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Klingberg-Allvin, MarieORCID iD iconorcid.org/0000-0002-8947-2949
Publications (10 of 67) Show all publications
Klingberg-Allvin, M., Hatakka, M., Erlandsson, K., Osman, F., Byrskog, U. & Egal, J. (2019). "Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region. Midwifery, 69, 135-142
Open this publication in new window or tab >>"Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region
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2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 69, p. 135-142Article in journal (Refereed) Published
Abstract [en]

The aim of this study is to explore midwifery educators’ expected outcomes in the net-based master's programme, the programmes’ realised outcomes and the reported difference regarding the increased choices for the graduates and the effect on their agency.

Design

In this case study, we focused on a net-based master's programme in sexual and reproductive health in Somalia. Somalia suffers from a shortage of skilled birth attendants and there is a need for building up the capacity of midwifery educators.

Setting and participants

Data was collected in focus group discussions at the start of the programme and eight months after the students graduated. The data were analysed through the lens of the choice framework, which is based on the capability approach.

Findings

Findings show that many of the graduates’ expectations were met, while some were more difficult to fulfil. While the midwives’ choices and resource portfolios had improved because of their role as educators, the social structure prevented them from acting on their agency, specifically in regards to making changes at the social level. Several of the positive developments can be attributed to the pedagogy and structure of the programme.

Conclusion

The flexibility of net-based education gave the midwifery educators a new educational opportunity that they previously did not have. Students gained increased power and influence on some levels. However, they still lack power in government organisations where, in addition to their role as educators, they could use their skills and knowledge to change policies at the social level.

Keywords
Net-based education, Quality midwifery education, Midwifery care, Somaliland, Capability approach, Choice framework
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29004 (URN)10.1016/j.midw.2018.11.007 (DOI)30503998 (PubMedID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2018-12-07Bibliographically approved
Klingberg-Allvin, M., Atuhairwe, S., Cleeve, A., Byamugisha, J. K., Larsson, E. C., Makenzius, M., . . . Gemzell-Danielsson, K. (2018). Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa. Global Health Action, 11(1), Article ID 1490106.
Open this publication in new window or tab >>Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa
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2018 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1490106Article in journal (Refereed) Published
Abstract [en]

Universal access to comprehensive abortion care (CAC) is a reproductive right and is essential to reduce preventable maternal mortality and morbidity. In East Africa, abortion rates are consistently high, and the vast majority of all abortions are unsafe, significantly contributing to unnecessary mortality and morbidity. The current debate article reflects and summarises key action points required to continue to speed the implementation of and expand access to CAC in the East, Central, and Southern African (ECSA) health community. To ensure universal access to quality CAC, a regional platform could facilitate the sharing of best practices and successful examples from the region, which would help to visualise opportunities. Such a platform could also identify innovative ways to secure women's access to quality care within legally restrictive environments and would provide information and capacity building through the sharing of recent scientific evidence, guidelines, and training programmes aimed at increasing women's access to CAC at the lowest effective level in the healthcare system. This type of infrastructure for exchanging information and developing co-creation could be crucial to advancing the Sustainable Development Goals 2030 agenda.

Keywords
Central, Eastern, Northern Africa, Unsafe abortions, maternal mortality
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28137 (URN)10.1080/16549716.2018.1490106 (DOI)000437262000001 ()29972099 (PubMedID)
Available from: 2018-07-09 Created: 2018-07-09 Last updated: 2018-07-19Bibliographically approved
Makenzius, M., Faxelid, E., Gemzell-Danielsson, K., Odero, T. M., Klingberg-Allvin, M. & Oguttu, M. (2018). Contraceptive uptake in post abortion care-Secondary outcomes from a randomised controlled trial, Kisumu, Kenya.. PLoS ONE, 13(8), Article ID e0201214.
Open this publication in new window or tab >>Contraceptive uptake in post abortion care-Secondary outcomes from a randomised controlled trial, Kisumu, Kenya.
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 8, article id e0201214Article in journal (Refereed) Published
Abstract [en]

AIM: The aim was to explore contraceptive uptake, associated factors and satisfaction among post abortion-care (PAC) seeking women in Kenya. Due to unsafe abortions, almost 120 000 Kenyan women received PAC in 2012, and of these women, 70% did not use contraception before pregnancy.

