.

AGUSAN DEL SUR STATE COLLEGE OF AGRICULTURE AND

TECHNOLOGY
BACHELOR OF SCIENCE IN BIOLOGY

GINALOU CORALDE

Community Knowledge and Awareness on the Ecological

Services at Caimpugan Peat-land ,San Francisco Agusan del
Sur

Thesis Adviser:
JUNIFER VISTO
College of Arts and Sciences

October 2023

i
 TRANSMITTAL SHEET

This undergraduate thesis outline entitled “Community

Knowledge and Awareness on the Ecological Services at
Caimpugan Peatlan ,San Francisco Agusan del Sur”prepared
by GINALOU CORALDE in partial fulfillment of the requirements
for the degree in BACHELOR OF SCIENCE IN BIOLOGY, is hereby
accepted and endorsed.

JUNIFER S. VISTO
Adviser

____________
Date

ii
 APPROVAL SHEET

This undergraduate thesis outline entitled “ Community

Knowledge and Awareness on the Ecological Services at
Caimpugan Peatlan ,San Francisco Agusan del Sur ” prepared
and submitted by GINALOU CORALDE, in partial fulfillment of the
requirements for the degree of BACHELOR OF SCIENCE IN
BIOLOGY is hereby accepted and approved.

Chairperson, Examining Committee

____________
Date

Research Coordinator, College of Arts and Sciences

Date

Accepted as partial fulfillment of the requirements for the degree of

BACHELOR OF SCIENCE IN BIOLOGY

JUZAVIL V. JUARIO, MS.

Chairperson, Bachelor of Science in Biology

____________
Date

RACHEL M. PATANGAN, Ph.D.

____________
Date

ii
 TABLE OF CONTENTS

PRELIMENARIES PAGE
Title Page i
Transmittal sheet ii
Approval Sheet iii
Table of Contents vi
List of Table v
List of Figures vi

INTRODUCTION
Background of the Study 1
Objectives of the Study 3
Significance of the Study 3
Scope and Delimitation of the Study 4
Time and Place of the Study 5
Operational Definition of Terms 5
Conceptual Framework 7

REVIEW OF RELATED LITERATURE 8

METHODOLOGY
Research Design 14
Description of the Study 14
Data Gathering 15
Letter for Permission 16
Ethical Consideration 16
Data Analysis 16

LITERATURE CITED 22

ii
 LIST OF FIGURES

Figure Title Page

1 Schematic Diagram of the Study 7

2 Geographical Map of Caimpugan 15

Sanfrancisco, Agusan del Sur, Philippines

ii
 Introduction
Background of the Study
Peatlands, characterized by deep accumulations of organic material

known as peat, serve crucial roles such as being a significant terrestrial carbon

pool. They are utilized for agriculture, energy generation, and various

ecosystem services including habitat for diverse species, regulation of climates,

and recreational functions.

Globally, peatlands face a 0.02% annual decline in peat stocks, primarily

due to exploitation and fires. In 2015, 40% of hotspots in Indonesia were on

peatland, with Riau Province experiencing the largest peatland and forest fire

impact at 1,928.26 ha. Consequently, the government established the Peatland

Restoration Agency (BRG), focusing on conservation and restoration through a

3R program: re-vegetation, rewetting, and re-vitalization. Pelalawan District in

Riau, a significant hotspot, is a research focus for its role in maintaining

ecosystem balance and supporting local livelihoods amid degradation and fires

(D H Laia , Darsono and E Antriyandarti 2021).

However ,according to Rueda G 2021 based on his statistics for tropical

peatlands, the Philippines has a mean peatland area of 10,700 ha (Page et al.,

2016), 110 km2 or equivalent to ~11,000 ha (Joosten, 2009). There are two

major sites in the Philippines where peatlands have been confirmed: the

Caimpugan peatland at Agusan Marsh Wildlife Sanctuary in Agusan del Sur

and the Leyte Sab-a Basin at Alang-alang, Leyte (PAWB-DENR, 2009). Recent

1 1
assessments by the Biodiversity Management Bureau (BMB) and the

Ecosystems Research and Development Bureau (ERDB) of the Department of

Environment and Natural Resources (DENR) confirmed additional peatland

sites found in Victoria, Oriental Mindoro, Lalaguna and Rizal in Lopez, Quezon,

and La Paz and Talacogon in Agusan del Sur.

