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Danielsson, T., Schreyer, H., Woksepp, H., Johansson, T., Bergman, P., Månsson, A. & Carlsson, J. (2019). Two-peaked increase of serum myosin heavy chain-α after triathlon suggests heart muscle cell death. BMJ Open Sport & Exercise Medicine, 5, Article ID e000486.
Open this publication in new window or tab >>Two-peaked increase of serum myosin heavy chain-α after triathlon suggests heart muscle cell death
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2019 (English)In: BMJ Open Sport & Exercise Medicine, ISSN 2055-7647, Vol. 5, article id e000486Article in journal (Refereed) Published
Abstract [en]

Objective It has been suggested that the mechanism behind cardiac troponin elevation after strenuous exercise is passage through a cell membrane with changed permeability rather than myocardial cell death. We hypothesised that an increase of cardiac specific myosin heavy chain-alpha (MHC-α; 224 kDa compared with cardiac troponin T’s (cTnT) 37 kDa) could hardly be explained by passage through a cell membrane.

Methods Blood samples were collected from 56 athletes (15 female, age 42.5±9.7, range 24–70 years) before, directly after and on days 1–8 after an Ironman. Biomarkers (C reactive protein (CRP), cTnT, creatinekinase (CK), MHC-α, myoglobin (MG), creatinine (C) and N-terminal prohormone of brain natriuretic peptide (NTproBNP) were measured.

Results The course of MHC-α concentration (μg/L) was 1.33±0.53 (before), 2.57±0.78 (directly after), 1.51±0.53 (day 1), 2.74±0.55 (day 4) and 1.83±0.76 (day 6). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ±80 ng/L (12–440; reference<15), NT-proBNP 776±684 ng/L (92–4700; ref.<300), CK 68±55 μkat/L (5–280; ref.<1.9), MG 2088±2350 μg/L (130–17 000; ref.<72) and creatinine 100±20 μmol/L (74–161; ref.<100), CRP 49±23 mg/L(15–119; ref.<5).

Conclusion MHC-α exhibited a two-peaked increase which could represent a first release from the cytosolic pool and later from cell necrosis. This is the first investigation of MHC-α plasma concentration afterexercise.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Sport and Fitness Sciences
Research subject
Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-79922 (URN)10.1136/ bmjsem-2018-000486 (DOI)
Available from: 2019-01-25 Created: 2019-01-25 Last updated: 2019-01-28Bibliographically approved
Danielsson, T., Schreyer, H., Woksepp, H., Johansson, T., Bergman, P., Månsson, A. & Carlsson, J. (2019). Two-peaked increase of serum myosin heavy chain-α after triathlon suggests heart muscle cell death. BMJ open sport & exercise medicine, 5(1), Article ID e000486.
Open this publication in new window or tab >>Two-peaked increase of serum myosin heavy chain-α after triathlon suggests heart muscle cell death
Show others...
2019 (English)In: BMJ open sport & exercise medicine, ISSN 2055-7647, Vol. 5, no 1, article id e000486Article in journal (Refereed) Published
Abstract [en]

Objective: It has been suggested that the mechanism behind cardiac troponin elevation after strenuous exercise is passage through a cell membrane with changed permeability rather than myocardial cell death. We hypothesised that an increase of cardiac specific myosin heavy chain-alpha (MHC-α; 224 kDa compared with cardiac troponin T's (cTnT) 37 kDa) could hardly be explained by passage through a cell membrane.

Methods: Blood samples were collected from 56 athletes (15 female, age 42.5±9.7, range 24-70 years) before, directly after and on days 1-8 after an Ironman. Biomarkers (C reactive protein (CRP), cTnT, creatine kinase (CK), MHC-α, myoglobin (MG), creatinine (C) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were measured.

Results: The course of MHC-α concentration (µg/L) was 1.33±0.53 (before), 2.57±0.78 (directly after), 1.51±0.53 (day 1), 2.74±0.55 (day 4) and 1.83±0.76 (day 6). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ± 80 ng/L (12-440; reference<15), NT-proBNP 776±684 ng/L (92-4700; ref.<300), CK 68±55 µkat/L (5-280; ref.<1.9), MG 2088±2350 µg/L (130-17 000; ref.<72) and creatinine 100±20 µmol/L (74-161; ref.<100), CRP 49±23 mg/L (15-119; ref.<5).

Conclusion: MHC-α exhibited a two-peaked increase which could represent a first release from the cytosolic pool and later from cell necrosis. This is the first investigation of MHC-α plasma concentration after exercise.