METHODS: This study was nested in a larger randomised controlled trial, where 859 women sought PAC at two public hospitals in Kisumu, in June 2013-May 2016. The women were randomly assigned to a midwife or a physician for PAC, including contraceptive counselling, and followed up at 7-10 days and three months. Associated factors for contraceptive uptake were analysed with binary logistic regression, and contraceptive method choice, adherence and satisfaction level were examined by descriptive statistics, using IBM SPSS Statistics for Windows, Version 22.0.

RESULTS: Out of the 810 PAC-seeking women, 76% (n = 609) accepted the use of contraception. Age groups of 21-25 (OR: 2.35; p < 0.029) and 26-30 (OR: 2.22; p < 0.038), and previous experience of 1-2 gravidities (OR 1.939; p = 0.018) were independent factors associated with the up-take. Methods used: injections 39% (n = 236); pills 27% (n = 166); condoms 25% (n = 151); implant 7% (n = 45) and intrauterine device (IUD) 1% (n = 8). At 3-month follow-up of the women (470/609; 77%), 354 (75%) women still used contraception, and most (n = 332; 94%) were satisfied with the method. Reasons for discontinuation were side-effects (n = 44; 39%), partner refusal (n = 27; 24%), planned pregnancy (n = 27; 24%) and lack of resupplies (n = 15; 13%).

CONCLUSIONS: PAC-seeking women seem highly motivated to use contraceptives, yet a quarter decline the use, and at 3-month follow-up a further quarter among the users had discontinued. Implant, IUD and permanent method are rarely used. Strategies to improve contraceptive counselling, particularly to adolescent girls, and to increase access to a wide range of methods, as well as provider training and supervision may help to improve contraceptive acceptance and compliance among PAC-seeking women in Kisumu, Kenya.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28308 (URN)10.1371/journal.pone.0201214 (DOI)000441308500014 ()30096148 (PubMedID)2-s2.0-85052335851 (Scopus ID)
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2018-09-10Bibliographically approved
Rehnström Loi, U., Lindgren, M., Faxelid, E., Oguttu, M. & Klingberg-Allvin, M. (2018). Decision-making preceding induced abortion: a qualitative study of women’s experiences in Kisumu, Kenya. Reproductive Health, 15, Article ID 166.
Open this publication in new window or tab >>Decision-making preceding induced abortion: a qualitative study of women’s experiences in Kisumu, Kenya
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2018 (English)In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 15, article id 166Article in journal (Refereed) Published
Abstract [en]

Background

Unwanted pregnancies and unsafe abortions are prevalent in regions where women and adolescent girls have unmet contraceptive needs. Globally, about 25 million unsafe abortions take place every year. In countries with restrictive abortion laws, safe abortion care is not always accessible. In Kenya, the high unwanted pregnancy rate resulting in unsafe abortions is a serious public health issue. Gaps exist in knowledge regarding women’s decision-making processes in relation to induced abortions in Kenya. Decision-making is a fundamental factor for consideration when planning and implementing contraceptive services. This study explored decision-making processes preceding induced abortion among women with unwanted pregnancy in Kisumu, Kenya.

Methods

Individual face-to-face in-depth interviews were conducted with nine women aged 19–32 years old. Women who had experienced induced abortion were recruited after receiving post-abortion care at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) or Kisumu East District Hospital (KDH) in Kisumu, Kenya. In total, 15 in-depth interviews using open-ended questions were conducted. All interviews were tape-recorded, transcribed and coded manually using inductive content analysis.

Results

Respondents described their own experiences regarding decision-making preceding induced abortion. This study shows that the main reasons for induced abortion were socio-economic stress and a lack of support from the male partner. In addition, deviance from family expectations and gender-based norms highly influenced the decision to have an abortion among the interviewed women. The principal decision maker was often the male partner who pressed for the termination of the pregnancy indirectly by declining his financial or social responsibilities or directly by demanding termination. In some cases, the male partner controlled decision-making by arranging an unsafe abortion without the woman’s consent. Strategic choices regarding whom to confide in were employed as protection against abortion stigma. This contributed to a culture of silence around abortion and unwanted pregnancy, a factor that made women more vulnerable to complications.

