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Nordstrom, Anna
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Publications (10 of 75) Show all publications
Högström, G., Nordström, A. & Nordström, P. (2016). Aerobic fitness in late adolescence and the risk of early death: a prospective cohort study of 1.3 million Swedish men. International Journal of Epidemiology, 45(4), 1159-1168.
Open this publication in new window or tab >>Aerobic fitness in late adolescence and the risk of early death: a prospective cohort study of 1.3 million Swedish men
2016 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 45, no 4, 1159-1168 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Fitness level and obesity have been associated with death in older populations. We investigated the relationship between aerobic fitness in late adolescence and early death, and whether a high fitness level can compensate the risk of being obese.

METHODS: The cohort comprised 1 317 713 Swedish men (mean age, 18 years) that conscripted between 1969 and 1996. Aerobic fitness was assessed by an electrically braked cycle test. All-cause and specific causes of death were tracked using national registers. Multivariable adjusted associations were tested using Cox regression models.

RESULTS: During a mean follow-up period of 29 years, 44 301 subjects died. Individuals in the highest fifth of aerobic fitness were at lower risk of death from any cause [hazard ratio (HR), 0.49; 95% confidence interval (CI), 0.47-0.51] in comparison with individuals in the lowest fifth, with the strongest association seen for death related to alcohol and narcotics abuse (HR, 0.20; 95% CI, 0.15-0.26). Similar risks were found for weight-adjusted aerobic fitness. Aerobic fitness was associated with a reduced risk of death from any cause in normal-weight and overweight individuals, whereas the benefits were reduced in obese individuals (P < 0.001 for interaction). Furthermore, unfit normal-weight individuals had 30% lower risk of death from any cause (HR, 0.70; 95% CI, 0.53-0.92) than did fit obese individuals.

CONCLUSIONS: Low aerobic fitness in late adolescence is associated with an increased risk of early death. Furthermore, the risk of early death was higher in fit obese individuals than in unfit normal-weight individuals.

Place, publisher, year, edition, pages
Oxford University Press, 2016
Keyword
Fitness, obesity, death
National Category
Geriatrics Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-121364 (URN)10.1093/ije/dyv321 (DOI)000393182000030 ()26686843 (PubMedID)
Available from: 2016-06-01 Created: 2016-06-01 Last updated: 2018-01-10Bibliographically approved
Nordström, P., Michaëlsson, K., Hommel, A., Norrman, P. O., Thorngren, K.-G. & Nordström, A. (2016). Geriatric Rehabilitation and Discharge Location After Hip Fracture in Relation to the Risks of Death and Readmission. Journal of the American Medical Directors Association, 17(1), Article ID UNSP 91.e1.
Open this publication in new window or tab >>Geriatric Rehabilitation and Discharge Location After Hip Fracture in Relation to the Risks of Death and Readmission
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2016 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 1, UNSP 91.e1Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate the effects of geriatric rehabilitation on short-term risk of death and readmission after a hip fracture were investigated in a nationwide cohort. In addition, the association of discharge location (nursing home or patient's home) with the short-term risk of death was assessed.

DESIGN, SETTING, AND PARTICIPANTS: The cohort consisted of 89,301 individuals at least 50 years of age, with a first hip fracture registered in the Swedish quality register RIKSHÖFT, the years 2004-2012.

MEASURES: Short-term risk of death and readmission to hospital after discharge was compared at 8 hospitals, where most patients received inpatient care in geriatric wards, and those treated at 71 regular hospitals.

