| 1. |
- Snögren, Maria
(författare)
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Munhälsa – Äldre personers upplevelser och vårdpersonals attityder och kunskaper
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Det är känt att äldre personer har bättre munhälsa i dag och fler kvarvarande tänder än tidigare generationer. Det är en komplex uppgift att utföra munvård för att förebygga nedsatt munhälsa på någon annan. Nedsatt munhälsa kan påverka allmänhälsan på olika sätt, till exempel genom smärta och nedsatt aptit. Nedsatt munhälsa kan också vara en bidragande orsak till infektioner lokalt i munnen, men även i andra delar av kroppen. Det har dock visat sig att vårdpersonal (sjuksköterskor, undersköterskor och vårdbiträden) inom kommunal äldreomsorg försummar utförandet av munvård hos äldre personer av olika skäl, däribland tidsbrist, okunskap och bristande rutiner. Vårdpersonal värdesätter kunskap om munhälsa och efterfrågar utbildning om munhälsa och munvård. Kompetensutveckling för vårdpersonal tar tid samtidigt som den digitala utvecklingen och tillgången till digitala tjänster ökar. Digital utbildning kan vara en lösning till att sprida kunskap i en hel arbetsgrupp. Studier har visat på stort värde av möjligheten till interaktivitet, repetition och feedback som tydligt förknippas med ett ökat lärande vid användande av digitala utbildningar. Studier visar även att vårdpersonal som kompetensutvecklas genom utbildning om munhälsa tillhandahåller bättre munvård till äldre personer efter utbildning.Syfte: Det övergripande syftet var att studera äldre personers uppfattning om munhälsa och vårdpersonals attityder till och kunskaper om omvårdnad relaterat till munhälsa. Ytterligare ett syfte var att beskriva vårdpersonals attityder och kunskaper före och efter en digital utbildning i munhälsa och användbarheten av denna.Metod: Avhandlingen inkluderar fyra delstudier varav två har en kvalitativ design, delstudie I och IV, en med kvantitativ design, delstudie II och en med mixad metod, delstudie III. Delstudie I inkluderar äldre personer och delstudie II-IV inkluderar vårdpersonal. Data har samlats in med hjälp av frågeformulär, individuella intervjuer och fokusgruppsintervjuer. Kvalitativ analys genomfördes med hjälp av kvalitativ innehållsanalys i delstudie I och IV. Kvantitativa analyser genomfördes med Psykometrisk utvärdering med klassisk testteori (CTT) kompletterad med Item Response Theory (IRT) i delstudie II och beskrivande statistik och Wilcoxon signed-rank test i delstudie III.Resultat: Resultaten visar att det är komplext att utföra munvård på någon annan och kräver att tid ges till att bygga personkännedom mellan vårdpersonalen och den äldre personen som får hjälp med munvård. Personkännedom beskrivs av vårdpersonal främja och ge trygghet i utförandet av munvård. Äldre personer beskriver att de är experter på sina egna upplevelser av munhälsan och att denna kunskap behöver delas med vårdpersonalen. Personkännedom etableras och uppnås genom att vårdpersonalen skapar förtroende, är närvarande, förutser behov, är pålästa och genom att reflektera över vården. Det är ett förtroende att utföra munvård på någon annan, vilket underlättas av personkännedom. Det ger vårdpersonalen information och bättre förutsättningarna att utföra god munvård och att synliggöra hinder som tids-, personal- och kunskapsbrist. Äldre personer värdesätter en god munhälsa och vårdpersonalen värdesätter kunskap relaterad till munhälsa. Ett sätt att sprida kunskap om munhälsa bland vårdpersonalen är genom digitala utbildningsinterventioner. Kombinationen av teoretisk kunskap med hjälp av digital utbildning och praktiska övningar beskrivs av vårdpersonalen som ett sätt att ge både teoretisk och praktisk kunskap. Att arbeta tillsammans över professionsgränser i omvårdnad kring munvården beskrivs ofta brista inom kommunal äldreomsorg. Arbetet tillsammans upplevs dock fungera bra vid palliativ omvårdnad. Äldre personer beskriver en önskan om hjälp med sin munhälsa när behov uppstår.Slutsatser: Äldre personer värdesätter en god munhälsa och vårdpersonalen värdesätter kunskap relaterad till munhälsa. Munvård är komplex och förutsätter att vårdpersonalen erhåller kunskap, rutiner, tid och samarbetar för att utföra den med god personkännedom om den äldre person. Digital utbildning är ett sätt att öka kunskapen om munhälsa bland vårdpersonalen. En kombination av teori med hjälp av digital utbildning och praktiska övningar bidrar till både teoretisk och praktisk kunskap. Samarbetet kring munvård mellan sjuksköterskor, undersköterskor och vårdbiträden fungerade inte alltid optimalt, däremot fungerade samarbetet bra vid palliativ omvårdnad. Samarbete, tid och kunskap samt reflektion anses vara viktiga faktorer för vårdverksamheter att beakta i framtiden för att god munvård ska kunna utföras inom kommunal äldreomsorg.
