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Borendal Wodlin, Ninnie
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Publications (10 of 14) Show all publications
Asklöf, M., Kjölhede, P., Borendal Wodlin, N. & Nilsson, L. (2018). Bioelectrical impedance analysis; a new method to evaluate lymphoedema, fluid status, and tissue damage after gynaecological surgery - A systematic review. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 228, 111-119
Open this publication in new window or tab >>Bioelectrical impedance analysis; a new method to evaluate lymphoedema, fluid status, and tissue damage after gynaecological surgery - A systematic review
2018 (English)In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 228, p. 111-119Article, review/survey (Refereed) Published
Abstract [en]

The aim of this descriptive review is to summarise the current knowledge of non-invasive bioelectrical impedance analysis (BIA) used with gynaecological surgical patients in regard to postoperative development of lymphoedema and determination of perioperative fluid balance, and as a prognostic factor in cancer mortality and a predictor of postoperative complications. The databases PubMed, MEDLINE, Scopus Web of Science, the Cochrane Library, and reference lists of selected articles were searched for relevant articles published during the period January 2008-April 2018. Only papers published in English were retrieved. Thirty-seven articles were evaluated. Where gynaecological studies were lacking, studies with a study population from neighbouring clinical fields were used instead. Studies on the clinical use of BIA with gynaecological surgical patients were divided into three categories: the postoperative development of lower limb lymphoedema (n = 7), perioperative hydration measuring (n = 3), and the BIA parameter phase angle as a prognostic factor in cancer survival and as predictive for postoperative complications (n = 6). Of these 16 studies only three used a pure gynaecological study population. Three different methods of BIA were used in these articles: single frequency-BIA, multifrequency-BIA and bioimpedance spectroscopy. BIA was found to detect lymphoedema with a sensitivity of 73% and a specificity of 84%. Studies indicated that BIA was able to detect lower limb lymphoedema at an early stage even before it became clinically detectable. During postoperative hydration measurements, an increase in extracellular fluid volume and extracellular fluid volume in relation to total body fluid volume, as well as a decrease in phase angle, were associated with higher frequencies of postoperative complications. Moreover, low values for the phase angle have been associated with increased mortality in cancer patients. However, the number of studies in this field was limited. From our review, BIA seems to be a useful tool for use in the clinical setting of the gynaecological surgical patient. The theoretical approach of using bioelectrical impedance values to measure the fluid distribution in the body compartments offers wide opportunities in the clinical setting. However, so far, all studies have set up cut-off limits within the study population, and reference values for a general population need to be defined. There are also rather few studies on a gynaecological study population. Hence, there is a need for further studies within gynaecological surgery focusing on early detection of lower limb lymphoedema, perioperative fluid balance, and postoperative complications in order to establish the value of BIA in clinical praxis. (C) 2018 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV, 2018
Keywords
Bioelectrical impedance analysis; Body water; Extracellular fluid; Gynaecological surgery; Lymphoedema; Postoperative complications
National Category
Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:liu:diva-152094 (URN)10.1016/j.ejogrb.2018.06.024 (DOI)000445991800019 ()29933195 (PubMedID)
Note

Funding Agencies|Linkoping University; Region Ostergotland

Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2019-06-28
Borendal Wodlin, N. (2017). Intraoperative cervical treatment does not affect the prevalence of vaginal bleeding 1 year postoperatively after subtotal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery. Acta Obstetricia et Gynecologica Scandinavica, 96(12), 1430-1437
Open this publication in new window or tab >>Intraoperative cervical treatment does not affect the prevalence of vaginal bleeding 1 year postoperatively after subtotal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery
2017 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 12, p. 1430-1437Article in journal (Refereed) Published
Abstract [en]

