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  • 1. Asberg, Signild
    et al.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Henriksson, Karin M
    Terént, Andreas
    Reduced risk of death with warfarin: results of an observational nationwide study of 20 442 patients with atrial fibrillation and ischaemic stroke2013In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 8, no 8, p. 689-695Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Warfarin is demonstrated to be superior in efficacy over antiplatelet agents for the prevention of stroke, but the relationship between warfarin and mortality is less clear. Our aim was to investigate this relationship in a large cohort of unselected patients with atrial fibrillation and ischaemic stroke.

    METHODS: This observational study was based on patients who were discharged alive and registered in the Swedish Stroke Register in 2001 through 2005. Vital status was retrieved by linkage to the Swedish Cause of Death Register. We calculated a propensity score for the likelihood of warfarin prescription at discharge from hospital. The risk of death and 95% confidence intervals were estimated in Cox regression models.

    RESULTS: Out of the 20 442 patients with atrial fibrillation and ischaemic stroke (mean age = 79·5 years), 31% (n = 6399) were prescribed warfarin. After adjustment for the propensity score, warfarin was associated with a reduced risk of death (0·67; 95% confidence interval, 0·63-0·71). The crude rate (per 100 person-years) of fatal non-haemorrhagic stroke was lower in patients who received warfarin (1·60; 95% confidence interval, 1·34-1·89) compared to those who received antiplatelet (6·83; 95% confidence interval, 6·42-7·25). The rates (per 100 person-years) of fatal haemorrhagic stroke were 0·21 (95% confidence interval, 0·12-0·32) and 0·43 (95% confidence interval, 0·34-0·55) in patients prescribed warfarin and antiplatelet therapy, respectively.

    CONCLUSIONS: In addition to its established benefit for stroke prevention, warfarin therapy in patients with atrial fibrillation and ischaemic stroke was associated with a reduced risk of death, without an increased risk of fatal haemorrhagic stroke.

  • 2.
    Asplund, Kjell
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Department of Statistics.
    Inflammation, poststroke depression and statins2011In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 6, no 6, p. 567-568Article in journal (Refereed)
  • 3.
    Asplund, Kjell
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Hulter Åsberg, Kerstin
    Appelros, Peter
    Bjarne, Daniela
    Eriksson, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johansson, Åsa
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jonsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Norrving, Bo
    Stegmayr, Birgitta
    Terént, Andreas
    Wallin, Sari
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wester, Per-Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care2011In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 6, no 2, p. 99-108Article in journal (Refereed)
    Abstract [en]

    Background Riks-Stroke, the Swedish Stroke Register, is the world's longest-running national stroke quality register (established in 1994) and includes all 76 hospitals in Sweden admitting acute stroke patients. The development and maintenance of this sustainable national register is described.

    Methods Riks-Stroke includes information on the quality of care during the acute phase, rehabilitation and secondary prevention of stroke, as well as data on community support. Riks-Stroke is unique among stroke quality registers in that patients are followed during the first year after stroke. The data collected describe processes, and medical and patient-reported outcome measurements. The register embraces most of the dimensions of health-care quality (evidence-based, safe, provided in time, distributed fairly and patient oriented).

    Result Annually, approximately 25 000 patients are included. In 2009, approximately 320 000 patients had been accumulated (mean age 76-years). The register is estimated to cover 82% of all stroke patients treated in Swedish hospitals. Among critical issues when building a national stroke quality register, the delicate balance between simplicity and comprehensiveness is emphasised. Future developments include direct transfer of data from digital medical records to Riks-Stroke and comprehensive strategies to use the information collected to rapidly implement new evidence-based techniques and to eliminate outdated methods in stroke care.

    Conclusions It is possible to establish a sustainable quality register for stroke at the national level covering all hospitals admitting acute stroke patients. Riks-Stroke is fulfilling its main goals to support continuous quality improvement of Swedish stroke services and serve as an instrument for following up national stroke guidelines.

