Husbandry and Nutrition
Original
Characterization of the actors in the
pasteurized milk chain in the province of Sancti Spíritus, Cuba
Caracterización
de los actores de la cadena de la leche pasteurizada en la provincia de Sancti
Spíritus, Cuba
Juan E. Hernández García*, Angel
Pentón Ponce de León*
, José A. Nápoles Gómez**
, Lázaro Pablo Rodríguez
Álvarez***
, Odenys
Gómez Brito***
, María de los Ángeles
Gutiérrez Jorge****
*Department of Veterinary. Faculty of Agricultural Sciences, Sancti
Spíritus University. “José Martí Pérez”. Cuba.
**Experimental Station of Pasture and Forages, Sancti Spíritus. Cuba.
***Ministry of
Agriculture in Sancti Spíritus province, Cuba.
****Institute of Veterinary Medicine, Sancti Spíritus. Cuba.
Correspondencia: juanemilio@uniss.edu.cu
Recibido: Marzo, 2021;
Aceptado: Junio, 2021; Publicado: Enero, 2022.
Background: The study of chains at a local
level starts from a new configuration constitutes a new
working philosophy in the agri-food sector in Cuba. Objective. The aim of the paper is to
characterize of the actors in the pasteurized milk chain in four municipalities of
Sancti Spíritus province. Methods: It was based on the primary
and secondary available information obtained at workshops with the
participation of national actors and international experts. The
characterization of the actors included the variables described in previous
chain studies, the construction of the SWOT Matrix and an action plan. Results: The links of the chain are: Production, collection,
processing and marketing. At the primary
sector, there are different productive farms with non-governmental dominance. They had a production of
approximately 20,000 liters/year, having 20 not specialized female cattle in
milk production. Some of the farms use animal traction for milk collection and
the industry does this process with tank trucks. The processing link presents
technology with limitations and insufficient equipment. The SWOT Matrix
revealed that the nutrition is not sufficient and the composition of milk is
not good. Besides, the process of collection and the industrial distribution
that affect the quality of milk. Conclusions: The
characterization of the actors showed that in the primary link with
predominance of the non-state sector, but there is low milk production. For the
collection of milk, they use animal traction and tanker trucks. Obsolete
technologies are found in the processing link, while commercialization actors
are limited by hygienic conditions.
Key words: Dairy production, dairy
cattle, dairy value chain food chain, food access, pasteurized
milk (Source: AGROVOC)
Antecedentes: El estudio de las cadenas a
nivel local constituye una nueva filosofía de trabajo en el sector
agroalimentario en Cuba. Objetivo.
El objetivo del trabajo fue caracterizar los actores de la cadena de la leche
pasteurizada en cuatro municipios de la provincia de Sancti Spíritus. Métodos: Se basó en la información
primaria y secundaria disponible obtenida en talleres con la participación de
actores nacionales y expertos internacionales. La caracterización de los
actores incluyó las variables descritas en estudios de cadenas previos, la
construcción de la Matriz DAFO y un plan de acción. Resultados: Los eslabones de la cadena fueron: Producción,
recolección, procesamiento y comercialización. En el sector primario, existen
diferentes fincas productivas con predominio del sector no estatal. La
producción aproximada por fincas era de 20.000 litros/año y contando con
rebaños de 20 hembras, no especializadas en la producción de leche. Algunas
granjas utilizan tracción animal para la recolección de leche y la industria
realiza este proceso con camiones cisterna. En el eslabón procesamiento se
observó limitaciones tecnológicas y equipamiento insuficiente y en la
comercialización deficiencias en las condiciones higiénicas. Los análisis de la
matriz DAFO ponderó como principales variables la insuficiente nutrición de los
animales y las afectaciones de la calidad de la leche a lo largo de la cadena. Conclusiones: La caracterización de los
actores mostró que en el eslabón primario predomina el sector no estatal, pero
tiene muy baja producción de leche. Para la recolección de la leche, utilizan
camiones cisterna y la tracción animal. En el eslabón de procesamiento se
encontraron tecnologías obsoletas y equipos insuficientes, mientras que los
actores de la comercialización están limitados por las condiciones higiénicas.
Palabras clave: Acceso a alimentos, cadena
alimentaria, cadena de valor láctea, ganado lechero, leche pasteurizada,
producción láctea (Fuente: AGROVOC).
