Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Null, N.; Avellaneda, N.; Al Masri, M.; Baimakhanov, A.; Balasubramaniam, D.; Bhangu, A.; Bouchagier, K.; Bozbiyik, O.; Carpelan, A.; Chwat, C.; Cunha, M.; Dawson, B.E.; Mallen, M.V.D.; Ellebæk, M.B.; Gonzalez, T.E.; Elshami, M.; Fakhradiyev, I.; Ozkan, O.F.; Fleres, F.; Futaba, K.; Gallo, G.; Ghosh, D.; Glasbey, J.C.; Harrison, E.; Hooper, R.L.; Jain, R.; Kamarajah, S.; Veetil, S.K.; Kamer, E.; Keatley, J.; Knowles, C.H.; Kulimbet, M.; Lal, P.; Elizabeth, L.; Polamreddy, B.M.; Minaya-Bravo, A.; Mittal, R.; Morton, D.G.; Nadal, L.R.M.; Negoi, I.; Nepogodiev, D.; Omar, O.; Pata, F.; Pinkney, T.; Potter, M.A.; Rottoli, M.; Santos, G.; Smith, I.; Spinelli, A.; Venn, M.; Hooper, R.; Morton, D.; Bywater, E.; Evans, J.; Magill, L.; Mckay, S.; Bordom, D.O.; Simões, J.; Venn, M.L.; Adeyeye, A.; Avellaneda, N.; Buchs, N.; Cato, L.; Finch, D.; Umar, G.I.; Bravo, A.M.; Junior, H.M.; Neary, P.; Poskus, T.; Roslani, A.; Samadov, E.; Sbaih, M.; Shalaby, M.; Singh, B.; Sinha, A.; Vardanyan, A.; Chaudhry, S.; Frasson, M.; Millward, J.; Sánchez-Guillén, L.; Stijns, J.; Zimmerman, D.D.E.; Beard, D.; Campbell, M.; Moug, S.; Aytac, E.; Blackwell, S.; Buchwald, P.; Chowdhury, S.M.; Dardanov, D.; Dulskas, A.; Elhadi, M.; El-Hussuna, A.; Garoufalia, Z.; Aslam, M.I.; Kelly, M.; Knowles, C.; Mendes, B.; Simon, N.; Pellino, G.; Sebastian, S.; Sivrikoz, E.; Tejedor, P.; Vaizey, C.; Bianchi, R.; Christensen, P.; Lee, S.; Lohsiriwat, V.; Mantoo, S.K.; Mazlan, L.; Jun Won, U.; Wang, J.Y.; Watanabe, J.; Yao, H.; Bengueddach, A.; Tidjane, A.; Tabeti, B.; Behilil, C.; Boudjenan-Serradj, N.; Bensafir, S.; Meharzi, S.E.I.; Aissat, A.; Ghouali, A.K.; Larabi, K.; Riffi, O.; Kacimi, S.E.O.; Mesli, S.N.; Rezoug, W.; Mitidieri, A.; José, A.; Pablo, C.; Rodriguez, C.A.; Panettiere, M.F.; Barbalace, N.; Juan, T.; Lucena, J.; Houdin, A.; Fernandez, E.; Lococo, J.; Pedro, L.; Loban, M.; Vecchio, P.; Grinblat, A.; Carrie, A.; Veracierto, F.; Santillan, M.; Napolitano, M.; Rosa, S.L.; Gonzalez, C.M.; Ferro, E.; Muñoz, J.P.; Ventorutti, T.; Cabrera, C.; Carrizo, C.; Mospane, C.; Leiro, F.; Espino, J.; Trama, M.; Potolicchio, A.; Dindri, F.; Buey, L.; Lucas, N.; Catalano, P.; Astilleta, R.; Quiroga, Y.; Valli, D.; Alexandre, F.; Martres, G.; Rosato, G.; Lemme, G.; Romero, V.; Doniquian, A.M.; Pachajoa, D.A.P.; Llahi, F.; Fiorenza, J.M.; Parodi, M.; Ocaña, N.; Gallardo, A.; Valenzuela, A.; Perriello, J.; Nador, R.; Fermani, C.; Garay, L.; Blanco, P.; Villalobos, S.; Posner, F.; Vieyra, N.; Fiorito, P.; Ciabattari, P.; de Kort, C.; Daryanani, D.; Smit, J.; Gosselink, M.P.; Janssen, N.; Feiss, A.; Lee, C.H.A.; Taylor, D.; Edington, J.; Chen, N.; Ong, W.M.; Aigner, F.; Moitzi, G.; Gemes, G.; Braumille, M.; Mitteregger, M.; Gerald, S.; Uranitsch, S.; Belarmino, A.; Waha, J.; Kahn, J.; Treiber, M.; Schemmer, P.; Mikalauskas, S.; Ibrahimli, A.; Orujova, E.; Namazov, I.; Alikhanli, J.; Asgarov, M.; Kutkut, A.; Almahmeed, E.; Aljawder, H.; Juma, I.; Johnston, K.; Saeed, M.F.; Khairi, S.; Matovic, E.; Omerasevic, M.; Delibegovic, S.; Hodzic, S.; Rudell, A.G.; Fuzari, J.; Farah, J.F.; Dos Santos, M.B.A.; Lupinacci, R.A.; Pereira, T.S.; da Silveira Sete, A.; Filho, A.L.; de Souza Pires, B.L.; de Queiroz, F.L.; Amaral, H.A.T.; Dos Santos, M.A.M.; de Miranda Silvestre, S.C.; Hanan, B.; Reis, C.; Cassia, G.; da Luz, M.; Delgado, M.; Campanati, R.; Silva, R.; Bomfa-Barbosa, A.; Alves, B.C.; Costa, B.X.M.; Cortes, B.G.W.; Lemos, F.H.T.; Arreguy-Borges, K.; Silva, T.B.; Assis, A.; Freitas, A.H.; Rezende, D.; Silva, H.; Alvarenga, I.; Cascais, R.; Silva, T.; Pinto, H.; Silva, I.; Leite, L.; Massahud, M.; Meyer, M.; Tibúrcio, R.; Martinez, C.A.R.; Espinha, D.R.; Marson, F.A.L.; de Oliveira Góes, I.A.; de Souza Artioli, L.M.; Boschiero, M.N.; Takahashi, C.Y.; de Oliveira, F.G.; Junior, H.F.L.; de Oliveira, J.C.C.; Dos Santos, J.M.; Gerber, M.T.; Erdmann, T.R.; Barbosa, A.; Fernandes, A.; Júnior, A.N.; Júnior, H.M.; Moreira, J.; Ribeiro, M.; Moreira, P.; Carvalho, A.; Santos, B.; Fidelis, F.; Cruz, I.; Codes, L.; Aibe, R.; Boudoux, S.; Favacho, B.C.; Pinto, F.; Gava, G.; Pivati, I.R.; Vilain, L.F.; Kim, N.; Nunes, R.L.; Dimitrov, D.; Peneva, K.; Karamanliev, M.; Dimitrova, S.; Ivanov, T.; Atanasov, B.; Dzharov, G.; Shtereva, M.; Slavchev, M.; Belev, N.; Krastev, P.; Arabadzhiev, A.; Tonova, D.; Tzoneva, D.; Sokolov, M.; Gribnev, P.; Maslyankov, S.; Pavlov, V.; Bakmaz, B.; Dijan, E.; Ćoza, I.; Mihanovic, J.; Kučić, J.; Sulen, N.; Katušić, Z.; Hudáček, K.; Farkašová, M.; Marková, M.; Grolich, T.; Kala, Z.; Pazdírek, F.; Hoch, J.; Filipová, L.; Kocián, P.; Přikryl, P.; Høgn, A.; Møller, B.; Slot, D.K.; Bælum, J.K.; Cour, K.L.; Eriksen, N.D.; Mahmoud, A.; Abdellatif, A.; Nafea, A.; Ewedah, M.; Soliman, M.; Yakout, N.; Argawy, O.; Sallam, I.; Kamel, I.; Sherif, M.; Ashmawy, S.; Ali, A.; Saad, M.; Ahmed, M.; Mohamed, M.; Mohamed, N.; Mahmoud, S.; Mahmoud, S.; Rashed, A.M.; Abd-Errazik, M.A.; Ammar, M.A.; Mohammed, R.; Ebrahem, A.; Abd El Aal, A.; Abdou, K.; Wagdy, M.; Qassem, M.; Taha, M.; El-Wafa, Y.A.; Shehta, A.; El Metwally, A.; Hamed, H.; Ali, M.A.; Elrefai, M.; El