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Topic:Epidemiology

Epidemiology in horses involves the study of the distribution and determinants of health-related states and events in equine populations. It encompasses the investigation of patterns, causes, and effects of diseases and health conditions within horse populations. This field of study aims to identify risk factors for disease and targets for preventive healthcare. Key components of equine epidemiology include disease surveillance, outbreak investigation, and the study of disease dynamics within herds or regions. Research in this area often focuses on infectious diseases, zoonotic diseases, and the impact of environmental factors on equine health. This page compiles peer-reviewed research studies and scholarly articles that explore various aspects of epidemiology in horses, including disease prevalence, transmission pathways, and strategies for disease prevention and control.
The host cellular protein Ndufaf4 interacts with the vesicular stomatitis virus M protein and affects viral propagation.
Virus genes    February 26, 2021   Volume 57, Issue 3 250-257 doi: 10.1007/s11262-021-01833-0
Pan W, Shen Z, Wang H, He H.Vesicular stomatitis virus (VSV) is an archetypal member of Mononegavirales which causes important diseases in cattle, horses and pigs. The matrix protein (M) of VSV plays critical roles in the replication, assembly/budding and pathogenesis of VSV. To further investigate the role of M during viral growth, we used a two-hybrid system to screen for host factors that interact with the M protein. Here, NADH: ubiquinone oxidoreductase complex assembly factor 4 (Ndufaf4) was identified as an M-binding partner, and this interaction was confirmed by yeast cotransformation and GST pulldown assays. ...
First Evidence of Ehrlichia minasensis Infection in Horses from Brazil.
Pathogens (Basel, Switzerland)    February 25, 2021   Volume 10, Issue 3 265 doi: 10.3390/pathogens10030265
Muraro LS, Souza AO, Leite TNS, Cândido SL, Melo ALT, Toma HS, Carvalho MB, Dutra V, Nakazato L, Cabezas-Cruz A, Aguiar DM.The genus includes tick-borne bacterial pathogens affecting humans, domestic and wild mammals. has been identified in different animal species and geographical locations, suggesting that this is a widely distributed and generalist . In the present study, we evaluated infection in 148 Equidae presented to the Medical Clinic Department of a Veterinary Hospital from a midwestern region of Brazil. Blood samples and ticks collected from the animals were tested by Polymerase Chain Reaction (PCR) for the presence of spp. A multigenic approach including Anaplasmataceae-specific (i.e., 16S rRNA, , ...
[Diseases connected with work in hay in Iceland. Causes and scientific studies].
Laeknabladid    February 25, 2021   Volume 107, Issue 3 130-136 doi: 10.17992/lbl.2021.03.626
Gislason D, Asmundsson T, Gislason T.Diseases connected with work in hay have been known in Iceland for a long time. In 1981 scientific studies of these diseases were started in Iceland at the request of the Farmers Union. The results of these studies are summarized in this article. In studies of hay a great amount of storage mites, moulds and thermophilic actinomycetes (microlyspora faeni) were found in addition to allergens from mice and pollen. Symptoms caused by hay dust were mainly from nose and eyes in people with positive skin tests, but cough, dyspnea and fever were equally common in those with negative skin tests. The mo...
Treatments for Endometritis in Mares Caused by Streptococcus equi Subspecies zooepidemicus: A Structured Literature Review.
Journal of equine veterinary science    February 24, 2021   Volume 102 103430 doi: 10.1016/j.jevs.2021.103430
Li J, Zhao Y, Gao Y, Zhu Y, Holyoak GR, Zeng S.Bacterial infections are the main causes of endometritis in mares. It is well known that the most common bacterial pathogen is Streptococcus equi subspecies zooepidemicus (SEZ). This structured review was completed according to the PRISMA procedure to search endometritis treatment protocols published between 1990 and 2020 it was our intent to evaluate the actual effects of different treatment protocols for endometritis caused by SEZ. The trials included were collected from Pubmed, CAB and Agricola. Ten articles with 116 horses and 17 different interventions were identified. The results of this...
Salivary Cortisol, Equine Characteristics, and Management Factors Associated With Strongyle-Type Egg Shedding of Ohio Horses.
