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Leijon, M. E., Algotson, A., Bernhardsson, S., Ekholm, D., Ersberg, L., Höök, M.-s. J., . . . Nilsen, P. (2024). Generation Pep – study protocol for an intersectoral community-wide physical activity and healthy eating habits initiative for children and young people in Sweden. Frontiers In Public Health, 12
Open this publication in new window or tab >>Generation Pep – study protocol for an intersectoral community-wide physical activity and healthy eating habits initiative for children and young people in Sweden
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2024 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 12Article, review/survey (Refereed) Published
Abstract [en]

Background: There is overwhelming evidence for the preventive effects of regular physical activity and healthy eating habits on the risk for developing a non-communicable disease (NCD). Increasing attention has been paid to community-wide approaches in the battle against NCDs. Communities can create supportive policies, modify physical environments, and foster local stakeholder engagement through intersectoral collaboration to encourage communities to support healthy lifestyles. The Pep initiative is based on intersectoral community-wide collaboration among Sweden’s municipalities. Primary targets are municipality professionals who work with children and young people as well as parents of children <18 years. The goal is to spread knowledge and create commitment to children’s and young people’s health with a special focus on physical activity and healthy eating habits to facilitate and support a healthy lifestyle. The overarching aim of the research project described in this study protocol is to investigate factors that influence the implementation of the Pep initiative in Sweden, to inform tailored implementation strategies addressing the needs and local prerequisites of the different municipalities.

Methods: The project includes a qualitative and a quantitative study and is framed by a theoretical model involving four complementary forms of knowledge, explicitly recognized in the Pep initiative: knowledge about the issue; knowledge about interventions; knowledge about the context; and knowledge about implementation. Study 1 is a focus group study exploring barriers and facilitators for implementing the Pep initiative. The study will be carried out in six municipalities, selected purposively to provide wide variation in municipality characteristics, including population size and geographical location. Data will be analyzed using thematic analysis. Study 2 is a cross-sectional web-based survey investigating the implementability of the Pep initiative in Sweden’s 290 municipalities. Conditions for implementing different areas of the Pep initiative will be examined in terms of the acceptability, appropriateness, and feasibility, three predictors of implementation success. Data will be analyzed using non-parametric statistics.

Discussion: The findings of the two studies will increase understanding of the prerequisites for implementing the Pep initiative in Swedish municipalities, which will provide valuable input into how implementation of the Pep initiative can best be facilitated in the different municipality settings.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2024
Keywords
physical activity, eating habits, community-wide, intersectoral, public health, implementation, children, young people
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-201227 (URN)10.3389/fpubh.2024.1299099 (DOI)
Available from: 2024-02-27 Created: 2024-02-27 Last updated: 2024-03-04Bibliographically approved
Kallemose, T., Kirk, J. W., Karlsson, E., Seing, I., Stefánsdóttir, N. T., Vrangbæk, K., . . . Nilsen, P. (2023). Political trust in the handling of the COVID-19 pandemic: a survey in Denmark and Sweden. BMC Global and Public Health, 1(12)
Open this publication in new window or tab >>Political trust in the handling of the COVID-19 pandemic: a survey in Denmark and Sweden
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2023 (English)In: BMC Global and Public Health, E-ISSN 2731-913X, Vol. 1, no 12Article in journal (Refereed) Published
Abstract [en]

BackgroundThe initial responses to the COVID-19 pandemic in Denmark and Sweden differed markedly. Balancing disparate concerns was crucial to generate trust in the COVID-19 restrictions. The aim was to investigate the extent to which there was trust in the handling of the pandemic by the Danish and Swedish governments and public health authorities in each country. A further aim was also to investigate the characteristics of those in Denmark and Sweden who expressed the lowest degree of trust.

MethodsCross-sectional surveys were conducted in 2021, using web panels that are nationally representative of the socio-demographic characteristics. The population consisted of 2619 individuals from Denmark and 2633 from Sweden, representative of the age, sex and region of residence of the populations aged ≥ 18 years. Trust in government and health authorities was captured in two separate trust questions on a 5-point Likert scale and dichotomized into low trusters and non-low trusters for analysis.

ResultsApproximately, 61% of the Danish respondents expressed moderately large or very large trust in the government’s handling of the pandemic. The corresponding proportion for Sweden was 42%. The proportion of low trusters was 11% in Denmark and 34% in Sweden (p < 0.001). Moderately large or very large trust in the public health authority’s handling was expressed by 83% of the Danish respondents and 74% of the Swedish respondents. The proportion of low trusters was 5% in Denmark and 17% in Sweden (p < 0.001). In both countries, trust was lower among men than among women. Age and education were associated with trust but differed between countries (p <  = 0.011).

