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MANUSCRIPT CRITERIA AND INFORMATION
INTRODUCTION
These instructions apply to all categories of manuscripts, including Letters to the Editor. Additional instructions follow for submissions to the Clinical Challenges series, which is for invited manuscripts only. Manuscripts may be submitted electronically or as hard copy. Send manuscripts to the Editor, Michael M. E. Johns, MD, Archives of Otolaryngology–Head & Neck Surgery, Emory University, Woodruff Health Sciences Center Administration Building, Suite 400, 1440 Clifton Rd NE, Atlanta, GA 30322; telephone (404) 778-2322; fax (404) 778-3100; e-mail: archoto{at}jama-archives.org. See information below for specifics on mailing and e-mailing your submission.
All accepted manuscripts become the permanent property of the AMA and may not be published elsewhere without permission from both the author(s) and the AMA.
Authorship Responsibility, Criteria, and Contributions; Financial Disclosure; Copyright Transfer; and Acknowledgment Statement. In the cover letter include (1) statement on authorship responsibility, (2) statement on financial disclosure, (3) 1 of the 2 statements on copyright or federal employment, and (4) a statement of acknowledgment. Each of the first 3 statements must be read and signed by all authors.1 The corresponding author must sign the acknowledgment statement. (See the Required Forms page at the end of these Instructions.)
Data Access and Responsibility. For reports containing original data, at least 1 author (eg, the principal investigator) should indicate that he or she "had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis."2
Group Authorship. If authorship is attributed to a group (either solely or in addition to 1 or more individual authors), all members of the group must meet the full criteria and requirements for authorship described in these Instructions. A group must designate at least 1 or more individuals as authors or members of a writing group who meet full authorship criteria and requirements and who will take responsibility for the group, in which case the other group members are not authors, but may be listed in an acknowledgment.3
Acknowledgments. Authors are responsible for obtaining written permission from all persons named in an acknowledgment, if applicable.4 The corresponding author must sign section 4 of the Required Forms page at the end of these Instructions.
Case Descriptions and Photographs. Include a signed statement of consent to publish (in print and online) all case descriptions and photographs from all patients (parents or legal guardians for minors) who can be identified in such written descriptions, photographs, or pedigrees. Please do not send masked photographs of patients. (See patient permission.)
Manuscript Preparation
Manuscripts should be prepared in accordance with the American Medical Association Manual of Style5 and/or the "Uniform Requirements for Manuscripts Submitted to Biomedical Journals." 6
Submit the original manuscript and 2 photocopies on standard-sized white bond paper in double-spaced, letter-quality format, each stapled separately. Please include a diskette containing the text of your manuscript, and any tables, figures, and line art. Specify the following on the diskette: first author, computer operating system used, and word processing software used. For electronic submission, please e-mail your manuscript to archoto{at}jama-archives.org. Your print mail address and telephone and fax numbers should also be included. Tables, figures, and text should be included in the same file. Manuscripts submitted by e-mail should not also be submitted by mail. Please note that the Required Forms page must still be submitted by mail or fax. If an electronic submission is accepted for publication, please note that we will need hard copies of the manuscript and high-quality glossies of all figures (computer-generated graphics produced by high-quality laser printers are acceptable for black-and-white line art only). We will also require that the text, tables, and figures be put in separate files at this stage.
Length of Manuscript. As a rule of thumb, 3 typed double-spaced pages translate into 1 typeset page when manuscripts are prepared in 12-point font with standard 1-inch (2.5-cm) margins. The right margin should be unjustified (ragged). Authors should make allowance for tables and illustrations, which tend to occupy a substantial fraction of the overall space budget. While the editorial board occasionally approves nonconforming manuscripts, it does so only when they are considered to possess exceptional merit. Submissions that do not conform to recommended space limitations are subjected to a particularly rigorous editorial review and are thus less likely to be accepted than those that fall within recommended guidelines.
Double-space throughout, including title page, abstract, text, acknowledgments, references, legends, and tables. Number pages consecutively in the upper right-hand corner, beginning with the title page.
Titles should not exceed 75 characters, including punctuation and spacing. Avoid abbreviations in the title, abstract, and text.
