Zakażenia Związane Z Opieką Zdrowotną U Pacjentów Oparzonych: OD Patogenezy DO Zintegrowanej Kontroli Zakażeń
References
- Abdi FA, Motumma AN, Kalayu AA, Abegaz WE. Prevalence and antimicrobial-resistant patterns of Pseudomonas aeruginosa among burn patients attending Yekatit 12 Hospital Medical College in Addis Ababa, Ethiopia. PLoS One. 2024 Mar;19(3).
https://doi.org/10.1371/journal.pone.0289586 - Alfadli M, El-Sehsah EM, Ramadan MAM. Risk factors and distribution of MDROs among patients with healthcare associated burn wound infection. Germs. 2018 Dec;8(4):199–206.
https://doi.org/10.18683/germs.2018.1147 - Armour AD, Shankowsky HA, Swanson T, Lee J, Tredget EE. The impact of nosocomially-acquired resistant Pseudomonas aeruginosa infection in a burn unit. J Trauma. 2007 Jul;63(1):164–171.
https://doi.org/10.1097/01.TA.0000240175.18189.AF - Ayobami O, Willrich N, Reuss A, Eckmanns T, Markwart R. The ongoing challenge of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Europe: an epidemiological analysis of bloodstream infections. Emerg Microbes Infect. 2020 Jun;9(1):1180–1193.
https://doi.org/10.1080/22221751.2020.1769500 - Ballard J, Edelman L, Saffle J, Sheridan R, Kagan R, Bracco D, Cancio L, Cairns B, Baker R, Fillari P, et al. Positive fungal cultures in burn patients: a multicenter review. J Burn Care Res. 2008 Jan-Feb;29(1):213–221.
https://doi.org/10.1097/BCR.0b013e31815f6ecb - Barajas-Nava LA, López-Alcalde J, Roqué i Figuls M, Solà I, Bonfill Cosp X. Antibiotic prophylaxis for preventing burn wound infection. Cochrane Database Syst Rev. 2013 Jun;2013(6).
https://doi.org/10.1002/14651858.CD008738.pub2 - Bourgi J, Said JM, Yaakoub C, Atallah B, Al Akkary N, Sleiman Z, Ghanimé G. Bacterial infection profile and predictors among patients admitted to a burn care center: a retrospective study. Burns. 2020 Dec;46(8):1968–1976.
https://doi.org/10.1016/j.burns.2020.05.004 - Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections. Clin Microbiol Rev. 2006 Apr;19(2):403–434.
https://doi.org/10.1128/CMR.19.2.403-434.2006 - Corcione S, Pensa A, Castiglione A, Lupia T, Bortolaso B, Romeo MR, Stella M, De Rosa FG. Epidemiology, prevalence and risk factors for infections in burn patients: results from a regional burn centre’s analysis. J Chemother. 2021 Feb;33(1):62–66.
https://doi.org/10.1080/1120009X.2020.1780776 - de La Cal MA, Cerdá E, García-Hierro P, Lorente L, Sánchez -Concheiro M, Díaz C, van Saene HK. Pneumonia in patients with severe burns: a classification according to the concept of the carrier state. Chest. 2001 Apr;119(4):1160–1165.
https://doi.org/10.1378/chest.119.4.1160 - Doi Y. Treatment options for carbapenem-resistant Gram-negative bacterial infections. Clin Infect Dis. 2019 Nov;69(Suppl 7)–S575.
https://doi.org/10.1093/cid/ciz830 - Dudoignon E, Chevret S, Tsague S, Hamane S, Chaouat M, Plaud B, Vicault E, Mebazaa A, Legrand M, Alanio A, et al. Risk factors and outcome associated with fungal infections in patients with severe burn injury: 10-year retrospective IFI-BURN study. Clin Infect Dis. 2024 Sep;79(3):682–689.
https://doi.org/10.1093/cid/ciae337 - Eftekhar F, Naseh Z. Extended-spectrum β-lactamase and carbapenemase production among burn and non-burn clinical isolates of Klebsiella pneumoniae. Iran J Microbiol. 2015 Jun;7(3):144–149.