IntroductionThe objectives were to establish the prevalence of persistent vaginal bleeding following subtotal hysterectomy, to analyze the effect of intraoperative cervical treatment on the occurrence of persistent vaginal bleeding, and to evaluate the impact of persistent vaginal bleeding on the patient-reported opinion concerning result of surgery and medical condition. Material and methodsRetrospective study with data from the Swedish National Register for Gynecological Surgery including 5240 women undergoing subtotal hysterectomy for benign conditions between January 2004 and June 2016. Demographic and clinical data were obtained from the pre- and perioperative forms. Data concerning occurrence of persistent vaginal bleeding, rating of medical condition and contentment with result of surgery were collected from the 1-year inquiry form. Statistical analyses were performed with multivariable logistic regression models. The results are presented as adjusted odd ratios and 95% confidence intervals. ResultsPersistent vaginal bleeding occurred in 18.6%. Intraoperative cervical treatment did not affect the frequency of persistent vaginal bleeding (adjusted odds ratio 1.48; 95% confidence interval 0.93-2.37). More than 90% were satisfied with the result of the hysterectomy, but women with persistent vaginal bleeding were less content compared with those without persistent vaginal bleeding (adjusted odds ratio 0.42; 95% confidence interval 0.26-0.67). The self-perception of the medical condition did not differ between the women with and without persistent vaginal bleeding (adjusted odds ratio 1.16; 95% confidence interval 0.33-4.12). ConclusionsNearly two in ten women may expect persistent vaginal bleeding following subtotal hysterectomy, and cervical treatment intraoperatively did not affect this. More than 90% were satisfied with the result but women with persistent vaginal bleeding were less content. Preoperative information on this risk of persistent vaginal bleeding may be important when choosing hysterectomy technique.

Place, publisher, year, edition, pages
WILEY, 2017
Keywords
Intraoperative cervical treatment; opinion of result of surgery; persistent vaginal bleeding; self-perception of medical condition; subtotal hysterectomy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-143615 (URN)10.1111/aogs.13229 (DOI)000416159200006 ()28865144 (PubMedID)
Note

Funding Agencies|Region Ostergotland

Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2018-04-18
Borendal Wodlin, N., Nilsson, L. & Kjölhede, P. (2014). Snabbspår har fördelar vid elektiv gynekologisk kirurgi.. Läkartidningen, 111(25-26), 2-7
Open this publication in new window or tab >>Snabbspår har fördelar vid elektiv gynekologisk kirurgi.
2014 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 25-26, p. 2-7Article in journal (Refereed) Published
Abstract [sv]

Principerna för snabbspår i samband med elektiv kirurgi har visat sig förbättra och påskynda postoperativ återhämtning.

Snabbspår bygger på en kombination av evidensbaserade åtgärder och förhållningssätt pre-, per- och postoperativt.

Översikten ger stöd för uppfattningen att snabbspår ska användas i samband med elektiv benign gynekologisk kirurgi för att optimera patientens återhämtning.

Trots övertygande evidens behövs ytterligare studier, information och utbildning för att förbättra införandet av principer för snabbspår i samband med gynekologisk kirurgi. 

Engagemang från alla inblandade personalkategorier är avgörande för möjligheten till implementering.

Abstract [en]

Fast-track is a multimodal strategy aimed at achieving an improved and accelerated postoperative recovery. The strategy combines unimodal evidence-based interventions concerning preoperative preparation, peroperative principles and postoperative care. There is substantial evidence for the benefits of following fast-track concepts in general elective surgery to enhance postoperative recovery. The main findings of this review are that there are benefits likewise within elective gynecological surgery, but studies of quality of life, patient satisfaction and health economics are needed. Studies of fast-track within non-elective surgery and gynaecological oncology surgery are lacking. Widespread information and education is needed to improve the rate of implementation of fast-track. Comprehensive involvement of the entire staff dealing with the patient in the perioperative period is crucial to ensure implementation and development of surgical care aiming for enhanced postoperative recovery.

National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-115279 (URN)25072075 (PubMedID)
Available from: 2015-03-12 Created: 2015-03-12 Last updated: 2019-06-28Bibliographically approved
Tjomsland, V., Ellegård, R., Kjölhede, P., Borendal Wodlin, N., Hinkula, J., Lifson, J. & Larsson, M. (2013). Blocking of integrins inhibits HIV-1 infection of human cervical mucosa immune cells with free and complement-opsonized virions. European Journal of Immunology, 43(9), 2361-2372
Open this publication in new window or tab >>Blocking of integrins inhibits HIV-1 infection of human cervical mucosa immune cells with free and complement-opsonized virions
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2013 (English)In: European Journal of Immunology, ISSN 0014-2980, E-ISSN 1521-4141, Vol. 43, no 9, p. 2361-2372Article in journal (Refereed) Published
Abstract [en]