INTRODUCTION
The new schemes of agricultural production, the dynamics of the commerce from the point of view of the globalization of economies and markets, as well as the increasing public attention on quality, environmental protection and international regulations require a new overview (Amirnejad and Tonakbar, 2015; Daou et al., 2020; Ledo et al., 2020; Martínez et al., 2017).
Sancti Spíritus province, Cuba has a
great agricultural tradition and milk is one of the major products enhancing
its socio-economic development. Nowadays, the province has considerable masses of cattle
of different Races and productive farms. These potentialities should be
enhanced to meet the population's needs in terms of quantity, quality and
safety.
The production chain is a system that
begins from the primary production up to the consumption. It integrates the
actors (men and women) with different characteristics and with specific roles.
They develop cross-linked and interdependent activities around the evolution
and performance of a product, which attempts to be competitive for the local or
regional development (Simanca et al.,
2016). The concept
of productive chain is an increasingly used alternative for studying the
components and the relations of the agents (Ríos et al., 2016), which are necessary to visualize reality and territorial interests (Imelda et al., 2017, Barati and Kalantari,
2017; Food and Agriculture Organization, 2014; Van Campenhout et
al., 2019).
For a better competitiveness of a production chain, it is necessary to implement two types of complementary stages: 1) Analysis of the productive chain; and 2) strategy for decision making (Van der Heyden and Camacho, 2004). SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) is an important tool to analyze and think strategically about the development of agricultural chains (Baudino et al., 2017). A SWOT analysis will help the agricultural chain to identify their critical strategic factors. Once they are identified, they are starting points to support organizational change: consolidating the strengths and minimizing the weaknesses, taking advantage of opportunities, and eliminating or reducing threats. The SWOT analysis is based on two pillars: the internal analysis and external analysis of the chain (Moghaddaszadeh et al., 2015).
In Cuba, some works have been carried
out in the last years focusing on production chains (Armenteros-Amaya et al., 2020; Hernández-Rodríguez et
al., 2020)
There are
important elements in the strategy of the Cuban Ministry of Agriculture and it
is reflected in the National Science Program on Production of Human Food (Ministry of
Science, Technology and Environment [MSTE],
2020).This
research was part of the plan of activities conceived in the project "Agrocadena: support program for the strengthening of Agrifood Chains (AGROCADENAS) prioritizes the study of the milk,
promoted by the United Nations Development Program (UNDP) and the Ministry of
Agriculture, with the collaboration of the Ministry of Internal Trade and the
Ministry of Food Industry and financial support from the European Union (EU)
and the Swiss Agency for Development Cooperation (Cosude/SDC).
This paper aims to characterize the
actors in the pasteurized milk chain in the province of Sancti Spíritus,
Cuba and to propose strategic objectives for its development.
MATERIALS AND METHODS
For the development of this research in
four municipalities of the local
level in Sancti Spíritus province, Cuba: Cabaiguan,
Fomento, Yaguajay and
Sancti Spiritus, this study was carried out from 2014 to 2017, the indications
of the methodology were focused on production chains as described by other
authors (Van der Heyden and Camacho, 2004, Suárez-Castellá et al., 2016).
To overcome the concerns regarding being simplistic or subjective in the
analysis of agricultural chain, primary data were collected by authors through
field observations and in-depth interviews with key stakeholders. The data
included information provided in meetings and questionnaires filled in by
various actors in different moments of the study (Table 1). Secondary data were
collected from related publications and documents issued by the competent
institutions in the province. The official statistics on trends in production,
market and consumption of milk and other milk products in Cuba and the world
were also included in the analysis (Martínez et
al., 2017).
Table 1. Behavior of
actors' participation in the analysis of the different chain links.
Links
|
Workshops
|
Participants
|
Male
|
Female
|
Preparatory
|
6
|
348
|
255
|
93
|
Determination of scope
|
7
|
149
|
30
|
119
|
Analysis of background,
surroundings |
3
|
121
|
91
|
30
|
Actors' analysis
|
3
|
216
|
168
|
48
|
Planning (SWOT analysis)
|
3
|
75
|
48
|
27
|
Total
|
22
|
909
|
592
|
317
|
Besides, secondary information was
obtained at workshops with the participation of national actors and
international experts with great experience on agricultural chain links. The
analysis of the plan links was also taken into consideration (Saiz and Castañedo, 2016).
