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Hedman, Leif R
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Publications (10 of 38) Show all publications
Courteille, O., Fahlstedt, M., Ho, J., Hedman, L., Fors, U., Von Holst, H., . . . Möller, H. (2018). Learning through a virtual patient vs. recorded lecture: a comparison of knowledge retention in a trauma case. International Journal of Medical Education, 9, 86-92
Open this publication in new window or tab >>Learning through a virtual patient vs. recorded lecture: a comparison of knowledge retention in a trauma case
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2018 (English)In: International Journal of Medical Education, ISSN 2042-6372, E-ISSN 2042-6372, Vol. 9, p. 86-92Article in journal (Refereed) Published
Abstract [en]

Objectives: To compare medical students' and residents' knowledge retention of assessment, diagnosis and treatment procedures, as well as a learning experience, of patients with spinal trauma after training with either a Virtual Patient case or a video-recorded traditional lecture. Methods: A total of 170 volunteers (85 medical students and 85 residents in orthopedic surgery) were randomly allocated (stratified for student/resident and gender) to either a video-recorded standard lecture or a Virtual Patient-based training session where they interactively assessed a clinical case portraying a motorcycle accident. The knowledge retention was assessed by a test immediately following the educational intervention and repeated after a minimum of 2 months. Participants' learning experiences were evaluated with exit questionnaires. A repeated-measures analysis of variance was applied on knowledge scores. A total of 81% (n = 138) of the participants completed both tests. Results: There was a small but significant decline in first and second test results for both groups (F-(1,F-135) = 18.154, p = 0.00). However, no significant differences in short-term and long-term knowledge retention were observed between the two teaching methods. The Virtual Patient group reported higher learning experience levels in engagement, stimulation, general perception, and expectations. Conclusions: Participants' levels engagement were reported in favor of the VP format. Similar knowledge retention was achieved through either a Virtual Patient or a recorded lecture.

Place, publisher, year, edition, pages
IJME, 2018
Keywords
Simulation-based trauma education, virtual patient, knowledge retention, biomechanics
National Category
Educational Sciences Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:umu:diva-147344 (URN)10.5116/ijme.5aa3.ccf2 (DOI)000429160200001 ()29599421 (PubMedID)
Available from: 2018-05-11 Created: 2018-05-11 Last updated: 2018-06-09Bibliographically approved
Escher, C., Creutzfeldt, J., Meurling, L., Hedman, L., Kjellin, A. & Fellaender-Tsai, L. (2017). Medical students' situational motivation to participate in simulation based team training is predicted by attitudes to patient safety. BMC Medical Education, 17, Article ID 37.
Open this publication in new window or tab >>Medical students' situational motivation to participate in simulation based team training is predicted by attitudes to patient safety
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2017 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 17, article id 37Article in journal (Refereed) Published
Abstract [en]

Background: Patient safety education, as well as the safety climate at clinical rotations, has an impact on students' attitudes. We explored medical students' self-reported motivation to participate in simulation-based teamwork training (SBTT), with the hypothesis that high scores in patient safety attitudes would promote motivation to SBTT and that intrinsic motivation would increase after training.

Methods: In a prospective cohort study we explored Swedish medical students' attitudes to patient safety, their motivation to participate in SBTT and how motivation was affected by the training. The setting was an integrated SBTT course during the surgical semester that focused on non-technical skills and safe treatment of surgical emergencies. Data was collected using the Situational Motivation Scale (SIMS) and the Attitudes to Patient Safety Questionnaire (APSQ).

Results: We found a positive correlation between students' individual patient safety attitudes and self-reported motivation (identified regulation) to participate in SBTT. We also found that intrinsic motivation increased after training. Female students in our study scored higher than males regarding some of the APSQ sub-scores and the entire group scored higher or on par with comparable international samples.

