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Oakes, B. D., Mattsson, L.-G., Näsman, P. & Glazunov, A. A. (2018). A Systems-Based Risk Assessment Framework for Intentional Electromagnetic Interference (IEMI) on Critical Infrastructures. Risk Analysis, 38(6), 1279-1305
Open this publication in new window or tab >>A Systems-Based Risk Assessment Framework for Intentional Electromagnetic Interference (IEMI) on Critical Infrastructures
2018 (English)In: Risk Analysis, ISSN 0272-4332, E-ISSN 1539-6924, Vol. 38, no 6, p. 1279-1305Article in journal (Refereed) Published
Abstract [en]

Modern infrastructures are becoming increasingly dependent on electronic systems, leaving them more vulnerable to electrical surges or electromagnetic interference. Electromagnetic disturbances appear in nature, e.g., lightning and solar wind; however, they may also be generated by man-made technology to maliciously damage or disturb electronic equipment. This article presents a systematic risk assessment framework for identifying possible, consequential, and plausible intentional electromagnetic interference (IEMI) attacks on an arbitrary distribution network infrastructure. In the absence of available data on IEMI occurrences, we find that a systems-based risk assessment is more useful than a probabilistic approach. We therefore modify the often applied definition of risk, i.e., a set of triplets containing scenario, probability, and consequence, to a set of quadruplets: scenario, resource requirements, plausibility, and consequence. Probability is replaced by resource requirements and plausibility, where the former is the minimum amount and type of equipment necessary to successfully carry out an attack scenario and the latter is a subjective assessment of the extent of the existence of attackers who possess the motivation, knowledge, and resources necessary to carry out the scenario. We apply the concept of intrusion areas and classify electromagnetic source technology according to key attributes. Worst-case scenarios are identified for different quantities of attacker resources. The most plausible and consequential of these are deemed the most important scenarios and should provide useful decision support in a countermeasures effort. Finally, an example of the proposed risk assessment framework, based on notional data, is provided on a hypothetical water distribution network.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
Critical infrastructures, intentional electromagnetic interference (IEMI), operational models, risk analysis, water distribution network
National Category
Transport Systems and Logistics
Identifiers
urn:nbn:se:kth:diva-231194 (URN)10.1111/risa.12945 (DOI)000434645900013 ()29314162 (PubMedID)2-s2.0-85040365367 (Scopus ID)
Funder
Swedish Civil Contingencies AgencyThe Swedish Post and Telecom Authority (PTS)
Note

QC 20180720

Available from: 2018-07-20 Created: 2018-07-20 Last updated: 2018-07-20Bibliographically approved
Eriksson, B., Wandell, P., Dahlstrom, U., Näsman, P., Lund, L. H. & Edner, M. (2018). Comorbidities, risk factors and outcomes in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care- and hospital care-based outpatient clinics. Scandinavian Journal of Primary Health Care, 36(2), 207-215
Open this publication in new window or tab >>Comorbidities, risk factors and outcomes in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care- and hospital care-based outpatient clinics
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2018 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 2, p. 207-215Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study is to describe patients with heart failure and an ejection fraction (EF) of more than or equal to 40%, managed in both Primary- and Hospital based outpatient clinks separately with their prognosis, comorbidities and risk factors. Further to compare the heart failure medication in the two groups. Design: We used the prospective Swedish Heart Failure Registry to include 9654 out-patients who had HF and EF >= 40%, 1802 patients were registered in primary care and 7852 in hospital care. Descriptive statistical tests were used to analyze base line characteristics in the two groups and multivariate logistic regression analysis to assess mortality rate in the groups separately. Setting: The prospective Swedish Heart Failure Registry. Setting: The prospective Swedish Heart Failure Registry. Subjects: Patients with heart failure and an ejection fraction (EF) of more than or equal to 40%. Main outcome measures: Comorbidities, risk factors and mortality. Results: Mean-age was 77.5 (primary care) and 70.3 years (hospital care) p < 0.0001, 46.7 vs. 36.3% women respectively (p < 0.0001) and EF >= 50% 26.1 vs. 13.4% (p < 0.0001). Co-morbidities were common in both groups (97.2% vs. 92.3%), the primary care group having more atrial fibrillation, hypertension, ischemic heart disease and COPD. According to the multivariate logistic regression analysis smoking, COPD and diabetes were the most important independent risk factors in the primary care group and valvular disease in the hospital care group. All-cause mortality during mean follow-up of almost 4 years was 315% in primary care and 27.8% in hospital care. One year-mortality rates were 7.8%, and 7.0% respectively. Conclusion: Any co-morbidity was noted in 97% of the HF-patients with an EF of more than or equal to 40% managed at primary care based out-patient clinics and these patients had partly other independent risk factors than those patients managed in hospital care based outpatients clinics. Our results indicate that more attention should be payed to manage COPD in the primary care group.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
Keywords
Heart failure, preserved ejection fraction, primary care, risk factors, outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-228293 (URN)10.1080/02813432.2018.1459654 (DOI)000431601000013 ()29633886 (PubMedID)2-s2.0-85045147465 (Scopus ID)
Note