- Ekrami A, Kalantar E. Bacterial infections in burn patients at a burn hospital in Iran. Indian J Med Res. 2007 Dec;126(6): 541–544.
- Fleischer M, Zienkiewicz M. Mikrobiologiczne mapowanie szpitala. Forum Zakażeń. 2018 Sep;9(4):213–219.
https://doi.org/10.15374/FZ2018041 - Gallo L, Kim P, Gallo M, Olaiya O, Main C, Avram R, Bain J, Thoma A, Voineskos SH, Coroneos C. Incidence and risk factors associated with microbial colonization of burn wounds: an observational study. Plast Surg (Oakv). 2025 May;33(2):269–275.
https://doi.org/10.1177/22925503231214760 - Gandhi AA, Prasad PS, Nataraj G, Puri V. Temporal changes in bacterial profile of burn wound infections in a tertiary care hospital and risk factors for invasion: a prospective cohort study. J Clin Diagn Res. 2025 Jan;19(1)–DC05.
https://doi.org/10.7860/JCDR/2025/70627.20461 - Gomersall J, Mortimer K, Hassan D, Whitehead KA, Slate AJ, Ryder SF, Chambers LE, El Mohtadi M, Shokrollahi K. Ten--year analysis of bacterial colonisation and outcomes of major burn patients with a focus on Pseudomonas aeruginosa. Microorganisms. 2024 Jan;12(1):42.
https://doi.org/10.3390/microorganisms12010042 - Güldoğan CE, Kendirci M, Tikici D, Gündoğdu E, Yastı AÇ. Clinical infection in burn patients and its consequences. Ulus Travma Acil Cerrahi Derg. 2017 Nov;23(6):466–471.
https://doi.org/10.5505/tjtes.2017.16064 - Gur I, Zilbert A, Toledano K, Roimi M, Stern A. Clinical impact of fungal colonization of burn wounds in patients hospitalized in the intensive care unit: a retrospective cohort study. Trauma Surg Acute Care Open. 2024 Apr;9(1).
https://doi.org/10.1136/tsaco-2023-001325 - Heyland DK, Wischmeyer P, Jeschke MG, Wibbenmeyer L, Turgeon AF, Stelfox HT, Day AG, Garrel D. A randomized trial of enteral glutamine to minimize thermal injury (the RE-ENERGIZE trial): a clinical trial protocol. Scars Burn Heal. 2017 Dec;3:2059513117745241.
https://doi.org/10.1177/2059513117745241 - Horta R, Tomaz D, Egipto P, Silva A. The outcome of fungal infections in a burn intensive care unit: a study of 172 patients. Ann Burns Fire Disasters. 2020 Jun;33(2):101–106.
- Hryniewicz W, Kulig J, Ozorowski T, Mól A, Kulig P, Wąchol D. Stosowanie antybiotyków w wybranych zakażeniach skóry i tkanek miękkich. Warszawa (Polska): Narodowy Instytut Leków; 2012. ISBN 978-83-932196-9-8.
- Hu Y, Li D, Xu L, Hu Y, Sang Y, Zhang G, Dai H. Epidemiology and outcomes of bloodstream infections in severe burn patients: a six-year retrospective study. Antimicrob Resist Infect Control. 2021 Jun;10(1):98.
https://doi.org/10.1186/s13756-021-00969-w - Huang D, Qi M, Hu Y, Yu M, Liang Z. The impact of Candida spp airway colonization on clinical outcomes in patients with ventilator-associated pneumonia: a systematic review and meta-analysis. Am J Infect Control. 2020 Jun;48(6):695–701.
https://doi.org/10.1016/j.ajic.2019.11.002 - Kalligeros M, Shehadeh F, Karageorgos SA, Zacharioudakis IM, Mylonakis E. MRSA colonization and acquisition in the burn unit: a systematic review and meta-analysis. Burns. 2019 Nov;45(7):1528–1536.
https://doi.org/10.1016/j.burns.2019.05.014 - Kiley JL, Greenhalgh DG. Infections in burn patients. Surg Clin North Am. 2023 Jun;103(3):427–437.
https://doi.org/10.1016/j.suc.2023.02.005 - Knuth CM, Rehou S, Barayan D, Jeschke MG. Evaluating sepsis criteria in detecting alterations in clinical, metabolic, and inflammatory parameters in burn patients. Shock. 2022 Aug;58(2):103– 110.
