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Boissin, C., Laflamme, L., Fransén, J., Lundin, M., Huss, F., Wallis, L., . . . Lundin, J. (2023). Development and evaluation of deep learning algorithms for assessment of acute burns and the need for surgery. Scientific Reports, 13(1), Article ID 1794.
Open this publication in new window or tab >>Development and evaluation of deep learning algorithms for assessment of acute burns and the need for surgery
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2023 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, article id 1794Article in journal (Refereed) Published
Abstract [en]

Assessment of burn extent and depth are critical and require very specialized diagnosis. Automated image-based algorithms could assist in performing wound detection and classification. We aimed to develop two deep-learning algorithms that respectively identify burns, and classify whether they require surgery. An additional aim assessed the performances in different Fitzpatrick skin types. Annotated burn (n = 1105) and background (n = 536) images were collected. Using a commercially available platform for deep learning algorithms, two models were trained and validated on 70% of the images and tested on the remaining 30%. Accuracy was measured for each image using the percentage of wound area correctly identified and F1 scores for the wound identifier; and area under the receiver operating characteristic (AUC) curve, sensitivity, and specificity for the wound classifier. The wound identifier algorithm detected an average of 87.2% of the wound areas accurately in the test set. For the wound classifier algorithm, the AUC was 0.885. The wound identifier algorithm was more accurate in patients with darker skin types; the wound classifier was more accurate in patients with lighter skin types. To conclude, image-based algorithms can support the assessment of acute burns with relatively good accuracy although larger and different datasets are needed.

Place, publisher, year, edition, pages
Springer Nature, 2023
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-503202 (URN)10.1038/s41598-023-28164-4 (DOI)000985232500032 ()36720894 (PubMedID)
Funder
Swedish Research Council, 2016-01819Karolinska Institute
Note

Correction in: Scientific Reports, vol. 12, issue 1, article number 4973

DOI: 10.1038/s41598-023-31508-9

Available from: 2023-06-09 Created: 2023-06-09 Last updated: 2024-03-01Bibliographically approved
Rangaiah, P., Kouki, M., Dhouibi, Y., Huss, F., Mandal, B., Augustine, B., . . . Augustine, R. (2023). Dielectric Characterization and Statistical Analysis of Ex-Vivo Burnt Human Skin Samples for Microwave Sensor Development. IEEE Access, 11, 4359-4372
Open this publication in new window or tab >>Dielectric Characterization and Statistical Analysis of Ex-Vivo Burnt Human Skin Samples for Microwave Sensor Development
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2023 (English)In: IEEE Access, E-ISSN 2169-3536, Vol. 11, p. 4359-4372Article in journal (Refereed) Published
Abstract [en]

The dielectric properties of skin tissues in relation to different degrees of burn are a necessary prerequisite for designing non-invasive microwave sensing modalities. Due to the difficulties in obtaining human tissue samples, such databases are largely unavailable. To bridge the knowledge gap in this field, we attempt to create a dielectric database of various burn-degree skin samples and their statistical analysis in this work. This research is part of the European "Senseburn " project, which aims to create a non-invasive diagnostic tool that can measure the severity and depth of burns on humans in a clinical setting. In this work, several ex-vivo burnt samples were collected from the Uppsala University Hospital (Akademiska sjukhuset, Sweden). Out of that, eight samples with different degrees of burns in various human body locations were selected for the analysis. The dielectric characterization of the categorized samples was done using an Keysight N1501A dielectric open-end co-axial probe Kit. The dielectric characterization was made from 500 MHz to 10 GHz with 1001 points. The measurement was made systematically, and the clinician feedback forms were gathered and analyzed throughout the process. The measurement data followed the FASTCLUS procedure, which was initially analyzed using density plot, convergence, and cubic clustering criteria. For the statistical analysis, 11 frequency points were considered for eight samples. The results of the fundamental statistical analysis using the FASTCLUS procedure resulted in 88 data sets. Later, data sets were analyzed in sample-wise clusters. Every sample was made with two clusters, i.e., cluster 1, which consisted of healthy sectors, and cluster 2, which consisted of burnt sectors. We made the linear approximations for the sample-wise clusters and found the constant real permittivity difference. Furthermore, we found a pattern in the constant real permittivity differences of every sample that is proportional to the burn degrees. This information is needed in order to identify optimization parameters, i.e., the sensitivity with respect to dielectric difference for various burn degrees. For this purpose, extensive measurement campaigns across the microwave frequency band from 500 MHz - 10 GHz were conducted. Based on the analysis of dielectric data, each skin region of interest (ROI) has its own dielectric properties. Additionally, we developed a proof of concept non-invasive flexible microwave sensor based on the dielectric database collected from burnt ex-vivo human tissue samples. In this way, we could distinguish between phantoms with different dielectric properties in the burned human tissue sample range.