Sorogy, M.; Abdelkhalek, M.; Ragab, A.; Refky, B.; Metwally, I.H.; Abdelkhalek, M.; Kamal, M.; Zuhdy, M.; Shetiwy, M.; Sakr, A.; Elfallal, A.; Elfeki, H.; Eldakroury, I.; Elbahrawy, K.; Mostafa, M.; Emile, S.; Tessema, A.; Tasew, A.; Gezahegn, H.; Bekele, K.; Belay, M.; Gudisa, Z.; Teferu, Z.; Väyrynen, A.; Kechagias, A.; Turunen, A.; Katunin, J.; Parhiala, M.; Pengerma, P.; Lahti, P.; Vihervaara, H.; Huhtinen, H.; Pasonen, J.; Heino, R.; Pakarinen, S.; Falenius, V.; Pinard, B.; Nobile, C.; Duchalais, E.; Drissi, F.; Meurette, G.; Podevin, J.; Lepenndu, M.; Hoetzel, A.; Jud, A.; Jauch, D.; Stefan, F.; Neeff, H.; Holzner, P.; Nguyen, P.; Ryl, A.; Kehl, F.; Pullig, F.; Baral, J.; Münch, S.; Fütterer, C.; Reißfelder, C.; Sandra-Petrescu, F.; Herrle, F.; Hardt, J.; Lamm, L.; Seyfried, S.; Gharbi, A.; Aydin, F.; Stavrou, G.; Sperber, J.; de Deken, J.; Schwarzkopf, K.; Widyaningsih, R.; Polidorou, A.; Mpakas, A.; Tokidis, E.; 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Balestri, R.; Vasale, A.; Crescentini, G.; Ranieri, G.; Sinibaldi, G.; Biondi, A.; Sanesi, A.P.; Vacca, C.; Lorenzon, L.; Sollazzi, L.; Persiani, R.; Pezzuto, R.; Ferroni, A.F.; Stipa, F.; Volturo, L.; Moretti, M.; Tierno, S.M.; Marina, S.; Mingoli, A.; Fiori, E.; Pugliese, F.; Brachini, G.; Carta, G.; Sapienza, P.; Lapolla, P.; Mazzotta, E.; Carannante, F.; Capolupo, G.T.; Masciana, G.; Sica, I.; Caricato, M.; Antonelli, S.; Fiume, D.; Spoletini, D.; Lisi, G.; Carlini, M.; Menduni, V.; Arturi, A.; Proietto, B.; de Lucia, C.; Baldi, C.; Passantino, D.G.; Romeo, G.; Paola, M.D.; Sensi, B.; Sica, G.; Siragusa, L.; Dauri, M.; Franceschill, M.; Campanelli, M.; Bellato, V.; Porcu, A.; Garau, A.G.G.; Masala, M.L.; Oggianu, S.; Tedde, T.; Perra, T.; Pazzola, V.; Venezia, D.F.; Roviello, F.; Giacomini, G.; Carbone, L.; Marano, L.; Verre, L.; Marano, M.; Ciccarese, A.A.; Bagnardi, F.; Shahu, J.; Siciliano, W.; Iacomino, A.; Armellin, C.; Marson, F.; Zanus, G.; Santoro, G.A.; de Paoli, M.; Grossi, U.; Sekimoto, M.; Kobayashi, T.; Horiguchi, A.; Koike, D.; Yonekura, H.; Kato, H.; Yoshino, K.; Arakawa, S.; Asano, Y.; Alawneh, F.; Rajab, I.; Ramadan, M.; Masri, M.A.; Qaisi, M.A.; Alsamneh, M.; Mubaidin, O.; Al-Jarrah, A.; Ababneh, H.; Khdair, K.; Tawarh, T.; Sabri, W.; Arida, Z.A.; Dzhumabekov, B.; Klyshbayeva, D.; Ispbayeva, K.; Nadyrov, M.; Tanabayeva, S.; Saliev, T.; Jumanov, A.; Aitbaeva, A.; Arynov, A.; Nadyrov, M.; Maulenov, N.; Dushimova, Z.; Park, E.J.; Kim, H.; Kang, J.; Baik, S.H.; Song, Y.; Kwak, H.D.; Kim, J.; Son, J.H.; Chung, J.S.; Lee, H.; Baek, J.; Nam, K.H.; Lee, K.C.; Lee, W.; Jeon, Y.; Kim, C.W.; Park, S.; Son, G.M.; Ahn, H.M.; Lee, I.Y.; Kim, T.K.; Pcolkins, A.; Sivins, A.; Lobovs, D.; Ancans, G.; Kreice, I.; Budnikova, I.; Jelovskis, I.; Emhareb, A.; Abaidalla, A.; Hammed, A.; Khairallah, M.; Jibreel, S.S.; Mohmmad, W.A.S.; Hasan, W.; Venskutonis, D.; Daugėla, E.; Dainius, E.; Juočas, J.; Kutkevičius, J.; Vaitkutė, K.; Bradulskis, S.; Macas, A.; Pauzas, H.; Jokubauskas, M.; Lizdenis, P.; Budrikienė, R.; Svagzdys, S.; Saladzinskas, Z.; Volkoviene, G.; Makauskiene, J.; Kuliavas, J.; Bernotaite, V.; Danys, D.; Kontrimaviciute, E.; Poskus, E.; Kryzauskas, M.; Jakubauskas, M.; Jotautas, V.; Zakaria, A.D.; Kai, M.W.P.; Zainy, R.H.M.; Tan, S.S.; Zain, W.Z.W.; Zakaria, Z.; Yusoff, Z.M.; Raduan, F.; Sagap, I.; Razali, N.Y.F.; Rahman, N.A.; Kanthan, S.B.C.; Nie, Y.C.; Azman, Z.A.M.; Ang, C.W.; Tang, C.Y.; Poh, K.S.; Kevin, N.; Hashim, N.M.; Xavier, R.; Khong, T.L.; Amir, A.S.; Ali, C.S.C.; Yew, C.K.; Henry, F.; Muniandy, J.; Baharom, S.; Eng, S.C.R.; Felicia Su-Min, H.; Amin-Tai, H.; Jabar, M.F.; Satar, M.H.S.A.; Fathi, N.Q.; Rao, P.S.; Podesta, A.M.C.; Cini, C.; Psaila, J.; Debono, M.; Sammut, M.; Spiteri, N.; Andrejevic, P.; Muro, A.G.; Leon, B.P.; Perez, J.A.V.; Quiñonez, J.R.A.; Vera, M.T.R.; Gutierrez, V.M.M.; Bobadilla, B.J.; Martinez, C.M.; de León Rendón, J.L.; Hererro, J.A.V.; Cuichan, M.V.Y.; Baez, N.F.; Prevost, P.G.; Hoyos-Torres, A.; Ruiz-Muñoz, E.A.; 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doi:10.1093/bjs/znad370

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates.

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries / N. Null, N. Avellaneda, M. Al Masri, A. Baimakhanov, D. Balasubramaniam, A. Bhangu, K. Bouchagier, O. Bozbiyik, A. Carpelan, C. Chwat, M. Cunha, B.E. Dawson, M.V.D. Mallen, M.B. Ellebæk, T.E. Gonzalez, M. Elshami, I. Fakhradiyev, O.F. Ozkan, F. Fleres, K. Futaba, G. Gallo, D. Ghosh, J.C. Glasbey, E. Harrison, R.L. Hooper, R. Jain, S. Kamarajah, S.K. Veetil, E. Kamer, J. Keatley, C.H. Knowles, M. Kulimbet, P. Lal, E. Li, B.M. Polamreddy, A. Minaya-Bravo, R. Mittal, D.G. Morton, L.R.M. Nadal, I. Negoi, D. Nepogodiev, O. Omar, F. Pata, T. Pinkney, M.A. Potter, M. Rottoli, G. Santos, I. Smith, A. Spinelli, M. Venn, R. Hooper, D. Morton, E. Bywater, J. Evans, L. Magill, S. Mckay, D.O. Bordom, J. Simões, M.L. Venn, A. Adeyeye, N. Avellaneda, N. Buchs, L. Cato, D. Finch, G.I. Umar, A.M. Bravo, H.M. 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Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

