Publications by authors named "Ty Beal"

16 Publications

  • Page 1 of 1

Differences in modelled estimates of global dietary intake.

Lancet 2021 May;397(10286):1708-1709

Global Alliance for Improved Nutrition, Geneva, Switzerland.

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http://dx.doi.org/10.1016/S0140-6736(21)00714-5DOI Listing
May 2021

Affordability of nutritious foods for complementary feeding in South Asia.

Nutr Rev 2021 03;79(Suppl 1):52-68

United Nations Children's Fund, Regional Office for South Asia, Kathmandu, Nepal.

The high prevalence of stunting and micronutrient deficiencies among children in South Asia has lifelong health, educational, and economic consequences. For children aged 6-23 months, undernutrition is influenced by inadequate intake of complementary foods containing nutrients critical for growth and development. The affordability of nutrients lacking in young children's diets in Bangladesh, India, and Pakistan was assessed in this study. Using data from nutrient gap assessments and household surveys, household food expenditures were compared with the cost of purchasing foods that could fill nutrient gaps. In all 3 countries, there are multiple affordable sources of vitamin A (orange-fleshed vegetables, dark leafy greens, liver), vitamin B12 (liver, fish, milk), and folate (dark leafy greens, liver, legumes, okra); few affordable sources of iron and calcium (dark leafy greens); and no affordable sources of zinc. Affordability of animal-source protein varies, with several options in Pakistan (fish, chicken, eggs, beef) and India (fish, eggs, milk) but few in Bangladesh (eggs). Approaches to reduce prices, enhance household production, or increase incomes are needed to improve affordability.
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http://dx.doi.org/10.1093/nutrit/nuaa139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948078PMC
March 2021

Affordability of nutritious foods for complementary feeding in Eastern and Southern Africa.

Nutr Rev 2021 03;79(Suppl 1):35-51

United Nations Children's Fund, Regional Office for Eastern and Southern Africa, Nairobi, Kenya.

Low intake of diverse complementary foods causes critical nutrient gaps in the diets of young children. Inadequate nutrient intake in the first 2 years of life can lead to poor health, educational, and economic outcomes. In this study, the extent to which food affordability is a barrier to consumption of several nutrients critical for child growth and development was examined in Ethiopia, Mozambique, South Africa, Tanzania, Uganda, and Zambia. Drawing upon data from nutrient gap assessments, household surveys, and food composition tables, current consumption levels were assessed, the cost of purchasing key nutritious foods that could fill likely nutrient gaps was calculated, and these costs were compared with current household food expenditure. Vitamin A is affordable for most households (via dark leafy greens, orange-fleshed vegetables, and liver) but only a few foods (fish, legumes, dairy, dark leafy greens, liver) are affordable sources of iron, animal-source protein, or calcium, and only in some countries. Zinc is ubiquitously unaffordable. For unaffordable nutrients, approaches to reduce prices, enhance household production, or increase household resources for nutritious foods are needed.
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http://dx.doi.org/10.1093/nutrit/nuaa137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948081PMC
March 2021

Micronutrient gaps during the complementary feeding period in South Asia: A Comprehensive Nutrient Gap Assessment.

Nutr Rev 2021 03;79(Suppl 1):26-34

United Nations Children's Fund (UNICEF), New York, New York, USA.

Micronutrient malnutrition is a key driver of morbidity and mortality for millions of children in South Asia. Understanding the specific micronutrients lacking in the diet during the complementary feeding period is essential for addressing undernutrition caused by inadequate diets. A Comprehensive Nutrient Gap Assessment was used to synthesize diverse evidence and estimate the public health significance of complementary-feeding micronutrient gaps and identify evidence gaps in 8 countries in South Asia. There were important gaps across the region in iron, zinc, vitamin A, folate, vitamin B12, and, to a lesser extent, calcium and vitamin C. The most nutrient-dense, whole-food sources of these micronutrients include liver, small fish, eggs, ruminant meat, and dark leafy greens. Investment is needed in some countries to collect data on micronutrient biomarkers and dietary intakes. A food systems approach is essential for improving child diets and reducing malnutrition, which affects millions of children, their futures, and society at large across South Asia and beyond.
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http://dx.doi.org/10.1093/nutrit/nuaa144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947968PMC
March 2021

Micronutrient gaps during the complementary feeding period in 6 countries in Eastern and Southern Africa: a Comprehensive Nutrient Gap Assessment.

Nutr Rev 2021 03;79(Suppl 1):16-25

United Nations Children's Fund (UNICEF), New York, New York, USA.

