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Eriksson, Marie, ProfessorORCID iD iconorcid.org/0000-0003-3298-1555
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Publications (10 of 104) Show all publications
Darehed, D., Blom, M., Glader, E.-L., Niklasson, J., Norrving, B., Bray, B. D. & Eriksson, M. (2019). Diurnal variations in the quality of stroke care in Sweden. Acta Neurologica Scandinavica, 140(2), 123-130
Open this publication in new window or tab >>Diurnal variations in the quality of stroke care in Sweden
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2019 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 140, no 2, p. 123-130Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: A recent study of acute stroke patients in England and Wales revealed several patterns of temporal variation in quality of care. We hypothesized that similar patterns would be present in Sweden and aimed to describe these patterns. Additionally, we aimed to investigate whether hospital type conferred resilience against temporal variation.

MATERIALS & METHODS: We conducted this nationwide registry-based study using data from the Swedish Stroke Register (Riksstroke) including all adult patients registered with acute stroke between 2011 and 2015. Outcomes included process measures and survival. We modeled time of presentation as on/off hours, shifts, day of week, 4h and 12 h time blocks. We studied hospital resilience by comparing outcomes across hospital types.

RESULTS: 113862 stroke events in 72 hospitals were included. The process indicators and survival all showed significant temporal variation. Door-to-needle (DTN) time within 30 minutes was less likely during nighttime than daytime (OR 0.50; 95% CI 0.41-0.60). Patients admitted during off-hours had lower odds of direct stroke unit (SU) admission (OR 0.72; 95% CI 0.70-0.75). 30-day survival was lower in nighttime versus daytime presentations (OR 0.90, 95% CI 0.84-0.96). The effects of temporal variation differed significantly between hospital types for DTN time within 30 minutes and direct SU admission where university hospitals were more resilient than specialized non-university hospitals.

CONCLUSIONS: Our study shows that variation in quality of care and survival is present throughout the whole week. We also found that university hospitals were more resilient to temporal variation than specialized non-university hospitals.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Off hours, Quality of care, Stroke, Temporal variation, Weekend effect, Weekly variation
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-158646 (URN)10.1111/ane.13112 (DOI)000474934000006 ()31046131 (PubMedID)
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-09-06Bibliographically approved
Bråndal, A., Eriksson, M., Glader, E.-L. & Wester, P. (2019). Effect of early supported discharge after stroke on patient reported outcome based on the Swedish Riksstroke registry. BMC Neurology, 19, Article ID 40.
Open this publication in new window or tab >>Effect of early supported discharge after stroke on patient reported outcome based on the Swedish Riksstroke registry
2019 (English)In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 19, article id 40Article in journal (Refereed) Published
Abstract [en]

Background: The efficacy of early supported discharge (ESD) has not been tested in current stroke care setting, which provide relatively short hospital stays, access to hyper-acute therapies and early carotid stenosis interventions. This study aimed to compare patient-reported outcome measures (PROM) among patients with stroke that received modern stroke unit care with or without ESD.

Methods: Observational study of 30,232 patients with first-ever stroke registered in the Riksstroke registry in Sweden, between 1 January 2010 and 31 December 2013. Patient characteristics were collected from the Riksstroke and Statistics Sweden databases. The primary outcome was satisfaction with the rehabilitation at 3 months after discharge. Secondary outcome were information about stroke provided, tiredness/fatigue, pain, dysthymia/ depression, general health status and dependence in activities of daily living (mobility, toileting and dressing) at 3 months after the stroke. We used separate multivariable logistic regression models for each PROM variable to analyze associations between PROMs and ESD/no ESD.

Results: The ESD group comprised 1495 participants: the control group comprised 28,737 participants. Multivariable logistic regression models of PROMs showed that, compared to controls, the ESD group was more satisfied with rehabilitation after discharge (OR: 1.78, 95% CI: 1.17–2.49), experienced less dysthymia/depression (OR: 0.68, 95% 0.55–0.84) and showed more independence in mobility (OR: 1.50, 95% CI: 1.17–1.92), toileting (OR: 1.30, 95%CI: 1.05–1.61), and dressing (OR: 1.23, 95%CI: 1.02–1.48).