null, null;Avellaneda, Nicholas;Al Masri, Mahmoud;Baimakhanov, Abylai;Balasubramaniam, Dinesh;Bhangu, Aneel;Bouchagier, Konstantinos;Bozbiyik, Osman;Carpelan, Anu;Chwat, Carina;Cunha, Miguel;Dawson, Brett E;Mallen, Maria Victoria Duque;Ellebæk, Mark Bremholm;Gonzalez, Tomás Elosua;Elshami, Mohamedraed;Fakhradiyev, Ildar;Ozkan, Omer Faruk;Fleres, Francesco;Futaba, Kaori;Gallo, Gaetano;Ghosh, Dhruv;Glasbey, James C;Harrison, Ewen;Hooper, Richard L;Jain, Ritu;Kamarajah, Sivesh;Veetil, Sreejith Kannummal;Kamer, Erdinc;Keatley, James;Knowles, Charles H;Kulimbet, Mukhtar;Lal, Pawanindra;Li, Elizabeth;Polamreddy, Bala Mahesh;Minaya-Bravo, Ana;Mittal, Rohin;Morton, Dion Gregory;Nadal, Luis Roberto Manzione;Negoi, Ionut;Nepogodiev, Dmitri;Omar, Omar;Pata, Francesco;Pinkney, Thomas;Potter, Mark A;Rottoli, Matteo;Santos, Guilherme;Smith, Iain;Spinelli, Antonino;Venn, Mary;Hooper, Richard;Morton, Dion;Bywater, Edward;Evans, Jonathan;Magill, Laura;McKay, Siobhan;Bordom, Daniel Osei;Simões, Joana;Venn, Mary L;Adeyeye, Ademola;Avellaneda, Nicolas;Buchs, Nicolas;Cato, Liam;Finch, David;Umar, Garzali Ibrahim;Bravo, Ana Minaya;Junior, Helio Moreira;Neary, Peter;Poskus, Tomas;Roslani, April;Samadov, Elgun;Sbaih, Mohammed;Shalaby, Mostafa;Singh, Baljit;Sinha, Aad;Vardanyan, Armen;Chaudhry, Sanjay;Frasson, Matteo;Millward, Jim;Sánchez-Guillén, Luis;Stijns, Jasper;Zimmerman, David D E;Beard, David;Campbell, Marion;Moug, Susan;Aytac, Erman;Blackwell, Sue;Buchwald, Pamela;Chowdhury, Sharfuddin M;Dardanov, Dragomir;Dulskas, Audrius;Elhadi, Muhammed;El-Hussuna, Alaa;Garoufalia, Zoe;Aslam, Muhammad Imran;Kelly, Michael;Knowles, Charles;Mendes, Beatriz;Ng, Simon;Pellino, Gianluca;Sebastian, Shaji;Sivrikoz, Emre;Tejedor, Patricia;Vaizey, Carolynne;Bianchi, Romina;Christensen, Peter;Lee, Suk-Hwan;Lohsiriwat, Varut;Mantoo, Surendra Kumar;Mazlan, Luqman;Um, Jun Won;Wang, Jaw Yuan;Watanabe, Jun;Yao, Hongwei;Bengueddach, Aicha;Tidjane, Anisse;Tabeti, Benali;Behilil, Chakib;Boudjenan-Serradj, Nabil;Bensafir, Salim;Meharzi, Sif El Islam;Aissat, Abdenour;Ghouali, Amine Khayreddine;Larabi, Khadidja;Riffi, Omar;Kacimi, Salah Eddine Oussama;Mesli, Smain Nabil;Rezoug, Walid;Mitidieri, Alejandro;José, Alvarado;Pablo, Chaves;Rodriguez, Cristian Ariel;Panettiere, Maria Florencia;Barbalace, Nicolas;Juan, Tricarico;Lucena, Jose;Houdin, Anabella;Fernandez, Eugenia;Lococo, Julio;Pedro, Luis;Loban, Mariana;Vecchio, Pablo;Grinblat, Ariel;Carrie, Augusto;Veracierto, Federico;Santillan, Mateo;Napolitano, Milena;Rosa, Sonia La;Gonzalez, Carla Mariela;Ferro, Ezequiel;Muñoz, Juan Pablo;Ventorutti, Tatiana;Cabrera, Claudia;Carrizo, Claudia;Mospane, Claudio;Leiro, Fabio;Espino, Julieta;Trama, Mauro;Potolicchio, Analia;Dindri, Franco;Buey, Lourdes;Lucas, Nicolas;Catalano, Pablo;Astilleta, Romina;Quiroga, Yenny;Valli, Diego;Alexandre, Flavia;Martres, Gladys;Rosato, Guillermo;Lemme, Gustavo;Romero, Veronica;Doniquian, Alejandro Marcelo;Pachajoa, Diana Alejandra Pantoja;Llahi, Florencia;Fiorenza, Juan Maria;Parodi, Matias;Ocaña, Noelia;Gallardo, Alfredo;Valenzuela, Andres;Perriello, Juan;Nador, Rodolfo;Fermani, Claudio;Garay, Lorena;Blanco, Pablo;Villalobos, Santiago;Posner, Federico;Vieyra, Nicolas;Fiorito, Pablo;Ciabattari, Paula;de Kort, Chantal;Daryanani, Deepu;Smit, Justin;Gosselink, Martijn Pieter;Janssen, Nadeche;Feiss, Anna;Lee, Chun Hin Angus;Taylor, Danielle;Edington, John;Chen, Nevin;Ong, Wei Ming;Aigner, Felix;Moitzi, Gabriele;Gemes, Geza;Braumille, Markus;Mitteregger, Martin;Gerald, Seitinger;Uranitsch, Stefan;Belarmino, Armin;Waha, James;Kahn, Judith;Treiber, Michael;Schemmer, Peter;Mikalauskas, Saulius;Ibrahimli, Arturan;Orujova, Elnara;Namazov, Ilgar;Alikhanli, Jhale;Asgarov, Mohsum;Kutkut, Aymen;Almahmeed, Ebrahim;Aljawder, Hasan;Juma, Isam;Johnston, Keith;Saeed, Mirza Faraz;Khairi, Sara;Matovic, Ervin;Omerasevic, Mediha;Delibegovic, Samir;Hodzic, Samir;Rudell, Angela Genoefa;Fuzari, Jamile;Farah, José Francisco;Dos Santos, Maria Beatriz Alves;Lupinacci, Renato Arioni;Pereira, Talison Silas;da Silveira Sete, Alexandre;Filho, Antônio Lacerda;de Souza Pires, Bruno Lucena;de Queiroz, Fábio Lopes;Amaral, Hélida Aline Tomacheski;Dos Santos, Marco Antônio Miranda;de Miranda Silvestre, Simone Chaves;Hanan, Bernardo;Reis, Claudilaine;Cassia, Gabriela;da Luz, Magda;Delgado, Marina;Campanati, Renato;Silva, Rodrigo;Bomfa-Barbosa, Alysson;Alves, Brenda Chayanny;Costa, Breno Xaia Martins;Cortes, Bruno Giusti Werneck;Lemos, Fernando Henrique Teodoro;Arreguy-Borges, Kanthya;Silva, Thaisa Barbosa;Assis, Ana;Freitas, Antonio Hilário;Rezende, Daniel;Silva, Helio;Alvarenga, Isabella;Cascais, Raquel;Silva, Thaisa;Pinto, Henrique;Silva, Ilson;Leite, Lílian;Massahud, Matheus;Meyer, Matheus;Tibúrcio, Rafael;Martinez, Carlos Augusto Real;Espinha, Daniela Roncoletta;Marson, Fernando Augusto Lima;de Oliveira Góes, Igor Arantes;de Souza Artioli, Luana Maria;Boschiero, Matheus Negri;Takahashi, Carina Yumi;de Oliveira, Flávia Gomes;Junior, Humberto Fenner Lyra;de Oliveira, João Carlos Costa;Dos Santos, José Mauro;Gerber, Marlus Tavares;Erdmann, Thomas Rolf;Barbosa, Anderson;Fernandes, Andre;Júnior, Ayr Nasser;Júnior, Helio Moreira;Moreira, José;Ribeiro, Mara;Moreira, Pedro;Carvalho, Alexandre;Santos, Bianca;Fidelis, Flávia;Cruz, Isabela;Codes, Lina;Aibe, Raquel;Boudoux, Sabrina;Favacho, Bernard Costa;Pinto, Fabio;Gava, Guilherme;Pivati, Isabela Ramos;Vilain, Luciano Ferreira;Kim, Nam;Nunes, Rafael Leite;Dimitrov, Dobromir;Peneva, Kristin;Karamanliev, Martin;Dimitrova, Slavina;Ivanov, Tsvetomir;Atanasov, Boyko;Dzharov, Georgi;Shtereva, Maria;Slavchev, Mihail;Belev, Nikolay;Krastev, Panche;Arabadzhiev, Angel;Tonova, Dimitrina;Tzoneva, Dochka;Sokolov, Manol;Gribnev, Petar;Maslyankov, Svilen;Pavlov, Vasil;Bakmaz, Bernarda;Dijan, Emilio;Ćoza, Ivo;Mihanovic, Jakov;Kučić, Jurica;Sulen, Nina;Katušić, Zvonimir;Hudáček, Kamil;Farkašová, Martina;Marková, Miriam;Grolich, Tomáš;Kala, Zdeněk;Pazdírek, Filip;Hoch, Jiří;Filipová, Lenka;Kocián, Petr;Přikryl, 