{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T11:56:48Z","timestamp":1773921408939,"version":"3.50.1"},"reference-count":57,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2018,10,10]],"date-time":"2018-10-10T00:00:00Z","timestamp":1539129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Uniting for Health Innovation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The cholera epidemic that occurred in Haiti post-earthquake in 2010 has resulted in over 9000 deaths during the past eight years. Currently, morbidity and mortality rates for cholera have declined, but cholera cases still occur on a daily basis. One continuing issue is an inability to accurately predict and identify when cholera outbreaks might occur. To explore this surveillance gap, a metagenomic approach employing environmental samples was taken. In this study, surface water samples were collected at two time points from several sites near the original epicenter of the cholera outbreak in the Central Plateau of Haiti. These samples underwent whole genome sequencing and subsequent metagenomic analysis to characterize the microbial community of bacteria, fungi, protists, and viruses, and to identify antibiotic resistance and virulence associated genes. Replicates from sites were analyzed by principle components analysis, and distinct genomic profiles were obtained for each site. Cholera toxin converting phage was detected at one site, and Shiga toxin converting phages at several sites. Members of the Acinetobacter family were frequently detected in samples, including members implicated in waterborne diseases. These results indicate a metagenomic approach to evaluating water samples can be useful for source tracking and the surveillance of pathogens such as Vibrio cholerae over time, as well as for monitoring virulence factors such as cholera toxin.<\/jats:p>","DOI":"10.3390\/ijerph15102211","type":"journal-article","created":{"date-parts":[[2018,10,10]],"date-time":"2018-10-10T11:53:13Z","timestamp":1539172393000},"page":"2211","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["A Metagenomic Approach to Evaluating Surface Water Quality in Haiti"],"prefix":"10.3390","volume":"15","author":[{"given":"Monika A.","family":"Roy","sequence":"first","affiliation":[{"name":"Department of Environmental Health Sciences, School of Public Health &amp; Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA"},{"name":"Biotechnology Training Program, University of Massachusetts Amherst, Amherst, MA 01003, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean M.","family":"Arnaud","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences, School of Public Health &amp; Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul M.","family":"Jasmin","sequence":"additional","affiliation":[{"name":"Equipes mobiles d\u2019intervention rapide (EMIRA) du Minist\u00e8re de la Sant\u00e9 Publique et de la Population (MSPP), Hinche HT 5111, Haiti"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve","family":"Hamner","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences, School of Public Health &amp; Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nur A.","family":"Hasan","sequence":"additional","affiliation":[{"name":"CosmosID Inc., 1600 East Gude Drive, Rockville, MD 20850, USA"},{"name":"Center for Bioinformatics and Computational Biology, University of Maryland, College Park, MD 20742, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita R.","family":"Colwell","sequence":"additional","affiliation":[{"name":"CosmosID Inc., 1600 East Gude Drive, Rockville, MD 20850, USA"},{"name":"Center for Bioinformatics and Computational Biology, University of Maryland, College Park, MD 20742, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy E.","family":"Ford","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences, School of Public Health &amp; Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,10,10]]},"reference":[{"key":"ref_1","unstructured":"UN Office for the Coordination of Humanitarian Affairs (2018, May 06). Haiti: Cholera figures, December 2017 (as of 29 January 2018). UN Office for the Coordination of Humanitarian Affairs: 2018. Available online: https:\/\/reliefweb.int\/report\/haiti\/haiti-cholera-figures-december-2017-29-january-2018."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"12","DOI":"10.4269\/ajtmh.16-0948","article-title":"Strengthening National Disease Surveillance and Response\u2014Haiti, 2010\u20132015","volume":"97","author":"Juin","year":"2017","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_3","unstructured":"US Centers for Disease Control and Prevention (2018, May 06). Cholera: Vibrio Cholerae Infection, Available online: https:\/\/www.cdc.gov\/cholera\/general\/index.html."