https://doi.org/10.1097/SHK.0000000000001965 - Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006 Aug;6:130.
https://doi.org/10.1186/1471-2334-6-130 - Kramer A, Dissemond J, Kim S, Willy C, Mayer D, Papke R, Tuchmann F, Assadian O. Consensus on wound antisepsis: update 2018. Skin Pharmacol Physiol. 2018 Jan;31(1):28–58.
https://doi.org/10.1159/000481545 - Lachiewicz AM, Hauck CG, Weber DJ, Cairns BA, van Duin D. Bacterial infections after burn injuries: impact of multidrug resistance. Clin Infect Dis. 2017 Dec;65(12):2130–2136.
https://doi.org/10.1093/cid/cix682 - Lade H, Joo HS, Kim JS. Molecular basis of non-β-lactam antibiotics resistance in Staphylococcus aureus. Antibiotics (Basel). 2022 Oct;11(10):1378.
https://doi.org/10.3390/antibiotics11101378 - Ladhani HA, Yowler CJ, Claridge JA. Burn wound colonization, infection, and sepsis. Surg Infect (Larchmt). 2021 Feb;22(1):44–48.
https://doi.org/10.1089/sur.2020.346 - Lam NN, Hung TD, Hung DK. Acute respiratory distress syndrome among severe burn patients in a developing country: application result of the Berlin definition. Ann Burns Fire Disasters. 2018 Mar;31(1):9–12.
- Li F, Song M, Xu L, Deng B, Zhu S, Li X. Risk factors for catheter-associated urinary tract infection among hospitalized patients: a systematic review and meta-analysis of observational studies. J Adv Nurs. 2019 Mar;75(3):517–527.
https://doi.org/10.1111/jan.13863 - Liao C, Huang X, Wang Q, Yao D, Lu W. Virulence factors of Pseudomonas aeruginosa and antivirulence strategies to combat its drug resistance. Front Cell Infect Microbiol. 2022;12:926758.
https://doi.org/10.3389/fcimb.2022.926758 - Lindblad M, Huss F, Tano E, Lytsy B, Sütterlin S. Preventing outbreaks in burn units: the role of hygiene compliance and early warning systems. Antimicrob Resist Infect Control. 2025 Jul;14:75.
https://doi.org/10.1186/s13756-025-01592-9 - Liodaki E, Kalousis K, Mauss KL, Kisch T, Mailaender P, Stang F. Epidemiology of pneumonia in a burn care unit: the influence of inhalation trauma on pneumonia and of pneumonia on burn mortality. Ann Burns Fire Disasters. 2015 Jun;28(2):128–133.
- Maraki S, Mantadakis E, Mavromanolaki VE, Kofteridis DP, Samonis G. A 5-year surveillance study on antimicrobial resistance of Acinetobacter baumannii clinical isolates from a tertiary Greek hospital. Infect Chemother. 2016 Sep;48(3):190–198.
https://doi.org/10.3947/ic.2016.48.3.190 - Michalopoulos A, Falagas ME. Treatment of Acinetobacter infections. Expert Opin Pharmacother. 2010 Apr;11(5):779–788.
https://doi.org/10.1517/14656561003596350 - Moins-Teisserenc H, Cordeiro DJ, Audigier V, Ressaire Q, Benyamina M, Lambert J, Maki G, Homyrda L, Toubert A, Legrand M. Severe altered immune status after burn injury is associated with bacterial infection and septic shock. Front Immunol. 2021 Mar;12:586195.
https://doi.org/10.3389/fimmu.2021.586195 - Mortada H, Alhindi N, Abukhudair A, Alanazi S, AlSahli A, Arab K. The effects of glutamine supplementation on reducing mortality and morbidity among burn patients: a systematic review and meta-analysis of randomized controlled trials. JPRAS Open. 2023 Mar;35:6–17.
https://doi.org/10.1016/j.jpra.2022.09.003 - Mosier MJ, Pham TN, Klein MB, Gibran NS, Arnoldo BD, Gamelli RL, Tompkins RG, Herndon DN. Early enteral nutrition in burns: compliance with guidelines and associated outcomes in a multicenter study. J Burn Care Res. 2011 Jan–Feb;32(1):104–109.
