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Knutsson, J., Priwin, C., Hessen-Soderman, A.-C., Rosenblad, A. & von Unge, M. (2018). A randomized study of four different types of tympanostomy ventilation tubes: Full-term follow-up. International Journal of Pediatric Otorhinolaryngology, 107, 140-144
Open this publication in new window or tab >>A randomized study of four different types of tympanostomy ventilation tubes: Full-term follow-up
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2018 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 107, p. 140-144Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the impact of tympanostomy ventilation tube material (silicone vs fluoroplastic) and shape (short vs long) regarding time to extrusion, occurrence of otorrhea, occlusion, tube removal and occurrence of persistent perforation.

Methods and material: Four different types of ventilation tubes were used; Long Armstrong tubes, Donaldson tubes, Shepard tubes and straight tubes, representing four specific combinations of VT material (silicone or fluoroplastic) and shape (short, double flanged or long, single flanged). Four hundred children scheduled for bilateral tube insertion were included in a randomized trial. The patients received one type of tube in the right ear and another type in the left ear. The incidence of tube extrusion and complications were monitored post-operatively every third month by an otolaryngologist.

Results: Twenty-two children were excluded during surgery. Out of the studied 378 children the mean age was 35.3 months. 63.8% were boys. Short tubes extruded earlier than long tubes; hazard ratio (HR) 4.84 (95% CI 3.50-6.69, p < 0.001). Long Armstrong tubes were least prone to extrude. Silicone tubes resulted in significantly longer time to first infection in a VT ear, HR 1.68 (95% CI 1.03-2.76, p = 0.039). Donaldson tubes rendered the longest mean time to first infection (p = 0.025). Infections did not affect tube extrusion rates significantly (p = 0.879). No significant differences were found regarding tube occlusion, tube extraction or persistent perforation.

Conclusions: Long tubes are less prone to extrude early. Long Armstrong tubes have the least propensity to extrude early. Silicone tubes render significantly longer time to first infection. Donaldson tubes result in least infections. Infection does not affect extrusion rates significantly.

Keyword
Ventilation tubes, Tympanostomy tubes, Secretory otitis media, Extrusion, Otorrhea, Occlusion, Complications, Material, Tympanic membrane perforation
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-351643 (URN)10.1016/j.ijporl.2018.02.012 (DOI)000428492100027 ()29501296 (PubMedID)
Available from: 2018-05-31 Created: 2018-05-31 Last updated: 2018-05-31Bibliographically approved
Cloodt, E., Rosenblad, A. & Rodby-Bousquet, E. (2018). Demographic and modifiable factors associated with knee contracture in children with cerebral palsy. Developmental Medicine & Child Neurology, 60(4), 391-396
Open this publication in new window or tab >>Demographic and modifiable factors associated with knee contracture in children with cerebral palsy
2018 (English)In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 60, no 4, p. 391-396Article in journal (Refereed) Published
Abstract [en]

AimTo identify the prevalence of knee contracture and its association with gross motor function, age, sex, spasticity, and muscle length in children with cerebral palsy (CP). MethodCross-sectional data for passive knee extension were analysed in 3045 children with CP (1756 males, 1289 females; mean age 8y 1mo [SD 3.84]). CP was classified using the Gross Motor Function Classification System (GMFCS) levels I (n=1330), II (n=508), III (n=280), IV (n=449), and V (n=478). Pearson's chi(2) test and multiple binary logistic regression were applied to analyse the relationships between knee contracture and GMFCS level, sex, age, spasticity, hamstring length, and gastrocnemius length. ResultsKnee contracture greater than or equal to 5 degrees occurred in 685 children (22%). The prevalence of knee contracture was higher in older children and in those with higher GMFCS levels. Odds ratios (ORs) for knee contracture were significantly higher for children at GMFCS level V (OR=13.17), with short hamstring muscles (OR=9.86), and in the oldest age group, 13 years to 15 years (OR=6.80). InterpretationKnee contracture is associated with higher GMFCS level, older age, and shorter muscle length; spasticity has a small effect. Maintaining muscle length, especially of the hamstrings, is important for reducing the risk of knee contracture.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-351680 (URN)10.1111/dmcn.13659 (DOI)000428388000019 ()29318610 (PubMedID)
Available from: 2018-06-05 Created: 2018-06-05 Last updated: 2018-06-05Bibliographically approved
Calais, F., Ostman, M. E., Hedberg, P., Karlsson, A., Leppert, J. & Fröbert, O. (2018). Incremental prognostic value of coronary and systemic atherosclerosis after myocardial infarction. International Journal of Cardiology, 261, 6-11
Open this publication in new window or tab >>Incremental prognostic value of coronary and systemic atherosclerosis after myocardial infarction
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 261, p. 6-11Article in journal (Refereed) Published
Abstract [en]

