Rift Valley Fever (RVF) is a viral disease affecting animals and humans, causing symptoms such as fever, liver damage, and bleeding, particularly prevalent in Africa. This study focuses on numerical solutions for a non-linear delayed dynamic epidemiological model of RVF. It extends a control problem incorporating the susceptible, infected, treated, recovered vector to analyze the impact of measures such as mosquito repellent and treatment. The goal is to examine how time delays in implementing control measures affect the dynamics of an epidemic. The model considers delay factors such as mosquito replication, hospitalization, travel restrictions, and isolation due to the lack of proper vaccination. The study explores the model’s aspects, including the reproduction number, equilibrium points, and stability. Local and global implications are examined using techniques such as the Lyapunov function and the Brauer-F lemma. Numerical analysis employs the non-standard finite difference method, establishing the local stability of the equilibrium through the effective reproduction number Rrvf and sensitivity analysis. The research highlights the importance of treatment and delay strategies in reducing RVF transmission, emphasizing the critical need for immunization and preventive measures.
I. INTRODUCTION
A deadly illness that caused lamb deaths in Kenya in 19121 was characterized as having potential adverse economic effects. Two decades later, the same illness was cited as the cause of a schism between a scientist and his co-workers. The mosquito-transmitted phlebovirus has been around for almost a century in many parts of the world. One of the five genera that make up the family Bunyaviridae is the Phlebovirus genus.2 This genus contains viruses that were formerly referred to as uukuviruses and phlebotomus fever viruses. The genus’s prototype, Rift Valley fever virus (RVFV), is one of the most significant viral zoonoses in Africa. Humans are believed to get the virus by direct contact with infected animals, aerosolized blood from infected vertebrates, or infected arthropod vectors. Rift Valley Fever (RVF) has an incubation period of 2–6 days in humans. Symptoms include fever, muscle pain, headache, and sensitivity to light. RVF can be transmitted vertically from the mother to the fetus and horizontally through contact with infected animals or their tissues. Mosquitoes play a crucial role in horizontal transmission by biting infected animals and then spreading the virus to humans.3 It still has the potential to harm people and livestock. A pandemic might have a severe adverse effect on low-income communities. Due to its economic impact and unexpected re-emergence, RVF is considered a threat to animals and humans. Understanding the various eco-epidemiologies of the virus can help develop effective interventions and surveillance strategies. In 1931, a shepherd investigating a property in Kenya’s Rift Valley discovered the RVF virus.4 Pregnant animals miscarry because newborn animals, mainly sheep and goats, have a high death rate because of contact with infected animals and their body fluids, as well as their corpses and organs. These things, including internal organs, during animal handling dissection and stinging can lead to human infection with the Rift Valley fever virus. Only one stranded RNA virus, the West Nile virus, belongs to the Flaviviridae family, which also includes many other significant human infections, including the dengue, eastern encephalitis, and yellow fever viruses.5
The first case of West Nile virus was identified in 19375 in a feverish patient in Uganda. Consequently, research observed that WNV transmission was endemic6 and major in tropical regions of Africa, South Asia, and northwestern Australia and is also episodic in more temperate regions of Europe. Similar to vector-borne illnesses, the extended transmission seasons made possible by the tropics’ higher temperatures occasionally led to more profound transmission due to quick mosquito and virus growth and increased biting rates. Eighty percent of people over the age of 15 in some African cultures have antibodies to WNV, even though the virus was once thought to be practically asymptomatic and was even tried as a treatment for most malignancies in the 1950s. In Africa, RVF was regarded as an animal disease until 1975. Rare human instances have little symptoms of illness.
Hemorrhagic fever and demise epidemics on a significant scale had been documented in South Africa in the middle of 1975, Egypt in 1977, and Mauritania in 1987. One of the most severe epidemics ever recorded occurred in East Africa in December 1997, with inexplicable fatalities, reported in southern Somalia and the northern regions of southern Kenya.7 This pandemic grew to be regarded as the most dangerous in the area. RVF was first discovered outside of the African continent in Saudi Arabia and Yemen in September 2000, resulting in significant farm animal losses and catastrophic fatalities. The epidemic was first reported in Kenya from 2006 to 2007. Later, the effects spread to Tanzania and Somalia. In 2007 and 2008, Madagascar and South Africa were destroyed. However, 20 outbreaks have been reported in Europe.