https://doi.org/10.1097/BCR.0b013e318204b3be - Norbury W, Herndon DN, Tanksley J, Jeschke MG, Finnerty CC. Infection in burns. Surg Infect (Larchmt). 2016 Apr;17(2):250–255.
https://doi.org/10.1089/sur.2013.134 - Oehmcke S, Shannon O, Mörgelin M, Herwald H. Streptococcal M proteins and their role as virulence determinants. Clin Chim Acta. 2010 Sep;411(17–18):1172–1180.
https://doi.org/10.1016/j.cca.2010.04.032 - Oleszczak-Momot W, Jurkiewicz A. Kontrola wewnętrzna dzia-łań zapobiegających szerzeniu się zakażeń i chorób zakaźnych w podmiotach leczniczych w świetle obowiązujących aktów prawnych. Med Og Nauk Zdr. 2015;21(2):142–145.
https://doi.org/10.5604/20834543.1152910 - Özkurt Z, Altoparlak Ü, Yılmaz Sİ, Erol S, Özden K, Akçay MN. Reducing hospital infection rates in the burn unit by adherence to infection control measures: a six-year experience. Turk J Med Sci. 2012 Feb;42(1):17–24.
https://doi.org/10.3906/sag-1005-824 - Ozlu O, Basaran A. Infections in patients with major burns: a retrospective study of a burn intensive care unit. J Burn Care Res. 2022 Jul;43(4):926–930.
https://doi.org/10.1093/jbcr/irab222 - Paczosa MK, Mecsas J. Klebsiella pneumoniae: going on the offense with a strong defense. Microbiol Mol Biol Rev. 2016 Jun;80(3):629– 661.
https://doi.org/10.1128/MMBR.00078-15 - Palackic A, Popp D, Tapking C, Houschyar KS, Branski LK. Fungal infections in burn patients. Surg Infect (Larchmt). 2021 Feb;22(1):83–87.
https://doi.org/10.1089/sur.2020.299 - Pawlik K, Mączyńska A, Fleischer M, Hryniewicz W. Kontrola środowiska szpitalnego w zapobieganiu zakażeniom wywoływanym przez wieloantybiotykooporne patogeny alarmowe. Warszawa (Polska): Narodowy Instytut Leków; 2020. ISBN 978-83-949636-4-4.
- Peck MD. Epidemiology of burns throughout the world. Part I: distribution and risk factors. Burns. 2011 Nov;37(7):1087–1100.
https://doi.org/10.1016/j.burns.2011.06.005 - Perween N, Prakash SK, Siddiqui O. Multi drug resistant Klebsiella isolates in burn patients: a comparative study. J Clin Diagn Res. 2015 Sep;9(9)–DC16.
https://doi.org/10.7860/JCDR/2015/13837.6576 - Petersen-Morfin S, Bocanegra-Ibarias P, Morfin-Otero R, Garza-González E, Perez-Gomez HR, González-Diaz E, Esparza-Ahumada S, León-Garnica G, Amezcua-Salazar G, Rodriguez-Noriega E. New Delhi metallo-beta-lactamase (NDM-1)-producing Klebsiella pneumoniae isolated from a burned patient. Am J Case Rep. 2017 Jul;18:805–809.
https://doi.org/10.12659/AJCR.903992 - Pruskowski KA, Rizzo JA, Cancio LC. Fungal infections in burn patients from 2014–2019: a 5-year retrospective review. J Burn Care Res. 2020 Mar;41(Suppl 1)–S91.
https://doi.org/10.1093/jbcr/iraa024.140 - Raes K, Blot K, Vogelaers D, Labeau S, Blot S. Protective isolation precautions for the prevention of nosocomial colonisation and infection in burn patients: a systematic review and meta-analysis. Intensive Crit Care Nurs. 2017 Oct;42:22–29.
https://doi.org/10.1016/j.iccn.2017.03.005 - Ramos GE. Antibiotic prophylaxis in burn patients: a review of current trends and recommendations for treatment. J Infectiology. 2018;1(1):1–5.