Title Page (page 1 of manuscript). Give full names, highest academic degrees, and institutional affiliations of all authors. (If an author's affiliation has changed since the work was done, list the new affiliation as well.) Designate a corresponding author and include a complete mailing address, telephone number, fax number, and e-mail address (if available). Specify the address to which requests for reprints should be sent. If the manuscript was presented at a meeting, please specify the name of the meeting, the city where it was held, and the exact date on which the paper was read or the poster was presented. Also include on the title page a word count for the text only, exclusive of the title, abstract, references, tables, and figure legends.
Abstract (page 2 of manuscript). Include a structured abstract of no more than 250 words for reports of original data from clinical or basic science investigations and reviews (including meta-analyses).7 (See "Instructions for Preparing Structured Abstracts.") For case reports, include an unstructured abstract of no more than 150 words.
Informed Consent. For experimental investigations of human subjects, state in the "Methods" section of the manuscript that the appropriate institutional review board approved the project. For those investigators who do not have formal ethics review committees (institutional or regional), the principles outlined in the Declaration of Helsinki should be followed.8 Specify in the "Methods" section the manner in which consent was obtained from all human subjects.
Animal Experimentation. For experimental investigations of animal subjects, specify in the "Methods" section of the manuscript what animal-handling protocols were followed, eg, "Institutional guidelines regarding animal experimentation were followed." For those investigators who do not have formal ethics review committees (institutional or regional), the principles outlined in the Declaration of Helsinki should be followed.8
Units of Measure. Conventional units of measure are preferred, with Système International (SI) units expressed secondarily (in parentheses). In tables and figures, a conversion factor to SI may be presented in the footnote or legend to economize space. Exceptions to this policy include calories, hematocrit, glycosylated hemoglobin, blood cell counts, and ejection fraction, for which conventional units alone should be expressed. The metric system is preferred for length, area, mass, and volume. (See SI conversion table.)
Drug Names. Use generic names of drugs, unless the specific trade name of a drug used is directly relevant to the discussion.
References. Number references in the order they are mentioned in the text; do not alphabetize. In text, tables, and legends, identify references with superscript arabic numerals. In listing references, follow AMA style, abbreviating names of journals according to Index Medicus. List all authors and/or editors up to 6; if more than 6, list the first 3 and "et al." The reference numbers in the reference list should be keystroked. Please do not use a word processing program to generate the reference numbers, using such features as automatic footnotes or endnotes.
Web References. Please keep a print copy of any reference to Web-only information. If the URL changes or disappears, interested readers may contact the corresponding author for a copy of the information.
Authors are responsible for the accuracy and completeness of their references and for correct text citation.
Tables. Double-space on separate sheets of standard-sized white bond paper. Title all tables and number them in order of citation in the text. If a table must be continued, repeat the title, head, and stubs on a second sheet, followed by "(cont)."
Illustrations. Submit 3 sets of all figures: (1) unmounted, untrimmed (12.7 x 17.3 cm [5 x 7 inches]) high-contrast glossy prints for all graphs and black-and-white photographs; (2) high-contrast prints for roentgenograms; or (3) color prints accompanied by the original positive color (35-mm) transparencies. (Do not send glass-mounted transparencies.) Affix a typed gummed label with figure number, first author, and an arrow indicating "top" on the back of each figure or frame of slides.
Computer-generated graphics produced by high-quality laser printers are acceptable for black-and-white line art only. Line drawings should be submitted in triplicate as glossy prints and must be accompanied by a signed copyright transfer (see section 3 of the Required Forms page) from the illustrator(s).
Acknowledge all illustrations and tables reprinted from other publications and submit written permission to reproduce (in print and online and in all licensed versions) from the original publishers. (See permission form.)
Digitally enhanced images (eg, computed tomographic–magnetic resonance imaging scans, blots, photographs, photomicrographs, ultrasound images, x-ray films) must be clearly identified in the figure legends as electronically enhanced or manipulated. Please include and clearly label 3 copies of the enhanced images and 3 copies of the original images for review by our referees.
Digital Art Submissions. Submit digital files for images and illustrations originally created digitally. RGB color submissions are preferred. Calibrated color proofs should be submitted with color digital film, if possible. The canvas size of continuous tone images should be at least 5 inches wide (depth not important) with an image resolution of at least 350 ppi. Line art images should have a minimum resolution of at least 1270 ppi. Formats acceptable are EPS, TIFF, and JPG. (See additional guidelines for submitting digital figures.)