RESULTS: The risks of death within 30 days of admission were 7.1% in patients admitted to geriatric ward hospitals and 7.4% in those treated at regular hospitals (multivariable-adjusted hazard ratio [HR] 0.91, 95% CI 0.85-0.97), whereas the odds of readmission within 30 days of discharge were 8.7% and 9.8%, respectively (multivariable-adjusted odds ratio 0.86, 95% CI 0.81-0.91). The risk of death was influenced by discharge location and inpatient length of stay (LOS). Thus, for patients discharged to short-term nursing homes with a LOS of at most 10 days, each additional day of LOS reduction increased the risk of death within 30 days of discharge by 13% (HR 1.13, 95% CI 1.08-1.18). This association was reduced in patients discharged to permanent nursing homes (HR 1.04, 95% CI 1.02-1.07), and not significant in those discharged to their own home (OR 1.00, 95% CI 0.91-1.10).

CONCLUSION: The risks of death and readmission were lower in patients with hip fracture who received care in hospitals with geriatric wards. The risk of death after discharge increased with shorter LOS, especially in patients discharged to short-term nursing homes.

Keyword
Hip fracture, geriatric rehabilitation, death, readmission
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-111890 (URN)10.1016/j.jamda.2015.07.004 (DOI)000366756400019 ()26297621 (PubMedID)2-s2.0-84939838758 (Scopus ID)
Available from: 2015-11-25 Created: 2015-11-25 Last updated: 2017-12-01Bibliographically approved
Johansson, J., Nordström, A. & Nordström, P. (2016). Greater Fall Risk in Elderly Women Than in Men Is Associated With Increased Gait Variability During Multitasking. Journal of the American Medical Directors Association, 17(6), 535-540.
Open this publication in new window or tab >>Greater Fall Risk in Elderly Women Than in Men Is Associated With Increased Gait Variability During Multitasking
2016 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 6, 535-540 p.Article in journal (Refereed) Published
Abstract [en]

Objective: As 90% of fractures are caused by falls, and as fractures are more common in elderly women than in elderly men, a better understanding of potential sex differences in fall rates and underlying mechanisms is needed. The purpose of this study was to determine whether women are more prone than men to falling, and to evaluate whether the risk of falling is associated with variations in gait patterns.

Design, setting, and participants: The cohort for this prospective observational study consisted of 1390 community-dwelling men and women aged 70 years, examined in a health survey between July 2012 and November 2014.

Measurements: Gait patterns were measured using a computerized walkway system during normal-speed, fast-speed, and dual-task trials. Triaxial accelerometers were used to collect objective data on physical activity, and self-reported fall data were collected by telephone 6 and 12 months after examination. Incident low-energy falls were defined as unexpected events in which participants came to rest on the ground.

Results: During the follow-up period, 148 study participants (88 women, 60 men; P = .01) reported falls. After adjusting for multiple confounders, including objective measures of physical activity, socioeconomic factors, cardiovascular disease, and cognitive function, the odds ratio for falling in women was 1.49 (95% confidence interval [CI] 1.02–2.19). Variations in gait pattern were significantly (20%–40%) increased in fallers compared with nonfallers during the dual-task trial for step width, step length, stride length, step time, stance time, stride velocity, and single support time (all P < .05). Furthermore, women showed 15% to 35% increased variability in all of these gait parameters during the dual-task trial compared with men (all P < .01).

Conclusion: In the present cohort, 70-year-old women were at greater risk of falls compared with their male counterparts. This increased risk was associated with increased variation in gait pattern during dual-task activities, and may contribute to women's greater fracture risk compared with men.

Place, publisher, year, edition, pages
Elsevier, 2016
Keyword
Incident falls, gait variability, dual-task, elderly, physical activity
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-123443 (URN)10.1016/j.jamda.2016.02.009 (DOI)000377400500013 ()27006336 (PubMedID)
Funder
Swedish Research Council
Available from: 2016-07-20 Created: 2016-07-04 Last updated: 2018-01-15Bibliographically approved
Wikström-Frisén, L., Nordström, A., Mincheva-Nilsson, L. & Larsén, K. (2016). Impact of Season and Oral Contraceptive use on Cortisol Levelsin Physically Active Women. Journal of Exercise, Sports & Orthopedics, 3(2).
Open this publication in new window or tab >>Impact of Season and Oral Contraceptive use on Cortisol Levelsin Physically Active Women
2016 (English)In: Journal of Exercise, Sports & Orthopedics, ISSN 2374-6904, Vol. 3, no 2Article in journal (Refereed) Published
Abstract [en]

