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Robert, G., Sarre, S., Maben, J., Griffiths, P. & Chable, R. (2020). Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the 'Productive Ward. BMJ Quality and Safety, 29, 31-40
Open this publication in new window or tab >>Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the 'Productive Ward
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2020 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 29, p. 31-40Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The 'Productive Ward: Releasing Time to Care' programme is a quality improvement (QI) intervention introduced in English acute hospitals a decade ago to: (1) Increase time nurses spend in direct patient care. (2) Improve safety and reliability of care. (3) Improve experience for staff and patients. (4) Make changes to physical environments to improve efficiency.

OBJECTIVE: To explore how timing of adoption, local implementation strategies and processes of assimilation into day-to-day practice relate to one another and shape any sustained impact and wider legacies of a large-scale QI intervention.

DESIGN: Multiple methods within six hospitals including 88 interviews (with Productive Ward leads, ward staff, Patient and Public Involvement representatives and senior managers), 10 ward manager questionnaires and structured observations on 12 randomly selected wards.

RESULTS: Resource constraints and a managerial desire for standardisation meant that, over time, there was a shift away from the original vision of empowering ward staff to take ownership of Productive Ward towards a range of implementation 'short cuts'. Nonetheless, material legacies (eg, displaying metrics data; storage systems) have remained in place for up to a decade after initial implementation as have some specific practices (eg, protected mealtimes). Variations in timing of adoption, local implementation strategies and contextual changes influenced assimilation into routine practice and subsequent legacies. Productive Ward has informed wider organisational QI strategies that remain in place today and developed lasting QI capabilities among those meaningfully involved in its implementation.

CONCLUSIONS: As an ongoing QI approach Productive Ward has not been sustained but has informed contemporary organisational QI practices and strategies. Judgements about the long-term sustainability of QI interventions should consider the evolutionary and adaptive nature of change processes.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020
Keywords
continuous quality improvement, healthcare quality improvement, implementation science, qualitative research, quality improvement methodologies
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-47056 (URN)10.1136/bmjqs-2019-009457 (DOI)31358685 (PubMedID)HOA HHJ 2020;HHJIMPROVEIS (Local ID)HOA HHJ 2020;HHJIMPROVEIS (Archive number)HOA HHJ 2020;HHJIMPROVEIS (OAI)
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2020-01-03Bibliographically approved
Metz, A., Boaz, A. & Robert, G. (2019). Co-creative approaches to knowledge production: What next for bridging the research to practice gap?. Evidence & Policy: A Journal of Research, Debate and Practice, 15(3), 331-337
Open this publication in new window or tab >>Co-creative approaches to knowledge production: What next for bridging the research to practice gap?
2019 (English)In: Evidence & Policy: A Journal of Research, Debate and Practice, ISSN 1744-2648, E-ISSN 1744-2656, Vol. 15, no 3, p. 331-337Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Policy Press, 2019
National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:hj:diva-47050 (URN)10.1332/174426419X15623193264226 (DOI)000484784700001 ()2-s2.0-85073431853 (Scopus ID)
Note

Special Issue: Co-creative approaches to knowledge production and implementation. Guest edited by Allison Metz, Annette Boaz and Glenn Robert.

Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2019-12-11Bibliographically approved
Mulvale, G., Moll, S., Miatello, A., Robert, G., Larkin, M., Palmer, V. J., . . . Girling, M. (2019). Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration. Health Expectations, 22(3), 284-297
Open this publication in new window or tab >>Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration
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2019 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 22, no 3, p. 284-297Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Codesign has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective codesign.

OBJECTIVE: To explore citizens' involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements.

DESIGN: A modified case study approach. Pattern matching was used to compare reported challenges with a priori theoretical propositions.

SETTING AND PARTICIPANTS: A two-day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations.

INTERVENTION STUDIED: Eight case studies working with vulnerable and disadvantaged populations in three countries.

RESULTS: We identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. In response, a focus on relationships and flexibility is essential. We encourage codesign projects to enact a set of principles or heuristics rather than following pre-specified steps. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations.