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| 2. |
- Ahlborg, Mikael, 1985-
(författare)
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Social capital and inequalities in mental health among young adolescents in Sweden
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore social capital and inequalities in mental health among young adolescents in Sweden. This is a compilation thesis comprising four studies. Studies I and II are quantitative studies of crosssectional data from the Swedish Health Behaviour in School-aged Children survey. The aim of Study I was to investigate socioeconomic inequalities in health using both a subjective and an objective measure of socioeconomic status among Swedish adolescents. The findings showed that subjective socioeconomic status robustly and independently predicted mental health problems, poor life satisfaction and poor general health perception. The association between objective socioeconomic status and mental health was weakened, and even reversed, when subjective socioeconomic status was accounted for in regression models. A Latent Profile Analysis was applied in Study II with the aim of identifying distinct profiles of family, school and peer social capital in a nationally representative sample of adolescents and to explore health outcomes in those profiles. The findings showed that five distinct profiles best represented the data for 11 and 15-year olds, while a four-profile model was optimal for 13-year olds. Significant inequalities were identified between profiles when these were examined in terms of mental health problems and life satisfaction. The design of Study III was a qualitative semi-structured interview study. The aim was to explore social capital from the perspective of adolescents in relation to mental health. Adolescents spoke of having access to a safe space, feeling connected to others and predictability as important aspects of social relationships and networks in relation to mental health. The aim of Study IV was to identify and evaluate the design and psychometric properties of instruments for assessing social capital specifically developed and validated for self-reporting among adolescents (10-19 years). The design was a systematic review, in which 20 instruments were identified. The results revealed a lack of instruments that covered both the multidimensionality of social capital and contextual relevance in relation to adolescents. The conclusion from this thesis is that social capital may be useful for identifying vulnerable individuals and for differentiating between the natural imbalance of adolescence and what may lead to serious illness. Longitudinal research and refinement of the operationalization of the concept are, however, needed to enhance the understanding of these findings.
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| 3. |
- Wastesson, Karin, 1986-
(författare)
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Learning Managerial Work : First-line Managers’ Learning in Everyday Work within Swedish Elderly Care
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study’s overall aim is to contribute knowledge about first-line managers’ learning in everyday work within the context of elderly care. The study used a qualitative research approach and was carried out within four Swedish elderly care organisations. A total of 40 first-line managers were interviewed, 10 of whom kept time-use diaries. The theoretical framework is based on a workplace learning perspective originating from theory of situated learning. Situated learning theory includes the concepts of community of practice, legitimate peripheral participation, and membership, which serve as analytical tools to illuminate characteristics of learning from various angles. In addition, the concept of gender has been used to gain a deeper understanding for managers’ workplace learning in the female-dominated elderly care context.The findings showed that managers’ learning happened in a stream of varied tasks and interactions shaped by conditions in the workplace. The managers’ work was characterised by unpredictability and changing circumstances, which meant they continuously had to learn how to handle new situations and expand their repertoire of managerial practices. One common perception among themanagers was the importance of being able to make quick decisions with limited information, and assess the results afterwards. The managers learned how to deal with work situations by either maintaining and modifying current practices or inventing new ones. In addition to these three practices, their learning was affected by different conditions, particularly professional experience, work relationships and organisational conditions. The findings further showed that the managers had to learn to deal with expectations of how they should act in the managerial role based on their gender, and learn to navigate between gender ideals that permeated the female-dominated elderly care environment.Three conclusions were drawn from this study. The first was that managers took great responsibility for their own learning, including what they needed to know and how they would learn it. Despite the fact that they all had access to resources provided by the employer, managers often chose alternative ways to learn, usually by relying on informal networks and close personal relationships. As a result of this self-directed learning, they were able to make decisions that suited their learning needs, and effectively proceed in practice without having to confirm their chosen methods.The second conclusion was that work relationships played a central part in managers’ learning, within both the care work community and the first-line manager community. Work relationships with other first-line managers provided support for learning through, for example, knowledge exchange and joint discussions, as well as emotional support. Work relationships with subordinates were significant for learning, and could result in solutions to complex issues, which could have a direct effect on the daily operation of care work services. Due to the diverse mix of professions, varying interests, and formal positions of authority in the care work community, managers were required to devote considerable time and effort to facilitate collaboration and a shared repertoire. As a result, learning was seen as a stimulating and enjoyable experience, but was also demanding and sometimes boring.The third conclusion was that in the context of the female-dominated elderly care gender operated differently in two communities of practices. Male privilege was still prominent in the care work community, as men were accepted and perceived as legitimate leaders among their subordinates. Female managers instead had to navigate and balance the expectations associated with femininity and the managerial role in this community. However, the female-dominated elderly care context provided female managers with more opportunities to connect with equal peers and establish influential positions, whereas male managers could encounter challenges in gaining access to learning and participating in the first-line manager community.
