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Carlbring, P., Andersson, G., Cuijpers, P., Riper, H. & Hedman-Lagerlöf, E. (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cognitive Behaviour Therapy, 47(1), 1-18.
Open this publication in new window or tab >>Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis
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2018 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 1, 1-18 p.Article in journal (Refereed) Published
Abstract [en]

During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, -.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.

Place, publisher, year, edition, pages
Routledge, 2018
Keyword
Guided internet-delivered cognitive behavior therapy, anxiety and mood disorders, face-to-face therapy, meta-analysis, somatic disorders
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-143848 (URN)10.1080/16506073.2017.1401115 (DOI)29215315 (PubMedID)2-s2.0-85037730265 (Scopus ID)
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-01-10Bibliographically approved
Kues, J. N., Janda, C., Krzikalla, C., Andersson, G. & Weise, C. (2018). The effect of manipulated information about premenstrual changes on the report of positive and negative premenstrual changes.. Women & health, 58(1), 16-37.
Open this publication in new window or tab >>The effect of manipulated information about premenstrual changes on the report of positive and negative premenstrual changes.
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2018 (English)In: Women & health, ISSN 0363-0242, E-ISSN 1541-0331, Vol. 58, no 1, 16-37 p.Article in journal (Refereed) Published
Abstract [en]

Although women predominantly report negative premenstrual changes, a substantial portion of women also reports positive changes. Little is known about factors related to report of positive and negative premenstrual changes. The aim of this experimental study at the Philipps-University of Marburg from January and February 2015 was to investigate the effect of manipulated information about premenstrual changes on the retrospective report of premenstrual changes. A total of 241 healthy women were randomly assigned either to an experimental group (EG) reading: (1) text focusing on negative and positive premenstrual changes (EG1 (+/-)); (2) text focusing on negative changes (EG2 (-)); or (3) control group (CG) text. At least one positive premenstrual change was reported by the majority of the participating women. The results of the MANOVA and discriminant analysis showed that, after having read the text, EG2 (-) reported more negative and fewer positive premenstrual changes in a retrospective screening compared to EG1 (+/-) and CG. No significant difference was observed between EG1 (+/-) and CG. The results show the negative influence of information focusing on negative premenstrual changes on the retrospective report of both negative and positive premenstrual changes.

Place, publisher, year, edition, pages
Routledge, 2018
Keyword
Expectations, information, menstruation, positive premenstrual changes, premenstrual syndrome
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-143854 (URN)10.1080/03630242.2016.1263274 (DOI)27892822 (PubMedID)2-s2.0-85006930893 (Scopus ID)
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-01-10Bibliographically approved
Nordgreen, T., Gjestad, R., Andersson, G., Carlbring, P. & Havik, O. E. (2018). The implementation of guided Internet-based cognitive behaviour therapy for panic disorder in a routine-care setting: effectiveness and implementation efforts. Cognitive Behaviour Therapy, 47(1), 62-75.
Open this publication in new window or tab >>The implementation of guided Internet-based cognitive behaviour therapy for panic disorder in a routine-care setting: effectiveness and implementation efforts
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2018 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 1, 62-75 p.Article in journal (Refereed) Published
Abstract [en]

Panic disorder is a common mental disorder. Guided Internet-based cognitive behavioural therapy (Guided Internet-based cognitive behaviour therapy (ICBT)) is a promising approach to reach more people in need of help. In the present effectiveness study, we investigated the outcome of guided ICBT for panic disorder after implementation in routine care. A total of 124 patients were included in the study, of which 114 started the treatment. Large within-group effect sizes were observed on the primary panic disorder symptoms (post-treatment: d = 1.24; 6-month follow-up: d = 1.39) and moderate and large effects on secondary panic disorder symptoms and depressive symptoms at post-treatment and follow-up (d = .55-1.13). More than half (56.1%) of the patients who started treatment recovered or improved at post-treatment. Among treatment takers (completed at least five of the nine modules), 69.9% recovered or improved. The effectiveness reported in the present trial is in line with previous effectiveness and efficacy trials of guided ICBT for panic disorder. This provides additional support for guided ICBT as a treatment alternative in routine care.