Keywords
cardiovascular medicine, physiology, sports and exercise medicine
National Category
Cardiac and Cardiovascular Systems
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-80495 (URN)10.1136/bmjsem-2018-000486 (DOI)30740234 (PubMedID)
Projects
Iron(Wo)man
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-02-18Bibliographically approved
Bergman, P. (2018). Dags att omvärdera stillasittandet. Läkartidningen, 115, Article ID E9WD.
Open this publication in new window or tab >>Dags att omvärdera stillasittandet
2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id E9WDArticle in journal (Other (popular science, discussion, etc.)) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-77024 (URN)
Available from: 2018-07-29 Created: 2018-07-29 Last updated: 2019-02-12Bibliographically approved
Carlsson, J., Danielsson, T., Bergman, P. & Schreyer, H. (2018). Echocardiographic Findings and Cardiac Biomarkers in Non-Elite Triathletes – Data from the Kalmar Ironwoman Study. In: : . Paper presented at 23rd Annual Congress of the European College of Sport Science, "Sport Science at the cutting edge", 4-7 july 2018, Dublin, Ireland.
Open this publication in new window or tab >>Echocardiographic Findings and Cardiac Biomarkers in Non-Elite Triathletes – Data from the Kalmar Ironwoman Study
2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

INTRODUCTION: There is an ongoing debate about the impact of endurance exercise on cardiovascular health. Not at least data on cardiac biomarker changes (e.g. troponin T (cTnT), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and cardiac specific myosin heavy chain-alpha (MHC-α) have raised questions about exercise related cardiac injury. METHODS: In 52 non-elite athletes (14 female, 38 male; age 41.1 ± 9.7, range 24-70 years; all completed the race) biomarkers were measured by standard laboratory methods 7 days before, directly after, and day 1, 4 and 6 after a full Ironman distance triathlon (Swim 3.9 km, Bike 180 km, Run 42.2 km) . In 19 of these athletes (9 female, 10 male) echocardiography with 30 different standard measurements was performed before and directly after the race. RESULTS: Only MHC-α [µg/L] showed a two-peaked increase directly after (2.57 ± 0.78) and on day 4 (2.74 ± 0.55). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ± 80 ng/L (12-440; reference <15), NT-proBNP 776 ± 684 ng/L (92-4700; ref. < 300), CK 68 ± 55 µkat/L (5-280; ref. < 1.9), MG 2088 ± 2350 µg/L (130-17000; ref.< 72), and creatinine 100 ± 20 µmol/L (74-161; ref. < 100), CRP 49 ± 23 mg/L (15-119; ref.< 5). No significant echocardiographic changes were recorded. E.g. left ventricular end diastolic diameter (49.0 ± 4.7 mm before, 47.7 ± 5.0 mm after the race, right ventricular end diastolic diameter (34.3 ± 4.3 mm before, 33.3 ± 5.7 mm after the race), right atrial area (17.5 ± 2.9 cm2 before, 17.7 ± 3.6 cm2 after the race) and left atrial area (18.8 ± 3.7 cm2 before, 17.8 ± 2.2 cm2 after the race) did not show any significant acute changes. CONCLUSION: While an Ironman leads to remarkable disturbances in biomarkers as e.g. cTnT after the race was in the range of myocardial infarction in 100% of women and 97% of men, these alterations were not correlated to any acute echocardiographic changes in heart size or function. However, the significance of biochemical evidence of cardiac injury on long-term heart function and cardiovascular health remains unclear.

National Category
Cardiac and Cardiovascular Systems Sport and Fitness Sciences
Research subject
Natural Science, Medicine; Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-77240 (URN)
Conference
23rd Annual Congress of the European College of Sport Science, "Sport Science at the cutting edge", 4-7 july 2018, Dublin, Ireland
Available from: 2018-08-23 Created: 2018-08-23 Last updated: 2019-02-22Bibliographically approved
Andersson, M. (2018). Kompressionskläder ger ingen medicinsk effekt. Barometern (September), pp. 4-5
Open this publication in new window or tab >>Kompressionskläder ger ingen medicinsk effekt
2018 (Swedish)In: Barometern, ISSN 1103-906X, no September, p. 4-5Article in journal, News item (Other (popular science, discussion, etc.)) Published
Place, publisher, year, edition, pages
Kalmar: Barometern-OT AB, 2018
National Category
Sport and Fitness Sciences
Research subject
Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-79173 (URN)
Available from: 2018-12-13 Created: 2018-12-13 Last updated: 2018-12-13Bibliographically approved
Ahnesjö, J. & Bergman, P. (2018). Outdoor Exercise is More Efficient than Indoor Exercise in Senior Citizens. Physiological Evidence from the HERO Project. In: : . Paper presented at 23rd Annual Congress of the European College of Sport Science, "Sport Science at the cutting edge", 4-7 july 2018, Dublin, Ireland.
Open this publication in new window or tab >>Outdoor Exercise is More Efficient than Indoor Exercise in Senior Citizens. Physiological Evidence from the HERO Project
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

