Accepted on 03 Oct 2022
Submitted on 03 Oct 2022
After the publication of Cardiovascular Risk Factors and Clinical Outcomes among Patients Hospitalized with COVID-19: Findings from the World Heart Federation COVID-19 Study [1], the authors noticed some minor errors that required correcting. These fell into four different categories:
One decimal point value was missed in Tables 2a and 2b. 2a was also missing the titles in the first two columns, which were ‘Overall, N (%)’ and ‘Survivors, N(%)’. On Table 3, two decimal point values were added for the blood results: WBC, Troponin T.
Table 2a
Demographic and clinical characteristics of study participants.
| OVERALL | SURVIVORS | IN-HOSPITAL DEATHS N (%) | POST DISCHARGE 30-DAY DEATHS, N (%) | P-VALUE FOR DIFFERENCE | |
|---|---|---|---|---|---|
| N (%) | N (%) | ||||
| N | 5313 | 4512 (84.9) | 683 (12.9) | 118 (2.6) | |
| Age, mean (SD) | 57.0 (16.1) | 55.6 (16.0) | 64.8 (14.2) | 65.4 (13.4) | <0.001 |
| Male | 3159 (59.4) | 2642 (83.6) | 431 (13.6) | 86 (2.7) | <0.001 |
| Female | 2154 (40.5) | 1870 (86.8) | 252 (11.7) | 32 (1.5) | |
| Ethnic Origin | <0.001 | ||||
| Caucasian | 800 (15.1) | 749 (93.6) | 45 (5.6) | 6 (0.8) | |
| Hispanic | 542 (10.2) | 403 (74.4) | 134 (24.7) | 5 (0.9) | |
| Black | 796 (15.0) | 669 (84) | 117 (14.7) | 10 (1.3) | |
| Middle Eastern | 315 (5.9) | 283 (89.8) | 18 (5.7) | 14 (4.4) | |
| Asian | 2442 (46.0) | 2046 (83.8) | 324 (13.3) | 72 (2.9) | |
| Other | 346 (6.5) | 303 (84.4) | 45 (12.5) | 11 (3.1) | |
| World Bank income groups | <0.001 | ||||
| LIC | 376 (7.1) | 331 (88.0) | 39 (10.4) | 6 (1.6) | |
| LMIC | 2526 (47.5) | 2141 (81.3) | 403 (15.3) | 89 (3.4) | |
| UMIC | 1044 (19.6) | 742 (79.2) | 181 (19.3) | 14 (1.5) | |
| HIC | 1367 (25.7) | 1298 (95) | 60 (4.4) | 9 (0.7) | |
| Education | <0.001 | ||||
| Up to primary | 510 (9.6) | 388 (76.1) | 110 (21.6) | 12 (2.4) | |
| Up to secondary | 1162 (21.9) | 1011 (87.0) | 123 (10.6) | 28 (2.4) | |
| College/University | 1264 (23.8) | 1140 (90.2) | 111 (8.8) | 13 (1.0) | |
| Unknown | 2291 (43.1) | 1906 (82.5) | 338 (14.6) | 65 (2.8) | |
| Smoking status | <0.001 | ||||
| Never | 3080 (58.0) | 2664 (86.5) | 359 (11.7) | 56 (1.8) | |
| Current | 370 (7.0) | 342 (92.2) | 22 (5.9) | 7 (1.9) | |
| Former | 751 (14.1) | 645 (85.9) | 89 (11.9) | 17 (2.3) | |
| Unknown | 1110 (20.9) | 861 (77.5) | 212 (19.1) | 38 (3.4) | |
| Body mass index (Kg/m2), mean (SD) | 26.9 (5.3) | 0.35 | |||
| Underweight (<18) | 71 (1.3) | 65 (91.5) | 5 (7.0) | 1 (1.5) | |
| Normal weight (18–24) | 1414 (26.6) | 1246 (87.9) | 147 (10.4) | 25 (1.8) | 0.57 |
| Overweight (25–29) | 1289 (24.3) | 1137 (88.3) | 139 (10.8) | 12 (0.9) | |
| Obese (≥30) | 831 (15.6) | 730 (88.2) | 88 (10.6) | 10 (1.2) | |
SD = standard deviation; row percentage reported for all categorical variables.