Conclusion: In order to enable safe practice and professionalism in healthcare, students' engagement in patient safety education is important. Our finding that students' patient safety attitudes show a positive correlation to motivation and that intrinsic motivation increases after training underpins patient safety climate and integrated teaching of patient safety issues at medical schools in order to help students develop the knowledge, skills and attitudes required for safe practice.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2017
Keywords
Simulator, Teamwork, Medical education, Situational motivation, Attitudes, Patient safety, Surgery, Clinical performance, Crew resource management
National Category
Psychology
Identifiers
urn:nbn:se:umu:diva-133539 (URN)10.1186/s12909-017-0876-5 (DOI)000397432200001 ()28183316 (PubMedID)
Available from: 2017-06-22 Created: 2017-06-22 Last updated: 2018-06-09Bibliographically approved
Creutzfeldt, J., Hedman, L. & Fellander-Tsai, L. (2016). Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students' Experiences Using a Multiplayer Virtual World. JMIR Serious Games, 4(2), Article ID e22.
Open this publication in new window or tab >>Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students' Experiences Using a Multiplayer Virtual World
2016 (English)In: JMIR Serious Games, E-ISSN 2291-9279, Vol. 4, no 2, article id e22Article in journal (Refereed) Published
Abstract [en]

Background: Emergency medical practices are often team efforts. Training for various tasks and collaborations may be carried out in virtual environments. Although promising results exist from studies of serious games, little is known about the subjective reactions of learners when using multiplayer virtual world (MVW) training in medicine.

Objective: The objective of this study was to reach a better understanding of the learners’ reactions and experiences when using an MVW for team training of cardiopulmonary resuscitation (CPR).

Methods: Twelve Swedish medical students participated in semistructured focus group discussions after CPR training in an MVW with partially preset options. The students’ perceptions and feelings related to use of this educational tool were investigated. Using qualitative methodology, discussions were analyzed by a phenomenological data-driven approach. Quality measures included negotiations, back-and-forth reading, triangulation, and validation with the informants.

Results: Four categories characterizing the students’ experiences could be defined: (1) Focused Mental Training, (2) Interface Diverting Focus From Training, (3) Benefits of Practicing in a Group, and (4) Easy Loss of Focus When Passive. We interpreted the results, compared them to findings of others, and propose advantages and risks of using virtual worlds for learning.

Conclusions: Beneficial aspects of learning CPR in a virtual world were confirmed. To achieve high participant engagement and create good conditions for training, well-established procedures should be practiced. Furthermore, students should be kept in an active mode and frequent feedback should be utilized. It cannot be completely ruled out that the use of virtual training may contribute to erroneous self-beliefs that can affect later clinical performance.

Keywords
avatars, cardiopulmonary resuscitation, educational technology, medical students, experiences, multiplayer virtual worlds, patient simulation, virtual learning environments
National Category
Learning
Identifiers
urn:nbn:se:umu:diva-138686 (URN)10.2196/games.6448 (DOI)000390935000005 ()27986645 (PubMedID)
Available from: 2017-08-30 Created: 2017-08-30 Last updated: 2018-06-09Bibliographically approved
Schlickum, M., Hedman, L. & Fellander-Tsai, L. (2016). Visual-spatial ability is more important than motivation for novices in surgical simulator training: a preliminary study. International Journal of Medical Education, 7, 56-61
Open this publication in new window or tab >>Visual-spatial ability is more important than motivation for novices in surgical simulator training: a preliminary study
2016 (English)In: International Journal of Medical Education, ISSN 2042-6372, E-ISSN 2042-6372, Vol. 7, p. 56-61Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate whether surgical simulation performance and previous video gaming experience would correlate with higher motivation to further train a specific simulator task and whether visual-spatial ability would rank higher in importance to surgical performance than the above. It was also examined whether or not motivation would correlate with a preference to choose a surgical specialty in the future and if simulator training would increase the interest in choosing that same work field. Methods: Motivation and general interest in surgery was measured pre- and post-training in 30 medical students at Karolinska Institutet who were tested in a laparoscopic surgical simulator in parallel with measurement of visual-spatial ability and self-estimated video gaming experience. Correlations between simulator performance metrics, visual-spatial ability and motivation were statistically analyzed using regression analysis. Results: A good result in the first simulator trial correlated with higher self-determination index (r = -0.46, p=0.05) in male students. Visual-spatial ability was the most important underlying factor followed by intrinsic motivation score and finally video gaming experience (p=0.02, p=0.05, p=0.11) regarding simulator performance in male students. Simulator training increased interest in surgery when studying all subjects (p=0.01), male subjects (p=0.02) as well as subjects with low video gaming experience (p=0.02). Conclusions: This preliminary study highlights individual differences regarding the effect of simulator training on motivation that can be taken into account when designing simulator training curricula, although the sample size is quite small and findings should be interpreted carefully.

