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Mulic-Lutvica, AjlanaORCID iD iconorcid.org/0000-0003-4394-8769
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Publications (10 of 23) Show all publications
Saleh Gargari, S., Essén, B., Fallahian, M., Mulic-Lutvica, A. & Mohammadi, S. (2019). Auditing the appropriateness of cesarean delivery using the Robson classification among women experiencing a maternal near miss. International Journal of Gynecology & Obstetrics, 144(1), 49-55
Open this publication in new window or tab >>Auditing the appropriateness of cesarean delivery using the Robson classification among women experiencing a maternal near miss
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2019 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 144, no 1, p. 49-55Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate appropriateness of cesarean delivery and cesarean delivery‐related morbidity among maternal near misses (MNMs) using the Robson ten‐group classification system.

Methods: In the present audit study, medical records were assessed for women who experienced MNM and underwent cesarean delivery at three university hospitals in Tehran, Iran, between March 1, 2012, and May 1, 2014. Local auditors assessed cesarean delivery indications and morbidity experienced. All records were re‐assessed using Swedish obstetric guidelines. Findings were reported using the Robson ten‐group classification system. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results: Of the 61 women included, cesarean deliveries were more likely to be considered appropriate by local auditors compared with Swedish ones (OR 2.7, 95% CI 1.3–5.7). Cesarean delivery‐related morbidity was attributed to near‐miss events for 10 (16%) MNMs and was found to have aggravated 25 (41%). Of 16 women classified as Robson group 1–4, cesarean delivery‐related MNM was identified in 15 (94%), compared with 13 (43%) of 30 women in group 10. Cesarean delivery with appropriate indication was associated with very low likelihood of cesarean delivery‐related MNM (OR 0.2, 95% CI 0.1–0.6).

Conclusion: Cesarean delivery in the absence of appropriate indication could be an unsafe delivery choice. Audits using the Robson classification system facilitate understanding inappropriate cesarean delivery and its impact on maternal health.

Keywords
Cesarean appropriateness, Cesarean delivery, Clinical audit, Iran, Maternal near miss, Robson classification
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-372020 (URN)10.1002/ijgo.12698 (DOI)000452298100008 ()30353540 (PubMedID)
Funder
Swedish Research Council
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-01-21Bibliographically approved
Maack, H. P., Skalkidou, A., Sjöholm, A., Eurenius-Orre, K., Mulic-Lutvica, A., Wikström, A.-K. & Sundström Poromaa, I. (2019). Maternal body mass index moderates antenatal depression effects on infant birthweight. Scientific Reports, 9, Article ID 6213.
Open this publication in new window or tab >>Maternal body mass index moderates antenatal depression effects on infant birthweight
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 6213Article in journal (Refereed) Published
Abstract [en]

Obesity and depression are two common medical problems that pregnant women present with in antenatal care. Overweight and obesity at the beginning of the pregnancy, and excessive weight gain during pregnancy, are independent explanatory variables for fetal birthweight and independent risk factors for giving birth to a large for gestational age (LGA) infant. However, the effect of co-morbid depression has received little attention. This study set out to investigate if maternal body mass index (BMI) in early pregnancy moderates antenatal depression effects on infant birthweight. 3965 pregnant women participated in this longitudinal cohort study, where cases (n = 178) had Edinburgh Postnatal Depression Scale (EPDS) score >= 17 in gestational week 17 or 32, and remaining women (n = 3787) were used as controls. The influence of maternal BMI and antenatal depressive symptoms on standardized birthweight was evaluated by analysis of covariance, with adjustment for relevant confounders. Depressed women with BMI 25.0 kg/m(2) or more gave birth to infants with significantly greater standardized birthweight than non-depressed overweight women, whereas the opposite pattern was noted in normal weight women (BMI by antenatal depressive symptoms interaction; F(1,3839) = 6.32; p = 0.012. The increased birthweight in women with co-prevalent overweight and depressive symptoms was not explained by increased weight gain during the pregnancy. Maternal BMI at the beginning of pregnancy seems to influence the association between antenatal depressive symptoms and infant birthweight, but in opposite directions depending on whether the pregnant women is normal weight or overweight. Further studies are needed to confirm our finding.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2019
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-383196 (URN)10.1038/s41598-019-42360-1 (DOI)000464988500025 ()30996270 (PubMedID)
Available from: 2019-07-23 Created: 2019-07-23 Last updated: 2019-07-23Bibliographically approved
Hellkvist, A., Wikström, J., Mulic-Lutvica, A., Ericson, K., Eriksson-Falkerby, C., Lindgren, P., . . . Axelsson, O. (2019). Postmortem magnetic resonance imaging vs autopsy of second trimester fetuses terminated due to anomalies. Acta Obstetricia et Gynecologica Scandinavica, 98(7), 865-876
Open this publication in new window or tab >>Postmortem magnetic resonance imaging vs autopsy of second trimester fetuses terminated due to anomalies
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2019 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 7, p. 865-876Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Our aim was to investigate the accuracy of postmortem fetal magnetic resonance imaging (MRI) compared to fetal autopsy in second trimester pregnancies terminated due to fetal anomalies. A secondary aim was to compare the MRI evaluations of two senior radiologists.