},{"key":"ref_4","first-page":"11","article-title":"Risk factors of cholera transmission in rural areas in Haiti","volume":"27","author":"Gazin","year":"2017","journal-title":"Med. Sante Trop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.epidem.2013.09.004","article-title":"Examining rainfall and cholera dynamics in Haiti using statistical and dynamic modeling approaches","volume":"5","author":"Eisenberg","year":"2013","journal-title":"Epidemics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.3201\/eid\/1509.081334","article-title":"Using satellite images of environmental changes to predict infectious disease outbreaks","volume":"15","author":"Ford","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"896","DOI":"10.4269\/ajtmh.17-0048","article-title":"Assessment of Risk of Cholera in Haiti following Hurricane Matthew","volume":"97","author":"Khan","year":"2017","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.mimet.2016.12.014","article-title":"Application of a paper based device containing a new culture medium to detect Vibrio cholerae in water samples collected in Haiti","volume":"133","author":"Briquaire","year":"2017","journal-title":"J. Microbiol. Methods"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Matias, W.R., Julceus, F.E., Abelard, C., Mayo-Smith, L.M., Franke, M.F., Harris, J.B., and Ivers, L.C. (2017). Laboratory evaluation of immunochromatographic rapid diagnostic tests for cholera in Haiti. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0186710"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1007\/s10661-015-4677-1","article-title":"Evaluation of a field appropriate membrane filtration method for the detection of Vibrio cholerae for the measurement of biosand filter performance in the Artibonite Valley, Haiti","volume":"187","author":"Thomson","year":"2015","journal-title":"Environ. Monit. Assess."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"356","DOI":"10.3201\/eid2003.131293","article-title":"Monitoring water sources for environmental reservoirs of toxigenic Vibrio cholerae O1, Haiti","volume":"20","author":"Alam","year":"2014","journal-title":"Emerg. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Baron, S., Lesne, J., Moore, S., Rossignol, E., Rebaudet, S., Gazin, P., Barrais, R., Magloire, R., Boncy, J., and Piarroux, R. (2013). No Evidence of Significant Levels of Toxigenic V. cholerae O1 in the Haitian Aquatic Environment During the 2012 Rainy Season. PLoS Curr., 5.","DOI":"10.1371\/currents.outbreaks.7735b392bdcb749baf5812d2096d331e"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Alam, M.T., Weppelmann, T.A., Longini, I., De Rochars, V.M., Morris, J.G., and Ali, A. (2015). Increased isolation frequency of toxigenic Vibrio cholerae O1 from environmental monitoring sites in Haiti. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0124098"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1186\/s13059-017-1299-7","article-title":"Comprehensive benchmarking and ensemble approaches for metagenomic classifiers","volume":"18","author":"McIntyre","year":"2017","journal-title":"Genome Biol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ghai, R., Rodriguez-Valera, F., McMahon, K.D., Toyama, D., Rinke, R., Cristina Souza de Oliveira, T., Wagner Garcia, J., Pellon de Miranda, F., and Henrique-Silva, F. (2011). Metagenomics of the water column in the pristine upper course of the Amazon river. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0023785"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Saleem, F., Mustafa, A., Kori, J.A., Hussain, M.S., and Kamran Azim, M. (2018). Metagenomic Characterization of Bacterial Communities in Drinking Water Supply System of a Mega City. Microb. Ecol.","DOI":"10.1007\/s00248-018-1192-2"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chu, B.T.T., Petrovich, M.L., Chaudhary, A., Wright, D., Murphy, B., Wells, G., and Poretsky, R. (2018). Metagenomics Reveals the Impact of Wastewater Treatment Plants on the Dispersal of Microorganisms and Genes in Aquatic Sediments. Appl. Environ. Microbiol., 84.","DOI":"10.1128\/AEM.02168-17"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"118","DOI":"10.4269\/ajtmh.13-0601","article-title":"Environmental surveillance for toxigenic Vibrio cholerae in surface waters of Haiti","volume":"92","author":"Kahler","year":"2015","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"790","DOI":"10.4269\/ajtmh.14-0165","article-title":"Water-related infrastructure in a region of post-earthquake Haiti: High levels of fecal contamination and need for ongoing monitoring","volume":"91","author":"Widmer","year":"2014","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Pomerantz, A., Penafiel, N., Arteaga, A., Bustamante, L., Pichardo, F., Coloma, L.A., Barrio-Amoros, C.L., Salazar-Valenzuela, D., and Prost, S. (2018). Real-time DNA barcoding in a rainforest using nanopore sequencing: Opportunities for rapid biodiversity assessments and local capacity building. Gigascience, 7.","DOI":"10.1093\/gigascience\/giy033"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Srivathsan, A., Baloglu, B., Wang, W., Tan, W.X., Bertrand, D., Ng, A.H.Q., Boey, E.J.H., Koh, J.J.Y., Nagarajan, N., and Meier, R. (2018). A MinION-based pipeline for fast and cost-effective DNA barcoding. Mol. Ecol. Resour.","DOI":"10.1101\/253625"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1038\/nrg.2017.88","article-title":"Towards a genomics-informed, real-time, global pathogen surveillance system","volume":"19","author":"Gardy","year":"2018","journal-title":"Nat. Rev. Genet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.3201\/eid1707.110059","article-title":"Understanding the cholera epidemic, Haiti","volume":"17","author":"Piarroux","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_24","unstructured":"(2018, April 28). Weatherbase. Monthly-Weather Averages Summary. Available online: http:\/\/www.weatherbase.com\/."