  • 4.
    Darehed, David
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Blom, M.
    Glader, Eva-Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Niklasson, Johan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Norrving, B.
    Eriksson, M.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Acute stroke patients are subject to seasonal variation in quality of care and survival: a Swedish nationwide registry-based study2018In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 177-177Article in journal (Other academic)
  • 5. Eriksson, G.
    et al.
    Hellman, T.
    Nilsson, A. O.
    Johansson, U.
    Ekbladh, E.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    The return to work process after stroke changes over time while participating in a newly designed person-centred rehabilitation programme2018In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 31-31Article in journal (Other academic)
  • 6.
    Eriksson, Marie
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Glader, Eva-Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Norrving, B.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Post-stroke suicide attempts and completed suicides: A socioeconomic and nationwide perspective2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 33-33Article in journal (Other academic)
  • 7.
    Fordell, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Wahlin, A.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Ekman, U.
    Lenfeldt, Niklas
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Rehabilitation of chronic spatial neglect strengthens functional connectivity between nodes of the dorsal attention network2018In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 42-42Article in journal (Other academic)
  • 8.
    Fordell, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wåhlin, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Ekman, U.
    Lenfeldt, N.
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Rehabilitation in chronic neglect using VR strengthens connectivity between nodes of the dorsal attention network2018In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 50-50Article in journal (Other academic)
    Abstract [en]

    More knowledge is required about the neural mechanisms of functional recovery of spatial neglect in chronic phase after stroke. In this functional magnetic resonance imaging (fMRI) study, we aimed to evaluate changes in resting state functional connectivity (FC) within the dorsal attention network (DAN) in chronic neglect after scanning training in VR that previously shown improvement in left side awareness in behavioral tests and activity of daily living. (Fordell et al 2016)

    Method: Thirteen subjects with chronic spatial neglect (mean duration ¼ 43 months, SD ¼ 29 months) underwent resting state fMRI at baseline and after 15 hours RehAtt training (3x1hr / week for 5 weeks). RehAtt scanning training in 3D includes multi-sensory stimulation and is controlled by their contra-lesional hand using a robotic pen (force-feedback). The analysis specifically examined resting state functional connectivity within the DAN. In addition, using spatial concordance correlation, changes in the spatial topology of the DAN to other networks were analyzed.

    Results: We found an increase in interhemispheric FC between the right FEF and the left IPS following training (pre: 0.33 0.17 [mean SD]; post: 0.45 0.13; p ¼ 0.004). The spatial concordance analyses indicated that training had stronger influence on the DAN compared to other networks.

    Conclusion: VR training that improved left side awareness in chronic stroke patients also increased connectivity within the DAN. Specifically, a region responsible for saccadic eye movement to the left became more integrated with the left posterior parietal cortex. These results highlight a mechanism that can be exploited in the rehabilitation of chronic spatial neglect