Place, publisher, year, edition, pages
IEEE, 2023
Keywords
Dielectrics, Skin, Transmission line measurements, Surgery, Statistical analysis, Probes, Permittivity, Burnt skin, microwave profiling
National Category
Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:uu:diva-497056 (URN)10.1109/ACCESS.2023.3234185 (DOI)000917230200001 ()
Funder
Swedish Foundation for Strategic Research, RIT170020
Available from: 2023-02-24 Created: 2023-02-24 Last updated: 2024-02-20Bibliographically approved
Dimander, J., Andersson, A., Lindqvist, C., Miclescu, A. & Huss, F. (2023). Documented nutritional therapy in relation to nutritional guidelines post burn injury: a retrospective observational study. Clinical Nutrition ESPEN, 56, 222-229
Open this publication in new window or tab >>Documented nutritional therapy in relation to nutritional guidelines post burn injury: a retrospective observational study
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2023 (English)In: Clinical Nutrition ESPEN, E-ISSN 2405-4577, Vol. 56, p. 222-229Article in journal (Refereed) Published
Abstract [en]

Background & aims: Intensive nutritional therapy is an essential component of burn care. Regardingpost-minor burn injuries, the literature is lacking. The aim of this study was to evaluate documentednutritional therapy in relation to international guidelines after both minor and major burn injuries. The secondary aim of this study was to evaluate the adequacy of energy and protein intake compared toindividual nutritional goals post-burn injury.

Methods: A retrospective observational single-centre study including patients admitted between 2017and 2019 at a burn centre in Sweden was performed. The patients included in the study were >18 years old and in need of hospital care for > 72 h post-burn injury. Information about patients' demographics,nutritional therapy, and clinical characteristics of burn injury was collected. The patients were dividedaccording to total body surface area burnt (TBSA %) into minor burn injuries (TBSA <20%) and major burninjuries (TBSA >20%). Descriptive statistics were used to analyse data. Adherence to guidelines wasestablished by comparing 24 nutritional therapy recommendations to documented treatment. If documented nutritional treatment were in accordance with guidelines, adherence was considered high(>80%), moderate (60-79.9%) or low (<59.9%).

Results: One hundred thirty-four patients were included, 90 patients with minor burn injuries and 44patients with major burn injuries. Documented adherence to the nutritional guideline was overall low.After minor burn injury, 8% (2/24) of nutritional therapy recommendations had a high adherence (fatintake <35% of total energy intake and enteral nutrition as prioritized feeding route), 17% (4/24) amoderate adherence, and 75% (18/24) a low adherence. In patients treated after a major burn injury,there were two recommendations with documented high adherence (Vitamin C and Zinc); 25% (6/24)had moderate adherence, and 67% (16/24) had low adherence. In addition, quite a large amount ofmissing data was found.Adequacy of documented nutritional intake, compared to the individual documented goal, was 78%(±23%) for energy and 66% (±22%) for protein after minor burn injury. After major burn injury, the adequacy was 89% (±21%) for energy and 78% (±19%) for protein, respectively.

Conclusions: This study revealed low adherence to nutritional guidelines in patients treated for minorand major burn injuries. Compared to major burn injuries, lower documented adequacy for both energyand proteins was found in minor burn injuries. Given the disparity between guidelines and documentednutritional therapy, and the lack of specific guidelines for minor burn injuries, there could be aconsiderable risk of inadequate nutritional therapy post-burn injury.

Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Anesthesiology and Intensive Care
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-508395 (URN)10.1016/j.clnesp.2023.06.003 (DOI)001027857900001 ()37344077 (PubMedID)
Available from: 2023-07-31 Created: 2023-07-31 Last updated: 2024-02-20Bibliographically approved
Huss, F. (2023). Fire-Related Injury Mechanisms. In: Marcus Runefors, Ragnar Andersson, Mattias Delin, Thomas Gell (Ed.), Residential Fire Safety: An Interdisciplinary Approach (pp. 45-66). Springer Nature
Open this publication in new window or tab >>Fire-Related Injury Mechanisms
2023 (English)In: Residential Fire Safety: An Interdisciplinary Approach / [ed] Marcus Runefors, Ragnar Andersson, Mattias Delin, Thomas Gell, Springer Nature, 2023, p. 45-66Chapter in book (Refereed)
Place, publisher, year, edition, pages
Springer Nature, 2023
Series
The Society of Fire Protection Engineers Series
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-490040 (URN)10.1007/978-3-031-06325-1_4 (DOI)978-3-031-06324-4 (ISBN)
Available from: 2022-12-07 Created: 2022-12-07 Last updated: 2024-02-20Bibliographically approved
Greenhalgh, D. G., Hill, D. M., Burmeister, D. M., Gus, E. I., Cleland, H., Padiglione, A., . . . Cartotto, R. (2023). Surviving Sepsis After Burn Campaign. Burns, 49(7), 1487-1524
Open this publication in new window or tab >>Surviving Sepsis After Burn Campaign
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2023 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 49, no 7, p. 1487-1524Article in journal (Refereed) Published
Abstract [en]

Introduction: The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. Methods: The International Society for Burn Injuries (ISBI) reached out to regional or na-tional burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and out-come" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC parti-cipants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. Results: The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for in burn should be on a basis. Conclusion: Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients. (c) 2023 Elsevier Ltd and ISBI. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Sepsis, Septic shock, Burns, Infection, Prevention, Resuscitation
National Category
Anesthesiology and Intensive Care Surgery
Identifiers
urn:nbn:se:uu:diva-519151 (URN)10.1016/j.burns.2023.05.003 (DOI)001112481000001 ()37839919 (PubMedID)
Available from: 2024-01-03 Created: 2024-01-03 Last updated: 2024-02-20Bibliographically approved
Fransén, J., Lundin, J., Fredén, F. & Huss, F. (2022). A proof-of-concept study on mortality prediction with machine learning algorithms using burn intensive care data. Scars, Burns & Healing
Open this publication in new window or tab >>A proof-of-concept study on mortality prediction with machine learning algorithms using burn intensive care data
2022 (English)In: Scars, Burns & Healing, ISSN 2059-5131Article in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction

Burn injuries are a common traumatic injury. Large burns have high mortality requiring intensive care and accurate mortality predictions. To assess if machine learning (ML) could improve predictions, ML algorithms were tested and compared with the original and revised Baux score.

Methods

Admission data and mortality outcomes were collected from patients at Uppsala University Hospital Burn Centre from 2002 to 2019. Prognostic variables were selected, ML algorithms trained and predictions assessed by analysis of the area under the receiver operating characteristic curve (AUC). Comparison was made with Baux scores using DeLong test.

Results

A total of 17 prognostic variables were selected from 92 patients. AUCs in leave-one-out cross-validation for a decision tree model, an extreme boosting model, a random forest model, a support-vector machine (SVM) model and a generalised linear regression model (GLM) were 0.83 (95% confidence interval [CI] = 0.72–0.94), 0.92 (95% CI = 0.84–1), 0.92 (95% CI = 0.84–1), 0.92 (95% CI = 0.84–1) and 0.84 (95% CI = 0.74–0.94), respectively. AUCs for the Baux score and revised Baux score were 0.85 (95% CI = 0.75–0.95) and 0.84 (95% CI = 0.74–0.94). No significant differences were observed when comparing ML algorithms with Baux score and revised Baux score. Secondary variable selection was made to analyse model performance.

Conclusion

This proof-of-concept study showed initial credibility in using ML algorithms to predict mortality in burn patients. The sample size was small and future studies are needed with larger sample sizes, further variable selections and prospective testing of the algorithms.

Place, publisher, year, edition, pages
Sage Publications, 2022
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-490045 (URN)10.1177/20595131211066585 (DOI)35198237 (PubMedID)
Available from: 2022-12-07 Created: 2022-12-07 Last updated: 2024-02-20
Heyland, D. K., Wibbenmeyer, L., Pollack, J. A., Friedman, B., Turgeon, A. F., Eshraghi, N., . . . Day, A. G. (2022). A Randomized Trial of Enteral Glutamine for Treatment of Burn Injuries. New England Journal of Medicine, 387(11), 1001-1010
Open this publication in new window or tab >>A Randomized Trial of Enteral Glutamine for Treatment of Burn Injuries
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2022 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 387, no 11, p. 1001-1010Article in journal (Refereed) Published
Abstract [en]

BACKGROUND

Glutamine is thought to have beneficial effects on the metabolic and stress response to severe injury. Clinical trials involving patients with burns and other critically ill patients have shown conflicting results regarding the benefits and risks of glutamine supplementation.