On April 17, 2008,8 the Madagascar Ministry of Health announced that RVF was an epidemic. Almost 476 probable cases of RVF, including 19 fatalities, were reported from four provinces between January and June 2008. The Madagascar Ministry of Health recorded 236 suspected cases, including seven fatalities, between December 2008 and May 2009. The South African government recorded 237 verified cases of RVF in people between February and July 2010, including 26 fatal cases from nine regions. On October 4, 2012, the Mauritania Ministry of Health reported an RVF epidemic. The index case first appeared on September 16, 2012, and by November 13, 2012. A total of 36 cases, including 18 deaths, had been recorded from six areas. The rate of animal illness and death was rapidly rising as of June 2022.9 Between August 30, 2022, and October 17, 2022, around 47 cases, of which the majority were animal breeders, were recorded in Mauritania. There were also 23 documented deaths during that time.10 This comprehensive review aimed to consolidate knowledge of RVFV epidemiology from 1937 to 2022 and highlighted knowledge gaps pertinent to plans for human vaccination trials by using different delay factors.
Mosquitoes are particularly susceptible due to the disease incidence in livestock. Advising that isolating people from one another is a workable preventive measure during an outbreak, we can also reduce sickness if people apply insect repellent. To further investigate theoretically the long-term circulation of the disease at the population level, numerical simulations are employed to validate the logical results. A vector–host epidemic model with vertical transmission was examined using the model described in Ref. 11. We expanded12 the model by varying the interaction rates within the host population, as well as vertical transmission between the host and vector populations. As we cannot control the vector but can lower the risk of disease exposure in people, we expand their model by including delay tactics in the host populations.
One significant type of mathematical modeling is delay modeling,20–22 which proves highly beneficial in solving such problems. An example of a serious disease where delay modeling is essential is Rift Valley fever, a terrible illness that leads to numerous deaths. Therefore, delay modeling is vital in combating this disease effectively. In the mathematical modeling of Rift Valley Fever (RVF), incorporating delays into the differential equations mirrors real-world scenarios. The reproduction number is key in understanding the disease’s dynamics: a number below one signifies control, while that above one indicates ongoing transmission. Integrating delays, such as those from quarantine or hospitalization, is vital. Since controlling infection rates is complex, employing tactics such as mosquito control and isolation is crucial for effective pandemic management. To protect themselves from Rift Valley fever, people should steer clear of infected animals or their body fluids, apply insect repellent to fend off mosquito bites, and maintain good hygiene by washing their hands regularly. It is evident that controlling epidemic diseases is crucial. Given that most vector-borne diseases are zoonoses, implementing control measures is vital. Understanding the dynamic nature of these diseases is essential for effective control measures and ensuring that people are treated to prevent further infections.12
Various mathematical models are used to study and control Rift Valley Fever (RVF). These models primarily focus on different geographical regions, scale levels, and host vector dynamics. Notably, the models include both deterministic and stochastic approaches to assess control strategies, risk mapping, and scenario comparisons. For instance, the EFSA AHAW Panel’s models are stochastic and applied at sub-national and national levels in Mayotte and the Netherlands, respectively, focusing on livestock and vector control through compartmental models (SEIRV and SIR).13 Gachohi et al. utilized a deterministic model for Kenya at a local scale, incorporating multiple vertebrate hosts (cattle and small ruminants) and vectors (Aedes and Culex) within an SEIR framework.14 Similarly, Gaff et al. and Adongo et al. presented theoretical deterministic models for livestock control, emphasizing scenario comparisons through compartmental methods (SEIRV and SEIR).15,16 Chamchod and Yang’s studies also offered deterministic models targeting livestock control with variations in infection states and vector taxa.17,18 Overall, it highlights the diversity in modeling techniques and control strategies across different regions and scales, emphasizing the importance of both deterministic and stochastic methods in understanding and managing RVF outbreaks.