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Million;Gudisa, Zewude;Teferu, Zinash;Väyrynen, Antti;Kechagias, Ari;Turunen, Arto;Katunin, Jevgeni;Parhiala, Mikael;Pengerma, Pasi;Lahti, Petra;Vihervaara, Hanna;Huhtinen, Heikki;Pasonen, Jaana;Heino, Riitta;Pakarinen, Sakari;Falenius, Ville;Pinard, Béatrice;Nobile, Camille;Duchalais, Emilie;Drissi, Farouk;Meurette, Guillaume;Podevin, Juliette;Lepenndu, Marguerite;Hoetzel, Alexander;Jud, Andreas;Jauch, Dominik;Stefan, Fichtner-Feigl;Neeff, Hannes;Holzner, Philipp;Nguyen, Philipp;Ryl, Alice;Kehl, Franz;Pullig, Frieder;Baral, Jörg;Münch, Steffen;Fütterer, Carsten;Reißfelder, Christoph;Sandra-Petrescu, Flavius;Herrle, Florian;Hardt, Julia;Lamm, Lena;Seyfried, Steffen;Gharbi, Akram;Aydin, Funda;Stavrou, Gregor;Sperber, Jonas;de Deken, Julie;Schwarzkopf, Konrad;Widyaningsih, Rizky;Polidorou, Andreas;Mpakas, Aristidis;Tokidis, Evris;Loun, Lounta;Petropoulou, Thalia;Balalis, Dimitrios;Korkolis, Dimitrios;Manatakis, Dimitrios;Assimakopoulou, Elena;Bourazani, Maria;Gklavas, Antonios;Kalamara, Eirini;Papaconstantinou, Ioannis;Theodoraki, Kassiani;Chardalias, Leonidas;Konstadoulakis, Manousos;Theodosopoulos, Theodosios;Soulioti, Eleftheria;Kavezou, Foteini;Filippou, Jana;Papadoliopoulou, Maria;Michalopoulos, Nikolaos;Vassiliu, Pantelis;Sidiropoulos, Theodoros;Charakopoulou, Alexandra;Panagiotou, Anna;Kokkinakis, Konstantinos;Lambridi, Electra;Psarologos, Michail;Maria, Sotiropoulou;Giannaraki, Styliani;Kapiris, Stylianos;Triantafyllou, Alexandra;Theodoropoulos, Charalampos;Matthaiou, Georgia;Westzaan, Natalia;Etelka, Santo;Triantafyllou, Tania;Schizas, Dimitrios;Mpaili, Eustratia;Karydakis, Lysandros;Mpoura, Maria;Danassi, Despoina;Karavokyros, Ioannis;Dimitriou, Nikoletta;Livanou, Xrysoyla;Kikira, Athanasia;Tsourouflis, Gerasimos;Tomara, Nefeli-Kaiti;Nikiteas, Nikolaos;Dorovinis, Panagiotis;Tsiotos, Gregory;Stamou, Konstantinos;Kocka, Neriada;Ballian, Nikiforos;Kalakonas, Spyros;Athanasakis, Elias;Chrysos, Emmanuel;Xynos, Evangelos;Tsiaoussis, John;Papadaki, Kyriaki;Xenaki, Sofia;Nyktari, Vasileia;Sarakatsianou, Chamaidi;Bompou, Effrosyni;Arnaoutoglou, Eleni;Tzovaras, George;Baloyiannis, Ioannis;Mamaloudis, Ioannis;Perivoliotis, Konstantinos;Apostolidi, Eirini;Mulita, Francesk;Karpetas, Georgios;Maroulis, Ioannis;Vailas, Michail;Petra, Angeliki;Kontis, Elissaios;Kaouras, Emmanouil;Katsaros, Ioannis;Katsiaras, Lykourgos;Manikis, Panagiotis;Papadopoulou, Triada;Papadopoulos, Aristeidis;Manioti, Eleni;Zeringa, Georgia;Katsinelis, Ioannis;Mouzakis, Odysseas;Kouki, Pinelopi;Nikolaou, Vasiliki;Marinis, Athanasios;Alexopoulou, Kalliopi;Papadaki, Maria;Vederaki, Styliani-Aikaterini;Samara, Athina;Giakoustidis, Dimitris;Christodoulidis, Grigorios;Bareka, Metaxia;Chatzikomnitsa, Paraskevi;Tsigara, Stavroula;Papadopoulos, Vasileos;Zarzava, Eirini;Anestiadou, Elissavet;Lydia, Loutzidou;Apostolakidou, Magda;Ioannidis, Orestis;Simeonidis, Savvas;Mpitsianis, Stefanos;Tam, Prudence Tai Huen;Ng, Simon Siu Man;Lau, Vivian Nga Man;Tse, Wing Kin;Bánky, Balázs;Dolhai, Erika;Horváth, Éva;Golub, József;Marton, József;Lakatos, Lóránd;Suszták, Nóra;Maurya, Ajeet Pratap;Kumawat, Hansraj;Saxena, Pradeep;Lather, Rahul;Waindeskar, Vaishali;Khanduri, Archana;Goyal, Laxmi;Gupta, Rahul;Singh, Sudhir;Saksena, Ajesh Raj;Rayani, Basanth Kumar;Kasula, Jayamma;Raju, Kvvn;Shah, Manan Mukundlal;Thammineedi, Subramanyeshwar Rao;Patnaik, Sujit Chyau;Rathod, Darshana;Poonia, Dharma Ram;Vishnoi, Jeewan Ram;Sharma, Nivedita;Byshetty, Rajendar;Yadav, Ram Kishan;Misra, Sanjeev;Dhali, Arkadeep;Dhali, Gopal Krishna;Biswas, Jyotirmoy;Ray, Sukanta;Ghose, Tapas;Pipara, Amrit;Singh, Huirongbam Madon;Roy, Manas Kumar;Desai, Neha;Thambudorai, Robin;Ishwarappagol, Vijaykumar;Chaturvedi, Arun;Verma, Devanshi;Akhtar, Naseem;Gupta, Sameer;Rajan, Shiv;Tiwari, Tanmay;Kumar, Vijay;Mahajan, Amit;Jain, Deepak;Liddle, Dootika;Jyoti, Jyoti;Haque, Parvez David;Prem, William;Lakshminarayana, Badareesh;S, Bharath Veerabhadrappa;Poojary, Prema Harish;Bhat, Rama Rani Krishna;Mathew, Stanley;Gupta, Lalit;Bains, Lovenish;Kumar, Manish;Singh, Nishu;Sharma, Akanksha;Kumar, Ashwani;Garg, Lalit;Aggarwal, Manisha;Jakhar, Ruchi;Kumar, Ajit;Bose, Bodhisattva;Huda, Farhanul;Thakur, Nitish;Dhar, Puneet;Seenivasagam, Rajkumar Kottayasamy;Prakash, Sharath;Chaudhari, Abhishek;Shukla, Ashish;Mahakalkar, Chandrashekhar;Saxena, Garima;Mahuli, Kshiti;Kaple, Meghali;Kshirsagar, Shivani;Mehraj, Asif;Parray, Fazl;Aziz, Gowhar;Chowdri, Nisar;Wani, Rauf;Gurcoo, Showkat;Shah, Zameer;Madhavan, Sathish;Subbarayan, Shankar;Vino, Smila;Aravindan, U;George, Gejoe;Ck, Harikumar;Yadev, I P;Chisthi, Meer;Ps, Revathy;Sreekumar, R C;Vijayan, Varun;Theodore, Bernice;Victor, Catherine;Jesudason, Mark Ranjan;Arulappan, Nirupama;Philip, Rajeevan;Durai, Sheela;Creavin, Ben;Cullinane, Carolyn;Davis, Cian;Flynn, Collette;Liam, Devane;Cooke, Fiachra;Earley, Helen;Peter, Mccullough;Hamilton, Vida;Trani, Antonella Di;Conversano, Ivana;Cianci, Pasquale;Petta, Rocco;Picciariello, Arcangelo;Altomare, Donato F;Martines, Gennaro;Grasso, Salvatore;Moffa, Secondino;Papagni, Vincenzo;Zanoni, Andrea;Belvedere, Angela;Romano, Angela;Croce, Gianni