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| 4. |
- Eriksson, Anna-Karin, 1979-
(författare)
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Global history or inter|nationalist discourse!? : Unsettling the 'comfort women' issue
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Survivors of the ‘comfort’ system, the state-sponsored regime of military sexual exploitation and a core institution in the expansion of the empire of Japan from 1932 to 1945, continue to go unrecognised almost 80 years past 1945 and 30 years after the breakthrough by human rights activists in 1991. That such a brutal regime of sexual exploitation remains unrecognised by the state is remarkable and merits attention. In this thesis, I suggest that the ‘comfort women’ issue remains stuck in a deadlock that freezes it in the inter-state framing of a status quo. As a result the comfort women, the survivors and supposed protagonists, are rendered as mere tiles in a series of inter-state conflicts between the State of Japan and its neighbours in Northeast Asia as one of the fiercest battlegrounds in this region’s ‘history wars’. My purpose in the thesis is to offer possibilities to rethink the comfort women issue beyond this deadlock. To this end, I (1) identify the dynamics that sustain and reify the deadlock (Paper 1 and Paper 2) and (2) unsettle these dynamics (Paper 3 and Paper 4).
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| 5. |
- Grönte, Maria
(författare)
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Skam, moralarbete och faderskap : en studie om mötet mellan socialsekreterare och pappor vid våld i nära relationer
- 2024
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Men's domestic violence and/or abuse (DVA) is a widespread social issue. Often, the men are fathers, and the victims are mothers and children. In Sweden, social workers (SWs) are expected to involve these fathers in child protection investigations (CPIs) and work towards changing their behavior. However, engaging fathers in CPIs has proven to be a challenging task, especially when they involve DVA by fathers. The overall aim of this licentiate thesis is to examine how fathers can be engaged in CPIs initiated as a result of their suspected DVA against the mothers of their children. The licentiate thesis is a compilation thesis that consist of two articles, with the first having been published in a peer-review journal and the second submitted to a journal awaiting review. Using qualitative methods. I conducted semi structured interviews with 15 social workers on a total of 31 occasions during their work with 12 ongoing CPIs. Seven fathers have also been interviewed. The interviewed fathers had been involved in CPIs as a result of their DVA against the mothers of their children and had undergone treatment targeting their violent/abusive behavior.The interviews with the SWs are addressed in the first article, and the interviews with the fathers in the second article. The data were analysed using thematic analysis. The first article examines the strategies used by SWs to achieve cooperation with fathers in CPIs that involve the father being suspected of DVA against the child's mother. This analysis is rooted in the framework of shame, guilt, and social bonds. The results suggest that whether social workers succeed in achieving cooperation with fathers is related to the social workers' strategies of building secure social bonds with the fathers, which may alleviate the fathers' feelings of shame. However, there is a risk that these strategies may lead to DVA being minimized or overlooked. Striking a balance between building a social bond and addressing DVA is crucial, and the timing of addressing DVA plays a central role. The second article highlights fathers' experiences of interactions with SWs in the context of CPIs initiated as a result of their DVA against the mothers of their children. In particular, the focus is directed at how ideals of fatherhood, power relations, and shame influence fathers' experiences of engaging in these meetings. The analysis is guided by shame, guilt and social bonds linked to a gender theoretical framework. The results suggest that DVA contributes to fathers violating moral ideals of good fatherhood, which threatens to deprive them of contact with their children and also triggers feelings of shame. In the CPIs, it is the SWs, often female, who hold power over the processes while fathers are subordinated, which challenges expected power structures and hegemonic masculinity ideals. Fathers' engagement in CPIs is enabled when fathers adopt a subordinate position, which is facilitated by SWs meeting them with care and non-judgmental attitudes. This subordinate position can be a useful means for fathers to maintain an intact masculine position when DVA is exposed, shame is triggered, and their fatherhood and social bonds are threatened. However, SWs need to be attentive to the risk that fathers may both downplay their DVA and adopt positions that may be perceived as caring, egalitarian, and change-oriented even though their dominance – in the form of DVA – may persist.In summary, the study indicates that it is challenging but possible to successfully engage these fathers in CPIs. The study suggests that SWs need to balance building social bonds with the fathers and addressing the violence without imposing further shame. The findings highlight a particularly crucial aspect in the interaction, which is the SWs' ability to meet the fathers in a way that they do not feel judged for who they are - perpetrators of DVA. Instead, focusing on the violence as actions, on what they have done. In doing so, actions are separated from the self and can instead manifest as guilt. This approach can both facilitate fathers' engagement in CPIs and point towards taking responsibility for and changing the violent/abusive behaviors.
