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Lehmann, S., Ringbaek, T., Lökke, A., Grote, L., Hedner, J. & Lindberg, E. (2019). A randomized trial to determine the impact of indacaterol/glycopyrronium on nighttime oxygenation and symptoms in patients with moderate-to-severe COPD: the DuoSleep study. The International Journal of Chronic Obstructive Pulmonary Disease, 14, 199-210
Open this publication in new window or tab >>A randomized trial to determine the impact of indacaterol/glycopyrronium on nighttime oxygenation and symptoms in patients with moderate-to-severe COPD: the DuoSleep study
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2019 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 14, p. 199-210Article in journal (Refereed) Published
Abstract [en]

Purpose: This study investigated the effect of dual bronchodilation with the long-acting beta-receptor agonist/long-acting muscarinic antagonist combination, indacaterol/glycopyrronium (IND/GLY), on nighttime oxygenation, lung function, sleep quality, and symptoms in patients with moderate-to-severe COPD.

Patients and methods: This was a 4-week, double-blind, multicenter, placebo-controlled, two-period crossover study. Patients were randomized in a 1:1 ratio to receive IND/GLY 110/50 mu g once daily or matching placebo. The primary objective was to evaluate the effect of treatment with IND/GLY on mean nighttime oxygenation, compared with placebo. The secondary objective was to determine the time spent <90% in blood oxygen saturation (SpO(2)) compared with placebo. Exploratory objectives were to assess the effect of IND/GLY, compared with placebo, on sleep quality measured by the Medical Outcomes Study (MOS) Sleep Scale and the COPD and Asthma Sleep Impact Scale (CASIS) questionnaires and on symptoms assessed by COPD Assessment Test (CAT) questionnaire.

Results: In total, 38 patients were randomized (n= 22, IND/GLY; n= 16, placebo). The change in nighttime oxygenation (SpO(2)) was similar, and there was a comparable difference in time spent,90% SpO(2) between IND/GLY and placebo. Increases from baseline for the difference between IND/GLY and placebo for trough FEV1, FVC, and inspiratory capacity (P<0.05) were seen, with a corresponding reduction in residual volume and functional residual capacity (P<0.05). IND/GLY treatment showed an improvement in scores for CAT (P=0.0208), CASIS, and the MOS Sleep Scale measures, Sleep Problems Index I, Sleep Problems Index II (P=0.0315), Sleep Adequacy, Sleep Disturbance Scale, Somnolence Scale, and Short of Breath Scale (P=0.0031).

Conclusion: In this study, IND/GLY 110/50 mu g once daily improved symptoms, sleep quality, and lung function, but showed no effect on nighttime oxygenation in patients with moderate-to-severe COPD.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD, 2019
Keywords
bronchodilator, sleep, hypoxia, quality of life, lung function
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-375229 (URN)10.2147/COPD.S184127 (DOI)000455508400001 ()30666100 (PubMedID)
Available from: 2019-01-29 Created: 2019-01-29 Last updated: 2019-01-29Bibliographically approved
Tan, X., Titova, O. E., Lindberg, E., Elmståhl, S., Lind, L., Schiöth, H. B. & Benedict, C. (2019). Association Between Self-Reported Sleep Duration and Body Composition in Middle-Aged and Older Adults. Journal of Clinical Sleep Medicine (JCSM), 15(3), 431-435
Open this publication in new window or tab >>Association Between Self-Reported Sleep Duration and Body Composition in Middle-Aged and Older Adults
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2019 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 15, no 3, p. 431-435Article in journal (Refereed) Published
Abstract [en]

STUDY OBJECTIVES: The current study sought to examine whether self-reported sleep duration is linked to an adverse body composition in 19,709 adults aged 45 to 75 years.

METHODS: All variables used in the current study were derived from the Swedish EpiHealth cohort study. Habitual sleep duration was measured by questionnaires. Body composition was assessed by bioimpedance. The main outcome variables were fat mass and fat-free mass (in kg). Analysis of covariance adjusting for age, sex, fat mass in the case of fat-free mass (and vice versa), leisure time physical activity, smoking, and alcohol consumption was used to investigate the association between sleep duration and body composition.