INTRODUCTION: IntroductionPhysical exercise has been proven beneficial for health in all ages. In elderly, physical exercise, may contribute to prolonged life with maintained high quality and less costs associated with health care for society. In this study we explore if exercise out of doors may provide extra benefits as compared to exercise indoors and we measure power output, lactate levels and perceived effort in 49 senior citizens performing 20 minutes of moderate physical activity.METHODS:MethodThe HERO project is a randomized cross-over experiment with three different treatments <indoors, simulated="" outdoors="" and="">. The study sample consisted of 49 healthy senior citizens. They performed 20 minutes moderate intensity physical activity on an ergometer bike in all three conditions. Before immediately after and at minutes 10, 20, 30, 60 and 120 we sampled blood lactate. Power output was computed at 7 occasions during the 20 minutes of cycling, as was the rating of perceived exertion . Data was analyzed using mixed linear models. RESULTS:ResultsOur findings show that there were no differences between the two indoor treatments in any of the measured variables. In the outdoor treatment, however, there were significant effects on blood lactate levels and power output but not in perceived exertion, suggesting that exercise out of doors makes the test person more efficient although the experience of effort stay unaffected.CONCLUSION:Discussion/conclusionsOur results support the notion that the outdoors may provide extraordinary conditions for exercise, not only because it appear to results in more exercise/effort, the outdoors is also an “arena” with high availability and most often totally for free. Previous results from the HERO project also suggests that white blood cell counts are affected by the outdoor treatment, something that may be related to the observed increased power output herein

National Category
Sport and Fitness Sciences
Research subject
Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-77200 (URN)
Conference
23rd Annual Congress of the European College of Sport Science, "Sport Science at the cutting edge", 4-7 july 2018, Dublin, Ireland
Funder
The Kamprad Family Foundation, 20132082
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2019-02-22Bibliographically approved
Danielsson, T., Carlsson, J., Bergman, P. & Ahnesjö, J. (2018). Peak oxygen uptake predicts finishing- and segment time in a full distance Ironman. In: Presented at the 23rd annual Congress of the European College of Sport Science (ECSS), Dublin, Ireland, July 4-7, 2018: . Paper presented at 23rd annual Congress of the European College of Sport Science (ECSS), Dublin, Ireland, July 4-7, 2018.
Open this publication in new window or tab >>Peak oxygen uptake predicts finishing- and segment time in a full distance Ironman
2018 (English)In: Presented at the 23rd annual Congress of the European College of Sport Science (ECSS), Dublin, Ireland, July 4-7, 2018, 2018Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

INTRODUCTION: Ironman competitions and other extreme endurance events has spread worldwide attracting thousands of endurance-trained athletes, athletes who differ in anthropometric and training characteristics. The relationship between peak oxygen uptake and finishing- and segment time during a full distance IRONMAN competition (Swim 3.9km, Bike 180km and Run 42.2km) has not been examined thoroughly in non-elite athletes.

PURPOSE: The aim of the present study was to investigate the relationship between peak oxygen uptake (VO2peak), finishing time and segment time in non-elite athletes.

METHODS: 39 non-elite athletes (10 female; age 41.1 ± 9.7, range 24-70 years) performed a 20 m shuttle run test to assess VO2peak. Association between VO2 and finishing- and segment time was estimated using bivariate correlation tests. Gender specific analysis was also performed.

RESULTS: VO2peak peak was on average 49.9 ± 6.4 O2 ml/kg/minute, range 36.5-63.9 (pooled genders). Finishing time was on average 11h and 52 min. The average times for the different segments were; Swim 1h 21m, Bike 5h 46min and Run 4h 33min. The relationship between VO2peak and finishing time was significant to p<0.001 and                         0.51. The relationship between segment times were Swim  0.19, Bike  0.37 and Run  0.46 all at p<0.001. Gender specific analyses revealed that the association between VO2peak and finishing time was   0.80 for females and  0.49 for males. 