Di;Tanzanu, Marta;Cardelli, Stefano;Lauro, Augusto;Sartarelli, Lodovico;Binetti, Margherita;Cervellera, Maurizio;Tonini, Valeria;Sanna, Barbara;Pusceddu, Elisabetta;Runfola, Matteo;Manunza, Romina;Pisanu, Adolfo;Cois, Alessandro;Frongia, Federica;Esposito, Giuseppe;Podda, Mauro;Mura, Paolo;Marzella, Angela;Scotto, Bruno;Cuneo, Davide;Ascari, Francesca;Giulino, Giuseppina;Varoli, Michele;Laquatra, Noemi;Fortunato, Crescenza;Marino, Fabio;Perrone, Fabrizio;Pace, Margherita;Convertini, Ornella;Cutellè, Clelia;Ammerata, Giorgio;Sena, Giuseppe;Pignataro, Marco;Scozzafava, Marco;Mazza, Michele;Bruni, Andrea;Curro, Giuseppe;Hila, Jozel;Ammendola, Michele;Curcio, Silvia;Signorelli, Vincenzo;Marano, Alessandra;Sasia, Diego;Borghi, Felice;Giuffrida, Maria Carmela;Bonardello, Michela;Palmisano, Sarah;Testa, Valentina;Porta, Andrea;Scaltrini, Francesca;Iacob, Giulio;Gaspa, Ilaria;Guatteri, Luca;Coladonato, Massimiliano;Zapparoli, Alessandro;Pesce, Antonio;Feo, Carlo V;Pindozzi, Fioralba;Bigoni, Irene;Torchiaro, Marco;Fabbri, Nicolò;Cianchi, Fabio;Staderini, Fabio;Elena, Fanti;Coratti, Francesco;Barbato, Giuseppe;Fortuna, Laura;Romagnoli, Stefano;Bergamini, Carlo;Villa, Gianluca;Cecchini, Ilaria;Martellucci, Jacopo;Izzo, Martina;Trafeli, Martina;Scheiterle, Maximilian;Manoocheehri, Farshad;Cagnazzo, Federica;Spampinato, Marcello Giuseppe;Adam, Nicolas;Depalma, Norma;D'Ugo, Stefano;Garritano, Stefano;Mazzeo, Carmelo;Cucinotta, Eugenio;Melita, Francesca;Viscosi, Francesca;Biondo, Santino Antonio;Tripodi, Vincenzo Francesco;Foppa, Caterina;Greco, Massimilano;Sacchi, Matteo;Carvello, Michele;Deac, Vasile;Laurenti, Virginia;Frontali, Alice;Zappone, Anna;Cammarata, Francesco;Colombo, Francesco;Ferrario, Luca;Currà, Maria Cristina;P. Danelli;Vignali, Andrea;Umberto, Casiraghi;Mastriale, Francesco;Riccardo, Rosati;Turi, Stefano;Elmore, Ugo;Galimberti, Andrea;Ceretti, Andrea Pisani;Vespo, Damiano;Opocher, Enrico;Longhi, Marco;Mariani, Nicolò Maria;Flandoli, Claudia;Ciulli, Cristina;Vaira, Giulia;Ripamonti, Lorenzo;Cigagna, Luca;Oldani, Massimo;Tamini, Nicolò;Palumbo, Alessio;Castaldi, Antonio;Antropoli, Carmine;Rupealta, Niccolò;Palmiero, Nicola;Donatiello, Valerio;Novi, Alessandra;Cappiello, Antonio;Bianco, Francesco;de Luca, Michele;Incollingo, Paola;Esposito, Rosario;Gili, Simona;Aprea, Giovanni;de Simone, Giuseppe;Palomba, Giuseppe;Capuano, Marianna;Basile, Raffaele;D'Angelo, Salvatore;Tropeano, Francesca Paola;Luglio, Gaetano;Pagano, Gianluca;de Palma, Giovanni Domenico;Cricrì, Michele;Milone, Marco;Manigrasso, Michele;Anoldo, Pietro;Boccia, Giuseppe;Raiano, Giuseppe;Nuzzo, Maria Michela Di;Calabria, Mariangela;Peltrini, Roberto;Castiglioni, Simone;Bracale, Umberto;Cervone, Carmela;Rega, Daniela;Caliendo, Domenico;Benetti, Emilio;Delrio, Paolo;Guarino, Rita;de Franciscis, Silvia;Coppolino, Francesco;Romano, Francesco Maria;Selvaggi, Francesco;Sciaudone, Guido;Selvaggi, Lucio;de Stefano, Mauro;Resendiz, Aridai;Carosso, Fabio;Degiuli, Maurizio;Salusso, Paola;Reddavid, Rossella;Benetti, Sara;Callari, Cosimo;Miceli, Dario Di;Pardo, Donatella;Sabatino, Giuseppina;Licari, Leo;Lirosi, Maria Carmen;Sorce, Vincenzo;Peri, Andrea;Mori, Anna;Pugliese, Luigi;Filardo, Matteo;Nuccio, Patrizia;Dominioni, Tommaso;Massimo, Ciciliot;Giuseppina, Forte;Angelo, Franceschi;Raffaele, Galleano;Michele, Malerba;Roberto, Pirozzolo;Mondini, Alberto;Muratore, Andrea;Valentino, Cristina;Calabro', Marcello;Danna, Riccardo;Cremonini, Camilla;Sbarbaro, Catia;Tartaglia, Dario;Coccolini, Federico;Chiarugi, Massimo;Musetti, Serena;Pagani, Stefano;Neri, Carlo Maria;Leoni, Chiara;Rossi, Elisabetta;Randisi, Emanuele;Puccini, Marco;Buccianti, Piero;Balestri, Riccardo;Vasale, Alessandro;Crescentini, Giacomo;Ranieri, Giorgio;Sinibaldi, Giovanni;Biondi, Alberto;Sanesi, Anna Paola;Vacca, Cristina;Lorenzon, Laura;Sollazzi, Liliana;Persiani, Roberto;Pezzuto, Roberto;Ferroni, Andrea Felice;Stipa, Francesco;Volturo, Lino;Moretti, Marco;Tierno, Simone Maria;Marina, Suor;Mingoli, Andrea;Fiori, Enrico;Pugliese, Francesco;Brachini, Gioia;Carta, Giuseppina;Sapienza, Paolo;Lapolla, Pierfrancesco;Mazzotta, Erica;Carannante, Filippo;Capolupo, Gabriella Teresa;Masciana, Gianluca;Sica, Ilde;Caricato, Marco;Antonelli, Serena;Fiume, Diego;Spoletini, Domenico;Lisi, Giorgio;Carlini, Massimo;Menduni, Viola;Arturi, Alessandro;Proietto, Barbara;de Lucia, Chiara;Baldi, Claudio;Passantino, Domitilla Gaia;Romeo, Gherardo;Paola, Massimiliano Di;Sensi, Bruno;Sica, Giuseppe;Siragusa, Leandro;Dauri, Mario;Franceschill, Marzia;Campanelli, Michela;Bellato, Vittoria;Porcu, Alberto;Garau, Alessandra Grazia Giuseppina;Masala, Maria Luisa;Oggianu, Silvia;Tedde, Tecla;Perra, Teresa;Pazzola, Vincenzo;Venezia, Dario Francesco;Roviello, Franco;Giacomini, Giovanni;Carbone, Ludovico;Marano, Luigi;Verre, Luigi;Marano, Mario;Ciccarese, Angelo Antonio;Bagnardi, Francesco;Shahu, Juliana;Siciliano, Wladimiro;Iacomino, Alessandro;Armellin, Claudia;Marson, Franco;Zanus, Giacomo;Santoro, Giulio Aniello;de Paoli, Massimo;Grossi, Ugo;Sekimoto, Mitsugu;Kobayashi, Toshinori;Horiguchi, Akihiko;Koike, Daisuke;Yonekura, Hiroshi;Kato, Hiroyuki;Yoshino, Kenji;Arakawa, Satoshi;Asano, Yukio;Alawneh, Fade;Rajab, Ibrahim;Ramadan, Mah'D;Masri, Mahmoud Al;Qaisi, Mohammad Al;Alsamneh, Muneer;Mubaidin, Osama;Al-Jarrah, Amar;Ababneh, Hazim;Khdair, Khaldoon;Tawarh, Tayseer;Sabri, Wafa;Arida, Zahed Abu;Dzhumabekov, Berik;Klyshbayeva, Damila;Ispbayeva, Karlygash;Nadyrov, Momynzhan;Tanabayeva, Shynar;Saliev, Timur;Jumanov, Abay;Aitbaeva, Arai;Arynov, Ardak;Nadyrov, Momunzhan;Maulenov, Nurlan;Dushimova, Zaure;Park, Eun Jung;Kim, Heeyong;Kang, Jeonghyun;Baik, Seung Hyuk;Song, Young;Kwak, Han Deok;Kim, Joungmin;Son, Ju Hwan;Chung, Jun Seong;Lee, Hyeongon;Baek, Jeong-Heum;Nam, Kug