Place, publisher, year, edition, pages
Routledge, 2018
Keyword
Panic disorder, cognitive behavioural therapy, effectiveness, guided Internet-based treatment, implementation
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-143853 (URN)10.1080/16506073.2017.1348389 (DOI)28714775 (PubMedID)2-s2.0-85024385408 (Scopus ID)
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-01-10Bibliographically approved
Zwerenz, R., Becker, J., Johansson, R., Frederick, R. J., Andersson, G. & Beutel, M. E. (2017). Transdiagnostic, Psychodynamic Web-Based Self-Help Intervention Following Inpatient Psychotherapy: Results of a Feasibility Study and Randomized Controlled Trial.. JMIR mental health, 4(4), Article ID e41.
Open this publication in new window or tab >>Transdiagnostic, Psychodynamic Web-Based Self-Help Intervention Following Inpatient Psychotherapy: Results of a Feasibility Study and Randomized Controlled Trial.
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2017 (English)In: JMIR mental health, ISSN 2368-7959, Vol. 4, no 4, e41Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mental disorders have become a major health issue, and a substantial number of afflicted individuals do not get appropriate treatment. Web-based interventions are promising supplementary tools for improving health care for patients with mental disorders, as they can be delivered at low costs and used independently of time and location. Although psychodynamic treatments are used frequently in the face-to-face setting, there has been a paucity of studies on psychodynamic Web-based self-help interventions.

OBJECTIVE: The objective of this study was to determine the feasibility and preliminary efficacy of a transdiagnostic affect-focused psychodynamic Web-based self-help intervention designed to increase emotional competence of patients with mental disorders.

METHODS: A total of 82 psychotherapy inpatients with mixed diagnoses were randomized into two groups. Following discharge, the intervention group (IG) got access to a guided version of the intervention for 10 weeks. After a waiting period of 10 weeks, the wait-list control group (WLCG) got access to an unguided version of the intervention. We reported the assessments at the beginning (T0) and at the end of the intervention, resp. the waiting period (T1). The primary outcome was satisfaction with the treatment at T1. Secondary outcome measures included emotional competence, depression, anxiety, and quality of life. Statistical analyses were performed with descriptive statistics (primary outcome) and analysis of covariance; a repeated measurement analysis of variance was used for the secondary outcomes. Effect sizes were calculated using Cohen d and data were analyzed as per protocol, as well as intention-to-treat (ITT).

RESULTS: Patients were chronically ill, diagnosed with multiple diagnoses, most frequently with depression (84%, 58/69), anxiety (68%, 47/69), personality disorder (38%, 26/69), and depersonalization-derealization disorder (22%, 15/69). A majority of the patients (86%, 36/42) logged into the program, of which 86% (31/36) completed the first unit. Satisfaction with the units mastered was rated as good (52%, 16/31) and very good (26%, 9/31). However, there was a steady decline of participation over the course of the program; only 36% of the participants (13/36) participated throughout the trial completing at least 50% of the sessions. According to the ITT analysis, participants improved statistically significantly and with moderate effect sizes (Cohen d) compared with the WLCG regarding depression (d=0.60), quality of life (d=0.53), and emotional competence (d=0.49). Effects were considerably stronger for the completers with respect to depression (d=1.33), quality of life (d=0.83), emotional competence (d=0.68), and general anxiety (d=0.62).

CONCLUSIONS: Although overall program satisfaction and benefit of the program were favorable with respect to the indicators of emotional disorders, the rate of completion was low. Our findings point to the need to target the intervention more specifically to the needs and capabilities of participants and to the context of the intervention.

TRIAL REGISTRATION: Clinicaltrials.gov NCT02671929; https://clinicaltrials.gov/ct2/show/NCT02671929 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb).

Place, publisher, year, edition, pages
Toronto, Canada: J M I R Publications, Inc., 2017
Keyword
Internet, aftercare, clinical trial, emotion-focused therapy, inpatients, psychoanalytic psychotherapy
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-143856 (URN)10.2196/mental.7889 (DOI)000414983000009 ()29038094 (PubMedID)
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-01-11Bibliographically approved
Andersson, G., Topooco, N., Havik, O. & Nordgreen, T. (2016). 6 Internet-supported versus face-to-face cognitive behavior therapy for depression. Expert Review of Neurotherapeutics, 16(1), 55-60.
Open this publication in new window or tab >>6 Internet-supported versus face-to-face cognitive behavior therapy for depression
2016 (English)In: Expert Review of Neurotherapeutics, ISSN 1473-7175, E-ISSN 1744-8360, Vol. 16, no 1, 55-60 p.Article, review/survey (Refereed) Published
Abstract [en]