One of the known causes of peatland degradation is the lack of

awareness of the stakeholders on the vital ecosystem services. Ecosystem

services refer to “the benefits people obtain from ecosystems, either directly or

indirectly” (Millennium Ecosystem Assessment (2015), and can be classified as

supporting, provisioning, regulating, or cultural services (Li et al., 2017).

Therefore, the researchers will be conducting a study to assess the

knowledge and awareness of the community members about the ecological

services provided by the peatland that would benefit both the economy and the

environment. It is also to overemphasize the importance of ecological service

distribution at Caimpugan Peat-land Sanfrancisco Agusan del Sur.

2 1
Objectives of the Study

This study generally will aim to asses the community knowledge and

awareness on the ecological services at Caimpugan Peatland,Sanfrancisco

Agusan del Sur.

Specifically, this study will also aim to:

1.To determine the Socio-Demographic profile of the respondents in term of:

a. Sex b. Age c. Educational attainment

d. Occupation e.Monthly Income

2.To determine the knowledge among the community members on ecological

services of peatland and peat-land ecosystem.

3.To assess the community awareness on the peatland ecosytem and ecological

services provided by the peatland.

4.To determine the significant relationship in knowledge and awareness on the

ecological service provided by the peatland in accordance to their profile.

3 1
 Significance of the Study

This research will aim to provide vital information and knowledge in

conserving ecological services of peat-land. Furthermore, this study gives

benefits to the following:

Department of Environment and Natural Resources (DENR). This study will

provide information awareness and community knowledge on the ecological

services of peatland in Caimpugan Sanfrancisco Agusan del Sur which can

serve as the strong foundation for any conservation action taking by the

environmental organization.

Protected Area Management Office (PAMO).This Study will help the PAMO to

provide more information about conserving and protecting the peatland of

AMWS to the near resident.

Local Government Unit (LGU). This study will help to the Local Government

Unit to promote an environmental program that can help to conserve the

peatland.

Future Researchers. This study will provide foundational data regarding the

community knowledge and awareness on the ecological services of peat land

and can also support the researcher in future relevant studies.

Resident. This study will raise awareness among the community about the

relevance of peatland the need to conserve and utilized peat-land resources.

4 1
 Scope and Delimitation of the Study

This study focuses on assessing the community knowledge and

awareness regarding the ecological services of peat-land. It includes

understanding how communities perceive and utilize peat-land resources, as

well as their understanding of the environmental benefits provided by peat-

lands.

However, this study is limited to a specific geographic area or

community, aiming to provide a detailed analysis of the knowledge and

awareness within this particular group. Additionally, the research does not

delve into in-depth ecological studies of peat-land but rather concentrates on

the community's awareness and understanding of peat-land's ecological services

Time and Place of the Study

This study will be conducted during the second semester of the academic

year 2023-2024 at Barangay Caimpugan Peatland as part of Agusan Marsh

Wildlife Sanctuary,Sanfrancisco Agusan del Sur,Philippines.The peatland

is part of the proclaimed Agusan Marsh Wildlife Sanctuary (AMWS) per

Presidential Proclamation No. 913(ASEAN Peatland Forest ).

5 1
 Operational Definition of Terms

Agusan Marsh Wildlife Sanctuary(AMWS) - is one of the most ecologically

significant wetlands in the Philippines. It also refers to location area where you

can found the peatland and see the different beauty of the view that is

composed of many species that would offer in AMWS.

Awareness of ecological services - this refers on the perception of the public

about how importance to conserve the Ecosystem of AMWS.

Community knowledge-knowledge held by individuals or shared by a

community, which is built up over time through direct use of, or interaction

with, a resource or environment (natural or social). This is referring to the

knowledge towards the conversation of ecosystem services.

Ecological Services- This is any positive benefit that wildlife or ecosystems

provide to people and benefits can be direct or indirect—small or large. This is

also referring to the ecological services(fish production, flood control) that are

provides in Agusan Marsh Wildlife Sanctuary.

Peatland-are wetlands with a thick water logged soil layer made up of dead

and decaying plant materials and can be found in Agusan Marsh Wildlife

Sanctuary.