DISCUSSION AND CONCLUSIONS: Codesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when working with services for vulnerable populations. The need for flexibility and responsiveness to service user needs may challenge expectations about timelines and outcomes. User-centred evaluations of codesigned public services are needed.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
codesign, public services, vulnerable populations
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42600 (URN)10.1111/hex.12864 (DOI)000470930200003 ()30604580 (PubMedID)2-s2.0-85066507115 (Scopus ID)GOA HHJ 2019;HHJIMPROVEIS (Local ID)GOA HHJ 2019;HHJIMPROVEIS (Archive number)GOA HHJ 2019;HHJIMPROVEIS (OAI)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-07-14Bibliographically approved
McAllister, S., Robert, G., Tsianakas, V. & McCrae, N. (2019). Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review. International Journal of Nursing Studies, 93, 106-118
Open this publication in new window or tab >>Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review
2019 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 93, p. 106-118Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The review aimed to 1) explore the constituents of nurse-patient therapeutic engagement on acute mental health wards; 2) map factors that influence engagement to the Theoretical Domains Framework and 3) integrate results into a conceptual model of engagement to inform the development of interventions to improve engagement.

DESIGN: A systematic integrative review using an established framework specific to the integrative review methodology.

DATA SOURCES: Database searches (CINAHL, PsycINFO, BNI and Cochrane Library) and hand searching identified 3414 articles. After screening, applying eligibility criteria, and quality appraisal, 37 articles were included: n = 27 empirical research studies, n = 10 expert opinion pieces, n = 1 case study and n = 1 theoretical report.

REVIEW METHODS: Peer-reviewed empirical studies, theoretical reports or expert opinion pieces that explored therapeutic engagement as a stated aim and were conducted in acute mental health inpatient settings from the patient or nurse perspective were included. Data were extracted from the introduction, results and discussion sections of empirical research, and the complete article of theoretical and expert opinion pieces. Data were coded then grouped into subthemes and themes. Data relating to influencing factors were further categorised according to the Theoretical Domains Framework. Results were synthesised into a conceptual model of engagement.

RESULTS: Five conceptually distinct, but closely related constructs of engagement - called the "Principles of Engagement" - emerged: 1) Understanding the person and their experiences; 2) Facilitating growth; 3) Therapeutic use of self; 4) Choosing the right approach and 5) Authoritative vs. emotional containment. Influences on engagement ranged across all 14 theoretical domains of the Theoretical Domains Framework.

CONCLUSION: A holistic understanding of the essential components of engagement may make it easier for nurses to recognise what they do, and to do it well. The model can be used to generate testable hypotheses about how and where to target behavioural change interventions. The Principles of Engagement must be reflected in the development of interventions to improve engagement.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Integrative review, Intervention development, Mental health nursing, Theoretical Domains Framework, Therapeutic engagement
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Identifiers
urn:nbn:se:hj:diva-47058 (URN)10.1016/j.ijnurstu.2019.02.013 (DOI)000468710200012 ()30908958 (PubMedID)2-s2.0-85063202716 (Scopus ID)HOA HHJ 2019;HHJIMPROVEIS (Local ID)HOA HHJ 2019;HHJIMPROVEIS (Archive number)HOA HHJ 2019;HHJIMPROVEIS (OAI)
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2019-12-11Bibliographically approved
Hanna, E. & Robert, G. (2019). Ethics of limb disposal: Dignity and the medical waste stockpiling scandal. Journal of Medical Ethics, 45(9), 575-578
Open this publication in new window or tab >>Ethics of limb disposal: Dignity and the medical waste stockpiling scandal
2019 (English)In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 45, no 9, p. 575-578Article in journal (Refereed) Published
Abstract [en]

