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Bär M, Luger T. Using a Passive Back Exoskeleton During a Simulated Sorting Task: Influence on Muscle Activity, Posture, and Heart Rate. HUMAN FACTORS 2024; 66:40-55. [PMID: 35225011 PMCID: PMC10756017 DOI: 10.1177/00187208211073192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate using a back exoskeleton in a simulated sorting task in a static forward bent trunk posture on muscle activity, posture, and heart rate (HR). BACKGROUND Potentials of exoskeletons for reducing musculoskeletal demands in work tasks need to be clarified. METHODS Thirty-six healthy males performed the sorting task in 40°-forward bent static trunk posture for 90 seconds, in three trunk orientations, with and without exoskeleton. Muscle activity of the erector spinae (ES), biceps femoris (BF), trapezius descendens (TD), rectus abdominis (RA), vastus laterals (VL), and gastrocnemius medialis was recorded using surface electromyography normalized to a submaximal or maximal reference electrical activity (%RVE (reference voluntary electrical activity)/%MVE). Spine and lower limb postures were assessed by gravimetric position sensors, and HR by electrocardiography. RESULTS Using the exoskeleton resulted in decreased BF muscle activity [-8.12%RVE], and minor changes in ES [-1.29%MVE], RA [-0.28%RVE], VL [-0.49%RVE], and TD [+1.13%RVE] muscle activity. Hip and knee flexion increased [+8.1°; +6.7°]. Heart rate decreased by 2.1 bpm. Trunk orientation had an influence on BF muscle activity. CONCLUSION Using the back exoskeleton in a short sorting task with static trunk posture mainly reduced hip extensor muscle activity and changed lower limb but not spine posture. Implications of using a back exoskeleton for workers' musculoskeletal health need further clarification. APPLICATION The detected changes by using the Laevo® illustrate the need for further investigation prior to practical recommendations of using exoskeletons in the field. Investigating various work scenarios in different kind of workers and long-term applications would be important elements.
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Affiliation(s)
- Mona Bär
- Mona Bär, Institute of Occupational and Social Medicine and Health Services Research, University of Tübingen and University Hospital Tübingen, Wilhelmstraße 27, Tübingen 72074, Germany; e-mail:
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Gál-Pottyondy A, Petró B, Takács M, Négyesi J, Nagatomi R, Kiss RM. Compensatory muscle activation and spinal curve changes in response to fatigue among adolescent male athletes. BMC Sports Sci Med Rehabil 2023; 15:57. [PMID: 37055780 PMCID: PMC10103397 DOI: 10.1186/s13102-023-00668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND The prone plank test has been often used to assess the strength and endurance of trunk muscles. We aimed to develop a new measurement protocol to objectively monitor the changes in spinal curves and muscle activity simultaneously. METHODS Eleven adolescent male basketball athletes (13-17 years) performed a one-minute plank test. Spinal curvatures (thoracic kyphosis (TK) and lumbar lordosis (LL)) were determined at each time point by optical tracking of markers placed on the spinous processes of 10 vertebrae. Eleven muscles were measured by surface electromyography to determine muscle fatigue via changes in median frequency. RESULTS TK significantly increased (p = 0.003) from the first to the last 10 s of the plank test; changes in LL were mixed within the group. Only the rectus abdominis showed consistent and significant fatigue (p < 0.001). The increased spinal curves significantly correlated with the fatigue of biceps femoris (TK: r = -0.75, p = 0.012; LL: r = -0.71, p = 0.019) indicating a compensatory muscle activation and spinal curve changes in response to fatigue. CONCLUSION Our protocol may support future researches that aim to objectively evaluate the prone plank test and which posture-related muscles need strengthening for the individual.
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Affiliation(s)
- Anna Gál-Pottyondy
- Doctoral School of Sport Sciences, Hungarian University of Sports Science, Budapest, Hungary
| | - Bálint Petró
- Faculty of Mechanical Engineering, Department of Mechatronics, Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | | | - János Négyesi
- Faculty of Mechanical Engineering, Department of Mechatronics, Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
- Fit4Race Kft, Budapest, Hungary
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoichi Nagatomi
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rita M Kiss
- Faculty of Mechanical Engineering, Department of Mechatronics, Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary.