6 1
 Conceptual Framework

Input Process Output

Knowledge and
Awareness of the
resident at Caimpugan
Peatland as part of
Agusan Marsh Wildlife
Sanctuary ,Sanfrancisco
Agusan del Sur.
Schematic Diagram of the Study
 Survey Questionnaire
The researcher gathered
 Qualitative Method
community knowledge
 Random Sampling
and awareness on
 Interpretation of the data
ecological services from
the residents of
Caimpugan San
Francisco, Agsund del
Sur,Philippines.

Schematic Diagram of this Study

Figure 1 shows the diagram that presents the flow of activities that will be

assessed by the researcher from input to processing to output. The input

shows the knowledge and awareness of resident in Caimpugan

Peatland ,Sanfrancisco Agusan del Sur.The process shows activities through

survey questionnaire such as demographic survey and level of community

knowledge and awareness on the ecological services. The output will give

results or the data gathered and analyze the community knowledge and

awareness on the ecological services of peatland.

7 1
 Review Related Literature

Ecological Services

Ecosystem services refer to the several benefits that are derived from the

natural environment. According to Garcia C,et al 2020 ,the rank one ecosystem

services in AMWS are flood control, conservation of biodiversity, provision of

water resources ,fish production, scenic beauty for creation, carbon

Sequestration and storage

According to Garcia C et al., 2020, for dwellers within the AMWS, the

dominant ecosystem service provided by the marsh is the provisioning of food

mainly fish and provision of water for the farm. On the other hand, the

downstream community views flood control, conservation of biodiversity, and

water provisioning as the perceived benefits and important ecosystem services

that AMWS provides in their locality. Flooding control service is the regulatory

service that has an impact towards the lower stretches of Agusan River and

land managers can invest in enhancing this kind to services to potential

buyers. Too much financial effort has been given to flood control projects in low

lying areas in the region particularly in Butuan city but less priority to enhance

the conservation and environmental development of the marsh

Community knowledge and Attitudes

Moreover , the knowledge is viewed as “a complex concept which consists

of information and skills acquired through experience. It is also about truth

and belief,perspective, judgement and expectations” (Hari et.al,

8 1
2016). Awareness, on the other hand, is “the state or ability to perceive, to feel,

or to be conscious of events, objects, or sensory patterns”.

In addition ,in terms of the attitude of respondents towards AMWS,

82.5% of the respondents had knowledge about it; only 2.5% of the

respondents said to have learned about AMWS in the school and majority

(79.25%) of them have not visited the area. Also, majority of the respondents

have not participated training or seminars on environmental protection while

26.25% of the respondents considered local government units‟ information

campaign on solid waste management as their trainings on environment

protect (Reyes J and Yorobe 2018).

Awareness and Communication

Furthermore ,environmentally aware and empowered youths are

potentially the greatest agent of change for the long-term protection and

stewardship of the environment. Thus, environmental education which

promotes such change will enable these youths to have a greater voice on

environmental issue if effectively implemented in Nigeria. The result revealed

that high level of knowledge and positive attitude towards the environment

among the students. Also, it was observed that the relationship between their

knowledge and attitude towards the environment is a negative, little or no

relationship. Therefore, it was concluded that environmental literate students

especially in tertiary institutions are being nurtured to foster EE in Nigeria.

9 1
Thus the researchers recommend that more needs to be done to promote and

encourage EE at all levels in the country especially by the government and its

agency to ensure effective implementation; nongovernmental organizations and

international bodies all have a role to play in the country sustainable

development goals (Norris E and Juliet D 2016).

Policy and Management

However ,the Convention on Wetlands, called the Ramsar Convention, is

an intergovernmental treaty whose mission is “the conservation and wise use of

all wetlands through local and national actions and international cooperation,

as a contribution towards achieving sustainable development throughout the

world”. Under the “three pillars” of the Convention, the Contracting Parties

commit to:work towards the wise use of all their wetlands; designate suitable

wetlands for the list of Wetlands of International Importance (the “Ramsar

List”) and ensure their effective management; and cooperate internationally on

transboundary wetlands, shared wetland systems and shared species (Denyer

K.,et al 2018).

Moreover, local government initiatives for protected area management

Agusan Marsh Development Alliance, Agusan del Sur, 24 to 26 January 2007

Policy to Implement and Mechanisms to Activate Change

Since its formation, the alliance implemented these different support activities:

10 1
  Facilitated projects for indigenous peoples living within the marsh under

the Kalahi program funded by the Presidential Social Fund released

through NAPC ,

 Assisted in project proposal making of POs and NGOs for funding by

PACAP AusAid.

