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<title xml:lang="en">Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11</title>
<author>
<name sortKey="Maercker, Andreas" sort="Maercker, Andreas" uniqKey="Maercker A" first="Andreas" last="Maercker">Andreas Maercker</name>
<affiliation>
<nlm:aff id="au1">
<institution>Department of Psychology, Division of Psychopathology, University of Zurich</institution>
<addr-line>Switzerland</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Brewin, Chris R" sort="Brewin, Chris R" uniqKey="Brewin C" first="Chris R" last="Brewin">Chris R. Brewin</name>
<affiliation>
<nlm:aff id="au2">
<institution>Department of Clinical, Educational and Health Psychology, University College London</institution>
<addr-line>London, UK</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Bryant, Richard A" sort="Bryant, Richard A" uniqKey="Bryant R" first="Richard A" last="Bryant">Richard A. Bryant</name>
<affiliation>
<nlm:aff id="au3">
<institution>School of Psychology, University of New South Wales</institution>
<addr-line>Sydney, Australia</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Cloitre, Marylene" sort="Cloitre, Marylene" uniqKey="Cloitre M" first="Marylene" last="Cloitre">Marylene Cloitre</name>
<affiliation>
<nlm:aff id="au4">
<institution>Division of Dissemination and Training, National Center for PTSD</institution>
<addr-line>Menlo Park, CA, USA</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Van Ommeren, Mark" sort="Van Ommeren, Mark" uniqKey="Van Ommeren M" first="Mark" last="Van Ommeren">Mark Van Ommeren</name>
<affiliation>
<nlm:aff id="au5">
<institution>Department of Mental Health and Substance Abuse, World Health Organization</institution>
<addr-line>Geneva, Switzerland</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Jones, Lynne M" sort="Jones, Lynne M" uniqKey="Jones L" first="Lynne M" last="Jones">Lynne M. Jones</name>
<affiliation>
<nlm:aff id="au6">
<institution>FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard University</institution>
<addr-line>Cambridge, MA, USA</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Humayan, Asma" sort="Humayan, Asma" uniqKey="Humayan A" first="Asma" last="Humayan">Asma Humayan</name>
<affiliation>
<nlm:aff id="au7">
<institution>Institute of Psychiatry</institution>
<addr-line>Benazir Bhutto Hospital, Murree Road, Rawalpindi, Pakistan</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kagee, Ashraf" sort="Kagee, Ashraf" uniqKey="Kagee A" first="Ashraf" last="Kagee">Ashraf Kagee</name>
<affiliation>
<nlm:aff id="au8">
<institution>Department of Psychology, Stellenbosch University</institution>
<addr-line>Stellenbosch, South Africa</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Llosa, Augusto E" sort="Llosa, Augusto E" uniqKey="Llosa A" first="Augusto E" last="Llosa">Augusto E. Llosa</name>
<affiliation>
<nlm:aff id="au9">
<institution>Epicentre</institution>
<addr-line>Paris, France</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Rousseau, Cecile" sort="Rousseau, Cecile" uniqKey="Rousseau C" first="Cécile" last="Rousseau">Cécile Rousseau</name>
<affiliation>
<nlm:aff id="au10">
<institution>Department of Psychiatry, McGill University Health Center</institution>
<addr-line>Montréal, Canada</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Somasundaram, Daya J" sort="Somasundaram, Daya J" uniqKey="Somasundaram D" first="Daya J" last="Somasundaram">Daya J. Somasundaram</name>
<affiliation>
<nlm:aff id="au11">
<institution>University of Jaffna</institution>
<addr-line>Sri Lanka</addr-line>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="au12">
<institution>Glenside Mental Health Services</institution>
<addr-line>Glenside, South Australia, Australia</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Souza, Renato" sort="Souza, Renato" uniqKey="Souza R" first="Renato" last="Souza">Renato Souza</name>
<affiliation>
<nlm:aff id="au13">
<institution>International Committee of the Red Cross</institution>
<addr-line>Geneva, Switzerland</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Suzuki, Yuriko" sort="Suzuki, Yuriko" uniqKey="Suzuki Y" first="Yuriko" last="Suzuki">Yuriko Suzuki</name>
<affiliation>
<nlm:aff id="au14">
<institution>National Center of Neurology and Psychiatry, National Institute of Mental Health</institution>
