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Cesta, C. E., Johansson, A. L. V., Hreinsson, J., Rodriguez-Wallberg, K. A., Olofsson, J. I., Holte, J., . . . Iliadou, A. N. (2018). A prospective investigation of perceived stress, infertility-related stress, and cortisol levels in women undergoing in vitro fertilization: influence on embryo quality and clinical pregnancy rate. Acta Obstetricia et Gynecologica Scandinavica, 97(3), 258-268
Open this publication in new window or tab >>A prospective investigation of perceived stress, infertility-related stress, and cortisol levels in women undergoing in vitro fertilization: influence on embryo quality and clinical pregnancy rate
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2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 258-268Article in journal (Refereed) Published
Abstract [en]

Introduction

Women undergoing fertility treatment experience high levels of stress. However, it remains uncertain if and how stress influences in vitro fertilization (IVF) cycle outcome. This study aimed to investigate whether self-reported perceived and infertility-related stress and cortisol levels were associated with IVF cycle outcomes.

Material and methods

A prospective cohort of 485 women receiving fertility treatment was recruited from September 2011 to December 2013 and followed until December 2014. Data were collected by online questionnaire prior to IVF start and from clinical charts. Salivary cortisol levels were measured. Associations between stress and cycle outcomes (clinical pregnancy and indicators of oocyte and embryo quality) were measured by logistic or linear regression, adjusted for age, body mass index, education, smoking, alcohol and caffeine consumption, shiftwork and night work.

Results

Ultrasound verified pregnancy rate was 26.6% overall per cycle started and 32.9% per embryo transfer. Stress measures were not associated with clinical pregnancy: when compared with the lowest categories, the adjusted odds ratio (OR) and 95% confidence interval (CI) for the highest categories of the perceived stress score was 1.04 (95% CI 0.58-1.87), infertility-related stress score was OR = 1.18 (95% CI 0.56-2.47), morning and evening cortisol was OR = 1.18 (95% CI 0.60-2.29) and OR = 0.66 (95% CI 0.34-1.30), respectively.

Conclusions

Perceived stress, infertility-related stress, and cortisol levels were not associated with IVF cycle outcomes. These findings are potentially reassuring to women undergoing fertility treatment with concerns about the influence of stress on their treatment outcome.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
In vitro fertilization, IVF outcome, stress, cortisol, embryo quality
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-350064 (URN)10.1111/aogs.13280 (DOI)000426055500004 ()29250769 (PubMedID)
Funder
EU, FP7, Seventh Framework Programme, 259679Swedish Research Council, K2011-69X-21871-01-6Swedish Research Council, SIMSAM 340-2013-5867
Available from: 2018-05-03 Created: 2018-05-03 Last updated: 2018-05-03Bibliographically approved
Petridou, E. T., Georgakis, M. K., Erdmann, F., Ma, X., Heck, J. E., Auvinen, A., . . . Skalkidou, A. (2018). Advanced parental age as risk factor for childhood acute lymphoblastic leukemia: results from studies of the Childhood Leukemia International Consortium. European Journal of Epidemiology, 33(10), 965-976
Open this publication in new window or tab >>Advanced parental age as risk factor for childhood acute lymphoblastic leukemia: results from studies of the Childhood Leukemia International Consortium
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2018 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 33, no 10, p. 965-976Article in journal (Refereed) Published
Abstract [en]