CONCLUSION: Our results suggest that VO2peak is a good predictor of finishing time (approx. 50%) as well as for segment time with 19%, 37% and 46% for Swim, Bike and Run respectively (pooled genders). For females VO2peak explains as much as 80% of the variation in finishing time.

National Category
Sport and Fitness Sciences
Research subject
Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-77097 (URN)
Conference
23rd annual Congress of the European College of Sport Science (ECSS), Dublin, Ireland, July 4-7, 2018
Projects
IRON(WO)MAN
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-02-22Bibliographically approved
Jönsson, T., Ekvall Hansson, E., Thorstensson, C. A., Eek, F., Bergman, P. & Dahlberg, L. E. (2018). The effect of education and supervised exercise on physical activity, pain, quality of life and self-efficacy - an intervention study with a reference group.. BMC Musculoskeletal Disorders, 19(1), Article ID 198.
Open this publication in new window or tab >>The effect of education and supervised exercise on physical activity, pain, quality of life and self-efficacy - an intervention study with a reference group.
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2018 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 19, no 1, article id 198Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Individuals with knee and hip osteoarthritis (OA) are less physically active than people in general, and many of these individuals have adopted a sedentary lifestyle. In this study we evaluate the outcome of education and supervised exercise on the level of physical activity in individuals with knee or hip OA. We also evaluate the effect on pain, quality of life and self-efficacy.

METHODS: Of the 264 included individuals with knee or hip OA, 195 were allocated to the intervention group. The intervention group received education and supervised exercise that comprised information delivered by a physiotherapist and individually adapted exercises. The reference group consisted of 69 individuals with knee or hip OA awaiting joint replacement and receiving standard care. The primary outcome was physical activity (as measured with an accelerometer). The secondary outcomes were pain (Visual Analog Scale), quality of life (EQ-5D), and self-efficacy (Arthritis Self-Efficacy Scale, pain and other symptoms subscales). Participants in both groups were evaluated at baseline and after 3 months. The intervention group was also evaluated after 12 months.

RESULTS: No differences were found in the number of minutes spent in sedentary or in physical activity between the intervention and reference groups when comparing the baseline and 3 month follow-up. However, there was a significant difference in mean change (mean diff; 95% CI; significance) between the intervention group and reference group favoring the intervention group with regard to pain (13; 7 to 19; p < 0.001), quality of life (- 0.17; - 0.24 to - 0.10; p < 0.001), self-efficacy/other symptoms (- 5; - 10 to - 0.3; p < 0.04), and self-efficacy/pain (- 7; - 13 to - 2; p < 0.01). Improvements in pain and quality of life in the intervention group persisted at the 12-month follow-up.

CONCLUSIONS: Participation in an education and exercise program following the Swedish BOA program neither decreased the average amount of sedentary time nor increased the level of physical activity. However, participation in such a program resulted in decreased pain, increased quality of life, and increased self-efficacy.

TRIAL REGISTRATION: The trial is registered with ClinicalTrials.gov. Registration number: NCT02022566 . Retrospectively registered 12/18/2013.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Accelerometer, Exercise, Hip, Knee, Osteoarthritis, Patient education, Physical activity
National Category
Physiotherapy
Research subject
Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-77016 (URN)10.1186/s12891-018-2098-3 (DOI)30037339 (PubMedID)
Available from: 2018-07-27 Created: 2018-07-27 Last updated: 2018-08-31Bibliographically approved
Bergman, P. (2018). The number of repeated observations needed to estimate the habitual physical activity of an individual to a given level of precision.. PLoS ONE, 13(2), Article ID e0192117.
Open this publication in new window or tab >>The number of repeated observations needed to estimate the habitual physical activity of an individual to a given level of precision.
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 2, article id e0192117Article in journal (Refereed) Published
Abstract [en]