Keywords
Motivation, video games, surgical simulator, surgical training, visual-spatial ability
National Category
Psychology
Identifiers
urn:nbn:se:umu:diva-129998 (URN)10.5116/ijme.56b1.1691 (DOI)000386885200001 ()26897701 (PubMedID)
Available from: 2017-01-12 Created: 2017-01-11 Last updated: 2018-06-09Bibliographically approved
Meurling, L., Hedman, L., Lidefelt, K.-J., Escher, C., Fellander-Tsai, L. & Wallin, C.-J. (2014). Comparison of high- and low equipment fidelity during paediatric simulation team training: a case control study. BMC Medical Education, 14, 221
Open this publication in new window or tab >>Comparison of high- and low equipment fidelity during paediatric simulation team training: a case control study
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2014 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 14, p. 221-Article in journal (Refereed) Published
Abstract [en]

Background: High-fidelity patient simulators in team training are becoming popular, though research showing benefits of the training process compared to low-fidelity models is rare. We explored in situ training for paediatric teams in an emergency department using a low-fidelity model (plastic doll) and a high-fidelity paediatric simulator, keeping other contextual factors constant. The goal was to study differences in trainees' and trainers' performance along with their individual experiences, during in situ training, using either a low-fidelity model or a high-fidelity paediatric simulator.

Methods: During a two-year period, teams involved in paediatric emergency care were trained in groups of five to nine. Each team performed one video-recorded paediatric emergency scenario. A case control study was undertaken in which 34 teams used either a low-fidelity model (n = 17) or a high-fidelity paediatric simulator (n = 17). The teams' clinical performances during the scenarios were measured as the time elapsed to prescribe as well as deliver oxygen. The trainers were monitored regarding frequency of their interventions. We also registered trainees' and trainers' mental strain and flow experience.

Results: Of 225 trainees' occasions during 34 sessions, 34 trainer questionnaires, 163 trainee questionnaires, and 28 videos, could be analyzed. Time to deliver oxygen was significantly longer (p = 0.014) when a high-fidelity simulator was used. The trainees' mental strain and flow did not differ between the two types of training. The frequency of trainers interventions was lower (p < 0.001) when trainees used a high-fidelity simulator; trainers' perceived mental strain was lower (< 0.001) and their flow experience higher (p = 0.004) when using high-fidelity simulator.

Conclusions: Levels of equipment fidelity affect measurable performance variables in simulation-based team training, but trainee s' individual experiences are similar. We also note a reduction in the frequency of trainers' interventions in the scenarios as well as their mental strain, when trainees used a high-fidelity simulator.