<addr-line>Tokyo, Japan</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Weissbecker, Inka" sort="Weissbecker, Inka" uniqKey="Weissbecker I" first="Inka" last="Weissbecker">Inka Weissbecker</name>
<affiliation>
<nlm:aff id="au15">
<institution>International Medical Corps</institution>
<addr-line>Washington, DC, USA</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Wessely, Simon C" sort="Wessely, Simon C" uniqKey="Wessely S" first="Simon C" last="Wessely">Simon C. Wessely</name>
<affiliation>
<nlm:aff id="au16">
<institution>Institute of Psychiatry</institution>
<addr-line>King's College London, London, UK</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="First, Michael B" sort="First, Michael B" uniqKey="First M" first="Michael B" last="First">Michael B. First</name>
<affiliation>
<nlm:aff id="au17">
<institution>Department of Psychiatry, Columbia University Medical Center</institution>
<addr-line>New York, NY, USA</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Reed, Geoffrey M" sort="Reed, Geoffrey M" uniqKey="Reed G" first="Geoffrey M" last="Reed">Geoffrey M. Reed</name>
<affiliation>
<nlm:aff id="au5">
<institution>Department of Mental Health and Substance Abuse, World Health Organization</institution>
<addr-line>Geneva, Switzerland</addr-line>
</nlm:aff>
</affiliation>
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<idno type="doi">10.1002/wps.20057</idno>
<date when="2013">2013</date>
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<title xml:lang="en" level="a" type="main">Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11</title>
<author>
<name sortKey="Maercker, Andreas" sort="Maercker, Andreas" uniqKey="Maercker A" first="Andreas" last="Maercker">Andreas Maercker</name>
<affiliation>
<nlm:aff id="au1">
<institution>Department of Psychology, Division of Psychopathology, University of Zurich</institution>
<addr-line>Switzerland</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Brewin, Chris R" sort="Brewin, Chris R" uniqKey="Brewin C" first="Chris R" last="Brewin">Chris R. Brewin</name>
<affiliation>
<nlm:aff id="au2">
<institution>Department of Clinical, Educational and Health Psychology, University College London</institution>
<addr-line>London, UK</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Bryant, Richard A" sort="Bryant, Richard A" uniqKey="Bryant R" first="Richard A" last="Bryant">Richard A. Bryant</name>
<affiliation>
<nlm:aff id="au3">
<institution>School of Psychology, University of New South Wales</institution>
<addr-line>Sydney, Australia</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Cloitre, Marylene" sort="Cloitre, Marylene" uniqKey="Cloitre M" first="Marylene" last="Cloitre">Marylene Cloitre</name>
<affiliation>
<nlm:aff id="au4">
<institution>Division of Dissemination and Training, National Center for PTSD</institution>
<addr-line>Menlo Park, CA, USA</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Van Ommeren, Mark" sort="Van Ommeren, Mark" uniqKey="Van Ommeren M" first="Mark" last="Van Ommeren">Mark Van Ommeren</name>
<affiliation>
<nlm:aff id="au5">
<institution>Department of Mental Health and Substance Abuse, World Health Organization</institution>
<addr-line>Geneva, Switzerland</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Jones, Lynne M" sort="Jones, Lynne M" uniqKey="Jones L" first="Lynne M" last="Jones">Lynne M. Jones</name>
<affiliation>
<nlm:aff id="au6">
<institution>FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard University</institution>
<addr-line>Cambridge, MA, USA</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Humayan, Asma" sort="Humayan, Asma" uniqKey="Humayan A" first="Asma" last="Humayan">Asma Humayan</name>
<affiliation>
<nlm:aff id="au7">
<institution>Institute of Psychiatry</institution>
<addr-line>Benazir Bhutto Hospital, Murree Road, Rawalpindi, Pakistan</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kagee, Ashraf" sort="Kagee, Ashraf" uniqKey="Kagee A" first="Ashraf" last="Kagee">Ashraf Kagee</name>
<affiliation>
<nlm:aff id="au8">
<institution>Department of Psychology, Stellenbosch University</institution>
<addr-line>Stellenbosch, South Africa</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Llosa, Augusto E" sort="Llosa, Augusto E" uniqKey="Llosa A" first="Augusto E" last="Llosa">Augusto E. Llosa</name>