Physical activity behavior varies naturally from day to day, from week to week and even across seasons. In order to assess the habitual level of physical activity of a person, the person must be monitored for long enough so that the level can be identified, taking into account this natural within-person variation. An important question, and one whose answer has implications for study- and survey design, epidemiological research and population surveillance, is, for how long does an individual need to be monitored before such a habitual level or pattern can be identified to a desired level of precision? The aim of this study was to estimate the number of repeated observations needed to identify the habitual physical activity behaviour of an individual to a given degree of precision. A convenience sample of 50 Swedish adults wore accelerometers during four consecutive weeks. The number of days needed to come within 5-50% of an individual's usual physical activity 95% of the time was calculated. To get an idea of the uncertainty of the estimates all statistical estimates were bootstrapped 2000 times. The mean number of days of measurement needed for the observation to, with 95% confidence, be within 20% of the habitual physical activity of an individual is highest for vigorous physical activity, for which 182 days are needed. For sedentary behaviour the equivalent number of days is 2.4. To capture 80% of the sample to within ±20% of their habitual level of physical activity, 3.4 days is needed if sedentary behavior is the outcome of interest, and 34.8 days for MVPA. The present study shows that for analyses requiring accurate data at the individual level a longer measurement collection period than the traditional 7-day protocol should be used. In addition, the amount of MVPA was negatively associated with the number of days required to identify the habitual physical activity level indicating that the least active are also those whose habitual physical activity level is the most difficult to identify. These results could have important implications for researchers whose aim is to analyse data on an individual level. Before recommendations regarding an appropriate monitoring protocol are updated, the present study should be replicated in different populations.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Sport and Fitness Sciences
Research subject
Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-70902 (URN)10.1371/journal.pone.0192117 (DOI)000423793400069 ()
Available from: 2018-02-14 Created: 2018-02-14 Last updated: 2018-02-15Bibliographically approved
Carlsson, J., Danielsson, T. & Bergman, P. (2017). A two-peaked increase of serum myosin heavy chain-α after full distance triathlon demonstrates heart muscle cell death. Paper presented at 83th Annual Meeting of the German Cardiac Society – Cardiac and Circulation Research, Mannheim, Germany, April 19-22, 2017. Clinical Research in Cardiology, 106(Suppl 1), Article ID P1159.
Open this publication in new window or tab >>A two-peaked increase of serum myosin heavy chain-α after full distance triathlon demonstrates heart muscle cell death
2017 (English)In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 106, no Suppl 1, article id P1159Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: There is an ongoing debate about the significance of cardiac troponin T (cTnT) elevation after strenuous exercise: heart muscle cell death versus physiologic mechanism of release through an intact cell membrane. While cTnT is a small molecule (37 kDa), cardiac specific myosin heavy chain-alpha (MHC-α) is much larger (224 kDa) and an increase after exercise could hardly be explained by passage through an intact cardiac cell membrane. PURPOSE: To measure MHC-α, and other biomarkers (C-reactive protein (CRP); cTnT, creatine kinase (CK), myoglobin (MG), creatinine (C), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) before and after a full distance Ironman in order to answer the question of heart muscle cell death versus physiologic changes. 

Methods: In 52 non-elite athletes (14 female, 38 male; age 41.1 ± 9.7, range 24-70 years; all completed the race) biomarkers were measured by standard laboratory methods 7 days before, directly after, and day 1, 4 and 6 after the race. MHC-α was measured with a commercially available ELISA with no cross reactivity with other myosins. 

Results: The course of MHC-α concentration [µg/L] was 1.33 ± 0.53 (before), 2.57 ± 0.78 (directly after), 1.51 ± 0.53 (day 1), 2.74 ± 0.55 (day 4) and 1.83 ± 0.76 (day 6). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ± 80 ng/L (12-440; reference <15), NT-proBNP 776 ± 684 ng/L (92-4700; ref. < 300), CK 68 ± 55 µkat/L (5-280; ref. < 1.9), MG 2088 ± 2350 µg/L (130-17000; ref.< 72), and creatinine 100 ± 20 µmol/L (74-161; ref. < 100), CRP 49 ± 23 mg/L (15-119; ref.< 5). There was a significant correlation between MHC-α and NT-proBNP (R=0.48; p<0.001) but neither between MHC-α and cTnT (R=0.13; p=0.36) nor MHC-α and myoglobin (R=0.18; p=0.2). 

Conclusion: An Ironman leads to remarkable disturbances in biomarkers as e.g. cTnT was in the range of myocardial infarction in 100% of women and 97% of men. This is to our best knowledge the first investigation of MHC-α after strenuous exercise and its two-peaked increase most likely represents first release from the cytosolic pool and later from cell necrosis including the contractile apparatus. However, many questions remain, not at least why MHC-α baseline levels are as high as 1.33 ± 0.53 µg/L. 

Place, publisher, year, edition, pages
Springer, 2017
National Category
Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-67877 (URN)10.1007/s00392-017-1105-2 (DOI)
Conference
83th Annual Meeting of the German Cardiac Society – Cardiac and Circulation Research, Mannheim, Germany, April 19-22, 2017
Available from: 2017-09-08 Created: 2017-09-08 Last updated: 2018-12-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4934-8684

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