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Elgh, Eva
Publications (10 of 20) Show all publications
Behrens, A., Elgh, E., Leijon, G., Kristensen, B., Eklund, A. & Malm, J. (2020). The Computerized General Neuropsychological INPH Test revealed improvement in idiopathic normal pressure hydrocephalus after shunt surgery. Journal of Neurosurgery, 132(3), 733-740
Open this publication in new window or tab >>The Computerized General Neuropsychological INPH Test revealed improvement in idiopathic normal pressure hydrocephalus after shunt surgery
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2020 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 132, no 3, p. 733-740Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE The Computerized General Neuropsychological INPH Test (CoGNIT) provides the clinician and the researcher with standardized and accessible cognitive assessments in patients with idiopathic normal pressure hydrocephalus (INPH). CoGNIT includes tests of memory, executive functions, attention, manual dexterity, and psychomotor speed. Investigations of the validity and reliability of CoGNIT have been published previously. The aim of this study was to evaluate CoGNIT's sensitivity to cognitive change after shunt surgery in patients with INPH.

METHODS Forty-one patients with INPH (median Mini-Mental State Examination score 26) were given CoGNIT preoperatively and at a postoperative follow-up 4 months after shunt surgery. Scores were compared to those of 44 healthy elderly control volunteers. CoGNIT was administered by either a nurse or an occupational therapist.

RESULTS Improvement after shunt surgery was seen in all cognitive domains: memory (10-word list test, p < 0.01); executive functions (Stroop incongruent color and word test, p < 0.01); attention (2-choice reaction test, p < 0.01); psychomotor speed (Stroop congruent color and word test, p < 0.01); and manual dexterity (4-finger tapping, p < 0.01). No improvement was seen in the Mini-Mental State Examination score. Preoperative INPH test scores were significantly impaired compared to healthy control subjects (p < 0.001 for all tests).

CONCLUSIONS In this study the feasibility for CoGNIT to detect a preoperative impairment and postoperative improvement in INPH was demonstrated. CoGNIT has the potential to become a valuable tool in clinical and research work.

Place, publisher, year, edition, pages
AMER ASSOC NEUROLOGICAL SURGEONS, 2020
Keywords
normal pressure hydrocephalus, neuropsychological tests, software
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-169344 (URN)10.3171/2018.10.JNS18701 (DOI)000518385400008 ()30738407 (PubMedID)
Available from: 2020-04-15 Created: 2020-04-15 Last updated: 2020-04-15Bibliographically approved
Elgh, E. & Hu, X. (2019). Dynamic Trajectory of Long-Term Cognitive Improvement Up to 10 Years in Young Community-Dwelling Stroke Survivors: A Cohort Study. Frontiers in Neurology, 10, Article ID 97.
Open this publication in new window or tab >>Dynamic Trajectory of Long-Term Cognitive Improvement Up to 10 Years in Young Community-Dwelling Stroke Survivors: A Cohort Study
2019 (English)In: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 10, article id 97Article in journal (Refereed) Published
Abstract [en]

Background and objective: The trajectories of long-term and domain-specific cognitive alterations over a decade after stroke are largely unknown. This study aims to investigate the dynamic alterations of domain-specific cognitive performance among young stroke survivors over 10 years after their first stroke.

Methods: A prospective cohort study was carried out on 38 young stroke survivors (aged 18-65 at stroke onset) living in the community at 10 years after their first stroke. The cognitive outcomes were assessed repeatedly at 1 week, 7 months, and 10 years after their first stroke on the sub-domains: process speed (Symbol search and Coding from WAIS, TMT-A), visual attention (Bells test), visuospatial function (Block design from WAIS, RCFT), executive function (TMT-B, verbal fluency), verbal function [Letter fluency (FAS) from D-KEFS and CD], working memory (Digit Span from WAIS), immediate memory (RCFT and CD), and delayed memory (RCFT and CD). Global cognition was evaluated with Mini mental state examination at the two later time-points.

Results: We found a delayed significant improvement of working memory with total recovery 10 years after participants' stroke. Visuospatial function recovered already at 7 months and remained stable at 10-year follow-up. Process speed demonstrated a significant decrease at 10 years compared to 7 months after stroke onset, a decrease which could be compensated by enhancements of other cognitive domains. No further deterioration was found in verbal function, immediate-, and delayed memory, and executive function during 10-year follow-up. Global cognition improved by on average two points between 7 months and 10 years. Education level and fatigue showed low to moderate positive correlations with cognitive improvements.