Insufficient quantity and inadequate quality of foods in early life are key causes of all forms of malnutrition. Identification of nutrient and dietary gaps in the diets of infants and young children is essential to inform policies and programs designed to improve child diets. A Comprehensive Nutrient Gap Assessment was used to assess the public health significance of nutrient gaps during the complementary feeding period and to identify evidence gaps in 6 countries in Eastern and Southern Africa. Important gaps were identified in iron, vitamin A, zinc, and calcium and, to a lesser extent, vitamin B12 and folate. The best whole-food sources of these micronutrients available in part or all of the countries studied include beef liver, chicken liver, small dried fish, beef, and eggs. Investment is needed in many countries to collect data on micronutrient biomarkers and dietary intake. Strategic actions to improve child diets will require engagement and intervention across relevant systems to accelerate progress on improving the diets of infants and young children.
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http://dx.doi.org/10.1093/nutrit/nuaa142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947982PMC
March 2021

Comprehensive Nutrient Gap Assessment (CONGA): A method for identifying the public health significance of nutrient gaps.

Nutr Rev 2021 03;79(Suppl 1):4-15

Global Alliance for Improved Nutrition, London, UK.

Identifying dietary nutrient gaps and interpreting their public health significance are essential for improving poor diets and reducing malnutrition. Evidence indicative of the burden of nutrient deficiencies and inadequate nutrient intake or availability exists in many countries yet is often misinterpreted or underused in decision-making. Clear guidance is lacking on how to synthesize and interpret the relevant evidence, which comes in many forms. To fill this methodological gap, an approach called Comprehensive Nutrient Gap Assessment was created to enable use of existing evidence to assess the public health significance of nutrient gaps and identify evidence gaps. Comprehensive Nutrient Gap Assessment requires ≥ 2 experts in nutritional assessment but does not require primary data collection or secondary quantitative data analysis. It can be implemented relatively quickly with low costs, for specific countries and subnational regions, and updated on the basis of new data with minimal effort. The findings from a Comprehensive Nutrient Gap Assessment are easily interpretable by nontechnical decision makers yet include clear justification for technical audiences.
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http://dx.doi.org/10.1093/nutrit/nuaa140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947985PMC
March 2021

Eating behaviour of Indonesian adolescents: a systematic review of the literature.

Public Health Nutr 2021 Jun 10;24(S2):s84-s97. Epub 2020 Sep 10.

Global Alliance for Improved Nutrition (GAIN), Menara Palma, 7th floor, Suite 705, Jl. HR Rasuna Said Blok X-2 Kav.6, Jakarta12950, Indonesia.

Objectives: Global evidence has shown that behaviour acquired during adolescence often lasts into adulthood. Diet quality of and malnutrition in Indonesian adolescents is a neglected area of research. The current study reviews all studies related to eating behaviour in Indonesian adolescents to support evidence-based policy to improve diets.

Design: We searched electronic databases (six international and one local), from January 2000 to April 2018. The search terms used were (1) prevalence (prevalence OR number* OR case*, incidence OR survey), (2) adolescents (adolescen* OR school-age OR young adult), (3) Indonesia (Indonesia*) and (4) eating pattern (eat* OR fruit OR vegetable OR food recall OR food OR frequenc* OR consumption OR dietary intake). Articles were assessed against a critical appraisal tool.

Setting: Indonesia.

Participants: 10-19 years.

Results: We discovered 15 studies related to eating behaviour, 5 of which were secondary analyses of nationally representative surveys and one was a nationwide survey. Of the nine studies, one study was conducted in multiple cities, and the rest were conducted in a single city or smaller area. There were seven main topics from the included studies: nutrient adequacy, fruit and vegetable consumption, water and beverage intake, Na intake, breakfast habit, snacking frequency and western fast food consumption.

Conclusions: Adolescents consume inadequate amounts of protein, fruits and vegetables, and excessive amounts of Na and western fast food. Measures are needed to improve and motivate adolescents to adopt healthier eating patterns. Furthermore, there is a need to have one standard definition and measurement of eating behaviour in Indonesia.
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http://dx.doi.org/10.1017/S1368980020002876DOI Listing
June 2021

Child Overweight or Obesity Is Associated with Modifiable and Geographic Factors in Vietnam: Implications for Program Design and Targeting.

Nutrients 2020 May 1;12(5). Epub 2020 May 1.

Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.