Table 2b
COVID-19 symptoms and comorbidities among study participants.
| COVID-SYMPTOMS AND VITAL SIGNS | OVERALL | SURVIVORS | IN-HOSPITAL DEATHS N (%) | POST DISCHARGE 30-DAY DEATHS N (%) |
|---|---|---|---|---|
| N (%) | N (%) | |||
| Diagnosed by using RT-PCR | 5050 (95.0) | 4299(85.1) | 644(12.8) | 107(2.1) |
| Median time from symptom onset to admission (IQR) in minutes | 5 (3–8) | 5 (3–8) | 5 (3–8) | 4 (2–7) |
| History of self-reported fever | 3526 (66.4) | 3002 (85.1) | 459 (13.0) | 65 (1.9) |
| Cough | 3624 (68.2) | 3087 (85.2) | 472 (13.0) | 65 (1.8) |
| Dyspnoea OR Tachypnoea | 3308 (62.3) | 2689 (81.3) | 534(16.1) | 85 (2.6) |
| Heart rate (beats/min), mean (SD) | 92.1 (17.8) | 91.2 (17.0) | 96.9 (21.6) | 95.7 (17.3) |
| Bradycardia (HR<60bpm) mean (SD) | 101 (1.9) | 85 (84) | 15 (15) | 1 (1) |
| Tachycardia (HR>100bpm) mean (SD) | 1409 (26.5) | 1103 (78) | 265 (19) | 41 (3) |
| Systolic BP (mmHg), mean (SD) | 128.8 (20.9) | 128.7 (19.9) | 129.7 (25.4) | 129.7 (26.3) |
| Diastolic BP (mmHg), mean (SD) | 78.2 (13.0) | 78.5 (12.5) | 76.4 (15.4) | 77.0 (14.9) |
| Shortness of Breath (SOB) | ||||
| SOB < 100m | 1336 (25.5) | 1047(78.4) | 252 (18.8) | 37 (2.8) |
| SOB 100–500m | 479 (9.1) | 364(76.0) | 96 (20.0) | 19 (4.0) |
| SOB > 500m | 225 (4.3) | 203(90.2) | 15 (6.7) | 7 (3.1) |
| Co-morbidities (Cardiovascular) | ||||
| Hypertension | 2511 (47.3) | 2060 (82.0) | 398 (16.0) | 53 (2.0) |
| Diabetes | 1700 (32.0) | 1346 (79.2) | 306 (17.8) | 48 (3.0) |
| Coronary artery disease | 580 (10.9) | 446 (76.9) | 103 (17.8) | 31 (5.3) |
| Heart Failure | 290 (5.5) | 238 (82.1) | 45 (15.5) | 7 (2.4) |
| Stroke | 197 (3.7) | 159 (80.7) | 28 (14.2) | 10 (5.1) |
| Atrial Fibrillation | 159 (3.0) | 134 (84.3) | 22 (13.8) | 3 (1.9) |
| Peripheral vascular disease | 106 (2.0) | 85 (80.2) | 18 (17.0) | 3 (2.8) |
| Cardiomyopathies | 60 (1.1) | 53 (88.3) | 6 (10.0) | 1 (1.7) |
| Rheumatic Heart Disease | 56 (1.1) | 49 (87.5) | 7 (12.5) | 0 (0) |
| Chagas disease | 36 (0.7) | 34 (94.4) | 2 (5.6) | 0 (0) |
| Congenital heart disease | 182 (3.4) | 166 (91.2) | 9 (4.9) | 7 (3.8) |
| Valvular disease | 118 (2.2) | 94 (79.7) | 21(17.8) | 3 (2.5) |
| Co-morbidities (Non-Cardiovascular) | ||||
| Chronic kidney disease | 404 (7.6) | 299 (74.0) | 86 (21.3) | 19 (4.7) |
| Chronic pulmonary disease | 208 (3.9) | 160 (76.5) | 44 (21.1) | 5 (2.4) |
| Asthma | 219 (4.1) | 200 (91.3) | 18 (8.2) | 1 (0.5) |
| Chronic Immunosuppression | 136 (2.6) | 110 (80.9) | 25 (18.4) | 1 (0.7) |
| HIV | 71 (1.3) | 62 (87.3) | 6 (8.5) | 3 (4.2) |
| Tuberculosis | 56 (1.1) | 49 (87.5) | 7 (12.5) | 0 (0) |
| Cancer on chemotherapy | 114 (2.1) | 90 (78.9) | 20 (17.5) | 4 (3.6) |
| Renal replacement therapy | 62 (1.2) | 45 (72.6) | 16 (25.8) | 1 (1.6) |
| Previous organ transplant | 45 (0.8) | 38 (84.8) | 7 (15.6) | 0 (0) |
Rt-PCR = Reverse Transcription Polymerase Chain Reaction; SD = standard deviation; IQR = Inter quartile range; BP = blood pressure; SOB = Shortness of breath; HIC = high income countries; UMIC = upper middle-income countries; LMIC = lower middle-income countries; LIC = low-income countries; HIV = Human immunodeficiency virus. Row percentage reported for all categorical variables.