Conclusions: The concordance of cognitive improvements between domain-specific and global cognitions strongly suggest that some young stroke survivors do improve their cognitive outcome over a 10-year period following their first stroke. This finding fills a gap of knowledge with respect to the dynamic trajectory of post-stroke cognition, with important implications in clinical practice.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2019
Keywords
cognition, cognitive improvement, cognitive impairment, stroke, young adults, longitudinal study
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-156872 (URN)10.3389/fneur.2019.00097 (DOI)000458600400001 ()
Available from: 2019-03-12 Created: 2019-03-12 Last updated: 2019-03-12Bibliographically approved
Lunde, K. A., Chung, J., Dalen, I., Pedersen, K. F., Linder, J., Domellöf, M. E., . . . Maple-Grødem, J. (2018). Association of glucocerebrosidase polymorphisms and mutations with dementia in incident Parkinson's disease. Alzheimer's & Dementia, 14(10), 1293-1301
Open this publication in new window or tab >>Association of glucocerebrosidase polymorphisms and mutations with dementia in incident Parkinson's disease
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2018 (English)In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, ISSN 1552-5260, Vol. 14, no 10, p. 1293-1301Article in journal (Refereed) Published
Abstract [en]

Introduction

Both polymorphisms and mutations in glucocerebrosidase (GBA) may influence the development of dementia in patients with Parkinson's disease.

Methods

Four hundred forty-two patients and 419 controls were followed for 7 years. Dementia was diagnosed using established criteria. Participants were analyzed for GBA genetic variants, including E326K, T369M, and L444P. Associations between GBA carrier status and dementia were assessed with Cox survival analysis.

Results

A total of 12.0% of patients with Parkinson's disease carried a GBA variant, and nearly half (22/53) of them progressed to dementia during follow-up. Carriers of deleterious GBA mutations (adjusted hazard ratio 3.81, 95% confidence interval 1.35 to 10.72; P = .011) or polymorphisms (adjusted hazard ratio 1.79; 95% confidence interval 1.07 to 3.00; P = .028) progressed to dementia more rapidly than noncarriers.

Discussion

GBA variants are of great clinical relevance for the development of dementia in Parkinson's disease, especially due to the relatively higher frequency of these alleles compared with other risk alleles.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Parkinson's Disease
National Category
Neurology
Research subject
Genetics; Neurology
Identifiers
urn:nbn:se:umu:diva-148814 (URN)10.1016/j.jalz.2018.04.006 (DOI)000446086000006 ()
Projects
NYPUM projectParkWest studyPINE study
Funder
The Kempe FoundationsVästerbotten County CouncilThe Kempe FoundationsVästerbotten County Council
Available from: 2018-06-12 Created: 2018-06-12 Last updated: 2019-11-19Bibliographically approved
Bäckström, D., Eriksson Domellöf, M., Granåsen, G., Linder, J., Mayans, S., Elgh, E., . . . Forsgren, L. (2018). Polymorphisms in dopamine-associated genes and cognitive decline in Parkinson's disease. Acta Neurologica Scandinavica, 137(1), 91-98
Open this publication in new window or tab >>Polymorphisms in dopamine-associated genes and cognitive decline in Parkinson's disease
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2018 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 137, no 1, p. 91-98Article in journal (Refereed) Published
Abstract [en]

Objectives: Cognitive decline is common in Parkinson's disease (PD), but the underlying mechanisms for this complication are incompletely understood. Genotypes affecting dopamine transmission may be of importance. This study investigates whether genotypes associated with reduced prefrontal dopaminergic tone and/or reduced dopamine D2-receptor availability (Catechol-O-methyltransferase [COMT] Val(158)Met genotype and DRD2 (CT)-T-957 genotype) affect the development of cognitive deficits in PD.

Materials and methods: One hundred and 34 patients with idiopathic PD, participating in a regional, population-based study of incident parkinsonism, underwent genotyping. After extensive baseline investigations (including imaging and biomarker analyses), the patients were followed prospectively during 6-10 years with neuropsychological evaluations, covering six cognitive domains. Cognitive decline (defined as the incidence of either Parkinson's disease mild cognitive impairment [PD-MCI] or dementia [PDD], diagnosed according to published criteria and blinded to genotype) was studied as the primary outcome.

Results: Both genotypes affected cognition, as shown by Cox proportional hazards models. While the COMT(158)Val/Val genotype conferred an increased risk of mild cognitive impairment in patients with normal cognition at baseline (hazard ratio: 2.13, P=.023), the DRD2(957)T/T genotype conferred an overall increased risk of PD dementia (hazard ratio: 3.22, P<.001). The poorer cognitive performance in DRD2(957)T/T carriers with PD occurred mainly in episodic memory and attention.