Advanced parental age has been associated with adverse health effects in the offspring including childhood (0-14 years) acute lymphoblastic leukemia (ALL), as reported in our meta-analysis of published studies. We aimed to further explore the association using primary data from 16 studies participating in the Childhood Leukemia International Consortium. Data were contributed by 11 case-control (CC) studies (7919 cases and 12,942 controls recruited via interviews) and five nested case-control (NCC) studies (8801 cases and 29,690 controls identified through record linkage of population-based health registries) with variable enrollment periods (1968-2015). Five-year paternal and maternal age increments were introduced in two meta-analyses by study design using adjusted odds ratios (OR) derived from each study. Increased paternal age was associated with greater ALL risk in the offspring (ORCC 1.05, 95% CI 1.00-1.11; ORNCC 1.04, 95% CI 1.01-1.07). A similar positive association with advanced maternal age was observed only in the NCC results (ORCC 0.99, 95% CI 0.91-1.07, heterogeneity I (2) = 58%, p = 0.002; ORNCC 1.05, 95% CI 1.01-1.08). The positive association between parental age and risk of ALL was most marked among children aged 1-5 years and remained unchanged following mutual adjustment for the collinear effect of the paternal and maternal age variables; analyses of the relatively small numbers of discordant paternal-maternal age pairs were not fully enlightening. Our results strengthen the evidence that advanced parental age is associated with increased childhood ALL risk; collinearity of maternal with paternal age complicates causal interpretation. Employing datasets with cytogenetic information may further elucidate involvement of each parental component and clarify underlying mechanisms.

Place, publisher, year, edition, pages
SPRINGER, 2018
Keywords
Maternal age, Paternal age, Acute lymphoblastic leukemia, Childhood, Risk factors, Case-control
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-363208 (URN)10.1007/s10654-018-0402-z (DOI)000445160700006 ()29761423 (PubMedID)
Available from: 2018-10-18 Created: 2018-10-18 Last updated: 2018-10-18Bibliographically approved
Edvinsson, Å., Olivier, J., Hellgren, C., Kallak, T. K., Åkerud, H., Skalkidou, A., . . . Sundström Poromaa, I. (2018). Antenatal Depression and Placental Function: A Protein Validated Gene Expression Study. Paper presented at Meeting of the International-Federation-of-Placenta-Associations (IFPA), SEP 21-24, 2018, Tokyo, JAPAN. Placenta, 69, E62-E62
Open this publication in new window or tab >>Antenatal Depression and Placental Function: A Protein Validated Gene Expression Study
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2018 (English)In: Placenta, ISSN 0143-4004, E-ISSN 1532-3102, Vol. 69, p. E62-E62Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-367143 (URN)000444236500217 ()
Conference
Meeting of the International-Federation-of-Placenta-Associations (IFPA), SEP 21-24, 2018, Tokyo, JAPAN
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2018-11-29Bibliographically approved
Eckerdal, P., Georgakis, M. K., Kollia, N., Wikström, A.-K., Högberg, U. & Skalkidou, A. (2018). Delineating the association between mode of delivery and postpartum depression symptoms: A  longitudinal study. Acta Obstetricia et Gynecologica Scandinavica, 97(3), 301-311, Article ID 29215162.
Open this publication in new window or tab >>Delineating the association between mode of delivery and postpartum depression symptoms: A  longitudinal study
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2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 301-311, article id 29215162Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Although a number of perinatal factors have been implicated in the etiology of postpartum depression, the role of mode of delivery remains controversial. Our aim was to explore the association between mode of delivery and postpartum depression, considering the potentially mediating or confounding role of several covariates. MATERIAL AND METHODS: In a longitudinal-cohort study in Uppsala, Sweden, with 3888 unique pregnancies followed up postpartum, the effect of mode of delivery (spontaneous vaginal delivery, vacuum extraction, elective cesarean section, emergency cesarean section) on self-reported postpartum depression symptoms (Edinburgh Postnatal Depression Scale >/=12) at 6 weeks postpartum was investigated through logistic regression models and path analysis. RESULTS: The overall prevalence of postpartum depression was 13%. Compared with spontaneous vaginal delivery, women who delivered by emergency cesarean section were at higher risk for postpartum depression 6 weeks after delivery in crude (odds ratio 1.45, 95% confidence interval 1.04-2.01) but not in adjusted analysis. However, the path analysis revealed that emergency cesarean section and vacuum extraction were indirectly associated with increased risk of postpartum depression, by leading to postpartum complications, self-reported physical symptoms postpartum, and therefore a negative delivery experience. In contrast, history of depression and fear of delivery increased the odds of postpartum depression and led more frequently to elective cesarean section; however, it was associated with a positive delivery experience. CONCLUSIONS: Mode of delivery has no direct impact on risk of postpartum depression; nevertheless, several modifiable or non-modifiable mediators are present in this association. Women delivering in an emergency setting by emergency cesarean section or vacuum extraction, and reporting negatively experienced delivery, constitute a high-risk group for postpartum depression.