  • 9.
    Glader, Eva-Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Jonsson, B.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Socioeconomic status predicts return to work after first stroke in younger adults2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 174-174Article in journal (Other academic)
  • 10.
    Irewall, Anna-Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Johansson, C.
    Ostersund Hosp, Dept Stroke & Neurol, Ostersund, Sweden.
    Strömvall, A.
    Ostersund Hosp, Dept Cardiol, Ostersund, Sweden.
    Mooe, Thomas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Nurse-led, telephone-based secondary preventive intervention after stroke or TIA Improves blood pressure after 12 months of follow-up2014In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 9 3, p. 278-279Article in journal (Other academic)
  • 11.
    Johansson, E.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Cuadrado-Godia, E.
    Hayden, D.
    Ois, A.
    Roquerl, J.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Kelly, P. J.
    Risk and predictors of recurrent stroke in symptomatic carotid stenosis awaiting revascularization-Pooled analysis of individual patient data2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 19-19Article in journal (Other academic)
  • 12.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Arnerlöv, Conny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Risk of recurrent stroke before carotid endarterectomy: the ANSYSCAP study2013In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 8, no 4, p. 220-227Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Carotid endarterectomy yields greater risk reduction for ipsilateral ischemic stroke when performed within two-weeks of the last cerebrovascular symptom than when performed two-weeks or more after the last symptom. However, additional benefit might be gained if carotid endarterectomy is performed earlier than within two-weeks. AIMS: To investigate the 90-day risk of ipsilateral ischemic stroke recurrence after amaurosis fugax, retinal artery occlusion, transient ischemic attack, or minor ischemic stroke in patients with 50-99% carotid stenosis before carotid endarterectomy, with emphasis on the first 14 days. METHODS: Prospective cohort study. 230 consecutive patients with symptomatic 50-99% carotid stenosis (North American Symptomatic Carotid Endarterectomy Trial grading method) who underwent evaluation before carotid endarterectomy. Of these, 183 underwent carotid endarterectomy; the median delay to carotid endarterectomy was 29 days. Blood pressure lowering medication was used by 93% and lipid-lowering medication by 90%. RESULTS: The risk of ipsilateral ischemic stroke recurrence before carotid endarterectomy was 5·2% (n = 12) within two-days, 7·9% (n = 18) within seven-days, 11·2% (n = 25) within 14 days, and 18·6% (n = 33) within 90 days of the presenting event. The risk of ipsilateral ischemic stroke recurrence was higher if the presenting event was a stroke (adjusted hazard ratio 12·4, P = 0·015) or transient ischemic attack (adjusted hazard ratio 10·2, P = 0·026) compared with an amaurosis fugax. DISCUSSION: The risk of recurrent ipsilateral ischemic stroke was high within the first days of the presenting event. Many recurrences would likely have been avoided if carotid endarterectomy had been performed within the first days of the presenting event.

  • 13. Lekander, I.
    et al.
    Andreasson, S.
    Ekstrand, E.
    von Euler, M.
    Fagervall-Yttling, B.
    Henricson, L.
    Kostulas, K.
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Willers, C.
    Pessah-Rasmussen, H.
    Casemix-adjusted comparison of resource use first year following a stroke in Sweden - Results from Sveus2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 360-361Article in journal (Other academic)
  • 14.
    Lindmark, Anita
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Glader, Eva-Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Norrving, Bo
    Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Socioeconomic disparities in stroke case fatality: observations from Riks-Stroke, the Swedish stroke register2014In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 9, no 4, p. 429-436Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Low socioeconomic status (low education and income level) has been found to be associated with increased stroke mortality. However, findings from previous studies on the association between socioeconomic status and case fatality (survival) after stroke have been inconsistent.

    AIMS: The study aims to explore the association between socio-economic status and survival after stroke using Riks-Stroke, the Swedish Stroke Register, with emphasis on changes in survival (in)equality with time after stroke.

    METHODS: All 76 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. Riks-Stroke data on 18- to 74-year-old patients with onset of first stroke during the years 2001-2009 were combined with data from other official Swedish registers. Case fatality was analyzed by socioeconomic status (education, income, country of birth, and cohabitation) and other patient characteristics.

    RESULTS: Of the 62 497 patients in the study, a total of 6094 (9·8%) died within the first year after stroke. Low income, primary school education, and living alone were independently associated with higher case fatality after the acute phase. Differences related to income and cohabitation were present already early, at 8-28 days after stroke, with the gaps expanding thereafter. The association between education and case fatality was not present until 29 days to one-year after stroke. Dissimilarities in secondary preventative medications prescribed on discharge from hospital had only a minor impact on these differences.

    CONCLUSIONS: Socioeconomic status had only a limited effect on acute phase case fatality, indicating minor disparities in acute stroke treatment. The survival inequality, present already in the subacute phase, increased markedly over time since the stroke event. The socioeconomic differences could not be explained by differences in secondary prevention at discharge from hospital. Large socioeconomic differences in long-term survival after stroke may exist also in a country with limited income inequity.