Hyun;Lee, Kyung Cheon;Lee, Won-Suk;Jeon, Youngbae;Kim, Chang Woo;Park, Sang-Eun;Son, Gyung Mo;Ahn, Hong Min;Lee, In Young;Kim, Tae Kyun;Pcolkins, Andrejs;Sivins, Armands;Lobovs, Dmitrijs;Ancans, Guntis;Kreice, Ilona;Budnikova, Ina;Jelovskis, Ivans;Emhareb, Abdalla;Abaidalla, Ahmed;Hammed, Amane;Khairallah, Marwan;Jibreel, Salma Saleh;Mohmmad, Walid A S;Hasan, Wisam;Venskutonis, Donatas;Daugėla, Edvardas;Dainius, Edvinas;Juočas, Juozas;Kutkevičius, Juozas;Vaitkutė, Kristina;Bradulskis, Saulius;Macas, Andrius;Pauzas, Henrikas;Jokubauskas, Mantas;Lizdenis, Paulius;Budrikienė, Rima;Svagzdys, Saulius;Saladzinskas, Zilvinas;Volkoviene, Gerda;Makauskiene, Jolanta;Kuliavas, Justas;Bernotaite, Vlada;Danys, Donatas;Kontrimaviciute, Egle;Poskus, Eligijus;Kryzauskas, Marius;Jakubauskas, Matas;Jotautas, Valdemaras;Zakaria, Andee Dzulkarnaen;Kai, Micheal Wong Pak;Zainy, Rhendra Hardy Mohamad;Tan, Shong Sheng;Zain, Wan Zainira Wan;Zakaria, Zaidi;Yusoff, Zakiah Mohd;Raduan, Farhana;Sagap, Ismail;Razali, Noor Yanti Fazlina;Rahman, Nurafdzillah Abdul;Kanthan, Soma Balaganapati Chandra;Nie, Yeoh Chih;Azman, Zairul Azwan Mohd;Ang, Chin Wee;Tang, Chu Yik;Poh, Keat Seong;Ng, Kevin;Hashim, Norhayati Mohd;Xavier, Ruben;Khong, Tak Loon;Amir, Ahmad Suhaimi;Ali, Che Saniati Che;Yew, Chor Kuan;Henry, Fitjerald;Muniandy, Jothinathan;Baharom, Salahudin;Eng, Stanley Chee Ren;Hu, Felicia Su-Min;Amin-Tai, Hizami;Jabar, Mohd Faisal;Satar, Mohd Hady Shukri Abdul;Fathi, Nik Qisti;Rao, Prashanti Surichandra;Podesta, Anne Marie Camilleri;Cini, Charles;Psaila, Josephine;Debono, Marianne;Sammut, Matthew;Spiteri, Neville;Andrejevic, Predrag;Muro, Adriana Galaviz;Leon, Benicia Perez;Perez, Jesus Alonso Valenzuela;Quiñonez, Jose Raul Acosta;Vera, Marina Teresa Ramirez;Gutierrez, Victor Manuel Maciel;Bobadilla, Billy Jimenez;Martinez, Claudia Martinez;de León Rendón, Jorge Luis;Hererro, Juan Antonio Villanueva;Cuichan, Marco Vinicio Yugsi;Baez, Noelia Fernández;Prevost, Patsy Garduño;Hoyos-Torres, Alejandro;Ruiz-Muñoz, Erick Alejandro;Alvarez-Bautista, Francisco Emmanuel;Ortíz-Méndez, Guillermina;Zamudio-Bautista, Jorge Luis;Salgado-Nesme, Noel;Vergara-Fernández, Omar;Sanchez-Valdivieso, Enrique;Martinez, Gregoria;Navarrete-Aleman, Jaime;Perez-Arellano, Jorge;Maldonado-Barron, Rebeca;Hernandez-Krauss, Rosy;Ousadden, Abdelmalek;Benjelloun, El Bachir;Bzikha, Ilham;Ibnmajdoub, Karim;Mazaz, Khalid;Marghich, Omar;Touzani, Soumaya;Benkabbou, Amine;Souadka, Amine;El Ahmadi, Brahim;Zaari, Fatimazahraa;Laamri, Imad;Majbar, Mohammed Anass;Mohsine, Raouf;Van, Charles Berlo;Seuren, Danielle;Gillissen, Freek;Aarts, Frits;Konsten, Joop;Van, Maarten Heinsbergen;Schlooz, Sjef;Naiqiso, Alena;Merrie, Arend;Varghese, Chris;Pugh, Felicity;Bissett, Ian;Wilson, Kasmira;Mitchell, Simon;Dawson, Carmel;Hill, Charlotte;Wright, Deborah;Hubley, Shelley;Lin, Anthony;Jones, Deborah;Siggins, Lauren;Fagan, Paul;Wu, Scott;Ekwesianya, Andrew;Nwoye, Chukwuemeka;Agara, Daniel;Ejiofor, Gloria;Sundaynweke, Nneka;Kwentoh, Nwanneka;Ewah, Richard;Aremu, Abdurrahman;Ballah, Abubakar;Ningi, Adamu;Ohia, Ernest;Mienda, Isa;Aliyu, Mohammed;Oloko, Nasirudeen;Okunlola, Abiodun;Abiyere, Henry;Bolanle, Olajide Edward;Babatunde, Olanrewaju;Fatudimu, Samuel;Orewole, Tesleem;Mba, Emmanuel Louis;Felix, Michael Shalzim;Abdulfatah, Mustapha;Ibrahim, Naziru;Masoro, Umar;Fakoya, Adegbolahan;Irabor, David;Anyadike, Florence;Ulasi, Ikechukwu;Orji, Mathias;Afuwape, Oludolapo;Ayandipo, Omobolaji;Aremu, Isiaka;Adegboye, Kazeem;Gbadegesin, Peter;Aminu, Bashiru;Aghadi, Ifeanyi Kene;Makama, Jerry Godfrey;Joshua, Samaila;Kache, Stephen Akau;Sheshe, Abdulrahman Abba;Bala, Abubakar Muhammad;Garzali, Ibrahim Umar;Abdullahi, Mustapha Miko Mohammed;Muhammad, Nasiru;Umar, Nura Aliyu;Muhammad, Saminu;Okoye, Aloysius;Emegoakor, Chiemelu;Nwosu, Chimdiebele;Egwuonwu, Ochonma Amobi;Ekwunife, Okechukwu;Amadigwe, Rita;Ojiakor, Samuel;Akere, Abidemi;Okereke, Chukwuma;Olaleye, Oluwaseun;Ige, Oluwasuyi;Olubayo, Oyetunde;Olatiilu, Tope;Idris, Mohammad;Shehu, Ahmad;Oluyori, Dupe;Nwabuoku, Emeka;Ukwubile, Linus;Bashir, Mohammed;Daniyan, Muhammad;Rauf, Hareem;Ali, Madeeha;Zakaria, Maheen;Hameed, Malika;Amanullah, Nazli;Chawla, Tabish;Waqar, Usama;Jamal, Abid;Butt, Anam;Kerawala, Asad;Samson, Samuel;Dodhy, Afia Arshed;Gill, Aun Jamal;Malik, Awais;Ali, Danish;Mohsin, Hassan;Afzal, Muhammad Farooq;Batool, Sana;Suleman, Ayra;Khalid, Junaid;Zafar, Madiha;Dilawar, Maha;Janjua, Muhammad Haris;Sarwar, Muhammad Zeeshan;Naqi, Syed Asghar;Akbar, Ali;Afzal, Ameer;Anwar, Jamal;Gondal, Khalid Masud;Shaukat, Maria;Waheed, Mariam;Sohail, Mohammad;Mukhtiar, Nida;Ammar, Ahmed Siddique;Hussain, Ahsan;Khan, Alam Noor;Sarwar, Albash;Khan, Imran;Khattak, Shehrbano;Oqaili, Bassam;Saada, Bayan;Zatari, Dirar;Jubran, Fahmi;Hamdan, Fatima;Emar, Mohammed;Alawi, Raneen;Jacome, Gustavo;Insturain, Ivelin;Arauz, Jazmin;Hurtado, Mariela;Beron, Reinaldo Isaacs;Castaño, Renata;Cao, Victor Hugo Bruno;Kwiatkowski, Andrzej;Dobkowski, Grzegorz;Bartosiak, Katarzyna;Walędziak, Maciej;Możański, Marcin;Zadrożna, Monika;Kowalewski, Piotr;Fiedziuk, Agnieszka;Wątroba, Anna;Los, Anna;Sitarska, Magdalena;Rząca, Marek;Zawadzki, Marek;Czarnecki, Roman;Tavares, Crisitna;Santos, Filipa;Borges, Filipe;Real, João Corte;Lima, Maria João;Carlos, Sandra;Pereira, Vasco;Pacheco, André;Gomes, Gabriel;Pimenta, Joana;Elisiario, Luisa;Jervis, Maria;Gonçalves, Vera;Pedro, Vera;Jordão, Daniel;Neves, Filipe Reis;Conceição, Luis;Ângelo, Miguel