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Simmelink R, Moll E, Verhoeven C. The influence of the attending midwife on the occurrence of episiotomy: A retrospective cohort study. Midwifery 2023; 125:103773. [PMID: 37453396 DOI: 10.1016/j.midw.2023.103773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Episiotomy at the time of vaginal birth can result in short- and long-term complications for women. Therefore, it is important to study factors that influence the occurrence of episiotomy. AIM To examine to what extent the individual factors of clinical midwives in the same working conditions contribute to variations in episiotomy. METHODS A retrospective cohort study was performed at a secondary care hospital in Amsterdam, the Netherlands, using data from women who were assisted by a clinical midwife during birth in 2016. The clinical midwives filled out a questionnaire to determine individual factors. The predictive value of the individual factors of the clinical midwives was examined in a multiple logistic regression model on episiotomy. RESULTS A total of 1302 births attended by 27 midwives were included. The mean episiotomy rate was 12.7%, with a range from 3.2% to 30.8% among midwives (p = 0.001). When stratified for parity, within the primipara group there was a significant variation in episiotomy among midwives with a range from 7.9% to 47.8% (p = 0.006). No significant variation was found in the occurrence of third/fourth degree tears or intact perineum. There was a significant difference in episiotomy for maternal indication among midwives (p = 0.041). Predictors for an episiotomy were number of years since graduation and place of bachelor education of the clinical midwife. CONCLUSION This study shows that individual factors of clinical midwives influence the rate of episiotomy. Predictors for an episiotomy were the number of years since graduation and place of bachelor education. This shows that continuous training of clinical midwives could contribute to reducing the number of unnecessary episiotomies. Since suspected fetal distress is the only evidence based indication to perform an episiotomy, there is room for improvement given the variation in the number of episiotomies performed for maternal indication.
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Affiliation(s)
- Renate Simmelink
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, OLVG-West Hospital, Jan Tooropstraat 164, Amsterdam, the Netherlands.
| | - Etelka Moll
- Department of Obstetrics and Gynaecology, OLVG-West Hospital, Jan Tooropstraat 164, Amsterdam, the Netherlands
| | - Corine Verhoeven
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, the Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham NG7 2RD, United Kingdom; Department of Obstetrics and Gynaecology, Maxima Medical Centre, De Run 4600, Veldhoven, the Netherlands
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Chauhan J, Vyas H, Singh P, Sharma MC, Thirunavukkarasu D. Effect of supported sitting position during second stage of labor on its outcome in primigravidae: A quasi-experimental study. J Family Med Prim Care 2023; 12:2014-2019. [PMID: 38024889 PMCID: PMC10657044 DOI: 10.4103/jfmpc.jfmpc_359_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background The childbirth position has a significant influence on labor, maternal comfort, and neonatal outcome. In sitting position, there is a faster fetal descent with the effect of gravity. The information on this subject is relatively scant. Therefore, this study aimed to examine the effect of a supported sitting position during second stage of labor on its outcome in primigravidae. Materials and Methods A quasi-experimental study with a post-test only control group design was used. 60 primigravidae were selected using total enumerative sampling. The labor outcome was assessed by self-structured maternal neonatal outcome checklist and socio-demographic proforma. Results Statistically significant difference was observed on the mean duration of second stage of labor among primigravidae in control and experimental group (t = 5.87, P < 0.001) and also in the APGAR score of newborns (t = -3.98, P < 0.001). A statistical significant association of duration of second stage of labor with height and intensity of maternal work was also observed. Conclusions A supported sitting position during labor was found to be effective in reducing duration of the second stage of labor. This can be used as a nursing intervention while providing care during labor especially at primary healthcare centers that can help in reducing the duration of second stage of labor.
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Affiliation(s)
- Jagriti Chauhan
- Nursing Officer, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Himanshu Vyas
- College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pratibha Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mukesh C. Sharma
- College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Yang L, Yi T, Zhou M, Wang C, Xu X, Li Y, Sun Q, Lin X, Li J, Meng Z. Clinical effectiveness of position management and manual rotation of the fetal position with a U-shaped birth stool for vaginal delivery of a fetus in a persistent occiput posterior position. J Int Med Res 2021; 48:300060520924275. [PMID: 32495671 PMCID: PMC7273577 DOI: 10.1177/0300060520924275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To examine the effects of position management, manual rotation of the fetal
position, and using a U-shaped birth stool in primiparous women with a fetus
in a persistent occiput posterior position. Methods This was a prospective pilot study of women who delivered at Gansu Provincial
Maternity and Child-care Hospital between January and June 2018. The women
were divided into the position management ([PM] position management, manual
rotation of fetal position, use of a U-shaped birth stool at different
stages, and routine nursing) and control groups (position selected by women
and routine nursing). Results There were 196 women in the PM group and 188 in the control group. There were
no significant differences in maternal age, gestational weeks, newborn
weight, and the neonatal asphyxia rate between the PM and control groups.