<affiliation>
<nlm:aff id="au9">
<institution>Epicentre</institution>
<addr-line>Paris, France</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Rousseau, Cecile" sort="Rousseau, Cecile" uniqKey="Rousseau C" first="Cécile" last="Rousseau">Cécile Rousseau</name>
<affiliation>
<nlm:aff id="au10">
<institution>Department of Psychiatry, McGill University Health Center</institution>
<addr-line>Montréal, Canada</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Somasundaram, Daya J" sort="Somasundaram, Daya J" uniqKey="Somasundaram D" first="Daya J" last="Somasundaram">Daya J. Somasundaram</name>
<affiliation>
<nlm:aff id="au11">
<institution>University of Jaffna</institution>
<addr-line>Sri Lanka</addr-line>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="au12">
<institution>Glenside Mental Health Services</institution>
<addr-line>Glenside, South Australia, Australia</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Souza, Renato" sort="Souza, Renato" uniqKey="Souza R" first="Renato" last="Souza">Renato Souza</name>
<affiliation>
<nlm:aff id="au13">
<institution>International Committee of the Red Cross</institution>
<addr-line>Geneva, Switzerland</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Suzuki, Yuriko" sort="Suzuki, Yuriko" uniqKey="Suzuki Y" first="Yuriko" last="Suzuki">Yuriko Suzuki</name>
<affiliation>
<nlm:aff id="au14">
<institution>National Center of Neurology and Psychiatry, National Institute of Mental Health</institution>
<addr-line>Tokyo, Japan</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Weissbecker, Inka" sort="Weissbecker, Inka" uniqKey="Weissbecker I" first="Inka" last="Weissbecker">Inka Weissbecker</name>
<affiliation>
<nlm:aff id="au15">
<institution>International Medical Corps</institution>
<addr-line>Washington, DC, USA</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Wessely, Simon C" sort="Wessely, Simon C" uniqKey="Wessely S" first="Simon C" last="Wessely">Simon C. Wessely</name>
<affiliation>
<nlm:aff id="au16">
<institution>Institute of Psychiatry</institution>
<addr-line>King's College London, London, UK</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="First, Michael B" sort="First, Michael B" uniqKey="First M" first="Michael B" last="First">Michael B. First</name>
<affiliation>
<nlm:aff id="au17">
<institution>Department of Psychiatry, Columbia University Medical Center</institution>
<addr-line>New York, NY, USA</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Reed, Geoffrey M" sort="Reed, Geoffrey M" uniqKey="Reed G" first="Geoffrey M" last="Reed">Geoffrey M. Reed</name>
<affiliation>
<nlm:aff id="au5">
<institution>Department of Mental Health and Substance Abuse, World Health Organization</institution>
<addr-line>Geneva, Switzerland</addr-line>
</nlm:aff>
</affiliation>
</author>
</analytic>
<series>
<title level="j">World Psychiatry</title>
<idno type="ISSN">1723-8617</idno>
<idno type="eISSN">2051-5545</idno>
<imprint>
<date when="2013">2013</date>
</imprint>
</series>
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<front>
<div type="abstract" xml:lang="en">
<p>The diagnostic concepts of post-traumatic stress disorder (PTSD) and other disorders specifically associated with stress have been intensively discussed among neuro- and social scientists, clinicians, epidemiologists, public health planners and humanitarian aid workers around the world. PTSD and adjustment disorder are among the most widely used diagnoses in mental health care worldwide. This paper describes proposals that aim to maximize clinical utility for the classification and grouping of disorders specifically associated with stress in the forthcoming 11th revision of the International Classification of Diseases (ICD-11). Proposals include a narrower concept for PTSD that does not allow the diagnosis to be made based entirely on non-specific symptoms; a new complex PTSD category that comprises three clusters of intra- and interpersonal symptoms in addition to core PTSD symptoms; a new diagnosis of prolonged grief disorder, used to describe patients that undergo an intensely painful, disabling, and abnormally persistent response to bereavement; a major revision of “adjustment disorder” involving increased specification of symptoms; and a conceptualization of “acute stress reaction” as a normal phenomenon that still may require clinical intervention. These proposals were developed with specific considerations given to clinical utility and global applicability in both low- and high-income countries.</p>