Phases of the
study
The study included the following phases:
·
Preparatory (motivation and learning)
In order to guarantee the communicative level, the
workshops were developed in different levels: municipal, provincial and
regional. They involved 348 participants, 73 % were men and 27 %, women. As
previously mentioned, in each of these workshops various experts participated.
The participants included: managers of all levels of
the territory; producers, specialists, technicians, experts and representatives
from Nongovernmental Organization, as well as representatives of Agricultural
Projects. Other organisms had also a significant performance in the mentioned
activities. They were: Ministry of Science, Technology and Environment;
Institute of Hydraulic Resources; Credit and Commerce Bank. National Insurance
Enterprise; Group of Logistics of the Ministry of Agriculture; National
Association of Small Farmers; Cuban Association of Animal Production; National
Center of Animal Control; Provincial Weather Center of Sancti Spíritus;
Provincial Group of Economy and Planning; Provincial Direction of Finances and
Prices; Dairy Industry; Department of Commerce; Provincial Delegation of the
Ministry of Agriculture; Territorial Office of Normalization; Experimental
Station of Pasture and Forages in Sancti Spíritus; the Institute of Veterinary
Medicine; and the University of Sancti Spíritus, which played an important role
for the organization of the research.
·
Determination of the scope of the diagnosis (chain,
objective, product, territories). For the selection of the chain the following criteria was taken into
account: i) National strategies (import
substitution), ii) High demand (industries of the territory), iii) Tradition,
culture and potentialities, iv) Profitability and v) Jobs.
·
Analysis of the context where the chain is applied, including background,
environment, regulatory frame and infrastructure.
·
Direct
actors in the different links (production, collection, processing and
marketing), and different indirect actors were included in the
study: i) Regulating entities and organizers, ii) Service
suppliers, iii) Suppliers of raw materials
·
Analysis of the sub-processes. For the analysis of the sub-processes of the links of the chain, the productive flow was constructed to identify the
critical points for the improvement plan.
·
Actors' characterization. The group criteria included:
Production link: Form of
organization: the ones of the state form and not state sector. Volume of total
milk production (103L/year): High (>40.0), Medium (20.0 – 39.9) and Low (<19.9).
Number of female cattle (heads): Large (>50), Medium (20 - 49) and Small (<20).
Collection link: Means of transportation: animal
traction or motorcar. Distance to
the cooling point (km): less
than 3 km, 4 to 6 km, 7 to 10 km and more than 10 km. Destination: Directly to the sale point or to the cooling point.
Processing links: The industrial dairy processing sector in Sancti Spíritus province, Cuba,
was classified according to three criteria: their industrial capacity (quantity
of milk processed yearly), their localization and the type of products they
sell (drinking milk and/or dairy derivatives).
Marketing links: Market: Wholesaler and retailer. Customer: Social consumption and other markets.
Construction
of the SWOT Matrix. SWOT analysis is a method that can be used to explore
the Strengths, Weaknesses, Opportunities and Threats of a particular issue. It
has many applications in various fields, including the food chain (Rafeeian and Taji, 2017, Trejo et al., 2016).
Statistical
analysis. The data were analyzed with the
statistical program SPSS 15.0.1 for Windows. A comparison of proportions was
used, considering in all cases a significance level of 5%.
RESULTS AND DISCUSSION
In the historical analysis of the
dairy chain operation in Sancti Spíritus province, Cuba, there were shown the
number of the principal moments for the development of the chain for
pasteurized milk; the number of moments (Figure 1). It was predominant the
post-revolutionary periods, specifically in the stage 1959-1980 an in 2000.
Figure 1. Number of
important moments in the development of the chain of pasteurized milk at Sancti
Spíritus province, Cuba.
According to the scope of the pasteurized milk chain, it was defined the
primary and secondary products: Primary: Pasteurized
milk in bags of 917 mL end Secondary:
Yogurt, cheese, ice cream, butter, powdered milk. The
elaboration of the map of the chain in a participatory way allowed to visualize
it with its links and actors (Figure 2).
Figure 2. Map of the chain of the bovine
pasteurized milk. It included four links.