https://doi.org/10.29245/2689-9981/2018/1.1105 - Robben PM, Ayalew MD, Chung KK, Ressner RA. Multidrug-resistant organisms in burn infections. Surg Infect (Larchmt). 2021 Feb;22(1):103–112.
https://doi.org/10.1089/sur.2020.129 - Roy S, Mukherjee P, Kundu S, Majumder D, Raychaudhuri V, Choudhury L. Microbial infections in burn patients. Acute Crit Care. 2024 May;39(2):214–225.
https://doi.org/10.4266/acc.2023.01571 - Ruegsegger L, Xiao J, Naziripour A, Kanumuambidi T, Brown D, Williams F, Marshall SH, Rudin SD, Yen K, Chu T, et al. Multidrug-resistant Gram-negative bacteria in burn patients. Antimicrob Agents Chemother. 2022 Sep;66(9).
https://doi.org/10.1128/aac.00688-22 - Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005 Oct;33(10):2184–2193.
https://doi.org/10.1097/01.CCM.0000181731.53912.D9 - Salmani A, Shakerimoghaddam A, Pirouzi A, Delkhosh Y, Eshraghi M. Correlation between biofilm formation and antibiotic susceptibility pattern in Acinetobacter baumannii MDR isolates retrieved from burn patients. Gene Rep. 2020 Dec;21:100816.
https://doi.org/10.1016/j.genrep.2020.100816 - Sánchez M, Herruzo R, Marbán A, Araujo P, Asensio MJ, Leyva F, Casado C, García-de-Lorenzo A. Risk factors for outbreaks of multidrug-resistant Klebsiella pneumoniae in critical burn patients. J Burn Care Res. 2012 May–Jun;33(3):386–392.
https://doi.org/10.1097/BCR.0b013e318231df95 - Sen S, Johnston C, Greenhalgh D, Palmieri T. Ventilator-associated pneumonia prevention bundle significantly reduces the risk of ventilator-associated pneumonia in critically ill burn patients. J Burn Care Res. 2016 May–Jun;37(3):166–171.
https://doi.org/10.1097/BCR.0000000000000228 - Sharma BR. Infection in patients with severe burns: causes and prevention thereof. Infect Dis Clin North Am. 2007 Sep;21(3):745– 759.
https://doi.org/10.1016/j.idc.2007.06.003 - Shokoohizadeh L, Ekrami A, Labibzadeh M, Ali L, Alavi SM. Antimicrobial resistance patterns and virulence factors of enterococci isolates in hospitalized burn patients. BMC Res Notes. 2018 Jan;11(1):1.
https://doi.org/10.1186/s13104-017-3088-5 - Shupp JW, Pavlovich AR, Jeng JC, Pezzullo JC, Oetgen WJ, Jaskille AD, Jordan MH, Shoham S. Epidemiology of bloodstream infections in burn-injured patients: a review of the National Burn Repository. J Burn Care Res. 2010 Jul–Aug;31(4):521–528.
https://doi.org/10.1097/BCR.0b013e3181e4d5e7 - Singh NP, Rani M, Gupta K, Sagar T, Kaur IR. Changing trends in antimicrobial susceptibility pattern of bacterial isolates in a burn unit. Burns. 2017 Aug;43(5):1083–1087.
https://doi.org/10.1016/j.burns.2017.01.016 - Skibba KE, Mitchell DC, Bell DE. The effective elimination of nosocomial burn wound infections with daily wound care. J Burn Care Res. 2019 Apr;40(Suppl 1)–S104.
https://doi.org/10.1093/jbcr/irz013.173 - Sopata M, Mrozikiewicz-Rakowska B, Jawień A, Woroń J, Malka M, Karpiński TM, Sobieszek-Kundro A, Gabriel M, Mańkowski P, Szewczyk MT, et al. Stanowisko Polskiego Towarzystwa Leczenia Ran – postępowanie przeciwdrobnoustrojowe w ranie skolonizowanej, z cechami infekcji i zagrożonej infekcją w erze antybiotykooporności. Leczenie Ran. 2023;20(4):125–141.