METHODS

In a double-blind, randomized, placebo-controlled trial, we assigned patients with deep second-or third-degree burns (affecting >= 10% to >= 20% of total body-surface area, depending on age) within 72 hours after hospital admission to receive 0.5 g per kilogram of body weight per day of enterally delivered glutamine or placebo. Trial agents were given every 4 hours through a feeding tube or three or four times a day by mouth until 7 days after the last skin grafting procedure, discharge from the acute care unit, or 3 months after admission, whichever came first. The primary outcome was the time to discharge alive from the hospital, with data censored at 90 days. We calculated subdistribution hazard ratios for discharge alive, which took into account death as a competing risk.

RESULTS A total of 1209 patients with severe burns (mean burn size, 33% of total body-surface area) underwent randomization, and 1200 were included in the analysis (596 patients in the glutamine group and 604 in the placebo group). The median time to discharge alive from the hospital was 40 days (interquartile range, 24 to 87) in the glutamine group and 38 days (interquartile range, 22 to 75) in the placebo group (subdistribution hazard ratio for discharge alive, 0.91; 95% confidence interval [CI], 0.80 to 1.04; P = 0.17). Mortality at 6 months was 17.2% in the glutamine group and 16.2% in the placebo group (hazard ratio for death, 1.06; 95% CI, 0.80 to 1.41). No substantial between-group differences in serious adverse events were observed.

CONCLUSIONS

In patients with severe burns, supplemental glutamine did not reduce the time to discharge alive from the hospital.

Place, publisher, year, edition, pages
Massachusetts Medical Society, 2022
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-490041 (URN)10.1056/nejmoa2203364 (DOI)000852749800001 ()36082909 (PubMedID)
Available from: 2022-12-07 Created: 2022-12-07 Last updated: 2024-02-20Bibliographically approved
Karlsson, M., Elmasry, M., Steinvall, I., Huss, F., Olofsson, P., Elawa, S., . . . Sjöberg, F. (2022). Biosynthetic cellulose compared to porcine xenograft in the treatment of partial-thickness burns: A randomised clinical trial.. Burns, 48(5), 1236-1245, Article ID S0305-4179(21)00264-3.
Open this publication in new window or tab >>Biosynthetic cellulose compared to porcine xenograft in the treatment of partial-thickness burns: A randomised clinical trial.
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2022 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 48, no 5, p. 1236-1245, article id S0305-4179(21)00264-3Article in journal (Refereed) Published
Abstract [en]

AIM: The aim was to compare two dressing treatments for partial-thickness burns: biosynthetic cellulose dressing (BsC) (Epiprotect® S2Medical AB, Linköping, Sweden) and porcine xenograft (EZ Derm®, Mölnlycke Health Care, Gothenburg, Sweden).

METHODS: Twenty-four adults with partial-thickness burns were included in this randomized clinical trial conducted at The Burn Centers in Linköping and Uppsala, Sweden between June 2016 and November 2018. Time to healing was the primary outcome. Secondary outcomes were wound infection, pain, impact on everyday life, length of hospital stay, cost, and burn scar outcome (evaluated with POSAS).

RESULTS: We found no significant differences between the two dressing groups regarding time to healing, wound infection, pain, impact on everyday life, duration of hospital stay, cost, or burn scar outcome at the first follow up. Burn scar outcome at the 12-month follow up showed that the porcine xenograft group patients scored their scars higher on the POSAS items thickness (p = 0.048) and relief (p = 0.050). This difference was, however, not confirmed by the observer.

CONCLUSIONS: The results showed the dressings performed similarly when used in adults with burns evaluated as partial thickness.