Directs actors are integrated for: i) Production: Cooperatives
(Credit and Services Cooperatives), Agricultural Workers of the Cooperatives,
Basic Units of Cooperative Production, Governmental
Basic Unit for Agriculture and Individual producers, ii) Collection: Milk carriers, Independent collectors and collectors of the Dairy Industry,
iii) Processing: Locality of
the factors and Basic Unit implied. There are three industries in the province: two factories in Sancti Spíritus city and
Merida, in Yaguajay municipality. They assume these roles, but the pasteurized milk
is only produced in Sancti Spíritus and iv) Marketing: Basic Unit for the industry and the Governmental Unit
of Commerce in the province.
Different indirect actors were included: i) Regulating entities and organizers: They include
different entities; some of them
belong to the Ministry of Agriculture, Health entities, Entities for Science
and Environment, Food Industry,
Basic Industries and Commerce, ii) Service
suppliers: Twelve entities were identified as suppliers, many of them
belonging to the Ministry of Agriculture (five), Nongovernmental Organizations
(two), the University and other Research Centers, the nongovernmental sector,
the Credit and Commerce Bank and the Ministry of Basic Industry, iii) Suppliers of raw materials: Cuban Oil
Industry, National Laboratories for Bio-pharmacy Industries, Enterprise for
marketing, Ministry of Basic Industry, Industry of Containers, National
Enterprise of Agricultural Supplies. They
are summarized in table 2.
Table 2. Summary of
the number and classification of indirect actors.
|
Suppliers of Raw Materials |
Logistic |
Regulating |
|||||||||
Indirect actors |
Production |
Collection |
Processing |
Marketing |
Production |
Collection |
Processing |
Marketing |
Production |
Collection |
Processing |
Marketing |
5 |
2 |
4 |
1 |
0 |
0 |
4 |
0 |
3 |
2 |
4 |
2 |
|
Financial services |
Training Services |
Technical Assistance |
||||||||||
Production |
Collection |
Processing |
Marketing |
Production |
Collection |
Processing |
Marketing |
Production |
Collection |
Processing |
Marketing |
|
|
2 |
0 |
3 |
1 |
8 |
1 |
1 |
0 |
7 |
|
10 |
1 |
The study
of the links generated positive
impacts and learning.
·
It is necessary to consider in the elaboration of the
strategies the non-feasibility of depending on only one market because it
limits the development of potentialities in the dairy chain in Cuba.
·
The programs have
to be accompanied by the necessary links to do a best use of the lands of the
country.
Regarding the Cuban governmental policies on valuable chains, 23 policies are
related to the agricultural production and 19 are specifically linked to the
development of the bovine cattle. Regarding environmental factors, they included climate, temperature and
influences of bio-productive indicators and water. Water is an abundant
resource in the province. The access to it has been limited in periods of
drought that affect the systems of irrigation.
Winds and the meteorological events were the others two variables that
were taken into consideration. These factors have impacts of the milk
production in cow (Conejo-Morales, WingChing-Jones, 2020, Kumar
et al., 2020, Tao et al., 2020).
The infrastructure affected the development of the dairy chain.
Its incidence was shown in the different links and it evidenced
weaknesses in the electric system and communication variants (telephone,
e-mail, etc.). Energy is another indicator very associated to
productivity and efficiency in the different links, showing a weak use of
renewable sources.
Regarding the socio-cultural
facts, the province has 465,674 inhabitants, that is, 68.7 inhab./km². They are 50.7% men and 49.3% women (index of masculinity: 1.028). The housing development is 70 %. Sancti
Spíritus is the most populated city and the principal municipality. The growth
in the population is slow, becoming evident a gradual increase of the
population over 60 years, accompanied of low birth rates and a negative
migratory balance in the province. The socio-cultural facts were including for Alhammd, (2020); in
his study of characteristics of Dairy value chain in Jordan.
The workers at the cattle sector are
in an advanced age; the majority of them belong to
the age groups: 51 - 60 years and over 60 years. Their level
of education is varied. The experience of these workers is a potentiality for
the tradition and cattle culture of the province. Women represent about 50% of
the technical staff in other sectors, but in the cattle sector, they do not
surpass the 15%. They do not have a high percentage in the occupational
categories: Executives and Managers.
Table 3 shows the principal
sub-processes that were verified in the different links of the chain of the
pasteurized milk in Sancti Spíritus province, Cuba. The only
common sub-process was planning.