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| 6. |
- Lindkvist, Emma, 1984-
(författare)
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System studies of biogas production : comparisons and performance
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Biogas has the potential to be part of the transition towards a more sustainable energy system. Biogas is a renewable energy source and can play an important role in modern waste management systems. Biogas production can also help recirculate nutrients back to farmland. Besides all this, biogas is a locally produced energy source with the potential to increase global resource efficiency, since it can lead to more value and less waste, as well as decreased negative environmental effects. However, biogas production systems are complex, including different substrates, different applications for biogas and digestate, and different technology solutions for digestion, pre-treatment and for upgrading the raw gas. To increase the development of biogas production systems, knowledge sharing is a key factor. To increase this knowledge sharing, comprehensible analysis and comparisons of biogas production systems are necessary. Thus, studies are needed to verify the resource efficiency of biogas production systems from different perspectives.The aim of this thesis is to perform a systems analysis of biogas production systems and to explore how to analyse and compare biogas production systems. An additional aim is to study biogas production systems from a systems perspective, with a focus on environment, energy and economy. Studying biogas production systems from different system levels, as well as from different approaches, is beneficial because it results in deeper knowledge of biogas systems and greater opportunities to identify synergies.Systems studies of biogas are important, since biogas systems are often complex and integrated with other systems. In this thesis, biogas systems analyses are performed at different levels. In the widest system study, classifications of different biogas plants are analysed and classifications in different European countries are compared, with the prospect of paving the way for a new common classification for biogas plants in Europe. Today, classifications vary between countries, and hence comparisons of plants in different countries are difficult. In the narrowest system study, a new methodology for analysing energy demand at different biogas production plants has been developed. The aim was to develop a methodology that is applicable for all kinds of biogas plants with energy inputs. The methodology describes the process of analysing energy demand and allocating energy to sub-processes and unit processes.Further, an approach for assessing the resource efficiency of different treatment options for organic waste was designed. The approach includes environmental, economic and energy perspectives, and was applied to five different regions with several food manufacturing companies. A study of treatment options for organic waste from a single food company was also conducted. The results showed that biogas production is a resource-efficient way to treat waste from the food industry. The approach enables a wider analysis of biogas systems, and the results from the applications show the complexity of assessing resource efficiency. It is also shown that it is important to understand that the resource efficiency of a system is always in relation to the substituted system.In this thesis, three different approaches to analysing biogas production systems are presented: categorization, resource efficiency analysis and energy demand analysis. These approaches all contribute to the understanding of biogas systems and can help, in different ways, to increase knowledge about biogas systems in the world. If knowledge about different biogas systems can be easily disseminated, more of the unused potential of biogas production may be realized, and hence more fossil fuels can be replaced within the energy system.
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| 7. |
- Rock, Anna Ida R.