QC 20180521

Available from: 2018-05-21 Created: 2018-05-21 Last updated: 2018-05-21Bibliographically approved
Wang, A., Arver, S., Flanagan, J., Gyberg, V., Näsman, P., Ritsinger, V. & Mellbin, L. G. (2018). Dynamics of testosterone levels in patients with newly detected glucose abnormalities and acute myocardial infarction. Diabetes & Vascular Disease Research, 15(6), 511-518
Open this publication in new window or tab >>Dynamics of testosterone levels in patients with newly detected glucose abnormalities and acute myocardial infarction
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2018 (English)In: Diabetes & Vascular Disease Research, ISSN 1479-1641, E-ISSN 1752-8984, Vol. 15, no 6, p. 511-518Article in journal (Refereed) Published
Abstract [en]

Objective: Low testosterone has been associated with increased cardiovascular risk and glucose abnormalities. This study explored the prevalence of low testosterone, dynamics over time and prognostic implications in acute myocardial infarction patients with or without glucose abnormalities. Methods: Male acute myocardial infarction patients (n = 123) and healthy controls (n = 124) were categorised as having normal or abnormal glucose tolerance (impaired glucose tolerance or diabetes) by oral glucose tolerance testing. Testosterone was measured at hospital admission, discharge, 3 and 12 months thereafter in patients. Patients and controls were followed for 11 years for major cardiovascular events (cardiovascular death/acute myocardial infarction/stroke/severe heart failure). Results: At hospital admission, more patients had low testosterone (<= 300 ng/dl) and lower median levels than controls (64 vs 28%; p < 0.001 and 243 vs 380 ng/dl; p < 0.01). At the subsequent time points, testosterone had increased to 311, 345 and 357 ng/dl. Patients with abnormal glucose tolerance had the highest prevalence (75%) of low levels. In adjusted Cox regression models, neither total nor free testosterone predicted major cardiovascular events. Conclusion: Low testosterone levels were common in male acute myocardial infarction patients in the acute phase, especially in the presence of abnormal glucose tolerance, but increased over time indicating that testosterone measured in close proximity to acute myocardial infarction should be interpreted with caution.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Testosterone, diabetes mellitus type 2, glucose intolerance, prediabetic state, myocardial infarction, prognosis
National Category
Health Sciences
Identifiers
urn:nbn:se:kth:diva-239792 (URN)10.1177/1479164118802543 (DOI)000450313700005 ()30280926 (PubMedID)2-s2.0-85056343096 (Scopus ID)
Note

QC 20190108

Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-01-17Bibliographically approved
Lundstrom, E., Isaksson, E., Wester, P., Laska, A.-C. & Näsman, P. (2018). Enhancing Recruitment Using Teleconference and Commitment Contract (ERUTECC): study protocol for a randomised, stepped-wedge cluster trial within the EFFECTS trial. Trials, 19, Article ID 14.
Open this publication in new window or tab >>Enhancing Recruitment Using Teleconference and Commitment Contract (ERUTECC): study protocol for a randomised, stepped-wedge cluster trial within the EFFECTS trial
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2018 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 19, article id 14Article in journal (Refereed) Published
Abstract [en]