Legends. Legends (maximum 40 words) should be typed double-spaced, on a separate page from the text. Indicate magnification and stains used for photomicrographs. Include specific postoperative intervals where applicable.
Rejected Manuscripts. Rejected original manuscripts will not be returned to authors unless specifically requested in the cover letter. All original illustrations, photographs, and slides will be returned.4
Editing. Accepted manuscripts are copyedited according to AMA style and returned to the author for approval. Authors are responsible for all statements made in their work, including changes made by the copy editor and authorized by the corresponding author.
Reprints. Reprint order forms are included with the edited typescript sent for approval to authors. Reprints are shipped 3 weeks after publication.
Embargo Policy. Information regarding the content and publication date of accepted manuscripts is confidential. Information contained in or about accepted manuscripts cannot appear in print, radio, television, or in electronic form or be released to the media until 3 PM CST on the third Monday of the month.
ORIGINAL ARTICLES are concise (1) reports of clinical data, (2) reports of basic science data, or (3) reviews, including meta-analyses, that represent advanced information and a new contribution to biomedical literature as determined by the ARCHIVES editorial staff. Original articles require structured abstracts as detailed under "Abstract."
REPORTS OF RANDOMIZED CONTROLLED TRIALS. For manuscripts reporting the results of randomized controlled trials, the CONSORT checklist (Table) should be completed and submitted with the manuscript.
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Checklist of Items to Include When Submitting Reports of Randomized Controlled Trials to the Archives of Otolaryngology—Head and Neck Surgery*
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CLINICAL NOTES/CASE REPORTS.9 A case report should be concise and focused on one topic that results in final publication of not more than 2 journal pages, including references. These reports should describe a new disease state (with diagnostic documentation including pathologic findings), identification of a new complication from a treatment or procedure, a new diagnostic technique, or a new technology transferred from one field to another. The case report should not be simply the report of an old disease in a new site solely because it has not been reported in the medical literature, unless there is a diagnostic point to distinguish it from other diseases. If the report provides a new treatment option, the disease should be of such rarity that it is unlikely that a series could be developed that would be amenable to standard investigational analysis. Case reports may also be based on seminal observations that provide an understanding of the mechanism of disease, particularly when the pathophysiology involves a rare and not easily retested event.
CLINICAL PROBLEM SOLVING: RADIOLOGY AND PATHOLOGY. Residents and fellows in otolaryngology and radiology are invited to submit quiz cases for this section and to write letters to the ARCHIVES commenting on cases presented. Quiz cases should follow the patterns established (maximum length 5 pages, double-spaced, and 3-4 figures) and must be submitted in triplicate. Photomicrographs must be clear and can include an outline drawing with important structures labeled. Illustrations must be submitted as positive color transparencies (35 mm preferred; please, no glass slides). Please do not submit color prints unless accompanied by original transparencies. Please package slides carefully to avoid damage. Material for the Clinical Problem Solving section should be mailed to the Editor. Reprints are not available from the authors.
CLINICAL CHALLENGES. The author's charge is to present a fair and balanced reflection of the good-quality information in the recent medical literature. The format is (1) Hypothesis: the controversial or puzzling statement; (2) Pro: a summary of current knowledge supporting this statement; (3) Con: a summary of current knowledge refuting this statement; (4) Bottom Line: your opinion of the truth or fallacy (or partial truth/fallacy) of the original hypothetical statement; and (5) References: the most relevant only, 10 or fewer. Also list the key words used in your literature search, so others can duplicate it if they wish. This review should be concise, taking up no more than 3 journal pages, or 8 to 10 double-spaced 11- or 12-pitch pages. If you use any illustrations, please figure one-quarter journal page per figure. Your manuscript will be peer reviewed, as are all articles for this journal, and revisions may be requested. The author should also enclose a self-photograph to be published along with the Clinical Challenges article. When this review is published in the ARCHIVES, it will appear along with a short clinical commentary by 1 or 2 other otolaryngologists generally regarded as experts in this area. While your review is intended as straight information, these commentaries will reflect the personal experience of the clinicians. Please mail your Clinical Challenges submission to the Editor's office in Atlanta. Also, note that the Clinical Challenges series is for invited manuscripts only. The Editor, however, welcomes suggestions of topics for the monthly series.