Background: The role of systemic atherosclerosis in myocardial infarction (MI) patients is not fully understood. We investigated the incremental prognostic value of coronary and systemic atherosclerosis after acute MI by estimating extra-cardiac artery disease (ECAD) and extent of coronary atherosclerosis.

Methods and results: The study included 544 prospective MI patients undergoing coronary angiography. For all patients, the longitudinal coronary atherosclerotic extent, expressed as Sullivan extent score (SES) was calculated. In addition, the patients underwent non-invasive screening for ECAD in the carotid, aortic, renal and lower limb. SES was found to be associated with ECAD independent of baseline clinical parameters [adjusted odds ratio (OR) 1.04 95% confidence interval (CI) 1.02–1.06, P < 0.001]. Extensive systemic atherosclerosis, defined as the combination of extensive coronary disease (SES ≥ 17) and ECAD, was associated with higher risk for all-cause mortality compared to limited systemic atherosclerosis (SES < 17 and no ECAD) (hazard ratio [HR] 2.9 95% CI 1.9–4.5, P < 0.001, adjusted for Global Registry of Acute Coronary Events risk score parameters 1.8, 95% CI 1.1–3.0, P = 0.019). The risk for the composite endpoint of cardiovascular death or hospitalization was significantly higher in patients with extensive systemic atherosclerosis compared to patients with limited systemic atherosclerosis (HR 3.1, 95% CI 2.1–4.7, P < 0.001, adjusted HR 1.9, 95% CI 1.2–3.1, P < 0.004).

Conclusions: Visual estimation of the longitudinal coronary atherosclerotic extent at the time of MI predicts ECAD. Coexistence of extensive coronary disease and ECAD defines a group with particularly poor prognosis after MI.

Keyword
Atherosclerosis, Myocardial infarction, Coronary artery disease, Extra-cardiac artery disease, Prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-353355 (URN)10.1016/j.ijcard.2018.02.035 (DOI)000430081000002 ()29657058 (PubMedID)
Available from: 2018-06-12 Created: 2018-06-12 Last updated: 2018-06-12Bibliographically approved
Husdal, R., Karlsson, A., Leksell, J., Eliasson, B., Jansson, S., Jerden, L., . . . Thors Adolfsson, E. (2018). Resources and organisation in primary health care are associated with HbA1c level: A nationwide study of 230958 people with Type 2 diabetes mellitus.. Primary Care Diabetes, 12(1), 23-33
Open this publication in new window or tab >>Resources and organisation in primary health care are associated with HbA1c level: A nationwide study of 230958 people with Type 2 diabetes mellitus.
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2018 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 12, no 1, p. 23-33Article in journal (Refereed) Published
Abstract [en]

AIMS: To examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbA1c level in people with Type 2 diabetes mellitus (T2DM).

METHODS: People with T2DM attending 846 PHCCs (n=230958) were included in this cross-sectional study based on PHCC-level data from a questionnaire sent to PHCCs in 2013 and individual-level clinical data from 2013 for people with T2DM reported in the Swedish National Diabetes Register, linked to individual-level data on socio-economic status and comorbidities. Data were analysed using a generalized estimating equations linear regression models.

RESULTS: After adjusting for PHCC- and individual-level confounding factors, personnel resources associated with lower individual HbA1c level were mean credits of diabetes-specific education among registered nurses (RNs) (-0.02mmol/mol for each additional credit; P<0.001) and length of regular visits to RNs (-0.19mmol/mol for each additional 15min; P<0.001). Organisational features associated with HbA1c level were having a diabetes team (-0.18mmol/mol; P<0.01) and providing group education (-0.20mmol/mol; P<0.01).

CONCLUSIONS: In this large sample, PHCC personnel resources and organisational features were associated with lower HbA1c level in people with T2DM.