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Motor variability during a repetitive lifting task is impaired by wearing a passive back-support exoskeleton. J Electromyogr Kinesiol 2023; 68:102739. [PMID: 36566692 DOI: 10.1016/j.jelekin.2022.102739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Evaluate whether wearing a passive back-support exoskeleton during repetitive lifting impairs motor variability of erector spinae muscle and spine movement and whether this association is influenced by lifting style. SCOPE Thirty-six healthy males performed ten lifts in four randomized conditions with exoskeleton (without, with) and lifting style (squat, stoop) as dependent variables. One lifting cycle contained four phases: bending/straighten without/with load. Erector spinae muscular activity, thoracic kyphosis and lumbar lordosis were measured with surface electromyography and gravimetric position sensors, respectively. Absolute and relative cycle-to-cycle variability were calculated. The effects of exoskeleton and exoskeleton × lifting style were assessed on outcomes during the complete lifting cycle and its four phases. RESULTS For the complete lifting cycle, muscular variability and thoracic kyphosis variability decreased whereas lumbar lordosis variability increased with exoskeleton. For lifting phases, effects of exoskeleton were mixed. Absolute and relative muscular variability showed a significant interaction effect for the phase straighten with load; variability decreased with exoskeleton during squat lifting. CONCLUSION Using the exoskeleton impaired several motor variability parameters during lifting, supporting previous findings that exoskeletons may limit freedom of movement. The impact of this result on longer-term development of muscular fatigue or musculoskeletal disorders cannot yet be estimated.
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Roy S, Grünwald AT, Lampe R. A non-invasive method for scoliosis assessment-A new mathematical concept using polar angle. PLoS One 2022; 17:e0275395. [PMID: 36178916 PMCID: PMC9524697 DOI: 10.1371/journal.pone.0275395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
Scoliosis is one of the most common pediatric spinal diseases that leads to a three-dimensional deformity of the spine and has a high risk of progression during growth. Regular clinical monitoring and follow-up X-rays are needed to providing proper treatment at that time. Repetitive X-rays can results in an increased risk of radiation related health problems. We present a non-invasive, ionizing radiation-free method for assessing scoliosis and its progression from the 3D images of the body torso, captured by a body scanner. A new concept is introduced based on a mathematical method in polar coordinate system to quantify and characterize the deformities in the torso from 2D transverse cross-sections of the 3D torso images at example cases for a healthy individual and for two patients with scoliosis. To capture quantitatively the characteristics of scoliosis, and to verify them at the example cases two asymmetry parameters and a linear fitting parameter are calculated: a) back side area asymmetry, b) left right area asymmetry, and c) coefficient of determination (R2). Within the analyzed patients, both the area asymmetries are maximum at the apex of scoliosis, and increase with the severity of scoliosis. R2 values are smaller in the case of patients compared with the healthy. Furthermore, the parameters show a trend when compared with the Cobb angle from the X-ray and the findings match with clinical examination. Therefore, the quantities are able to capture, certain characteristics associated with scoliosis. These quantities can be compared as a measure of deformities of torso, during the follow-up examinations in the future, without ionizing radiations.
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Affiliation(s)
- Susmita Roy
- School of Medicine, Klinikum Rechts der Isar, Orthopaedic Department, Research Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Paediatric Neuroorthopaedics, Technical University of Munich, Munich, Germany
| | - Alexander T.D. Grünwald
- School of Medicine, Klinikum Rechts der Isar, Orthopaedic Department, Research Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Paediatric Neuroorthopaedics, Technical University of Munich, Munich, Germany
| | - Renée Lampe
- School of Medicine, Klinikum Rechts der Isar, Orthopaedic Department, Research Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Paediatric Neuroorthopaedics, Technical University of Munich, Munich, Germany
- Markus Würth Professorship, Technical University of Munich, Munich, Germany
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Luger T, Bär M, Seibt R, Rimmele P, Rieger MA, Steinhilber B. A passive back exoskeleton supporting symmetric and asymmetric lifting in stoop and squat posture reduces trunk and hip extensor muscle activity and adjusts body posture - A laboratory study. APPLIED ERGONOMICS 2021; 97:103530. [PMID: 34280658 DOI: 10.1016/j.apergo.2021.103530] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
The influence of a passive exoskeleton was assessed during repetitive lifting with different lifting styles (squat, stoop) and orientations (frontal/symmetric, lateral/asymmetric) on trunk and hip extensor muscle activity (primary outcomes), abdominal, leg, and shoulder muscle activity, joint kinematics, and heart rate (secondary outcomes). Using the exoskeleton significantly and partially clinically relevant reduced median/peak activity of the erector spinae (≤6%), biceps femoris (≤28%), rectus abdominis (≤6%) and increased median/peak activity of the vastus lateralis (≤69%), trapezius descendens (≤19%), and median knee (≤6%) and hip flexion angles (≤11%). Using the exoskeleton had only limited influence on muscular responses. The findings imply the exoskeleton particularly supports hip extension and requires an adjusted body posture during lifting with different styles and orientations. The potential of using exoskeletons for primary/secondary prevention of musculoskeletal disorders should be investigated in future research including a greater diversity of users in terms of age, gender, health status.