Conclusions

The findings suggest that financial, social and gender-based dependencies influence women’s agency and perceived options in decision-making regarding abortion.

Keywords
Abortion, Decision-making, Qualitative methodology, In-depth interviews, Kenya
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28653 (URN)10.1186/s12978-018-0612-6 (DOI)000446381200002 ()30285768 (PubMedID)2-s2.0-85054469473 (Scopus ID)
Funder
Swedish Research Council
Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2018-10-23Bibliographically approved
Abdillahi, H. A., Hassan, K. A., Kiruja, J., Osman, F., Egal, J. A., Klingberg-Allvin, M. & Erlandsson, K. (2017). A mixed-methods study of maternal near miss and death after emergency cesarean delivery at a referral hospital in Somaliland. International Journal of Gynecology & Obstetrics, 138(1), 119-124
Open this publication in new window or tab >>A mixed-methods study of maternal near miss and death after emergency cesarean delivery at a referral hospital in Somaliland
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2017 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 138, no 1, p. 119-124Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To explore maternal near miss and death after emergency cesarean delivery in Somaliland, including the impact of the prerequisite for family consent.

METHODS: A facility-based, mixed-methods study was conducted to assess all maternal near misses and deaths recorded at a referral hospital that provided services to women from all regions of Somaliland. The data sources comprised a quantitative prospective cross-sectional study using the WHO near-miss tool (performed from August 1 to December 31, 2015) and qualitative interviews with 17 healthcare providers working at the referral hospital who were in direct contact with the women in labor (performed from January 15 to March 15, 2015).

RESULTS: Of the 138 maternal near misses and deaths recorded, 50 (36%) were associated with emergency cesarean delivery. The most frequent maternal complication was severe pre-eclampsia (n=17; 34%), and the most frequent underlying causes were hypertensive disorders (n=31; 62%) and obstetric hemorrhage (n=15; 30%). Healthcare providers were often prevented from performing emergency cesarean delivery until the required consent had been received from the woman's extended family.

CONCLUSION: Maternity care in Somaliland must be improved, and the issue of legal authority for consent examined, to ensure both safe and timely provision of emergency cesarean delivery. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Cesarean delivery, Consent, Maternal death, Near miss, Somaliland
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-24701 (URN)10.1002/ijgo.12176 (DOI)000405092600021 ()28391614 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2017-04-11 Created: 2017-04-11 Last updated: 2017-10-23Bibliographically approved
Osman, F., Flacking, R., Schön, U.-K. & Klingberg-Allvin, M. (2017). A support program for Somali-born parents on children's behavioral problems. Pediatrics, 139(3)
Open this publication in new window or tab >>A support program for Somali-born parents on children's behavioral problems
2017 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 139, no 3Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The objectives of this study were to evaluate a culturally tailored parenting support program (Ladnaan) for Somali-born parents and to determine its effectiveness on children’s emotional and behavioral problems.

METHODS: This randomized controlled trial included 120 Somali-born parents with children aged 11 to 16 years. The parents reported self-perceived stress in relation to parenting practices. The intervention consisted of culturally tailored societal information combined with the parenting program Connect. Parents received 12 weeks of intervention, 1 to 2 hours each week, in groups of 12 to 17 parents. Nine group leaders with a Somali background who received a standardized training program delivered the intervention. The primary outcome was a decrease in emotional and behavioral problems based on a Child Behavior Checklist. Parents were randomly allocated either to an intervention group or a wait-list control group. Covariance analyses were conducted according to intention-to-treat principles.

RESULTS: The results showed significant improvement in the children in the intervention group for behavioral problems after a 2-month follow-up. The largest effect sizes according to Cohen’s d were in aggressive behavior (95% confidence interval [CI], 1.06 to 3.07), social problems (95% CI, 0.64 to 1.70), and externalizing problems (95% CI, 0.96 to 3.53).