Keyword
HbA(1c), Organisation, Personnel resources, Primary health care system, Type 2 diabetes mellitus
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-332689 (URN)10.1016/j.pcd.2017.09.003 (DOI)000423008800003 ()28964673 (PubMedID)
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-04-10Bibliographically approved
Hedberg Nyqvist, K., Rosenblad, A., Volgsten, H., Funkquist, E.-L. & Mattsson, E. (2017). Early skin-to-skin contact between healthy late preterm infants and their parents: an observational cohort study. PeerJ, 5, Article ID e3949.
Open this publication in new window or tab >>Early skin-to-skin contact between healthy late preterm infants and their parents: an observational cohort study
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2017 (English)In: PeerJ, ISSN 2167-8359, E-ISSN 2167-8359, Vol. 5, article id e3949Article in journal (Refereed) Published
Abstract [en]

Background

Skin-to-skin contact (SSC) is an important factor to consider in the care of late preterm infants (born between 34 0/7 and 36 6/7 completed weeks of gestation). The literature suggests that SSC between preterm infants and their mothers facilitates breastfeeding. However, more studies are needed to explore potential dose-response effects between SSC and breastfeeding as well as studies that explicitly investigate SSC by fathers among late preterm infants. The aim was to investigate the duration of healthy late preterm infants’ SSC with the mother and father, respectively, during the first 48 h after birth and the associations with breastfeeding (exclusive/partial at discharged), clinical and demographic variables.

Methods

This was an observational cohort study in which parents to healthy late preterm infants, born between 34 5/7 and 36 6/7 completed weeks of gestation, recorded duration of SSC provided by mother and father, respectively. Demographic and clinical variables were retrieved from the medical records and were used as predictors. Multiple linear regression analysis was used to assess the association between the predictors and the outcome, SSC (hours), separately for mothers and fathers.

Results

The mean (standard deviation [SD]) time per day spent with SSC with mothers (n = 64) and fathers (n = 64), was 14.7 (5.6) and 4.4 (3.3) hours during the first day (24 h) after birth and 9.2 (7.1) and 3.1 (3.3) hours during the second day (24 h), respectively. Regarding SSC with mothers, no variable was significantly associated with SSC during the first day, while the mean (95% confidence interval [CI]) time of SSC during the second day was 6.9 (1.4–12.4) hours shorter for each additional kg of birthweight (p = 0.014). Concerning SSC with fathers, the mean (95% CI) time of SSC during the first day was 2.1 (0.4–3.7) hours longer for infants born at night (p = 0.015), 1.7 (0.1–3.2) hours longer for boys (p = 0.033), 3.2 (1.2–5.2) hours longer for infants born by caesarean section (p = 0.003), and 1.6 (0.1–3.1) hours longer for infants exclusively breastfed at discharge (p = 0.040). During the second day, the mean (95% CI) time of SSC with fathers was 3.0 (0.6–5.4) hours shorter for each additional kg of birthweight (p = 0.014), 2.0 (0.5–3.6) hours longer for infants born during night-time (p = 0.011), 2.9 (1.4–4.4) hours longer if the mother was primipara (p < 0.001), and 1.9 (0.3–3.5) hours shorter if supplementary artificial milk feeds were given. None of the other predictors, i.e., mother’s age, gestational age, or induction of labor were significantly associated with infants’ SSC with mothers or fathers during any of the first two days after birth.

Conclusion

Future studies are warranted that investigate duration of SSC between late preterm infants and their parents separately and the associations with breastfeeding and other variables of clinical importance.

Keyword
Preterminfants, Skin-to-skincontact, Breastfeeding, Latepreterminfants, Mothers, Fathers
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-333035 (URN)10.7717/peerj.3949 (DOI)000413966900002 ()29104822 (PubMedID)
Available from: 2017-11-06 Created: 2017-11-06 Last updated: 2018-02-08Bibliographically approved
Condén, E., Rosenblad, A., Wagner, P., Leppert, J., Ekselius, L. & Åslund, C. (2017). Is type D personality an independent risk factor for recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients?. European Journal of Preventive Cardiology, 24(5), 522-533
Open this publication in new window or tab >>Is type D personality an independent risk factor for recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients?
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2017 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 5, p. 522-533Article in journal (Refereed) Published
Abstract [en]

