{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T16:01:50Z","timestamp":1792857710615,"version":"4.5.0"},"reference-count":84,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T00:00:00Z","timestamp":1622764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>A massive chemical detonation occurred on August 4, 2020 in the Port of Beirut, Lebanon. An uncontrolled fire in an adjacent warehouse ignited ~2,750 tons of Ammonium Nitrate (AN), producing one of the most devastating blasts in recent history. The blast supersonic pressure and heat wave claimed the lives of 220 people and injured more than 6,500 instantaneously, with severe damage to the nearby dense residential and commercial areas. This review represents one of the in-depth reports to provide a detailed analysis of the Beirut blast and its health and environmental implications. It further reviews prior AN incidents and suggests actionable recommendations and strategies to optimize chemical safety measures, improve emergency preparedness, and mitigate the delayed clinical effects of blast and toxic gas exposures. These recommended actionable steps offer a starting point for government officials and policymakers to build frameworks, adopt regulations, and implement chemical safety protocols to ensure safe storage of hazardous materials as well as reorganizing healthcare system disaster preparedness to improve emergency preparedness in response to similar large-scale disasters and promote population safety. Future clinical efforts should involve detailed assessment of physical injuries sustained by blast victims, with systemic mitigation and possible treatment of late blast effects involving individuals, communities and the region at large.<\/jats:p>","DOI":"10.3389\/fpubh.2021.657996","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T11:11:51Z","timestamp":1622805111000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":79,"title":["Beirut Ammonium Nitrate Blast: Analysis, Review, and Recommendations"],"prefix":"10.3389","volume":"9","author":[{"given":"Samar","family":"Al-Hajj","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan R.","family":"Dhaini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Mondello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haytham","family":"Kaafarani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firas","family":"Kobeissy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph G.","family":"DePalma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.jhazmat.2004.02.039","article-title":"First lessons of the Toulouse ammonium nitrate disaster 21st September 2001 AZF plant France","volume":"111","author":"Dechy","year":"2004","journal-title":"J Hazard Mater"},{"key":"B2","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.jhazmat.2016.01.039","article-title":"Case study and lessons learned from the ammonium nitrate explosion at the West Fertilizer facility","volume":"308","author":"Laboureur","year":"2016","journal-title":"J Hazard Mater"},{"key":"B3","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/S0022-3476(53)80001-6","article-title":"The physical growth and development of children who survived the atomic bombing of Hiroshima or Nagasaki","volume":"43","author":"Greulich","year":"1953","journal-title":"J Pediatr"},{"key":"B4","unstructured":"Beirut Explosion: Lebanon's Government \u2018To Resign' As Death Toll Rises2020"},{"key":"B5","unstructured":"Beirut Port Blast Emergency Strategic Response Plan2020"},{"key":"B6","unstructured":"Beirut Rapid Damage and Needs Assessment (RDNA)2020"},{"key":"B7","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1111\/acem.14147","article-title":"Airway breathing circulation: an emergency medicine resident's experience of the Beirut explosion","volume":"28","author":"Abdul-Nabi","year":"2020","journal-title":"Acad Emerg Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2020-210880.","article-title":"Beirut explosion aftermath: lessons and guidelines","author":"Al-Hajj","year":"2021","journal-title":"Emerg Med J"},{"key":"B9","unstructured":"A brief report on the Beirut port explosion\n            CheaitoMA\n            Al-HajjS\n          Mediterr J Emerg Med Acute Care92020"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1038\/d41586-020-02361-x","article-title":"Why Beirut's ammonium nitrate blast was so devastating","author":"Guglielmi","year":"2020","journal-title":"Nature"},{"key":"B11","doi-asserted-by":"publisher","first-page":"303","DOI":"10.5055\/ajdm.2020.0379","article-title":"The Beirut blast 2020: lessons learned from the Swiss emergency medical team specialized \u201cmother & child","volume":"15","author":"Hagon","year":"2020"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1186\/s12913-020-05906-y","article-title":"The 2020 blast in the Port of Beirut: can the Lebanese health system\u201d build back better\"?","volume":"20","author":"Landry","year":"2020","journal-title":"BMC Health Serv Res."