Southern African Journal of Gynaecological Oncology最新文献

{"title":"Retrospective review of 37.4 Gy in 11 fractions for the palliation of advanced cervical cancer","authors":"Andriani K Morphis, H. Napo, G. Joubert","doi":"10.1080/20742835.2021.1991099","DOIUrl":"https://doi.org/10.1080/20742835.2021.1991099","url":null,"abstract":"Background Bleeding, pain and discharge are common symptoms of cervical cancer that can be effectively palliated with radiotherapy. Aim To evaluate the effectiveness of an external beam radiotherapy dose of 37.4 Gy in 11 fractions for the local palliation of advanced cervical cancer. Methods This study is a retrospective review of all patients receiving palliative radiotherapy (37.4 Gy in 11 fractions) at the Department of Oncology, Universitas Hospital, Bloemfontein South Africa, from 2009 to 2013. The data from 324 cases were analysed. Data obtained included patient age, ECOG performance status, FIGO staging, histological type and grade, HIV status and CD4 count. The presence of renal impairment and patient-reported symptoms before and after treatment, as well as the duration of therapy, was also documented. The five-year overall survival was determined from available follow-up data. Results The majority of patients (50.9%) were between 40 and 59 years of age, 138 (42.6%) were HIV-positive and most patients presented with FIGO stage 4 disease 228 (70.4%). Squamous cell carcinoma (SCC) was the most frequent histological type (n = 292; 90.4%). Tumour grade was well differentiated in 16 (4.9%) patients, moderately differentiated in 171 (52.8%) cases and poorly differentiated in 113 (34.9%). Most patients reported relief of symptoms one month post-treatment: 76.6% of patients reported improvement of pain, while bleeding and discharge had resolved in 99.5% and 79.3% of patients, respectively. Similar observations were noted at 3-, 6- and 12-month follow-up. Morphine analgesia was required in less than 10% of patients over the 12 month follow-up period. Of the initial cohort, 11 (3.4%) patients were still alive five years after completing palliative radiotherapy.","PeriodicalId":41638,"journal":{"name":"Southern African Journal of Gynaecological Oncology","volume":"13 1","pages":"36 - 41"},"PeriodicalIF":0.3,"publicationDate":"2021-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42392236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges managing women with suspected Lynch Syndrome in Zimbabwe: a case report","authors":"Kotti-Emily Mukucha, Marshall T Manase, C. Muronda, J. Whittaker, B. Guzha","doi":"10.1080/20742835.2021.1991100","DOIUrl":"https://doi.org/10.1080/20742835.2021.1991100","url":null,"abstract":"Lynch Syndrome (LS) is associated with a genetic predisposition to colorectal, endometrial and multiple extracolonic cancers. The lifetime risk of developing endometrial and ovarian cancers is 40–62% and 4–12% respectively. The case is presented of a 56-year-old woman with a prior history of colorectal cancer who later developed endometrial carcinoma. Tumour immunohistochemistry showed microsatellite instability (MSI)-high, which is observed in 90% of LS-associated carcinomas. Germline molecular testing to confirm the diagnosis is not available in Zimbabwe. Her case is discussed together with the difficulties associated with the management of patients in Zimbabwe suspected to have LS.","PeriodicalId":41638,"journal":{"name":"Southern African Journal of Gynaecological Oncology","volume":"13 1","pages":"42 - 44"},"PeriodicalIF":0.3,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42272366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective study comparing the efficiency of recurrent LSIL cytology to high-grade cytology as predictors of high-grade cervical intraepithelial neoplasia or worse (CIN2+)","authors":"R. Suleman, M. Botha","doi":"10.1080/20742835.2021.1962020","DOIUrl":"https://doi.org/10.1080/20742835.2021.1962020","url":null,"abstract":"Background Cervical cancer (CC) is one of the most preventable cancers; however, it is the leading cause of cancer-related female deaths in South Africa. This study aimed to compare the efficiency of recurrent low-grade squamous intraepithelial lesion (LSIL) cytology as criteria to predict CIN2+ incidence, to a single initial high-grade squamous intraepithelial lesion (HSIL) cytology. Methods A retrospective cohort study comprising 344 women was conducted from January 2014 to December 2018 at the Colposcopy Clinic, Tygerberg Hospital. The women were categorised into two groups: (1) women with a recurrent LSIL