When athletes optimize their physical performance, an imbalance could occur between the strain of training, time for recovery and the athlete’s individual tolerance of stress that could lead to overreaching and overtraining syndrome. Cortisol has been suggested to be a biological, diagnostic marker to detect overreaching and overtraining syndrome, since it is thought to indicate stress. This study aimed to provide normative data on cortisol levels, hence investigate seasonality and impact of oral contraceptive use to elucidate if cortisol could be used as a diagnostic marker to detect overreaching and overtraining syndrome in female athletes. The women, divided in two groups, oral contraceptive users (n = 15) and non-users (n = 18), were followed over a nine-month period with monthly blood sampling for cortisol testing and a Profile of Mood State questionnaire (POMS) as a subjective measure of overreaching and overtraining syndrome.Findings indicated seasonal variations in cortisol levels, with different pattern in oral contraceptive users to non-users and moreover, higher cortisol levels in users to nonusers irrespective of season. No differences in seasonal variation in Global POMS score within the groups and no differences in Global POMS score between the groups were detected. Due to seasonality, impact of oral contraceptive use on cortisol levels, methodological considerations and standardization, as well as due to no convincing relationship to Global POMS score, cortisol is not suggested to be an optimal biological, diagnostic marker to detect overreaching and overtraining syndrome in physically active women.

Keyword
hormones, overreaching, overtraining syndrome, female athletes, Profile of Mood State
National Category
Sport and Fitness Sciences
Research subject
Physiology
Identifiers
urn:nbn:se:umu:diva-124841 (URN)
Available from: 2016-08-26 Created: 2016-08-26 Last updated: 2016-12-21Bibliographically approved
Nyström, H., Nordström, A. & Nordström, P. (2016). Risk of Injurious Fall and Hip Fracture up to 26 y before the Diagnosis of Parkinson Disease: Nested Case-Control Studies in a Nationwide Cohort. PLoS Medicine, 13(2), Article ID e1001954.
Open this publication in new window or tab >>Risk of Injurious Fall and Hip Fracture up to 26 y before the Diagnosis of Parkinson Disease: Nested Case-Control Studies in a Nationwide Cohort
2016 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 13, no 2, e1001954Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Low muscle strength has been found in late adolescence in individuals diagnosed with Parkinson disease (PD) 30 y later. This study investigated whether this lower muscle strength also may translate into increased risks of falling and fracture before the diagnosis of PD.

METHODS AND FINDINGS: Among all Swedish citizens aged ≥50 y in 2005, two nested case-control cohorts were compiled. In cohort I, individuals diagnosed with PD during 1988-2012 (n = 24,412) were matched with up to ten controls (n = 243,363), and the risk of fall-related injuries before diagnosis of PD was evaluated. In cohort II, individuals with an injurious fall in need of emergency care during 1988-2012 (n = 622,333) were matched with one control (n = 622,333), and the risk of PD after the injurious fall was evaluated. In cohort I, 18.0% of cases and 11.5% of controls had at least one injurious fall (p < 0.001) prior to PD diagnosis in the case. Assessed by conditional logistic regression analysis adjusted for comorbid diagnoses and education level, PD was associated with increased risks of injurious fall up to 10 y before diagnosis (odds ratio [OR] 1.19, 95% CI 1.08-1.31; 7 to <10 y before diagnosis) and hip fracture ≥15 y before diagnosis (OR 1.36, 95% CI 1.10-1.69; 15-26 y before diagnosis). In cohort II, 0.7% of individuals with an injurious fall and 0.5% of controls were diagnosed with PD during follow-up (p < 0.001). The risk of PD was increased for up to 10 y after an injurious fall (OR 1.18, 95% CI 1.02-1.37; 7 to <10 y after diagnosis). An important limitation is that the diagnoses were obtained from registers and could not be clinically confirmed for the study.