 Facilitated special programs to IPs like the mobile literacy class and

floating clinics .

 Reforestation of the riverbanks.

These activities have had various levels of success.

PACAP-AusAid has indeed begun operating in the area so the proposal

development by the alliance appears to have been successful. Other NGOs,

with the support of PACAP, are also operating within the marsh on

programs for health and literacy, and these seem to be filling some of the

basic needs and services of the communities residing within the Agusan

Marsh. The link between these other groups and the alliance is unclear, and

the NGO volunteers who operate the floating clinic (funded by PACAP) did

not seem to be aware of the alliance at all.

Challenge and Barriers

Nevertheless,the importance and relevance of Agusan Marsh cannot be

overemphasized as it performs a significant ecosystem service by serving as a

natural sponge, by absorbing the excess water brought about by the

11 1
unpredictable weather conditions in the area,” said DENR-13 Director Alicer in

his message. Cuna cited scientific studies that showed the disappearance of 64

percent of the world’s wetlands since the 1900s and 87 percent since the

1700s.Cuna said the disappearance of wetlands emanates from population

pressure, fishery resource, overexploitation, siltation and sedimentation, and

most importantly, climate change (Lopez, A 2019 ).

Unfortunately, the Society for the Conservation of the Philippine Wetland

according to them this unique ecosystem is being threatened by a wide range of

issues and problems that compromise the ability of the AMWS to sustain these

important ecological functions and services, to wit: pollution from mining

upstream, wildlife and timber poaching and unregulated in-migration. On top

of these, there is low awareness about the importance of the AMWS among the

stakeholders, thus participation in planning, management and decision-

making is compromised.

Moreover, according to Garcia et al.,2020 the common problems the key

informants observed occurring in the downstream areas are flooding, water

pollution, riverbank erosion, and improper waste disposal. Seasonal flooding

becomes a problem due to its risk to inhabitants and damage to properties

incurred. Water pollution is said to be mostly caused by mining activities

(large-scale or small-scale). Riverbank erosion or scouring is also seen as a

problem because it reduces the area utilized for any other purpose. Riverbanks

of Agusan river are mostly utilized as agricultural land, and with continuous

12 1
erosion, the land area decreases, thereby decreasing food production as

well.Improper solid waste management has been a "battle" of every local

government unit in the Philippines and no matter the effort in the

implementation of waste management programs, and problems continue to

exists. Most recurring problems on solid waste are the following; no segregation

of solid waste at source, burning of solid wastes, the presence of plastics in

water bodies, and unregulated dumping of wastes by households located near

riverbanks.

13 1
 Materials and Methods

Research Design
This study used descriptive design in assessing the knowledge and

awareness on the ecological services provided by the peatland. The study will

be utilized a survey questionnaire to gather the quantitative data.

This research study will employ descriptive survey research. It is an

approach to descriptive research that blends quantitative data to provide

relevant and the collection of information from a sample of individuals through

their responses to questions" (Check & Schutt, 2019).In this study, the

researcher will conducting the research questionnaire to asses their knowledge

and awareness on the ecological services of Caimpugan Peatland,Sanfrancisco

Agusan del Sur.

Description of the Study Area

This study will be conducted at Caimpugan, San francisco Agsusan del

Sur.It'spopulation as determined by the 2020 Census was 1,889 composed of

372 household. This represented 2.34% of the total population of San

Francisco.Caimpugan is situated at approximately 8.3934, 125.9149, in the

island of Mindanao. Elevation at these coordinates is estimated at 20.8 meters

or 68.2 feet above mean sea level.The Caimpugan Peatland at the Agusan

Marsh Wildlife Sanctuary (AMWS) is considered a "wonderland," a sacred land

for the Manobos.The peatland holds the only recorded remaining intact peat

swamp forest – the largest of its kind in the Philippines(Vera Ruiz 2020).
14 1
 Map-of-Caimpugan-peatland-swamp-forest-agusan-del -sur-Province-lower-inset-mindnao.png
Caimpugan Peatlanf , Sanfransisco Agusan del Sur, Philippines

Data Gathering

Slovin formula will used to determine the sample size .The survey will be

conducted among 193 households to assess their awareness on the ecological

services of wetland and knowledge about conservation. Slovin’s formula was

used to determine the sample size from the population of 242 households with

confidence level of 95% and 5 margin of error. Key informant interview (KII),

particularly with Protected Area Management Office (PAMO) and Community

Environment and Natural Resources Office (CENRO)in Sanfransisco Agusan del

15 1
Sur, who are the main actors in wetland protection and conservation, was also

conducted to supplement the quantitative data from the household survey.