Keywords
Postpartum depression, cesarean section, delivery experience, mode of delivery, vacuum extraction
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-343030 (URN)10.1111/aogs.13275 (DOI)000426055500009 ()
Projects
Basic
Funder
Swedish Research Council, 523-2014-2342Marianne and Marcus Wallenberg Foundation
Available from: 2018-02-25 Created: 2018-02-25 Last updated: 2018-10-08Bibliographically approved
Kullinger, M., Granfors, M., Kieler, H. & Skalkidou, A. (2018). Discrepancy between pregnancy dating methods affects obstetric and neonatal outcomes: a population-based register cohort study. Scientific Reports, 8, Article ID 6936.
Open this publication in new window or tab >>Discrepancy between pregnancy dating methods affects obstetric and neonatal outcomes: a population-based register cohort study
2018 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 6936Article in journal (Refereed) Published
Abstract [en]

To assess associations between discrepancy of pregnancy dating methods and adverse pregnancy, delivery, and neonatal outcomes, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for discrepancy categories among all singleton births from the Medical Birth Register (1995–2010) with estimated date of delivery (EDD) by last menstrual period (LMP) minus EDD by ultrasound (US) -20 to +20 days. Negative/positive discrepancy was a fetus smaller/larger than expected when dated by US (EDD postponed/changed to an earlier date). Large discrepancy was <10th or >90th percentile. Reference was median discrepancy ± 2 days. Odds for diabetes and preeclampsia were higher in pregnancies with negative discrepancy, and for most delivery outcomes in case of large positive discrepancy (+9 to +20 days): shoulder dystocia [OR 1.16 (95% CI 1.01–1.33)] and sphincter injuries [OR 1.13 (95% CI 1.09–1.17)]. Odds for adverse neonatal outcomes were higher in large negative discrepancy (–4 to –20 days): low Apgar score [OR 1.18 (95% CI 1.09–1.27)], asphyxia [OR 1.18 (95% CI 1.11–1.25)], fetal death [OR 1.47 (95% CI 1.32–1.64)], and neonatal death [OR 2.19 (95% CI 1.91–2.50)]. In conclusion, especially, large negative discrepancy was associated with increased risks of adverse perinatal outcomes. 

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-345955 (URN)10.1038/s41598-018-24894-y (DOI)000431204500016 ()29720591 (PubMedID)
Projects
Discrepancy between pregnancy dating methods – correlates and outcomes
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2018-07-25Bibliographically approved
Elenis, E., Skalkidou, A., Skoog Svanberg, A., Sydsjö, G., Stavreus-Evers, A. & Åkerud, H. (2018). HRG C633T polymorphism and risk of gestational hypertensive disorders: a pilot study. BMC Medical Genetics, 19, Article ID 44.
Open this publication in new window or tab >>HRG C633T polymorphism and risk of gestational hypertensive disorders: a pilot study
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2018 (English)In: BMC Medical Genetics, ISSN 1471-2350, E-ISSN 1471-2350, Vol. 19, article id 44Article in journal (Refereed) Published
Abstract [en]

Background: Preeclampsia and gestational hypertensive disorders are thought to occur due to endothelial cell dysfunction and abnormal placentation, triggered by angiogenesis-related factors yet undetermined. The aim of this study was to investigate whether a genetic polymorphism (SNP) of Histidine-rich glycoprotein (HRG), HRG C633T SNP, is associated with gestational hypertensive disorders.

Methods: It was performed a nested case-control study from the BASIC Cohort of Uppsala University Hospital comprising 92 women diagnosed with gestational hypertensive disorders without other comorbidities and 200 women with full term uncomplicated pregnancies, all genotyped regarding HRG C633T SNP.