CONCLUSIONS: The increased risks of falling and hip fracture prior to the diagnosis of PD may suggest the presence of clinically relevant neurodegenerative impairment many years before the diagnosis of this disease.

Place, publisher, year, edition, pages
Public library science, 2016
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-116133 (URN)10.1371/journal.pmed.1001954 (DOI)000373038600005 ()26836965 (PubMedID)
Available from: 2016-02-08 Created: 2016-02-08 Last updated: 2017-11-30Bibliographically approved
Berginström, N., Johansson, J., Nordström, P. & Nordström, A. (2015). Attention in Older Adults: A Normative Study of the Integrated Visual and Auditory Continuous Performance Test for Persons Aged 70 Years. Clinical Neuropsychologist (Neuropsychology, Development and Cognition: Section D), 29(5), 595-610.
Open this publication in new window or tab >>Attention in Older Adults: A Normative Study of the Integrated Visual and Auditory Continuous Performance Test for Persons Aged 70 Years
2015 (English)In: Clinical Neuropsychologist (Neuropsychology, Development and Cognition: Section D), ISSN 1385-4046, E-ISSN 1744-4144, Vol. 29, no 5, 595-610 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Our objective was to present normative data from 70-year-olds on the Integrated Visual and Auditory Continuous Performance Test (IVA), a computerized measure of attention and response control. Method: 640 participants (330 men and 310 women), all aged 70years, completed the IVA, as well as the Mini-Mental State Examination and the Geriatric Depression Scale. Results: Data were stratified by education and gender. Education differences were found in 11 of 22 IVA scales. Minor gender differences were found in six scales for the high-education group, and two scales for the low-education group. Comparisons of healthy participants and participants with stroke, myocardial infarction, or diabetes showed only minor differences. Correlations among IVA scales were strong (all r > .34, p < .001), and those with the widely used Mini-Mental State Examination were weaker (all r < .21, p < .05). Skewed distributions of normative data from primary IVA scales measuring response inhibition (Prudence) and inattention (Vigilance) represent a weakness of this test. Conclusions: This study provides IVA norms for 70-year-olds stratified by education and gender, increasing the usability of this instrument when testing persons near this age. The data presented here show some major differences from original IVA norms, and explanations for these differences are discussed. Explanations include the broad age-range used in the original IVA norms (66-99years of age) and the passage of 15years since the original norms were collected.

Place, publisher, year, edition, pages
Taylor & Francis, 2015
Keyword
Aging, Neurocognitive testing, Attention, Normative data
National Category
Geriatrics Neurology
Identifiers
urn:nbn:se:umu:diva-109953 (URN)10.1080/13854046.2015.1063695 (DOI)000361211600002 ()26160019 (PubMedID)
Available from: 2015-10-13 Created: 2015-10-09 Last updated: 2017-12-01Bibliographically approved
Gustafsson, H., Nordström, A. & Nordström, P. (2015). Depression and subsequent risk of Parkinson disease: A nationwide cohort study. Neurology, 84(24), 2422-2429.
Open this publication in new window or tab >>Depression and subsequent risk of Parkinson disease: A nationwide cohort study
2015 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 84, no 24, 2422-2429 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the long-term risk of Parkinson disease (PD) after depression and evaluate potential confounding by shared susceptibility to the 2 diagnoses.

METHODS: The nationwide study cohort included 140,688 cases of depression, matched 1:3 using a nested case-control design to evaluate temporal aspects of study parameters (total, n = 562,631). Potential familial coaggregation of the 2 diagnoses was investigated in a subcohort of 540,811 sibling pairs. Associations were investigated using multivariable adjusted statistical models.