cytology result, with recurrent cytology scheduled within 6–12 months; (2) women diagnosed with a single initial HSIL cytology result. The outcome was dichotomised into (1) normal or cervical intraepithelial neoplasia 1 (<CIN2) and (2) cervical intraepithelial neoplasia 2/3 or CC (CIN2+). Pearson’s chi-square test (X2) and Fisher’s exact test were used to assess any association between the patient-related factors considered and CIN2+ incidence. Results The sensitivity, specificity, PPV and NPV for referral HSIL cytology was 72.73% (95% CI 65.96–78.80), 79.10% (95% CI 71.24–85.64), 83.72% (95% CI 78.54–87.85) and 66.25% (95% CI 60.61–71.46), respectively. HIV status (p = 0.012) and ARV treatment (p = 0.015) were found to have statistically significant associations with CIN2+ incidence. Conclusions A single initial HSIL result is a more efficient predictor of CIN2+ incidence compared with a recurrent LSIL cytology result. The HIV-negative women were more accurately identified as CIN2+, compared with HIV-positive women. Women not on ARV treatment were more accurately identified as <CIN2+, compared with women on ARV treatment.","PeriodicalId":41638,"journal":{"name":"Southern African Journal of Gynaecological Oncology","volume":"13 1","pages":"18 - 25"},"PeriodicalIF":0.3,"publicationDate":"2021-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44949282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective study of the epidemiology and histological subtypes of ovarian epithelial neoplasms at Charlotte Maxeke Johannesburg Academic Hospital","authors":"Lusela Pillay, R. Wadee","doi":"10.1080/20742835.2021.1962084","DOIUrl":"https://doi.org/10.1080/20742835.2021.1962084","url":null,"abstract":"Background Epithelial ovarian neoplasms constitute the majority of ovarian tumours and are the most common malignant ovarian neoplasm. They are the eighth leading cause of cancer deaths worldwide. This study evaluated the epidemiology and histological subtypes of epithelial ovarian neoplasms at a single institution. Methods This retrospective, quantitative analysis evaluated 123 epithelial ovarian neoplasms between 2013 and 2017 and classified them according to age, biological behaviour and histological subtype. Results Of 123 cases, 64 (52.0%), tumours were benign, 30 (24.4%) were borderline and 29 (23.6%) tumours were malignant. Serous cystadenoma was the most common benign tumour (42.2%). Mucinous borderline tumours were the most common borderline neoplasm (50.0%). High-grade serous carcinoma was the most common carcinoma (58.6%). Patients presented at an older age with borderline tumours and malignant tumours, compared with patients with benign tumours. Conclusion The current study demonstrated that serous tumours were the most common type of benign and malignant tumours whilst mucinous neoplasms were the commonest subtype of borderline tumours. These findings are congruent with multiple similar studies. A higher number of borderline tumours were seen in this cohort in comparison with previous studies. This suggests a need for additional sampling of borderline tumours, over and above the international standard, in our population, to definitively exclude invasive malignancy. This study also demonstrated the histological progression of benign serous and mucinous tumours to borderline tumours and low-grade serous carcinoma and mucinous carcinoma, respectively, which supports the stepwise tumour progression model of these tumours.","PeriodicalId":41638,"journal":{"name":"Southern African Journal of Gynaecological Oncology","volume":"13 1","pages":"26 - 35"},"PeriodicalIF":0.3,"publicationDate":"2021-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46675346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic inguinal lymph node dissection in carcinoma of the vulva: experience and intermediate results at one institution","authors":"Setheme Daniel Mosehle, F. Guidozzi","doi":"10.1080/20742835.2021.1912274","DOIUrl":"https://doi.org/10.1080/20742835.2021.1912274","url":null,"abstract":"Objective: The goal of the study was to assess the feasibility of Laparoscopic Minimally Invasive Inguinal Lymph Node Dissection (L-MILND) for carcinoma of the vulva where sentinel lymph node biopsy could not be done. Laparoscopic Minimally Invasive Inguinal Lymph Node Dissection (L-MILND) is a procedure developed to decrease morbidity associated with inguinal lymphadenectomy while maintaining acceptable oncological outcomes. Initial experience and feasibility of this technique at the authors’ institution is reported. Setting: Dr George Mukhari Academic Hospital/Sefako Makgatho Health Sciences University. Patients: Sixteen L-MILND performed in nine patients with T1b squamous cell carcinoma of the vulva from May 2016 to April 2020. This is a retrospective analysis of the preoperative, intraoperative and postoperative characteristics. Results: The median age was 40 years (37–71 years). L-MILND’s median duration and the radical wide local excision was 223 ± 40 minutes (180 to 300 minutes). There were no intraoperative complications. The mean drain output per patient of both inguinal areas was 315 ml (50–990 ml). On average, drains were removed on day 6 (range 3–10 days). The mean number of nodes harvested was 5 (range 0–32 nodes). One patient had 1 positive node out of 32 harvested. The postoperative complications included: lymphoedema (1 groin, 6.25%), seroma (6 groins, 37.5%) and lymphorrhea (4 groins, 25.0%). Overall follow-up has been 3–50 (mean 28.3 months) months, and all patients were alive with no disease. Conclusion: The significant advantage of L-MILND appears to be the low rate of inguinal wound complications that may be associated with open procedures. This nevertheless comes at the expense of long operative times and seroma formation. This procedure is feasible and safe, though there is a need for large prospective studies with extended follow-up.","PeriodicalId":41638,"journal":{"name":"Southern African Journal of Gynaecological Oncology","volume":"13 1","pages":"11 - 17"},"PeriodicalIF":0.3,"publicationDate":"2021-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20742835.2021.1912274","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46745027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of microscopic haematuria can reduce the need for staging cystoscopy to exclude invasion of the urinary bladder by cervical carcinoma","authors":"L. Vlok, S. Wessels, K. Du Toit, A. van der Merwe","doi":"10.1080/20742835.2021.1908674","DOIUrl":"https://doi.org/10.1080/20742835.2021.1908674","url":null,"abstract":"Introduction Previous literature indicates that the detection of haematuria on urine microscopy, to exclude bladder invasion by cervical cancer, has a high specificity. It also aids the evaluation of whether a patient needs a staging cystoscopy or not. The purpose of this study was to replicate these findings, and also to determine whether a urinary dipstick test for microscopic haematuria can be used as a screening test to identify bladder invasion by cervical cancer. Methods A prospective observational study was conducted from January 2015 until December 2016 at a tertiary referral centre. It included all patients with newly diagnosed stage 2 or higher cervical cancer who received a staging cystoscopy at the authors’ institution. Urine was collected by means of catheterisation and sent for urinary dipstick test and urine microscopy. Microscopy results were compared with cystoscopy findings. Results Urinary dipstick testing for microscopic haematuria was performed on 143 patients. The sensitivity of the test was 1 and the specificity was 0.85. The negative predictive value was 1 and the positive predictive value was 0.5. With urine microscopy for haematuria, if more than 10 000 erythrocytes per millilitre was used for defining microscopic haematuria, the sensitivity was 1, the specificity 0.8, the positive predictive value 0.43 and the negative predictive value 1. Conclusion The presence of microhaematuria can be used as a screening test to predict possible invasion of the urinary bladder by cervical cancer, and can thus be used to identify patients needing cystoscopy. Urine dipstick testing (Bayer Multix 10SG dipstick) provided statistically similar results to urine microscopy (if >10 000 erythrocytes equates microhaematuria) to identify patients needing cystoscopy.","PeriodicalId":41638,"journal":{"name":"Southern African Journal of Gynaecological Oncology","volume":"13 1","pages":"7 - 10"},"PeriodicalIF":0.3,"publicationDate":"2021-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20742835.2021.1908674","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47969226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BRAF testing in a South African cohort of MLH1 deficient endometrial carcinomas: lessons learnt","authors":"R. Wadee, W. Grayson","doi":"10.1080/20742835.2021.1884348","DOIUrl":"https://doi.org/10.1080/20742835.2021.1884348","url":null,"abstract":"Introduction Endometrial carcinomas are common female genital tract malignancies. Western countries identified BRAF mutations in very few