Conclusion: In the setting of modern stroke unit care, ESD appeared to have positive effects on stroke rehabilitation, in the subacute phase.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Stroke, Early supported discharge, Rehabilitation, Patient reported outcome measurement
National Category
Cardiac and Cardiovascular Systems Neurology Nursing
Identifiers
urn:nbn:se:umu:diva-120124 (URN)10.1186/s12883-019-1268-8 (DOI)000461384100001 ()30866844 (PubMedID)2-s2.0-85062847136 (Scopus ID)
Note

Originally included in thesis  in manuscript form with title: "Effect of early supported discharge after stroke on patient reported outcome: observational study from the Swedish Riksstroke registry".

Available from: 2016-05-09 Created: 2016-05-09 Last updated: 2019-04-04Bibliographically approved
Westerlind, E., Persson, H. C., Eriksson, M., Norrving, B. & Sunnerhagen, K. S. (2019). Return to work after stroke: A Swedish nationwide registry-based study.. Acta Neurologica Scandinavica
Open this publication in new window or tab >>Return to work after stroke: A Swedish nationwide registry-based study.
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2019 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: A substantial proportion of individuals with stroke are of working age. After stroke, it is important to return to work (RTW), both for the individual's satisfaction with life and economically for society. The current comprehensive, long-term study aimed at investigating in what time period the RTW continues after stroke and what factors could predict RTW.

MATERIALS AND METHODS: All individuals registered in the registry Riksstroke with stroke in Sweden at ages 18-58 years during 2011 were eligible for participation. RTW was based on sickness absence data from the Social Insurance Agency covering 1 year prestroke to 5 years post-stroke. Time to RTW was analyzed with Kaplan-Meier curves. Potential predictors of RTW were analyzed with Cox regression and logistic regression.

RESULTS: For RTW analyses, 1695 participants were included. Almost 50% RTW within 3 months, 70% within 1 year, and 80% within 2 years post-stroke. However, the RTW continued for several years, with a total of 85% RTW. Predictors of favorable time to RTW were male sex, ischemic stroke, and long university education compared with primary school education. Predictors of unfavorable times to RTW were higher stroke severity, defined by the level of consciousness, and older ages. Participants with self-expectations of RTW 1 year post-stroke had higher odds of RTW within 5 years.

CONCLUSIONS: The RTW continues for a longer time after stroke than previously known. Both self-expectations and demographical, socioeconomic, stroke-related factors were important predictors of RTW. This knowledge could assist healthcare professionals to individualize the rehabilitation post-stroke.

Keywords
follow-up study, rehabilitation, return to work, stroke
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-164773 (URN)10.1111/ane.13180 (DOI)31659744 (PubMedID)
Available from: 2019-10-31 Created: 2019-10-31 Last updated: 2019-10-31
Sundström, J., Söderholm, M., Söderberg, S., Alfredsson, L., Andersson, M., Bellocco, R., . . . Wiberg, B. (2019). Risk factors for subarachnoid haemorrhage: a nationwide cohort of 950 000 adults. International Journal of Epidemiology, Article ID dyz163.
Open this publication in new window or tab >>Risk factors for subarachnoid haemorrhage: a nationwide cohort of 950 000 adults
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2019 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, article id dyz163Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.

METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.

RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.

CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.

Keywords
Stroke, cohort study, epidemiology
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162427 (URN)10.1093/ije/dyz163 (DOI)31363756 (PubMedID)
Note

2019-08-22: Epub ahead of print. Granskad. /LiL

Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-22Bibliographically approved
Eliasson, M., Eriksson, M., Lundqvist, R., Wennberg, P. & Söderberg, S. (2018). Comparison of trends in cardiovascular risk factors between two regions with and without a community and primary care prevention programme. Paper presented at European-Society-of-Cardiology Congress, AUG 25-29, 2018, Munich, GERMANY. European Heart Journal, 39, 76-76
Open this publication in new window or tab >>Comparison of trends in cardiovascular risk factors between two regions with and without a community and primary care prevention programme
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2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 76-76Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2018
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-157619 (URN)10.1093/eurheartj/ehy564.P608 (DOI)000459824000219 ()
Conference
European-Society-of-Cardiology Congress, AUG 25-29, 2018, Munich, GERMANY
Note