MATERIAL AND METHODS: This was a prospective study including 34 fetuses from pregnancies terminated in the second trimester due to fetal anomalies. All women accepted a postmortem MRI and an autopsy of the fetus. Two senior radiologists performed independent evaluations of the MRI images. A senior pathologist performed the fetal autopsies. The degree of concordance between the MRI evaluations and the autopsy reports was estimated as well as the consensus between the radiologists.

RESULTS: Thirty-four fetuses were evaluated. Sixteen cases were associated with the central nervous system (CNS), five musculoskeletal, one cardiovascular, one urinary tract, and 11 cases had miscellaneous anomalies such as chromosomal aberrations, infections, and syndromes. In the 16 cases related to the CNS, both radiologists reported all or some, including the most clinically significant anomalies in 15 (94%; CI 70-100%) cases. In the 18 non-CNS cases, both radiologists reported all or some, including the most clinically significant anomalies in six (33%; CI 5-85%) cases. In 21 cases (62%; CI 44-78%) cases, both radiologists held opinions that were consistent with the autopsy reports. The degree of agreement between the radiologists was high, with a Cohen's Kappa of 0.87.

CONCLUSIONS: Postmortem fetal MRI can replace autopsy for second trimester fetuses with CNS anomalies. For non-CNS anomalies, the concordance is lower but postmortem MRI can still be of value when autopsy is not an option.

Keywords
Fetal anomalies, Fetal diagnosis, Post-mortem fetal MRI, Prenatal diagnosis, Prospective study, Second trimester
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-375605 (URN)10.1111/aogs.13548 (DOI)000472678200006 ()30694559 (PubMedID)
Funder
Swedish Society of Medicine
Available from: 2019-01-31 Created: 2019-01-31 Last updated: 2019-09-13Bibliographically approved
Lindström, L., Wikström, A.-K., Bergman, E., Mulic-Lutvica, A., Högberg, U., Ahlsson, F. & Lundgren, M. (2019). Postnatal growth in children born small for gestational age with and without smoking mother. Pediatric Research, 85(7), 961-966
Open this publication in new window or tab >>Postnatal growth in children born small for gestational age with and without smoking mother
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2019 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 85, no 7, p. 961-966Article in journal (Refereed) Published
Abstract [en]

Background: Maternal smoking impairs fetal growth; however, if postnatal growth differs between children born small for gestational age (SGA) with smoking and non-smoking mother is unknown.

Methods: Cohort-study of term born children born appropriate for gestational age with non-smoking mother (AGA-NS, n=30,561), SGA (birthweight <10th percentile) with smoking mother (SGA-S, n=171) or SGA with non-smoking mother (SGA-NS, n=1761). Means of height and weight measurements, collected at birth, 1.5, 3, 4 and 5 years, were compared using a generalized linear mixed effect model. Relative risks of short stature (<10th percentile) were expressed as adjusted risk ratios (aRR).

Results: At birth, children born SGA-S were shorter than SGA-NS, but they did not differ in weight. At 1.5 years, SGA-S had reached the same height as SGA-NS. At 5 years, SGA-S were 1.1 cm taller and 1.2 kg heavier than SGA-NS. Compared with AGA-NS, SGA-S did not have increased risk of short stature at 1.5 or 5 years, while SGA-NS had increased risk of short stature at both ages; aRRs 3.0 (95% CI 2.6;3.4) and 2.3 (95% CI 2.0;2.7), respectively.