Keywords
low-fidelity, high-fidelity, simulation, team training, leader, follower, trainer, trainees, mental rain, paediatric
National Category
Educational Sciences
Identifiers
urn:nbn:se:umu:diva-98876 (URN)10.1186/1472-6920-14-221 (DOI)000345784700001 ()
Available from: 2015-02-04 Created: 2015-01-27 Last updated: 2018-06-07Bibliographically approved
Kjellin, A., Hedman, L., Escher, C. & Fellander-Tsai, L. (2014). Hybrid simulation: bringing motivation to the art of teamwork training in the operating room. Scandinavian Journal of Surgery, 103(4), 232-236
Open this publication in new window or tab >>Hybrid simulation: bringing motivation to the art of teamwork training in the operating room
2014 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 103, no 4, p. 232-236Article in journal (Refereed) Published
Abstract [en]

Background and Aims: Crew resource management-based operating room team training will be an evident part of future surgical training. Hybrid simulation in the operating room enables the opportunity for trainees to perform higher fidelity training of technical and non-technical skills in a realistic context. We focus on situational motivation and self-efficacy, two important factors for optimal learning in light of a prototype course for teams of residents in surgery and anesthesiology and nurses. Material and Methods: Authentic operating room teams consisting of residents in anesthesia (n = 2), anesthesia nurses (n = 3), residents in surgery (n = 2), and scrub nurses (n = 6) were, during a one-day course, exposed to four different scenarios. Their situational motivation was self-assessed (ranging from 1 = does not correspond at all to 7 = corresponds exactly) immediately after training, and their self-efficacy (graded from 1 to 7) before and after training. Training was performed in a mock-up operating theater equipped with a hybrid patient simulator (SimMan 3G; Laerdal) and a laparoscopic simulator (Lap Mentor Express; Simbionix). The functionality of the systematic hybrid procedure simulation scenario was evaluated by an exit questionnaire (graded from 1 = disagree entirely to 5 = agree completely). Results and Conclusions: The trainees were mostly intrinsically motivated, engaged for their own sake, and had a rather great degree of self-determination toward the training situation. Self-efficacy among the team members improved significantly from 4 to 6 (median). Overall evaluation showed very good result with a median grading of 5. We conclude that hybrid simulation is feasible and has the possibility to train an authentic operating team in order to improve individual motivation and confidence.

Keywords
Simulation, surgical training, education
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-98858 (URN)10.1177/1457496913516897 (DOI)000345705900003 ()
Available from: 2015-03-02 Created: 2015-01-27 Last updated: 2018-06-07Bibliographically approved
Ahlqvist, J. B., Nilsson, T. A., Hedman, L. R., Desser, T. S., Dev, P., Johansson, M., . . . Gold, G. E. (2013). A randomized controlled trial on 2 simulation-based training methods in radiology: effects on radiologic technology student skill in assessing image quality.. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 8(6), 382-387
Open this publication in new window or tab >>A randomized controlled trial on 2 simulation-based training methods in radiology: effects on radiologic technology student skill in assessing image quality.
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2013 (English)In: Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, ISSN 1559-2332, E-ISSN 1559-713X, Vol. 8, no 6, p. 382-387Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: A simulator for virtual radiographic examinations was developed. In the virtual environment, the user can perform and analyze radiographic examinations of patient models without the use of ionizing radiation. We investigated if this simulation technique could improve education of radiology technology students. We compared student performance in the assessment of radiographic image quality after training with a conventional manikin or with the virtual radiography simulator.

METHODS: A randomized controlled experimental study involving 31 first-year radiology technology students was performed. It was organized in 4 phases as follows: (I) randomization to control or experimental group based on the results of an anatomy examination; (II) proficiency testing before training; (III) intervention (control group, exposure and analysis of radiographic images of the cervical spine of a manikin; experimental group, exposure and analysis of the cervical spine images in the virtual radiography simulator); and (IV) proficiency testing after training.

RESULTS: The experimental group showed significantly higher scores after training compared with those before training (P < 0.01). A linear mixed-effect analysis revealed a significant difference between the control and experimental groups regarding proficiency change (P = 0.01).

CONCLUSIONS: Virtual radiographic simulation is an effective tool for learning image quality assessment. Simulation can therefore be a valuable adjunct to traditional educational methods and reduce exposure to x-rays and tutoring time.