COVER PHOTOGRAPHS. Submissions must be formatted horizontally. They can be black and white or color and at least 3.5 x 5 inches but no larger than 8 x 10 inches. If you wish to submit a digital photograph, please see our digital art submissions guidelines elsewhere in these Instructions. Due to legal concerns, no recognizable people should appear in the picture. Please include details about where the picture was taken, how you happened to be there, and anything else you think is interesting about the image. We need the photographer's complete name, highest academic degree, city and state of residence, and a statement explaining how the photographer is affiliated with the journal. Send submissions to the Archives of Otolaryngology—Head & Neck Surgery, 1440 E Clifton Rd NE, Suite 400, Atlanta, GA 30322. If you would like your photo returned, please enclose a self-addressed, stamped envelope. Cover photos will be chosen at the discretion of the Archives editorial staff.
REFLECTIONS. This section features an essay of 1 printed page (approximately 3 double-spaced pages, or 900 words) designed to relate those personal experiences in medicine that have no scientific or statistical basis. All submissions to Reflections must be previously unpublished and be accompanied by the Required Forms page. Any reference to individuals mentioned by name must be accompanied by a signed release from the individual or from the individual's family, if the individual is deceased.
INSTRUCTIONS FOR PREPARING STRUCTURED ABSTRACTS*
All manuscripts that are (1) reports of clinical data, (2) reports of basic science data, or (3) reviews, including meta-analyses, should be submitted with structured abstracts as described below.
To permit quick and selective scanning and allow more information to be conveyed per unit of space, the headings outlined below should be included in the abstract. For brevity, parts of the abstract can be written in phrases rather than complete sentences. (For example: "2. Design. Double-blind randomized trial," rather than "2. Design. The study was conducted as a double-blind, randomized trial.")
*Adapted from Haynes RB, Mulrow CD, Huth EJ, Altman DG, Gardner MJ. More informative abstracts revisited. Ann Intern Med. 1990;113:69-76.
Reports of Clinical Data
Authors submitting manuscripts reporting clinical data should prepare an abstract of no more than 250 words under the following headings: Objective, Design, Setting, Patients (or Other Participants), Interventions (if any), Main Outcome Measures, Results, and Conclusions. The content following each heading should be as follows:
1. Objective. The abstract should begin with a clear statement of the precise objective or question addressed in the report. If more than 1 objective is addressed, the main objective should be indicated and only key secondary objectives stated. If an a priori hypothesis was tested, it should be stated.
2. Design. The basic design of the study should be described. The duration of follow-up, if any, should be stated. As many of the following terms as apply should be used.
A. Intervention studies: randomized controlled trial; nonrandomized controlled trial; double-blind; placebo controlled; crossover trial; before-after trial.
B. For studies of screening and diagnostic tests: criterion standard (that is, a widely accepted standard with which a new or alternative test is being compared; this term is preferred to "gold standard"); blinded or masked comparison.
C. For studies of prognosis: inception cohort (subjects assembled at a similar and early time in the course of the disorder and followed thereafter); cohort (subjects followed forward in time, but not necessarily from a common starting point); validation cohort or validation sample if the study involves the modeling of clinical predictions.
D. For studies of causation: randomized controlled trial; cohort; case-control; survey (preferred to "cross-sectional study").
E. For descriptions of the clinical features of medical disorders: survey; case series.
F. For studies that include a formal economic evaluation: cost-effectiveness analysis; cost-utility analysis; cost-benefit analysis. For new analyses of existing data sets, the data set should be named and the basic study design disclosed.
3. Setting. To assist readers to determine the applicability of the report to their own clinical circumstances, the study setting(s) should be described. Of particular importance is whether the setting is the general community, a primary care or referral center, private or institutional practice, ambulatory or hospitalized care.