Background: Many randomised controlled trials (RCTs) fail to meet their recruitment goals in time. Trialists are advised to include study recruitment strategies within their trials. EFFECTS is a Swedish, academic-led RCT of fluoxetine for stroke recovery. The trial's primary objective is to investigate whether 20 mg fluoxetine daily compared with placebo for 6 months after an acute stroke improves the patient's functional outcome. The first patient was included on 20 October 2014 and, as of 31 August 2017, EFFECTS has included 810 of planned 1500 individuals. EFFECTS currently has 32 active centres. The primary objective of the ERUTECC (Enhancing Recruitment Using Teleconference and Commitment Contract) study is to investigate whether a structured teleconference re-visit with the study personnel at the centres, accompanied by a commitment contract, can enhance recruitment by 20% at 60 days post intervention, compared with 60 days pre-intervention, in an ongoing RCT. Methods: ERUTECC is a randomised, stepped-wedge cluster trial embedded in EFFECTS. The plan is to start ERUTECC with a running-in period of September 2017. The first intervention is due in October 2017, and the study will continue for 12 months. We are planning to intervene at all active centres in EFFECTS, except the five top recruiting centres (n=27). The rationale for not intervening at the top recruiting centres is that we believe they have reached their full potential and the intervention would be too weak for them. The hypothesis of this study is that a structured teleconference re-visit with the study personnel at the centres, accompanied by a commitment contract, can enhance recruitment by 20% 60 days post intervention, compared to 60 days pre-intervention, in an ongoing RCT. Discussion: EFFECTS is a large, pragmatic RCT of stroke in Sweden. Results from the embedded ERUTECC study could probably be generalised to high-income Western countries, and is relevant to trial management and could improve trial management in the future. It might also be useful in clinical settings outside the field of stroke.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2018
Keywords
Stroke, Randomised controlled trial, RCT, Recruitment, Randomised stepped-wedge cluster trial
National Category
Clinical Medicine
Identifiers
urn:nbn:se:kth:diva-221943 (URN)10.1186/s13063-017-2367-8 (DOI)000419608100004 ()29310679 (PubMedID)2-s2.0-85040447644 (Scopus ID)
Note

QC 20180130

Available from: 2018-01-30 Created: 2018-01-30 Last updated: 2018-01-30Bibliographically approved
Grosso, G., Sippl, N., Kjellstrom, B., Amara, K., de Faire, U., Elvin, K., . . . Svenungsson, E. (2018). IgG Antiphospholipid Antibodies, -a Common but Neglected Finding in Patients with Myocardial Infarction. Arthritis & Rheumatology, 70
Open this publication in new window or tab >>IgG Antiphospholipid Antibodies, -a Common but Neglected Finding in Patients with Myocardial Infarction
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2018 (English)In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 70Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2018
National Category
Clinical Medicine
Identifiers
urn:nbn:se:kth:diva-238544 (URN)000447268901388 ()
Note

QC 20181105

Available from: 2018-11-05 Created: 2018-11-05 Last updated: 2018-11-05Bibliographically approved
Rudberg, A.-S., Berge, E., Gustavsson, A., Näsman, P. & Lundström, E. (2018). Long-term health-related quality of life, survival and costs by different levels of functional outcome six months after stroke. European Stroke Journal, 3(2), 157-164
Open this publication in new window or tab >>Long-term health-related quality of life, survival and costs by different levels of functional outcome six months after stroke
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2018 (English)In: European Stroke Journal, ISSN 2396-9873, E-ISSN 2396-9881, Vol. 3, no 2, p. 157-164Article in journal (Refereed) Published
Abstract [en]

Introduction: Information about the impact of functional outcome after stroke is currently missing on health-related quality of life, survival and costs. This information would be valuable for health economic evaluations and for allocation of resources in stroke health care. Patients and methods: Data on 297 Swedish patients included in the Third International Stroke Trial were analysed including functional outcome at six months (measured by Oxford Handicap Scale), health-related quality of life up to 18 months (EQ-5D-3L) and survival up to 36 months. We used record linkage to collect data on costs up to 36 months, using national patient registers. Results: Patients with a better functional outcome level at six months had a significantly better health-related quality of life at 18 months (p<0.05), better long-term survival (p<0.05) and lower costs (p<0.001), for all time points up to 36 months. The difference in costs was mainly due to differences in days spent in hospital (p<0.005). Discussion: This study showed an association between functional outcome at six months and health-related quality of life up to 18 months, and costs up to 36 months. Conclusion: Functional outcome six months after stroke is an important determinant of health-related quality of life, survival and costs over 36 months. Effective interventions aimed at reducing short-term disability levels are therefore also expected to reduce the overall burden of stroke.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2018
Keywords
Stroke, quality adjusted life year, health economy, EQ-5D, functional level, survival
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:kth:diva-228418 (URN)10.1177/2396987317753444 (DOI)000432064200008 ()2-s2.0-85060508959 (Scopus ID)
Note