The analysis of the production chain
in each sub-process and process was an exercise where the actors attempted to
know and to understand the status and functioning of the productive chain. It
enabled to identify the critical points that slow down the competitiveness of
the chain and the competitive advantages that enhance the development. This
exercise of analysis must allow also acknowledging and visualizing the
principal barriers of participation and breaches of access to opportunities and
resources that exist in the chains.
Table 3. Links of the
chain of pasteurized milk and its principal sub-processes.
Production |
Collection |
Processing |
Marketing |
Planning Nutrition Development Reproduction Milking process |
Planning Collection and storage Transportation Delivering |
Planning Exchange for the interrelations Milk reception Cooling Storage Clarification Homogenization Pasteurization Cooling Storage Bottled Storage in refrigerators Transportation and distribution Technological
discipline |
Planning Exchange for the interrelations Transportation Distribution. |
In the production links the no state
form predominates (98.8%); they are represented fundamentally by the Credit and
Services Cooperatives. They group 94% of the producers and are characterized by
having less than 20 cows (3,373 producer/87.2%). They are non-dairy cattle and
provide 104 liters/year of milk (Table 4). Producers do not use
advanced technology in the production and the milking is mainly manual, so the
university participate in their training when new technologies are introduced (García-Hernández et al., 2018).
Table 4. Actors'
characterization of cattle milk production in Sancti Spiritus province (in percentage).
Criteria Form of organization |
n= 4560 |
|||||||||||||||||
No state sector |
State sector |
|||||||||||||||||
98.8a |
1.2b |
|||||||||||||||||
Volume of production ML/year |
n=4505 |
n=55 |
||||||||||||||||
High |
Medium |
Small |
High |
Medium |
Small |
|||||||||||||
5.2c |
8.9b |
85.9a |
40 a |
14.5b |
45.5a |
|||||||||||||
Cow in production (heads) |
n=236 |
n=402 |
n=3867 |
n=22 |
n=8 |
n=25 |
||||||||||||
High |
Medium |
Small |
High |
Medium |
Small |
High |
Medium |
Small |
High |
Medium |
Small |
High |
Medium |
Small |
High |
Medium |
Small |
|
93.6a |
2.1b |
4.2b |
9.4b |
79.1a |
11.4b |
9b |
3.8c |
87.2a |
90.9a |
5b |
5b |
75a |
25b |
0c |
28b |
72a |
0c |
Legend: Percentages on the same line with different superscript (a, b, c) are significantly different (P <0.05).
In the collection links (Table 5),
they use different means of transportation, including animal traction
(95.7%), to the cooling point, mostly for distances of 7 to 10 km (74.8%), with
volumes of milk of more than 60 liters. The industry collection group has
routes with isothermal cars, running distances between 80 -110 km, generally in
four hours of duration.
Table 5. Actors'
characterization of milk collection in the Sancti Spiritus province, Cuba (in percentage).
Means of
transportation (n=236) |
Animal traction 95.7a |
Motor car 4.3 b |
||
Destination |
n=226 |
n=10 |
||
Direct at the point
of sale |
Cooling point |
Direct at the point
of sale |
Cooling point |
|
25.2b |
74.8a |
40a |
60a |
Legend: Percentages on the same line with different superscript (a, b) are significantly different (P <0.05).
The methodology for planning had the starting point in
the diagnosis of the initial situation of the chain of pasteurized milk in
Sancti Spiritus. The SWOT Matrix (Strengths, Weaknesses, Opportunities and
Threats) was constructed using a collective group, which provide evidences from
the beginning of the chain. They identified initially 11 Strengths, 28
weaknesses, 18 opportunities and 13 threats. These were regrouped and in a
second moment it allowed pondering the weaknesses.
Strengths: i) Existence of culture and cattle tradition backed by
educational and sciences institutions with qualified human capital, ii) Good
sanitary condition of the cattle bovine mass, iii) Different
forms of management, iv) Quality of the human capital, v) Collection of the
milk cold at 70 % and vi) Satisfactory sanitary hygiene of the
milk tank.
Opportunities:
i) The product is a
national priority for feeding, mainly to children, pregnant
women, and older adults, ii) Economic and social
transformation in the country, iii) Opening to foreign investment in the
agricultural sector, iv) Environmental conditions that favor the use of
renewable sources of energy, v) Availability and storage of water for the
lactic chain and vi) No satisfaction in the milk market at
the province.