ConclusionsIn this study, differences in trust between Denmark and Sweden and both overall and within socio-demographic factors were observed. However, given the limitations and bias in the study, it is difficult to determine the cause and true size of these differences. With that in mind, we still believe specific populations and subgroups within those populations have the potential to affect trust in handling of the COVID-19 pandemic, and that these should be kept in mind when developing and communicating responses to pandemics.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Political trust, Pandemic restrictions, COVID-19, Restrictions
National Category
Public Administration Studies
Identifiers
urn:nbn:se:liu:diva-198106 (URN)10.1186/s44263-023-00009-2 (DOI)
Note

Funding agencies: Open access funding provided by Royal Library, Copenhagen University Library. This study was funded by the Innovation Fund Denmark.

Available from: 2023-09-25 Created: 2023-09-25 Last updated: 2023-09-25
Lindberg, C., Fock, J., Nilsen, P. & Schildmeijer, K. (2023). Registered nurses efforts to ensure safety for home-dwelling older patients. Scandinavian Journal of Caring Sciences, 37(2), 571-581
Open this publication in new window or tab >>Registered nurses efforts to ensure safety for home-dwelling older patients
2023 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, no 2, p. 571-581Article in journal (Refereed) Published
Abstract [en]

BackgroundThe international development of health care, an ageing population and rapid technical development mean that more care is being performed in patient homes. This care environment is often unpredictable and involves both formal and informal caregivers, making it potentially unsafe. There is sparse knowledge about how patient safety is protected in home health care in Sweden and how registered nurses work to prevent risks and promote safe care.AimThe aim of the study was to explore registered nurses efforts to reduce perceived risks for home-dwelling older patients and ensure safe home health care.MethodWe used a qualitative design with individual interviews with 13 registered nurses working in municipalities in southeast Sweden. The narratives were analysed with inductive content analysis.FindingsThe findings showed that the registered nurses tried to secure a safe care environment and took an active role in care, striving to stay one step ahead of the patient. These three types of efforts are likely interdependent, suggesting they are all needed to reduce perceived risks for home-dwelling older patients and ensure patient safety in home health care.ConclusionsIt is a challenge for registered nurses to maintain patient safety when performing care in patient homes. Continuity of care is required and must be based not only on self-reliance among registered nurses but also on trusting relationships with patients, next of kin, colleagues and other personnel, as well as on the development of organisational conditions adapted to patient needs.

Place, publisher, year, edition, pages
WILEY, 2023
Keywords
home health care; patient safety; qualitative research; registered nurses; risks
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-191032 (URN)10.1111/scs.13142 (DOI)000905826700001 ()36582025 (PubMedID)
Available from: 2023-01-20 Created: 2023-01-20 Last updated: 2024-02-20Bibliographically approved
Karlsson, N., Skagerström, J., O’Donnell, A., Abidi, L., Thomas, K., Nilsen, P. & Lid, T. G. (2023). Relationship Between Educational Level and Attitudes Towards Alcohol Conversations in Healthcare: A Cross-Sectional Survey Conducted in Four European Countries. International Journal of Public Health, 68, Article ID 1605634.
Open this publication in new window or tab >>Relationship Between Educational Level and Attitudes Towards Alcohol Conversations in Healthcare: A Cross-Sectional Survey Conducted in Four European Countries
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2023 (English)In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 68, article id 1605634Article in journal (Refereed) Published
Abstract [en]

Objectives: To examine the association between educational level and attitudes towards alcohol conversations in healthcare using population-based surveys of adults in England, the Netherlands, Norway, and Sweden; and to compare attitudes towards alcohol conversations in healthcare between these four countries. Methods: Cross-sectional surveys were conducted amongst adults in the general population in England (n = 3,499), the Netherlands (n = 2,173), Norway (n = 1,208), and Sweden (n = 3,000). Logistic regression analysis was used to examine associations between attitudes towards alcohol conversations in healthcare and educational level, key demographic variables, alcohol consumption, and country of residence. Results: In all four countries, low educational level (p < 0.001) and male gender (p < 0.001) were associated with holding negative attitudes towards discussing alcohol in healthcare. Risky drinkers had more negative attitudes than low risky drinkers towards discussing alcohol in healthcare (p < 0.001) in all countries except England (p = 0.48), and also reported low levels of perceived honesty and confidence in healthcare (p < 0.001). Conclusion: These findings highlight the importance of considering patients’ socio-economic status when developing and implementing alcohol prevention interventions in healthcare. Copyright © 2023 Karlsson, Skagerström, O’Donnell, Abidi, Thomas, Nilsen and Lid.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
Adult; Alcohol Drinking; Attitude; Cross-Sectional Studies; Delivery of Health Care; Educational Status; Humans; Male; adult; attitude; cross-sectional study; drinking behavior; educational status; epidemiology; health care delivery; human; male; prevention and control
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-193212 (URN)10.3389/ijph.2023.1605634 (DOI)000963379100001 ()37035102 (PubMedID)2-s2.0-85151993866 (Scopus ID)
Note

