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Otto-Yáñez M, Sarmento da Nóbrega AJ, Torres-Castro R, Araújo PRS, Carvalho de Farias CA, Dornelas De Andrade ADF, Puppo H, Resqueti VR, Fregonezi GADF. Maximal Voluntary Ventilation Should Not Be Estimated From the Forced Expiratory Volume in the First Second in Healthy People and COPD Patients. Front Physiol 2020; 11:537. [PMID: 32581835 PMCID: PMC7296050 DOI: 10.3389/fphys.2020.00537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/30/2020] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the concordance between the value of the actual maximum voluntary ventilation (MVV) and the estimated value by multiplying the forced expiratory volume in the first second (FEV1) and a different value established in the literature. METHODS A retrospective study was conducted with healthy subjects and patients with stable chronic obstructive pulmonary disease (COPD). Five prediction formulas MVV were used for the comparison with the MVV values. Agreement between MVV measured and MVV obtained from five prediction equations were studied. FEV1 values were used to estimate MVV. Correlation and agreement analysis of the values was performed in two groups using the Pearson test and the Bland-Altman method; these groups were one group with 207 healthy subjects and the second group with 83 patients diagnosed with COPD, respectively. RESULTS We recruited 207 healthy subjects (105 women, age 47 ± 17 years) and 83 COPD patients (age 66 ± 6 years; 29 GOLD II, 30 GOLD III, and 24 GOLD IV) for the study. All prediction equations presented a significant correlation with the MVV value (from 0.38 to 0.86, p < 0.05) except for the GOLD II subgroup, which had a poor agreement with measured MVV. In healthy subjects, the mean difference of the value of bias (and limits of agreement) varied between -3.9% (-32.8 to 24.9%), and 27% (-1.4 to 55.3%). In COPD patients, the mean difference of value of bias (and limits of agreement) varied between -4.4% (-49.4 to 40.6%), and 26.3% (-18.3 to 70.9%). The results were similar in the subgroup analysis. CONCLUSION The equations to estimate the value of MVV present a good degree of correlation with the real value of MVV, but they also show a poor concordance. For this reason, we should not use the estimated results as a replacement for the real value of MVV.
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Affiliation(s)
- Matías Otto-Yáñez
- Physical Therapy, Universidad Autónoma de Chile, Santiago, Chile
- Programa de Doutorado em Biotecnologia RENORBIO, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes, Empresa Brazileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Antônio José Sarmento da Nóbrega
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes, Empresa Brazileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Palomma Russelly Saldanha Araújo
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes, Empresa Brazileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Catharinne Angélica Carvalho de Farias
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes, Empresa Brazileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | | | - Homero Puppo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Vanessa Regiane Resqueti
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes, Empresa Brazileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Guilherme Augusto de Freitas Fregonezi
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes, Empresa Brazileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
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Stevens D. Static hyperinflation is associated with ventilatory limitation and exercise tolerance in adult cystic fibrosis. CLINICAL RESPIRATORY JOURNAL 2018; 12:1949-1957. [PMID: 29330966 DOI: 10.1111/crj.12763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/06/2017] [Accepted: 01/09/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Lung hyperinflation is a potential mechanism limiting exercise tolerance. However, available data on the impact of static hyperinflation on exercise performance in adult cystic fibrosis are lacking. Furthermore, the relative contribution of both static and dynamic hyperinflation to exercise performance is unknown. OBJECTIVES The aim of this study was to determine the impact of static hyperinflation on exercise tolerance and lung dynamics in adult cystic fibrosis. METHODS Clinical data of 107 adult patients with cystic fibrosis, including pulmonary function, lung volumes and cardiopulmonary exercise from the Toronto Cystic Fibrosis database, were collected and analyzed. Patients were classified as having static hyperinflation with a residual volume to total lung capacity (RV/TLC) ratio of 30% or greater. RESULTS Patients with static hyperinflation demonstrated a significant reduction in exercise performance [peak oxygen uptake (% predicted) 70 ± 17 vs 80 ± 17; P = .006] and were more likely to experience ventilatory limitation when exercising (Fisher's exact test P < .001). Correlation analysis showed significant relationships between measures of static hyperinflation [RV/TLC ratio (%)] and exercise performance [peak oxygen uptake (% predicted); r = -.38, P < .001] and dynamic hyperinflation (r = -.35, P < .001). Multiple linear regression showed that the contribution of static hyperinflation to exercise performance [peak oxygen uptake (% predicted)] was greater than that of airway obstruction (forced expiratory volume in 1 second). CONCLUSION Clinicians working with this patient group in a pulmonary rehabilitation or health care setting may wish to consider using measures of static hyperinflation as end points to determine program or treatment efficacy.