Place, publisher, year, edition, pages
ElsevierElsevier BV, 2022
Keywords
Burn wound dressing, Cellulose dressing, Healing time, Partial thickness burn, Porcine skin
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-459184 (URN)10.1016/j.burns.2021.09.017 (DOI)000849634500024 ()34629186 (PubMedID)
Available from: 2021-11-22 Created: 2021-11-22 Last updated: 2024-02-20Bibliographically approved
Holm, S., Engström, O., Melander, M., Horvath, M. C., Fredén, F., Lipcsey, M. & Huss, F. (2022). Cutaneous steam burns and steam inhalation injuries: a literature review and a case presentation. European journal of plastic surgery, 45(6), 881-896
Open this publication in new window or tab >>Cutaneous steam burns and steam inhalation injuries: a literature review and a case presentation
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2022 (English)In: European journal of plastic surgery, ISSN 0930-343X, E-ISSN 1435-0130, Vol. 45, no 6, p. 881-896Article in journal (Refereed) Published
Abstract [en]

Scald is one type of burn that s often mentioned alone and occurs mostly in the paediatric population. Inhaled steam is mostly cooled off in the airways, why thermal damage is rarely seen. A sudden exposure to hot steam/inhalation can cause a thermal inhalation injury. A scoping review was performed, with the aim to summarize all published papers in English, about steam-related injuries. The search was conducted using the PubMed (R) and Cochrane libraries on 19th of May 2021, without a set time period. Out of a total of 1186 identified records, 31 were chosen for review. Burns related to the contact with steam are generally rare and can be both minor and severe. The more severe cases related to steam exposure are mostly workplace accidents and the minor injuries reported in the literature are often related to steam inhalation therapy, especially in the paediatric population. This review describes the challenges that can be found dealing with patients suffering from cutaneous steam burns and/or steam inhalation injuries. A steam injury to the airways or the skin can be directly life-threatening and should be treated with caution. This type of injury can lead to acute respiratory insufficiency and sometimes death. A case of a male patient with extensive cutaneous steam burns and a steam inhalation injury who passed away after 11 days of treatment is also presented to illustrate this review. Level of evidence: Level V, Therapeutic; Risk/Prognostic Study.

Place, publisher, year, edition, pages
Springer Nature, 2022
National Category
Anesthesiology and Intensive Care Surgery
Identifiers
urn:nbn:se:uu:diva-490043 (URN)10.1007/s00238-022-01955-0 (DOI)000790631200002 ()
Funder
Uppsala University
Available from: 2022-12-07 Created: 2022-12-07 Last updated: 2024-02-20Bibliographically approved
Asswad, A. G., Holm, S., Engström, O., Huss, F., Lipcsey, M. & Rudolph, A. (2022). Delayed, Unprovoked, Hemodynamic Collapse with Following Asystole in a Pediatric Patient Following a High-Voltage Injury: A Case Report and Literature Review. Pediatric Cardiology, 43(5), 1163-1168
Open this publication in new window or tab >>Delayed, Unprovoked, Hemodynamic Collapse with Following Asystole in a Pediatric Patient Following a High-Voltage Injury: A Case Report and Literature Review
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2022 (English)In: Pediatric Cardiology, ISSN 0172-0643, E-ISSN 1432-1971, Vol. 43, no 5, p. 1163-1168Article, review/survey (Refereed) Published
Abstract [en]

Electrical incidents are common and mostly uneventful, though can be severe and sometimes lethal. Aside from skin, muscle and soft tissue damage, electrical injuries can cause cardiac arrhythmias, the most common cardiac complication. The case of a 14-year-old girl who sustained 48.5% TBSA burns following a high-voltage electrical injury is described. She suffered five episodes of asystole 78 h following the injury, requiring extracorporeal membrane oxygenation. The cause of the delayed asystole was investigated and a PubMed literature search was conducted to explore late presenting cardiac sequelae following electrical injuries. This yielded fifteen studies, identified as relevant, of high quality and in the English language. These studies included a total of 1411 patients of whom only 3 were found to have had late potentially lethal arrhythmias, all manifesting within the first 24 h after the injury. Of these patients, 32 suffered cardiac arrests shortly after the electrical injury, 11 of which were documented as asystolic arrests though these were all from a single study with the rural locale and prolonged delay in arrival to the hospital setting contributing to this finding. To our knowledge, this is the only pediatric cardiac arrest developing in a stable patient over 72 h following the initial electrical injury. No other patient has suffered any significant cardiac complications first presenting outside the initial 24-h period following the electrical injury. Guidelines and recommendations on post electrical injury observation of patient vary and further research into this field is required to allow for guidance unification.

Place, publisher, year, edition, pages
Springer Nature, 2022
Keywords
Electrical injury, Cardiac arrest, Pediatric, Burns
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-484120 (URN)10.1007/s00246-022-02838-8 (DOI)000753882400001 ()35137275 (PubMedID)
Available from: 2022-09-13 Created: 2022-09-13 Last updated: 2024-02-20Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-9735-1434

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