Finding agency: University of Stavanger, Faculty ofHealth Sciences, Norway

Available from: 2023-04-21 Created: 2023-04-21 Last updated: 2023-05-04
Nilsen, P., Neher, M., Ellström, P.-E. & Gardner, B. (2022). A learning perspective on implementation. In: Frances Rapport, Robyn Clay-Williams, and Jeffrey Braithwaite (Ed.), Implementation Science: The Key Concepts (pp. 169-170). London: Routledge
Open this publication in new window or tab >>A learning perspective on implementation
2022 (English)In: Implementation Science: The Key Concepts / [ed] Frances Rapport, Robyn Clay-Williams, and Jeffrey Braithwaite, London: Routledge, 2022, p. 169-170Chapter in book (Refereed)
Place, publisher, year, edition, pages
London: Routledge, 2022
Keywords
Implementation, learning
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-189211 (URN)9780367626136 (ISBN)
Available from: 2022-10-13 Created: 2022-10-13 Last updated: 2022-12-15Bibliographically approved
Nilsen, P., Svedberg, P., Nygren, J., Frideros, M., Johansson, J. & Schueller, S. (2022). Accelerating the impact of artificial intelligence in mental healthcare through implementation science.. Implementation research and practice, 3, Article ID 26334895221112033.
Open this publication in new window or tab >>Accelerating the impact of artificial intelligence in mental healthcare through implementation science.
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2022 (English)In: Implementation research and practice, ISSN 2633-4895, Vol. 3, article id 26334895221112033Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The implementation of artificial intelligence (AI) in mental healthcare offers a potential solution to some of the problems associated with the availability, attractiveness, and accessibility of mental healthcare services. However, there are many knowledge gaps regarding how to implement and best use AI to add value to mental healthcare services, providers, and consumers. The aim of this paper is to identify challenges and opportunities for AI use in mental healthcare and to describe key insights from implementation science of potential relevance to understand and facilitate AI implementation in mental healthcare.

METHODS: The paper is based on a selective review of articles concerning AI in mental healthcare and implementation science.

RESULTS: Research in implementation science has established the importance of considering and planning for implementation from the start, the progression of implementation through different stages, and the appreciation of determinants at multiple levels. Determinant frameworks and implementation theories have been developed to understand and explain how different determinants impact on implementation. AI research should explore the relevance of these determinants for AI implementation. Implementation strategies to support AI implementation must address determinants specific to AI implementation in mental health. There might also be a need to develop new theoretical approaches or augment and recontextualize existing ones. Implementation outcomes may have to be adapted to be relevant in an AI implementation context.

CONCLUSION: Knowledge derived from implementation science could provide an important starting point for research on implementation of AI in mental healthcare. This field has generated many insights and provides a broad range of theories, frameworks, and concepts that are likely relevant for this research. However, when taking advantage of the existing knowledge basis, it is important to also be explorative and study AI implementation in health and mental healthcare as a new phenomenon in its own right since implementing AI may differ in various ways from implementing evidence-based practices in terms of what implementation determinants, strategies, and outcomes are most relevant.Plain Language Summary: The implementation of artificial intelligence (AI) in mental healthcare offers a potential solution to some of the problems associated with the availability, attractiveness, and accessibility of mental healthcare services. However, there are many knowledge gaps concerning how to implement and best use AI to add value to mental healthcare services, providers, and consumers. This paper is based on a selective review of articles concerning AI in mental healthcare and implementation science, with the aim to identify challenges and opportunities for the use of AI in mental healthcare and describe key insights from implementation science of potential relevance to understand and facilitate AI implementation in mental healthcare. AI offers opportunities for identifying the patients most in need of care or the interventions that might be most appropriate for a given population or individual. AI also offers opportunities for supporting a more reliable diagnosis of psychiatric disorders and ongoing monitoring and tailoring during the course of treatment. However, AI implementation challenges exist at organizational/policy, individual, and technical levels, making it relevant to draw on implementation science knowledge for understanding and facilitating implementation of AI in mental healthcare. Knowledge derived from implementation science could provide an important starting point for research on AI implementation in mental healthcare. This field has generated many insights and provides a broad range of theories, frameworks, and concepts that are likely relevant for this research.

