffeine may improve the ability to stay awake and attend to a task, but it doesn’t do much to prevent the sort of procedural errors that can cause things like medical mistakes and car accidents.”

The US population has a pervasive lack of sleep, a problem that has intensified during the pandemic, Asst Prof Fenn said. Having inadequated sleep impacts not only cognition and mood, but can eventually weaken immunity.

“Caffeine increases energy, reduces sleepiness and can even improve mood, but it absolutely does not replace a full night of sleep, Fenn said. “Although people may feel as if they can combat sleep deprivation with caffeine, their performance on higher-level tasks will likely still be impaired. This is one of the reasons why sleep deprivation can be so dangerous.”

Asst Prof Fenn said that the study has theoretical and practical implications.

“If we had found that caffeine significantly reduced procedural errors under conditions of sleep deprivation, this would have broad implications for individuals who must perform high stakes procedures with insufficient sleep, like surgeons, pilots and police officers,” she concluded. “Instead, our findings underscore the importance of prioritising sleep.”

The study can be found online.

Source: Michigan State University

Categories : COVID General InterestTags :

COVID Sniffer Dogs Have a 94% Sensitivity, Study Shows

On By ModernMedia
Image by Foto-Rabe from Pixabay

Quickly and efficiently screening incoming travellers for COVID is currently beyond present technology, but dogs — with their keen sense of smell that has aided humans for thousands of years — may be a solution.

An Ekurhuleni-based company is in the final stages of training dogs to be deployed as COVID sniffers at South African points of entry, just in time for the expected third wave, eNCA reports.

Currently, the most widespread test is the rapid antigen (lateral flow) test, which has been shown to produce more false positives for COVID than real detections in low prevalence situations — such as travellers arriving in a country.

Alternatively, the polymerase chain reaction (PCR) test has the greatest sensitivity but is time-consuming and expensive. And most currently available tests involve nasopharyngeal swabs — an unpleasant experience for most people. 

Dogs, with their keen sense of smell have long been used to sniff out drugs and explosives. In recent years they have also been trained to sniff out certain cancers and malaria, although they are not regularly used for this.
Using medical sniffer dogs has the advantage of being extremely quick and could be used in resource-constrained settings.

In the first months of the pandemic, many wondered whether dogs could in fact smell the disease, and began training dogs to see if it was possible. 
Past studies had already established that the volatile organic compounds (VOCs) released in body odour change during respiratory infections. VOCs associated with COVID infection showed a clear distinction between infected and uninfected individuals, suggestive of a strong, distinctive smell.

Initial trials with trained sniffer dogs at airports in France, Lebanon and FInland found that the dogs were even capable of detecting infection before it could be picked up with clinical tests.

A recent study led by the London School of Hygiene & Tropical Medicine (LSHTM) estimated that a plane with 300 passengers could be screened in 30 minutes with two sniffer dogs, and only those passengers identified by the dogs would be required to take a PCR test.

The study, which is not yet peer-reviewed and which is currently available as a pre-print, found that dogs could be trained to detect COVID in 94.3% (test sensitivity) — comparable to the gold standard of PCR tests with 97.2% sensitivity. They also have a specificity of 92%, meaning that they have a low rate of false positives.

Dr Claire Guest, Chief Scientific Officer at Medical Detection Dogs, which assisted in the study, said: “These fantastic results are further evidence that dogs are one of the most reliable biosensors for detecting the odour of human disease. Our robust study shows the huge potential for dogs to help in the fight against COVID.

“Knowing that we can harness the amazing power of a dog’s nose to detect COVID quickly and non-invasively gives us hope for a return to a more normal way of life through safer travel and access to public places, so that we can again socialise with family and friends.”

Besides simple detection, the dogs could also serve as a visible deterrent to people wanting to travel with fake COVID passports, the authors said.
The findings of their study also provided valuable knowledge which could be applied to future pandemics.
The authors acknowledged the limitation that the dogs were conducting the tests in a controlled environment as opposed to the real world.

Primary source: London School of Hygiene & Tropical Medicine

Secondary source: eNCA

Journal information: Pre-print available online