1)
Weaknesses: i) Missuses of herd and
incomplete zoo-technician cycle, ii) Insufficient alimentary base for the
cattle exploitation, iii) Irrational use (use and handling) of the exclusive
land for the bovine cattle, iv) Affectation in the quality of the milk in all links of the chain, v) Low quality of the raw milk produced
and vi) Insufficient specialized transportation for milk collection.
Threats: i)
There are not national policies for the
integration of chains, ii) Marketing
of raw milk, iii) The chain depends of
external markets for some materials, iv) Risks for the climatic changes, v) The
nonexistence of impartial laboratories and vi) Existence of better remunerated
sectors
Different options were finally
proposed for the discussion, but the six most popularly addressed for the plan of actions were the following:
1.
Inadequate handling and nutrition of the cattle mass.
2.
Inadequate sanitary quality and composition of the
milk.
3.
Inadequate practices in the process of collection for
the industry, distribution and commercialization that affect the quality of
milk.
4.
Not advanced infrastructure, equipments
and instruments in all the chain.
5.
Insufficient offer and inadequate quality of the
services.
6.
The
integration of all of the actors of the chain was weak, so interconnection
between the linksph of the chain was evidently
necessary.
One of
the most appropriate
techniques, under the topic
of strategic planning
is the technical analysis of
strengths, weaknesses, opportunities and threats (SWOT) (Rafeeian & Taji, 2017). SWOT
analysis supported the development of the plan action for the municipalities
implicated in the agricultural chain of pasteurized milk at Sancti Spiritus,
province, Cuba. The analysis result showed
that the strategy for the development of chain in Sancti Spiritus is a SO
strategy (Strengths - Opportunities). Those are summarized in Objectives, whit
Strategic actions and proposals of actions that are not done today (Table 6).
Table 6. Summary of
the plan of actions for the chain of the
pasteurized milk at Sancti Spiritus province, Cuba.
Objective |
Strategic
actions |
Indicators of change |
Proposals of actions that are not done today |
Achieving an efficient handling and nutrition of the cattle mass. |
5 |
7 |
1 |
Improving the hygienic sanitary quality and
composition of the raw milk. |
7 |
8 |
5 |
Better standards of quality of the processes of
collection, processing and distribution of milk. |
4 |
4 |
0 |
Increasing the use of installed capacity, improving
in the infrastructure, the technological equipment and instruments. |
4 |
5 |
0 |
Improving of the offer in quantity and quality of
the services and the raw materials for the production. |
4 |
4 |
4 |
Better integral functioning of the chain. |
9 |
5 |
2 |
Total |
33 |
33 |
12 |
This situation raises another challenge for the dairy chains in many countries, related to the implementation of support programs destined to farmers (Sraïri et al., 2013, Soethoudt et al., 2018). This generates significant losses (Minten, Tamru and Reardon, 2021). In fact, with the huge numbers of non-specialized smallholder cattle farms, most of the farms are dispersed, so intervention is quite limited and suggests great defies (Armenteros-Amaya et al., 2020; Martínez et al., 2017).
CONCLUSIONS
The characterization of the actors of the
pasteurized milk chain in four municipalities of Sancti Spiritus province showed that in the primary link with predominance of the
non-state sector, but there is low milk production. For the collection of milk,
they use animal traction and tanker trucks. Obsolete technologies and
insufficient equipment are found in the processing link, while
commercialization actors are limited by hygienic conditions. The comprehensive
analysis of actors in the pasteurized milk chain in the province of Sancti
Spíritus, Cuba, allowed to suggest for their development strategic objectives,
intervention actions and indicators of change.
ACKNOWLEDGMENT
The authors thank
all participants of the chain. A special recognition to the Agricultural Chain
Project, to the Ministry of Agriculture in the province and to the different
actors that took part in the development of this work. Also
to Ph.D. Mercedes Fernández and M Sc. Yenima Martínez
Castro for their contribution to the
language revision of the paper.
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AUTHORS CONTRIBUTION
Conception
and research design: JEHG, APPL, JANG, LPRA, OGB, MAGJ; data analysis and
interpretation: JEHG, APPL, JANG, LPRA, OGB, MAGJ; article writing: JEHG, APPL,
JANG, LPRA, OGB, MAGJ.
CONFLICT OF INTERESTS
The authors
declare that there are no conflicts of interest.