},{"key":"B13","author":"Mansour","year":"","journal-title":"Beirut Port Ammonium Nitrate Explosion"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e12203","DOI":"10.1002\/prs.12203","article-title":"Beirut ammonium nitrate explosion: are not we really learning anything?","volume":"39","author":"Pasman","year":"2020","journal-title":"Process Saf Prog."},{"key":"B15","doi-asserted-by":"publisher","first-page":"104387","DOI":"10.1016\/j.jlp.2020.104387","article-title":"Investigative consequence analysis: a case study research of Beirut explosion accident","volume":"69","author":"Sivaraman","year":"","journal-title":"J Loss Prev Process Ind"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1002\/prep.202000227","article-title":"An estimate of the TNT-equivalent net explosive quantity (NEQ) of the Beirut port explosion using publicly-available tools and data","volume":"45","author":"Stennett","year":"2020","journal-title":"Propellants Explosives Pyrotechnics."},{"key":"B17","doi-asserted-by":"publisher","first-page":"111834","DOI":"10.1016\/j.ecoenv.2020.111834","article-title":"Ammonium nitrate is a risk for environment: a case study of Beirut (Lebanon) chemical explosion and the effects on environment","volume":"210","author":"Ur Rehman","year":"2021","journal-title":"Ecotoxicol Environ Saf"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00256-020-03707-2","article-title":"Beirut port explosion: unusual presentation of bilateral blast-related extensor mechanism rupture","volume":"50","author":"Zaiter","year":"2021","journal-title":"Skeletal Radiol"},{"key":"B19","unstructured":"Atlassian by the World Food Program2020"},{"key":"B20","unstructured":"Mass Casualty Trauma Management2020"},{"key":"B21","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1089\/neu.2007.0439","article-title":"Blast-induced brain injury and posttraumatic hypotension and hypoxemia","volume":"26","author":"DeWitt","year":"2009","journal-title":"J. Neurotrauma"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1179069519872213","DOI":"10.1177\/1179069519872213","article-title":"Blast-related traumatic brain injury: current concepts and research considerations","volume":"13","author":"Bryden","year":"2019","journal-title":"J Exp Neurosci"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1056\/NEJMra042083","article-title":"Blast injuries","volume":"352","author":"DePalma","year":"2005","journal-title":"N Engl J Med"},{"key":"B24","unstructured":"Explosions and Blast Injuries A Primer for Clinicians2003"},{"key":"B25","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1016\/j.jhazmat.2008.10.054","article-title":"Thermal stability and kinetics of decomposition of ammonium nitrate in the presence of pyrite","volume":"165","author":"Gunawan","year":"2009","journal-title":"J Hazard Mater"},{"key":"B26","unstructured":"Nitrogen Oxides (NO, NO2020"},{"key":"B27","first-page":"348","article-title":"Evaluation of biological significance of nitrogen oxides exposure","volume":"10","author":"Kagawa","year":"1985","journal-title":"Tokai J Exp Clin Med"},{"key":"B28","first-page":"73","article-title":"Exposure to nitrogen dioxide (NO2) and respiratory disease risk","volume":"13","author":"Chauhan","year":"1998","journal-title":"Rev Environ Health"},{"key":"B29","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1016\/j.envpol.2007.06.012","article-title":"Human health effects of air pollution","volume":"151","author":"Kampa","year":"2008","journal-title":"Environ Pollut"},{"key":"B30","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/j.etp.2004.12.004","article-title":"NO2-induced airway inflammation is associated with progressive airflow limitation and development of emphysema-like lesions in C57BL\/6 mice","volume":"56","author":"Wegmann","year":"2005","journal-title":"Exp Toxicol Pathol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/1476-069X-12-43","article-title":"Long-term