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Zsuzsanna Balla, H., Theodorsson, E. & Ström, J. O. (2019). Evaluation of commercial, wireless dermal thermometers for surrogate measurements of core temperature. Scandinavian Journal of Clinical and Laboratory Investigation
Open this publication in new window or tab >>Evaluation of commercial, wireless dermal thermometers for surrogate measurements of core temperature
2019 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686Article in journal (Refereed) Epub ahead of print
Abstract [en]

Extensive research has been devoted to developing methods for assessing core body temperature, and to determine which method is most accurate. A number of wireless dermal thermometers for home use are presently available, but their relation to core body temperature and suitability for use in clinical research has hitherto not been assessed. The current study aimed to evaluate such thermometers by comparing them to the results of a rectal thermometer. Four wireless dermal thermometers for home use (FeverSmart, iThermonitor, Quest Temp Sitter, and Thermochron iButton) were applied to 15 patients during 24 h, and rectal temperature was measured at four occasions. Pearson correlation revealed moderate correlation for the Feversmart (r = 0.75), iThermonitor (r = 0.79), and Thermochron iButton (r = 0.71) systems. The Quest Temp Sitter system malfunctioned repeatedly, and the correlation (r = 0.29) for this method should therefore be assessed with caution. All dermal thermometers rendered lower average temperatures than Terumo c405 (Feversmart -0.70 ± 0.65 °C; iThermonitor -0.77 ± 0.53 °C, Quest Temp Sitter -1.18 ± 0.66 °C, and Thermochron iButton -0.87 ± 0.65 °C). Sensitivity of the dermal thermometers for detecting core temperatures ≥38.0 °C was low, ranging from 0.33 to 0.6, but improved to 0.60 to 0.80 after adjusting temperatures by the methods' average deviation from rectal temperature. The results from the dermal thermometers tested here showed an insufficient correlation to core temperature to be used for core temperature monitoring in clinical research and practice. Unfortunately, other options for non-invasive temperature measurements are few. The two thermometers with the least unsatisfactory performance profile in our evaluations were the Feversmart and iThermonitor systems.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Body temperature elevation, fever, methodology, thermometer
National Category
Biomedical Laboratory Science/Technology
Identifiers
urn:nbn:se:oru:diva-73246 (URN)10.1080/00365513.2018.1519722 (DOI)30882250 (PubMedID)
Available from: 2019-03-20 Created: 2019-03-20 Last updated: 2019-03-20Bibliographically approved
Ingberg, E., Dock, H., Theodorsson, E., Theodorsson, A. & Ström, J. O. (2018). Effect of laser Doppler flowmetry and occlusion time on outcome variability and mortality in rat middle cerebral artery occlusion: inconclusive results. BMC neuroscience (Online), 19(1), Article ID 24.
Open this publication in new window or tab >>Effect of laser Doppler flowmetry and occlusion time on outcome variability and mortality in rat middle cerebral artery occlusion: inconclusive results
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2018 (English)In: BMC neuroscience (Online), ISSN 1471-2202, E-ISSN 1471-2202, Vol. 19, no 1, article id 24Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Stroke is among the leading causes of death and disability. Although intense research efforts have provided promising treatment options in animals, most clinical trials in humans have failed and the therapeutic options are few. Several factors have been suggested to explain this translational difficulty, particularly concerning methodology and study design. Consistent infarcts and low mortality might be desirable in some, but not all, studies. Here, we aimed to investigate whether the use of laser Doppler flowmetry (LDF) and the occlusion time (60 vs. 45 min) affected outcome variability and mortality in a rat stroke model. Eighty ovariectomized female Wistar rats were subjected to ischemic stroke using intraluminal filament middle cerebral artery occlusion with or without LDF and with occlusion times of 45 or 60 min. Outcome was evaluated by triphenyl tetrazolium chloride staining of brain slices to measure infarct size and a modified sticky tape test.

RESULTS: Neither LDF nor occlusion times of 45 versus 60 min significantly affected mortality, outcome variability or outcome severity.

CONCLUSIONS: Due to the unexpectedly high mortality and variability the statistical power was very low and thus the results were inconclusive.