Table 3
ECG, ECHO, and laboratory findings among COVID-19 patients at admission.
| OVERALL N (%) | SURVIVORS N (%) | IN-HOSPITAL DEATHS N (%) | POST DISCHARGE 30-DAY DEATHS N (%) | P-VALUE FOR DIFFERENCE | |
|---|---|---|---|---|---|
| ECG data (N = 3490) | |||||
| Atrial fibrillation (yes) | 131 (2.5) | 97 (2.1) | 31 (4.5) | 3 (2.5) | 0.003 |
| T-wave changes (yes) | 774 (14.6) | 593 (13.1) | 153 (22.4) | 28 (23.7) | <0.001 |
| QT/QTC duration, median (IQR) | 419.0 (331.5, 447.0) | 415.5 (259.0, 445.0) | 428.0 (360.0, 457.0) | 448.0 (413.5, 467.0) | <0.001 |
| ECHO findings (Median, IQR) (N = 259) | |||||
| Ejection fraction 1. Teicholz (EF1), | 59.1 (49.0, 64.0) | 60.0 (52.0, 64.0) | 55.0 (45.0, 64.0) | 59.0 (59.0, 60.0) | 0.23 |
| Ejection fraction 2. Visual estimations (EF2), | 55.0 (45.0, 60.0) | 55.0 (45.0, 60.0) | 51.5 (45.0, 59.0) | 50.0 (35.0, 55.0) | 0.082 |
| Right ventricular function | 0.002 | ||||
| Mildly/severely abnormal | 47 (0.9) | 28 (59.1) | 18 (38.6) | 1 (2.3) | |
| Laboratory parameters (median, IQR) (N = 4330) | |||||
| Hemoglobin, mmol/L | 7.9 (7.1, 8.8) | 8.0 (7.1, 8.8) | 7.8 (6.6, 8.7) | 7.5 (6.5, 8.4) | <0.001 |
| WBC count, ×10^9/L | 4.7 (0.0, 8.4) | 5.1 (0.0, 8.5) | 0.018 (0.009, 7.5) | 0.0184 (0.009, 6.9) | <0.001 |
| Platelets, 10^3/µL | 230.5 (168.0, 336.0) | 233.0 (170.0, 342.0) | 219.0 (157.0, 306.0) | 228.0 (154.0, 425.0) | <0.001 |
| ALT/SGPT, μmol/(s•L) | 0.60 (0.38, 0.97) | 0.58 (0.38, 0.95) | 0.65 (0.40, 1.11) | 0.63 (0.41, 1.09) | 0.003 |
| AST/SGOT, μmol/(s•L) | 0.67 (0.47, 1.05) | 0.65 (0.45, 1.00) | 0.79 (0.52, 1.37) | 0.82 (0.53, 1.30) | <0.001 |
| Creatinine-conversion, μmol/L | 87.5 (70.6, 113.2) | 85.0 (69.0, 107.0) | 99.9 (74.3, 150.3) | 104.3 (82.2, 195.4) | <0.001 |
| Sodium, mmol/L | 137.0 (134.0, 140.0) | 137.0 (134.0, 140.0) | 136.3 (133.0, 140.0) | 136.0 (133.0, 139.0) | 0.10 |