Major depression and depressive symptoms are highly prevalent and there is a need for different forms of psychological treatments that can be delivered from a distance at a low cost. In the present review the authors contrast face-to-face and Internet-delivered cognitive behavior therapy (ICBT) for depression. A total of five studies are reviewed in which guided ICBT was directly compared against face-to-face CBT. Meta-analytic summary statistics were calculated for the five studies involving a total of 429 participants. The average effect size difference was Hedges g=0.12 (95% CI: -0.06-0.30) in the direction of favoring guided ICBT. The small difference in effect has no implication for clinical practice. The overall empirical status of clinician-guided ICBT for depression is commented on and future challenges are highlighted. Among these are developing treatments for patients with more severe and long-standing depression and for children, adolescents and the elderly. Also, there is a need to investigate mechanisms of change.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2016
Keyword
Cognitive behavior therapy; depression; face-to-face treatment; Internet delivery; mood disorders
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-125156 (URN)10.1586/14737175.2015.1125783 (DOI)000368642400001 ()26610160 (PubMedID)
Note

Funding Agencies|Swedish research council; Linkoping University; E-COMPARED project (EC)

Available from: 2016-02-15 Created: 2016-02-15 Last updated: 2018-01-10
Schulz, A., Stolz, T., Vincent, A., Krieger, T., Andersson, G. & Berger, T. (2016). A sorrow shared is a sorrow halved? A three-arm randomized controlled trial comparing internet-based clinician-guided individual versus group treatment for social anxiety disorder.. Behaviour Research and Therapy, 84, 14-26.
Open this publication in new window or tab >>A sorrow shared is a sorrow halved? A three-arm randomized controlled trial comparing internet-based clinician-guided individual versus group treatment for social anxiety disorder.
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2016 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 84, 14-26 p.Article in journal (Refereed) Published
Abstract [en]

A growing body of evidence suggests that internet-based cognitive behavioural treatments (ICBT) are effective to treat social anxiety disorder (SAD). Whereas the efficacy of clinician-guided ICBT has been established, ICBT in a group format has not yet been systematically investigated. This three-arm RCT compared the efficacy of clinician-guided group ICBT (GT) with clinician guided individual ICBT (IT) and a wait-list (WL). A total of 149 individuals meeting the diagnostic criteria for SAD were randomly assigned to one of three conditions. Primary endpoints were self-report measures of SAD and diagnostic status taken at baseline, after the twelve-week intervention and at six-month follow-up. Secondary endpoints were symptoms of depression, interpersonal problems and general symptomatology. At post-treatment, both active conditions showed superior outcome regarding SAD symptoms (GT vs. WL: d = 0.84-0.74; IT vs. WL: d = 0.94-1.22). The two active conditions did not differ significantly in symptom reduction (d = 0.12-0.26, all ps > 0.63), diagnostic response rate or attrition. Treatment gains were maintained at follow-up. The group format reduced weekly therapist time per participant by 71% (IT: 17 min, GT: 5 min). Findings indicate that a clinician-guided group format is a promising approach in treating SAD.

Place, publisher, year, edition, pages
Elsevier, 2016
Keyword
Internet treatment; ICBT; Social anxiety disorder; Guided self-help; Group therapy; Peer support; RCT
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-130823 (URN)10.1016/j.brat.2016.07.001 (DOI)000382411000003 ()27423374 (PubMedID)
Note

Funding agencies: Swiss National Science Foundation [PP00P1_144824/1]

Available from: 2016-08-26 Created: 2016-08-26 Last updated: 2017-11-28Bibliographically approved
Beukes, E. W., Vlaescu, G., Manchaiah, V. K. C., Baguley, D. M., Allen, P. M., Kaldo, V. & Andersson, G. (2016). Development and technical functionality of an Internet-based intervention for tinnitus in the UK. Internet Interventions, 6, 6-15.
Open this publication in new window or tab >>Development and technical functionality of an Internet-based intervention for tinnitus in the UK
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2016 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 6, 6-15 p.Article in journal (Refereed) Published
Abstract [en]

Purpose

Creative approaches to improve access to evidence-based tinnitus treatments are required. The purpose of this study was to develop an Internet-based cognitive behavioural therapy (iCBT) intervention, for those experiencing tinnitus in the United Kingdom (UK). Furthermore, it aimed, through technical functionality testing, to identify specific aspects of the iCBT that require improving.