The initial interaction between HIV-1 and the host occurs at the mucosa during sexual intercourse. In cervical mucosa, HIV-1 exists both as free and opsonized virions and this might influence initial infection. We used cervical explants to study HIV-1 transmission, the effects of opsonization on infectivity, and how infection can be prevented. Complement opsonization enhanced HIV-1 infection of dendritic cells (DCs) compared with that by free HIV-1, but this increased infection was not observed with CD4+ T cells. Blockage of the α4-, β7-, and β1-integrins significantly inhibited HIV-1 infection of both DCs and CD4+ T cells. We found a greater impairment of HIV-1 infection in DCs for complement-opsonized virions compared with that of free virions when αM/β2- and α4-integrins were blocked. Blocking the C-type lectin receptor macrophage mannose receptor (MMR) inhibited infection of emigrating DCs but had no effect on CD4+ T-cell infection. We show that blocking of integrins decreases the HIV-1 infection of both mucosal DCs and CD4+ T cells emigrating from the cervical tissues. These findings may provide the basis of novel microbicidal strategies that may help limit or prevent initial infection of the cervical mucosa, thereby reducing or averting systemic HIV-1 infection.

Keywords
CD4+ T cells, Complement system, DCs, HIV, Integrins
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97646 (URN)10.1002/eji.201243257 (DOI)000327819200016 ()23686382 (PubMedID)
Available from: 2013-09-19 Created: 2013-09-19 Last updated: 2019-06-28
Borendal Wodlin, N. & Nilsson, L. (2013). The development of fast-track principles in gynecological surgery. Acta Obstetricia et Gynecologica Scandinavica, 92(1), 17-27
Open this publication in new window or tab >>The development of fast-track principles in gynecological surgery
2013 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 1, p. 17-27Article, review/survey (Refereed) Published
Abstract [en]

Fast-track is a multimodal strategy aimed at reducing the physiological burden of surgery to achieve an enhanced postoperative recovery. The strategy combines unimodal evidence-based interventions in the areas of preoperative preparation, anesthesia, surgical factors and postoperative care. The advantages of fast-track most likely extend to gynecology, although so far have scarcely been reported. This review summarizes current evidence concerning use of fast-track in general and in gynecological surgery. The main findings of this review are that there are benefits within elective gynecological surgery, but studies of quality of life, patient satisfaction and health economics in elective surgery are needed. Studies of fast-track within the field of non-elective gynecological surgery are lacking. Widespread education is needed to improve the rate of implementation of fast-track. Close involvement of the entire surgical team is imperative to ensure a structured perioperative care aiming for enhanced postoperative recovery.

Place, publisher, year, edition, pages
Informa Healthcare / Wiley-Blackwell, 2013
Keywords
anesthesia, enhanced recovery, fast-track, gynecology, postoperative care, preoperative preparation, surgery
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89752 (URN)10.1111/j.1600-0412.2012.01525.x (DOI)000313714500004 ()
Note

Funding Agencies|County Council of Ostergotland||Linkoping University||

Available from: 2013-03-07 Created: 2013-03-05 Last updated: 2017-12-06
Kjölhede, P., Borendal Wodlin, N., Nilsson, L., Fredrikson, M. & Wijma, K. (2012). Impact of stress coping capacity on recovery from abdominal hysterectomy in a fast-track programme: a prospective longitudinal study. British Journal of Obstetrics and Gynecology, 119(8), 998-1007
Open this publication in new window or tab >>Impact of stress coping capacity on recovery from abdominal hysterectomy in a fast-track programme: a prospective longitudinal study
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2012 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, no 8, p. 998-1007Article in journal (Refereed) Published
Abstract [en]

Objective To evaluate the effect of stress coping capacity in combination with mode of anaesthesia on postoperative recovery in fast-track abdominal hysterectomy. Design Prospective longitudinal study. Setting Five hospitals in the south-east of Sweden. Population A cohort of 162 women undergoing fast-track abdominal hysterectomy for benign conditions. Methods Self-administered questionnaires, the Stress Coping Inventory (SCI) and the Swedish Postoperative Symptom Questionnaire (SPSQ), and clinical information were collected prospectively. Stress coping capacity was categorised as high or low according to the summed score of the SCI. Comparisons of effect variables were adjusted using a propensity score-matching model. Main outcome measures Associations between stress coping capacity and hospital stay, sick leave, use of analgesic and self-reported postoperative symptoms. Results Women with high stress coping capacity had a significantly shorter sick leave, experienced postoperative symptoms significantly less often, and with lower intensity, than women with low stress coping capacity. With the exception of symptom intensity, these findings were related to having had the operation under spinal anaesthesia as opposed to general anaesthesia. Hospital stay, use of analgesics and abdominal pain were not related to stress coping capacity. Conclusions In patients for whom spinal anaesthesia was applied, high stress coping seems to be a quality that helps patients manage the burden of surgery. It is desirable for the individual, as well as for the healthcare system, to enhance recovery by using intervention programmes designed to improve or manage stress coping, particularly for individuals with low stress coping capacity. This recommendation merits further investigation.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
Keywords
Abdominal hysterectomy; fast-track; general anaesthesia; spinal anaesthesia; stress coping capacity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79789 (URN)10.1111/j.1471-0528.2012.03342.x (DOI)000305281800013 ()
Available from: 2012-08-17 Created: 2012-08-14 Last updated: 2019-06-28
Kjölhede, P., Langström, P., Nilsson, P., Borendal Wodlin, N. & Nilsson, L. (2012). Quality of sleep the night after surgery, does it matter? A prospective cohort study of women undergoing fast track abdominal hysterectomy in ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, vol 91, issue SI, pp 18-18. In: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA: (pp. 18-18). Informa Healthcare / Wiley-Blackwell, 91(SI)
Open this publication in new window or tab >>Quality of sleep the night after surgery, does it matter? A prospective cohort study of women undergoing fast track abdominal hysterectomy in ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, vol 91, issue SI, pp 18-18
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2012 (English)In: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, Informa Healthcare / Wiley-Blackwell , 2012, Vol. 91, no SI, p. 18-18Conference paper, Published paper (Refereed)
Abstract [en]