QC 20180528

Available from: 2018-05-28 Created: 2018-05-28 Last updated: 2019-03-18Bibliographically approved
Johansson, I., Dahlstrom, U., Edner, M., Näsman, P., Ryden, L. & Norhammar, A. (2018). Random plasma glucose predicts long-term mortality in patients with heart failure without previously known diabetes - insights from the Swedish heart failure registry (SwedeHF). Paper presented at European-Society-of-Cardiology Congress, AUG 25-29, 2018, Munich, GERMANY. European Heart Journal, 39, 224-225
Open this publication in new window or tab >>Random plasma glucose predicts long-term mortality in patients with heart failure without previously known diabetes - insights from the Swedish heart failure registry (SwedeHF)
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2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 224-225Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2018
National Category
Clinical Medicine
Identifiers
urn:nbn:se:kth:diva-246300 (URN)10.1093/eurheartj/ehy565.1104 (DOI)000459824000666 ()
Conference
European-Society-of-Cardiology Congress, AUG 25-29, 2018, Munich, GERMANY
Note

QC 20190320

Available from: 2019-03-20 Created: 2019-03-20 Last updated: 2019-03-20Bibliographically approved
Nordendahl, E., Gustafsson, A., Norhammar, A., Näsman, P., Ryden, L. & Kjellstrom, B. (2018). Severe Periodontitis Is Associated with Myocardial Infarction in Females. Journal of Dental Research, 97(10), 1114-1121
Open this publication in new window or tab >>Severe Periodontitis Is Associated with Myocardial Infarction in Females
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2018 (English)In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 97, no 10, p. 1114-1121Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to test the hypothesis that there is a sex difference in the association between periodontitis (PD) and a first myocardial infarction (MI). The analysis in the case-control study was based on 785 patients (147 females and 638 males) with a first MI and 792 matched controls (147 females and 645 males), screened for cardiovascular risk factors and subjected to a panoramic dental X-ray. Periodontal status was defined by alveolar bone loss and diagnosed as no PD (>= 80% remaining alveolar bone), mild to moderate PD (66% to 79%), or severe PD (<66%). Logistic regression was used when analyzing PD as a risk factor for MI, adjusting for age, smoking, diabetes, education, and marital status. The mean age was 64 +/- 7 y for females and 62 +/- 8 y for males. Severe PD was more common in female patients than female controls (14 vs. 4%, P = 0.005), with an increased risk for severe PD among female patients with a first MI (odds ratio [OR] = 3.92, 95% confidence interval [CI] = 1.53 to 10.00, P = 0.005), which remained (OR = 3.72, 95% CI = 1.24 to 11.16, P = 0.005) after adjustments. Male patients had more severe PD (7% vs. 4%; P = 0.005) than male controls and an increased risk for severe PD (OR = 1.88, 95% CI = 1.14 to 3.11, P = 0.005), but this association did not remain following adjustment (OR = 1.67, 95% CI = 0.97 to 2.84, NS). Severe PD was associated with MI in both females and males. After adjustments for relevant confounders, this association did, however, remain only in females. These data underline the importance of considering poor dental health when evaluating cardiovascular risk, especially in females.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC, 2018
Keywords
cardiovascular disease, inflammation, risk factors, atherosclerosis, gender difference, epidemiology
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:kth:diva-234160 (URN)10.1177/0022034518765735 (DOI)000442273700007 ()29596754 (PubMedID)2-s2.0-85045069984 (Scopus ID)
Note

QC 20181022

Available from: 2018-10-22 Created: 2018-10-22 Last updated: 2018-10-22Bibliographically approved
Johansson, I., Dahlstrom, U., Edner, M., Näsman, P., Ryden, L. & Norhammar, A. (2018). Type 2 diabetes and heart failure: Characteristics and prognosis in preserved, mid-range and reduced ventricular function. Diabetes & Vascular Disease Research, 15(6), 494-503
Open this publication in new window or tab >>Type 2 diabetes and heart failure: Characteristics and prognosis in preserved, mid-range and reduced ventricular function
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2018 (English)In: Diabetes & Vascular Disease Research, ISSN 1479-1641, E-ISSN 1752-8984, Vol. 15, no 6, p. 494-503Article in journal (Refereed) Published
Abstract [en]