Conclusions: The results favor the hypothesis that dopamine deficiency in PD not only relate to mild cognitive deficits in frontostriatal functions, but also to a decline in memory and attention. This could indicate that dopamine deficiency impairs a wide network of brain areas.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
COMT, dementia, DRD2, mild cognitive impairment, neurodegeneration, Parkinson's disease, Parkinson's disease genetics, population-based
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-143002 (URN)10.1111/ane.12812 (DOI)000417029600014 ()
Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2020-04-15Bibliographically approved
Bäckström, D., Eriksson Domellöf, M., Granåsen, G., Linder, J., Mayans, S., Elgh, E., . . . Forsgren, L. (2017). PITX3 genotype and risk of dementia in Parkinson's disease: A population-based study. Journal of the Neurological Sciences, 381, 278-284
Open this publication in new window or tab >>PITX3 genotype and risk of dementia in Parkinson's disease: A population-based study
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2017 (English)In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 381, p. 278-284Article in journal (Refereed) Published
Abstract [en]

Dementia is a devastating manifestation of Parkinson's disease (PD). This study investigates whether a common polymorphism in the PITX3 gene (rs2281983), which is of importance for the function of dopaminergic neurons, affects the risk of developing dementia in PD and whether it affects dopamine transporter (DAT) uptake. We PITX3 genotyped 133 patients with new-onset, idiopathic PD, participating in a population-based study in Sweden. Patients were followed prospectively during 6-11 years with extensive investigations, including neuropsychology and DAT-imaging with I-123 FP-CIT. The primary outcome was the incidence of PD dementia (PDD), diagnosed according to published criteria, studied by the Kaplan-Meier method and Cox proportional hazards. Performance in individual cognitive domains, the incidence of visual hallucinations, disease progression and striatal DAT uptake on imaging was also investigated. PD patients carrying the PITX3 C allele had an increased risk of developing PDD (hazard ratio: 2.87, 95% CI: 1.42-5.81, p = 0.003), compared to the PD patients homozygous for the T-allele. Furthermore, the PITX3 C allele carriers with PD had a poorer cognitive performance in the visuospatial domain (p < 0.001) and a higher incidence of visual hallucinations. A trend towards a lower striatal DAT uptake in the PITX3 C allele carriers was suggested, but could not be confirmed. Our results show that a common polymorphism in the PITX3 gene affects the risk of developing PDD and visuospatial dysfunction in idiopathic PD. If validated, these findings can provide new insights into the neurobiology and genetics of non-motor symptoms in PD.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV, 2017
Keywords
Parkinson's disease, PITX3, Dementia, Parkinson's disease genetics, DAT scan
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-142267 (URN)10.1016/j.jns.2017.08.3259 (DOI)000414819100057 ()28991698 (PubMedID)
Available from: 2017-12-01 Created: 2017-12-01 Last updated: 2019-01-23Bibliographically approved
Domellöf, M. E., Ekman, U., Forsgren, L. & Elgh, E. (2015). Cognitive function in the early phase of Parkinson's disease, a five-year follow-up. Acta Neurologica Scandinavica, 132(2), 79-88
Open this publication in new window or tab >>Cognitive function in the early phase of Parkinson's disease, a five-year follow-up
2015 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 132, no 2, p. 79-88Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Presence of mild cognitive impairment (MCI) as a predictor for Parkinson's disease dementia (PDD) has been discussed from a clinical perspective. Recently, a Movement Disorder Society (MDS) commissioned Task Force published guidelines for PD-MCI. However, long-term follow-ups of the PD-MCI guidelines for the prediction of PDD have been sparse.

METHOD: In a community-based cohort of PD, the MDS guidelines for PD-MCI and consensus criteria for PDD were applied on 147 subjects. The predictive ability of PD-MCI for PDD was investigated. Additionally, baseline comparisons were conducted between MCI that converted to PDD and those who did not, and evolvement of motor function was investigated.

RESULTS: One fourth of the population developed PDD. MCI and age at baseline predicted later occurrence of PDD, and baseline results of tests measuring episodic memory, visuospatial function, semantic fluency, and mental flexibility differed between MCI converters and non-converters. Postural instability/gait (PIGD) phenotype and education did not predict later occurrence of PDD, but increased postural/gait disturbances were shown across time in those developing dementia.

CONCLUSION: The new PD-MCI guidelines are useful to detect patients at risk for developing PDD. The PIGD phenotype at diagnosis was not a predictor of PDD within 5 years, but the study supports a temporal association between postural/gait disturbances and PDD. Older patients with PD-MCI at baseline with decline in episodic memory, semantic fluency, and mental flexibility need to be carefully monitored regarding cognition and likely also for fall risk.