| Potassium, mmol/L | 4.2 (3.8, 4.7) | 4.2 (3.8, 4.6) | 4.3 (3.8, 4.9) | 4.5 (4.1, 5.0) | <0.001 |
| CRP, mg/L | 53.8 (17.4, 110.7) | 48.0 (15.7, 100.0) | 93.2 (40.2, 174.0) | 82.9 (21.5, 156.1) | <0.001 |
| ESR, mm/hr | 43.0 (25.0, 67.0) | 41.0 (24.0, 65.0) | 52.0 (34.0, 81.0) | 53.0 (40.0, 79.0) | <0.001 |
| Troponin, ng/mL | 1.0 (0.1, 9.0) | 1.0 (0.1, 9.0) | 0.1 (0.037, 11.0) | 20.0 (2.9, 32.0) | 0.007 |
| Troponin T, pg/mL | 9.0 (0.5, 24.9) | 8.0 (0.6, 20.0) | 21.0 (5.5, 64.5) | 0.123 (0.014, 16.0) | <0.001 |
| BNP, pmol/L | 7.8 (1.5, 28.1) | 6.0 (1.2, 21.4) | 16.0 (5.1, 49.4) | 19.9 (2.2, 44.1) | <0.001 |
| NT-proBNP, pmol/L | 60.1 (12.1, 254.4) | 46.7 (10.3, 224.2) | 110.7 (34.3, 415.5) | 505.5 (285.5, 1641.0) | <0.001 |
| CK-Mb, ukat/L, | 0.24 (0.017, 13.0) | 0.23 (0.017, 13.0) | 0.47 (0.034, 19.0) | 0.049 (0.017, 0.613) | 0.001 |
| Total cholesterol, mmol/L | 4.0 (3.1, 5.0) | 4.2 (3.4, 5.2) | 3.4 (2.7, 4.3) | 3.9 (2.5, 4.4) | <0.001 |
| HbA1c, % | 6.9 (6.1, 8.5) | 6.9 (6.1, 8.5) | 7.0 (6.2, 8.4) | 6.4 (5.9, 9.7) | 0.80 |
| D-dimer, mg/FEU/L | 1.0 (0.4, 4.4) | 0.9 (0.4, 3.9) | 1.8 (0.7, 4.8) | 2.5 (1.2, 26.5) | <0.001 |
| Ferritin, μg/L | 514.1 (225.3, 1001.9) | 476.0 (197.5, 962.0) | 687.7 (350.3, 1365.2) | 656.6 (392.0, 1068.0) | <0.001 |
| IL-6, pg/mL | 25.2 (8.7, 64.7) | 21.6 (7.0, 52.0) | 65.8 (21.9, 125.0) | 36.0 (17.6, 133.5) | <0.001 |
| Urea (BUN), mmol/L, | 8.5 (5.5, 14.6) | 7.7 (5.2, 12.9) | 13.9 (7.9, 23.8) | 17.0 (10.4, 28.2) | <0.001 |
| PT (seconds) | 13.4 (12.0, 15.9) | 13.3 (12.0, 15.6) | 13.9 (12.1, 16.7) | 13.2 (11.7, 16.7) | 0.012 |
| INR ratio | 1.1 (0.9, 1.25) | 1.1 (0.9, 1.23) | 1.1 (0.96, 1.32) | 1.1 (0.0119, 1.32) | 0.015 |
IQR = interquartile range; mmol/L millimoles per liter; mg/L = milligrams per liter.
Four collaborators were inadvertently missed off the original list: L. Tetteh Appiah, Nabil Varwani, Lucky Rose Adika, and Humphrey Robert Guya.
