Loading…
Serological and Epidemiological Analysis of an Outbreak of Gastroenteritis Among Military Recruits in Germany Caused by Cryptosporidium parvum
Background: Cryptosporidium spp. cause enteritic disease worldwide. Besides those patients with an impaired immune system, the general population is also at risk. Patients and Methods: Stool samples from participants of a military field exercise were tested for enteritic pathogens and sera were anal...
Saved in:
| Published in: | Infection 2008-10, Vol.36 (5), p.450-457 |
|---|---|
| Main Authors: | , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c400t-32ddc251b7639ffc34368a34385684edde8fea8a5bfb15c5f67140f61164a6173 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c400t-32ddc251b7639ffc34368a34385684edde8fea8a5bfb15c5f67140f61164a6173 |
| container_end_page | 457 |
| container_issue | 5 |
| container_start_page | 450 |
| container_title | Infection |
| container_volume | 36 |
| creator | Brockmann, S. O. Dreweck, C. Wagner-Wiening, C. Hagen, R. M. Kimmig, P. Petry, F. Jakobi, V. |
| description | Background:
Cryptosporidium
spp. cause enteritic disease worldwide. Besides those patients with an impaired immune system, the general population is also at risk.
Patients and Methods:
Stool samples from participants of a military field exercise were tested for enteritic pathogens and sera were analyzed for
Cryptosporidium
-antibodies. All participants received a questionnaire for assessing possible risk factors.
Results:
After a 5-day field training, 201 of a total of 450 soldiers (45%) developed acute gastroenteritis. Immediate microbiological analysis ruled out enteropathogenic bacteria and viruses as the cause of the disease. Only after hospitalization of one of the patients diagnostic procedures were expanded to the identification of parasites and
Cryptosporidium parvum
was identified. In addition, 14 fecal samples of 217 specimens were subsequently identified in a
Cryptosporidium
antigen ELISA. A serological analysis of 214 sera revealed 72% positive for specific IgG antibodies compared with 17% of a control group of soldiers who had not participated in the field training (relative risk 3.38; 95% CI 2.39–4.77; p < 0.001). Analysis of specific IgM levels was less conclusive. Epidemiological analysis of questionnaires correlated drinking of tap water, or consumption of various meals with gastroenteritis. However, the source of contamination could not be identified.
Conclusion:
Cryptosporidium
spp. can cause acute enteritis even in healthy, young adults as demonstrated by this outbreak. Using serological methods, the extent of the outbreak could be estimated in a retrospective analysis. |
| doi_str_mv | 10.1007/s15010-008-7317-7 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69805243</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1597886411</sourcerecordid><originalsourceid>FETCH-LOGICAL-c400t-32ddc251b7639ffc34368a34385684edde8fea8a5bfb15c5f67140f61164a6173</originalsourceid><addsrcrecordid>eNqFkd-K1DAUxoMo7rj6AN5I8MK76jlN86eXw7COwi4Lu3pd0iYZsrZNTVphXsJnNmUGFwTZm5zknN_5At9HyFuEjwggPyXkgFAAqEIylIV8RjZYsbqAWrLnZAMMoFBYigvyKqUHAOB1JV-SC1SyRsXUhvy-tzH04eA73VM9Gno1eWMH_7e3HXV_TD7R4PKc3i5zG63-sT73Os0x2HG20c-Z2A5hPNAb3_tZxyO9s11c_JyoH-nexkGPR7rTS7KGtvkWj9Mc0hSiN34Z6KTjr2V4TV443Sf75lwvyffPV992X4rr2_3X3fa66CqAuWClMV3JsZWC1c51rGJC6XwqLlRljbHKWa00b12LvONOSKzACURRaYGSXZIPJ90php-LTXMz-NTZvtejDUtqRK2AlxV7EiyzpwL4qvj-H_AhLDGblxnkAhlTKkN4groYUorWNVP0QzarQWjWSJtTpE2OtFkjbVbhd2fhpR2sedw4Z5iB8gSkPBoPNj7-_H_VP7birc0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>215613388</pqid></control><display><type>article</type><title>Serological and Epidemiological Analysis of an Outbreak of Gastroenteritis Among Military Recruits in Germany Caused by Cryptosporidium parvum</title><source>Springer Nature</source><creator>Brockmann, S. O. ; Dreweck, C. ; Wagner-Wiening, C. ; Hagen, R. M. ; Kimmig, P. ; Petry, F. ; Jakobi, V.</creator><creatorcontrib>Brockmann, S. O. ; Dreweck, C. ; Wagner-Wiening, C. ; Hagen, R. M. ; Kimmig, P. ; Petry, F. ; Jakobi, V.</creatorcontrib><description>Background:
Cryptosporidium
spp. cause enteritic disease worldwide. Besides those patients with an impaired immune system, the general population is also at risk.