Keywords
Parkinson’s Disease, dementia, mildcognitive impairment, motor dysfunction, cohort study
National Category
Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:umu:diva-99485 (URN)10.1111/ane.12375 (DOI)000357735300002 ()25644230 (PubMedID)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2018-06-07Bibliographically approved
Behrens, A., Eklund, A., Elgh, E., Smith, C., Williams, M. A. & Malm, J. (2014). A computerized neuropsychological test battery designed for idiopathic normal pressure hydrocephalus. Fluids and Barriers of the CNS, 11, Article ID 22.
Open this publication in new window or tab >>A computerized neuropsychological test battery designed for idiopathic normal pressure hydrocephalus
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2014 (English)In: Fluids and Barriers of the CNS, ISSN 2045-8118, E-ISSN 2045-8118, Vol. 11, article id 22Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A tool for standardized and repeated neuropsychological assessments in patients with idiopathic normal pressure hydrocephalus (INPH) is needed. The objective of this study was to develop a computerized neuropsychological test battery designed for INPH and to evaluate its reliability, validity and patient's ability to complete the tests.

METHODS: Based on a structured review of the literature on neuropsychological testing in INPH, the eight tests most sensitive to the INPH cognitive profile were implemented in a computerized format. The Geriatric Depression Scale (GDS) was also included. Tests were presented on a touch-screen monitor, with animated instructions and speaker sound. The battery was evaluated with the following cohorts: A. Test-retest reliability, 44 healthy elderly; B. Validity against standard pen and pencil testing, 28 patients with various cognitive impairments; C. Ability to complete test battery, defined as completion of at least seven of the eight tests, 40 investigated for INPH.

RESULTS: A. All except the figure copy test showed good test-retest reliability, r = 0.67-0.90; B. A high correlation was seen between conventional and computerized tests (r = 0.66-0.85) except for delayed recognition and figure copy task; C. Seventy-eight percent completed the computerized battery; Patients diagnosed with INPH (n = 26) performed worse on all tests, including depression score, compared to healthy controls.

CONCLUSIONS: A new computerized neuropsychological test battery designed for patients with communicating hydrocephalus and INPH was introduced. Its reliability, validity for general cognitive impairment and completion rate for INPH was promising. After exclusion of the figure copy task, the battery is ready for clinical evaluation and as a next step we suggest validation for INPH and a comparison before and after shunt surgery.

TRIAL REGISTRATION: ClinicalTrials.org NCT01265251.

Keywords
Dementia, Hydrocephalus, Normal pressure, Neuropsychological tests, Neuropsychology, Reliability and validity, Software
National Category
Psychiatry Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:umu:diva-96190 (URN)10.1186/2045-8118-11-22 (DOI)25279138 (PubMedID)
Available from: 2014-11-12 Created: 2014-11-12 Last updated: 2018-06-07Bibliographically approved
Degerman, S., Domellöf, M., Landfors, M., Linder, J., Lundin, M., Haraldsson, S., . . . Forsgren, L. (2014). Long Leukocyte Telomere Length at Diagnosis Is a Risk Factor for Dementia Progression in Idiopathic Parkinsonism. PLoS ONE, 9(12), Article ID e113387.
Open this publication in new window or tab >>Long Leukocyte Telomere Length at Diagnosis Is a Risk Factor for Dementia Progression in Idiopathic Parkinsonism
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2014 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 12, article id e113387Article in journal (Refereed) Published
Abstract [en]

Telomere length (TL) is regarded as a marker of cellular aging due to the gradual shortening by each cell division, but is influenced by a number of factors including oxidative stress and inflammation. Parkinson's disease and atypical forms of parkinsonism occur mainly in the elderly, with oxidative stress and inflammation in afflicted cells. In this study the relationship between blood TL and prognosis of 168 patients with idiopathic parkinsonism (136 Parkinson's disease [PD], 17 Progressive Supranuclear Palsy [PSP], and 15 Multiple System Atrophy [MSA]) and 30 controls was investigated. TL and motor and cognitive performance were assessed at baseline (diagnosis) and repeatedly up to three to five years follow up. No difference in TL between controls and patients was shown at baseline, nor any significant difference in TL stability or attrition during follow up. Interestingly, a significant relationship between TL at diagnosis and cognitive phenotype at follow up in PD and PSP patients was found, with longer mean TL at diagnosis in patients that developed dementia within three years.