The one ninety tree (193) respondents were given a tested questionnaires

to determine their socio- demographic, economic status, and understanding

the ecological services provided by the peatland and asses the awareness on

the peatland ecosystem. The queries were dichotomous questions answerable

by “Yes” or “No.

Letter for Permission

A formal letter of permission will be sent and signed by the punong

barangay of San Marcos,Bunawan Agusan del Sur. This letter aims to have

permission to conduct an interview survey with respect to the community of a

particular area.

Ethical Consideration

This study will guarantee informed consent, confidentiality, anonymity,

and the voluntarily participation of respondents. This may require protecting

the confidentiality of our respondents' information, and we will take every

measure necessary to protect the respondent.

Data Analysis

The statistical tools used in this study include descriptive statistics,

specifically frequency and percentage, to describe the community knowledge

and awareness of the ecological services provided by the peatland in

16 1
Caimpugan San Francisco, Agusan del Sur. Additionally, correlation analysis

will be employed to examine whether demographic factors correlate with

knowledge and awareness

17 1
 sSurvey /Interview Questionnaire

This survey questionnaire is adapted from the study of Girlie H. Rueda 2020

“Community Knowledge and Awareness on the Ecological Services in

Caimpugan Sanfrancisco Agusan del Sur”

PART1Direction: Please carefully provide the following details about yourself by

putting check(/) .Your responses are important for research purposes, and all

information will kept in confidential.

Household Head: (optional) Sex: Female Male

Age:Below 30 years old 31 -60 years old Civil Status:Married Single

Above 61 years old Separated Live in
Widow/Widower
Educational Attainment:
Elementary Undergraduate Elementary Graduate Vocational
High School Undergraduate High School Graduate Non Schooling
College Undergraduate College Graduate

Occupation:Skilled worker Farmer Fisherman Monthly

Income :
Employee Separated Live in Less than P5000
P5,001 to P10,000
More than P10,000

PART 2 Direction: Put check (/) if yes and put x if no. Be honest and accurate. Provide

truthful answers based on your actual experience and opinions .Avoid guessing.

A. Knowledge on the ecological

services and peatland ecosystem. Yes (/) No(x)

18 1
1.Are peatland are important? If yes ,pls specify the

ecological services

provided by the

peatland .

2. Do you have knowledge of the

peatland ecosystem?In terms of ?

 Muddy/water underneath

 Not suitable for farming/yield

not good

 Water is rusty

 Soil is black

 Occurrence of fire

3.Do you have an idea on what If yes proceed

destroys peatland? question no.4

4.Do you witness the peatland

fires?

5.Do you engage in farming in the

peatland?

6.Do you apply fertilization in

farming

7. What will be the frequency of

applications?

a. Once a week?

b. Once a month?

19 1
c. Once a year?

d. 2-4 times every cropping

season?

II.Awareness Yes (/) No(x)

8.Do you aware the presence in

peatland?

9.Are you aware on probable effects of If yes proceed

peatland agriculture? no.10

10.Do you observe drainage canals If yes pls answer

inside the peatland? question no.11

11.Does draining the peatland help

produce high yields?

12.Do you participate EIC If yes pls no.13

(Education,Information ,Communication)

activities on conserving the peatland

ecosystem?

13What you have learned from EIC

activities?

a. Avoid dumping and burning of wastes

inside the peatland?

20 1
b. Do not cut trees?

c. Observe safety measure when inside

the peatland as the soil is indeed soft?

d. The construction of house(hollow

bollocks)is discourage?

e. Plant many tress as possible?

14.Do you conserve the peatland

15.How do you conserve the peatland?

 Protect the peatland?

 Do not touch or till the land ?

 Do not create canals?

 Do not make the peatland idle ?

 Do not let the grasses dominate the

peatland ?

 Do not burn wastes?

 Do not cut trees?