Supplement: 1

Meeting Abstract: P608

Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-03-26Bibliographically approved
Eliasson, M., Eriksson, M., Lundqvist, R., Wennberg, P. & Söderberg, S. (2018). Comparison of trends in cardiovascular risk factors between two regions with and without a community and primary care prevention programme. European Journal of Preventive Cardiology, 25(6), 1765-1772
Open this publication in new window or tab >>Comparison of trends in cardiovascular risk factors between two regions with and without a community and primary care prevention programme
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2018 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 25, no 6, p. 1765-1772Article in journal (Refereed) Published
Abstract [en]

Background The effect of primary prevention of cardiovascular disease is debated. The Västerbotten Intervention Programme (VIP) is an individual and community-based public health programme that comprises the whole county of Västerbotten (VB). In the neighbouring county of Norrbotten (NB), no programmes have been implemented.

Method Between 1994 and 2014, five surveys were performed in the two counties on persons aged 40 to 75 years within the Northern Sweden MONICA Study. The number of subjects participating was 6600 (75.4%). We compared time trends in risk factors between the two counties using regression models including age, county and year of survey. To test whether time trends differed between counties, the interaction between county and year was included in the models.

Results Systolic blood pressure declined in both counties, and the decline was faster in Västerbotten than in Norrbotten ( p = 0.043 for interaction county*year). Diastolic blood pressure declined in VB but increased in NB ( p < 0.001). Cholesterol levels declined at a similar rate in both counties whereas body mass index increased in both counties. Fasting glucose decreased in VB ( p = 0.003) and increased in NB. The prevalence of regular smokers decreased faster in VB than in NB ( p = 0.01). Trend in waist and hip circumference, known diabetes, having an academic degree, being physically inactive or 10 year cardiovascular mortality according to SCORE did not differ.

Conclusion Blood pressure, glucose and smoking improved at a faster rate in the county with a community and primary care-based intervention than in the county without such an intervention.

Place, publisher, year, edition, pages
London: Sage Publications, 2018
Keywords
Prevention, blood pressure, cardiovascular disease, cholesterol, cohort, diabetes, glucose, obesity, risk factor, smoking
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-149620 (URN)10.1177/2047487318778349 (DOI)000448077100013 ()29846119 (PubMedID)
Available from: 2018-06-25 Created: 2018-06-25 Last updated: 2019-05-23Bibliographically approved
Lindmark, A., de Luna, X. & Eriksson, M. (2018). Sensitivity analysis for unobserved confounding of direct and indirect effects using uncertainty intervals. Statistics in Medicine, 37(10), 1744-1762
Open this publication in new window or tab >>Sensitivity analysis for unobserved confounding of direct and indirect effects using uncertainty intervals
2018 (English)In: Statistics in Medicine, ISSN 0277-6715, E-ISSN 1097-0258, Vol. 37, no 10, p. 1744-1762Article in journal (Refereed) Published
Abstract [en]

To estimate direct and indirect effects of an exposure on an outcome from observed data, strong assumptions about unconfoundedness are required. Since these assumptions cannot be tested using the observed data, a mediation analysis should always be accompanied by a sensitivity analysis of the resulting estimates. In this article, we propose a sensitivity analysis method for parametric estimation of direct and indirect effects when the exposure, mediator, and outcome are all binary. The sensitivity parameters consist of the correlations between the error terms of the exposure, mediator, and outcome models. These correlations are incorporated into the estimation of the model parameters and identification sets are then obtained for the direct and indirect effects for a range of plausible correlation values. We take the sampling variability into account through the construction of uncertainty intervals. The proposed method is able to assess sensitivity to both mediator‐outcome confounding and confounding involving the exposure. To illustrate the method, we apply it to a mediation study based on the data from the Swedish Stroke Register (Riksstroke). An R package that implements the proposed method is available.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
direct effects, indirect effects, mediation, sensitivity analysis, sequential ignorability, unmeasured confounding
National Category
Probability Theory and Statistics
Research subject
Statistics
Identifiers
urn:nbn:se:umu:diva-125929 (URN)10.1002/sim.7620 (DOI)000429730500011 ()29462839 (PubMedID)
Note

First published in thesis 2016 in manuscript form.