We draw on the concept of dignity to consider the ethics of the disposal of amputated limbs. The ethics of the management and disposal of human tissue has been subject to greater scrutiny and discussion in recent years, although the disposal of the limbs often remains absent from such discourses. In light of the recent UK controversy regarding failures in the medical waste disposal and the stockpiling of waste (including body parts), the appropriate handling of human tissue has been subject to further scrutiny. Although this scandal has evoked concern regarding procurement and supply chain issues, as well as possible health and safety risks from such a stockpile', the dignity of those patients' implicated in this controversy has been less widely discussed. Drawing at Foster's (2014) work, we argue that a dignity framework provides a useful lens to frame consideration of the disposal of limbs after amputation. Such a framework may be difficult to reconcile with the logic of business and the biovalue' of the medical waste, but would we argue afford more patient-centred approaches towards disposal. It may also facilitate better practices to help mitigate future stockpiling incidences. 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
business, human dignity, human tissue, quality of health care, adult, amputation, article, drawing, drug safety, ethics, health care quality, human, incidence, limb, logic, waste disposal
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Medical Ethics
Identifiers
urn:nbn:se:hj:diva-47054 (URN)10.1136/medethics-2019-105554 (DOI)000487540700002 ()31358558 (PubMedID)2-s2.0-85070833063 (Scopus ID)HOA HHJ 2019;HHJIMPROVEIS (Local ID)HOA HHJ 2019;HHJIMPROVEIS (Archive number)HOA HHJ 2019;HHJIMPROVEIS (OAI)
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2019-12-11Bibliographically approved
Jones, L., Pomeroy, L., Robert, G., Burnett, S., Anderson, J. E., Morris, S., . . . Fulop, N. J. (2019). Explaining organisational responses to a board-level quality improvement intervention: Findings from an evaluation in six providers in the English National Health Service. BMJ Quality and Safety, 28(3), 198-204
Open this publication in new window or tab >>Explaining organisational responses to a board-level quality improvement intervention: Findings from an evaluation in six providers in the English National Health Service
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2019 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 28, no 3, p. 198-204Article in journal (Refereed) Published
Abstract [en]

Background: Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis' typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.

Methods: We conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England. Our data comprised board member interviews (n=54), board meeting observations (24 hours) and relevant documents.

Results: Two organisations transformed their processes in a way that was consistent with the objectives of the intervention, and one customised the intervention with positive effects. In two further organisations, the intervention was only loosely coupled with organisational processes, and participation in the intervention stopped when it competed with other initiatives. In the final case, the intervention was corrupted to reinforce existing organisational processes (a focus on external regulatory requirements). The organisational response was contingent on the availability of 'slack' - expressed by participants as the 'space to think' and 'someone to do the doing' - and the presence of a functioning board.

Conclusions: Underperforming organisations, under pressure to improve, have little time or resources to devote to organisation-wide quality improvement initiatives. Our research highlights the need for policy-makers and regulators to extend their focus beyond the choice of intervention, to consider how the chosen intervention will be implemented in public sector hospitals, how this will vary between contexts and with what effects. We provide useful information on the necessary conditions for a board-level quality improvement intervention to have positive effects.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
governance, organizational theory, quality improvement, adult, article, England, female, field work, health care personnel, human, interview, major clinical study, male, national health service, public sector, total quality management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42577 (URN)10.1136/bmjqs-2018-008291 (DOI)30381330 (PubMedID)2-s2.0-85056110523 (Scopus ID)GOA HHJ 2019;HHJIMPROVEIS (Local ID)GOA HHJ 2019;HHJIMPROVEIS (Archive number)GOA HHJ 2019;HHJIMPROVEIS (OAI)
Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-03-22Bibliographically approved
Kjellström, S., Areskoug Josefsson, K., Andersson-Gäre, B., Andersson, A.-C., Ockander, M., Käll, J., . . . Robert, G. (2019). Exploring, measuring and enhancing the coproduction of health and well-being at the national, regional and local levels through comparative case studies in Sweden and England: the 'Samskapa' research programme protocol. BMJ Open, 9(7), Article ID e029723.
Open this publication in new window or tab >>Exploring, measuring and enhancing the coproduction of health and well-being at the national, regional and local levels through comparative case studies in Sweden and England: the 'Samskapa' research programme protocol
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e029723Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:

Cocreation, coproduction and codesign are advocated as effective ways of involving citizens in the design, management, provision and evaluation of health and social care services. Although numerous case studies describe the nature and level of coproduction in individual projects, there remain three significant gaps in the evidence base: (1) measures of coproduction processes and their outcomes, (2) mechanisms that enable inclusivity and reciprocity and (3) management systems and styles. By focusing on these issues, we aim to explore, enhance and measure the value of coproduction for improving the health and well-being of citizens.