The full, corrected contributor list is:
Rio de Janeiro, Brazil, Instituto Nacional de Cardiologia: A. Issa, H. Cramer, C. Lamas, M. Paulino, V. Belidio, L. Sabioni, Buenos Aires, Argentina, Hospital de Clinicas of the University: R. Pérez de la Hoz, J. Martin Aladio, M. Matsudo, S. Swieszkowski, A. Perez de la Hoz, Buenos Aires, Argentina, Sanatorio Güemes: E. J. Zaidel, J. Perea, M. Ariel Oliva, N. Carboni Martinez, N. Bisso, L. Gheco, Dhaka, Bangladesh, Dhaka Medical College Hospital: S. Talukder, S.Akter, M. Robed Amin, M. Ahmedul Kabir, M. Khairul Islam, M. Mohiuddin Sharif, K. Fayzus Salahin, S. Hossain, Dhaka, Bangladesh, Kuwait Bangladesh Friendship Govt. Hospital: A. Rahim, K. M. Rubayet Anwar, S. Sajmin Siddiqa, M. Rahman, A. Hossain, Dhaka, Bangladesh, Bangladesh Specialized Hospital: A. Wadud Chowdhury, M. Mohiuddin Ahmed, M. Mushfiqur Rahman, U. F. Sultana, Srpska, Bosnia and Herzegovina, University Clinical Center Republic of Srpska: B. Stanetic, I. Ovcina, B. Dujakovic, R. Tamburic, D. Vulic, R. Skrbic, Temuco, Chile, Hospital Dr. Hernán Henríquez Aravena: P. Figuero, F. La, C. Acs, S. Saavedra Bogota, Colombia, Clinica de Occidente: J Lugo-Peña, M. Ángel Zuleta, Cali, Colombia, Fundacion Valle del Lili: J. Esteban Gomez Mesa, S. Stephania Galindo-Coral, Maria Claudia Montes, Tbilisi, Georgia, High Technology Medical Centre: University Clinic (HTMC), K. Chelidze, I. Mamatsashvli, Kumasi, Ghana, Komfo Anokye Teaching Hospital: L Tetteh Appiah, Y. Hardy, J. Hutton, Accra, Ghana, Military Hospital: A. Toppar, Ludhiana, India, Dayanand Medical College Hospital: B. Mohan, M. Mennen, S. Singla, K. Jain, Ankush, Hyderabad, India, Apollo Hospital: V. Ram, G. Praveen Kumar, K. Subba Reddy, B. V. K. S. Sowmya, M. Rebecca, Hyderabad, India, Apollo Medical College: Jubilee Hills, S. Kuruvada, A. Nimmagadda, A. Begum, Jodhpur, India, P. Bhardwaj, J. Charan, S. Deora, D. Sharma, New Delhi, India, All India Institute Of Medical Sciences (AIIMS): N Naik, N Rai Jakarta, Indonesia, National Cardiovascular Center harapan Kita Hospital: D. Juzar, I Firdaus, B. Putra, M. Rayhan, Isfahan, Iran, Amin Hospital: Ladan Sadeghian, N. Sarrafzadegan, Khorshid hospital, Isfahan, Iran, Mohammad Hashemi, Kyoto, Japan, Kyoto Medical Center: K. Hasegawa, Y. Iida, Tokyo, Japan, Kitasato University School of Medicine: J. Ako, R. Kameda, Tochigi, Japan, NHO Tochigi Medical Center: T. Kato, Mombasa, Kenya, Coast General Teaching and Referral Hospital: E. Ogola, K. Mwazo, V. Vaghela, S. Mohamed, A. Abeid, V. Mumbo, M. Ali Mohamed, A. Ikbal Varvani, M. Omar, V. Karegi, B. Nduati, Swaleh, E. Gacheri, D. Anyanga, S. M. Mohamed, E. Gacheri Riungu, D. Anyanga, Nabil Varwani, Mombasa, Kenya, The Mombasa Hospital: S. Mohamed, E. Gacheri Riungu, D. Anyanga, J. Kamuyu Muriuki, K. Rose, Lucky Rose Adika, Humphrey Robert Guya, Guanajuato, Mexico, ISSSTE Clínica Hospital de Guanajuato: A. Puentes Puentes, Lagos Nigeria, College of Medicine University of Lagos, A. Mbakwem, Ibadan, Nigeria, University College Hospital: O. Ogah, O. Adekanmbi, O. Adebayo, Y. Oyebisi, O. Makinde, O.A. Orimolade, O. Makinde, S. Alabi, Sagamu, Nigeria, Olabisi Onabanjo University Teaching Hospital: F. Inofomoh, Ranti Familoni, Abimbola Olaitan, Victor Ayeni, Boluwatife Egbetola, Sindh, Pakistan, Tabba Heart Institute: S. Sheikh, H. Khan, Z Ahmed, S.F. Ali, R. Malik, Lisbon, Portugal, University Hospital Sta Maria: F. Pinto, D. Caldeira, S. Braz, J. Agostinho, J. Brito, H. Barbacena, F. Parlato, C. Carreiro, R. Soares, C. Gomes, A. Pinto Sousa, M. José Pires, St. Petersburg, Russia, Almazov National Medical Research Centre: A. Konradi, Z. Kobalava, Y. Yudina, M. Ionov, S. Verbilo, Y. Lavrishcheva, S. Bondar, Y. Khruleva Moscow, Russia, RUDN University, City clinical hospital named Vinogradov: L. Contselidze, Y. Khruleva, Kazan, Russia, Kazan Clinical Hospital, A. Galyavich, Z. Kim, Tomsk, Russia, Tomsk National Research Medical Centre, Asinovskaya Regional Hospital: A. Svarovskaya, A. Kuznetsova, Ryazan, Russia, Ryazan State Medical University, Ryazan Emergency Hospital: E. Philippov, Cape Town, South Africa, Groote Schuur Hospital: N. A. B. Ntusi, L. Chinhoyi, O. Briton, C. Viljoen, K. Sliwa, P. Singh, S. Mazondwa, M. Mennen, N. Williams, Khartoum, Sudan, Fedail Hospital: A. Suliman, Zurich, Switzerland, University Hospital of Zurich Hospital: F. Thienemann, V. Rossi, T. Studer, Atlanta, United States, A. Quyyumi, M. Prasad, D. Braun, Lusaka, Zambia, Levy Mwanawasa University Hospital: F. Goma, N. Mumba. ISSSTE Clínica Hospital de Guanajuato: J. E. Luna Cárdenas, G. Sánchez Loza.