Available from: 2016-09-23 Created: 2016-09-22 Last updated: 2018-06-07Bibliographically approved
Eriksson, M., Glader, E.-L., Norrving, B., Stegmayr, B. & Asplund, K. (2017). Acute stroke alert activation, emergency service use, and reperfusion therapy in Sweden. Brain and Behavior, 7(4), Article ID e00654.
Open this publication in new window or tab >>Acute stroke alert activation, emergency service use, and reperfusion therapy in Sweden
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2017 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 7, no 4, article id e00654Article in journal (Refereed) Published
Abstract [en]

Objectives: Ambulance services and stroke alerts reduce the time from stroke onset to acute stroke diagnosis. We describe the use of stroke alerts and ambulance services in different hospitals and patient groups and their relationship with reperfusion therapy. Methods: This nationwide study included 49,907 patients admitted with acute stroke who were registered in The Swedish Stroke Register (Riksstroke) in 2011-2012. Results: The proportions of patients admitted as stroke alerts out of all acute stroke admissions varied from 12.2% to 45.7% in university hospitals (n=9), 0.5% to 38.7% in specialized nonuniversity hospitals (n=22), and 4.2% to 40.3% in community hospitals (n=41). Younger age, atrial fibrillation (AF), living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were factors associated with a higher probability of stroke alerts. Living alone, primary school education, non-European origin, previous stroke, diabetes, smoking, and dependency in activities of daily living (ADL) were associated with a lower probability of stroke alert. The proportion of patients arriving at the hospital by ambulance varied from 60.3% to 94.5%. Older age, living alone, primary school education, being born in a European country, previous stroke, AF, dependency in ADL, living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were associated with ambulance services. Hospital stroke alert frequencies correlated strongly with reperfusion rates (r=.75). Conclusion: Acute stroke alerts have a significant potential to improve stroke reperfusion rates. Prehospital stroke management varies conspicuously between hospitals and patient groups, and the elderly and patients living alone have a markedly reduced likelihood of stroke alerts.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-132774 (URN)10.1002/brb3.654 (DOI)000399452500010 ()28413705 (PubMedID)
Available from: 2017-03-23 Created: 2017-03-23 Last updated: 2018-06-09Bibliographically approved
Ullberg, T., Glader, E.-L., Zia, E., Petersson, J., Eriksson, M. & Norrving, B. (2017). Associations between Ischemic Stroke Follow-Up, Socioeconomic Status, and Adherence to Secondary Preventive Drugs in Southern Sweden: Observations from the Swedish Stroke Register (Riksstroke). Neuroepidemiology, 48(1/2), 32-38
Open this publication in new window or tab >>Associations between Ischemic Stroke Follow-Up, Socioeconomic Status, and Adherence to Secondary Preventive Drugs in Southern Sweden: Observations from the Swedish Stroke Register (Riksstroke)
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2017 (English)In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 48, no 1/2, p. 32-38Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Currently, the knowledge that one has on adequate stroke follow-up practices is limited. We report associations between 90-day stroke follow-up, socio-economy and adherence to secondary prevention in southern Sweden.

METHODS: Data on 5,602 patients with ischemic stroke January 1, 2008-December 31, 2010, were obtained from Riksstroke and linked to official registers for information on education, birth country, doctor's follow-ups, and secondary prevention. Primary adherence at 4 months and persistence at 14 months post-stroke were calculated for warfarin, statins, antihypertensive, and antiplatelet drugs.