endometrial carcinomas, whilst an Eastern study documented mutations in one-fifth of endometrial carcinomas. We aimed to assess BRAF mutations in an ethnically mixed South African patient population using immunohistochemistry (IHC), polymerase chain reaction (PCR) and Sanger sequencing in relation to MLH1 methylation. Methods A total of 145 endometrioid endometrial carcinoma cases were retrieved from departmental archives and underwent MLH1, MSH2, MSH6 and PMS2 IHC testing. The 37 cases that showed MLH1 loss underwent BRAF IHC, PCR and Sanger sequencing. Results Six out of 37 cases demonstrated BRAF mutations: 4 were identified by PCR, whilst IHC and Sanger sequencing identified one mutation each. Three PCR mutations were at the V600E codon, whilst 1 case had a V600D mutation. Agreement between IHC versus overall BRAF mutational status, and sequencing versus overall mutational status, was 86.49% (p-value < 0.005). There was agreement of 94.59% between PCR and overall mutational status with statistically significant, moderate non-random concordance (kappa = 0.77, p = 0.0001). Discussion BRAF mutations were identified in 16.21% of cases, which is higher than frequencies noted in Western studies, but less than in an Eastern study. There was no association between MLH1 methylation and BRAF status in endometrial carcinomas from our patient population (kappa = −0.0223, p = 0.6649). Our results in endometrial carcinomas, similar to findings from Western studies, indicate that BRAF mutations are not beneficial in distinguishing which patients have spontaneously occurring tumours from those who may harbour germline mutations and are suspected of having Lynch syndrome.","PeriodicalId":41638,"journal":{"name":"Southern African Journal of Gynaecological Oncology","volume":"13 1","pages":"1 - 6"},"PeriodicalIF":0.3,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20742835.2021.1884348","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44182266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cohort study of treatment outcomes after radiotherapy in vulva carcinoma patients","authors":"T. Goba-Mjwara, H. Simonds","doi":"10.1080/20742835.2020.1855748","DOIUrl":"https://doi.org/10.1080/20742835.2020.1855748","url":null,"abstract":"Background Carcinoma of the vulva is an uncommon tumour. For locally advanced vulval cancer with proximity to the urethra or anal margin, surgery often involves exenteration with colostomy or urinary diversion, which results in significant physical and psychological morbidity. The use of neoadjuvant or primary chemoradiation is an acceptable treatment option for those patients deemed unsuitable for primary surgery in advance. In addition, if the patient has poor locoregional control this has a significant impact on quality of life following treatment. This study aimed to evaluate radiotherapy curative and palliative treatment outcomes for patients in a single institution. Methods A quantitative retrospective cohort analysis of all women diagnosed with vulval cancer managed in a single institution was undertaken. Eligible patients included patients with vulval carcinoma referred for radiotherapy (RT)—primary, adjuvant and palliative. Demographic and clinical data, treatment time and radiotherapy fractionation were noted. The primary end-points were local control (LC) and overall survival (OS). Results Forty-two patients were referred during the study period. Among the 33 evaluable patients, all patients completed treatment. At 12 months’ follow-up, 20 women were alive (4 with evidence of recurrent/persistent disease) and 13 had died (4 with documented recurrent disease). At the time of data analysis, 22 patients received curative treatment: definitive chemoradiation or radiation alone (n = 17) or adjuvant RT (n = 5). Of the 22 patients, 11 were in remission, 8 had been lost to follow-up, and 3 had documented local recurrence. In total, 11 patients received palliative treatment. The overall survival at 12 months for the patients who received primary surgery followed by adjuvant radiotherapy was 100%. There was, however, no significant difference between the survival for the definitive CRT/RT (57.5%) and the high-dose palliative RT (49.1%) groups. However, the dose of radiotherapy was significant; women who received a total dose of radiotherapy greater than 60 Gy had improved local control compared with those who received a total dose of less than 45 Gy. Conclusion Surgery followed by adjuvant treatment had a superior overall survival outcome compared with definitive chemoradiation