National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-81572 (URN)10.1097/SIH.0b013e3182a60a48 (DOI)000330318800005 ()24096919 (PubMedID)
Available from: 2013-10-16 Created: 2013-10-16 Last updated: 2018-06-08Bibliographically approved
Creutzfeldt, J., Hedman, L., Heinrichs, L., Youngblood, P. & Fellander-Tsai, L. (2013). Cardiopulmonary resuscitation training in High School using Avatars in Virtual Worlds: An International Feasibility Study. Journal of Medical Internet Research, 15(1), doi-10.2196/jmir.1715
Open this publication in new window or tab >>Cardiopulmonary resuscitation training in High School using Avatars in Virtual Worlds: An International Feasibility Study
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2013 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 15, no 1, p. doi-10.2196/jmir.1715Article in journal (Refereed) Published
Abstract [en]

Background: Approximately 300,000 people suffer sudden cardiac arrest (SCA) annually in the United States. Less than 30% of out-of-hospital victims receive cardiopulmonary resuscitation (CPR) despite the American Heart Association training over 12 million laypersons annually to conduct CPR. New engaging learning methods are needed for CPR education, especially in schools. Massively multiplayer virtual worlds (MMVW) offer platforms for serious games that are promising learning methods that take advantage of the computer capabilities of today's youth (ie, the digital native generation). Objective: Our main aim was to assess the feasibility of cardiopulmonary resuscitation training in high school students by using avatars in MMVM. We also analyzed experiences, self-efficacy, and concentration in response to training. Methods: In this prospective international collaborative study, an e-learning method was used with high school students in Sweden and the United States. A software game platform was modified for use as a serious game to train in emergency medical situations. Using MMVW technology, participants in teams of 3 were engaged in virtual-world scenarios to learn how to treat victims suffering cardiac arrest. Short debriefings were carried out after each scenario. A total of 36 high school students (Sweden, n=12; United States, n=24) participated. Their self-efficacy and concentration (task motivation) were assessed. An exit questionnaire was used to solicit experiences and attitudes toward this type of training. Among the Swedish students, a follow-up was carried out after 6 months. Depending on the distributions, t tests or Mann-Whitney tests were used. Correlation between variables was assessed by using Spearman rank correlation. Regression analyses were used for time-dependent variables. Results: The participants enjoyed the training and reported a self-perceived benefit as a consequence of training. The mean rating for self-efficacy increased from 5.8/7 (SD 0.72) to 6.5/7 (SD 0.57, P<.001). In the Swedish follow-up, it subsequently increased from 5.7/7 (SD 0.56) to 6.3/7 (SD 0.38, P=.006). In the Swedish group, the mean concentration value increased from 52.4/100 (SD 9.8) to 62.7/100 (SD 8.9, P=.05); in the US group, the concentration value increased from 70.8/100 (SD 7.9) to 82.5/100 (SD 4.7, P<.001). We found a significant positive correlation (P<.001) between self-efficacy and concentration scores. Overall, the participants were moderately or highly immersed and the software was easy to use. Conclusions: By using online MMVWs, team training in CPR is feasible and reliable for this international group of high school students (Sweden and United States). A high level of appreciation was reported among these adolescents and their self-efficacy increased significantly. The described training is a novel and interesting way to learn CPR teamwork, and in the future could be combined with psychomotor skills training.

Keywords
Serious games, virtual learning environments, MMVW, avatars, students, cardiopulmonary resuscitation, patient simulation, self-efficacy, concentration
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-67823 (URN)10.2196/jmir.1715 (DOI)000315113200016 ()
Available from: 2013-04-03 Created: 2013-04-03 Last updated: 2018-06-08Bibliographically approved
Schlickum, M., Fellander-Tsai, L., Hedman, L. & Henningsohn, L. (2013). Endourological simulator performance in female but not male medical students predicts written examination results in basic surgery. Scandinavian Journal of Urology, 47(1), 38-42
Open this publication in new window or tab >>Endourological simulator performance in female but not male medical students predicts written examination results in basic surgery
2013 (English)In: Scandinavian Journal of Urology, ISSN 2168-1805, Vol. 47, no 1, p. 38-42Article in journal (Refereed) Published
Abstract [en]