(författare)
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Statebuilding through diaspora recruitment? : The role of capacity, norms and representation for legitimacy in Somaliland and Liberia
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- How do the local elites and the wider population perceive returnees in post-war governments and what shapes these returnees’ legitimacy? Overall, while acknowledging some benefits, local elites in Somaliland and Liberia highlight challenges connected to returnees’ presence in governments and question their legitimacy. These challenges are mirrored in the perceptions of the Liberian population, who see returnees as less legitimate in government positions than stayees. The legitimacy of these returnees is mainly shaped by notions of capacity, democratic norms and practices as well as by how well they represent the local population. This thesis provides several pioneering studies of how diaspora returnees are perceived domestically. These issues are examined through three essays that rely on a wide array of novel data from Somaliland and Liberia. In essay I, I discuss under which conditions returnees in the Somaliland government are seen as legitimate. In essay II, I demonstrate how Liberian elite perceptions and experiences of returnee ministers only slightly correspond to the expectations held in international and national policy circles. In essays I and II, I mainly rely on elite interviews. However, in essay III, I investigate the research question from the perspective of the general Liberian population. Using a survey experiment, I demonstrate how a high presence of returnee ministers negatively affects cabinet legitimacy. This effect, however, is attenuated when returnees indicate that they will give up their ties to their host country. In this way, this thesis problematizes expectations of diaspora returnees by showing how they seldom constitute ideal interlocutors in statebuilding activities and their engagement often implies difficult trade-offs between central peacebuilding and statebuilding objectives. Dominance by returnees in the government excludes local actors and signals that qualifications acquired in the Global North are valued over domestic knowledge. This thesis concludes that in these contexts diaspora recruitment is highly political.
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| 8. |
- Engström, Gunnar, et al.
(författare)
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Pulmonary function and atherosclerosis in the general population : causal associations and clinical implications
- 2024
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Ingår i: European Journal of Epidemiology. - : Springer Nature. - 0393-2990 .- 1573-7284. ; 39:1, s. 35-49
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Tidskriftsartikel (refereegranskat)abstract
- Reduced lung function is associated with cardiovascular mortality, but the relationships with atherosclerosis are unclear. The population-based Swedish CArdioPulmonary BioImage study measured lung function, emphysema, coronary CT angiography, coronary calcium, carotid plaques and ankle-brachial index in 29,593 men and women aged 50–64 years. The results were confirmed using 2-sample Mendelian randomization. Lower lung function and emphysema were associated with more atherosclerosis, but these relationships were attenuated after adjustment for cardiovascular risk factors. Lung function was not associated with coronary atherosclerosis in 14,524 never-smokers. No potentially causal effect of lung function on atherosclerosis, or vice versa, was found in the 2-sample Mendelian randomization analysis. Here we show that reduced lung function and atherosclerosis are correlated in the population, but probably not causally related. Assessing lung function in addition to conventional cardiovascular risk factors to gauge risk of subclinical atherosclerosis is probably not meaningful, but low lung function found by chance should alert for atherosclerosis.
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| 9. |
- Eriksson, Maria A., 1965-, et al.
(författare)
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Leptin levels are not affected by enalapril treatment after an uncomplicated myocardial infarction, but associate strongly with changes in fibrinolytic variables in men
- 2020
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Taylor & Francis. - 0036-5513 .- 1502-7686. ; 80:4, s. 303-308
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Tidskriftsartikel (refereegranskat)abstract
- Leptin, an adipocyte-derived hormone, is involved in the regulation of body weight and is associated with obesity-related complications, notably cardiovascular disease (CVD). A putative link between obesity and CVD could be induction of plasminogen activator inhibitor-1 (PAI-1) synthesis by leptin. In this study, we hypothesized that the beneficial effect of the angiotensin-converting enzyme inhibitor (ACE(i)) enalapril on PAI-1 levels is mediated by effects on leptin levels. The association between leptin and components of the fibrinolytic system was evaluated in a non-prespecified post hoc analysis of a placebo-controlled randomized, double-blind trial where the effect of the ACE(i) enalapril on fibrinolysis was tested. A total of 46 men and 37 women were randomized to treatment with enalapril or placebo after (median 12 months) an uncomplicated myocardial infarction. At baseline, the participants were stable and had no signs of congestive heart failure. Leptin and fibrinolytic variables (mass concentrations of PAI-1, tissue plasminogen activator (tPA) and tPA-PAI complex) were measured at baseline, and after 10 days, 6 months and 12 months. Enalapril treatment did not change leptin levels, which increased significantly during 1 year of follow-up (p = .007). Changes in leptin levels were strongly associated with changes of tPA mass (p = .001), tPA-PAI complex (p = .003) and of PAI-1 (p = .006) in men, but not in women. Leptin levels are not influenced by treatment with an ACE(i). In contrast, leptin associates strongly with changes in fibrinolytic variables notably with a sex difference, which could be of importance for obesity-related CVD.
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| 10. |
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