RESULTS: During a median follow-up period of 6.8 (range, 0-26.0) years, 3,260 individuals in the cohort were diagnosed with PD. The multivariable adjusted odds ratio (OR) for PD was 3.2 (95% confidence interval [CI], 2.5-4.1) within the first year of depression, decreasing to 1.5 (95% CI, 1.1-2.0) after 15 to 25 years. Among participants with depression, recurrent hospitalization was an independent risk factor for PD (OR, 1.4; 95% CI, 1.1-1.9 for ≥5 vs 1 hospitalization). In family analyses, siblings' depression was not significantly associated with PD risk in index persons (OR, 1.1; 95% CI, 0.9-1.4).

CONCLUSIONS: The time-dependent effect, dose-response pattern for recurrent depression, and lack of evidence for coaggregation among siblings all indicate a direct association between depression and subsequent PD. Given that the association was significant for a follow-up period of more than 2 decades, depression may be a very early prodromal symptom of PD, or a causal risk factor.

National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-111892 (URN)10.1212/WNL.0000000000001684 (DOI)000369077700011 ()25995056 (PubMedID)
Available from: 2015-11-25 Created: 2015-11-25 Last updated: 2017-12-01Bibliographically approved
Nordström, P., Gustafson, Y., Michaëlsson, K. & Nordström, A. (2015). Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ. British Medical Journal, 350, Article ID h696.
Open this publication in new window or tab >>Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden
2015 (English)In: BMJ. British Medical Journal, ISSN 1756-1833, Vol. 350, h696Article in journal (Refereed) Published
Abstract [en]

Objective To investigate relation between inpatient length of stay after hip fracture and risk of death after hospital discharge. Setting Population >= 50 years old living in Sweden as of 31 December 2005 with a first hip fracture the years 2006-12. Participants 116 111 patients with an incident hip fracture from a closed nationwide cohort. Main outcome measure Death within 30 days of hospital discharge in relation to hospital length of stay after adjustment for multiple covariates. Results Mean inpatient length of stay after a hip fracture decreased from 14.2 days in 2006 to 11.6 days in 2012 (P<0.001). The association between length of stay and risk of death after discharge was non-linear (P<0.001), with a threshold for this non-linear effect of about 10 days. Thus, for patients with length of stay of <= 10 days (n=59 154), each 1-day reduction in length of stay increased the odds of death within 30 days of discharge by 8% in 2006 (odds ratio 1.08 (95% confidence interval 1.04 to 1.12)), which increased to16% in 2012 (odds ratio 1.16 (1.12 to 1.20)). In contrast, for patients with a length of stay of >= 11 days (n=56 957), a 1-day reduction in length of stay was not associated with an increased risk of death after discharge during any of the years of follow up. Limitations No accurate evaluation of the underlying cause of death could be performed. Conclusion Shorter length of stay in hospital after hip fracture is associated with increased risk of death after hospital discharge, but only among patients with length of stay of 10 days or less. This association remained robust over consecutive years.

National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-102289 (URN)10.1136/bmj.h696 (DOI)000349911800005 ()25700551 (PubMedID)
Available from: 2015-06-24 Created: 2015-04-23 Last updated: 2018-01-11Bibliographically approved
Gustafsson, H., Aasly, J., Stråhle, S., Nordström, A. & Nordstrom, P. (2015). Low muscle strength in late adolescence and Parkinson disease later in life. Neurology, 84(18), 1862-1869.
Open this publication in new window or tab >>Low muscle strength in late adolescence and Parkinson disease later in life
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2015 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 84, no 18, 1862-1869 p.Article in journal (Refereed) Published
Abstract [en]