Journal of equine veterinary science    February 24, 2021   Volume 101 103431 doi: 10.1016/j.jevs.2021.103431
Keating DL, Lehman JS, Burk SV.Identification of factors associated with parasite infestation in horses could reduce frequency of anthelmintic administration and slow development of anthelmintic resistance. The study aim was to evaluate management factors, equine characteristics, and equine salivary cortisol concentrations for association with strongyle-type egg shedding levels. As immunocompromised horses appear to be more susceptible to parasite infestation, it was hypothesized that salivary cortisol concentration could be associated with parasite egg shedding. Saliva and fecal samples were collected from 200 horses acros...
Novel seM-types of Streptococcus equi subsp. equi identified in isolates circulating in Argentina.
Equine veterinary journal    February 23, 2021   Volume 54, Issue 1 132-138 doi: 10.1111/evj.13420
Bustos CP, Muñoz AJ, Guida N, Waller A, Mesplet M.Strangles is a worldwide infectious disease caused by Streptococcus equi subsp. equi that affects the upper respiratory tract of horses. Streptococcus equi subsp. equi characterisation by seM-typing is internationally used for epidemiological studies and comparison of isolates. Objective: To identify and to compare the seM-types of Argentinian isolates of Streptococcus equi subsp. equi. Methods: Investigation of bacterial isolates using molecular and phylogenetic approaches. Methods: A total of 59 Argentinian isolates of Streptococcus equi subsp. equi obtained between 2007 and 2019 were studie...
Effects of storage time and temperature on thromboelastographic analysis in dogs and horses.
Veterinary clinical pathology    February 23, 2021   Volume 50, Issue 1 9-19 doi: 10.1111/vcp.12980
Lemon AV, Goddard A, Hooijberg EH.The accessibility of thromboelastography (TEG) to general practitioners is limited by short sample storage times (30 minutes) and storage temperatures (20-23°C). Objective: We aimed to evaluate the stability of canine and equine citrated blood samples when stored for extended periods of time, both at room temperature (RT) (20-23°C) and refrigerator temperature (FT) (2-7.5°C). Methods: Citrated whole blood samples from healthy dogs and horses (n = 10 for each) were stored for 30 minutes (baseline) at RT before TEG analysis. Baseline values for TEG variables R, K, α, MA, LY30, and LY60 w...
Prevalence and performance effects of neonatal disease in Thoroughbred and Standardbred foals in South-Eastern Australia.
Australian veterinary journal    February 23, 2021   Volume 99, Issue 5 152-162 doi: 10.1111/avj.13056
Raidal SL, Hughes KJ, Eastwell B, Noble N, Lievaart J.There is little information on foal mortality and the epidemiology of diseases in the neonatal period in Australian equine breeding enterprises. Methods: This was a prospective cohort study of 1219 foals on 15 breeding farms in south-eastern Australia to identify the proportion of foals recognised on farm as abnormal at birth or within the first 48 h postpartum, determine the prevalence and risk factors for neonatal disease and assess the subsequent performance of foals in the study population. Results: Overall, 27 foals died within 6 weeks of birth in the study population (2.2%), 142 foal...
Molecular surveillance of tick-borne diseases affecting horses in Poland-Own observations.
Veterinary medicine and science    February 23, 2021   Volume 7, Issue 4 1159-1165 doi: 10.1002/vms3.451
Teodorowski O, Kalinowski M, Winiarczyk D, Janecki R, Winiarczyk S, Adaszek Ł.The purpose of the study was to carry out the molecular surveillance of piroplasmosis, granulocytic anaplasmosis and lyme borreliosis in horses which originated from Poland and exhibited symptoms raising the suspicion of the aforementioned disease units. The presence of Theileria equi genetic material was detected in 37 out of 512 examined horses (7.2%), and Anaplasma phagocytophilum in 9 (1.8%). The DNA of Borrelia burgdorferi was found in 11 out of 204 examined horses (5.4%). The above-cited results indicate that the problem of tick-borne diseases affecting horses in Poland is not as signifi...
Horsing around: Escherichia coli ST1250 of equine origin harbouring epidemic IncHI1/ST9 plasmid with bla CTX-M-1 and an operon for short-chain fructooligosaccharides metabolism.