Background: Type D personality refers to a combination of simultaneously high levels of negative affectivity and social inhibition. The present study aimed to examine whether type D personality was independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality. Design: This was a prospective cohort study. Methods: Utilising data from the Vastmanland Myocardial Infarction Study, 946 post-acute myocardial infarction patients having data on the DS14 instrument used to measure type D personality were followed-up for recurrent myocardial infarction and all-cause mortality until 9 December 2015. Data were analysed using Cox regression, adjusted for established risk factors. Results: In total, 133 (14.1%) patients suffered from type D personality. During a mean follow-up time for recurrent myocardial infarction of 5.7 (3.2) years, 166 (17.5%) patients were affected by recurrent myocardial infarction, of which 26 (15.7%) had type D personality, while during a mean follow-up time for all-cause mortality of 6.3 (2.9) years, 321 (33.9%) patients died, of which 42 (13.1%) had type D personality. After adjusting for established risk factors, type D personality was not significantly associated with recurrent myocardial infarction or all-cause mortality using any of the previously proposed methods for measuring type D personality. A weak association was found between the social inhibition part of type D personality and a decreased risk of all-cause mortality, but this association was not significant after taking missing data into account in a multiple imputation analysis. Conclusions: No support was found for type D personality being independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2017
Keyword
All-cause mortality, recurrent myocardial infarction, type D personality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-320269 (URN)10.1177/2047487316687427 (DOI)000397434800009 ()28071958 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2017-04-18 Created: 2017-04-18 Last updated: 2017-04-18Bibliographically approved
Söderström, L., Rosenblad, A., Thors Adolfsson, E. & Bergkvist, L. (2017). Malnutrition is associated with increased mortality in older adults regardless of the cause of death. British Journal of Nutrition, 117(4), 532-540
Open this publication in new window or tab >>Malnutrition is associated with increased mortality in older adults regardless of the cause of death
2017 (English)In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 117, no 4, p. 532-540Article in journal (Refereed) Published
Abstract [en]

Malnutrition predicts preterm death, but whether this is valid irrespective of the cause of death is unknown. The aim of the present study was to determine whether malnutrition is associated with cause-specific mortality in older adults. This cohort study was conducted in Sweden and included 1767 individuals aged >= 65 years admitted to hospital in 2008-2009. On the basis of the Mini Nutritional Assessment instrument, nutritional risk was assessed as well nourished (score 24-30), at risk of malnutrition (score 17-23.5) or malnourished (score < 17). Cause of death was classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, into twenty different causes of death. Data were analysed using Cox proportional hazards regression models. At baseline, 55.1% were at risk of malnutrition, and 9.4% of the participants were malnourished. During a median follow-up of 5.1 years, 839 participants (47.5%) died. The multiple Cox regression model identified significant associations (hazard ratio (HR)) between malnutrition and risk of malnutrition, respectively, and death due to neoplasms (HR 2.43 and 1.32); mental or behavioural disorders (HR 5.73 and 5.44); diseases of the nervous (HR 4.39 and 2.08), circulatory (HR 1.95 and 1.57) or respiratory system (HR 2.19 and 1.49); and symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (HR 2.23 and 1.43). Malnutrition and risk of malnutrition are associated with increased mortality regardless of the cause of death, which emphasises the need for nutritional screening to identify older adults who may require nutritional support in order to avoid preterm death.

Keyword
cause-specific mortality, malnutrition, Mini Nutritional Assessment, malnutrition, older adults, survival analysis
National Category
Nutrition and Dietetics
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-267556 (URN)10.1017/S0007114517000435 (DOI)000399336800006 ()28290264 (PubMedID)
Funder
Swedish National Board of Health and Welfare, 11132/2011
Available from: 2015-11-24 Created: 2015-11-24 Last updated: 2017-05-15Bibliographically approved
Drevin, J., Kristiansson, P., Stern, J. & Rosenblad, A. (2017). Measuring pregnancy planning: A psychometric evaluation and comparison of two scales. Journal of Advanced Nursing, 73(11), 2765-2775
Open this publication in new window or tab >>Measuring pregnancy planning: A psychometric evaluation and comparison of two scales
2017 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 11, p. 2765-2775Article in journal (Refereed) Published
Abstract [en]