Child overweight or obesity is increasing in most countries, including Vietnam. We sought to elucidate the drivers of child overweight or obesity in Vietnam and understand how they vary geographically. We compiled nationally representative cross-sectional data from the Vietnam Nutrition Surveillance Survey collected annually between 2012-2015 and household income data from the General Statistics Office. We used a quasi-Poisson log link function to calculate relative risks (RRs) of under-five child overweight or obesity for 13 variables and stratified analyses by child age (<2 y and 2-5 y) and region. Additional analysis included log-log linear regression to assess the relationship between average provincial monthly per capita income and child overweight or obesity. The strongest associations with child overweight or obesity included birthweight >4000 g (RR: 1.66; 95% confidence interval (CI): 1.48, 1.86), maternal body mass index (BMI) ≥27.5 compared with BMI <23 (RR: 1.62; 95% CI: 1.47, 1.78), and living in the Southeast (RR: 2.06; 95% CI: 1.84, 2.30), Mekong River Delta (RR: 1.58; 95% CI: 1.41, 1.77), or Central South (RR: 1.54; 95% CI: 1.37, 1.74) compared with the Central Highland. A 20% higher provincial average monthly per capita income was associated with a 17.4% higher prevalence in child overweight or obesity ( < 0.0001, Adjusted R = 0.36). High birthweight and maternal BMI were strongly associated with child overweight or obesity but are not likely primary drivers in Vietnam, given their low prevalence. C-section delivery, sedentary lifestyle, high maternal education, urbanicity, and high household income affect a large proportion of the population and are, therefore, important risk factors. Policies and programs should target these factors and regions at greatest risk of overweight or obesity, particularly the Southeast and Mekong River Delta.
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http://dx.doi.org/10.3390/nu12051286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282258PMC
May 2020

Global Landscape of Malnutrition in Infants and Young Children.

Nestle Nutr Inst Workshop Ser 2020 28;93:1-14. Epub 2020 Jan 28.

Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland.

Malnutrition during the first years of life has immediate adverse health consequences, including increased mortality risk, and impaired long-term health and capacities. Undernutrition is an important contributor to poor linear growth, stunting, which affects over 149 million children <5 years of age worldwide, one-third of whom live in India. Over 49 million children are wasted; yet globally, there are also 40 million overweight children. Up-to-date data on the magnitude and distribution of micronutrient malnutrition globally and in many countries are lacking. Anemia has been used as a proxy for micronutrient malnutrition; yet anemia, like stunting, has a complex etiology and numerous nonnutritional as well as nutritional causes. Undernutrition, specifically stunting, wasting, and micronutrient deficiency increasingly coexist with overweight, but accurate data to assess the extent to which these co-exist in countries, households, and individuals and the factors that predict it are scarce. Recent analyses in several countries suggest that there is substantial variability within and among regions in the prevalence and determinants of malnutrition. More and better data that can be used to tailor policies and programs to local contexts are urgently needed if we are to accelerate progress toward addressing malnutrition in all its forms.
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http://dx.doi.org/10.1159/000503315DOI Listing
June 2021

Uncertainties in the GBD 2017 estimates on diet and health.

Lancet 2019 11;394(10211):1801-1802

Global Alliance for Improved Nutrition, Programme Services, London, UK.

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http://dx.doi.org/10.1016/S0140-6736(19)32502-4DOI Listing
November 2019

Bottlenecks and predictors of coverage and adherence outcomes for a micronutrient powder program in Ethiopia.

Matern Child Nutr 2019 10;15(S5):e12807

Global Alliance for Improved Nutrition, Geneva, Switzerland.

A theory-driven evaluation was conducted to assess performance of a trial to deliver micronutrient powder (MNP) through the Ethiopian Ministry of Health. We adapted an approach to coverage assessment, originally developed to identify bottlenecks in health service delivery, to examine sequential program outcomes and their correlates using cross-sectional survey data of caregivers of children 6-23 months (N = 1915). Separate multivariable Poisson regression models were used to estimate adjusted risk ratios of conceptually relevant determinants of coverage and adherence. Caregivers of children >11 months were more likely to have received MNP than caregivers of younger infants, yet children 12-17 months were 32% (P < 0.001) and children 18-23 months 38% (P < 0.001) less likely to have been fed MNP in the 14 days preceding the survey than children 6-11 months. Among caregivers who initiated feeding MNP, the most frequently reported reasons for discontinuing use were not obtaining additional supply (36.1%) and perceived child rejection of food with MNP (22.9%). For each additional time a caregiver met with frontline workers in the 3 months preceding the survey, they were 13% more likely to have recently fed MNP (P < 0.001). Caregivers' perception that MNP produced positive changes in children was associated with a 14% increase in the likelihood of having recently fed it (P < 0.001). These results emphasize the importance of counselling for MNP and infant and young child feeding for initial use and the importance of multiple contacts with frontline workers for continued use.
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http://dx.doi.org/10.1111/mcn.12807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856804PMC
October 2019

Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-Food Consumption: A Meta-Analysis of Global School-Based Student Health Surveys.