Duarte;Marques, Pedro;Saraiva, Raquel Prata;Caroço, Teresa Vieira;Windels, An;Machado, Arnaldo;Ribeiro, Cristina;Velez, Cristina;Oliveira, Joana;Melo, Miguel Rocha;Lima, Rita;Pires, António;Lareiro, Catarina;Martins, Ruben;Revez, Tatiana;Martins, Ana;Cardoso, Diogo;Alegre, Inês;Estevão, Pedro;Andrade, Diogo;Gomes, Diogo Carrola;Duarte, Maria José;Custódio, Pedro;Nemésio, Rodrigo Athayde;Rodrigues, Susana;Correia, Angela;Domingos, Hugo;Herrando, Ignacio;Azevedo, Jose;Fernandez, Laura;Azevedo, Patricia;Vieira, Pedro;Torre, Ana;Amado, Andreia;Paiva, Manuela;Saraiva, Raquel;Costa, Sílvia;Mendes, Tanya;Queirós, Tatiana;Silva, Albano;Faustino, Ana;Freitas, António;Mendes, Joana;Amaral, Luis;Quintanilha, Rui;Silva, Rui;Coelho, Ana Margarida;Ribeiro, Ana;Pinto, Carla;Ribeiro, Nuno;Reis, Rui;Costa, Susana;Fernandes, Vania;Sanches, Ana;Amorim, Edgar;Miguel, Inês;Rachadell, Juan;Sanches, Madalena;Oliveira, Sandra;Baptista, Victor;Roxo, Alberto;Devesa, Helena;Teslyak, Olena;Barradas, Renato;Marques, Sónia;Martins, Sónia;Pepino, Susana;Silva, Alberto;Deus, Ana Cláudia;Ferreira, Andreia;Marinho, Diogo;Sousa, Diogo;Martins, Maria João;Matias, Nuno;Pinto, Aurora;Correia, Débora;Amado, Fabíola;Cordeiro, Lisbete;Morales, Manuel;Lamas, Marta;Marçal, Sérgio;Rodrigues, Ana Isabel;Santos, Anabela;Marçal, André;Oliveira, António;Gomes, Carina;Ferreira, Cátia;Marques, Rita;Chitul, Andrei;Alexandrescu, Corina;Bezede, Cosmin;Cristian, Daniel;Mandi, Draga;Grama, Florin;Ungureanu, Raluca;Stoica, Bogdan;Diaconescu, Cati;Ciubotaru, Cezar;Tanase, Ioan;Grintescu, Ioana;Negoita, Valentina Madalina;Calin, Camelia;Simeanu, Catalina;Ciotarla, Danut Constantin;Caltea, Mihaela;Mirica, Radu Mihail;Luca, Anamaria;Pasca, Andrei;Vlad, Catalin;Bonci, Eduard-Alexandru;Stefanescu, Ioana;Achimas-Cadariu, Patriciu Andrei;Gata, Vlad Alexandru;Capusan, Alina;Petrisor, Cristina;Dindelegan, George;Seicean, Radu;Scurtu, Razvan;Bintintan, Vasile;Fagarasan, Vlad;Ionescu, Calin;Crisan, Dana;Zanc, Loredana;Ene-Cocis, Mihaela-Valentina;Muresan, Mihai-Stefan;Mihalcea, Sebastian Mihai;Dudric, Vlad;Musina, Ana-Maria;Ristescu, Anca-Irina;Roata, Cristian-Ene;Moglan, Mihaela;Dimofte, Mihail-Gabriel;Lunca, Sorinel;Iacob, Stefan;Dychko, Aleksander;Litvin, Andrey;Kapustina, Anna;Provozina, Arina;Anokhin, Evgeny;Zabiyaka, Mikhail;Shin, Alexander;Djumabayev, Khasan;Kuznetsova, Marina;Gordeyev, Sergey;Kochkina, Sofia;Mamedli, Zaman;Markaryan, Daniil;Galliamov, Eduard;Semina, Ekaterina;Agapov, Mihail;Malahov, Pavel;Garmanova, Tatiana;Kakotkin, Viktor;Zaycev, Andrey;Sumbaev, Anton;Bedzhanyan, Arkady;Orman, Evgenya;Petrenko, Konstantin;Bredikhin, Mikhail;Frolova, Yulia;Tulina, Inna;Bashilkina, Olga;Tsarkov, Petr;Rodimov, Sergey;Stamov, Vitaliy;Balaban, Vladimir;Alexnder, Abelevich;Yanishev, Alexey;Rogozhev, Dmitrii;Yakunina, Natalia;Chubukova, Natlia;Nugmanov, Ruslan;Karachun, Aleksei;Petrov, Aleksei;Domanskiy, Andrei;Panaiotti, Lidiia;Smolina, Marina;Sapronova, Tatyana;Pelipas, Yuriy;Zagaynov, Eugeny;Khrykov, Gleb;Davidovskaja, Larisa;Burlov, Nikita;Mankevich, Nikolay;Tverdohlebova, Tatyana;Bogatikov, Alexander;Lodygin, Alexander V;Krasnoselsky, Constantin;Vasiukova, Evgeniia-Surgeon;Kopteyev, Nikita R;Ovchinnikov, Timofey;Kashchenko, Victor A;Novikova, Anastasia;Terentyeva, Ekaterina;Kuleshov, Oleg;Pavlov, Rostislav;Koshel, Andrey;Kostromitsky, Dmitry;Drozdov, Evgeniy;Klokov, Sergey;Camacho, Amparo;Khan, Farhat N;Bandar, Mahdi Al;Shamim, Rafia;Chowdhury, Sharfuddin;Kovacevic, Bojan;Krdzic, Igor;Zdravkovic, Maja;Kenic, Marko;Milentijevic, Milica;Petkovic, Natasa;Radulovic, Radosav;Ngu, James;Teo, Nan Zun;Singh, Prit Anand;Ong, Suet Yan;Li, Sun;en Siew, Bei;Chee, Corissa;Koh, Jasmin Jia Min;Lee, Kai Yin;Tan, Ker Kan;Wong, Siew Ching;Loh, Will;Pujol, Andrea Fernandez;Rubio, Javier Corral;Farrés, Laia Pagés;Vendrell, Laura Lopez;Del Olmo, Maria Inmaculada Ureña;Pedregosa, Ana Belen;Galmes, Carla;Luckute, Daiva;Casanova, Daniel;Artigot, Mariano;Guedes, Xavier;Olivella, Yolanda;Sarda, Marc Sadurni;Toscano, Marta Jimenez;Damieta, Marta Pascual;Pera, Miguel;Gonçalvez, Sandra Alonso;Galvez, Sandra Torres;Ruiz, Silvia Salvans;Espin-Basany, Eloy;Marinello, Franco;Villarino-Villa, Laura;Heras, Marisol Vega-Las;Martin-Sanchez, Rocio;Mata, Rodrigo Mata;Blanco-Colino, Ruth;Otero, Ana;de Lacy, Antonio Maria;Sanahuja, Josep Marti;Bravo, Raquel;Ferraz, Teresa;Gonzabay, Victor;Gonzalez, Felix;Menendez, Pablo;Del Castillo, Vanesa Crespo Garcia;Lopez-Pelaez, Vicente Muñoz;Silva, Álvaro Soler;Lillo-García, Cristina;Tauler, Elena Miranda;Manresa, Maria Carmen Estañ;Pérez, Sandra Lario;Llopis, Saray Quinto;Rubio, Ainhoa Valle;Castillo, Enrique Roca;Miramón, Francisco Javier Jiménez;Rodriguez, Jose Luis Ramos;Rizo-Lamberti, Laura Alonso;Garrido, Pilar Garcia;Carneros, Virginia Jimenez;Alfonso, Beatriz Amorós;Sierra, Begoña González;Amador, Cristina García;Gomendio, Maria Dolores Picardo;Palomino, María Victoria Romo;de La Plaza Llamas, Roberto;Cafranga, Estíbaliz Gutiérrez;Ramos, Juan Luis Esteban;Estudillo, Marta Copano;Pérez, Raquel Escalera;Pernas, Rosa María;de Lebrusant Fernández, Sara;Bautista, Wilson Manuel Sánchez;Llamazares, Ana Llamazarez;Valbuena, Ana Lozano;Moran, Laura Alvarez;Alvarez, Laura Jimenez;Raposo, Lourdes Galan;Ceron, Silvia Ferrer;Calvo, Almudena Castro;Valcárcel, Cristina Rey;Peña, Jose Perez;Gómez, Luis Miguel Jimenez;Díez, Miguel Cuende;Lindenbaum, Paula Dujovne;Mata, Silvia