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Affiliation(s)
- Tessy Luger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Mona Bär
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Pia Rimmele
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
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Russell BS, Muhlenkamp-Wermert KA, Hoiriis KT. Measurement of Lumbar Lordosis: A Comparison of 2 Alternatives to the Cobb Angle. J Manipulative Physiol Ther 2020; 43:760-767. [PMID: 32888701 DOI: 10.1016/j.jmpt.2020.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 04/10/2020] [Accepted: 05/17/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to compare 2 alternative methods, the radiologic Harrison Posterior Tangent Method (HPTM) and the nonradiologic Spinal Mouse (SM), to the Cobb angle for measuring lumbar lordosis. METHODS Sixteen participants with previously existing lateral lumbopelvic radiographs underwent nonradiographic lordosis assessment with a Spinal Mouse. Then 2 investigators analyzed each radiograph twice using the Harrison Posterior Tangent Method and Cobb angle. Correlations were analyzed between HPTM, the Cobb angle, and SM using the Spearman rank correlation coefficient; intraexaminer and interexaminer agreement were analyzed for HPTM and the Cobb angle using intraclass correlation coefficients. RESULTS The HPTM correlated highly with the Cobb angle (Spearman ρ = 0.936, P < .001); SM had moderate to strong correlations with the Cobb angle (ρ = 0.737, P = .002) and HPTM (ρ = 0.707, P = .003). Intraexaminer and interexaminer agreement for the Cobb angle and HPTM were excellent (all intraclass correlation coefficients > 0.90). One participant had slight kyphosis according to HPTM and SM analyses (which consider the entire lumbar region), whereas the Cobb angle, based only on L1 and L5, reported mild lordosis for that participant. CONCLUSION In this sample, HPTM measurements showed high correlation with the commonly used Cobb angle, but this method requires more time and effort, and normal values have not been established. The SM may be an alternative when radiographs are inappropriate, but it measures soft tissue contours rather than lordosis itself.
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Affiliation(s)
- Brent S Russell
- Dr. Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia.
| | | | - Kathryn T Hoiriis
- Dr. Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia
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Bernstein P, Metzler J, Weinzierl M, Seifert C, Kisel W, Wacker M. Radiographic scoliosis angle estimation: spline-based measurement reveals superior reliability compared to traditional COBB method. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:676-685. [PMID: 32856177 DOI: 10.1007/s00586-020-06577-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/25/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVE Although being standard for scoliosis curve size estimation, COBB angle measurement is well known to be inaccurate, due to a high interobserver variance in end vertebra selection and end plate contour delineation. We propose a stepwise improvement by using a spline constructed from vertebra centroids to resemble spinal curve characteristics more closely. To enhance precision even further, a neural net was trained to detect the centroids automatically. MATERIALS & METHODS Vertebra centroids in AP spinal X-ray images of varying quality from 551 scoliosis patients were manually labeled by 4 investigators. With these inputs, splines were generated and the computed curve sizes were compared to the manually measured COBB angles and to the curve estimation obtained from the neural net. RESULTS Splines achieved a higher interobserver correlation of 0.92-0.95 compared to manual COBB measurements (0.83-0.92) and showed 1.5-2 times less variance, depending on the anatomic region. This translates into an average of 1° of interobserver measurement deviation for spline-based curve estimation compared to 3°-8° for COBB measurements. The neural net was even more precise and achieved mean deviations below 0.5°. CONCLUSION In conclusion, our data suggest an advantage of spline-based automated measuring systems, so further investigations are warranted to abandon manual COBB measurements.