Conclusions: Children born SGA-S have a more rapid catch-up growth than SGA-NS. This may have consequences for metabolic and cardiovascular health in children with smoking mothers.

National Category
Obstetrics, Gynecology and Reproductive Medicine Pediatrics
Identifiers
urn:nbn:se:uu:diva-374779 (URN)10.1038/s41390-019-0352-5 (DOI)000468524800013 ()30808020 (PubMedID)
Funder
Swedish Research Council, 2014-3561
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-09-05Bibliographically approved
Iliadis, S. I., Axfors, C., Johansson, S., Skalkidou, A. & Mulic-Lutvica, A. (2018). Women with prolonged nausea in pregnancy have increased risk for depressive symptoms postpartum. Scientific Reports, 8, Article ID 15796.
Open this publication in new window or tab >>Women with prolonged nausea in pregnancy have increased risk for depressive symptoms postpartum
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2018 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 15796Article in journal (Refereed) Published
Abstract [en]

The aim of this population-based, longitudinal study was to assess the association between nausea and vomiting in pregnancy (NVP) and perinatal depressive symptoms. Pregnant women (N = 4239) undergoing routine ultrasound at gestational week (GW) 17 self-reported on NVP and were divided into those without nausea (G0), early (<= 17 GW) nausea without medication (G1), early nausea with medication (G2), and prolonged (>17 GW) nausea (G3). The Edinburgh Postnatal Depression Scale at GW 17 and 32 (cut-off >= 13) and at six weeks postpartum (cut-off >= 12) was used to assess depressive symptoms. Main outcome measures were depressive symptoms at GW 32 and at six weeks postpartum. NVP was experienced by 80.7%. The unadjusted logistic regression showed a positive association between all three nausea groups and depressive symptoms at all time-points. After adjustment, significant associations with postpartum depressive symptoms remained for G3, compared to G0 (aOR = 1.66; 95% CI 1.1-2.52). After excluding women with history of depression, only the G3 group was at higher odds for postpartum depressive symptoms (aOR = 2.26; 95% CI 1.04-4.92). In conclusion, women with prolonged nausea have increased risk of depressive symptoms at six weeks postpartum, regardless of history of depression.

Place, publisher, year, edition, pages
Nature Publishing Group, 2018
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-369898 (URN)10.1038/s41598-018-33197-1 (DOI)000448270800016 ()30361517 (PubMedID)
Funder
Swedish Research Council, 521-2010-3293Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-1955Marianne and Marcus Wallenberg Foundation, MMW2011.0115The Swedish Medical Association, SLS-250581
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2018-12-19Bibliographically approved
Belachew, J., Eurenius, K., Mulic-Lutvica, A. & Axelsson, O. (2017). Placental location, postpartum hemorrhage and retained placenta in women with a previous cesarean section delivery: a prospective cohort study. Upsala Journal of Medical Sciences, 122(3), 185-189
Open this publication in new window or tab >>Placental location, postpartum hemorrhage and retained placenta in women with a previous cesarean section delivery: a prospective cohort study
2017 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 3, p. 185-189Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Women previously giving birth with cesarean section have an increased risk of postpartum hemorrhage (PPH) and retained placenta. The objective of this study was to determine if anterior placental location increased the risk of PPH and retained placenta in such women.

MATERIALS AND METHODS: We performed a prospective cohort study on 400 women with cesarean section delivery in a previous pregnancy. Ultrasound examinations were performed at gestational week 28-30, and placental location, myometrial thickness, and three-dimensional vascularization index (VI) were recorded. Data on maternal age, parity, BMI, smoking, gestational week at delivery, induction, delivery mode, oxytocin, preeclampsia, PPH, retained placenta, and birth weight were obtained for all women. Outcome measures were PPH (≥1,000 mL) and retained placenta.

RESULTS: The overall incidence of PPH was 11.0% and of retained placenta 3.5%. Twenty-three women (11.8%) with anterior placenta had PPH compared to 12 (6.9%) with posterior or fundal locations. The odds ratio was 1.94, but it did not reach statistical significance. There was no significant risk increase for retained placenta in women with anterior placentae. Seven of eight women with placenta previa had PPH, and four had retained placenta.

CONCLUSIONS: The overall risk of PPH and retained placenta was high for women with previous cesarean section. Anterior location of the placenta in such women tended to impose an increased risk for PPH but no risk increase of retained placenta. Placenta previa in women with previous cesarean section is associated with a high risk for PPH and retained placenta.