Antimicrobial agents and chemotherapy    February 22, 2021   Volume 65, Issue 5 e02556-20 doi: 10.1128/AAC.02556-20
Valcek A, Sismova P, Nesporova K, Overballe-Petersen S, Bitar I, Jamborova I, Kant A, Hrabak J, Wagenaar JA, Madec JY, Damborg P, van Duijkeren E....The relatedness of the equine-associated ST1250 and its single- and double-locus variants (ST1250-SLV/DLV), obtained from horses in Europe, was studied by comparative genome analysis. A total of 54 isolates of ST1250 and ST1250-SLV/DLV from healthy and hospitalized horses across Europe [Czech Republic (n=23), the Netherlands (n=18), Germany (n=9), Denmark (n=3) and France (n=1)] from 2008-2017 were subjected to whole-genome sequencing. An additional 25 draft genome assemblies of ST1250 and ST1250-SLV/DLV were obtained from the public databases. The isolates were compared for genomic feature...
Racehorse Trainer Mental Health: Prevalence and Risk Factors.
Journal of equine veterinary science    February 21, 2021   Volume 101 103423 doi: 10.1016/j.jevs.2021.103423
King L, Cullen SJ, O'Connor S, McGoldrick A, Pugh J, Warrington G, Losty C.Racehorse trainers play an important role within the horseracing industry. Despite this, scarce empirical information exists regarding the mental health of this population. Thus, the purpose of the present study was to explore the prevalence of symptoms related to common mental disorders (CMDs) and their associations with specific risk factors for CMD. Participants completed an anonymous online questionnaire. CMDs were assessed including distress, depression, generalized anxiety and adverse alcohol use. The risk factors examined included career dissatisfaction, social support and financial dif...
New World camelids are sentinels for the presence of Borna disease virus.
Transboundary and emerging diseases    February 21, 2021   Volume 69, Issue 2 451-464 doi: 10.1111/tbed.14003
Malbon AJ, Dürrwald R, Kolodziejek J, Nowotny N, Kobera R, Pöhle D, Muluneh A, Dervas E, Cebra C, Steffen F, Paternoster G, Gerspach C, Hilbe M.Borna disease (BD), a frequently fatal neurologic disorder caused by Borna disease virus 1 (BoDV-1), has been observed for decades in horses, sheep, and other mammals in certain regions of Europe. The bicoloured white-toothed shrew (Crocidura leucodon) was identified as a persistently infected species involved in virus transmission. Recently, BoDV-1 attracted attention as a cause of fatal encephalitis in humans. Here, we report investigations on BoDV-1-infected llamas from a farm in a BD endemic area of Switzerland, and alpacas from holdings in a region of Germany where BD was last seen in the...
Corrigendum to “Antimicrobial-Resistant Enterococcus faecium and Enterococcus faecalis Isolated From Healthy Thoroughbred Racehorses in Japan” [Journal of Equine Veterinary Science 94 (2020) 103232].
Journal of equine veterinary science    February 19, 2021   Volume 99 103391 doi: 10.1016/j.jevs.2021.103391
Sukmawinata E, Sato W, Uemura R, Kanda T, Kusano K, Kambayashi Y, Sato T, Ishikawa Y, Toya R, Sueyoshi M.No abstract available
Incidence, recurrence, and outcome of postrace atrial fibrillation in Thoroughbred horses.
Journal of veterinary internal medicine    February 19, 2021   Volume 35, Issue 2 1111-1120 doi: 10.1111/jvim.16063
Nath LC, Elliott AD, Weir J, Curl P, Rosanowski SM, Franklin S.Atrial fibrillation (AF) impacts performance and horse and jockey safety. Understanding the outcomes of AF identified postrace will better inform regulatory policy. Objective: To investigate the outcomes after episodes of AF identified postrace and determine whether affected horses are at increased risk of additional episodes compared to the general racing population. Methods: Total of 4684 Thoroughbred racehorses. Methods: Race records for Thoroughbred horses racing in Hong Kong from 2007 to 2017 were reviewed. Horses that performed below expectation were examined by cardiac auscultation and ...
Near-Complete Genome Sequences of Vesicular Stomatitis Virus Isolates from the 2020 Outbreak in Kansas.
Microbiology resource announcements    February 18, 2021   Volume 10, Issue 7 doi: 10.1128/MRA.01454-20
Doerksen T, Bird E, Henningson J, Palinski R.Here, we report the near-complete genome sequences of vesicular stomatitis virus (VSV) serotype Indiana isolates from the 2020 U.S. outbreak. The sequences were obtained from swabs collected from Kansas horses in July and August. The four genome sequences help improve our understanding of VSV outbreak dynamics in the United States.