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Affiliation(s)
- Daniel Stevens
- Department of Pediatrics, Division of Respirology, Faculty of Medicine and School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Division of Respirology, St Michael's Hospital, Toronto, ON, Canada
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Cano Porras D, Lunardi AC, Marques da Silva CCB, Paisani DM, Stelmach R, Moriya HT, Carvalho CRF. Comparison between the phase angle and phase shift parameters to assess thoracoabdominal asynchrony in COPD patients. J Appl Physiol (1985) 2017; 122:1106-1113. [DOI: 10.1152/japplphysiol.00508.2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 11/22/2022] Open
Abstract
Determining the presence of thoracoabdominal asynchrony in chronic obstructive pulmonary disease (COPD) patients is clinically relevant, but there is no consensus on the optimal parameters for performing this analysis. We assessed 22 COPD patients (FEV1 40 ± 10% predicted) and 13 healthy controls during rest and exercise with optoelectronic plethysmography (70% maximum workload) on a cycle ergometer. Thoracoabdominal asynchrony was calculated by using phase angle and phase shift parameters following a three-compartment model involving the upper and lower rib cages and abdomen. Patients were classified as having thoracoabdominal asynchrony (TAA+) or not (TAA−) based on control values (mean ± 2 SDs). The chest wall volume and compartmental contribution were also measured. Thoracoabdominal asynchrony was observed in the lower rib cage. The phase angle detected more TAA+ patients at rest (15 vs. 7 patients) and during exercise (14 vs. 8 patients) compared with the phase shift. TAA+ patients also presented a lower chest wall volume, lower rib cage contribution, and higher abdominal contribution to chest wall volume compared with the control and TAA− patients. Thoracoabdominal asynchrony was more detectable during rest and exercise using the phase angle parameter, and it was observed in the lower rib cage compartment, reducing the chest wall volume during exercise in patients with COPD. NEW & NOTEWORTHY This study contributes to advance the knowledge over the previous lack of consensus on the assessment of thoracoabdominal asynchrony. We rigorously evaluated the related features that interfere in the measurement of the asynchrony (measurement tool, chest wall model and calculation parameter). Our results suggest that phase angle detects more suitably thoracoabdominal asynchrony that occurs on the lower ribcage and leads to a reduction in the chest wall volume during exercise in COPD patients.