air pollution exposure and cardio- respiratory mortality: a review","volume":"12","author":"Hoek","year":"2013","journal-title":"Environ Health"},{"key":"B32","unstructured":"Chemical Safety Alert: Explosion Hazard From Ammonium Nitrate, EPA 550-F-97-002d1997"},{"key":"B33","unstructured":"Van DolahR\n            MasonC\n            PerzakF\n            HayJ\n            ForsheyD\n          Explosion Hazards of Ammonium Nitrate Under Fire Exposure1966"},{"key":"B34","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.jhazmat.2005.03.028","article-title":"Safety and security issues relating to low capacity storage of AN-based fertilizers","volume":"123","author":"Marlair","year":"2005","journal-title":"J Hazard Mater"},{"key":"B35","volume-title":"The Texas City Disaster","author":"Stephens","year":"1997"},{"key":"B36","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1136\/jramc-2018-000956","article-title":"Guidelines for using animal models in blast injury research","volume":"165","author":"Watts","year":"2019","journal-title":"J R Army Med Corps"},{"key":"B37","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1039\/tf9242000046","article-title":"Investigation on the chemical and physical properties of Oppau ammonium sulphate-nitrate at the government laboratory","volume":"20","author":"Robertson","year":"1924","journal-title":"Trans Faraday Soc"},{"key":"B38","unstructured":"Finland Explosion1963"},{"key":"B39","unstructured":"Mihailsti Explosion2004"},{"key":"B40","unstructured":"AtfieldC\n          Truck Explosion Injures Eight, Closes Mitchell Highway2014"},{"key":"B41","unstructured":"TessenderloGroup\n          Explosion at the Produits Chimiques de Tessenderloo (PCT) Factory, Wednesday 29 April 19421942"},{"key":"B42","unstructured":"McKinleyJ\n          Truck Explosion in Mexico Kills 372007"},{"key":"B43","unstructured":"FavershamTimes\n          Tales of Horror and Heroism After the Great Explosion2012"},{"key":"B44","unstructured":"Beirut Explosion: Lebanon's Government 'to Resign' as Death Toll Rises2020"},{"key":"B45","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/s11069-016-2403-0","article-title":"Facts and lessons related to the explosion accident in Tianjin Port, China","volume":"84","author":"Zhao","year":"2016","journal-title":"Nat Hazards"},{"key":"B46","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1017\/dmp.2015.186","article-title":"Epidemiologic investigation of injuries associated with the 2013 fertilizer plant explosion in West, Texas","volume":"10","author":"Metzger","year":"2016","journal-title":"Disaster Med Public Health Preparedness."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1016\/j.burns.2016.03.004","article-title":"Evaluation of blast injury patients from the 2015 Tianjin explosions in China","volume":"42","author":"Yu","year":"2016","journal-title":"Burns."},{"key":"B48","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1097\/TA.0b013e31825a760e","article-title":"Brain injury risk from primary blast","volume":"73","author":"Rafaels","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"key":"B49","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.bbr.2016.08.037","article-title":"Linking blast physics to biological outcomes in mild traumatic brain injury: Narrative review and preliminary report of an open-field blast model","volume":"340","author":"Song","year":"2018","journal-title":"Behav Brain Res"},{"key":"B50","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1682\/JRRD.2004.08.0095","article-title":"Utility of mechanism-of-injury-based assessment and treatment: blast injury program case illustration","volume":"42","author":"Belanger","year":"2005","journal-title":"J Rehabil Res Dev"},{"key":"B51","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/S0300-483X(97)03652-4","article-title":"The pathology of primary blast overpressure injury","volume":"121","author":"Mayorga","year":"1997","journal-title":"Toxicology"},{"key":"B52","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1002\/acn3.98","article-title":"Concussive brain injury from explosive blast","volume":"1","author":"de Lanerolle","year":"2014","journal-title":"Ann Clin Transl Neurol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"CNC42","DOI":"10.2217\/cnc-2017-0006","article-title":"Understanding blast-induced neurotrauma: how far have we