RESULTS: Short sleep (defined as ≤ 5 hours sleep per day) and long sleep (defined as 8 or more hours of sleep per day) were associated with lower fat-free mass and higher fat mass, compared with 6 to 7 hours of sleep duration (P< .05).

CONCLUSIONS: These observations could suggest that both habitual short and long sleep may contribute to two common clinical phenotypes in middle-aged and older humans, ie, body adiposity and sarcopenia. However, the observational nature of our study does not allow for causal interpretation.

Keywords
body fat, elderly, fat-free mass, middle-aged, sleep
National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-379286 (URN)10.5664/jcsm.7668 (DOI)000461417900009 ()30853046 (PubMedID)
Funder
Swedish Research CouncilNovo Nordisk, NNF14OC0009349Swedish Research Council, 2015-03100Ernfors FoundationÅke Wiberg Foundation, M17-0088Åke Wiberg Foundation, M18-0169Fredrik och Ingrid Thurings Stiftelse, 2017-00313Fredrik och Ingrid Thurings Stiftelse, 2018-00365
Available from: 2019-03-14 Created: 2019-03-14 Last updated: 2019-04-04Bibliographically approved
Triebner, K., Accordini, S., Calciano, L., Johannessen, A., Benediktsdottir, B., Bifulco, E., . . . Real, F. G. (2019). Exogenous female sex steroids may reduce lung ageing after menopause: A 20-year follow-up study of a general population sample (ECRHS). Maturitas, 120, 29-34
Open this publication in new window or tab >>Exogenous female sex steroids may reduce lung ageing after menopause: A 20-year follow-up study of a general population sample (ECRHS)
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2019 (English)In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 120, p. 29-34Article in journal (Refereed) Published
Abstract [en]

Objectives: Menopause involves hypoestrogenism, which is associated with numerous detrimental effects, including on respiratory health. Hormone replacement therapy (HRT) is often used to improve symptoms of menopause. The effects of HRT on lung function decline, hence lung ageing, have not yet been investigated despite the recognized effects of HRT on other health outcomes. Study design: The population-based multi-centre European Community Respiratory Health Survey provided complete data for 275 oral HRT users at two time points, who were matched with 383 nonusers and analysed with a two-level linear mixed effects regression model. Main outcome measures: We studied whether HRT use was associated with the annual decline in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Results: Lung function of women using oral HRT for more than five years declined less rapidly than that of nonusers. The adjusted difference in FVC decline was 5.6 mL/y (95%CI: 1.8 to 9.3, p = 0.01) for women who had taken HRT for six to ten years and 8.9 mL/y (3.5 to 14.2, p = 0.003) for those who had taken it for more than ten years. The adjusted difference in FEV1 decline was 4.4 mL/y (0.9 to 8.0, p = 0.02) with treatment from six to ten years and 5.3 mL/y (0.4 to 10.2, p = 0.048) with treatment for over ten years. Conclusions: In this longitudinal population-based study, the decline in lung function was less rapid in women who used HRT, following a dose-response pattern, and consistent when adjusting for potential confounding factors. This may signify that female sex hormones are of importance for lung ageing.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2019
Keywords
Hormone replacement therapy (HRT), Lung function, Menopause, Reproductive aging, Sex hormones
National Category
Respiratory Medicine and Allergy Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-376811 (URN)10.1016/j.maturitas.2018.11.007 (DOI)000456223000005 ()30583761 (PubMedID)
Funder
EU, Horizon 2020
Available from: 2019-02-22 Created: 2019-02-22 Last updated: 2019-02-22Bibliographically approved
Bengtsson, C., Jonsson, L., Holmstrom, M., Hellgren, J., Franklin, K., Gislason, T., . . . Lindberg, E. (2019). Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study. Journal of Clinical Sleep Medicine (JCSM), 15(6), 899-905, Article ID PII jc-18-00575.
Open this publication in new window or tab >>Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study
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2019 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 15, no 6, p. 899-905, article id PII jc-18-00575Article in journal (Refereed) Published
Abstract [en]