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3047","DOI":"10.1093\/bioinformatics\/btw354","article-title":"MultiQC: Summarize analysis results for multiple tools and samples in a single report","volume":"32","author":"Ewels","year":"2016","journal-title":"Bioinformatics"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Janes, V.A., Matamoros, S., Willemse, N., Visser, C.E., de Wever, B., Jakobs, M.E., Subramanian, P., Hasan, N.A., Colwell, R.R., and de Jong, M.D. (2017). Metagenomic sequencing to replace semi-quantitative urine culture for detection of urinary tract infections: A proof of concept. bioRxiv.","DOI":"10.1101\/178178"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"16324","DOI":"10.1038\/s41598-017-16353-x","article-title":"The microbiomes of blowflies and houseflies as bacterial transmission reservoirs","volume":"7","author":"Junqueira","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Connelly, S., Bristol, J.A., Hubert, S., Subramanian, P., Hasan, N.A., Colwell, R.R., and Kaleko, M. (2017). SYN-004 (ribaxamase), an oral beta-lactamase, mitigates antibiotic-mediated dysbiosis in a porcine gut microbiome model. J. Appl. Microbiol.","DOI":"10.1111\/jam.13432"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1073\/pnas.1523817113","article-title":"Cross-talk among flesh-eating Aeromonas hydrophila strains in mixed infection leading to necrotizing fasciitis","volume":"113","author":"Ponnusamy","year":"2016","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Hasan, N.A., Young, B.A., Minard-Smith, A.T., Saeed, K., Li, H., Heizer, E.M., McMillan, N.J., Isom, R., Abdullah, A.S., and Bornman, D.M. (2014). Microbial community profiling of human saliva using shotgun metagenomic sequencing. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0097699"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1126\/science.1254529","article-title":"Longitudinal analysis of microbial interaction between humans and the indoor environment","volume":"345","author":"Lax","year":"2014","journal-title":"Science"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Ondov, B.D., Bergman, N.H., and Phillippy, A.M. (2011). Interactive metagenomic visualization in a Web browser. BMC Bioinform., 12.","DOI":"10.1186\/1471-2105-12-385"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1111\/1574-6941.12008","article-title":"Comparison of DNA preservation methods for environmental bacterial community samples","volume":"83","author":"Gray","year":"2013","journal-title":"FEMS Microbiol. Ecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2369","DOI":"10.1128\/AEM.00141-07","article-title":"Isolation of potentially pathogenic Escherichia coli O157:H7 from the Ganges River","volume":"73","author":"Hamner","year":"2007","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_35","unstructured":"(2018, April 28). Weatherbase. Hinche, Haiti. Available online: http:\/\/www.weatherbase.com\/weather\/weather.php3?s=602189&cityname=Hinche-Centre-Haiti."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"348250","DOI":"10.1155\/2013\/348250","article-title":"Identification of opportunistic pathogenic bacteria in drinking water samples of different rural health centers and their clinical impacts on humans","volume":"2013","author":"Pindi","year":"2013","journal-title":"Biomed. Res. Int."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1086\/500202","article-title":"The epidemiology and control of Acinetobacter baumannii in health care facilities","volume":"42","author":"Fournier","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_38","first-page":"47","article-title":"Clinical characteristics of patients with Acinetobacter junii infection","volume":"42","author":"Hung","year":"2009","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2941","DOI":"10.1128\/AAC.00116-06","article-title":"Multicity outbreak of carbapenem-resistant Acinetobacter baumannii isolates producing the carbapenemase OXA-40","volume":"50","author":"Lolans","year":"2006","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_40","unstructured":"Centers for Disease Control and Prevention (2018, April 28). Healthcare-Associated Infections, Available online: https:\/\/www.cdc.gov\/hai\/organisms\/acinetobacter.html."