The duration of labor was shorter in the PM group than in the control group.
Pain and blood loss 2 hours after delivery and the episiotomy rate were
significantly lower in the PM group than in the control group. Conclusion Applying position management, manual rotation of the fetal position, and
using a U-shaped birth stool should be considered for women with a fetus in
a persistent occiput posterior position.
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Affiliation(s)
- Lin Yang
- Perinatal Center, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Tongying Yi
- Delivery Room, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Min Zhou
- Perinatal Center, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Cheng Wang
- Ministry of Science and Technology Development, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Xiaoying Xu
- Perinatal Center, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Yufang Li
- Department of Anesthesia Surgery, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Qingmei Sun
- Prenatal Diagnosis Center, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Xiaojuan Lin
- Prenatal Diagnosis Center, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Jing Li
- Department of Obstetrics, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Zhaoyan Meng
- Department of Obstetrics, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
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Zang Y, Lu H, Zhang H, Huang J, Ren L, Li C. Effects of upright positions during the second stage of labour for women without epidural analgesia: A meta‐analysis. J Adv Nurs 2020; 76:3293-3306. [PMID: 33009847 DOI: 10.1111/jan.14587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/12/2020] [Accepted: 08/27/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Yu Zang
- School of Nursing Peking University Beijing China
| | - Hong Lu
- School of Nursing Peking University Beijing China
| | - Huixin Zhang
- Department of Obstetrics and Gynaecology The Fourth Hospital of Hebei Medical University Shijiazhuang China
| | - Jing Huang
- School of Nursing Peking University Beijing China
| | - Lihua Ren
- School of Nursing Peking University Beijing China
| | - Chunying Li
- Health Science Library Peking University Beijing China
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Zang Y, Lu H, Zhao Y, Huang J, Ren L, Li X. Effects of flexible sacrum positions during the second stage of labour on maternal and neonatal outcomes: A systematic review and meta-analysis. J Clin Nurs 2020; 29:3154-3169. [PMID: 32531856 DOI: 10.1111/jocn.15376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/22/2020] [Accepted: 05/24/2020] [Indexed: 12/24/2022]
Abstract
AIMS AND OBJECTIVES To assess the effects of flexible sacrum positions on mode of delivery, duration of the second stage of labour, perineal trauma, postpartum haemorrhage, maternal pain, abnormal foetal heart rate patterns and Apgar scores based on published literature. BACKGROUND Maternal positions served as a nonmedical intervention may facilitate optimal maternal and neonatal outcomes during labour. Flexible sacrum positions are conducive to expanding pelvic outlet. Whether flexible sacrum positions have positive effects on maternal and neonatal well-being is a controversial issue under heated discussion. DESIGN We performed a systematic review and meta-analysis based on PRISMA guidelines. METHODS Randomised controlled trials (RCTs) comparing any flexible sacrum position with non-flexible sacrum position in the second stage of labour were included. PubMed, EMBASE, Cochrane Library, CINAHL, CNKI (China National Knowledge Infrastructure), SinoMed and Wanfang databases were searched from inception to 11 March 2019 for published RCTs. Risk of bias was assessed by the Cochrane criteria, and random-effects meta-analyses were conducted by RevMan 5.3. RESULTS Sixteen studies (3,397 women) published in English were included. Flexible sacrum positions in the second stage of labour could reduce the incidence of operative delivery, instrumental vaginal delivery, caesarean section, episiotomy, severe perineal trauma, severe pain and shorten the duration of active pushing phase in the second stage of labour. However, flexible sacrum positions may increase the incidence of mild perineal trauma. There was no significant difference in the duration of the second stage of labour, maternal satisfaction and other outcomes. CONCLUSIONS Flexible sacrum positions are superior in promoting maternal well-being during childbirth. However, several results require careful interpretation. More rigorous original studies are needed to further explore their effects. RELEVANCE TO CLINICAL PRACTICE The results support the use of flexible sacrum positions. Flexible sacrum positions are recommended to apply flexibly or tailor to individual woman's labour progress.