  • 15.
    Pennlert, Johanna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wiklund, P. G.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wisten, A.
    Asberg, S.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Antithrombotic treatment following intracerebral hemorrhage in patients with and without atrial fibrillation. A nationwide study based on Riksstroke2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 294-295Article in journal (Other academic)
  • 16. Vestesson, E.
    et al.
    Bray, B.
    James, M.
    Paley, L.
    Kavanagh, M.
    Tyrrell, P.
    Cloud, G.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Norrving, B.
    Rudd, A.
    An international comparison of thrombolysis in England and Wales, and Sweden using national registers2016In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 11, p. 38-38Article in journal (Other academic)
  • 17.
    Åsberg, Signild
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Statin therapy and the risk of intracerebral haemorrhage: a nationwide observational study2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 46-49Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The association between statin therapy and intracerebral haemorrhage is still unclear. The aim was to investigate whether prior use of statin was associated with risk of intracerebral haemorrhage.

    METHODS: Between 2006 and 2009, we identified 7696 cases of intracerebral haemorrhage that were first-ever strokes in the Swedish Stroke Register and 14 670 stroke-free controls that were matched on age and gender in the Population Register. Drug therapy at the time of intracerebral haemorrhage was extracted from the Drug Prescription Register. The risk of intracerebral haemorrhage with statins was estimated by conditional logistic regression.

    RESULTS: In cases and controls, the median age was 73 years and 53% were men. Intracerebral haemorrhage cases had higher prevalence of antithrombotic therapy, hypertension, and diabetes than controls. Statins were used by 1276 (16·6%) of the intracerebral haemorrhage cases and by 2552 (17·4%) of the controls. The crude odds ratios of intracerebral haemorrhage did not differ significantly between patients with and without statins, but after adjustment for antithrombotic therapy, hypertension, and diabetes, patients with statins had a decreased risk of intracerebral haemorrhage (odds ratio = 0·68, 95% confidence interval, 0·63-0·74). The highest proportion (>20%) of antecedent statins was seen in the 70-84 age group, for both cases and controls.

    CONCLUSIONS: In this matched case-controlled study, statin therapy was associated with a decreased risk of incident intracerebral haemorrhage. Future studies on risk of stroke with statin therapy after intracerebral haemorrhage are needed.

  • 18.
    Ögren, J.
    et al.
    Hosp Ostersund, Dept Internal Med, Sect Cerebrovasc Dis, Ostersund, Sweden.
    Irewall, Anna-Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Bergström, L.
    Hosp Ostersund, Dept Internal Med, Neurol Sect, Ostersund, Sweden.
    Mooe, Thomas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Intracranial hemorrhage after ischemic stroke Incidence, time-trends and predictors in a Swedish nationwide cohort of 196765 patients2014In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 9, p. 165-165Article in journal (Other academic)
    Abstract [en]

    BACKGROUND:

    Epidemiological data on the risk of intracranial hemorrhage (ICrH) after ischemic stroke are sparse. The aims of this study were to describe incidence, trends over time, and predictors of ICrH within 1 year after ischemic stroke.

    METHODS AND RESULTS:

    All patients registered in the Swedish stroke register Riksstroke for 1998 to 2009 were included (n=196 765), and data were combined with the National Patient Register to identify ICrH occurrence. A matched reference population was obtained. Incidence rates and cumulative incidences were calculated. Multivariable regression analyses were used to identify predictors. Analyses were performed separately for the first 30 days and days 31 to 365 after ischemic stroke. The incidence rate was 1.97% per year at risk for the first year (0.13% in the reference population) and 0.85% excluding the first 30 days. Over time, the cumulative incidence increased the first 30 days but decreased over days 31 to 365. Thrombolysis, previous ICrH, atrial fibrillation, and male sex were associated with increased risk of ICrH during the first 30 days. Previous ICrH, increasing age, and male sex were associated with increased risk during days 31 to 365. Statins and antithrombotic treatment did not independently predict ICrH occurrence.

    CONCLUSIONS:

    The incidence of ICrH within 1 year after ischemic stroke was ≈2% per year at risk, about 15 times higher compared with the reference population. Over the study period, ICrH risk increased within the first 30 days but decreased thereafter. Previous ICrH, thrombolysis, and male sex affected the risk, whereas an increased use of antithrombotic treatments and statins did not.

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