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Affiliation(s)
- Desiderio Cano Porras
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Adriana C. Lunardi
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Denise M. Paisani
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil; and
| | - Henrique T. Moriya
- Biomedical Engineering Laboratory, Department of Telecommunication and Control Engineering, School of Engineering, University of São Paulo, São Paulo, Brazil
| | - Celso R. F. Carvalho
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
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Nicholson TT, Barry PJ, Waterhouse DF, Nolan GM, McKone EF, Gallagher CG. Relationship between pulmonary hyperinflation and dyspnoea severity during acute exacerbations of cystic fibrosis. Respirology 2016; 22:141-148. [DOI: 10.1111/resp.12885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 05/15/2016] [Accepted: 05/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Trevor T. Nicholson
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
| | - Peter J. Barry
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
| | - Deirdre F. Waterhouse
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
| | - Geraldine M. Nolan
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
| | - Edward F. McKone
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
| | - Charles G. Gallagher
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
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Franco CB, Ribeiro AF, Morcillo AM, Zambon MP, Almeida MB, Rozov T. Air stacking: effects of Pilates mat exercises on muscle strength and on pulmonary function in patients with cystic fibrosis. J Bras Pneumol 2015; 40:521-7. [PMID: 25410840 PMCID: PMC4263333 DOI: 10.1590/s1806-37132014000500008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 06/03/2014] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE: To analyze the effects of Pilates mat exercises in patients with cystic fibrosis
(CF). METHODS: This was a clinical trial involving 19 CF patients recruited from either the CF
Outpatient Clinic of the State University at Campinas Hospital de
Clínicas or the Children's Institute of the University of São Paulo
School of Medicine Hospital das Clínicas. All of the patients
performed Pilates mat exercises for four months (one 60-min session per week). The
variables studied (before and after the intervention) were respiratory muscle
strength, MIP, MEP, FVC, and FEV1. RESULTS: After the intervention, MIP was significantly higher in the male patients (p =
0.017), as were MIP and MEP in the female patients (p = 0.005 and p = 0.007,
respectively). There were no significant differences between the pre- and
post-intervention values of FVC or FEV1, neither in the sample as a
whole nor among the patients of either gender. CONCLUSIONS: Our results show that Pilates mat exercises have beneficial effects on
respiratory muscle strength in CF patients.
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Bongers BC, Werkman MS, Takken T, Hulzebos EHJ. Ventilatory response to exercise in adolescents with cystic fibrosis and mild-to-moderate airway obstruction. SPRINGERPLUS 2014; 3:696. [PMID: 25512888 PMCID: PMC4254890 DOI: 10.1186/2193-1801-3-696] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/14/2014] [Indexed: 02/08/2023]
Abstract
Data regarding the ventilatory response to exercise in adolescents with mild-to-moderate cystic fibrosis (CF) are equivocal. This study aimed to describe the ventilatory response during a progressive cardiopulmonary exercise test (CPET) up to maximal exertion, as well as to assess the adequacy of the ventilatory response for carbon dioxide (CO2) exhalation. Twenty-two adolescents with CF (12 boys and 10 girls; mean ± SD age: 14.3 ± 1.3 years; FEV1: 78.6 ± 17.3% of predicted) performed a maximal CPET. For each patient, data of a sex- and age matched healthy control was included (12 boys and 10 girls; mean ± SD age: 14.3 ± 1.4 years). At different relative exercise intensities of 25%, 50%, 75%, and 100% of peak oxygen uptake (VO2peak), breathing pattern, estimated ventilatory dead space ventilation (VD/VT ratio), minute ventilation (VE) to CO2 production relationship (VE/VCO2-slope), partial end-tidal CO2 tension (PETCO2), and the VE to the work rate (VE/WR) ratio were examined. VO2peak was significantly reduced in CF patients (P = 0.01). We found no differences in breathing pattern between both groups, except for a significantly higher VE at rest and a trend towards a lower VE at peak exercise in patients with CF. Significantly higher values were found for the estimated VD/VT ratio throughout the CPET in CF patients (P < 0.01). VE/VCO2-slope and PETCO2 values differed not between the two groups throughout the CPET. VE/WR ratio values were significantly higher in CF during the entire range of the CPET (P < 0.01). This study found an exaggerated ventilatory response (high VE/WR ratio values), which was adequate for CO2 exhalation (normal VE/VCO2-slope and PETCO2 values) during progressive exercise up to maximal exhaustion in CF patients with mild-to-moderate airway obstruction.