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Affiliation(s)
- Yu Zang
- School of Nursing, Peking University, Beijing, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
| | - Yang Zhao
- School of Nursing, Peking University, Beijing, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing, China
| | - Lihua Ren
- School of Nursing, Peking University, Beijing, China
| | - Xia Li
- Urumqi Friendship Hospital, Urumqi, China
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Vertical Delivery as a Method of Prevention of Obstetric and Perinatal Complications. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Currently, there are many points of view on management of physiological labor, in particular, it concerns the intrapartum position of a woman. Tactics of modern obstetrics should ensure the safety of motherhood, which in future ensures the prosperity of the state. One of the alternative methods of delivery is the vertical position of a woman in the intrapartum period. It is impossible to describe the whole range of possible positions of a woman in the intrapartum period, the common ones being: lying position (lateral, reclining, lithotomy, Trendelenburg’s, etc.) or upright position (sitting, using a chair for childbirth, standing, squatting, standing on the knees, etc.). Opinions about how the vertical position of a mother in the intrapartum period affects the outcome of childbirth are quite ambiguous. The conclusions of various authors on that matter often contradict each other.The aim of the research was to study the role of vertical delivery in reducing the frequency of obstetric and perinatal complications.Materials: publications of foreign and domestic authors within the period from 1989 to 2017.Methods: systematic analysis and synthesis of literature data.Conclusion: Despite a significant number of studies, it is not possible to determine the universality of the vertical position in childbirth, therefore, the selection of patients for the management of vertical childbirth should be approached carefully. In the presence of pregnancy complications, preference should be given to the classic version of the position in childbirth. In women who have a low risk of perinatal complications, an upright position can be a worthy alternative. To prevent the development of bleeding in the III stage of labor and the early postpartum period, a woman should take a horizontal position after the birth of the fetus. This condition must also be observed when examining the birth canal. Thus, the rational tactics of conducting childbirth is to determine the optimal combination of vertical and horizontal positions at different periods of the childbirth process, taking into account the convenience for the woman in labor.
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Huang J, Zang Y, Ren LH, Li FJ, Lu H. A review and comparison of common maternal positions during the second-stage of labor. Int J Nurs Sci 2019; 6:460-467. [PMID: 31728401 PMCID: PMC6839002 DOI: 10.1016/j.ijnss.2019.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 01/05/2023] Open
Abstract
The second-stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth. Midwives play a pivotal role in managing maternal positions during the second-stage of labor. However, there is limited evidence to support an ideal maternal position during the second-stage of labor. Further, the difference between different maternal positions might not be apparent. This paper aims to review and compare the benefits and risks of common maternal positions during the second-stage of labor, thereby to provide midwives evidence-based practical guidelines.
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Affiliation(s)
- Jing Huang
- School of Nursing, Peking University, Beijing, China
| | - Yu Zang
- School of Nursing, Peking University, Beijing, China
| | - Li-Hua Ren
- School of Nursing, Peking University, Beijing, China
| | - Feng-Juan Li
- Maternal and Child Health Hospital of Xinjiang Uyghur Autonomous Region, Uyghur, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
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Rodrigues S, Silva P, Agius A, Rocha F, Castanheira R, Gross M, Calleja-Agius J. Intact Perineum: What are the Predictive Factors in Spontaneous Vaginal Birth? Mater Sociomed 2019; 31:25-30. [PMID: 31213951 PMCID: PMC6511367 DOI: 10.5455/msm.2019.31.25-30] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Perineal trauma at birth is distressing for women and can cause serious short and long term morbidity. Aim Investigate the prevalence and predictive factors of intact perineum after normal vaginal birth among Portuguese women who had spontaneous vaginal births. Methods A descriptive, cross-sectional, retrospective study was carried out among pregnant women who had spontaneous vaginal births, between January 1, 2017, and December 31, 2017, in a single birth centre in Portugal. Following ethical approval, the prevalence of intact perineum was calculated and multivariate analysis with logistic regression was carried out, to identify the predictive factors of having an intact perineum after spontaneous vaginal birth. Results A total of 1748 pregnant women had spontaneous vaginal births. Four hundred and forty-one women (25.2%) had intact perineum whereas in 1307 (74.8%) of women, the perineum was not intact. First-degree tears occurred in 23.2% (405/1748) of women, second-degree tears occurred in 4% (70/1748) of women while three women (0.2%) experienced a third-degree tear. The rate of episiotomies was 43.8% (766/1748). Episiotomy and first-degree tears occurred in 2.6% (45/1748), episiotomy and second-degree tears occurred in 0.7% (12/1748), while episiotomy and third-degree tears occurred in 0.3% (6/1748) of women. Having a previous caesarean section reduced the odds of intact perineum by 60%, while nulliparity reduced the odds by 70%. For every 250 grams increase in birth weight, the odds of sustaining an intact perineum were decreased by 13%. Alternative birth positions (excluding lithotomy) doubled the odds of maintaining an intact perineum. Conclusion The prevalence of intact perineum is 25,2%. Predictive factors for intact perineum include birth weight, parity, previous caesarean section and birthing position. Recognizing these factors could support and facilitate the management of spontaneous vaginal birth to promote an intact perineum. Further research is needed to gain better understanding of this phenomenon.