National Category
Basic Medicine Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-99223 (URN)10.1371/journal.pone.0113387 (DOI)000346375400009 ()
Available from: 2015-04-20 Created: 2015-02-04 Last updated: 2018-06-07Bibliographically approved
Ekman, U., Eriksson, J., Forsgren, L., Domellöf, M., Elgh, E., Lundquist, A. & Nyberg, L. (2014). Longitudinal changes in task-evoked brain responses in Parkinson's disease patients with and without mild cognitive impairment. Frontiers in Neuroscience, 8, Article ID 207.
Open this publication in new window or tab >>Longitudinal changes in task-evoked brain responses in Parkinson's disease patients with and without mild cognitive impairment
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2014 (English)In: Frontiers in Neuroscience, ISSN 1662-4548, E-ISSN 1662-453X, Vol. 8, article id 207Article in journal (Refereed) Published
Abstract [en]

Cognitive deficits are common in Parkinson's disease. Previous cross-sectional research has demonstrated a link between cognitive impairments and fronto-striatal dopaminergic dysmodulation. However, longitudinal studies that link disease progression with altered task-evoked brain activity are lacking. Therefore, our objective was to longitudinally evaluate working-memory related brain activity changes in Parkinson's disease patients with and without mild cognitive impairment (MCI). Patients were recruited within a longitudinal cohort study of incident patients with idiopathic parkinsonism. We longitudinally (at baseline examination and at 12-months follow-up) compared 28 patients with Parkinson's disease without MCI with 11 patients with Parkinson's disease and MCI. Functional MRI blood oxygen level dependent signal was measured during a verbal two-back working-memory task. Patients with MCI under-recruited bilateral medial prefrontal cortex at both time-points (main effect of group: p < 0.001, uncorrected). Critically, a significant group-by-time interaction effect (p < 0.001, uncorrected) was found in the right fusiform gyrus, indicating that working-memory related activity decreased for patients with Parkinson's disease and MCI between baseline and follow-up, while patients without MCI were stable across time-points. The functional connectivity between right fusiform gyrus and bilateral caudate nucleus was stronger for patients without MCI relative to patients with MCI. Our findings support the view that deficits in working-memory updating are related to persistent fronto-striatal under-recruitments in patients with early phase Parkinson's disease and MCI. The longitudinal evolution of MCI in Parkinson's disease translates into additional task-evoked posterior cortical changes.

Place, publisher, year, edition, pages
Frontiers, 2014
Keywords
Parkinson disease, MCI, longitudinal, working memory, functional MRI (fMRI)
National Category
Neurosciences Neurology
Identifiers
urn:nbn:se:umu:diva-96365 (URN)10.3389/fnins.2014.00207 (DOI)000346502400001 ()
Available from: 2014-11-18 Created: 2014-11-18 Last updated: 2018-06-07Bibliographically approved
Domellöf, M. E., Forsgren, L. & Elgh, E. (2013). Persistence of associations between cognitive impairment and motor dysfunction in the early phase of Parkinson's disease. Journal of Neurology, 260(9), 2228-2236
Open this publication in new window or tab >>Persistence of associations between cognitive impairment and motor dysfunction in the early phase of Parkinson's disease
2013 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 260, no 9, p. 2228-2236Article in journal (Refereed) Published
Abstract [en]

The relation between cognitive and motor functions in Parkinson's disease is not fully understood. In an incidence population of newly diagnosed drug na < ve patients with Parkinson's disease, associations were found between the degree of bradykinesia and postural instability and gait disturbances, measured by the Unified Disease Rating Scale, and different types of cognitive functions. To investigate the stability of these associations over time, we explored the association of differences between baseline and 1-year follow-up in 91 incident cases with Parkinson's disease. The magnitude of change between the two assessments was assessed together with analysis of differences based on which dopaminergic medication was used. Change in bradykinesia was associated with change in working memory and mental flexibility. Changes in postural instability and gait disturbances were associated with change in visuospatial memory. A negative effect of the dopamine agonist pramipexole on phonemic fluency performance was found compared to treatment with other dopaminergic drugs. Change in cognitive and motor functions were associated from time of diagnosis until 1 year after diagnosis. These persisting findings strengthen results from a previous cross-sectional study suggesting similar associations. The effects of dopamine agonists on phonemic fluency should be investigated further.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2013
Keywords
Parkinson's disease, Cognition, Population-based, Prospective, Dopamine agonist
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-81313 (URN)10.1007/s00415-013-6971-6 (DOI)000324099200004 ()
Available from: 2013-10-14 Created: 2013-10-07 Last updated: 2019-11-25Bibliographically approved
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