Objective:To evaluate maximal isometric muscle force at 18 years of age in relation to Parkinson disease (PD) later in life.Methods:The cohort consisted of 1,317,713 men who had their muscle strength measured during conscription (1969-1996). Associations between participants' muscle strength at conscription and PD diagnoses, also in their parents, were examined using multivariate statistical models.Results:After adjustment for confounders, the lowest compared to the highest fifth of handgrip strength (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.06-1.79), elbow flexion strength (HR 1.34, 95% CI 1.02-1.76), but not knee extension strength (HR 1.24, 95% CI 0.94-1.62) was associated with an increased risk of PD during follow-up. Furthermore, men whose parents were diagnosed with PD had reduced handgrip (fathers: mean difference [MD] -5.7 N [95% CI -7.3 to -4.0]; mothers: MD -5.0 N [95% CI -7.0 to -2.9]) and elbow flexion (fathers: MD -4.3 N [95% CI -5.7 to -2.9]; mothers: MD -3.9 N [95% CI -5.7 to -2.2]) strength, but not knee extension strength (fathers: MD -1.1 N [95% CI -2.9 to 0.8]; mothers: MD -0.7 N [95% CI -3.1 to 1.6]), than those with no such familial history.Conclusions:Maximal upper extremity voluntary muscle force was reduced in late adolescence in men diagnosed with PD 30 years later. The findings suggest the presence of subclinical motor deficits 3 decades before the clinical onset of PD.

National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-106274 (URN)10.1212/WNL.0000000000001534 (DOI)000354104100011 ()25841033 (PubMedID)
Available from: 2015-07-10 Created: 2015-07-09 Last updated: 2017-12-04Bibliographically approved
Johansson, J., Nordström, A. & Nordström, P. (2015). Objectively measured physical activity is associated with parameters of bone in 70-year-old men and women. Bone, 81, 72-79.
Open this publication in new window or tab >>Objectively measured physical activity is associated with parameters of bone in 70-year-old men and women
2015 (English)In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 81, 72-79 p.Article in journal (Refereed) Published
Abstract [en]

As the world's population ages, the occurrence of osteoporosis-related fractures is projected to increase. Low areal bone mineral density (aBMD), a well-known risk factor for fractures, may be influenced by physical activity (PA). In this cross-sectional study, we aimed to investigate potential associations between objective measures of PA and bone properties, in a population-based cohort of 1228 70-year-old men and women. We measured volumetric BMD (vBMD, mg/cm3) together with cross-sectional area (CSA, mm2) by peripheral quantitative computed tomography at sites located 4% and 66% in the distal–proximal trajectory at the tibia and radius. We also measured aBMD (g/cm2) by dual energy X-ray absorptiometry at the femoral neck, lumbar spine (L1–L4) and radius. Participants wore triaxial accelerometers for 7 consecutive days to obtain objective estimates of PA. The intensity of the objective PA was divided into light (100–1951 counts/min [CPM]), moderate (1952– 5724 cpm) and vigorous (≥5725 cpm). Maximal accelerations for the anterior–posterior (z), medio-lateral (x), and vertical (y) axes were also separately assessed. Associations were investigated using bivariate correlations and multiple linear regression, adjusted for height, weight and sex. Vigorous PA showed the strongest association with femoral neck aBMD (β = 0.09, p b 0.001), while both moderate and vigorous PAs were associated with cor- tical area and trabecular vBMD in the weight-bearing tibia (all p b 0.05). Peak vertical accelerations were associated significantly with cortical area (β = 0.09, p b 0.001) and trabecular vBMD (β = 0.09, p = 0.001) of the tibia, whereas peak anterior–posterior accelerations showed no correlation with these properties. No positive association was found between objectively measured PA and bone parameters of the radius. In conclusion, vertical accelerations and moderate to vigorous PA independently predict bone properties, especially in the weight-bearing tibia, in 70-year-old men and women. 

Place, publisher, year, edition, pages
Elsevier, 2015
Keyword
Physical activity, Aging, Peripheral quantitative computed tomography, Accelerometer, Volumetric BMD
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-112194 (URN)10.1016/j.bone.2015.07.001 (DOI)000365372800011 ()26151120 (PubMedID)
Funder
Swedish Research Council, 2011-2976
Available from: 2015-12-03 Created: 2015-12-03 Last updated: 2018-01-15Bibliographically approved
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