Place, publisher, year, edition, pages
Sage Publications, 2022
Keywords
artificial intelligence, implementation, mental health services
National Category
Information Systems, Social aspects Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-193332 (URN)10.1177/26334895221112033 (DOI)37091110 (PubMedID)
Available from: 2023-05-02 Created: 2023-05-02 Last updated: 2023-08-21
Hammarström, S., Bernhardsson, S., Nilsen, P., Elisson, J., Frostholm, E. & Lindroth, M. (2022). Ask me, listen to me, treat me well and I shall tell: a qualitative study of Swedish youths’ experiences of systematic assessment of sexual health and risk-taking (SEXIT). Sexual and Reproductive Health Matters, 30(1), Article ID 2146032.
Open this publication in new window or tab >>Ask me, listen to me, treat me well and I shall tell: a qualitative study of Swedish youths’ experiences of systematic assessment of sexual health and risk-taking (SEXIT)
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2022 (English)In: Sexual and Reproductive Health Matters, E-ISSN 2641-0397, Vol. 30, no 1, article id 2146032Article in journal (Refereed) Published
Abstract [en]

Sexual ill health among young people, in terms of sexually transmitted infections (STIs), unintended pregnancy, transactional sex and sexual violence, is a global public health concern. To that end, the SEXual health Identification Tool (SEXIT) was developed. The purpose of this study was to explore the visitors’ experiences of a youth clinic visit when SEXIT was used. A purposively selected sample of 20 participants (16–24 years of age) was recruited from three Swedish youth clinics using SEXIT. Participants were interviewed individually in March and April 2016, and data were analysed using inductive qualitative content analysis. The analysis resulted in four main categories describing the participants’ experiences of using SEXIT: “Issues of concern” includes descriptions of the items in SEXIT as important; “Enabling disclosure” describes how SEXIT serves as an invitation to talk and facilitates disclosure of negative experiences; “Road to change” captures experiences of the conversation with the healthcare professional; and “Managing power imbalance” describes experiences regarding the response and attitudes of the healthcare professional as well as the participants’ fears of being judged. The categories are connected by the overarching theme “Ask me, listen to me, treat me well and I shall tell”. This study contributes knowledge on young people’s experiences of a tool-supported dialogue on sexual health and risk-taking initiated by the healthcare professional. Structured questions in a written format, as a basis for dialogue, are appreciated and experienced as a functioning way of addressing sexual ill health and risk-taking at Swedish youth clinics.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
adolescents, risk assessment, sexual behaviour, sexually transmitted infections, sexualviolence, qualitative research, young adults, youth clinic, unintended pregnancy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-190422 (URN)10.1080/26410397.2022.2146032 (DOI)000893738600001 ()36476113 (PubMedID)
Available from: 2022-12-08 Created: 2022-12-08 Last updated: 2023-12-28Bibliographically approved
Ingvarsson, S., Hasson, H., Augustsson, H., Nilsen, P., von Thiele Schwarz, U. & Sandaker, I. (2022). Management strategies to de-implement low-value care-an applied behavior analysis.. Implementation Science Communications, 3(1), Article ID 69.
Open this publication in new window or tab >>Management strategies to de-implement low-value care-an applied behavior analysis.
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2022 (English)In: Implementation Science Communications, E-ISSN 2662-2211, Vol. 3, no 1, article id 69Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is a lack of knowledge about management strategies being used to de-implement low-value care (LVC). Furthermore, it is not clear from the current literature what mechanisms are involved in such strategies and how they can change physicians' behaviors. Understanding the mechanisms is important for determining a strategy's potential impact. Applied behavior analysis focuses on processes involved in increasing and decreasing behaviors. Therefore, the aim of this study is to understand what management strategies are being used to de-implement LVC and the possible mechanisms involved in those strategies, using concepts from applied behavior analysis.

METHOD: We applied a qualitative study design using an inductive approach to understand what management strategies are in use and then employed applied behavior analysis concepts to deductively analyze the mechanisms involved in them.

RESULTS: We identified eight different management strategies intended to influence LVC. Five of the strategies were developed at a regional level and had the potential to influence physicians' LVC-related behaviors either by functioning as rules on which LVC to de-implement or by initiating local strategies in each health care center that in turn could influence LVC practices. The local strategies had a stronger potential for influencing de-implementation.