To date, numerous mathematical models have been explored to comprehend the mechanisms underlying real-world phenomena. Researchers have investigated various methods to solve these models both analytically and numerically.28–41 A significant body of the literature has been dedicated to developing models for infectious diseases.42 The model that we used in our research, which was first proposed by Ross and later modified by Macdonald, has significantly influenced both the modeling and the application of control strategies for vector-borne diseases. Lashari et al. presented an analysis of a simple vector-host epidemic model with horizontal transmission. Abdullah et al. extended this model to include vertical transmission in both vector and host populations and introduced a treatment class in the host population with different interaction rates. We have analyzed delay control dynamics of the model developed by Abdullah et al.12
Given the absence of vaccines or complete treatments for Rift Valley fever globally, delay tactics such as social awareness, travel restrictions, hospitalization, control of the vector, protection against their bites, and isolation have been instrumental in controlling the disease. Risk of animal-to-human transmission of infection can be reduced by avoiding unsafe animal husbandry and slaughtering practices by maintaining good hygiene and by avoiding unsafe consumption of fresh blood, raw milk, or animal tissue in affected regions.43–45 The primary objective of this research is to validate the newly developed model through numerical simulations and to assess its effectiveness in tracking diseases such as Rift Valley fever. For this purpose, we have incorporated the τ rate factor that can reduce disease spread, and a negative sign with delta indicates that our problem is an initial value problem, tending toward initial values when the delay term is applied. Delay mathematical modeling is crucial in epidemiology, particularly for addressing real-world issues such as epidemic diseases.
This is the paper’s approach: A review of the literature on illnesses with a brief history about and illnesses similar to RVF is included in Sec. I. The delayed model’s formulation and mathematical analysis are covered in Sec. II; Sec. III addresses reproductive number analysis. Section IV presents the model’s stability locally and globally, as well as parameter sensitivity. In Sec. V, we present the results of our numerical simulations and discuss the convergence of our NSFD method. Numerical experiments at different points are presented in Sec. VI. The work’s final observations or conclusions are included in Sec. VII.
II. FORMULATION OF THE DELAY MATHEMATICAL MODEL
S(t) describes the susceptible human population.
I(t) demonstrates the infectious human population.
T(t) represents the human population under treatment.
R(t) reveals the recovered human population.
V(t) shows the susceptible population of the vector.
W(t) represents here the infected class of vector.
Here, t ≥ 0, τ ≤ t.We cannot control mosquito reproduction, but we can overcome this disease by following some rules and applying a time delay and precautions. The flowchart displayed in the image describes the entire process of the model’s construction.
III. ANALYSIS OF THE MODEL
In this section, we conduct a theoretical analysis of the dynamics exhibited by Rift Valley fever disease. Model equilibrium states, model properties such as the boundedness and positivity of solution, and the reproductive number of our delay model are analyzed.
A. Model equilibrium points
B. Model properties
For any finite time t ≥ 0, there is a unique and bounded solution to the system of equations in a positively invariant set.
Every equation in the system has a continuous right side in the convex domain Y = t, S(t), I(t), T(t), R(t), V(t), and W(t)) of (6 + 1)-dimensional space with the partial derivatives that are continuous. Thus, for a given limited period t ≥ 0 and with initial conditions, the problem has a unique solution.
C. Reproductive number
The basic reproductive number is used to analyze the dynamics of the system. Rrvf can defined as the expected number of the secondary cases that an ordinary affected person could cause in an entirely susceptible group throughout the infectious period. In our case, we represent the reproductive number with Rrvf.
Mathematically it is defined as Rrvf ∝ T.C.D, where , , and .
As a threshold, this amount is used to measure whether a disease will spread or disappear from the community. It may be determined with the approach of the next generation matrix. In this system, the infected population is indicated by I, T, and W, whereas those without infection compartments are marked by S, R, and V. The two matrices F and V describe the new rate of infection generation and the rate of transition between stages, respectively.
When there is no vertical transmission, ϵ1 = ϵ2 = 0 and the basic reproductive number for a model that only has side-to-side transmission is Rrvf.
IV. LOCAL STABILITY AND GLOBAL STABILITY
The local and global stability analysis at disease-free and endemic equilibrium points using Brauer, F lemma, and Castillo–Chavez’s methods and the Lyapunov function with specific properties is discussed in this section. In addition, we found the sensitivity analysis of the parameters.
A. Local stability
Trivial steady state E0 is locally asymptotically stable if the reproductive number Rrvf < 1.
Notice that all eigenvalues of our system are λ1 = −μ1 < 0, λ2 = −(ϵ1b1 + α + η + δ1) < 0, λ3 = −(γ + δ1 + μ1) < 0, λ4 = −μ1 < 0, λ5 = −μ2 < 0, and λ6 = −m < 0.