Patients and Methods:
Stool samples from participants of a military field exercise were tested for enteritic pathogens and sera were analyzed for
Cryptosporidium
-antibodies. All participants received a questionnaire for assessing possible risk factors.
Results:
After a 5-day field training, 201 of a total of 450 soldiers (45%) developed acute gastroenteritis. Immediate microbiological analysis ruled out enteropathogenic bacteria and viruses as the cause of the disease. Only after hospitalization of one of the patients diagnostic procedures were expanded to the identification of parasites and
Cryptosporidium parvum
was identified. In addition, 14 fecal samples of 217 specimens were subsequently identified in a
Cryptosporidium
antigen ELISA. A serological analysis of 214 sera revealed 72% positive for specific IgG antibodies compared with 17% of a control group of soldiers who had not participated in the field training (relative risk 3.38; 95% CI 2.39–4.77; p < 0.001). Analysis of specific IgM levels was less conclusive. Epidemiological analysis of questionnaires correlated drinking of tap water, or consumption of various meals with gastroenteritis. However, the source of contamination could not be identified.
Conclusion:
Cryptosporidium
spp. can cause acute enteritis even in healthy, young adults as demonstrated by this outbreak. Using serological methods, the extent of the outbreak could be estimated in a retrospective analysis.</description><identifier>ISSN: 0300-8126</identifier><identifier>EISSN: 1439-0973</identifier><identifier>DOI: 10.1007/s15010-008-7317-7</identifier><identifier>PMID: 18791838</identifier><language>eng</language><publisher>Munchen: Urban and Vogel</publisher><subject>Animals ; Antibodies, Protozoan - blood ; Antigens, Protozoan - blood ; Clinical and Epidemiological Study ; Cryptosporidiosis - epidemiology ; Cryptosporidiosis - immunology ; Cryptosporidiosis - parasitology ; Cryptosporidium ; Cryptosporidium parvum ; Cryptosporidium parvum - genetics ; Cryptosporidium parvum - isolation & purification ; Disease Outbreaks ; Drinking water ; Family Medicine ; Female ; Gastroenteritis ; Gastroenteritis - epidemiology ; Gastroenteritis - immunology ; Gastroenteritis - parasitology ; General Practice ; Germany - epidemiology ; Humans ; Immune system ; Immunoglobulin G - blood ; Infectious Diseases ; Internal Medicine ; Male ; Medicine ; Medicine & Public Health ; Microbiological analysis ; Military Personnel ; Outbreaks ; Parasites ; Retrospective Studies ; Risk factors ; Training ; Young Adult ; Young adults</subject><ispartof>Infection, 2008-10, Vol.36 (5), p.450-457</ispartof><rights>Springer 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-32ddc251b7639ffc34368a34385684edde8fea8a5bfb15c5f67140f61164a6173</citedby><cites>FETCH-LOGICAL-c400t-32ddc251b7639ffc34368a34385684edde8fea8a5bfb15c5f67140f61164a6173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18791838$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brockmann, S. O.</creatorcontrib><creatorcontrib>Dreweck, C.</creatorcontrib><creatorcontrib>Wagner-Wiening, C.</creatorcontrib><creatorcontrib>Hagen, R. M.</creatorcontrib><creatorcontrib>Kimmig, P.</creatorcontrib><creatorcontrib>Petry, F.</creatorcontrib><creatorcontrib>Jakobi, V.</creatorcontrib><title>Serological and Epidemiological Analysis of an Outbreak of Gastroenteritis Among Military Recruits in Germany Caused by Cryptosporidium parvum</title><title>Infection</title><addtitle>Infection</addtitle><addtitle>Infection</addtitle><description>Background:
Cryptosporidium
spp. cause enteritic disease worldwide. Besides those patients with an impaired immune system, the general population is also at risk.
Patients and Methods:
Stool samples from participants of a military field exercise were tested for enteritic pathogens and sera were analyzed for
Cryptosporidium
-antibodies. All participants received a questionnaire for assessing possible risk factors.
Results:
After a 5-day field training, 201 of a total of 450 soldiers (45%) developed acute gastroenteritis. Immediate microbiological analysis ruled out enteropathogenic bacteria and viruses as the cause of the disease. Only after hospitalization of one of the patients diagnostic procedures were expanded to the identification of parasites and
Cryptosporidium parvum
was identified. In addition, 14 fecal samples of 217 specimens were subsequently identified in a
Cryptosporidium
antigen ELISA. A serological analysis of 214 sera revealed 72% positive for specific IgG antibodies compared with 17% of a control group of soldiers who had not participated in the field training (relative risk 3.38; 95% CI 2.39–4.77; p < 0.001). Analysis of specific IgM levels was less conclusive. Epidemiological analysis of questionnaires correlated drinking of tap water, or consumption of various meals with gastroenteritis. However, the source of contamination could not be identified.