CONCLUSIONS: The large effect sizes in this study show that this 12-week culturally tailored parenting support program was associated with short-term improvements in children’s behavior. The study adds to the field of parenting interventions by demonstrating how to culturally tailor, engage, and retain parenting programs for immigrant parents.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23732 (URN)10.1542/peds.2016-2764 (DOI)28235795 (PubMedID)
Available from: 2016-12-26 Created: 2016-12-26 Last updated: 2017-12-19Bibliographically approved
Cleeve, A., Faxelid, E., Nalwadda, G. & Klingberg-Allvin, M. (2017). Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda. Culture, Health and Sexuality, 19(11), 1286-1300
Open this publication in new window or tab >>Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda
2017 (English)In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 19, no 11, p. 1286-1300Article in journal (Refereed) Published
Abstract [en]

Unsafe abortion in Africa continues to be a major contributor to the global maternal mortality which affects young women in particular. In Uganda, where abortion is legally restricted and stigmatised, unsafe abortion is a major public health issue. We explored reproductive agency in relation to unsafe abortion among young women seeking post-abortion care. Through in-depth interviews we found that reproductive agency was constrained by gender norms and power imbalances and strongly influenced by stigma. Lack of resources and the need for secrecy resulted in harmful abortion practices and delayed care-seeking. Women did not claim ownership of the abortion decision, but the underlying meaning in the narratives positioned abortion as an agentive action aiming to regain control over one's body and future. Women's experiences shaped contraceptive intentions and discourse, creating a window of opportunity that was often missed. This study provides unique insight into how young women negotiate and enact reproductive agency in Uganda. Health systems need to strengthen their efforts to meet young women's sexual and reproductive health needs and protect their rights. Enabling young women's agency through access to safe abortion and contraception is paramount.

Keywords
Gender norms, Uganda, reproductive agency, unsafe abortion, young women
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-24707 (URN)10.1080/13691058.2017.1310297 (DOI)000414216100008 ()28398161 (PubMedID)
Note

Open Access APC beslut 9/2017

Available from: 2017-04-13 Created: 2017-04-13 Last updated: 2017-11-16Bibliographically approved
Osman, F., Salari, R., Klingberg-Allvin, M., Schön, U.-K. & Flacking, R. (2017). Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial. BMJ Open, 7(12), Article ID e017600.
Open this publication in new window or tab >>Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e017600Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate the effectiveness of a culturally tailored parenting support programme on Somali-born parents' mental health and sense of competence in parenting.

DESIGN: Randomised controlled trial.

SETTING: A city in the middle of Sweden.

PARTICIPANTS: Somali-born parents (n=120) with children aged 11-16 years and self-perceived stress in their parenting were randomised to an intervention group (n=60) or a waiting-list control group (n=60).

INTERVENTION: Parents in the intervention group received culturally tailored societal information combined with the Connect parenting programme during 12 weeks for 1-2 hours per week. The intervention consisted of a standardised training programme delivered by nine group leaders of Somali background.

OUTCOME: The General Health Questionnaire 12 was used to measure parents' mental health and the Parenting Sense of Competence scale to measure parent satisfaction and efficacy in the parent role. Analysis was conducted using intention-to-treat principles.

RESULTS: The results indicated that parents in the intervention group showed significant improvement in mental health compared with the parents in the control group at a 2-month follow-up: B=3.62, 95% CI 2.01 to 5.18, p<0.001. Further, significant improvement was found for efficacy (B=-6.72, 95% CI -8.15 to -5.28, p<0.001) and satisfaction (B=-4.48, 95% CI -6.27 to -2.69, p<0.001) for parents in the intervention group. Parents' satisfaction mediated the intervention effect on parental mental health (β=-0.88, 95% CI -1.84 to -0.16, p=0.047).

CONCLUSION: The culturally tailored parenting support programme led to improved mental health of Somali-born parents and their sense of competence in parenting 2 months after the intervention. The study underlines the importance of acknowledging immigrant parents' need for societal information in parent support programmes and the importance of delivering these programmes in a culturally sensitive manner.

CLINICAL TRIAL REGISTRATION: NCT02114593.