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Affiliation(s)
- Bart C Bongers
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands ; Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten S Werkman
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands ; De Kinderkliniek, Almere, The Netherlands
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erik H J Hulzebos
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Inhaled tobramycin effectively reduces FEV1 decline in cystic fibrosis. An instrumental variables analysis. Ann Am Thorac Soc 2014; 10:205-12. [PMID: 23802816 DOI: 10.1513/annalsats.201209-082oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The efficacy of inhaled tobramycin on chronic Pseudomonas aeruginosa infections in patients with cystic fibrosis (CF) has been established in clinical trials. However, little is known about its clinical effectiveness on lung function outside randomized controlled trial settings; conventional analysis of existing registry data has heretofore been confounded by treatment selection bias. OBJECTIVE To determine effectiveness of inhaled tobramycin on FEV1 decline in patients with chronic P. aeruginosa infections using observational data from the Cystic Fibrosis Foundation Patient Registry. METHODS Patient-level tobramycin use was measured at first chronic P. aeruginosa infection (n = 13,686 patients; age, 6-21 yr). Decline in FEV1 2 years after infection was estimated for patients treated with tobramycin and compared with untreated patients. Multiple linear regressions with confounder adjustment and propensity scores were used to estimate mean FEV1 decline for each group. Because care is organized by centers, we used center-specific prescription rates as an instrument to reduce treatment-by-condition bias. MEASUREMENTS AND MAIN RESULTS Using center-level prescribing rates, instrumental variables analysis showed less FEV1 decline for patients who received tobramycin when first eligible compared with those who did not receive tobramycin (difference, 2.55% predicted; 95% confidence interval, 0.16-4.94; P = 0.0366). CONCLUSIONS Inhaled tobramycin is effective in reducing lung function decline among patients 6 to 21 years of age with CF. Because CF care is organized by center, using center-specific prescription rates as an instrumental variable is a feasible approach to using the Cystic Fibrosis Foundation Patient Registry to determine treatment effectiveness. More generally, this approach can correct for treatment-by-condition bias arising from observational studies.
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Werkman MS, Hulzebos EHJ, Helders PJM, Arets BGM, Takken T. Estimating peak oxygen uptake in adolescents with cystic fibrosis. Arch Dis Child 2014; 99:21-5. [PMID: 23894083 DOI: 10.1136/archdischild-2012-303439] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To predict peak oxygen uptake (VO2 peak) from the peak work rate (W peak) obtained during a cycle ergometry test using the Godfrey protocol in adolescents with cystic fibrosis (CF), and assess the accuracy of the model for prognostication clustering. METHODS Out of our database of anthropometric, spirometric and maximal exercise data from adolescents with CF (N=363; 140 girls and 223 boys; age 14.77 ± 1.73 years; mean expiratory volume in 1 s (FEV1%pred) 86.82 ± 17.77%), a regression equation was developed to predict VO2 peak (mL/min). Afterwards, this prediction model was validated with cardiopulmonary exercise data from another 60 adolescents with CF (28 girls, 32 boys; mean age 14.6 ± 1.67 years; mean FEV1%pred 85.43 ± 20.01%). RESULTS We developed a regression model VO2 peak (mL/min)=216.3-138.7 × sex (0=male; 1=female)+11.5 × W peak; R(2)=0.91; SE of the estimate (SEE) 172.57. A statistically significant difference (107 mL/min; p<0.001) was found between predicted VO2 peak and measured VO2 peak in the validation group. However, this difference was not clinically relevant because the difference was within the SEE of the model. Furthermore, we found high positive predictive and negative predictive values for the model for prognostication clustering (PPV 50-87% vs NPV 82-94%). CONCLUSIONS In the absence of direct VO2 peak assessment it is possible to estimate VO2 peak in adolescents with CF using only a cycle ergometer. Furthermore, the regression model showed to be able to discriminate patients in different prognosis clusters based on exercise capacity.
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Affiliation(s)
- Maarten S Werkman
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, , Utrecht, The Netherlands
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Rand S, Prasad SA. Exercise as part of a cystic fibrosis therapeutic routine. Expert Rev Respir Med 2012; 6:341-51; quiz 352. [PMID: 22788948 DOI: 10.1586/ers.12.19] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The role of exercise in cystic fibrosis (CF) is well established, and over the last three decades it has become an important component in the management of all individuals with CF. The role of exercise as a prognostic indicator or therapeutic tool is an important area of research interest in CF care internationally. This article summarizes the currently available evidence regarding exercise capacity in CF, the potential effects of exercise on health outcomes in CF and the challenges faced when trying to incorporate exercise into a CF therapeutic routine, and highlights some methods to facilitate the incorporation of exercise into CF therapeutic routines.
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Affiliation(s)
- Sarah Rand
- Cystic Fibrosis Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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