Conclusion:
Cryptosporidium
spp. can cause acute enteritis even in healthy, young adults as demonstrated by this outbreak. Using serological methods, the extent of the outbreak could be estimated in a retrospective analysis.</description><subject>Animals</subject><subject>Antibodies, Protozoan - blood</subject><subject>Antigens, Protozoan - blood</subject><subject>Clinical and Epidemiological Study</subject><subject>Cryptosporidiosis - epidemiology</subject><subject>Cryptosporidiosis - immunology</subject><subject>Cryptosporidiosis - parasitology</subject><subject>Cryptosporidium</subject><subject>Cryptosporidium parvum</subject><subject>Cryptosporidium parvum - genetics</subject><subject>Cryptosporidium parvum - isolation & purification</subject><subject>Disease Outbreaks</subject><subject>Drinking water</subject><subject>Family Medicine</subject><subject>Female</subject><subject>Gastroenteritis</subject><subject>Gastroenteritis - epidemiology</subject><subject>Gastroenteritis - immunology</subject><subject>Gastroenteritis - parasitology</subject><subject>General Practice</subject><subject>Germany - epidemiology</subject><subject>Humans</subject><subject>Immune system</subject><subject>Immunoglobulin G - blood</subject><subject>Infectious Diseases</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Microbiological analysis</subject><subject>Military Personnel</subject><subject>Outbreaks</subject><subject>Parasites</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Training</subject><subject>Young Adult</subject><subject>Young adults</subject><issn>0300-8126</issn><issn>1439-0973</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><recordid>eNqFkd-K1DAUxoMo7rj6AN5I8MK76jlN86eXw7COwi4Lu3pd0iYZsrZNTVphXsJnNmUGFwTZm5zknN_5At9HyFuEjwggPyXkgFAAqEIylIV8RjZYsbqAWrLnZAMMoFBYigvyKqUHAOB1JV-SC1SyRsXUhvy-tzH04eA73VM9Gno1eWMH_7e3HXV_TD7R4PKc3i5zG63-sT73Os0x2HG20c-Z2A5hPNAb3_tZxyO9s11c_JyoH-nexkGPR7rTS7KGtvkWj9Mc0hSiN34Z6KTjr2V4TV443Sf75lwvyffPV992X4rr2_3X3fa66CqAuWClMV3JsZWC1c51rGJC6XwqLlRljbHKWa00b12LvONOSKzACURRaYGSXZIPJ90php-LTXMz-NTZvtejDUtqRK2AlxV7EiyzpwL4qvj-H_AhLDGblxnkAhlTKkN4groYUorWNVP0QzarQWjWSJtTpE2OtFkjbVbhd2fhpR2sedw4Z5iB8gSkPBoPNj7-_H_VP7birc0</recordid><startdate>20081001</startdate><enddate>20081001</enddate><creator>Brockmann, S. O.</creator><creator>Dreweck, C.</creator><creator>Wagner-Wiening, C.</creator><creator>Hagen, R. M.</creator><creator>Kimmig, P.</creator><creator>Petry, F.</creator><creator>Jakobi, V.</creator><general>Urban and Vogel</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20081001</creationdate><title>Serological and Epidemiological Analysis of an Outbreak of Gastroenteritis Among Military Recruits in Germany Caused by Cryptosporidium parvum</title><author>Brockmann, S. O. ; Dreweck, C. ; Wagner-Wiening, C. ; Hagen, R. M. ; Kimmig, P. ; Petry, F. ; Jakobi, V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-32ddc251b7639ffc34368a34385684edde8fea8a5bfb15c5f67140f61164a6173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Animals</topic><topic>Antibodies, Protozoan - blood</topic><topic>Antigens, Protozoan - blood</topic><topic>Clinical and Epidemiological Study</topic><topic>Cryptosporidiosis - epidemiology</topic><topic>Cryptosporidiosis - immunology</topic><topic>Cryptosporidiosis - parasitology</topic><topic>Cryptosporidium</topic><topic>Cryptosporidium parvum</topic><topic>Cryptosporidium parvum - genetics</topic><topic>Cryptosporidium parvum - isolation & purification</topic><topic>Disease Outbreaks</topic><topic>Drinking water</topic><topic>Family Medicine</topic><topic>Female</topic><topic>Gastroenteritis</topic><topic>Gastroenteritis - epidemiology</topic><topic>Gastroenteritis - immunology</topic><topic>Gastroenteritis - parasitology</topic><topic>General Practice</topic><topic>Germany - epidemiology</topic><topic>Humans</topic><topic>Immune system</topic><topic>Immunoglobulin G - blood</topic><topic>Infectious Diseases</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Microbiological analysis</topic><topic>Military Personnel</topic><topic>Outbreaks</topic><topic>Parasites</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Training</topic><topic>Young Adult</topic><topic>Young adults</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brockmann, S. O.</creatorcontrib><creatorcontrib>Dreweck, C.</creatorcontrib><creatorcontrib>Wagner-Wiening, C.</creatorcontrib><creatorcontrib>Hagen, R. M.</creatorcontrib><creatorcontrib>Kimmig, P.</creatorcontrib><creatorcontrib>Petry, F.</creatorcontrib><creatorcontrib>Jakobi, V.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Infection</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brockmann, S. O.</au><au>Dreweck, C.</au><au>Wagner-Wiening, C.</au><au>Hagen, R. M.</au><au>Kimmig, P.</au><au>Petry, F.</au><au>Jakobi, V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serological and Epidemiological Analysis of an Outbreak of Gastroenteritis Among Military Recruits in Germany Caused by Cryptosporidium parvum</atitle><jtitle>Infection</jtitle><stitle>Infection</stitle><addtitle>Infection</addtitle><date>2008-10-01</date><risdate>2008</risdate><volume>36</volume><issue>5</issue><spage>450</spage><epage>457</epage><pages>450-457</pages><issn>0300-8126</issn><eissn>1439-0973</eissn><abstract>Background:
Cryptosporidium
spp. cause enteritic disease worldwide. Besides those patients with an impaired immune system, the general population is also at risk.