Keywords
Postpartum hemorrhage, previous cesarean section, retained placenta, ultrasound, vascularization index
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-331203 (URN)10.1080/03009734.2017.1356405 (DOI)000414107800005 ()28826360 (PubMedID)
Available from: 2017-10-12 Created: 2017-10-12 Last updated: 2018-02-14Bibliographically approved
Sohlberg, S., Mulic-Lutvica, A., Olovsson, M., Weis, J., Axelsson, O., Wikström, J. & Wikström, A.-K. (2015). MRI estimated placental perfusion in fetal growth assessment. Ultrasound in Obstetrics and Gynecology, 46(6), 700-705
Open this publication in new window or tab >>MRI estimated placental perfusion in fetal growth assessment
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2015 (English)In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 46, no 6, p. 700-705Article in journal (Refereed) Published
Abstract [en]

Objective

This study aimed to evaluate placental perfusion fraction estimated by magnetic resonance imaging (MRI) in vivo as a marker of placental function.

Methods

The study population included 35 pregnant women, of whom 13 had preeclampsia, examined at gestational weeks 22 to 40. Each woman underwent, within a 24 hour period: a MRI diffusion-weighted sequence (from which we calculated the placental perfusion fraction); venous blood sampling; and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. We compared the perfusion fraction in pregnancies with and without fetal growth restriction and estimated correlations between the perfusion fraction and ultrasound estimates and plasma markers with linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of preeclampsia (p < 0.05) and therefore we included an interaction term between preeclampsia and the covariates in the models.

Results

The median placental perfusion fraction in pregnancies with and without fetal growth restriction was 21% and 32%, respectively (p = 0.005). The correlations between the placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (p-values 0.002 to 0.0001). The highest coefficient of determination (R2= 0.56) for placental perfusion fraction was found for a model including pulsatility index in ductus venosus, plasma level of sFlt1, estimated fetal weight and presence of preeclampsia.

Conclusion

The placental perfusion fraction has potential to contribute to the clinical assessment in cases of placental insufficiency.

Keywords
Intrauterine growth restriction, Small for gestational age, Magnetic resonance imaging, Placenta, Perfusion, Perfusion fraction
National Category
Obstetrics, Gynecology and Reproductive Medicine Radiology, Nuclear Medicine and Medical Imaging
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-239293 (URN)10.1002/uog.14786 (DOI)000365855700011 ()25640054 (PubMedID)
Funder
Swedish Research Council, 2014-3561
Available from: 2014-12-21 Created: 2014-12-21 Last updated: 2017-12-05Bibliographically approved
Belachew, J., Axelsson, O., Eurenius, K. & Mulic-Lutvica, A. (2015). Three-dimensional ultrasound does not improve diagnosis of retained placental tissue compared to two-dimensional ultrasound. Acta Obstetricia et Gynecologica Scandinavica, 94(1), 112-116
Open this publication in new window or tab >>Three-dimensional ultrasound does not improve diagnosis of retained placental tissue compared to two-dimensional ultrasound
2015 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 1, p. 112-116Article in journal (Refereed) Published
Abstract [en]

The study objective was to improve ultrasonic diagnosis of retained placental tissue by measuring the volume of the uterine body and cavity using three-dimensional (3D) ultrasound. Twenty-five women who were to undergo surgical curettage due to suspected retained placental tissue were included. The volume of the uterine body and cavity was measured using the VOCAL imaging program. Twenty-one women had retained placental tissue histologically verified. Three of these had uterine volumes exceeding the largest volume observed in the normal puerperium. Seventeen of the 21 women had a uterine cavity volume exceeding the largest volume observed in the normal puerperium. In all 14 cases examined 28 days or more after delivery the cavity volume exceeded the largest volume observed in the normal puerperium. A large cavity volume estimated with 3D ultrasound is indicative of retained placental tissue. However, 3D ultrasound adds little or no diagnostic power compared to 2D ultrasound.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-240535 (URN)10.1111/aogs.12502 (DOI)000346704100019 ()25303033 (PubMedID)
Available from: 2015-01-07 Created: 2015-01-07 Last updated: 2017-12-05Bibliographically approved
Sohlberg, S., Wikström, A.-K., Olovsson, M., Lindgren, P., Axelsson, O., Mulic-Lutvica, A., . . . Wikström, J. (2014). In vivo(31)P-MR spectroscopy in normal pregnancy, early and late preeclampsia: A study of placental metabolism. Placenta, 35(5), 318-323
Open this publication in new window or tab >>In vivo(31)P-MR spectroscopy in normal pregnancy, early and late preeclampsia: A study of placental metabolism
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2014 (English)In: Placenta, ISSN 0143-4004, E-ISSN 1532-3102, Vol. 35, no 5, p. 318-323Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Preeclampsia affects about 3% of pregnancies and the placenta is believed to play a major role in its pathophysiology. Lately, the role of the placenta has been hypothesised to be more pronounced in preeclampsia of early (<34 weeks) rather than late (≥34 weeks) onset. (31)P Magnetic Resonance Spectroscopy (MRS) enables non-invasive, in vivo studies of placental metabolism. Our aim was to study placental energy and membrane metabolism in women with normal pregnancies and those with early and late onset preeclampsia.