Method

An innovative iCBT intervention for treating tinnitus in the UK has been developed using a cognitive-behavioural theoretical framework. This iCBT was evaluated by two user groups during this developmental phase. Initially, five expert reviews evaluated the intervention, prior to evaluation by a group of 29 adults experiencing significant levels of tinnitus distress. Both groups evaluated iCBT in an independent measures design, using a specifically designed satisfaction outcome measure.

Results

Overall, similar ratings were given by the expert reviewers and adults with tinnitus, showing a high level of satisfaction regarding the content, suitability, presentation, usability and exercises provided in the intervention. The iCBT intervention has been refined following technical functionality testing.

Conclusions

Rigorous testing of the developed iCBT intervention has been undertaken. These evaluations provide confidence that further clinical trials can commence in the UK, to assess the feasibility and effectiveness of this iCBT intervention for tinnitus.

Place, publisher, year, edition, pages
Elsevier, 2016
Keyword
Tinnitus, Tinnitus treatment, Internet-interventions, Cognitive behavioural therapy, e-Health
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-142241 (URN)10.1016/j.invent.2016.08.002 (DOI)2-s2.0-84983541736 (Scopus ID)
Available from: 2017-10-23 Created: 2017-10-23 Last updated: 2017-11-15Bibliographically approved
Lindner, P., Carlbring, P., Flodman, E., Hebert, A., Poysti, S., Hagkvist, F., . . . Andersson, G. (2016). Does cognitive flexibility predict treatment gains in Internet-delivered psychological treatment of social anxiety disorder, depression, or tinnitus?. PeerJ, 4(e1934).
Open this publication in new window or tab >>Does cognitive flexibility predict treatment gains in Internet-delivered psychological treatment of social anxiety disorder, depression, or tinnitus?
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2016 (English)In: PeerJ, ISSN 2167-8359, E-ISSN 2167-8359, Vol. 4, no e1934Article in journal (Refereed) Published
Abstract [en]

Little is known about the individual factors that predict outcomes in Internet-administered psychological treatments. We hypothesized that greater cognitive flexibility (i.e. the ability to simultaneously consider several concepts and tasks and switch effortlessly between them in response to changes in environmental contingencies) would provide a better foundation for learning and employing the cognitive restructuring techniques taught and exercised in therapy, leading to greater treatment gains. Participants in three trials featuring Internet-administered psychological treatments for depression (n = 36), social anxiety disorder (n = 115) and tinnitus (n = 53) completed the 64-card Wisconsin Card Sorting Test (WCST) prior to treatment. We found no significant associations between perseverative errors on the WCST and treatment gains in any group. We also found low accuracy in the classification of treatment responders. We conclude that lower cognitive flexibility, as captured by perseverative errors on the WCST, should not impede successful outcomes in Internet-delivered psychological treatments.

Place, publisher, year, edition, pages
PEERJ INC, 2016
Keyword
Wisconsin Card Sorting Test; Perseveration; Prediction; Psychotherapy; Internet
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-128749 (URN)10.7717/peerj.1934 (DOI)000374374300010 ()27114881 (PubMedID)
Available from: 2016-05-31 Created: 2016-05-30 Last updated: 2018-01-10
Philipp Klein, J., Berger, T., Schroeder, J., Spaeth, C., Meyer, B., Caspar, F., . . . Hohagen, F. (2016). Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial. Psychotherapy and Psychosomatics, 85(4), 218-228.
Open this publication in new window or tab >>Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial
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2016 (English)In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 85, no 4, 218-228 p.Article in journal (Refereed) Published
Abstract [en]