4. Patients or Other Participants. The clinical disorders, important eligibility criteria, and key sociodemographic features of patients should be stated. The numbers of participants and how they were selected should be provided (see below), including the number of otherwise eligible subjects who were approached but refused. If matching is used for comparison groups, characteristics that are matched should be specified. In follow-up studies, the proportion of participants who completed the study must be indicated. In intervention studies, the number of patients withdrawn for adverse effects should be given. For selection procedures, these terms should be used, if appropriate: random sample (where "random" refers to a formal, randomized selection in which all eligible subjects have a fixed and usually equal chance of selection); population-based sample; referred sample; consecutive sample; volunteer sample; convenience sample. These terms assist the reader to determine an important element of the generalizability of the study. They also supplement (rather than duplicate) the terms used by professional indexers when articles are entered into computerized databases.
5. Intervention(s). The essential features of any interventions should be described, including their method and duration of administration. The intervention should be named by its most common clinical name (for example, the generic term "chlorthalidone"). Common synonyms should be given as well to facilitate electronic text word searching. This would include the brand name of a drug if a specific product was studied.
6. Main Outcome Measure(s). The primary study outcome measurement(s) should be indicated as planned before data collection began. If the paper does not emphasize the main planned outcomes of a study, this fact should be stated and the reason indicated. If the hypothesis being reported was formulated during or after data collection, this information should be clearly stated.
7. Results. The main results of the study should be given. Measurements that require explanation for the expected audience of the manuscript should be defined. Important measurements not included in the presentation of results should be declared. As relevant, it should be indicated whether observers were blinded to patient groupings, particularly for subjective measurements. Due to the current limitations of retrieval from electronic databases, results must be given in narrative or point form rather than tabular form if the abstract is to appear in computerized literature services such as MEDLINE. If possible, the results should be accompanied by confidence intervals (for example, 95%) and the exact level of statistical significance. For comparative studies, confidence intervals should relate to the differences between groups. For nonsignificant differences for the major study outcome measure(s), the clinically important difference sought should be stated and the confidence interval for the difference between the groups should be given. When risk changes or effect sizes are given, absolute values should be indicated so that the reader can determine the absolute as well as relative impact of the finding. Approaches such as "number needed to treat" to achieve a unit of benefit are encouraged when appropriate; reporting of relative differences alone is usually inappropriate. If appropriate, studies of screening and diagnostic tests should use the terms "sensitivity," "specificity," and "likelihood ratio." If predictive values or accuracy is given, prevalence or pretest likelihood should be given as well. No data should be reported in the abstract that do not appear in the rest of the manuscript.
8. Conclusions. Only those conclusions of the study that are directly supported by the evidence reported should be given, along with their clinical application (avoiding speculation and overgeneralization), and indicating whether additional study is required before the information should be used in usual clinical settings. Equal emphasis must be given to positive and negative findings of equal scientific merit.
Reports of Basic Science
Authors submitting manuscripts reporting basic science data should prepare an abstract of no more than 250 words under the following headings: Objective, Design, Subjects, Interventions (if any), Results, and Conclusions. The content following each heading should be as follows:
1. Objective. The abstract should begin with a clear statement of the precise objective or question addressed in the report. If more than one objective is addressed, the main objective should be indicated and only key secondary objectives stated. If an a priori hypothesis was tested, it should be stated.
2. Design. The basic design of the study should be described. The duration of follow-up, if any, should be stated. As many of the following terms as apply should be used.
A. Intervention studies: randomized controlled trial; nonrandomized controlled trial; double-blind; placebo controlled; crossover trial; before-after trial.
B. For studies of screening and diagnostic tests: criterion standard; blinded or masked comparison.
C. For studies of causation: randomized controlled trial; cohort; case control; survey (preferred to "cross-sectional study").
D. For descriptions of biologic characteristics: anatomic; audiologic; physiologic; genetic analysis; etc.
3. Subjects. The numbers of subjects and how they were selected should be provided. If matching is used for comparison groups, characteristics that are matched should be specified. In intervention studies, the number of subjects withdrawn for adverse effects should be given.
4. Intervention(s). The essential features of any interventions should be described, including their method and duration of administration.