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Affiliation(s)
- Silvia Rodrigues
- Hospital of Braga and Abel Salazar Biomedical Sciences Institute, Portugal
| | - Paulo Silva
- Hospital of Braga and Portuguese Catholic University, Portugal
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Clesse C, Lighezzolo-Alnot J, De Lavergne S, Hamlin S, Scheffler M. Factors related to episiotomy practice: an evidence-based medicine systematic review. J OBSTET GYNAECOL 2019; 39:737-747. [DOI: 10.1080/01443615.2019.1581741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Christophe Clesse
- Interpsy Laboratory (EA4432), Université de Lorraine, Nancy, France
- Hospital Centre of Jury-les-Metz – Route d’Ars Laquenexy, Jury-Lesmetz, France
- Polyclinic Majorelle, Nancy, France
| | | | | | | | - Michèle Scheffler
- Polyclinic Majorelle, Nancy, France
- Cabinet de Gynécologie Médicale et Obstétrique, Nancy, France
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Tunestveit JW, Baghestan E, Natvig GK, Eide GE, Nilsen ABV. Factors associated with obstetric anal sphincter injuries in midwife-led birth: A cross sectional study. Midwifery 2018; 62:264-272. [PMID: 29734121 DOI: 10.1016/j.midw.2018.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 01/29/2018] [Accepted: 04/03/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Obstetric anal sphincter injurie (OASI) in vaginal births are a serious complication, and are associated with maternal morbidity. Focus on modifiable factors in midwives clinical skills and competences contributing to prevent the occurrence of OASI are essential. The objective of this study was to investigate the association between OASI and factors related to midwife-led birth such as manual support of perineum, active delivery of baby's shoulders, maternal birth position, and pushing and breathing techniques in second stage of labour. METHODS A prospective cross sectional study including primiparous (n = 129) and multiparous (n = 628) women in midwife-led non-instrumental deliveries with OASI (n = 96) or intact perineum (n = 661). Data were collected in a university hospital in Norway with two different birth settings: an alongside midwife-led unit with approximately 1500 births per year and an obstetrical unit with approximately 3500 births per year. In midwife-led births, there were a total of 2.6% OASI and 18.9% intact perineum. RESULTS The sample consisted of 757 women, 12.7% suffered OASI and 87.3% of participating women had an intact perineum. This selected sample compares the most serious outcome (OASI), and the optimal outcome (intact perineum).In primiparous women, 61 women suffered OASI and 68 women had intact perineum, while for multipara women, 35 women suffered OASI and 593 women had intact perineum. There was an increased risk of OASI if women actively pushed when the head was crowning compared to breathing the head out (adjusted OR: 3.10; 95% CI: 1.75 to 5.47). The maternal birth position associated with the lowest risk of OASI was kneeling position (adjusted OR: 0.15; 95% CI: 0.03 to 0.70), supine maternal birth position (adjusted OR: 2.52; 95% CI: 1.04 to 4.90) and oxytocin augmentation more than 30 min in second stage (OR: 1.93; 95% CI: 1.68 to 15.63) were associated with an increased risk of OASI, when adjusting for maternal, foetal, and obstetric factors. CONCLUSION Our study suggests that actively pushing when the baby's head is crowning, a supine maternal birth position and oxytocin augmentation more than 30 min in second stage, were associated with increased risk of OASI when compared to intact perineum. A kneeling maternal birth position was associated with a decreased risk of OASI.
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Affiliation(s)
- Jorunn Wik Tunestveit
- Department of Global Public Health and Primary Care, University of Bergen, Norway ; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
| | - Elham Baghestan
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Gerd Karin Natvig
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway ; Lifestyle Epidemiology Research Group, Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Anne Britt Vika Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway
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A randomised controlled trial in comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position in China. Midwifery 2017; 50:117-124. [DOI: 10.1016/j.midw.2017.03.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 03/11/2017] [Accepted: 03/29/2017] [Indexed: 11/21/2022]
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