CONCLUSION: Both strategies at a systemic level (regional) and on a local level (health care centers) must be considered to influence LVC-related behaviors. Strategies at the center level have a specific opportunity to impact LVC-related behaviors because they can be tailored to specific circumstances, even though some of them probably were initiated as an effect of strategies on a regional level. Using applied behavior analysis to understand these circumstances can be helpful for tailoring strategies to reduce LVC use.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Applied behavior analysis, De-implementation, Low-value care, Physicians, Primary health care, Rule-governed behavior, Sweden, Three-term contingency
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-193339 (URN)10.1186/s43058-022-00320-3 (DOI)35752858 (PubMedID)
Note

Funding agencies: Open access funding provided by Karolinska Institute; The Swedish Research Council for Health, Working Life and Welfare (FORTE) (project no. 2017–00449)

Available from: 2023-05-02 Created: 2023-05-02 Last updated: 2024-01-08
Levin, S., Nilsen, P., Bendtsen, P. & Bülow, P. (2022). Risk-Increasing and Risk-Reducing Factors for Violence: A Qualitative Study of Forensic Patients Perceptions. International Journal of Forensic Mental Health, 21(4), 383-398
Open this publication in new window or tab >>Risk-Increasing and Risk-Reducing Factors for Violence: A Qualitative Study of Forensic Patients Perceptions
2022 (English)In: International Journal of Forensic Mental Health, ISSN 1499-9013, E-ISSN 1932-9903, Vol. 21, no 4, p. 383-398Article in journal (Refereed) Published
Abstract [en]

This study investigated forensic patients perceptions of relevant factors for violence risk, to facilitate an understanding of potential reasons for violence and the effect of risk management interventions. Semi-structured interviews with 13 forensic patients were analyzed with qualitative content analysis using an inductive approach. The sample of participants could identify an array of potentially relevant factors for their use of violence related to themselves, the external context, social and relational aspects, as well as situational factors. Most also actively strived to manage such risk. Considering patients perceptions could potentially add relevant perspectives and improve clinical and structured risk assessments.

Place, publisher, year, edition, pages
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2022
Keywords
Violence; risk factors; protective factors; patient perceptions; risk assessment
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-182771 (URN)10.1080/14999013.2021.2023238 (DOI)000744293600001 ()2-s2.0-85122962266 (Scopus ID)
Available from: 2022-02-10 Created: 2022-02-10 Last updated: 2023-04-21Bibliographically approved
Nilsen, P., Fernemark, H., Seing, I., Schildmeijer, K. & Skagerström, J. (2022). Seven lessons from the coronavirus pandemic for primary health care: A qualitative study of registered and assistant nurses in Sweden. Scandinavian Journal of Caring Sciences, 36(4), 1197-1205
Open this publication in new window or tab >>Seven lessons from the coronavirus pandemic for primary health care: A qualitative study of registered and assistant nurses in Sweden
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2022 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 36, no 4, p. 1197-1205Article in journal (Refereed) Published
Abstract [en]

Aim The aim of this study was to explore lessons from the pandemic by registered and assistant nurses in Swedish primary health care (PHC) of potential relevance for the future operation of PHC. Methods Twenty-one semi-structured interviews were conducted with registered and assistant nurses. We used a purposeful sampling strategy to achieve a diverse sample with regard to size and location of PHC centres. Data were analysed using qualitative content analysis. Results Analysis yielded two categories: lessons from the pandemic pertaining to PHC personnel and patient behaviours (adaptability of the personnel; importance of hygiene and maintaining physical distance; and importance of being attentive to illness symptoms) and lessons from the pandemic related to primary healthcare work routines (effectiveness of digital job meetings; advantages of digital patient consultations; importance of keeping infectious patients separate from other patients; and the need to allow only pre-booked patient appointments). Conclusions The seven sub-categories represent seven lessons from the pandemic. The lessons generated both instrumental knowledge, which the nurses could apply in work-related decisions, and conceptual knowledge which yielded improved understanding of problems and potential solutions for PHC.

Place, publisher, year, edition, pages
Wiley, 2022
Keywords
change; coronavirus; learning; pandemic; primary health care
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-184725 (URN)10.1111/scs.13082 (DOI)000786540100001 ()35466416 (PubMedID)
Note

Funding Agencies|AFA Insurance; Forte (Forskningsradet for halsa, arbetsliv och valfard)

Available from: 2022-05-05 Created: 2022-05-05 Last updated: 2023-03-07Bibliographically approved
Projects
Implementing Artificial Intelligence (AI): Exploring how AI changes information and knowledge practices in healthcare [2022-05406_VR]; Halmstad University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0657-9079

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