Hence, all eigenvalues are negative, so E0 clearly shows that it is locally asymptotically stable.□
E1 points that are the disease-free equilibrium points are locally asymptotically stable if Rrvf is less than one; otherwise, if the reproductive number is greater than one, then it will be unstable.
(Brauer-F).
For the quadratic equation λ2 − cλ + d = 0, where |λi| < 1 i = 1, 2, both roots will be satisfied if and only if the following conditions are satisfied:
1 − c + d > 0;
1 + c + d > 0;
d < 1;
1 − c + d > 0
1 − (ϵ1b1 + β1N1e−δτ − k − m) + (−mϵ1b1 − mβ1N1e−δτ + km − β2β3N1N2),
1 − ϵ1b1 − β1N1e−δτ + k + m − mϵ1b1 − mβ1N1e−δτ + km − β2β3N1N2.
According to the given condition,
1 − ϵ1b1 − β1N1e−δτ + k + m − mϵ1b1 − mβ1N1e−δτ + km − β2β3N1N2 > 0.
1 + c + d > 0
1 + (ϵ1b1 + β1N1e−δτ − k − m) + (−mϵ1b1 − mβ1N1e−δτ + km − β2β3N1N2),
1 + ϵ1b1 + β1N1e−δτ − k − m − mϵ1b1 − mβ1N1e−δτ + km − β2β3N1N2.
According to the given condition,
1 + ϵ1b1 + β1N1e−δτ − k − m − mϵ1b1 − mβ1N1e−δτ + km − β2β3N1N2 > 0.
d < 1
−mϵ1b1 − mβ1N1e−δτ + km − β2β3N1N2 < 1.
The endemic equilibrium point E2 is locally asymptotically stable if Rrvf is .
B. Global stability
The Rift Valley fever-free equilibrium is globally asymptotically stable if both conditions satisfied , when Rrvf < 1.
Since S1 ≤ S, I1 ≤ I, and V1 ≤ V, we have . It also clearly represents that matrix B has non-negative non-diagonal entries, so B is an matrix. Therefore, our conditions are satisfied, and we can say that disease-free equilibrium points are globally asymptotically stable.□
The Rift Valley fever existing equilibrium E2 is globally asymptotically stable, if Rrvf > 1.
We know that the parametric values are non-negative, so we have , when γ1 ≤ γ2, and .
From the calculation, it can be observed that if conditions S = S2, I = I2, T = T2, R = R2, V = V2, and W = W2 are satisfied.
Hence, E2 globally asymptotically stable.□
C. Sensitivity analysis of parameters
Sensitivity analysis in epidemic models involves studying how changes in specific parameters affect the model’s behavior and outcomes. By varying these parameters systematically, researchers can see how sensitive the model’s predictions are to each change. This helps us identify which parameters have the most significant impact on the epidemic’s spread and control. The sensitivity analysis of the basic reproductive number Rrvf regarding every parameter is as follows:
Positive effect on Rrvf
1. ϵ1: (positive effect). 2. β1: (positive effect) 3. β3: (positive effect). 4. b1: (positive effect). 5. b2: (positive effect). 6. β2: (positive effect).
Negative effect on Rrvf
1. α: (negative effect). 2. η: (negative effect). 3. δ1: (negative effect). 4. μ1: (negative effect). 5. ϵ2: (negative effect). 6. δ2: (negative effect). 7. μ2: (negative effect). 8. γ: (negative effect).
The analysis reveals that some parameters exhibit positive sensitivity indices, while others have negative sensitivity indices, as shown in Fig. 2, similar to others. This indicates that certain parameters are directly related to Rrvf, while others have an inverse relationship with the reproduction number, that is, if the cure rate of mosquitoes increase, the disease will decrease. In addition, when the disease transmission rate of vector β2 increases, the disease will spread fast. These results indicate that parameters have significant effects on the basic reproductive number of the model.
(a) Behavior of Rrvf that decreases with an increasing cure rate α. (b) Rrvf value increases as vertical transmission β2 increases.
(a) Behavior of Rrvf that decreases with an increasing cure rate α. (b) Rrvf value increases as vertical transmission β2 increases.