METHODS AND ANALYSIS:

Nine ongoing coproduction projects form the core of an interactive research programme ('Samskapa') during a 6-year period (2019-2024). Six of these will take place in Sweden and three will be undertaken in England to enable knowledge exchange and cross-cultural comparison. The programme has a longitudinal case study design using both qualitative and quantitative methods. Cross-case analysis and a sensemaking process will generate relevant lessons both for those participating in the projects and researchers. Based on the findings, we will develop explanatory models and other outputs to increase the sustained value (and values) of future coproduction initiatives in these sectors.

ETHICS AND DISSEMINATION:

All necessary ethical approvals will be obtained from the regional Ethical Board in Sweden and from relevant authorities in England. All data and personal data will be handled in accordance with General Data Protection Regulations. Given the interactive nature of the research programme, knowledge dissemination to participants and stakeholders in the nine projects will be ongoing throughout the 6 years. External workshops-facilitated in collaboration with participating case studies and citizens-both during and at the end of the programme will provide an additional dissemination mechanism and involve health and social care practitioners, policymakers and third-sector organisations. 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
case study, codesign, coproduction, healthcare, social care, adult, article, cultural factor, England, human, organization, physician, quantitative analysis, scientist, Sweden, wellbeing
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-46421 (URN)10.1136/bmjopen-2019-029723 (DOI)000485269700101 ()31350253 (PubMedID)2-s2.0-85070675953 (Scopus ID)GOA HHJ 2019;HHJIMPROVEIS (Local ID)GOA HHJ 2019;HHJIMPROVEIS (Archive number)GOA HHJ 2019;HHJIMPROVEIS (OAI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01431
Available from: 2019-10-02 Created: 2019-10-02 Last updated: 2019-10-11Bibliographically approved
Robert, G., Kjellström, S., Areskoug Josefsson, K., Andersson-Gäre, B., Andersson, A.-C., Ockander, M., . . . Donetto, S. (2019). Exploring, measuring and enhancing the co-production of health and wellbeing at the national, regional and local levels through comparative case studies in Sweden and England: The 'Samskapa' research programme (study protocol). In: : . Paper presented at 14th ESA Conference, Europe and Beyond: Boundaries, Barriers and Belonging, 20-23 August 2019, Manchester, UK.
Open this publication in new window or tab >>Exploring, measuring and enhancing the co-production of health and wellbeing at the national, regional and local levels through comparative case studies in Sweden and England: The 'Samskapa' research programme (study protocol)
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2019 (English)Conference paper, Oral presentation only (Refereed)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-45081 (URN)
Conference
14th ESA Conference, Europe and Beyond: Boundaries, Barriers and Belonging, 20-23 August 2019, Manchester, UK
Available from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-06-25Bibliographically approved
Locock, L., Kirkpatrick, S., Brading, L., Sturmey, G., Cornwell, J., Churchill, N. & Robert, G. (2019). Involving service users in the qualitative analysis of patient narratives to support healthcare quality improvement. Research in Social Science and Disability, 5(1)
Open this publication in new window or tab >>Involving service users in the qualitative analysis of patient narratives to support healthcare quality improvement
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2019 (English)In: Research in Social Science and Disability, ISSN 1479-3547, E-ISSN 2056-7529, Vol. 5, no 1Article in journal (Refereed) Published
Abstract [en]