RESULTS: The 90-day follow-up rate was 75%. Patients not receiving a 90-day follow-up had lower age-adjusted OR of persistent drug use at 14 months for antihypertensive agents (OR = 0.74, 95% CI 0.60-0.91) and for antiplatelet drugs (OR = 0.72, 95% CI 0.60-0.87). Drug adherence rates 14 months post-stroke were 85% for antiplatelet drugs, 69% for warfarin, 88% for antihypertensive agents, and 76% for statins. One in three patients discontinued using one or more drug class within 14 months, and nonadherence was associated with activities of daily living dependency at 3 months (age-adjusted OR 0.63, 95% CI 0.57-0.69), but not with age, gender, or educational status.

CONCLUSIONS: The use of secondary preventive drugs decreases over the first year after stroke and remains suboptimal. Specific reasons for nonadherence warrant further study.

Place, publisher, year, edition, pages
S. Karger, 2017
Keywords
Ischemic stroke, Secondary prevention, Medication adherence, Socio-economic factors, Follow-up
National Category
Public Health, Global Health, Social Medicine and Epidemiology Neurology
Identifiers
urn:nbn:se:umu:diva-131978 (URN)10.1159/000456618 (DOI)000403361900004 ()28237982 (PubMedID)
Available from: 2017-02-27 Created: 2017-02-27 Last updated: 2018-06-09Bibliographically approved
Pennlert, J., Overholser, R., Asplund, K., Carlberg, B., Van Rompaye, B., Wiklund, P.-G. & Eriksson, M. (2017). Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients With Atrial Fibrillation. Stroke, 48(2), 314-320
Open this publication in new window or tab >>Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients With Atrial Fibrillation
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2017 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 48, no 2, p. 314-320Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: This study aims to provide observational data on the relationship between the timing of antithrombotic treatment and the competing risks of severe thrombotic and hemorrhagic events in a cohort of Swedish patients with atrial fibrillation and intracerebral hemorrhage (ICH).

METHODS: Patients with atrial fibrillation and a first-ever ICH were identified in the Swedish Stroke Register, Riksstroke, 2005 to 2012. Riksstroke was linked with other national registers to find information on treatment, comorbidity, and outcome. The optimal timing of treatment in patients with low and high thromboembolic risk was described through cumulative incidence functions separately for thrombotic and hemorrhagic events and for the combined end point vascular death or nonfatal stroke.

RESULTS: The study included 2619 ICH survivors with atrial fibrillation with 5759 person-years of follow-up. Anticoagulant treatment was associated with a reduced risk of vascular death and nonfatal stroke in high-risk patients with no significantly increased risk of severe hemorrhage. The benefit seemed to be greatest when treatment was started 7 to 8 weeks after ICH. For high-risk women, the total risk of vascular death or stroke recurrence within 3 years was 17.0% when anticoagulant treatment was initiated 8 weeks after ICH and 28.6% without any antithrombotic treatment (95% confidence interval for difference, 1.4%-21.8%). For high-risk men, the corresponding risks were 14.3% versus 23.6% (95% confidence interval for difference, 0.4%-18.2%).

CONCLUSIONS: This nationwide observational study suggests that anticoagulant treatment may be initiated 7 to 8 weeks after ICH in patients with atrial fibrillation to optimize the benefit from treatment and minimize risk.

Place, publisher, year, edition, pages
American Heart Association, 2017
Keywords
anticoagulants, atrial fibrillation, cerebral hemorrhage, ischemia, stroke
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-129335 (URN)10.1161/STROKEAHA.116.014643 (DOI)000394510300024 ()27999135 (PubMedID)
Note

Presented in part at the 2nd European Stroke Organisation Conference (ESOC 2016), Barcelona, Spain, May 10–12, 2016

Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2018-06-09Bibliographically approved
Projects
Junior researcher: Inequalities in Swedish stroke care with respect to socioeconomic status, country of birth, sex and age [2011-00657_Forte]; Umeå UniversityInequalities in Swedish stroke care with respect to socioeconomic status, country of birth, sex and age [2011-02395_VR]; Umeå UniversityMeasuring health and health care performance [2012-05934_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3298-1555

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