Food Nutr Bull 2019 12 16;40(4):444-459. Epub 2019 Oct 16.

Global Alliance for Improved Nutrition, Geneva, Switzerland.

Background: Adolescence presents an opportunity to influence diet, which impacts present and future health outcomes, yet adolescent diets globally are poorly understood.

Objective: We generate evidence on adolescent diets globally and explore patterns and trends by subpopulation.

Methods: We estimated mean frequency of consumption and prevalence of less-than-daily fruit and vegetable consumption, at-least-daily carbonated beverage consumption, and at-least-weekly fast-food consumption among school-going adolescents aged primarily 12 to 17 years from the Global School-based Student Health Surveys in Africa, Asia, Oceania, and Latin America between 2008 and 2015. Random-effects meta-analysis was used to pool estimates globally and by subgroup.

Results: On average, adolescents consumed fruit 1.43 (95% confidence interval [CI] 1.26-1.60) times per day, vegetables 1.75 (1.58-1.92) times per day, carbonated soft drinks 0.99 (0.77-1.22) times per day, and fast food 1.05 (0.78-1.32) times per week. Overall, 34.5% (95% CI 29.4-39.7) consumed fruit less than once per day, 20.6% (15.8-25.9) consumed vegetables less than once per day, 42.8% (35.2-50.7) drank carbonated soft drinks at least once per day, and 46.1% (38.6-53.7) consumed fast food at least once per week. Mean daily frequency of fruit consumption was particularly low in South and East Asia (1.30 [1.02-1.58]); carbonated soft drink consumption high in Latin America (1.54 [1.31-1.78]), high-income countries (1.66 [1.29-2.03]), and modern food system typologies (1.44 [0.75-2.12]); and mean weekly fast food consumption high in mixed food system typologies (1.29 [0.88-1.71]).

Conclusions: School-going adolescents infrequently consume fruits and vegetables and frequently consume carbonated soft drinks, but there is wide variability by subpopulation.
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http://dx.doi.org/10.1177/0379572119848287DOI Listing
December 2019

Perspective: Challenges in Use of Adolescent Anthropometry for Understanding the Burden of Malnutrition.

Adv Nutr 2019 07;10(4):563-575

Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC.

Improving nutritional status during adolescence is an opportunity to improve the lives of this generation and the next. Estimating the burden of malnutrition at a population level is fundamental to targeting interventions and measuring progress over time, and for adolescents, we usually depend on survey data and the 2007 WHO Growth Reference to do so. There is substantial risk of misguided conclusions regarding adolescent prevalence estimates, however, when underlying methodological limitations of the indicators and reference are not adequately considered. We use national prevalence estimates among girls and young women 10-22 y of age from the 2014 State of Food Security and Nutrition in Bangladesh report as an example to demonstrate that determining the true prevalence of undernutrition, overweight, and obesity is complicated by racial/ethnic variation across populations in timing of the adolescent growth spurt, growth potential, and body build. Further challenging the task are inherent limitations of the body mass index as an indicator of thinness and adiposity, and cutoffs that poorly distinguish a well-nourished population from a malnourished one. We provide recommendations for adolescent nutrition policy and program decision-making, emphasizing the importance of 1) critically interpreting indicators and distributions by age when using the 2007 WHO Growth Reference; 2) examining what is happening before and after adolescence, when interpretation of anthropometry is more straightforward, as well as trends over time; and 3) complementing anthropometry with other information, particularly dietary intake. Finally, we advocate that nutrition researchers prioritize exploration of better methods to predict peak height velocity, for development of standardized indicators to measure dietary quality among adolescents, and for studies that will illuminate causal paths so that we can effectively improve adolescent dietary intake and nutritional status.
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http://dx.doi.org/10.1093/advances/nmy133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628942PMC
July 2019

Child stunting is associated with child, maternal, and environmental factors in Vietnam.

Matern Child Nutr 2019 10 2;15(4):e12826. Epub 2019 May 2.

Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan.