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Affiliation(s)
- Peter Bernstein
- Department for Orthopaedics and Traumatology, University Comprehensive Spine Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Johannes Metzler
- Faculty of Informatics/Mathematics, HTW Dresden, Friedrich-List-Platz 1, 01069, Dresden, Germany
| | - Marlene Weinzierl
- Department for Orthopaedics and Traumatology, University Comprehensive Spine Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Carl Seifert
- Department for Orthopaedics and Traumatology, University Comprehensive Spine Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Wadim Kisel
- Department for Orthopaedics and Traumatology, University Comprehensive Spine Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Markus Wacker
- Faculty of Informatics/Mathematics, HTW Dresden, Friedrich-List-Platz 1, 01069, Dresden, Germany
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Jankowicz-Szymańska A, Fałatowicz M, Smoła E, Błyszczuk R, Wódka K. Relationship between frontal knee position and the degree of thoracic kyphosis and lumbar lordosis among 10-12-year-old children with normal body weight. PLoS One 2020; 15:e0236150. [PMID: 32726335 PMCID: PMC7390398 DOI: 10.1371/journal.pone.0236150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 06/30/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Incorrect positioning of the body in space increases the tension of the myofascial tissue and overloads the skeleton. It is important to look for factors that affect the deterioration of body posture that could be eliminated. Understanding the interrelationship between the positioning of individual body segments should be the key knowledge for those involved in the prevention and correction of faulty body posture. The study aimed to determine the relationship between the degree of physiological curvatures of the spine and the incidence of incorrect knee position. MATERIALS AND METHODS The study involved 685 children aged 10-12. Body height, weight and BMI were measured and calculated. The degree of thoracic kyphosis and lumbar lordosis was assessed using the Zebris Pointer ultrasound system. Valgus and varus knees were diagnosed in an upright position based on the intermalleolar distance with knees together, and intercondylar distance with the feet placed together. The statistical analysis uses descriptive statistics, the Mann-Whitney U test (comparison of girls and boys), the Kruskal-Wallis test, the Tukey's post hoc test (comparison of variables in participants with correct, varus and valgus knees) and Spearman's rank correlation coefficient (the relationship between the position of the spine and knees). RESULTS The examined girls were heavier than the boys and had higher BMI. Spine deformities and incorrect knee position are common among 10-12-year-old children. The girls and boys differed significantly in the spine shape in the sagittal plane and the intermalleolar distance. Round lumbar lordosis is more characteristic for girls, and for boys, round thoracic kyphosis. For both genders, valgus knees occur more often than varus knees and coexist with decreased thoracic kyphosis. The rounder the thoracic kyphosis, the greater distance between the knees and the smaller distance between ankles. CONCLUSIONS The frontal knee position significantly correlated with the depth of thoracic kyphosis.
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Affiliation(s)
| | - Michał Fałatowicz
- Faculty of Health Sciences, University of Applied Sciences in Tarnow, Tarnow, Poland
| | - Eliza Smoła
- Faculty of Health Sciences, University of Applied Sciences in Tarnow, Tarnow, Poland
| | - Renata Błyszczuk
- Faculty of Health Sciences, University of Applied Sciences in Tarnow, Tarnow, Poland
| | - Katarzyna Wódka
- Faculty of Health Sciences, University of Applied Sciences in Tarnow, Tarnow, Poland
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Lee TTY, Cheung JCW, Law SY, To MKT, Cheung JPY, Zheng YP. Analysis of sagittal profile of spine using 3D ultrasound imaging: a phantom study and preliminary subject test. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2019. [DOI: 10.1080/21681163.2019.1566025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Timothy Tin-Yan Lee
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - Siu-Yu Law
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - Michael Kai Tsun To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
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Is rasterstereography a valid noninvasive method for the screening of juvenile and adolescent idiopathic scoliosis? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:526-535. [DOI: 10.1007/s00586-018-05876-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/28/2018] [Accepted: 12/29/2018] [Indexed: 01/24/2023]
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