Patients and Methods:
Stool samples from participants of a military field exercise were tested for enteritic pathogens and sera were analyzed for
Cryptosporidium
-antibodies. All participants received a questionnaire for assessing possible risk factors.
Results:
After a 5-day field training, 201 of a total of 450 soldiers (45%) developed acute gastroenteritis. Immediate microbiological analysis ruled out enteropathogenic bacteria and viruses as the cause of the disease. Only after hospitalization of one of the patients diagnostic procedures were expanded to the identification of parasites and
Cryptosporidium parvum
was identified. In addition, 14 fecal samples of 217 specimens were subsequently identified in a
Cryptosporidium
antigen ELISA. A serological analysis of 214 sera revealed 72% positive for specific IgG antibodies compared with 17% of a control group of soldiers who had not participated in the field training (relative risk 3.38; 95% CI 2.39–4.77; p < 0.001). Analysis of specific IgM levels was less conclusive. Epidemiological analysis of questionnaires correlated drinking of tap water, or consumption of various meals with gastroenteritis. However, the source of contamination could not be identified.
Conclusion:
Cryptosporidium
spp. can cause acute enteritis even in healthy, young adults as demonstrated by this outbreak. Using serological methods, the extent of the outbreak could be estimated in a retrospective analysis.</abstract><cop>Munchen</cop><pub>Urban and Vogel</pub><pmid>18791838</pmid><doi>10.1007/s15010-008-7317-7</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0300-8126 |
| ispartof | Infection, 2008-10, Vol.36 (5), p.450-457 |
| issn | 0300-8126 1439-0973 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_69805243 |
| source | Springer Nature |
| subjects | Animals Antibodies, Protozoan - blood Antigens, Protozoan - blood Clinical and Epidemiological Study Cryptosporidiosis - epidemiology Cryptosporidiosis - immunology Cryptosporidiosis - parasitology Cryptosporidium Cryptosporidium parvum Cryptosporidium parvum - genetics Cryptosporidium parvum - isolation & purification Disease Outbreaks Drinking water Family Medicine Female Gastroenteritis Gastroenteritis - epidemiology Gastroenteritis - immunology Gastroenteritis - parasitology General Practice Germany - epidemiology Humans Immune system Immunoglobulin G - blood Infectious Diseases Internal Medicine Male Medicine Medicine & Public Health Microbiological analysis Military Personnel Outbreaks Parasites Retrospective Studies Risk factors Training Young Adult Young adults |
| title | Serological and Epidemiological Analysis of an Outbreak of Gastroenteritis Among Military Recruits in Germany Caused by Cryptosporidium parvum |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-26T09%3A29%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Serological%20and%20Epidemiological%20Analysis%20of%20an%20Outbreak%20of%20Gastroenteritis%20Among%20Military%20Recruits%20in%20Germany%20Caused%20by%20Cryptosporidium%20parvum&rft.jtitle=Infection&rft.au=Brockmann,%20S.%20O.&rft.date=2008-10-01&rft.volume=36&rft.issue=5&rft.spage=450&rft.epage=457&rft.pages=450-457&rft.issn=0300-8126&rft.eissn=1439-0973&rft_id=info:doi/10.1007/s15010-008-7317-7&rft_dat=%3Cproquest_cross%3E1597886411%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c400t-32ddc251b7639ffc34368a34385684edde8fea8a5bfb15c5f67140f61164a6173%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=215613388&rft_id=info:pmid/18791838&rfr_iscdi=true |