Results: The genetic analysis of the study sample showed that C/C genotype was more prevalent among controls. The presence of the T-allele showed a tendency towards an increased risk of gestational hypertensive disorders. After clustering the study participants based on their genotype, it was observed that the odds for gestational hypertensive disorders among heterozygous C/T or homozygous T/T carriers were higher compared to homozygous C/C carriers [OR 1.72, 95% CI (1.04-2.84)]. The association remained significant even after adjustment for maternal age, BMI and parity.

Conclusions: The HRG C633T genotype seems to be associated with gestational hypertensive disorders, and as part of a greater algorithm, might contribute in the future to the prediction of the individual susceptibility to the condition.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2018
Keywords
Angiogenesis, Gestational hypertensive disorders, HRG, HRG C633T SNP, Preeclampsia
National Category
Obstetrics, Gynecology and Reproductive Medicine Medical Genetics
Identifiers
urn:nbn:se:uu:diva-351434 (URN)10.1186/s12881-018-0550-8 (DOI)000427996000001 ()29540166 (PubMedID)
Funder
Swedish Research Council, D0277902Swedish Research Council, D0277901
Available from: 2018-05-31 Created: 2018-05-31 Last updated: 2018-05-31Bibliographically approved
Bränn, E., Fransson, E., White, R. A., Papadopoulos, F. C., Edvinsson, Å., Kamali-Moghaddam, M., . . . Skalkidou, A. (2018). Inflammatory markers in women with postpartum depressive symptoms. Journal of Neuroscience Research
Open this publication in new window or tab >>Inflammatory markers in women with postpartum depressive symptoms
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2018 (English)In: Journal of Neuroscience Research, ISSN 0360-4012, E-ISSN 1097-4547Article in journal (Refereed) Epub ahead of print
Abstract [en]

Postpartum depression (PPD) is a devastating disorder affecting not only more than 10% of all women giving birth, but also the baby, the family, and the society. Compiling evidence suggests the involvement of the immune system in the pathophysiology of major depression; yet, the immune response in perinatal depression is not as well studied. The aim of this study was to investigate the alterations in peripheral levels of inflammatory biomarkers in 169 Swedish women with and without depressive symptoms according to the Edinburgh postnatal depression scale or the M.I.N.I neuropsychiatric interview at eight weeks postpartum. Among the 70 markers analyzed with multiplex proximity extension assay, five were significantly elevated in women with postpartum depressive symptoms in the adjusted LASSO logistic regression analysis: Tumor necrosis factor ligand superfamily member (TRANCE) (OR-per 1 SD increase = 1.20), Hepatocyte growth factor (HGF) (OR = 1.17) Interleukin (IL)-18 (OR = 1.06), Fibroblast growth factor 23 (FGF-23) (OR = 1.25), and C-X-C motif chemokine 1 (CXCL1) (OR 1.11). These results indicate that women with PPD have elevated levels of some inflammatory biomarkers. It is, therefore, plausible that PPD is associated with a compromised adaptability of the immune system.

Keywords
cytokines, immune system, inflammation, maternal depression, pregnancy, protein markers
National Category
Psychiatry Immunology in the medical area Psychology
Identifiers
urn:nbn:se:uu:diva-362471 (URN)10.1002/jnr.24312 (DOI)30252150 (PubMedID)
Funder
Swedish Research Council, 521-2013-2339Swedish Research Council, 523-2014-2342Marianne and Marcus Wallenberg Foundation, 2011-Skalkidou
Available from: 2018-10-05 Created: 2018-10-05 Last updated: 2018-12-10Bibliographically approved
Henriksson, H. E., White, R. A., Sylvén, S. M., Papadopoulos, F. & Skalkidou, A. (2018). Meteorological parameters and air pollen count in association with self-reported peripartum depressive symptoms. European psychiatry, 54, 10-18
Open this publication in new window or tab >>Meteorological parameters and air pollen count in association with self-reported peripartum depressive symptoms
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2018 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 54, p. 10-18Article in journal (Refereed) Published
Abstract [en]

Background: Meteorological parameters and air pollen count have been associated with affective disorders and suicide. Regarding peripartum depression, the literature is restricted and inconclusive.