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12941-015-0100-6","article-title":"Resistance integrons: Class 1, 2 and 3 integrons","volume":"14","author":"Deng","year":"2015","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Mukherjee, N., Bartelli, D., Patra, C., Chauhan, B.V., Dowd, S.E., and Banerjee, P. (2016). Microbial Diversity of Source and Point-of-Use Water in Rural Haiti\u2014A Pyrosequencing-Based Metagenomic Survey. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0167353"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.envpol.2005.12.026","article-title":"Effect of Sphingobium yanoikuyae B1 inoculation on bacterial community dynamics and polycyclic aromatic hydrocarbon degradation in aged and freshly PAH-contaminated soils","volume":"144","author":"Cunliffe","year":"2006","journal-title":"Environ. Pollut."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Chen, H., Young, S., Berhane, T.K., and Williams, H.N. (2012). Predatory Bacteriovorax communities ordered by various prey species. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0034174"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"5488","DOI":"10.1128\/AEM.01633-13","article-title":"Widespread occurrence of bacterial human virulence determinants in soil and freshwater environments","volume":"79","author":"Soborg","year":"2013","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Zhang, B., Xia, Y., Wen, X., Wang, X., Yang, Y., Zhou, J., and Zhang, Y. (2016). The Composition and Spatial Patterns of Bacterial Virulence Factors and Antibiotic Resistance Genes in 19 Wastewater Treatment Plants. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0167422"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1007\/s00248-015-0720-6","article-title":"Significance and Roles of Proteus spp. Bacteria in Natural Environments","volume":"72","author":"Drzewiecka","year":"2016","journal-title":"Microb. Ecol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1111\/myc.12601","article-title":"Novel taxa of thermally dimorphic systemic pathogens in the Ajellomycetaceae (Onygenales)","volume":"60","author":"Dukik","year":"2017","journal-title":"Mycoses"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1128\/CMR.00013-08","article-title":"Candida parapsilosis, an emerging fungal pathogen","volume":"21","author":"Trofa","year":"2008","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"981424","DOI":"10.1155\/2012\/981424","article-title":"Epidemiology of Enterocytozoon bieneusi Infection in Humans","volume":"2012","author":"Matos","year":"2012","journal-title":"J. Parasitol. Res."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Boileau, M., Ferreira, J., Ahmad, I., Lavallee, C., Qvarnstrom, Y., and Dufresne, S.F. (2016). Successful Treatment of Disseminated Anncaliia algerae Microsporidial Infection With Combination Fumagillin and Albendazole. Open Forum Infect. Dis., 3.","DOI":"10.1093\/ofid\/ofw158"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Richterman, A., Cheung, H.C., Meiselbach, M.K., Jerome, G., Ternier, R., and Ivers, L.C. (2018). Risk Factors for Self-Reported Cholera within HIV-Affected Households in Rural Haiti. Open Forum Infect. Dis., 5.","DOI":"10.1093\/ofid\/ofy127"},{"key":"ref_53","first-page":"28132","article-title":"The case for a \u2018one health\u2019 approach to combating vector-borne diseases","volume":"5","author":"Faburay","year":"2015","journal-title":"Infect. Ecol. Epidemiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.rvsc.2011.05.009","article-title":"Characterization of enterotoxigenic E. coli (ETEC), Shiga-toxin producing E. coli (STEC) and necrotoxigenic E. coli (NTEC) isolated from diarrhoeic Mediterranean water buffalo calves (Bubalus bubalis)","volume":"93","author":"Borriello","year":"2012","journal-title":"Res. Vet. Sci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"37","DOI":"10.4269\/ajtmh.16-1023","article-title":"Cost Evaluation of a Government-Conducted Oral Cholera Vaccination Campaign-Haiti, 2013","volume":"97","author":"Routh","year":"2017","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e162","DOI":"10.1016\/S2214-109X(14)70368-7","article-title":"Effectiveness of reactive oral cholera vaccination in rural Haiti: A case-control study and bias-indicator analysis","volume":"3","author":"Ivers","year":"2015","journal-title":"Lancet Glob. Health"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"5819","DOI":"10.1016\/j.vaccine.2017.09.025","article-title":"Comparison of two control groups for estimation of oral cholera vaccine effectiveness using a case-control study design","volume":"35","author":"Franke","year":"2017","journal-title":"Vaccine"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/10\/2211\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:24:46Z","timestamp":1760196286000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/10\/2211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,10]]},"references-count":57,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,10]]}},"alternative-id":["ijerph15102211"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15102211","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,10]]}}}