Background: Mild to moderate depressive symptoms are common but often remain unrecognized and treated inadequately. We hypothesized that an Internet intervention in addition to usual care is superior to care as usual alone (CAU) in the treatment of mild to moderate depressive symptoms in adults. Methods: This trial was controlled, randomized and assessor-blinded. Participants with mild to moderate depressive symptoms (Patient Health Questionnaire, PHQ-9, score 5-14) were recruited from clinical and non-clinical set-tings and randomized to either CAU or a 12-week Internet intervention (Deprexis) adjunctive to usual care. Outcomes were assessed at baseline, 3 months (post-assessment) and 6 months (follow-up). The primary outcome measure was self-rated depression severity (PHQ-9). The main analysis was based on the intention-to-treat principle and used linear mixed models. Results: A total of 1,013 participants were randomized. Changes in PHQ-9 from baseline differed significantly between groups (t(825) = 6.12, p amp;lt; 0.001 for the main effect of group). The post-assessment between-group effect size in favour of the intervention was d = 0.39 (95% CI: 0.13-0.64). It was stable at follow-up, with d = 0.32 (95% CI: 0.06-0.69). The rate of participants experiencing at least minimally clinically important PHQ-9 change at the post-assessment was higher in the intervention group (35.6 vs. 20.2%) with a number needed to treat of 7 (95% CI: 5-10). Conclusions: The Internet intervention examined in this trial was superior to CAU alone in reducing mild to moderate depressive symptoms. The magnitude of the effect is clinically important and has public health implications. (C) 2016 S. Karger AG, Basel

Place, publisher, year, edition, pages
KARGER, 2016
Keyword
Internet intervention; Cognitive behaviour therapy; Depression; Randomized controlled trial
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-130322 (URN)10.1159/000445355 (DOI)000378259100004 ()27230863 (PubMedID)
Note

Funding Agencies|German Federal Ministry of Health [II A 5-2512 FSB 052]

Available from: 2016-07-29 Created: 2016-07-28 Last updated: 2017-11-28
Tham, A., Jonsson, U., Andersson, G., Söderlund, A., Allard, P. & Bertilsson, G. (2016). Efficacy and tolerability of antidepressants in people aged 65 years or older with major depressive disorder - A systematic review and a meta-analysis.. Journal of Affective Disorders, 205, 1-12.
Open this publication in new window or tab >>Efficacy and tolerability of antidepressants in people aged 65 years or older with major depressive disorder - A systematic review and a meta-analysis.
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2016 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 205, 1-12 p.Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: There has been a steady increase in the prescription of antidepressants for the elderly. This study comprises a systematic review of randomized, placebo-controlled trials of antidepressants for treatment of depressive disorder in people aged 65 years or more.

METHODS: PubMed, EMBASE, Cochrane Library, CINAL, and PsycINFO were searched until May 2016. Where appropriate, the results were synthesized in meta-analyses.

RESULTS: Twelve trials met the inclusion criteria. For patients with major depressive disorder, selective serotonin re-uptake inhibitors (SSRI) were not superior to placebo in achieving remission (OR: 0.79, 95% CI: 0.61-1.03) or response (OR=0.86, 95% CI: 0.51-1.10) after 8 weeks of treatment (three trials). However, maintenance treatment with SSRIs was superior to placebo in preventing relapse (OR: 0.22, 95% CI: 0.13-0.36; NNT=5, 95% CI: 3-6; two trials). Duloxetine was superior to placebo in achieving remission (OR: 1.78, 95% CI: 1.20-2.65; NNT=9, 95% CI: 6-20; three trials) and response (OR: 1.83, 95% CI: 1.96-4.08; two trials) in recurrent major depression after 8 weeks, but increased the risk of adverse events that can be problematic in the elderly.

LIMITATIONS: The quality of evidence was generally low or moderate, emphasizing the uncertainty of the results. Study populations only partly covered the heterogeneous population of elderly with depressed mood, limiting the generalizability.

CONCLUSION: The results underscore the importance of close monitoring of the effects of antidepressants in treatment of elderly patients with a depressive disorder. Methods for early detection of non-responders and effective treatment options for this group are needed.

Place, publisher, year, edition, pages
Elsevier, 2016
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-130824 (URN)10.1016/j.jad.2016.06.013 (DOI)000385440900001 ()27389296 (PubMedID)
Note

Funding agencies: Swedish Agency for Health Technology Assessment and Assessment of Social Services

Available from: 2016-08-26 Created: 2016-08-26 Last updated: 2017-11-28Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4753-6745

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