Study Objectives: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nasal cavity and paranasal sinuses. Associations between CRS and poor sleep quality have been reported. This 10-year follow-up study investigates possible associations between incident CRS and sleep quality. Methods: A questionnaire was sent to 16,500 individuals in Sweden, Norway, Denmark, Iceland and Estonia in 2000. It included questions on airway diseases, age, sex, body mass index, smoking habits, comorbidities, education and sleep quality. In 2010, a second questionnaire was sent to the same individuals, with a response rate of 53%. A subgroup of 5,145 individuals without nasal symptoms in 2000 was studied. Multiple logistic regression was performed to examine associations between CRS (defined according to the European position paper on rhinosinusitis and nasal polyps epidemiological criteria) at follow-up and sleep quality, with adjustment for potential confounders. Individuals with the respective sleep problem at baseline were excluded. Results: Over 10 years, 141 (2.7%) of the individuals without nasal symptoms in 2000 had developed CRS. CRS was associated with difficulties inducing sleep (adjusted odds ratio 2.81 [95% CI 1.67-4.70]), difficulties maintaining sleep (2.07 [1.35-3.18]), early morning awakening (3.03 [1.91-4.81]), insomnia (2.21 [1.46-3.35]), excessive daytime sleepiness (2.85 [1.79-4.55]), and snoring (3.31 [2.07-5.31]). Three insomnia symptoms at baseline increased the risk of CRS at follow-up by 5.00 (1.93-12.99). Conclusions: Incident CRS is associated with impaired sleep quality and excessive daytime sleepiness. Insomnia symptoms may be a risk factor for the development of CRS.

Place, publisher, year, edition, pages
AMER ACAD SLEEP MEDICINE, 2019
Keywords
chronic rhinosinusitis, CRS, epidemiology, insomnia, sleep quality
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-389988 (URN)10.5664/jcsm.7846 (DOI)000471747600013 ()31138385 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Heart Lung FoundationSwedish Asthma and Allergy Association
Available from: 2019-08-02 Created: 2019-08-02 Last updated: 2019-08-02Bibliographically approved
Amid Hägg, S., Emilsson, Ö. I., Franklin, K., Janson, C. & Lindberg, E. (2019). Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women. Sleep Medicine, 53, 94-100
Open this publication in new window or tab >>Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women
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2019 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 53, p. 94-100Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Daytime sleepiness is common in women and has negative health effects. Nocturnal gastroesophageal reflux (nGER) and snoring are risk factors for daytime sleepiness, but the effect of their interaction remains unknown. The aim of this study was to examine how nGER and snoring combined affected daytime sleepiness and involuntary falling asleep in women.

METHODS: A questionnaire was sent to randomly selected women in 2000 and 2010. Participants who answered questions regarding both nGER and snoring in both questionnaires were included (N = 4882). Daytime sleepiness was defined as severe or very severe problems with daytime sleepiness. Involuntary falling asleep was defined as sometimes, often or very often falling asleep involuntarily during the day. Respondents snoring loudly and disturbingly sometimes, often or very often were defined as snorers. Having nocturnal heartburn or acid reflux sometimes, often or very often was defined as having nGER.

RESULTS: Daytime sleepiness was reported by 14% of the participants, involuntary falling asleep by 11%. After adjustment for age, smoking, physical activity, caffeine intake and alcohol dependency, increased odd ratios (ORs) for both daytime sleepiness (adjusted OR 4.2, 95% confidence interval (CI): 1.9-9.2) and involuntary falling asleep (adjusted OR 3.1, 95% CI: 1.5-6.4) were seen in women with the combination of nGER and snoring at both baseline and follow-up. The association with daytime sleepiness was also strong for those with only persistent nGER but not for those with only persistent snoring.

CONCLUSION: Women with nGER were at increased risk of developing daytime sleepiness and snoring augmented this association. In addition, women with both nGER and snoring were also at increased risk of developing involuntary falling asleep.