n/a

Place, publisher, year, edition, pages
Informa Healthcare / Wiley-Blackwell, 2012
Series
ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, ISSN 0001-6349
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79097 (URN)000304987600016 ()
Available from: 2012-06-29 Created: 2012-06-29 Last updated: 2019-06-28
Nilsson, L., Borendal Wodlin, N. & Kjölhede, P. (2012). Risk factors for postoperative complications after fast-track abdominal hysterectomy. Australian and New Zealand journal of obstetrics and gynaecology, 52(2), 113-120
Open this publication in new window or tab >>Risk factors for postoperative complications after fast-track abdominal hysterectomy
2012 (English)In: Australian and New Zealand journal of obstetrics and gynaecology, ISSN 0004-8666, E-ISSN 1479-828X, Vol. 52, no 2, p. 113-120Article in journal (Refereed) Published
Abstract [en]

Background: Fast-track regimen has been shown to reduce postoperative complications in gastrointestinal surgery. less thanbrgreater than less thanbrgreater thanAims: We investigated the incidence and type of postoperative complications and associated risk factors after benign abdominal hysterectomy undertaken in a fast-track program. less thanbrgreater than less thanbrgreater thanMethods: A prospective longitudinal cohort study. In five Swedish hospitals, a cohort of 162 women, ASA 1-2, undergoing abdominal hysterectomy in a fast-track program was prospectively studied. Surgery was performed under spinal or general anaesthesia. The fast-track concept was standardised with discharge criteria and a restricted intravenous fluid regimen. Complications were systematically registered during the five-week follow-up period. Risk factors for complications were analysed using multiple logistic regression models. less thanbrgreater than less thanbrgreater thanResults: Forty-one (25.3%) developed postoperative complications, mainly infection and wound healing complications. The majority of the complications developed after discharge and were treated in the outpatient clinics. Four women (2.5%) were readmitted to hospital. Substantial risk factors for postoperative complications were obesity (OR 8.83), prior laparotomy (OR 2.92) and relative increase in body weight on the first postoperative day (OR 1.52). less thanbrgreater than less thanbrgreater thanConclusions: Minor infection and wound healing complications seem to be common in healthy women undergoing abdominal hysterectomy in a fast-track program. Obesity is an important risk factor also in fast-track abdominal hysterectomy. A modest increase in postoperative relative weight gain during the first postoperative day seemed to increase the risk of postoperative complications. This factor merits further study. Randomised studies are necessary to determine the impact of fast-track program and perioperative fluid regimens on postoperative complications.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
Keywords
fast track, hysterectomy, postoperative complications, risk factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76946 (URN)10.1111/j.1479-828X.2011.01395.x (DOI)000302233100003 ()
Note

Funding Agencies|Medical Research Council of South East Sweden; Linkoping University||County Council of Ostergotland||

Available from: 2012-05-02 Created: 2012-04-27 Last updated: 2019-06-28
Kjölhede, P., Langström, P., Nilsson, P., Borendal Wodlin, N. & Nilsson, L. (2012). The Impact of Quality of Sleep on Recovery from Fast-Track Abdominal Hysterectomy. Journal of Clinical Sleep Medicine (JCSM), 8(4), 395-402
Open this publication in new window or tab >>The Impact of Quality of Sleep on Recovery from Fast-Track Abdominal Hysterectomy
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2012 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 8, no 4, p. 395-402Article in journal (Refereed) Published
Abstract [en]