or radiotherapy alone in this small cohort, reflecting poorer outcomes for advanced disease.","PeriodicalId":41638,"journal":{"name":"Southern African Journal of Gynaecological Oncology","volume":"12 1","pages":"27 - 31"},"PeriodicalIF":0.3,"publicationDate":"2020-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20742835.2020.1855748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48057405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary ovarian neuroendocrine tumour arising in a benign mature cystic teratoma: a case report and literature review","authors":"R. Wadee, I. Beavon, Trudy Smith, L. Mbodi","doi":"10.1080/20742835.2020.1832776","DOIUrl":"https://doi.org/10.1080/20742835.2020.1832776","url":null,"abstract":"Abstract Primary ovarian neuroendocrine tumours are very uncommon tumours. Herein, we describe a case of 27-year-old female who presented with abdominal pain and an ovarian mass, for which she underwent a right salpingo-oophorectomy. Histopathological evaluation confirmed a right-sided primary ovarian neuroendocrine tumour occurring in a benign mature cystic teratoma. The patient has not undergone any additional therapy and is currently well. This case illustrates the need for thorough clinicopathological correlation together with adequate sampling to ensure accurate diagnosis and timeous management of the patient.","PeriodicalId":41638,"journal":{"name":"Southern African Journal of Gynaecological Oncology","volume":"12 1","pages":"23 - 26"},"PeriodicalIF":0.3,"publicationDate":"2020-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20742835.2020.1832776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41843220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of vulvar carcinoma at Groote Schuur hospital for the period 2002 to 2012 with particular emphasis on HPV-related disease","authors":"Francisca E Loggenberg, T. Adams","doi":"10.1080/20742835.2020.1763032","DOIUrl":"https://doi.org/10.1080/20742835.2020.1763032","url":null,"abstract":"Background: Vulvar carcinoma is rare and ranks fourth amongst the gynaecological malignancies. GLOBOCAN reported 44 235 new cases in 2018. There has been a rise in the number of cases of vulvar carcinoma in recent years and younger women are being affected by the disease. This rise is thought to be the result of more women being infected with human papilloma virus (HPV). HPV has been implicated in one of the pathways leading to the development of vulvar carcinoma. This study aims to review the cases of vulvar carcinoma at Groote Schuur Hospital and places particular emphasis on HPV-related disease. Methods: The study is a retrospective descriptive study of patients with vulvar carcinoma at Groote Schuur Hospital for the period 2002 to 2012. The study population included women with vulvar carcinoma who attended the multidisciplinary combined cancer clinic. Data were collected from folder reviews and an existing cancer database. Data were entered into data collection sheets that recorded patient demographics, disease aetiology, HIV status, treatment received, recurrences and multifocal disease. The analysis was performed using the R computing environment (RStudio Version 1.1.463) and MS Excel version 1808. Estimates of patient survival were computed using the Kaplan–Meier estimator. Results: There were 125 cases included in the study for the period 2002–2012. Data analysis revealed that 119 (95.2%) of the cases were squamous cell carcinomas. Among the squamous cell cancers, 98 (82.4%) had evidence of HPV disease, 18 (15.1%) occurred in patients with lichen sclerosus and 3 (2.5%) of patients had dual pathology. The mean age of the patients was 54.76 (SD 16.59) years. The youngest patient was 21 and the oldest 92 years of age. Of the 125 patients, 101 patients had clinical or histological evidence of HPV disease. In 76 patients (60.8%) the HIV status was known, of whom 75% were HIV negative and 25% HIV positive. Multifocal disease was present in 38.6% of the patients. Conclusion: This study revealed that there is a high burden of HPV-related disease at this centre, with younger women being affected by the disease. Patients are developing invasive disease despite their HIV status.","PeriodicalId":41638,"journal":{"name":"Southern African Journal of Gynaecological Oncology","volume":"12 1","pages":"17 - 22"},"PeriodicalIF":0.3,"publicationDate":"2020-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20742835.2020.1763032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43953306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}