Objective: To study the characteristics and prognostic implications of type 2 diabetes in different heart failure entities from a nationwide perspective. Methods: This observational study comprised 30,696 heart failure patients prospectively included in the Swedish Heart Failure Registry (SwedeHF) 2003-2011 from specialist care, with mortality information available until December 2014. Patients were categorized into three heart failure entities by their left ventricular ejection fraction (heart failure with preserved ejection fraction: > 50%, heart failure with mid-range ejection fraction: 40%-49% and heart failure with reduced ejection fraction: <40%). All-cause mortality stratified by type 2 diabetes and heart failure entity was studied by Cox regression. Results: Among the patients, 22% had heart failure with preserved ejection fraction, 21% had heart failure with mid-range ejection fraction and 57% had heart failure with reduced ejection fraction. The proportion of type 2 diabetes was similar, approximate to 25% in each heart failure entity. Patients with type 2 diabetes and heart failure with preserved ejection fraction were older, more often female and burdened with hypertension and renal impairment compared with heart failure with mid-range ejection fraction and heart failure with reduced ejection fraction patients among whom ischaemic heart disease was more common. Type 2 diabetes remained an independent mortality predictor across all heart failure entities after multivariable adjustment, somewhat stronger in heart failure with left ventricular ejection fraction below 50% (hazard ratio, 95% confidence interval; heart failure with preserved ejection fraction: 1.32 [1.22-1.43], heart failure with mid-range ejection fraction: 1.51 [1.39-1.65], heart failure with reduced ejection fraction: 1.46 [1.39-1.54]; p-value for interaction, p = 0.0049). Conclusion: Type 2 diabetes is an independent mortality predictor across all heart failure entities increasing mortality risk by 30%-50%. In type 2 diabetes, the heart failure with mid-range ejection fraction entity resembles heart failure with reduced ejection fraction in clinical characteristics, risk factor pattern and prognosis.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2018
Keywords
Diabetes mellitus, heart failure, left ventricular ejection fraction, prevalence, prognosis, registry
National Category
Health Sciences
Identifiers
urn:nbn:se:kth:diva-239791 (URN)10.1177/1479164118794619 (DOI)000450313700003 ()30176743 (PubMedID)2-s2.0-85056358087 (Scopus ID)
Note

QC 20190108

Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-01-09Bibliographically approved
Smaradottir, M. I., Ritsinger, V., Gyberg, V., Norhammar, A., Näsman, P. & Mellbin, L. G. (2017). Copeptin in patients with acute myocardial infarction and newly detected glucose abnormalities - A marker of increased stress susceptibility?: A report from the Glucose in Acute Myocardial Infarction cohort. Diabetes & Vascular Disease Research, 14(2), 69-76
Open this publication in new window or tab >>Copeptin in patients with acute myocardial infarction and newly detected glucose abnormalities - A marker of increased stress susceptibility?: A report from the Glucose in Acute Myocardial Infarction cohort
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2017 (English)In: Diabetes & Vascular Disease Research, ISSN 1479-1641, E-ISSN 1752-8984, Vol. 14, no 2, p. 69-76Article in journal (Refereed) Published
Abstract [en]

Objective: To characterize copeptin levels and to explore its prognostic importance in patients with acute myocardial infarction with newly detected glucose abnormalities. Methods: Copeptin was measured in 166 patients with acute myocardial infarction without known diabetes and in 168 age- and gender-matched controls. Participants were classified as having normal glucose tolerance or abnormal glucose tolerance (impaired glucose tolerance + type 2 diabetes mellitus) by oral glucose tolerance test. Study participants were followed over a decade for major cardiovascular event (acute myocardial infarction/stroke/congestive heart failure/cardiovascular death), cardiovascular and total death. Results: Median copeptin level was higher in patients (10.5 pmol/L) than controls (5.9 pmol/L; p < 0.01). Patients with abnormal glucose tolerance had higher copeptin (12.2 pmol/L) than those with normal glucose tolerance (7.9 pmol/L; p < 0.01) but levels of copeptin did not differ in controls with abnormal glucose tolerance or normal glucose tolerance. Copeptin predicted major cardiovascular events [n = 64; hazard ratio = 1.15 (1.01-1.32; p = 0.04)], cardiovascular mortality [n = 29; hazard ratio = 1.24 (1.06-1.46; p = 0.01)] and total death [n = 51; hazard ratio = 1.21 (1.05-1.40; p = 0.01)] in unadjusted Cox regression analyses in the patient cohort. In controls, copeptin predicted major cardiovascular events [n = 26; hazard ratio = 1.17 (1.01-1.36; p = 0.03)]. Conclusion: Copeptin levels are highest among acute myocardial infarction patients with glucose disturbances and predict an adverse prognosis in unadjusted analyses. These findings imply that raised copeptin reflects stress rather than acting as a pathogenic factor for glucose abnormalities.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
acute coronary syndrome, arginine vasopressin, biomarker, copeptin, Diabetes mellitus, prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:kth:diva-207968 (URN)10.1177/1479164116664490 (DOI)000394677900002 ()28118730 (PubMedID)2-s2.0-85012069966 (Scopus ID)
Note

QC 20170531

Available from: 2017-05-31 Created: 2017-05-31 Last updated: 2017-11-10Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7606-8771

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