Keywords
child protection, community child health, mental health, public health
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26770 (URN)10.1136/bmjopen-2017-017600 (DOI)000423826700065 ()29222136 (PubMedID)
Note

Open Access APC beslut 26/2017

Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2018-02-22Bibliographically approved
Erlandsson, K., Osman, F., Hatakka, M., Egal, J. A., Byrskog, U., Pedersen, C. & Klingberg-Allvin, M. (2017). Evaluation of an online master’s programme in Somaliland. A phenomenographic study on the experience of professional and personal development among midwifery faculty. Nurse Education in Practice, 25, 96-103
Open this publication in new window or tab >>Evaluation of an online master’s programme in Somaliland. A phenomenographic study on the experience of professional and personal development among midwifery faculty
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2017 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 25, p. 96-103Article in journal (Refereed) Published
Abstract [en]

To record the variation of perceptions of midwifery faculty in terms of the possibilities and challenges related to the completion of their first online master's level programme in Sexual and Reproductive Health and Rights in Somaliland. The informants included in this phenomenongraphical focus group study were those well-educated professional women and men who completed the master's program. The informant perceived that this first online master's level programme provided tools for independent use of the Internet and independent searching for evidence-based information, enhanced professional development, was challenge-driven and evoked curiosity, challenged professional development, enhanced personal development and challenged context-bound career paths. Online education makes it possible for well-educated professional women to continue higher education. It furthermore increased the informants' confidence in their use of Internet, software and databases and in the use of evidence in both their teaching and their clinical practice. Programmes such as the one described in this paper could counter the difficulties ensuring best practice by having a critical mass of midwives who will be able to continually gather contemporary midwifery evidence and use it to ensure best practice. An increase of online education is suggested in South-central Somalia and in similar settings globally.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Online education, Net-based education, Midwifery education, Human rights
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25050 (URN)10.1016/j.nepr.2017.05.007 (DOI)28575755 (PubMedID)2-s2.0-85019746618 (Scopus ID)
Note

Open Access APC beslut 15/2017

Available from: 2017-05-29 Created: 2017-05-29 Last updated: 2017-06-21Bibliographically approved
Kiruja, J., Osman, F., Egal, J. A., Essén, B., Klingberg-Allvin, M. & Erlandsson, K. (2017). Maternal near-miss and death incidences – Frequencies, causes and the referral chain in Somaliland: A pilot study using the WHO near-miss approach. Sexual & Reproductive HealthCare, 12, 30-36
Open this publication in new window or tab >>Maternal near-miss and death incidences – Frequencies, causes and the referral chain in Somaliland: A pilot study using the WHO near-miss approach
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2017 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 12, p. 30-36Article in journal (Refereed) Published
Abstract [en]

Background Somaliland is a self-declared country with a population of 3.5 million. Most of its population reside in rural areas. The objective of this pilot near-miss study was to monitor the frequency and causes of maternal near-miss and deaths and the referral chain for women to access Skilled Birth Attendants (SBA). Method: A facility-based study of all maternal near-miss and mortality cases over 5 months using the WHO near-miss tool in a main referral hospital. Reasons for bypassing the Antenatal Care facility (ANC) and late arrival to the referral hospital were investigated through verbal autopsy. Results: One hundred and thirty-eight (138) women with severe maternal complications were identified: 120 maternal near-miss, 18 maternal deaths. There were more near-miss cases on arrival (74.2%) compared with events that developed inside the hospital (25.8%). Likewise, there were more maternal deaths (77.8%) on arrival than was the case during hospitalization (22.2%). The most common mode of referral among maternal near-miss events was family referrals (66.7%). Of 18 maternal deaths, 15 were family referrals. Reasons for bypassing ANC were as follows: lack of confidence in the service provided; lack of financial resources; and lack of time to visit ANC. Reasons for late arrival to the referral hospital were as follows: lack of knowledge and transportation; and poor communication. Conclusion and clinical implication: To increase the utilization of ANC might indirectly lower the number of near-miss and death events. Collaboration between ANC staff and referral hospital staff and a more comprehensive near-miss project are proposed. © 2017 Elsevier B.V.

Keywords
Maternal death, Maternal near-miss, Referral chain, Somaliland
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-24581 (URN)10.1016/j.srhc.2017.02.003 (DOI)000401884100006 ()28477929 (PubMedID)2-s2.0-85013803837 (Scopus ID)
Available from: 2017-03-13 Created: 2017-03-13 Last updated: 2017-06-15Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8947-2949

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