https://doi.org/10.60075/lr.v20i4.59 - Styczyński J, Dzierżanowska-Fangrat K, Matysiak M, Kałwak K, Irga-Jaworska N, Szczepański T. Program racjonalnej terapii przeciwgrzybiczej „WYLECZ!”. Forum Zakażeń. 2021;12(3):133–138.
https://doi.org/10.15374/FZ2021016 - Sulik-Tyszka B, Wróblewska M. Aspergiloza – diagnostyka laboratoryjna i leczenie. Forum Zakażeń. 2021;12(3):123–131.
https://doi.org/10.15374/FZ2021013 - Surowiecka A. Sprawozdanie ze spotkania grupy roboczej ds. leczenia oparzeń pod patronatem Krajowego Konsultanta w dziedzinie chirurgii plastycznej i Dyrektora Departamentu Lecznictwa w Ministerstwie Zdrowia. Chir Plast Oparzenia. 2025;13(1):35–39.
https://doi.org/10.15374/ChPiO2025005 - Tao W, Xu G, Zhou J, Luo Y, Li PS. Glutamine supplementation on burn patients: a systematic review and meta-analysis. J Burn Care Res. 2024 May–Jun;45(3):675–684.
https://doi.org/10.1093/jbcr/irae007 - Tejiram S, Shupp JW. Innovations in infection prevention and treatment. Surg Infect (Larchmt). 2021 Feb;22(1):12–19.
https://doi.org/10.1089/sur.2020.202 - Thomas RE, Thomas BC. Reducing biofilm infections in burn patients’ wounds and biofilms on surfaces in hospitals, medical facilities and medical equipment to improve burn care: a systematic review. Int J Environ Res Public Health. 2021 Dec;18(24):13195.
https://doi.org/10.3390/ijerph182413195 - Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011 Feb;32(2):101–114.
https://doi.org/10.1086/657912 - Wanis M, Walker SAN, Daneman N, Elligsen M, Palmay L, Simor A, Cartotto R. Impact of hospital length of stay on the distribution of Gram negative bacteria and likelihood of isolating a resistant organism in a Canadian burn center. Burns. 2016 Feb;42(1):104–111.
https://doi.org/10.1016/j.burns.2015.07.010 - Wibbenmeyer L, Danks R, Faucher L, Amelon M, Latenser B, Kealey GP, Herwaldt LA. Prospective analysis of nosocomial infection rates, antibiotic use, and patterns of resistance in a burn population. J Burn Care Res. 2006 Mar–Apr;27(2):152–160.
https://doi.org/10.1097/01.BCR.0000203359.32756.F7 - Yeong EK, Sheng WH. Does early bloodstream infection pose a significant risk of in-hospital mortality in adults with burns? J Microbiol Immunol Infect. 2022 Feb;55(1):95–101.
https://doi.org/10.1016/j.jmii.2021.01.004 - Zhao H, Liu M, Wu J, Chen S, Yang H, Long J, Duan G. Mortality and genetic diversity of antibiotic-resistant bacteria associated with bloodstream infections: a systemic review and genomic analysis. BMC Infect Dis. 2024 Dec;24(1):1385.
https://doi.org/10.1186/s12879-024-10274-7 - Zheng XX, Kong LA, Lyu R, Xu CJ. Analysis of epidemiological characteristics and risk factors of catheter-associated urinary tract infections in patients with perineal and/or hip burns. Chin J Burns Wounds. 2024 Mar;40(3):289–295.
https://doi.org/10.3760/cma.j.cn501225-20231027-00138 - Zhou HY, Yuan Z, Du YP. Prior use of four invasive procedures increases the risk of Acinetobacter baumannii nosocomial bacteremia among patients in intensive care units: a systematic review and meta-analysis. Int J Infect Dis. 2014 May;22:25–30.
https://doi.org/10.1016/j.ijid.2014.01.018
Language: English, Polish
Page range: 174 - 188
Submitted on: Jan 8, 2026
Accepted on: Sep 14, 2026
Published on: Oct 13, 2026
Published by: Polish Society of Microbiologists
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Related subjects:
© 2026 Weronika A. Czapska, Anna Chrapusta, Agnieszka Gniadek, published by Polish Society of Microbiologists
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.