</div>
</front>
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<pmc article-type="research-article">
<pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">World Psychiatry</journal-id>
<journal-id journal-id-type="iso-abbrev">World Psychiatry</journal-id>
<journal-id journal-id-type="publisher-id">wps</journal-id>
<journal-title-group>
<journal-title>World Psychiatry</journal-title>
</journal-title-group>
<issn pub-type="ppub">1723-8617</issn>
<issn pub-type="epub">2051-5545</issn>
<publisher>
<publisher-name>Blackwell Publishing Ltd</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">24096776</article-id>
<article-id pub-id-type="pmc">3799241</article-id>
<article-id pub-id-type="doi">10.1002/wps.20057</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Special Articles</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Maercker</surname>
<given-names>Andreas</given-names>
</name>
<xref ref-type="aff" rid="au1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Brewin</surname>
<given-names>Chris R</given-names>
</name>
<xref ref-type="aff" rid="au2">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Bryant</surname>
<given-names>Richard A</given-names>
</name>
<xref ref-type="aff" rid="au3">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cloitre</surname>
<given-names>Marylene</given-names>
</name>
<xref ref-type="aff" rid="au4">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>van Ommeren</surname>
<given-names>Mark</given-names>
</name>
<xref ref-type="aff" rid="au5">5</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Jones</surname>
<given-names>Lynne M</given-names>
</name>
<xref ref-type="aff" rid="au6">6</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Humayan</surname>
<given-names>Asma</given-names>
</name>
<xref ref-type="aff" rid="au7">7</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kagee</surname>
<given-names>Ashraf</given-names>
</name>
<xref ref-type="aff" rid="au8">8</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Llosa</surname>
<given-names>Augusto E</given-names>
</name>
<xref ref-type="aff" rid="au9">9</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Rousseau</surname>
<given-names>Cécile</given-names>
</name>
<xref ref-type="aff" rid="au10">10</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Somasundaram</surname>
<given-names>Daya J</given-names>
</name>
<xref ref-type="aff" rid="au11">11</xref>
<xref ref-type="aff" rid="au12">12</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Souza</surname>
<given-names>Renato</given-names>
</name>
<xref ref-type="aff" rid="au13">13</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Suzuki</surname>
<given-names>Yuriko</given-names>
</name>
<xref ref-type="aff" rid="au14">14</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Weissbecker</surname>
<given-names>Inka</given-names>
</name>
<xref ref-type="aff" rid="au15">15</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Wessely</surname>
<given-names>Simon C</given-names>
</name>
<xref ref-type="aff" rid="au16">16</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>First</surname>
<given-names>Michael B</given-names>
</name>
<xref ref-type="aff" rid="au17">17</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Reed</surname>
<given-names>Geoffrey M</given-names>
</name>
<xref ref-type="aff" rid="au5">5</xref>
</contrib>
<aff id="au1">
<label>1</label>
<institution>Department of Psychology, Division of Psychopathology, University of Zurich</institution>
<addr-line>Switzerland</addr-line>
</aff>
<aff id="au2">
<label>2</label>
<institution>Department of Clinical, Educational and Health Psychology, University College London</institution>
<addr-line>London, UK</addr-line>
</aff>
<aff id="au3">
<label>3</label>
<institution>School of Psychology, University of New South Wales</institution>
<addr-line>Sydney, Australia</addr-line>
</aff>
<aff id="au4">
<label>4</label>
<institution>Division of Dissemination and Training, National Center for PTSD</institution>