Aims: To psychometrically test the London Measure of Unplanned Pregnancy and compare it with the Swedish Pregnancy Planning Scale. Background: The incidence of unplanned pregnancies is an important indicator of reproductive health. The London Measure of Unplanned Pregnancy measures pregnancy planning by taking contraceptive use, timing, intention to become pregnant, desire for pregnancy, partner agreement, and pre-conceptual preparations into account. It has, however, previously not been psychometrically evaluated using confirmatory factor analysis. The Likert-scored single-item Swedish Pregnancy Planning Scale has been developed to measure the woman's own view of pregnancy planning level. Design: Cross-sectional design. Methods: In 2012-2013, 5493 pregnant women living in Sweden were invited to participate in the Swedish Pregnancy Planning study, of whom 3327 (61%) agreed to participate and answered a questionnaire. A test-retest pilot study was conducted in 2011-2012. Thirty-two participants responded to the questionnaire on two occasions 14 days apart. Data were analysed using confirmatory factor analysis, Cohen's weighted kappa and Spearman's correlation. Results: All items of the London Measure of Unplanned Pregnancy contributed to measuring pregnancy planning, but four items had low item-reliability. The London Measure of Unplanned Pregnancy and Swedish Pregnancy Planning Scale corresponded reasonably well with each other and both showed good test-retest reliability. Conclusion: The London Measure of Unplanned Pregnancy may benefit from item reduction and its usefulness may be questioned. The Swedish Pregnancy Planning Scale is time-efficient and shows acceptable reliability and construct validity, which makes it more useful for measuring pregnancy planning.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keyword
antenatal care, confirmatory factor analysis, instrument development, midwives, nursing, pregnancy planning, psychometrics, reproducibility of results, reproductive health, unplanned pregnancy
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-339704 (URN)10.1111/jan.13364 (DOI)000418363000027 ()28620936 (PubMedID)
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2018-01-26Bibliographically approved
Husdal, R., Rosenblad, A., Leksell, J. & Thors Adolfsson, E. (2017). Organisation of diabetes care is associated with systolic blood pressure level: a cross-sectional study of 230,958 people with type 2 diabetes. Paper presented at 53rd Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), SEP 11-15, 2017, Lisbon, PORTUGAL. Diabetologia, 60(S1), S298-S299, Article ID 657.
Open this publication in new window or tab >>Organisation of diabetes care is associated with systolic blood pressure level: a cross-sectional study of 230,958 people with type 2 diabetes
2017 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 60, no S1, p. S298-S299, article id 657Article in journal, Meeting abstract (Other academic) Published
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-347286 (URN)000408315001434 ()
Conference
53rd Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), SEP 11-15, 2017, Lisbon, PORTUGAL
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2018-04-03Bibliographically approved
Husdal, R., Rosenblad, A., Leksell, J., Eliasson, B., Jansson, S., Jerdén, L., . . . Adolfsson, E. T. (2017). Resource allocation and organisational features in Swedish primary diabetes care: Changes from 2006 to 2013. Primary Care Diabetes, 11(1), 20-28
Open this publication in new window or tab >>Resource allocation and organisational features in Swedish primary diabetes care: Changes from 2006 to 2013
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2017 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 11, no 1, p. 20-28Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS: To compare the resource allocation and organisational features in Swedish primary diabetes care for patients with type 2 diabetes mellitus (T2DM) between 2006 and 2013.

METHODS: Using a repeated cross-sectional study design, questionnaires covering personnel resources and organisational features for patients with T2DM in 2006 and 2013 were sent to all Swedish primary health care centres (PHCCs) during the following year. In total, 684 (74.3%) PHCCs responded in 2006 and 880 (76.4%) in 2013.

RESULTS: Compared with 2006, the median list size had decreased in 2013 (p<0.001), whereas the median number of listed patients with T2DM had increased (p<0.001). Time devoted to patients with T2DM and diabetes-specific education levels for registered nurses (RNs) had increased, and more PHCCs had in-house psychologists (all p<0.001). The use of follow-up systems and medical check-ups had increased (all p<0.05). Individual counselling was more often based on patients' needs, while arrangement of group-based education remained low. Patient participation in setting treatment targets mainly remained low.

CONCLUSIONS: Even though the diabetes-specific educational level among RNs increased, the arrangement of group-based education and patient participation in setting treatment targets remained low. These results are of concern and should be prioritised as key features in the care of patients with T2DM.

National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-304779 (URN)10.1016/j.pcd.2016.08.002 (DOI)000392679200003 ()27578488 (PubMedID)
Available from: 2016-10-10 Created: 2016-10-10 Last updated: 2018-04-10Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3691-8326

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