METHODS: The study population included fourteen women with preeclampsia (five with early onset and nine with late onset preeclampsia) and sixteen women with normal pregnancy (seven with early and nine with late pregnancy). All women underwent a (31)P-MRS examination of the placenta.

RESULTS: The phosphodiester (PDE) spectral intensity fraction of the total (31)P signal and the phosphodiester/phosphomonoester (PDE/PME) spectral intensity ratio was higher in early onset preeclampsia than in early normal pregnancy (p = 0.03 and p = 0.02). In normal pregnancy the PDE spectral intensity fraction and the PDE/PME spectral intensity ratio increased with increasing gestational age (p = 0.006 and p = 0.001).

DISCUSSION: Since PDE and PME are related to cell membrane degradation and formation, respectively, our findings indicate increased cell degradation and maybe also decreased cell proliferation in early onset preeclampsia compared to early normal pregnancy, and with increasing gestational age in normal pregnancy.

CONCLUSIONS: Our findings could be explained by increased apoptosis due to ischaemia in early onset preeclampsia and also increased apoptosis with increasing gestational age in normal pregnancy.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-221881 (URN)10.1016/j.placenta.2014.02.005 (DOI)000335614500006 ()24612844 (PubMedID)
Available from: 2014-04-07 Created: 2014-04-07 Last updated: 2017-12-05Bibliographically approved
Sohlberg, S., Mulic-Lutvica, A., Lindgren, P., Ortiz-Nieto, F., Wikström, A.-K. & Wikström, J. (2014). Placental perfusion in normal pregnancy and early and late preeclampsia: A magnetic resonance imaging study.. Placenta, 35(3), 202-206
Open this publication in new window or tab >>Placental perfusion in normal pregnancy and early and late preeclampsia: A magnetic resonance imaging study.
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2014 (English)In: Placenta, ISSN 0143-4004, E-ISSN 1532-3102, Vol. 35, no 3, p. 202-206Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Our primary aim was to investigate if women with early or late preeclampsia have different placental perfusion compared with normal pregnancies. A secondary aim was to investigate if placental perfusion changes with increasing gestational age in normal pregnancy.

METHODS: The study population included thirteen women with preeclampsia (five with early and eight with late preeclampsia) and nineteen women with normal pregnancy (ten with early and nine with late pregnancy). Early was defined as <34 weeks and late as ≥34 weeks gestation. All women underwent a magnetic resonance imaging (MRI) examination including a diffusion weighted sequence at 1.5 T. The perfusion fraction was calculated.

RESULTS: Women with early preeclampsia had a smaller placental perfusion fraction (p = 0.001) and women with late preeclampsia had a larger placental perfusion fraction (p = 0.011), compared to women with normal pregnancies at the corresponding gestational age. The placental perfusion fraction decreased with increasing gestational age in normal pregnancies (p = 0.001).

CONCLUSION: Both early and late preeclampsia differ in placental perfusion from normal pregnant women. Observed differences are however in the opposite direction, suggesting differences in pathophysiology. Placental perfusion decreases with increasing gestational age in normal pregnancy.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-221884 (URN)10.1016/j.placenta.2014.01.008 (DOI)000333495900008 ()24529946 (PubMedID)
Available from: 2014-04-07 Created: 2014-04-07 Last updated: 2017-12-05Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-4394-8769

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