Child stunting in Vietnam has reduced substantially since the turn of the century but has remained relatively high for several years. We analysed data on children 6-59 months (n = 85,932) from the Vietnam Nutritional Surveillance System, a nationally representative cross-sectional survey. Multivariable Poisson regression models were used to estimate relative risk (RR) of stunting, stratified by child age and ecological region. Covariates at the child, maternal, household, and environmental levels were included based on available data and the World Health Organization conceptual framework on child stunting. Among children 6-23 months, the strongest associations with child stunting were child age in years (RR: 2.49; 95% CI [2.26, 2.73]), maternal height < 145 cm compared with ≥150 cm (RR: 2.04; 95% CI [1.85, 2.26]), living in the Northeast compared with the Southeast (RR: 2.01; 95% CI [1.69, 2.39]), no maternal education compared with a graduate education (RR: 1.77; 95% CI, [1.44, 2.16]), and birthweight < 2,500 g (RR: 1.75; 95% CI [1.55, 1.98]). For children 24-59 months, the strongest associations with child stunting were no maternal education compared with a graduate education (RR: 2.07; 95% CI [1.79, 2.40]), living in the Northeast compared with the Southeast (RR: 1.94; 95% CI [1.74, 2.16]), and maternal height < 145 cm compared with ≥150 cm (RR: 1.81; 95% CI [1.69, 1.94]). Targeted approaches that address the strongest stunting determinants among vulnerable populations are needed and discussed. Multifaceted approaches outside the health sector are also needed to reduce inequalities in socioeconomic status.
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http://dx.doi.org/10.1111/mcn.12826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859968PMC
October 2019

A review of child stunting determinants in Indonesia.

Matern Child Nutr 2018 10 17;14(4):e12617. Epub 2018 May 17.

Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland.

Child stunting reduction is the first of 6 goals in the Global Nutrition Targets for 2025 and a key indicator in the second Sustainable Development Goal of Zero Hunger. The prevalence of child stunting in Indonesia has remained high over the past decade, and at the national level is approximately 37%. It is unclear whether current approaches to reduce child stunting align with the scientific evidence in Indonesia. We use the World Health Organization conceptual framework on child stunting to review the available literature and identify what has been studied and can be concluded about the determinants of child stunting in Indonesia and where data gaps remain. Consistent evidence suggests nonexclusive breastfeeding for the first 6 months, low household socio-economic status, premature birth, short birth length, and low maternal height and education are particularly important child stunting determinants in Indonesia. Children from households with both unimproved latrines and untreated drinking water are also at increased risk. Community and societal factors-particularly, poor access to health care and living in rural areas-have been repeatedly associated with child stunting. Published studies are lacking on how education; society and culture; agriculture and food systems; and water, sanitation, and the environment contribute to child stunting. This comprehensive synthesis of the available evidence on child stunting determinants in Indonesia outlines who are the most vulnerable to stunting, which interventions have been most successful, and what new research is needed to fill knowledge gaps.
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http://dx.doi.org/10.1111/mcn.12617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175423PMC
October 2018

Global trends in dietary micronutrient supplies and estimated prevalence of inadequate intakes.

PLoS One 2017 11;12(4):e0175554. Epub 2017 Apr 11.

Department of Environmental Science and Policy, University of California Davis, Davis, California, United States of America.

Understanding dietary patterns is vital to reducing the number of people experiencing hunger (about 795 million), micronutrient deficiencies (2 billion), and overweight or obesity (2.1 billion). We characterize global trends in dietary quality by estimating micronutrient density of the food supply, prevalence of inadequate intake of 14 micronutrients, and average prevalence of inadequate intake of these micronutrients for all countries between 1961 and 2011. Over this 50-year period, the estimated prevalence of inadequate intakes of micronutrients has declined in all regions due to increased total production of food and/or micronutrient density. This decline has been particularly strong in East and Southeast Asia and weaker in South Asia and sub-Saharan Africa. Sub-Saharan Africa is the only region where dietary micronutrient density has declined over this 50-year period. At the global level, micronutrients with the lowest levels of adequate estimated intake are calcium, iron, vitamin A, and zinc, but there are strong differences between countries and regions. Fortification has reduced the estimated prevalence of inadequate micronutrient intakes in all low-income regions, except South Asia. The food supply in many countries is still far below energy requirements, which suggests a need to increase the availability and accessibility of nutritious foods. Countries where the food energy supply is adequate show a very large variation in dietary quality, and in many of these countries people would benefit from more diverse diets with a greater proportion of micronutrient-dense foods. Dietary quality can be improved through fortification, biofortification, and agricultural diversification, as well as efforts to improve access to and use of micronutrient-dense foods and nutritional knowledge. Reducing poverty and increasing education, especially of women, are integral to sustainably addressing malnutrition.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175554PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388500PMC
September 2017
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