Place, publisher, year, edition, pages
London: BioMed Central, 2018
Keywords
Rats, Middle cerebral artery occlusion, Ischemic stroke, Laser Doppler flowmetry, Mortality, Variability
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-66707 (URN)10.1186/s12868-018-0425-0 (DOI)000431072000001 ()29673328 (PubMedID)2-s2.0-85045563309 (Scopus ID)
Available from: 2018-04-23 Created: 2018-04-23 Last updated: 2018-05-14Bibliographically approved
David, F., Ingberg, E., Elvar, T. & Ström, J. O. (2018). Lack of association in acne and salivary testosterone. Journal of controversies in biomedical research, 4(1)
Open this publication in new window or tab >>Lack of association in acne and salivary testosterone
2018 (English)In: Journal of controversies in biomedical research, ISSN 2205-5975, Vol. 4, no 1Article in journal (Refereed) Published
Abstract [en]

The pathogenesis of acne vulgaris has only been partially elucidated. Various hormones, especially androgens, are likely to play a role, but results of studies are still inconclusive. The objective of the current study was to investigate whether day to day variation in salivary testosterone correlates with acne in males. Saliva samples were collected for 120 consecutive days from each of the 40 males. Salivary testosterone concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Facial acne lesions were assessed on a daily basis by photography by the participating males. Potential confounders’ (sexual intercourse, masturbation, physical exercise and disease) were also registered every day by the participants. A significant but weak association between salivary testosterone and acne was found (n = 4602, r = 0.031, P = 0.034). Elevated testosterone concentrations were associated with an increase in acne, but when testosterone concentrations were above twice the individual average, acne lesions paradoxically decreased. The current results indicate that daily fluctuations in salivary testosterone levels in males are associated with acne patterns, but the weak correlation suggests that the effect is too small to be of clinical significance. The analysis in the current study was complicated by a large number of days on which the participants had no acne, as well as the seemingly non-monotonic relation between testosterone and acne. This may indicate that the actual relation is stronger than concluded here.

Place, publisher, year, edition, pages
Codon Publications, 2018
Keywords
testosterone, acne, saliva
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:oru:diva-70170 (URN)10.15586/jcbmr.2018.25 (DOI)
Available from: 2018-11-14 Created: 2018-11-14 Last updated: 2019-02-11Bibliographically approved
Ström, J. O., Ingberg, E., Slezak, J. K., Theodorsson, A. & Theodorsson, E. (2018). Male Testosterone Does Not Adapt to the Partner's Menstrual Cycle. Journal of Sexual Medicine, 15(8), 1103-1110
Open this publication in new window or tab >>Male Testosterone Does Not Adapt to the Partner's Menstrual Cycle
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2018 (English)In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 15, no 8, p. 1103-1110Article in journal (Refereed) Published
Abstract [en]

Background: It has not yet been established whether men in heterosexual relationships adapt their hormone levels to their female partner's menstrual cycle to allocate reproductive resources to the period when the female is actually fertile.

Aim: This prospective observational study tested the hypothesis that some males have peaks in testosterone or acne (a possible biomarker for androgen activity) near their partners' ovulation, whereas other males display the opposite pattern.

Methods: 48 couples supplied menstrual cycle data, male salivary samples, and a protocol of daily activities for 120 days. Daily saliva samples were analyzed for testosterone concentrations by enzyme-linked immunosorbent assay. The main hypothesis was tested by analyzing whether each individual male's testosterone/acne response to ovulation (either an increase or a decrease in comparison to the individual's average levels) was stable over time. To do this, we analyzed the Spearman correlation between individually normalized periovulatory testosterone and acne during the first half of the study versus the second half of the study.

Outcomes: Correlation between each male individual's periovulatory testosterone and acne patterns during the first half of the study versus the second half of the study.

Results: No predictability in the male individuals' testosterone (Spearman's rho = -0.018, P = .905) or acne (Spearman's rho = -0.036, P = .862) levels during ovulation was found.

Clinical translation: The study being "negative," there is no obvious translational potential in the results.

Strengths and limitations: The main strength of this study lies in the excellent compliance of the study participants and the large number of sampling timepoints over several menstrual cycles, thereby allowing each male individual to be his own control subject. A limitation is that samples were only obtained in the morning; however, including later timepoints would have introduced a number of confounders and would also have hampered the study's feasibility.

Conclusions: The current results strongly indicate that male morning testosterone levels neither increase nor decrease in response to the partner's ovulation. This discordance to previous laboratory studies could indicate either that (i) the phenomenon of hormonal adaptation of men to women does not exist and earlier experimental studies should be questioned, (ii) that the phenomenon is short-lived/acute and wanes if the exposure is sustained, or (iii) that the male testosterone response may be directed toward other women than the partner. Copyright (C) 2018, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Acne, Menstrual cycle, Ovulation, Reproduction, Saliva, Testosterone
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-69101 (URN)10.1016/j.jsxm.2018.06.003 (DOI)000444630400007 ()30078462 (PubMedID)2-s2.0-85050874193 (Scopus ID)
Note

Funding Agencies:

Linköping University  

Region Östergötland  

Örebro University  

Region Örebro län  

Forskningskommitten

Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2018-10-01Bibliographically approved
Wästfelt, M., Cao, Y. & Ström, J. O. (2018). Predictors of post-stroke fever and infections: a systematic review and meta-analysis. BMC Neurology, 18, Article ID 49.
Open this publication in new window or tab >>Predictors of post-stroke fever and infections: a systematic review and meta-analysis
2018 (English)In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 18, article id 49Article, review/survey (Refereed) Published
Abstract [en]

Background: Fever after stroke is common, and often caused by infections. In the current study, we aimed to test the hypothesis that pneumonia, urinary tract infection and all-cause fever (thought to include at least some proportion of endogenous fever) have different predicting factors, since they differ regarding etiology.

Methods: PubMed was searched systematically for articles describing predictors for post-stroke pneumonia, urinary tract infection and all-cause fever. A total of 5294 articles were manually assessed; first by title, then by abstract and finally by full text. Data was extracted from each study, and for variables reported in 3 or more articles, a meta-analysis was performed using a random effects model.

Results: Fifty-nine articles met the inclusion criteria. It was found that post stroke pneumonia is predicted by age OR 1.07 (1.04-1.11), male sex OR 1.42 (1.17-1.74), National Institutes of Health Stroke Scale (NIHSS) OR 1.07 (1.05-1.09), dysphagia OR 3.53 (2.69-4.64), nasogastric tube OR 5.29 (3.01-9.32), diabetes OR 1.15 (1.08-1.23), mechanical ventilation OR 4.65 (2.50-8.65), smoking OR 1.16 (1.08-1.26), Chronic Obstructive Pulmonary Disease (COPD) OR 4.48 (1.82-11.00) and atrial fibrillation OR 1.37 (1.22-1.55). An opposite relation to sex may exist for UTI, which seems to be more common in women.

Conclusions: The lack of studies simultaneously studying a wide range of predictors for UTI or all-cause fever calls for future research in this area. The importance of new research would be to improve our understanding of fever complications to facilitate greater vigilance, monitoring, prevention, diagnosis and treatment.

Place, publisher, year, edition, pages
BioMed Central, 2018
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-66926 (URN)10.1186/s12883-018-1046-z (DOI)000431077600003 ()29685118 (PubMedID)2-s2.0-85045749509 (Scopus ID)
Note

Funding Agency:

Region Örebro län

Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-09-04Bibliographically approved
Andersson, C. R., Bergquist, J., Theodorsson, E. & Ström, J. O. (2017). Comparisons between commercial salivary testosterone enzyme-linked immunosorbent assay kits. Scandinavian Journal of Clinical and Laboratory Investigation, 77(8), 582-586
Open this publication in new window or tab >>Comparisons between commercial salivary testosterone enzyme-linked immunosorbent assay kits
2017 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 77, no 8, p. 582-586Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Measuring testosterone concentrations is of interest both in clinical situations and for research, the latter expanding rapidly during recent years. An increased demand for convenient methods has prompted a number of companies to develop enzyme-linked immunosorbent assay (ELISA) kits to measure testosterone concentrations in saliva. However, the inter-comparability of kits from different manufacturers have yet to be determined.

AIM OF STUDY: The aim of this study was to compare commercially available ELISA kits from four different manufacturers (Salimetrics, IBL, DRG and Demeditec).

METHODS: Saliva was collected from 50 participants (25 men and 25 women). Each sample was analysed by the four ELISA kits.

RESULTS: The correlations between the ELISA kits from Demeditec, DRG and Salimetrics were moderate to high with r-values > .77; however, proportional errors between the methods calls for caution. The ELISA kit from IBL malfunctioned and no results from this kit was obtained.

CONCLUSIONS: Results from studies using the ELISA kits from Demeditec, DRG and Salimetrics are generally comparable; however, translation using the formulae presented in the current study could increase the accuracy of these comparisons.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Androgens, immunoassay, methods, saliva, testosterone
National Category
Biomedical Laboratory Science/Technology
Identifiers
urn:nbn:se:oru:diva-63057 (URN)10.1080/00365513.2017.1339231 (DOI)000416756100004 ()28644096 (PubMedID)2-s2.0-85021199706 (Scopus ID)
Funder
Swedish Research Council, SRC 2015-4870
Note

Funding Agencies:

Linköping University  

Östergötland County  

Örebro University  

Region Örebro län  

Forskningskommitten 

Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2018-08-13Bibliographically approved
Ivars, K., Nelson, N., Theodorsson, A., Theodorsson, E., Ström, J. O. & Morelius, E. (2017). Development of salivary cortisol circadian rhythm in preterm infants. PLoS ONE, 12(8), Article ID e0182685.
Open this publication in new window or tab >>Development of salivary cortisol circadian rhythm in preterm infants
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 8, article id e0182685Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate at what age preterm infants develop a salivary cortisol circadian rhythm and identify whether it is dependent on gestational age and/or postnatal age. To evaluate whether salivary cortisol circadian rhythm development is related to behavioral regularity. To elucidate salivary cortisol levels in preterm infants during the first year of life.