Epidemiology of methicillin resistant Staphylococcus species carriage in companion animals in the Greater Brisbane Area, Australia.
Research in veterinary science    February 18, 2021   Volume 136 138-142 doi: 10.1016/j.rvsc.2021.02.012
Rynhoud H, Meler E, Gibson JS, Price R, Maguire T, Farry T, Bennett E, Hartono J, Soares Magalhães RJ.To detect methicillin resistant Staphylococcus aureus (MRSA) and S. pseudintermedius (MRSP) swab samples were collected from dogs, cats and horses from South East Queensland (SE QLD). MRSP carriage in dogs was 8.7% and no MRSP was isolated from cats and horses; no MRSA was isolated. Risk factors for carriage included previous hospitalisation, previous bacterial infection, consultation type, average precipitation, and human population density. The probability of MRSP carriage was highest in Brisbane city, Sunshine Coast and Gympie. This suggests that MRSP carriage in dog populations from SE QLD...
Validation of a Commercial Glanders ELISA as an Alternative to the CFT in International Trade of Equidae.
Frontiers in veterinary science    February 16, 2021   Volume 8 628389 doi: 10.3389/fvets.2021.628389
Elschner MC, Melzer F, Singha H, Muhammad S, Gardner I, Neubauer H.Glanders, caused by Burkholderia (B.) mallei is a notifiable zoonotic disease in equidae. For international trade and movement of equids, certificates of negative serological test results for antibodies against B. mallei are required. To date, the complement fixation test (CFT) is the mandatory test to issue these health certificates. The CFT is difficult to standardize and, due to its poor specificity, often leads to false-positive reactions resulting in trade restrictions with considerable financial consequences. In the present study, the new ID Screen Glanders Double Antigen Multispecies EL...
Evaluation of fasting plasma insulin and proxy measurements to assess insulin sensitivity in horses.
BMC veterinary research    February 15, 2021   Volume 17, Issue 1 78 doi: 10.1186/s12917-021-02781-5
Lindåse S, Nostell K, Bergsten P, Forslund A, Bröjer J.Proxies are mathematical calculations based on fasting glucose and/or insulin concentrations developed to allow prediction of insulin sensitivity (IS) and β-cell response. These proxies have not been evaluated in horses with insulin dysregulation. The first objective of this study was to evaluate how fasting insulin (FI) and proxies for IS (1/Insulin, reciprocal of the square root of insulin (RISQI) and the quantitative insulin sensitivity check index (QUICKI)) and β-cell response (the modified insulin-to-glucose ratio (MIRG) and the homeostatic model assessment of β-cell function (HOMA-β)...
Comparison of Fecal Microbiota of Horses Suffering from Atypical Myopathy and Healthy Co-Grazers.
Animals : an open access journal from MDPI    February 15, 2021   Volume 11, Issue 2 doi: 10.3390/ani11020506
Wimmer-Scherr C, Taminiau B, Renaud B, van Loon G, Palmers K, Votion D, Amory H, Daube G, Cesarini C.Equine atypical myopathy (AM) is caused by hypoglycin A (HGA) and methylenecyclopropylglycine (MCPG) intoxication resulting from the ingestion of seeds or seedlings of some Acer tree species. Interestingly, not all horses pasturing in the same toxic environment develop signs of the disease. In other species, it has been shown that the intestinal microbiota has an impact on digestion, metabolism, immune stimulation and protection from disease. The objective of this study was to characterize and compare fecal microbiota of horses suffering from AM and healthy co-grazers. Furthermore, potential d...
Expression of select mRNA in Thoroughbreds with catastrophic racing injuries.
Equine veterinary journal    February 15, 2021   Volume 54, Issue 1 63-73 doi: 10.1111/evj.13423
Page AE, Adam E, Arthur R, Barker V, Franklin F, Friedman R, Grande T, Hardy M, Howard B, Partridge E, Rutledge M, Scollay M, Stewart JC, Vale A....The ability to identify horses at risk for catastrophic injuries continues to be a pressing issue for the racing industry, especially given recent events in North America. Objective: Since most catastrophic injuries occur in areas of existing pathology and this pathology is likely to elicit an inflammatory response, it was hypothesised that analysis of messenger RNA (mRNA) expression would detect significant changes in select genes in horses at risk for a catastrophic injury. Methods: Prospective cohort study. Methods: Five racing jurisdictions across the United States participated in this stu...