V. NUMERICAL ANALYSIS
In this section, for numerical investigation we prefer the NSFD method, and this method positively preserves the numerical scheme. Further justification proved its convergence and consistency analysis.
A. Non-standard finite difference
B. Convergence analysis of the proposed NSFD
All conditions of the lemma (Brauer-F) are satisfied, so we can say that our scheme is stable.
C. Consistency analysis
VI. NUMERICAL COMPARISON OF GRAPHS AT DIFFERENT POINTS
We gather information from the source as mentioned in Table I and solve the model using the non-standard finite difference method. Some of the parameter values are based on reality, as mentioned in Ref. 12, from where we got maximum data. For initial conditions, let S(0) = 100, I(0) = 30, T(0) = 25, R(0) = 10, V(0) = 600, and W(0) = 100. Following the NSFD technique, we graphically represent the findings and demonstrate the impact of vertical transmission and cure rate. At the disease-free equilibrium, everyone seems to be in the susceptible compartment, and there is no ongoing transmission of the disease. Verifying that the numerical solutions yield the expected behavior at this point helps ensure that the model accurately represents the disease dynamics in the absence of infection. Disease-free points and endemic points are critical in stability analysis. For example, the disease-free equilibrium is often considered a reference point for stability analysis, and understanding the behavior of the system near this point is crucial.
Values of parameters.
Parameters . | Description . | Values/days . | Resources . |
---|---|---|---|
b1 | Human’s recruitment rate | 20 | 12 |
b2 | Vector’s recruitment rate | 100 | 12 |
δ1 | Death rate in humans by disease | 0.01 | 12 |
δ2 | Death rate in vectors by disease | 0.21 | 12 |
β1 | Transmission rate from human to human | 0.000 01 | 12 |
β2 | Transmission rate from vector to population | 0.0012 | 12 |
β3 | Transmission probability from | 0.001 | 12 |
humans to vector population | |||
μ1 | Mortality rate in humans by nature | 0.000 039 | 12 |
μ2 | Mortality rate in mosquitoes by nature | 0.1 | 12 |
α | Treatment parameter depends on delay tactics | [0 − 100] | Fitted |
γ | Recovery rate due to treatment | 0.4 | 12 |
η | Natural recovery rate | 0.01 | 12 |
ϵ1 | Newborn baby’s infected by parents | 0.001 | 12 |
ϵ2 | Vertical transmission in mosquitoes | 0.002 | 12 |
δ | The rate of mortality of humans at the susceptible point | 0.000 039 | Assumed |
τ | Time delay using pre-cautionary measurements | τ ≥ 0 | Assumed |
Parameters . | Description . | Values/days . | Resources . |
---|---|---|---|
b1 | Human’s recruitment rate | 20 | 12 |
b2 | Vector’s recruitment rate | 100 | 12 |
δ1 | Death rate in humans by disease | 0.01 | 12 |
δ2 | Death rate in vectors by disease | 0.21 | 12 |
β1 | Transmission rate from human to human | 0.000 01 | 12 |
β2 | Transmission rate from vector to population | 0.0012 | 12 |
β3 | Transmission probability from | 0.001 | 12 |
humans to vector population | |||
μ1 | Mortality rate in humans by nature | 0.000 039 | 12 |
μ2 | Mortality rate in mosquitoes by nature | 0.1 | 12 |
α | Treatment parameter depends on delay tactics | [0 − 100] | Fitted |
γ | Recovery rate due to treatment | 0.4 | 12 |
η | Natural recovery rate | 0.01 | 12 |
ϵ1 | Newborn baby’s infected by parents | 0.001 | 12 |
ϵ2 | Vertical transmission in mosquitoes | 0.002 | 12 |
δ | The rate of mortality of humans at the susceptible point | 0.000 039 | Assumed |
τ | Time delay using pre-cautionary measurements | τ ≥ 0 | Assumed |
Case 01: Simulation at disease free equilibrium (RVF by E1) without applying delay tactics
The graphs (a)–(f) in Fig. 3 demonstrate the graphical solution of the system (SITRVW) at Rift Valley fever disease free points with the initial data of the model where the system touches the disease free points E1. When there is no delay, the reproduction number’s value is 0.4461 < 1, which also combines the behavior of the model as presented in these graphs.
Time series plots (a)–(f) of the model’s equations at the disease-free equilibrium.