Methods: This prospective, longitudinal study included 51 preterm infants. 130 healthy full-term infants served as controls. Monthly salivary cortisol levels were obtained in the morning (07:30-09:30), at noon (10:00-12:00), and in the evening (19:30-21:30), beginning at gestational age week 28-32 and continuing until twelve months corrected age. Behavioral regularity was studied using the Baby Behavior Questionnaire.

Results: A salivary cortisol circadian rhythm was established by one month corrected age and persisted throughout the first year. The preterm infants showed a cortisol pattern increasingly more alike the full-term infants as the first year progressed. The preterm infants increase in behavioral regularity with age but no correlation was found between the development of salivary cortisol circadian rhythm and the development of behavior regularity. The time to establish salivary cortisol circadian rhythm differed between preterm and full-term infants according to postnatal age (p = 0.001) and was dependent on gestational age. Monthly salivary cortisol levels for preterm infants from birth until twelve months are presented. Additional findings were that topical corticosteroid medication was associated with higher concentrations of salivary cortisol (p = 0.02) and establishment of salivary cortisol circadian rhythm occurred later in infants treated with topical corticosteroid medication (p = 0.02).

Conclusions: Salivary cortisol circadian rhythm is established by one month corrected age in preterm infants. Establishment of salivary cortisol circadian rhythm is related to gestational age rather than to postnatal age. Salivary cortisol circadian rhythm development is not related to behavioral regularity.

Place, publisher, year, edition, pages
Public Library of Science, 2017
National Category
Pediatrics
Identifiers
urn:nbn:se:oru:diva-59419 (URN)10.1371/journal.pone.0182685 (DOI)000407396200081 ()28797126 (PubMedID)2-s2.0-85027284317 (Scopus ID)
Note

Funding Agencies:

Medical Research Council of Southeast Sweden, FORSS  FORSS-8396  FORSS-12268  FORSS-37391  FORSS-78011 

County Council of Östergötland, Sweden 

Available from: 2017-08-30 Created: 2017-08-30 Last updated: 2018-09-14Bibliographically approved
Appelros, P., Háls Berglund, M. & Ström, J. O. (2017). Long-Term Risk of Stroke after Transient Ischemic Attack. Cerebrovascular Diseases, 43(1-2), 25-30
Open this publication in new window or tab >>Long-Term Risk of Stroke after Transient Ischemic Attack
2017 (English)In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 43, no 1-2, p. 25-30Article in journal (Refereed) Published
Abstract [en]

Background: In the absence of active management, the stroke risk after a transient ischemic attack (TIA) may be high. Almost 10 years ago, the results of the EXPRESS and SOS-TIA studies called for a more rapid management of TIA patients. The purpose of this study was to investigate the other stroke risks in the longer term, after the implementation of a more active approach to TIA. We also wanted to assess the predictive value of the ABCD2 score in this context.

Methods: Riksstroke is the national stroke registry in Sweden. Data from Riksstroke's TIA module, and the national cause-of-death register, for the years 2011 and 2012 were used in this study. Stroke occurrence was monitored via Riksstroke. Cox's regression was used for risk evaluation. The predictive value of the ABCD2 score was assessed by calculating the area under the receiver operating characteristics curve.

Results: A total of 15,068 TIA episodes occurred in 14,102 patients. The follow-up time varied between 0 and 819 days, with an average of 417 days. The mortality for all TIA patients during the follow-up time was 7.1%. Of the unique patients, 545 had one or more strokes (3.9%), corresponding to 34 events per 1,000 person years. Significant risk factors for stroke were: age, previous TIA, atrial fibrillation (AF), oral anticoagulant (OAC) treatment, hypertension treatment, and the ABCD2 items speech impairment, unilateral weakness, and diabetes mellitus. The ABCD2 score correlated with a subsequent stroke, but its predictive value was low.

Conclusion: The risk of stroke is low after the acute phase of a TIA, probably lower than in previous studies. This may be due to better secondary prevention in recent years. Several risk factors predict stroke, notably hypertensive treatment, which may be inadequate; and AF, where OACs may be under-used. It is difficult to identify the role of the ABCD2 score in clinical practice.