21 1
 References

Girlie H. Rued Journal of Nature Studies 20(1): 1-15Online ISSN: 2244-

5226.Community Knowledge and Awareness on Ecological Service of

Peatland in Victory, Oriental Mindoro, Philippines. Retrieved from

https://www.journalofnaturestudies.org/files/JNS2015_Rueda_Commu

nity_Knowledge_Awareness.pdf

Chime MORA-GARCIA1,2*, Roberto G. CAMPOS Jr2, Romell A.

SERONAY(2020).PERCEIVED ECOSYSTEM SERVICES TOWARDS THE
CONSERVATION OF AGUSAN MARSH WILDLIFE SANCTUARY IN
MINDANAO, PHILIPPINES.Retrived from https://ijcs.ro/public/IJCS-20-
19_Garcia.pdf.

Sarah Gibbens 2021. The world’s wetlands are slipping away. This vibrant
sanctuary underscores the stakes. Retrieved from
https://www.nationalgeographic.com/environment/article/world-
wetlands-are-slipping-away-agusan-marsh-underscores-stakes

Julie Rose Degamo Apdohan ,Sarajane O Lopez ,Romell A Seronay(2021).

WILLINGNESS TO PAY TOWARDS THE CONSERVATION OF
ECOTOURISM RESOURCES AT AGUSAN MARSH WILDLIFE
SANCTUARY, AGUSAN DEL SUR, PHILIPPINES.Retrieved from
https://www.researchgate.net/publication/354593316

Hasan et al.,2020. Impact of land use change on ecosystem services: A

review.Retrievedfromhttps://www.sciencedirect.com/science/article/abs
/pii/S2211464520300464

22 1
Siti Mazwin Kamaruddin*, Puziah Ahmad, Norsyamira Alwee.Community
Awareness on Environmental Management through Local Agenda 21
(LA21).Retrievedfromhttps://www.sciencedirect.com/science/article/pii/
S1877042816303135?ref=cra_js_challenge&fr=RR-1.

Agusan Marsh Wildlife Sanctuary.Retrievedfrom https://wli.wwt.org.uk/?

member=agusan-marsh-sanctuary

D. Serre, J. Douvinet, C. Heinzlef, E.D. Lacombe, Coping Strategies in Dike

Protected Areas. In: Floods by Freddy Vinet, Risk Management, 2, 2017,
pp. 45-57.

J.K.P. Williams, J.W. Pomeroy, P. Badiou, S. Gabor, Wetlands, Flood Control

and Ecosystem Services in the Smith Creek Drainage Basin: A Case
Study in Saskatchewan, Canada, Ecological Economics, 147, 2018, pp.
36-47.

Maryudi, R.R. Devkota, C. Schusser, C. Yufanyi, M. Salla, H. Aurenhammer,

R.
Rotchanaphatharawit, M. Krott, Back to basics: considerations in
evaluating the outcomes of community forestry, Forest Policy Economy,
14, 2012, pp. 1–5.

M.A. Zanella, C. Schleyer, S. Speelmanc, Why do farmers join Payments for

Ecosystem Services (PES) schemes? An Assessment of PES water scheme
participation in Brazil. Ecological Economics, 105, 2014, pp. 166-1

Agusan Marsh Wildlife Sanctuary Protected Area Report, DENR- IPAS, Agusan
del Sur, Philippines, 2003

R.Z. Chen, M.H. Wong, Integrated wetlands for food production, Environmental
23 1
 Research, 148, 2016, pp. 429–442.

N.L. Nabahungu, S.M. Visser, Contribution of wetland agriculture to farmers'

livelihood in Rwanda, Ecological Economics, 71, 2011, pp. 4-12.

E. Pedersen, S.E.B. Weisner, M. Johansson, Wetland areas' direct

contributions to residents' well-being entitles them to high cultural
ecosystem values. Science of the Total Environment, 646, 2019, pp.
1315-1326

A.Z.M. Haq, Effects of floods on rice production in Bangladesh, Journal of

Agricultural Economics and Rural Development, 3(3), 2017, pp. 236-240.

Mohammad Afandi,4 and Suziana Hassan2020. Public awareness on

biodiversity conservation and well-being: case of Gunung Mulu National
Park,
Sarawak.Retrievedfromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PM
C9795449/

24 1
25 1