Keywords
Daytime sleepiness, Involuntary falling asleep, Nocturnal gastroesophageal reflux, Snoring
National Category
Medical and Health Sciences
Research subject
Lung Medicine
Identifiers
urn:nbn:se:uu:diva-375498 (URN)10.1016/j.sleep.2018.08.036 (DOI)000457169500016000457169500016 ()30504084 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2019-01-30 Created: 2019-01-30 Last updated: 2019-03-05Bibliographically approved
Palm, A. & Lindberg, E. (2019). Response to "The dark side of adherence" by Crawford and Vallieres [Letter to the editor]. Sleep Medicine, 59, 97-97
Open this publication in new window or tab >>Response to "The dark side of adherence" by Crawford and Vallieres
2019 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 59, p. 97-97Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-390003 (URN)10.1016/j.sleep.2018.10.019 (DOI)000471665700020 ()30551924 (PubMedID)
Available from: 2019-08-05 Created: 2019-08-05 Last updated: 2019-08-05Bibliographically approved
Ekström, M., Sundh, J., Schiöler, L., Lindberg, E., Rosengren, A., Bergström, G., . . . Toren, K. (2018). Absolute lung size and the sex difference in breathlessness in the general population. PLoS ONE, 13(1), Article ID e0190876.
Open this publication in new window or tab >>Absolute lung size and the sex difference in breathlessness in the general population
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 1, article id e0190876Article in journal (Refereed) Published
Abstract [en]

Background: Breathlessness is associated with major adverse health outcomes and is twice as common in women as men in the general population. We evaluated whether this is related to their lower absolute lung volumes.

Methods: Cross-sectional analysis of the population-based Swedish CardioPulmonarybioImage Study (SCAPIS) Pilot, including static spirometry and diffusing capacity (n = 1,013; 49% women). Breathlessness was measured using the modified Medical Research Council (mMRC) scale and analyzed using ordinal logistic regression adjusting for age, pack-years of smoking, body mass index, chronic airway limitation, asthma, chronic bronchitis, depression and anxiety in all models.

Results: Breathlessness was twice as common in women as in men; adjusted odds ratio (OR) 2.20 (95% confidence interval, 1.32-3.66). Lower absolute lung volumes were associated with increased breathlessness prevalence in both men and women. The sex difference in breathlessness was unchanged when adjusting for lung function in %predicted, but disappeared when controlling for absolute values of total lung capacity (OR 1.12; 0.59-2.15), inspiratory capacity (OR 1.26; 0.68-2.35), forced vital capacity (OR 0.84; 0.42-1.66), forced expiratory volume in one second (OR 0.70; 0.36-1.35) or lung diffusing capacity (OR 1.07; 0.58-1.97).

Conclusion: In the general population, the markedly higher prevalence of breathlessness in women is related to their smaller absolute lung volumes.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-341579 (URN)10.1371/journal.pone.0190876 (DOI)000419403800132 ()29304074 (PubMedID)
Funder
Swedish Heart Lung FoundationKnut and Alice Wallenberg FoundationSwedish Research CouncilVINNOVAForte, Swedish Research Council for Health, Working Life and WelfareSwedish Society of Medicine
Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-02-12Bibliographically approved
Titova, O. E., Lindberg, E., Elmstahl, S., Lind, L., Schiöth, H. B. & Benedict, C. (2018). Associations Between the Prevalence of Metabolic Syndrome and Sleep Parameters Vary by Age. Frontiers in Endocrinology, 9, Article ID 234.
Open this publication in new window or tab >>Associations Between the Prevalence of Metabolic Syndrome and Sleep Parameters Vary by Age
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2018 (English)In: Frontiers in Endocrinology, ISSN 1664-2392, E-ISSN 1664-2392, Vol. 9, article id 234Article in journal (Refereed) Published
Abstract [en]

Objective: To examine whether the relationship between the metabolic syndrome (MetS) and various sleep parameters [sleep duration, symptoms of sleep-disordered breathing (SDB), and sleep disturbances] varies by age. Methods: Waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol, and fasting glucose were used to determine MetS status in a cohort (N = 19,691) of middle-aged (aged 45-64 years) and older (aged >= 65 years) subjects. Habitual sleep duration (short, <= 6 h/day; normal, 7-8 h/day; and long >= 9 h/day), sleep disturbances (such as problems with falling and staying asleep), and symptoms of sleep-disordered breathing (SDB, such as snoring and sleep apneas) were measured by questionnaires. Results: Among the participants, 4,941 subjects (25.1%) fulfilled the criteria for MetS. In the entire sample, both short and long sleep durations were associated with higher prevalence of MetS as compared to normal sleep duration. When stratified by age, a similar pattern was observed for middle-aged subjects (<65 years old; prevalence ratio (PR) [95% CI], 1.13 [1.06-1.22] for short sleep and 1.26 [1.06-1.50] for long sleep duration). In contrast, in older individuals (>= 65 years old), only long sleep duration was linked to a higher prevalence of MetS (1.26 [1.12-1.42]; P < 0.01 for sleep duration x age). In the entire cohort, having at least one SDB symptom >= 4 times per week was linked to an increased prevalence of MetS; however, the PR was higher in middle-aged subjects compared with older subjects (1.50 [1.38-1.63] vs. 1.36 [1.26-1.47], respectively; P < 0.001 for SDB x age). Finally, independent of subjects' age, reports of sleep disturbances (i.e., at least one symptom >= 4 times per week) were associated with a higher likelihood of having MetS (1.12 [1.06-1.18]; P > 0.05 for sleep disturbance x age). Conclusion: Our results suggest that age may modify the associations between some sleep parameters and the prevalence of MetS.