Place, publisher, year, edition, pages
Basel, Switzerland: S. Karger, 2017
Keywords
Transient ischemic attack; Stroke risk assessment; Stroke risk factors
National Category
Cardiac and Cardiovascular Systems Neurology
Identifiers
urn:nbn:se:oru:diva-53250 (URN)10.1159/000451061 (DOI)000394585600005 ()27750222 (PubMedID)2-s2.0-84991769367 (Scopus ID)
Available from: 2016-10-25 Created: 2016-10-24 Last updated: 2018-07-27Bibliographically approved
Ruborg, R., Gunnarsson, K. & Ström, J. O. (2017). Predictors of post-stroke body temperature elevation. BMC Neurology, 17, Article ID 218.
Open this publication in new window or tab >>Predictors of post-stroke body temperature elevation
2017 (English)In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 17, article id 218Article in journal (Refereed) Published
Abstract [en]

Background: Growing evidence indicates that elevated body temperature after stroke is associated with unfavorable outcome. The aim of the current study was to investigate which factors predict temperature elevation within 48 h of stroke onset. Specifically, we hypothesized that temperature elevation would be associated with stroke symptom severity and that hemorrhagic stroke would cause a more pronounced temperature increase compared to ischemic stroke.

Methods: The medical records of 400 stroke patients were retrospectively reviewed. Multiple linear regression analysis was used to determine which factors were associated with elevated body temperature.

Results: Several factors were significantly associated with peak body temperature (the highest recorded body temperature) within 48 h of stroke onset: stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS) (regression coefficient; (RC) 0.022), female gender (RC 0.157), tympanic/non-rectal temperature reading (RC -0.265), swallowing difficulties (RC 0.335), intubation (RC 0.470), antipyretic treatment (RC 0.563), and C-reactive protein > 50 or signs of infection at admission (RC 0.298). Contrary to our expectations, patients with intracerebral hemorrhage did not have higher peak body temperatures than patients with ischemic stroke.

Conclusions: In conclusion, temperature elevation within the first 48 h of stroke onset is common, can be partially predicted using information at admission and is strongly associated with stroke severity. The strong association with stroke severity may, at least partly, explain the previously described association between post-stroke temperature elevation and unfavorable outcome.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Stroke, Fever, Body temperature, Infection
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-63818 (URN)10.1186/s12883-017-1002-3 (DOI)000418170700002 ()29237408 (PubMedID)2-s2.0-85038083143 (Scopus ID)
Note

Funding Agency:

Örebro County Council (Region Örebro län)

Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-08-13Bibliographically approved
Slezak, J. K., Ström, J. O. & Theodorsson, E. (2017). Testosterone-like immunoreactivity in hair measured in minute sample amounts - a competitive radioimmunoassay with an adequate limit of detection. Scientific Reports, 7, Article ID 17636.
Open this publication in new window or tab >>Testosterone-like immunoreactivity in hair measured in minute sample amounts - a competitive radioimmunoassay with an adequate limit of detection
2017 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 7, article id 17636Article in journal (Refereed) Published
Abstract [en]

The concentrations of testosterone deposited in hair during hair growth may provide a retrospective reflection of the concentrations of bioactive testosterone in plasma. The objective of this study was to develop a radioimmunoassay with a sufficiently low limit of detection to measure the testosterone-like immunoreactivity in smaller hair samples (5 mg) than used in earlier studies, and to compare three different extraction procedures. The competitive radioimmunoassay consisted of a polyclonal antiserum (immunogen testosterone-7 alpha-BSA) and a radioligand synthesised from testosterone-3-CMO-histamine. The within-assay and total coefficients of variation in the working range was 3% and 4.5%, respectively. The limit of detection was 0.87 pg/mL, which is equivalent to 0.12 pg/mg testosterone in 5 mg of hair. The concentration of testosterone-like immunoreactivity in hair samples was 1.23 (SD 0.47) pg/mg in women and 2.67 (SD 0.58) pg/mg in men (pulverised hair). Significantly improved precision was found when pulverised hair was used compared to non-pulverised hair. Our data indicate that pulverisation of the hair prior to hormone extraction is crucial. Detection limits fit for the intended purpose are achievable with 5 mg samples of hair.

Place, publisher, year, edition, pages
Nature Publishing Group, 2017
National Category
Analytical Chemistry Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-63817 (URN)10.1038/s41598-017-17930-w (DOI)000418250800021 ()29247184 (PubMedID)2-s2.0-85038244979 (Scopus ID)
Note

Funding Agency:

County Council of Östergötland

Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-08-13Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-6681-0546

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