come?","volume":"2","author":"Cernak","year":"2017","journal-title":"Concussion"},{"key":"B54","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.bbr.2016.08.036","article-title":"Combat blast related traumatic brain injury (TBI): decade of recognition; promise of progress","volume":"340","author":"DePalma","year":"2018","journal-title":"Behav Brain Res"},{"key":"B55","doi-asserted-by":"crossref","DOI":"10.1201\/b18126-3","article-title":"Combat TBI: history, epidemiology, and injury modes","volume-title":"Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects","author":"DePalma","year":"2015"},{"key":"B56","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1089\/neu.2007.0484","article-title":"Explosive blast neurotrauma","volume":"26","author":"Ling","year":"2009","journal-title":"J Neurotrauma"},{"key":"B57","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1097\/NEN.0b013e318235bef2","article-title":"Characteristics of an explosive blast-induced brain injury in an experimental model","volume":"70","author":"de Lanerolle","year":"2011","journal-title":"J Neuropathol Exp Neurol"},{"key":"B58","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1017\/S1049023X12000891","article-title":"Explosions and human health: the long-term effects of blast injury","volume":"27","author":"Finlay","year":"2012","journal-title":"Prehospital Disaster Med."},{"key":"B59","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.pathophys.2012.03.001","article-title":"Pathophysiology of battlefield associated traumatic brain injury","volume":"20","author":"Duckworth","year":"2013","journal-title":"Pathophysiology"},{"key":"B60","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1097\/00005373-200104000-00017","article-title":"Ultrastructural and functional characteristics of blast injury-induced neurotrauma","volume":"50","author":"Cernak","year":"2001","journal-title":"J Trauma"},{"key":"B61","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.4103\/1673-5374.237110","article-title":"Nanometer ultrastructural brain damage following low intensity primary blast wave exposure","volume":"13","author":"Song","year":"2018","journal-title":"Neural Regen Res"},{"key":"B62","doi-asserted-by":"publisher","first-page":"2017","DOI":"10.1016\/j.neuroimage.2011.10.050","article-title":"Diffuse and spatially variable white matter disruptions are associated with blast-related mild traumatic brain injury","volume":"59","author":"Davenport","year":"2012","journal-title":"Neuroimage"},{"key":"B63","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/j.mri.2011.12.018","article-title":"Voxel- and atlas-based analysis of diffusion tensor imaging may reveal focal axonal injuries in mild traumatic brain injury \u2013 comparison with diffuse axonal injury","volume":"30","author":"Kasahara","year":"2012","journal-title":"Magn Reson Imaging"},{"key":"B64","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1097\/HTR.0b013e3181e52c2a","article-title":"Diffusion tensor imaging of mild traumatic brain injury","volume":"25","author":"Niogi","year":"2010","journal-title":"J Head Trauma Rehabil"},{"key":"B65","doi-asserted-by":"publisher","first-page":"967","DOI":"10.3174\/ajnr.A0970","article-title":"Extent of microstructural white matter injury in postconcussive syndrome correlates with impaired cognitive reaction time: a 3T diffusion tensor imaging study of mild traumatic brain injury","volume":"29","author":"Niogi","year":"2008","journal-title":"AJNR Am J Neuroradiol"},{"key":"B66","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1056\/NEJMoa1008069","article-title":"Detection of blast-related traumatic brain injury in U.S. military personnel","volume":"364","author":"Mac Donald","year":"2011","journal-title":"N Engl J Med."},{"key":"B67","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1097\/00001199-200609000-00004","article-title":"Military TBI during the Iraq and Afghanistan wars","volume":"21","author":">Warden","year":"2006","journal-title":"J Head Trauma Rehabil"},{"key":"B68","doi-asserted-by":"publisher","first-page":"559318","DOI":"10.3389\/fneur.2020.559318","article-title":"Characteristics impact of U.S. military blast-related mild traumatic brain injury: a systematic review","volume":"11","author":"Phipps","year":"2020","journal-title":"Front. Neurol."