Patient or user involvement in health research is well-established but is often limited to advising on research questions and design, leaving researchers to collect and analyse ‘data’ (which in this paper means written copies of interviews with patients about their experiences). We were working with sets of interviews with 1) young people with depression and 2) people with experiences of stroke. We were looking for key themes that it would be useful for the NHS to know about, and we developed short films which healthcare staff can use to think about how to make care more patient-centred. We wanted to see what user involvement in this analysis would bring, and how best to achieve it practically.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Patient and public involvement; User involvement; Patient experience; Experience-based co-design; Qualitative analysis; Qualitative interviews; Quality improvement; Health research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42599 (URN)10.1186/s40900-018-0133-z (DOI)GOA HHJ 2019;HHJIMPROVEIS (Local ID)GOA HHJ 2019;HHJIMPROVEIS (Archive number)GOA HHJ 2019;HHJIMPROVEIS (OAI)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-12-11Bibliographically approved
Donetto, S., Desai, A., Zoccatelli, G., Robert, G., Allen, D., Brearley, S. & Rafferty, A. M. (2019). Organisational strategies and practices to improve care using patient experience data in acute NHS hospital trusts: an ethnographic study. Health Services and Delivery Research, 7(34)
Open this publication in new window or tab >>Organisational strategies and practices to improve care using patient experience data in acute NHS hospital trusts: an ethnographic study
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2019 (English)In: Health Services and Delivery Research, ISSN 2050-4349, Vol. 7, no 34Article in journal (Refereed) Published
Abstract [en]

Background

Although NHS organisations have access to a wealth of patient experience data in various formats (e.g. surveys, complaints and compliments, patient stories and online feedback), not enough attention has been paid to understanding how patient experience data translate into improvements in the quality of care.

Objectives

The main aim was to explore and enhance the organisational strategies and practices through which patient experience data are collected, interpreted and translated into quality improvements in acute NHS hospital trusts in England. The secondary aim was to understand and optimise the involvement and responsibilities of nurses in senior managerial and front-line roles with respect to such data.

Design

The study comprised two phases. Phase 1 consisted of an actor–network theory-informed ethnographic study of the ‘journeys’ of patient experience data in five acute NHS hospital trusts, particularly in cancer and dementia services. Phase 2 comprised a series of Joint Interpretive Forums (one cross-site and one at each trust) bringing together different stakeholders (e.g. members of staff, national policy-makers, patient/carer representatives) to distil generalisable principles to optimise the use of patient experience data.

Setting

Five purposively sampled acute NHS hospital trusts in England.

Results

The analysis points to five key themes: (1) each type of data takes multiple forms and can generate improvements in care at different stages in its complex ‘journey’ through an organisation; (2) where patient experience data participate in interactions (with human and/or non-human actors) characterised by the qualities of autonomy (to act/trigger action), authority (to ensure that action is seen as legitimate) and contextualisation (to act meaningfully in a given situation), quality improvements can take place in response to the data; (3) nurses largely have ultimate responsibility for the way in which data are collected, interpreted and used to improve care, but other professionals also have important roles that could be explored further; (4) formalised quality improvement can confer authority to patient experience data work, but the data also lead to action for improvement in ways that are not formally identified as quality improvement; (5) sense-making exercises with study participants can support organisational learning.

Limitations

Patient experience data practices at trusts performing ‘worse than others’ on the Care Quality Commission scores were not examined. Although attention was paid to the views of patients and carers, the study focused largely on organisational processes and practices. Finally, the processes and practices around other types of data were not examined, such as patient safety and clinical outcomes data, or how these interact with patient experience data.

Conclusions

NHS organisations may find it useful to identify the local roles and processes that bring about autonomy, authority and contextualisation in patient experience data work. The composition and expertise of patient experience teams could better complement the largely invisible nursing work that currently accounts for a large part of the translation of data into care improvements.

Future work

To date, future work has not been planned.

Place, publisher, year, edition, pages
National Institute of Health Research, 2019
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-47046 (URN)10.3310/hsdr07340 (DOI)POA HHJ 2019;HHJIMPROVEIS (Local ID)POA HHJ 2019;HHJIMPROVEIS (Archive number)POA HHJ 2019;HHJIMPROVEIS (OAI)
Available from: 2019-12-10 Created: 2019-12-10 Last updated: 2019-12-10Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8781-6675

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