Keywords
sleep duration, sleep disturbance, sleep-disordered breathing, metabolic syndrome, age
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-356873 (URN)10.3389/fendo.2018.00234 (DOI)000431867800001 ()29867766 (PubMedID)
Funder
Swedish Research Council, 2015-03100The Swedish Brain FoundationNovo Nordisk, NNF14OC0009349
Available from: 2018-08-09 Created: 2018-08-09 Last updated: 2019-03-15Bibliographically approved
Mindus, S., Malinovschi, A., Ekerljung, L., Forsberg, B., Gislason, T., Jogi, R., . . . Janson, C. (2018). Asthma and COPD overlap (ACO) is related to a high burden of sleep disturbance and respiratory symptoms: Results from the RHINE and Swedish GA(2)LEN surveys. PLoS ONE, 13(4), Article ID e0195055.
Open this publication in new window or tab >>Asthma and COPD overlap (ACO) is related to a high burden of sleep disturbance and respiratory symptoms: Results from the RHINE and Swedish GA(2)LEN surveys
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 4, article id e0195055Article in journal (Refereed) Published
Abstract [en]

Background: The term Asthma and COPD Overlap (ACO) describes a condition where asthma and COPD overlap. We aimed to investigate associations between ACO and insomnia and respiratory symptoms, and to investigate the prevalence of ACO and the characteristics of subjects with ACO in two Northern European population studies.

Methods: The study comprised 25 429 subjects aged >40 years who participated in one of two Northern European general population surveys. Both surveys included questions on asthma, COPD, respiratory and sleep-related symptoms, including difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and excessive daytime sleepiness. ACO was defined as having both self-reported asthma and COPD.

Results: The prevalence of ACO was 1.0%. The group with ACO had a higher prevalence of both insomnia and respiratory symptoms than subjects with only asthma or COPD. Having ACO was independently associated with a 2-3 times higher probability of having sleep-related symptoms as compared with the group without asthma or COPD, after adjustment for age, sex, BMI, smoking history and educational level (adjusted odds ratio 2.14-3.36, 95% CI).

Conclusion: Subjects with ACO have a high prevalence of insomnia and respiratory symptoms. To our knowledge, this is the first study to assess the association between sleep-related symptoms and ACO.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-351632 (URN)10.1371/journal.pone.0195055 (DOI)000428988800023 ()29608582 (PubMedID)
Funder
Swedish Asthma and Allergy AssociationSwedish Heart Lung FoundationThe Swedish Heart and Lung AssociationForte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2018-06-07 Created: 2018-06-07 Last updated: 2018-06-07Bibliographically approved
Sundbom, F., Malinovschi, A., Lindberg, E., Almqvist, C. & Janson, C. (2018). Asthma control and asthma severity in relation to sleep disturbances: Results of the LifeGene study. Paper presented at 28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE. European Respiratory Journal, 52
Open this publication in new window or tab >>Asthma control and asthma severity in relation to sleep disturbances: Results of the LifeGene study
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2018 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-376287 (URN)10.1183/13993003.congress-2018.PA5046 (DOI)000455567106527 ()
Conference
28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE
Note

Supplement: 62

Meeting Abstract: PA5046

Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-04Bibliographically approved
Organisations
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ORCID iD: ORCID iD iconorcid.org/0000-0002-8552-4510

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