Objective. The objective of this study was to examine the correlation between endourological simulator performance and demonstrated theoretical knowledge in the basic surgical sciences. Material and methods. In total, 158 fourth year medical students participated in the study, 83 females and 75 males, all surgical novices. All students performed the flexible endoscopic task Hall of Fame in the urological simulator URO Mentor (TM). Later during the same semester all students took the final theoretical examination in surgery. Results. In female medical students a significant correlation was found between surgical simulator performance and the examination results (r = -0.22, p = 0.04). There was no statistically significant correlation when looking at the total study population (r = -0.04, p = 0.58) or when looking at male medical students (r = 0.01, p = 0.9). Conclusion. Female medical students completing an endourological simulator task more efficiently passed the theoretical examination in the basic surgical sciences with significantly higher scores than females with low efficiency in the urological simulator. There are likely to be several explanations for this correlation, such as motivation and a lower amount of current video gaming experience.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
medical students, surgical simulation, surgical training, urology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-67814 (URN)10.3109/00365599.2012.693538 (DOI)000315356000007 ()
Available from: 2013-04-05 Created: 2013-04-03 Last updated: 2018-06-08Bibliographically approved
Westfelt, P., Hedman, L., Lindkvist, M. A., Enochsson, L., Fellander-Tsai, L. & Schmidt, P. T. (2013). Training nonanesthetist administration of propofol for gastrointestinal endoscopy in scenario-based full-scale hybrid simulation - a pilot study. Scandinavian Journal of Gastroenterology, 48(11), 1354-1358
Open this publication in new window or tab >>Training nonanesthetist administration of propofol for gastrointestinal endoscopy in scenario-based full-scale hybrid simulation - a pilot study
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2013 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 48, no 11, p. 1354-1358Article in journal (Refereed) Published
Abstract [en]

Objective. The use of nonanesthetist-administered propofol (NAAP) in GI endoscopy has long been controversial. In the setting of NAAP, acute situations can develop during endoscopy and thus training before starting with NAAPs is considered crucial. The aim was to evaluate a pilot study on crew resource management (CRM)-based training of teams of endoscopists and endoscopy nurses in NAAP in a full-scale hybrid simulation consisting of a full-scale human patient simulator and an endoscopy simulator. Our hypothesis was that the training would increase the self-efficacy of the participants. Material and methods. Four scenarios were created, each with typical side effects of propofol administration. All scenarios included the need for prompt decision-making and treatment. Colonoscopy, gastroscopy or endoscopic retrograde cholangiopancreatography (ERCP) cases were assigned to the course participants in coherence with their main clinical expertise in order to facilitate situated and contextualized training. Twenty-one participants (ten doctors and eleven nurses) completed a questionnaire on self-efficacy before and after the course. A questionnaire regarding the quality and yield of the course was also completed. Results. For all participants, the self-efficacy score was 26.0 (24.0-28.0; interquartile range) before training and 30.0 (27.0-30.5) after training (p = 0.0003). The ten doctors had a self-efficacy score before training of 26.5 (25.0-29.5) and 30.0 (29.0-33.0) after (p = 0.0078). The eleven nurses scored 24.0 (22.0-26.0) before and 28.0 (27.0-30.0) after training (p = 0.0098). Conclusions. Systematic target focused scenario-based training with hybrid simulation of NAAP in endoscopy resulted in increased self-efficacy in both nurses and physicians.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
crew resource management, endoscopy, self-efficacy, simulator
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-83901 (URN)10.3109/00365521.2013.836753 (DOI)000326716000017 ()
Available from: 2013-12-11 Created: 2013-12-10 Last updated: 2018-06-08Bibliographically approved
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