Study Objectives: To examine the impact of mode of anesthesia on perceived quality of sleep and to analyze the perceived quality of sleep in affecting recovery from surgery. less thanbrgreater than less thanbrgreater thanMethods: A randomized, controlled, open multicenter trial was conducted in 5 hospitals in Southeast Sweden. One-hundred eighty women scheduled for fast-track abdominal hysterectomy for benign conditions were randomized to spinal anesthesia or general anesthesia; 162 women completed the trial; 82 allocated to spinal anesthesia and 80 to general anesthesia. Symptoms and perceived quality of sleep after surgery were registered daily in the Swedish Postoperative Symptoms Questionnaire. less thanbrgreater than less thanbrgreater thanResults: Women in the general anesthesia group experienced bad quality of sleep the night after surgery significantly more often than the women who had spinal anesthesia (odds ratio [OR] 2.45; p = 0.03). This was almost exclusively attributed to a significantly higher consumption of opioids postoperatively in the general anesthesia group. Risk factors for bad quality of sleep during the first night postoperatively were: opioids (OR 1.07; p = 0.03); rescue antiemetics (OR 2.45; p = 0.05); relative weight gain (OR 1.47; p = 0.04); summary score of postoperative symptoms (OR 1.13; p = 0.02); and stress coping capacity (OR 0.98; p = 0.01). A longer hospital stay was strongly associated with a poorer quality of sleep the first night postoperatively (p = 0.002). less thanbrgreater than less thanbrgreater thanConclusions: The quality of sleep the first night after abdominal hysterectomy is an important factor for recovery. In fast-track abdominal hysterectomy, it seems important to use anesthesia and multimodal analgesia reducing the need for opioids postoperatively and to use strategies that diminish other factors that may interfere negatively with sleep. Efforts to enhance quality of sleep postoperatively by means of preventive measures and treatment of sleep disturbances should be included in fast-track programs.

Place, publisher, year, edition, pages
American Academy of Sleep Medicine, 2012
Keywords
Abdominal hysterectomy, fast track, general anesthesia, quality of sleep, postoperative recovery, spinal anesthesia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-85614 (URN)10.5664/jcsm.2032 (DOI)000310059400009 ()
Note

Funding Agencies|Medical Research Council of South East Sweden||Linkoping University||County Council of Ostergotland||

Available from: 2012-11-26 Created: 2012-11-26 Last updated: 2019-06-28
Borendal Wodlin, N., Nilsson, L., Carlsson, P. & Kjølhede, P. (2011). Cost-effectiveness of general anesthesia versus spinal anesthesia in fast track abdominal benign hysterectomy. American Journal of Obstetrics and Gynecology, 205(4), 043
Open this publication in new window or tab >>Cost-effectiveness of general anesthesia versus spinal anesthesia in fast track abdominal benign hysterectomy
2011 (English)In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 205, no 4, p. 043-Article in journal (Refereed) Published
Abstract [en]

Objective: The study objective was to compare total costs for hospital stay and postoperative recovery for two groups of women who underwent fast track abdominal benign hysterectomy, one group under general anesthesia, the other under spinal anesthesia. Costs were evaluated in relation to health related quality of life.

Study Design: Costs of treatment using data from a randomized multicenter study at five hospitals in Sweden were analyzed retrospectively. Of 180 women scheduled for benign abdominal hysterectomy; 162 were randomized for the study, 80 allocated to general anesthesia and 82 to spinal anesthesia.

Results: Total costs (hospital costs plus costs reduced productivity costs) were lower for the spinal anesthesia group. Women who had spinal anesthesia had a faster recovery measured by health related quality of life and QALYs gained in postoperative month one.

Conclusion: Use of spinal anesthesia for fast track benign abdominal hysterectomy was more cost-effective than general anesthesia.

Place, publisher, year, edition, pages
Elsevier, 2011
Keywords
Cost-effectiveness; Fast track hysterectomy; General anesthesia; Health economy; Spinal anesthesia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70468 (URN)10.1016/j.ajog.2011.05.043 (DOI)000296084600022 ()
Note

Funding agencies|Medical Research Council of South East Sweden||Linkoping University||County Council of Ostergotland||multicenter study group||

Available from: 2011-09-09 Created: 2011-09-09 Last updated: 2019-06-28Bibliographically approved
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