Time series plots (a)–(f) of the model’s equations at the disease-free equilibrium.
Case 02: Simulation at disease existing equilibrium (RVF by E2) without delay
Here, Fig. 4 represents graphs (a)–(f) for the model’s (SITRVW) equations’ response at Rift Valley fever disease existing points with initial data of the model; therefore, the system touches on disease existing points E2. In the absence of tactics, the value of the reproduction number is 1.1599 > 1, which also combines the behavior of the model as presented in these graphs.
Time series plots (a)–(f) of the model’s equations at the disease-existing equilibrium.
Time series plots (a)–(f) of the model’s equations at the disease-existing equilibrium.
Case 03: Simulations at RVF existing equilibrium with time delay effect
This section examines the impact on the system’s equations by putting the endemic equilibrium in the model for Rift Valley fever, utilizing artificial time delay variables to get a good effect. Figure 5 plots (a)–(c) represent how human vulnerability rises when delay techniques are used. On the other hand, we can see that Rift Valley fever patients’ infectivity falls and even approaches to zero.
Combined behavior of the system (a) at τ = 0.4, (b) at τ = 0.5, and (c) at τ = 0.9.
Combined behavior of the system (a) at τ = 0.4, (b) at τ = 0.5, and (c) at τ = 0.9.
Case 04: Comparison graph of the reproduction number and artificial delay term of the model
Figure 6 displays the fact that the increases in delay strategy can overcome the spread of Rift Valley fever, as needed.
Comparison graph of the reproduction number and artificial delay term of the model.
Comparison graph of the reproduction number and artificial delay term of the model.
Hence, by numerical investigation, we can clearly analyze that the researchers in this study apply mathematical techniques to inquire how delay strategies have an effect on the behavior of the SITRVW model.
VII. CONCLUSIONS
Vector-borne ailments are diseases that are spread by vectors to humans and animals. This research developed a delay epidemically model for vector-borne illness dynamics of transmission, including transmissions in both vertical and horizontal directions and a disease delay method. The model’s equilibrium points and fundamental reproduction are discovered. As the reproduction number increases, the sickness spreads into the population, and the disease dies off as it falls. Although the susceptible population increases, due to delay tactics, it does not have an effect on human beings because they remain safe due to these tactics. By using conditions on the threshold number, it has been shown that both equilibrium points are locally and globally stable. However, the global behavior of these equilibrium points is studied using the theory of Lyapunov function. The effect of other parameters can be easily understood by the sensitivity analysis of our reproductive number.
The NSFD scheme is dynamically consistent, and the results proved that the scheme preserves the properties of our mathematical model. The most effective methods for the delay factors are an increase in values of constant precautions and mosquito repellent. These parameters reduce the unconditional spread of disease stability through our convergence analysis. Furthermore, we conducted an in-depth investigation of how the delay factor affected the number of reproductions, the infected class, and the recovered class. Based on our findings, we were able to control the dynamics of the virus by applying various delay-causing techniques, such as mosquito replication, which has been shown to be the most efficient method to stop the disease from spreading. Humanity and the healthcare industry will benefit from this investigation’s findings. In conclusion, delayed epidemically mathematical models are an important addition to understanding virus dynamics. In the future, we intend to expand this work to include fractal fractional analysis of this model.
ACKNOWLEDGMENTS
We acknowledge the support of Universiti Sains Malaysia (USM) and we thank the reviewers for their valuable feedback.
AUTHOR DECLARATIONS
Conflict of Interest
The authors have no conflicts to disclose.
Author Contributions
Shah Zeb: Conceptualization (equal); Data curation (equal); Formal analysis (equal); Investigation (equal); Methodology (equal); Visualization (equal); Writing – original draft (equal). Siti Ainor Mohd Yatim: Conceptualization (equal); Investigation (equal); Project administration (equal); Supervision (equal); Writing – review & editing (equal). Muhammad Rafiq: Supervision (equal); Visualization (equal); Writing – review & editing (equal). Waheed Ahmad: Data curation (equal); Formal analysis (equal); Methodology (equal). Ayesha Kamran: Visualization (equal); Writing – review & editing (equal). Md. Fazlul Karim: Conceptualization (equal); Formal analysis (equal); Funding acquisition (equal); Writing – review & editing (equal).
DATA AVAILABILITY
The data that support the findings of this study are available within the article.