<addr-line>Menlo Park, CA, USA</addr-line>
</aff>
<aff id="au5">
<label>5</label>
<institution>Department of Mental Health and Substance Abuse, World Health Organization</institution>
<addr-line>Geneva, Switzerland</addr-line>
</aff>
<aff id="au6">
<label>6</label>
<institution>FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard University</institution>
<addr-line>Cambridge, MA, USA</addr-line>
</aff>
<aff id="au7">
<label>7</label>
<institution>Institute of Psychiatry</institution>
<addr-line>Benazir Bhutto Hospital, Murree Road, Rawalpindi, Pakistan</addr-line>
</aff>
<aff id="au8">
<label>8</label>
<institution>Department of Psychology, Stellenbosch University</institution>
<addr-line>Stellenbosch, South Africa</addr-line>
</aff>
<aff id="au9">
<label>9</label>
<institution>Epicentre</institution>
<addr-line>Paris, France</addr-line>
</aff>
<aff id="au10">
<label>10</label>
<institution>Department of Psychiatry, McGill University Health Center</institution>
<addr-line>Montréal, Canada</addr-line>
</aff>
<aff id="au11">
<label>11</label>
<institution>University of Jaffna</institution>
<addr-line>Sri Lanka</addr-line>
</aff>
<aff id="au12">
<label>12</label>
<institution>Glenside Mental Health Services</institution>
<addr-line>Glenside, South Australia, Australia</addr-line>
</aff>
<aff id="au13">
<label>13</label>
<institution>International Committee of the Red Cross</institution>
<addr-line>Geneva, Switzerland</addr-line>
</aff>
<aff id="au14">
<label>14</label>
<institution>National Center of Neurology and Psychiatry, National Institute of Mental Health</institution>
<addr-line>Tokyo, Japan</addr-line>
</aff>
<aff id="au15">
<label>15</label>
<institution>International Medical Corps</institution>
<addr-line>Washington, DC, USA</addr-line>
</aff>
<aff id="au16">
<label>16</label>
<institution>Institute of Psychiatry</institution>
<addr-line>King's College London, London, UK</addr-line>
</aff>
<aff id="au17">
<label>17</label>
<institution>Department of Psychiatry, Columbia University Medical Center</institution>
<addr-line>New York, NY, USA</addr-line>
</aff>
</contrib-group>
<pub-date pub-type="ppub">
<month>10</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="epub">
<day>04</day>
<month>10</month>
<year>2013</year>
</pub-date>
<volume>12</volume>
<issue>3</issue>
<fpage>198</fpage>
<lpage>206</lpage>
<permissions>
<copyright-statement>Copyright © 2013 World Psychiatric Association</copyright-statement>
<copyright-year>2013</copyright-year>
</permissions>
<abstract>
<p>The diagnostic concepts of post-traumatic stress disorder (PTSD) and other disorders specifically associated with stress have been intensively discussed among neuro- and social scientists, clinicians, epidemiologists, public health planners and humanitarian aid workers around the world. PTSD and adjustment disorder are among the most widely used diagnoses in mental health care worldwide. This paper describes proposals that aim to maximize clinical utility for the classification and grouping of disorders specifically associated with stress in the forthcoming 11th revision of the International Classification of Diseases (ICD-11). Proposals include a narrower concept for PTSD that does not allow the diagnosis to be made based entirely on non-specific symptoms; a new complex PTSD category that comprises three clusters of intra- and interpersonal symptoms in addition to core PTSD symptoms; a new diagnosis of prolonged grief disorder, used to describe patients that undergo an intensely painful, disabling, and abnormally persistent response to bereavement; a major revision of “adjustment disorder” involving increased specification of symptoms; and a conceptualization of “acute stress reaction” as a normal phenomenon that still may require clinical intervention. These proposals were developed with specific considerations given to clinical utility and global applicability in both low- and high-income countries.</p>
</abstract>
<kwd-group>
<kwd>Classification</kwd>
<kwd>mental disorders</kwd>
<kwd>ICD</kwd>
<kwd>nosology</kwd>
<kwd>PTSD</kwd>
<kwd>complex PTSD</kwd>
<kwd>prolonged grief disorder</kwd>
<kwd>cultural appropriateness</kwd>
<kwd>DSM</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>

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