Methods: This cross-sectional study included women (pregnant, n = 3843; postpartum, n = 3757) who participated in the BASIC (Biology, Affect, Stress, Imaging, and Cognition) study 2010-2015 and the UPPSAT (Uppsala-Athens) study (postpartum, n = 1565) in 2006-2007. Cases were defined according to presence of depressive symptoms during pregnancy (gestational week 32) and 6 weeks postpartum, using the Edinburgh Postnatal Depression Scale (EPDS). Exposure of sunshine, temperature, precipitation, snow coverage, and air pollen counts of durations of 1, 7, and 42 days prior to the outcome were studied for associations with depressive symptoms, using negative binomial regression.

Results: Prior to Bonferroni correction, the concentration of mugwort pollen, both one week and six weeks before the EPDS assessment at gestational week 32, was inversely associated with depressive symptoms in pregnancy, both before and after adjustment for season. No associations were found between the exposure to meteorological parameters and pollen and depressive symptoms, at the same day of depressive symptoms' assessment, the previous week, or the six weeks prior to assessment, either during pregnancy or postpartum after Bonferroni correction.

Conclusions: There was no evidence that neither short-term nor long-term exposure to meteorological parameters or air pollen counts were associated with self-reported peripartum depressive symptoms in Uppsala, Sweden.

Place, publisher, year, edition, pages
ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER, 2018
Keywords
Meteorological parameters, Pollen, Postpartum, Antenatal, Peripartum, Depressive symptoms
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-363217 (URN)10.1016/j.eurpsy.2018.06.010 (DOI)000445399800002 ()30031991 (PubMedID)
Funder
Swedish Research Council, 523-2014-2342Swedish Society of Medicine, SLS-250581Marianne and Marcus Wallenberg Foundation, MMW2011.0115Åke Wiberg FoundationStiftelsen Söderström - Königska sjukhemmet
Available from: 2018-10-15 Created: 2018-10-15 Last updated: 2018-10-15Bibliographically approved
Skalkidou, A., Kullinger, M., Georgakis, M. K., Kieler, H. & Kesmodel, U. S. (2018). Systematic misclassification of gestational age by ultrasound biometry: implications for clinical practice and research methodology in the Nordic countries. Acta Obstetricia et Gynecologica Scandinavica, 97(4), 440-444
Open this publication in new window or tab >>Systematic misclassification of gestational age by ultrasound biometry: implications for clinical practice and research methodology in the Nordic countries
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2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 4, p. 440-444Article in journal, Editorial material (Other academic) Published
Abstract [en]

Historically, pregnancy dating has been based on self-reported information on the first day of the last menstrual period. In the 1970s, ultrasound biometry was introduced as an alternative for pregnancy dating and is now the leading method in Nordic countries. The use of ultrasound led to a reduction of post-term births and fewer inductions, and is considered more precise than last menstrual period-based methods for pregnancy dating. Nevertheless, differences in early growth and specific situations, such as maternal obesity, can render its estimates less precise, leading to gestational age misclassification. Clinical implications of ultrasound dating include effect on timely induction in case of post-term pregnancies, treatment with corticosteroids in cases of anticipated preterm delivery and decision on viability in cases of extreme prematurity. Furthermore, gestational age misclassification may influence the numbers and the magnitude of some adverse perinatal outcomes, closely related to gestational age, which are recorded in the Nordic birth registers.

Keywords
Pregnancy dating, ultrasound biometry, last menstrual period, gestational age misclassification, Nordic countries
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-355820 (URN)10.1111/aogs.13300 (DOI)000427561800011 ()29352467 (PubMedID)
Note

Special Issue: SI

Available from: 2018-07-06 Created: 2018-07-06 Last updated: 2018-07-19Bibliographically 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
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4935-7532

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