Serological Evidence of Natural Exposure to Tick-Borne Pathogens in Horses, Romania.
Microorganisms    February 12, 2021   Volume 9, Issue 2 373 doi: 10.3390/microorganisms9020373
Bogdan AM, Ionita M, Mitrea IL.The purpose of this study was to investigate the seroprevalence of selected tick-borne-pathogens (TBPs) among Romanian horses. For this, a total of 223 animals originating from north, central, and southeast Romania, including horses from stud farms ( = 118) and working horses ( = 105), were tested using a commercial rapid ELISA-based test. Overall, 10.3% (95% confidence interval (CI): 6.7-15.1%) of the tested horses were seropositive for antibodies (Ab) against Additionally, 18.8% (95% CI: 13.9-24.6%) and 0.5% (95% CI: 0.01-2.5%) of horses were seropositive for Ab against sensu lato and spp...
Patterns of injury following equine trauma: a non-trauma centre experience.
Scottish medical journal    February 11, 2021   Volume 66, Issue 2 73-76 doi: 10.1177/0036933021994264
Dick L, Yule M, Green J, Young J.Horse riding carries risk of injury which can result in fatality. The majority of published literature describes major trauma centre experience. We aimed to characterise injury patterns following equine trauma at a Scottish district general hospital. Methods: A retrospective review of admissions following equine trauma was undertaken from 2014 to 2019. Mechanism and nature of injuries were noted. Patient management and outcomes were recorded and analysed to determine correlation. Results: Of the 162 patients identified, 121 (74.7 per cent) were female. The commonest mechanism and injury sustai...
Seroprevalence of Streptococcus equi subspecies equi in Croatia – Short communication.
Acta veterinaria Hungarica    February 10, 2021   Volume 68, Issue 4 361-363 doi: 10.1556/004.2020.00061
Štritof Z, Mitchell C, Turk N, Habuš J, Hađina S, Perharić M, Waller AS.Clinical cases resembling strangles are regularly seen in some areas of Croatia. However, there are no data on the prevalence of infection and the clinical forms or geographic distribution of the disease. The aim of this study was to determine the seroprevalence of Streptococcus equi subspecies equi in horses resident in Croatia, in order to estimate the geographic distribution of infection. The study included 291 horse sera from the eight counties where the majority of Croatian horses are kept. Sera were tested by indirect ELISA (iELISA) for the presence of serum antibodies against S. equi pr...
Training Young Horses: The Science behind the Benefits.
Animals : an open access journal from MDPI    February 9, 2021   Volume 11, Issue 2 463 doi: 10.3390/ani11020463
Logan AA, Nielsen BD.Conflicting research and anecdotal evidence have created disagreement among equestrians as to whether two-year-old horses should be trained and raced. The objective of this literature review is to evaluate epidemiological studies, as well as physiological data on equine bone, articular cartilage, and tendons to better determine the impact of training and racing two-year-old horses. The evaluation of numerous studies on the topic provides evidence that a horse which is trained or raced as a two-year-old has a lower risk of injury and better adapted tissues for the rigors of racing. Unfortunatel...
Residues of antibiotics in yeasts from ethanol production: a possible contamination route for feedingstuffs.
Journal of environmental science and health. Part. B, Pesticides, food contaminants, and agricultural wastes    February 9, 2021   Volume 56, Issue 4 307-312 doi: 10.1080/03601234.2021.1880223
Hoff RB, Molognoni L, Deolindo CTP, de Oliveira T, Mattos JLS, Oliveira LVA, Daguer H.Sugarcane yeast and brewer's yeast from ethanol production are widely used as ingredients of animal feed formulations in Brazil. To avoid the contamination of the must in ethanol production refineries, the use of antibiotics is one of the main preventive treatments. Thus, there is a risk of antibiotic residues carry over from yeast to animal feed. This unintentional addition of antibiotics can produce non-compliant feed products, due to regulatory aspects and their toxicity for animals. The results of an exploratory program to assess the occurrence of over 60 antibiotics and other pharmaceutic...
A reassortant G3P[12] rotavirus A strain associated with severe enteritis in donkeys (Equus asinus).