Throughout the article, some sentences required rewording:
Each hospital provided the following information at the beginning of the study: estimated size of population served, total number of beds, number of intensive care unit (ICU) beds, number of ventilators, number of cardiologists, availability of echocardiogram (ECG) and advanced care interventional and diagnostic capability (e.g., extracorporeal membrane oxygenation [ECMO], echocardiography [ECHO]), and number of COVID-19 patients admitted in the previous month.
Becomes:
Each hospital provided the following information at the beginning of the study: estimated size of population served, total number of beds, number of intensive care unit (ICU) beds, number of ventilators, number of specialists, availability of echocardiogram (ECG) and advanced care interventional and diagnostic capability (e.g., extracorporeal membrane oxygenation [ECMO], echocardiography [ECHO]), and number of COVID-19 patients admitted in the previous month.
Non-survivors more often presented with significantly higher heart rate, lower diastolic blood pressures, shortness of breath and more frequently had hypertension, diabetes, coronary heart disease, atrial fibrillation, rheumatic heart disease, Chagas disease, valvular disease, and chronic kidney disease (Table 2b).
Becomes:
Non-survivors more often presented with significantly higher heart rate, lower diastolic blood pressures, shortness of breath and more frequently had hypertension, diabetes, coronary artery disease, stroke, chronic kidney disease, chronic pulmonary disease, asthma and renal replacement therapy. (Table 2b).
Our analysis demonstrated a greater rate of in-hospital deaths, post discharge 30-day deaths and MACE among Hispanics, and Asian populations compared to Caucasians. Higher prevalence of comorbidities such as hypertension, diabetes, renal disease and obesity among Asians, Hispanics, and other populations (such as Blacks and Middle Eastern populations) may play a role in the increased mortality and MACE in our cohort of COVID-19 patients.
To:
Our analysis demonstrated a greater rate of in-hospital deaths, and post discharge 30-day deaths among Hispanics, Asian, Blacks and Middle Eastern populations compared to Caucasians. Higher prevalence of comorbidities such as hypertension, diabetes, renal disease and obesity among Asians, Hispanics, Blacks and Middle Eastern populations may play a role in the increased mortality and MACE in our cohort of COVID-19 patients.
Dr. Kavita Singh is supported by the National Institutes of Health, Fogarty International Centre, USA; Emerging Global Leader grant award number: 1 K43 TW011164. Dr Ribeiro is supported in part by Brazilian Agencies CNPq (310679/2016-8 and 465518/2014-1), by FAPEMIG (PPM-00428-17) and CAPES (88887.507149/2020-00). Karen Sliwa is supported by the Hippocrate Foundation and the Medical Research Council South Africa.
The authors have no competing interests to declare.
Prabhakaran D, Singh K, Kondal D, Raspail L, Mohan B, Kato T, et al. Cardiovascular Risk Factors and Clinical Outcomes among Patients Hospitalized with COVID-19: Findings from the World Heart Federation COVID-19 Study. Global Heart. 2022; 17(1): 40. DOI: https://doi.org/10.5334/gh.1128