},{"key":"B69","doi-asserted-by":"publisher","first-page":"641","DOI":"10.3109\/02699052.2011.580313","article-title":"Non-impact, blast-induced mild TBI and PTSD: concepts and caveats","volume":"25","author":"Chen","year":"2011","journal-title":"Brain Inj"},{"key":"B70","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1682\/JRRD.2005.07.0124","article-title":"Rehabilitation needs of an increasing population of patients: Traumatic brain injury, polytrauma, and blast-related injuries","volume":"42","author":"Lew","year":"2005","journal-title":"J Rehabil Res Dev"},{"key":"B71","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/02699050701829696","article-title":"PTSD and traumatic brain injury: folklore and fact?","volume":"22","author":"King","year":"2008","journal-title":"Brain Inj"},{"key":"B72","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1682\/JRRD.2008.05.0064","article-title":"Overlap of mild TBI and mental health conditions in returning OIF\/OEF service members and veterans","volume":"45","author":"Lew","year":"2008","journal-title":"J Rehabil Res Dev"},{"key":"B73","doi-asserted-by":"publisher","first-page":"223","DOI":"10.3233\/NRE-2010-0558","article-title":"Posttraumatic stress symptoms in OIF\/OEF service members with blast-related non-blast-related mild TBI","volume":"26","author":"Kennedy","year":"2010","journal-title":"NeuroRehabilitation"},{"key":"B74","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1586\/erm.10.104","article-title":"Blood-based diagnostics of traumatic brain injuries","volume":"11","author":"Mondello","year":"2011","journal-title":"Expert Rev Mol Diagn"},{"key":"B75","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1002\/med.21295","article-title":"The challenge of mild traumatic brain injury: role of biochemical markers in diagnosis of brain damage","volume":"34","author":"Mondello","year":"2014","journal-title":"Med Res Rev"},{"key":"B76","doi-asserted-by":"publisher","first-page":"49","DOI":"10.3389\/fneur.2015.00049","article-title":"Ubiquitin carboxy-terminal hydrolase-l1 as a serum neurotrauma biomarker for exposure to occupational low-level blast","volume":"6","author":"Carr","year":"2015","journal-title":"Front Neurol"},{"key":"B77","doi-asserted-by":"publisher","first-page":"e1126","DOI":"10.1212\/WNL.0000000000010087","article-title":"Blood biomarkers of traumatic brain injury and cognitive impairment in older veterans","volume":"95","author":"Peltz","year":"2020","journal-title":"Neurology"},{"key":"B78","doi-asserted-by":"publisher","first-page":"e1385","DOI":"10.1212\/WNL.0000000000006321","article-title":"Glial fibrillary acidic protein elevations relate to neuroimaging abnormalities after mild TBI","volume":"91","author":"Gill","year":"2018","journal-title":"Neurology"},{"key":"B79","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1089\/neu.2017.5182","article-title":"Blood-based protein biomarkers for the management of traumatic brain injuries in adults presenting to emergency departments with mild brain injury: a living systematic review and meta-analysis","volume":"38","author":"Mondello","year":"2018","journal-title":"J Neurotrauma"},{"key":"B80","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1016\/j.ijsolstr.2011.12.008","article-title":"On the blast resistance of laminated glass","volume":"49","author":"Hooper","year":"2012","journal-title":"Int J Solids Struct."},{"key":"B81","unstructured":"Beirut Rapid Damage and Needs Assessment2020"},{"key":"B82","doi-asserted-by":"publisher","first-page":"101889","DOI":"10.1016\/j.ijdrr.2020.101889","article-title":"Hospital disaster and emergency preparedness (HDEP) in Lebanon: a national comprehensive assessment","volume":"51","author":"Al-Hajj","year":"2020","journal-title":"Int J Disaster Risk Reduct."},{"key":"B83","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/dmp.2020.451.","article-title":"Beirut ammonium nitrate explosion: a man-made disaster in times of CoViD19 pandemic","author":"El Sayed","year":"2020","journal-title":"Disaster Med Public Health Preparedness"},{"key":"B84","unstructured":"Stopthebleed2020"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.657996\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T11:12:06Z","timestamp":1622805126000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.657996\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,4]]},"references-count":84,"alternative-id":["10.3389\/fpubh.2021.657996"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2021.657996","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,4]]},"article-number":"657996"}}