Equine veterinary journal    February 8, 2021   Volume 54, Issue 1 114-120 doi: 10.1111/evj.13425
Dong J, Liu G, Gao N, Suo J, Matthijnssens J, Li S, Yuan D, Du Y, Zhang J, Yamashita N, Haga T, Cook FR, Zhu W.In contrast to horses, the only evidence suggesting gastrointestinal disease in neonatal donkeys is associated with Group A rotaviruses (RVAs) is the detection of viral antigens by ELISA in just 1 of 82 symptomatic donkey foals. No additional, more comprehensive investigations have been conducted, and RVAs if circulating in donkey populations have not been molecularly characterised. Objective: To investigate if RVAs are associated with an outbreak of severe enteritis in neonatal donkeys and if associated determine the genotype(s) along with the phylogenetic relationship to RVA strains circulat...
Survey of the equine broodmare industry, abortion, and equine herpesvirus-1 vaccination in Ontario.
The Canadian veterinary journal = La revue veterinaire canadienne    February 6, 2021   Volume 62, Issue 2 124-132 
Cooper CJ, Arroyo LG, Pearl DL, Hewson J, Lillie BN.A survey of Ontario horse breeders was conducted in 2016 and retrospectively asked farm-level management questions regarding herd sizes, vaccination, respiratory disease, and abortion over the years 2014 to 2015. A total of 88 farm owners completed the survey, reporting 857 broodmares. Using logistic regression modelling, management influences on vaccine use, and the reporting of respiratory disease or abortion was investigated. Having veterinary records and the reasons for breeding were significantly associated with the odds of an abortion even after controlling for broodmare herd size. The o...
Helminth infections in Italian donkeys: Strongylus vulgaris more common than Dictyocaulus arnfieldi.
Journal of helminthology    February 4, 2021   Volume 95 e4 doi: 10.1017/S0022149X20001017
Buono F, Veronesi F, Pacifico L, Roncoroni C, Napoli E, Zanzani SA, Mariani U, Neola B, Sgroi G, Piantedosi D, Nielsen MK, Veneziano V.Donkeys have been used as working animals for transport and farm activities worldwide. Recently, in European countries, there has been an increasing interest in donkeys due to their use as pets, onotherapy or milk production. During 2014-2016, a countrywide survey was conducted to determine prevalence and risk factors of principal helminth infections in 1775 donkeys in 77 Italian farms. A questionnaire on management and parasite control practices was filled out for each farm. Faecal samples were examined using a modified McMaster technique, a centrifugation/flotation method and a sedimentation...
Third Generation Cephalosporin Resistant Enterobacterales Infections in Hospitalized Horses and Donkeys: A Case-Case-Control Analysis.
Antibiotics (Basel, Switzerland)    February 4, 2021   Volume 10, Issue 2 155 doi: 10.3390/antibiotics10020155
Shnaiderman-Torban A, Marchaim D, Navon-Venezia S, Lubrani O, Paitan Y, Arielly H, Steinman A.In human medicine, infections caused by third-generation cephalosporin-resistant (3GCRE) are associated with detrimental outcomes. In veterinary medicine, controlled epidemiological analyses are lacking. A matched case-case-control investigation (1:1:1 ratio) was conducted in a large veterinary hospital (2017-2019). In total, 29 infected horses and donkeys were matched to 29 animals with third-generation cephalosporin-susceptible (3GCSE) infections, and 29 uninfected controls (overall = 87). Despite multiple significant associations per bivariable analyses, the only independent predictor fo...
Designing of Western Blot Technique for Glanders Diagnosing in Iran.
Journal of equine veterinary science    February 3, 2021   Volume 99 103403 doi: 10.1016/j.jevs.2021.103403
Shakibamehr N, Mosavari N, Harzandi N, Mojgani N.Burkholderia mallei is the etiologic agent of glanders. It is difficult to diagnose this zoonotic disease in its early stages. Some methods such as the complement fixation test (CFT) cause some problems for veterinary authorities and financial losses to animal owners due to false-positive results. The mallein test requires appropriate laboratory equipment and skilled personnel. To quickly and accurately diagnose the disease, especially in areas where animals cannot be kept, new methods (such as the Western blot test [WBT]) should be used to identify the disease. This study designed and optimiz...
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