5. Results. The main results of the study should be given. Measurements that require explanation for the expected audience of the manuscript should be defined. Important measurements not included in the presentation of results should be declared. As relevant, it should be indicated whether observers were blinded to groupings, particularly for subjective measurements. Due to the current limitations of retrieval from electronic databases, results must be given in narrative or point form rather than tabular form if the abstract is to appear in computerized literature services such as MEDLINE. No data should be reported in the abstracts that do not appear in the rest of the manuscript. If more than one outcome measure is addressed, list results separately.
6. Conclusions. Only those conclusions of the study that are directly supported by the evidence reported should be given, along with their clinical application (avoiding speculation and overgeneralization), and indicating whether additional study is required before the information should be used in usual clinical settings. Equal emphasis must be given to positive and negative findings of equal scientific merit.
Review Manuscripts (Including Meta-analyses)
Authors submitting review manuscripts and reports of the results of meta-analyses should prepare an abstract of no more than 250 words under the following headings: Objective, Data Sources, Study Selection, Data Extraction, Data Synthesis, and Conclusions. The content following each heading should be as follows:
1. Objective. The abstract should begin with a precise statement of the primary objective of the review. The focus of this statement should be guided by whether the review emphasizes factors such as cause, diagnosis, prognosis, therapy, or prevention. It should include information about the specific population, intervention, exposure, and test or outcome that is being reviewed.
2. Data Sources. A succinct summary of data sources should be given, including any time restrictions. Potential sources include experts or research institutions active in the field, computerized databases and published indexes, registries, abstract booklets, conference proceedings, references identified from bibliographies of pertinent articles and books, and companies or manufacturers of tests or agents being reviewed. If a bibliographic database is used, the exact indexing terms used for article retrieval should be stated, including any constraints (for example, English language or human subjects).
3. Study Selection. The abstract should describe the criteria used to select studies for detailed review from among studies identified as relevant to the topic. Details of selection should include particular populations, interventions, outcomes, or methodologic designs. The method used to apply these criteria should be specified (for example, blind review, consensus, multiple reviewers). The proportion of initially identified studies that met selection criteria should be stated.
4. Data Extraction. Guidelines used for abstracting data and assessing data quality and validity (such as criteria for causal inference) should be described. The method by which the guidelines were applied should be stated (for example, independent extraction by multiple observers).
5. Data Synthesis. The main results of the review, whether qualitative or quantitative, should be stated. Methods used to obtain these results should be outlined. Meta-analyses should state the major outcomes that were pooled and include odds ratios or effect sizes and, if possible, sensitivity analyses. Numerical results should be accompanied by confidence intervals, if applicable, and exact levels of statistical significance. Evaluations of screening and diagnostic tests should address issues of sensitivity, specificity, likelihood ratios, receiver operating characteristic curves, and predictive values. Assessments of prognosis could include summarizations of survival characteristics and related variables. Major identified sources of variation between studies should be stated, including differences in treatment protocols, co-interventions, confounders, outcome measures, length of follow-up, and dropout rates.
6. Conclusions. The conclusions and their applications should be clearly stated, limiting generalization to the domain of the review. The need for new studies may be suggested.
ADDITIONAL INFORMATION PAGES
Updated August 2003
REFERENCES
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2. DeAngelis CD, Fontanarosa PB, Flanagin A. Reporting financial conflicts of interest and relationships between investigators and research sponsors. JAMA. 2001;286:89-91.
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3. Flanagin A, Fontanarosa PB, DeAngelis CD. Authorship for research groups. JAMA. 2002;288:3166-3168.
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4. Glass RM. New information for authors and readers: group authorship, acknowledgments, and rejected manuscripts. JAMA. 1992;268:299.
5. Iverson CL, Flanagin A, Fontanarosa PB, et al. American Medical Association Manual of Style. 9th ed. Baltimore, Md: Williams & Wilkins; 1998.
6. International Committee of Medical Journal Editors. Uniform Requirements for Manuscripts Submitted to Biomedical Journals. JAMA. 1997;277:927-934.
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7. Niparko JK, Johns ME. Structured abstracts come to the Archives of Otolaryngology–Head & Neck Surgery. Arch Otolaryngol Head Neck Surg. 1992;118:905.
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8. 52nd WMA General Assembly. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2000;284:3043-3049.
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9. Richtsmeier WJ. Editorial: case report. Arch Otolaryngol Head Neck Surg. 1993;119:926.
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