Kayser;Ruiz-De-La-Hermosa, Alicia;Abad-Motos, Ane;Toribio-Combarro, Begoña;Ripollés-Melchor, Javier;Fuenmayor-Valera, Maria Luisa;Ortega-Domene, Patricia;Loscos, Ana;Del Pueblo, Cristina Sanchez;Dziakova, Jana;Mugüerza, José María;Carlin, Patricia Saez;Anula, Rocio;Mouvet, Yvonne;Forero-Torres, Alexander;Andrés, Beatriz Díaz San;Marcos, Camino Morales;Rubio, Ines;Pascual, Isabel;Yague, Julio;Alcolea, Natalia González;Alonso, Alfredo;Diéguez, Beatriz;Ibañez, Ildefonso;Pérez, Jose Luis;Losada, Manuel;García-Conde, María;Hernández, Miguel;Blazquez-Martin, Alma;Vera-Mansilla, Cristina;Mendoza-Moreno, Fernando;Hernandez-Salvan, Javier;Diez-Alonso, Manuel;Hernandez-Juara, Pilar;Barrena-Blazquez, Silvestra;Minaya-Bravo, Ana María;Galván-Pérez, Armando;Miguel-Méndez, Carlos San;Gonzalez-Gonzalez, Enrique;Alvarez-Díez, Marcos;García-Ureña, Miguel Ángel;Llorente-Moreno, Miriam;Ruiz-Lozano, Carlos;Colás-Ruiz, Enrique;Pérez-Calvo, Javier;Gomila-Sanso, Joan Andreu;Álvarez-Llano, Laura;Serrano-Fuentes, Silvia Covadonga;Soto-Montesinos, Cristina;Dedeu-Bastardas, Imma;Perez-Reche, Isabel;Labró-Ciurans, Meritxell;Pardo-López, Sara;Pérez, Elisa García;Fernández, Ignacio Ortega;Canals, Lucía Otazu;Espino, Pablo Calvo;Ruano, Paloma Guillamot;Ricardo, Villamarín;Ros, Emilio Peña;Manuel, Esther Medina;Buleje, Jorge Alejandro Benavides;Prats, María Milagros Carrasco;Baños, Pedro Antonio Parra;González, Pilar Martínez;Celdrán, Rebeca González;Pellicer-Franco, Enrique M;Valero-Navarro, Graciela;Vicente-Villena, Juan Pablo;Martinez-Mercader, Maria Mar;Baeza-Murcia, Melody;Mengual-Ballester, Monica;Soria-Aledo, Victoriano;Fernández-Martínez, Daniel;Varela-Rodríguez, Lorena;Garcia-Flórez, Luis Joaquin;Fernández-Hevia, Maria;Gonzalez-Diaz, Maria Jose;Fernández-Arias, Sebastian;Puertas, Cristina Palomar;de San Pío Carvajal, Eduardo;Cebolla, Elena Sagarra;Brainsa, Eneida;Bayo, José Manuel Muros;Castro, Marta Cuartero;Blanco, Raquel Ríos;Gutierrez, Elsa;Pinto, Francisca Lima;Alegre, Javier Martinez;Flores, Natalia;ÓSullivan, Sara Nuñez;Fernández, Begoña Fadrique;Alonso, Javier Etreros;Conde, Juan Guillermo Ais;Ropero, Nicolas Monge;Bayón, Raquel Álvaro;Dominguez, Sara Hernández;Ramirez, Sofia;Martin de Pablos, Angel;Perez-Sanchez, Asuncion;Cano-Matias, Auxiliadora;Del-Rio-Lafuente, Francisco-Javier;Caballero-Delgado, Javier;Valdes-Hernandez, Javier;Gomez-Rosado, Juan-Carlos;Martinez, Cristina;Cholewa, Hanna;Sancho-Muriel, Jorge;Alberola, Maria José;Navasquillo, Mireia;Primo, Vicent;Moreno, Virginia;Espí-Macías, Alejandro;Moro-Valdezate, David;Carrascosa-Morales, Irene;Martín-Arévalo, José;Soro-Domingo, Marina;García-Botello, Stephanie;Pla-Marti, Vicente;Abellán, Antonio Melero;Pérez, Carolina Martínez;Cortés, Guillermo Felipe Valderas;Blasco, Laura Fraile;Chornet, Marta Roselló;Martín, Rosa Sanchis;Diego, Alejandro Romero-De;Vázquez-Fernández, Andrea;Pascual, Antonia;de Andrés-Asenjo, Beatriz;Beltrán de Heredia, Juan;Ruiz-Soriano, María;Rodríguez-Jiménez, Rita;Iribarren, Enrique Moncada;Rodríguez, Erene Victoria Flores;Del Carmen Casas García, Maria;García-Señoráns, Marta Paniagua;Valderrama, Óscar Cano;Rodríguez, Paula Fernández;Santos, Raquel Sánchez;Currás, Rosana Pérez;Vigorita, Vincenzo;Roche, Carlos Gracia;Delgado, Eduardo;Lafuente, Francisco;Gascon, Isabel;Saudi, Sef;Fraj, Victoria;Wickramasinghe, Dakshitha;de Zoysa, Ishan;Samarasekera, Nandadeva;Wickramarathne, Rasika;Dassanayake, Vihara;Balathayalan, Yathev;de Silva, Dulantha;Perera, Mariyan;Pulleperuma, Samanthi;Jayasekara, Sharitha;Wijenayake, Wasantha;Gunetilleke, Bhagya;Abeysinghe, Nayana;Chandrasinghe, Pramodh;Kumarage, Sumudu;Abdalradiy, Abdalrahmman G;Widatalla, Abu Bakr H;Ahmed, Amjed Yassir;Mohamed, Haiba A;Hamid, Hytham K S;Ali, Manhal Hashim;Eldin, Sami Jalal;Agger, Erika;Jutesten, Henrik;Lindgren, Jenny;Lepsenyi, Mattias;Azhar, Najia;Hansdotter, Pernilla;Ekepil, Anna;Lindén, Åsa;Brandström, Gustav;Smedberg, Jannica;Schiffer, Eduardo;Ris, Frédéric;Longchamp, Grégoire;Meyer, Jeremy;Dupret, Luc;Galetti, Ken;Regusci, Luca;Grischott, Marco;Malugani, Michela;Mouhandes, Abd El-Fattah;Danial, Aghyad Kudra;Khayat, Michel;Sbahi, Mohamad Hussam Eddin;Marawy, Mohamad Kher;Abdullah, Mohammad Amer;Douba, Zain;Mansour, Ali;Niazi, Ammar;Hamza, Amr;Mohamad, Aya Haji;Awead, Marwa;Mohammad, Saleh;Salloum, Samer;Jabar, Ahmad Al;Zazo, Aya;Shebli, Baraa;Ayoub, Kusay;Younes, Lina;Bannoud, Mohammad Hassan;Zazo, Rama;Saad, Ahmad;Hamdan, Alaa;Wakkaf, Habib;Adra, Lama;Souliman, Mahmoud;Anton, Majd;Hannouf, Sawsan;Li, Kuan Lin;Cheng, Kuang I;Ji, Shi Jie;Hsieh, Yi Chien;Parlak, Emine Arici;Demir, Mehmet;Kara, Umut;Peker, Yaşar Subutay;Yiğit, Direnç;Unal, Neslisah;Iflazoğlu, Nidal;Yalkin, Ömer;Topal, Serra;Gulcu, Baris;Ozturk, Ersin;Gümbelek, Gülnur;Terkanlıoğlu, Serkan;Koklucan, Arzu;Ince, Gorkem;Sen, Murat;Isik, Ozgen;Kural, Said;Akesen, Selcan;Yilmazlar, Tuncay;Sungurtekin, Hulya;Sungurtekin, Ugur;Vural, Ummuhan;Ozgen, Utku;Isik, Arda;Onk, Didem;Kurnaz, Eray;Ozker, Turkan Sel;Ipek, Ahmet;Ferlengez, Aysegul;Erturk, Candeniz;Tatar, Cihad;Sevik, Husnu;Akay, Omer;Sensoy, Ozlem;Hayirlioglu, Mehmet Bilhan;Aktas, Serhat;Ozben, Volkan;Aliyeva, Zumrud;Mutlu, Arda Ulaş;Gökay, Banu Vural;Saraçoğlu, Can;Aytaç, Erman;Gülmez, Mehmet;Işık, Merve Ünal;Hacim, Adnan;Akbas, Ahmet;Soyhan, Filiz;Turgut, Mehmet Alim;Demirgan, Serdar;Meric, Serhat;Altinel, Yuksel;Baris, Baver;Akova, Elif;Kahraman, Ersin;Kucuk, Hasan Fehmi;Saracoglu, Kemal Tolga;Kaya, Selcuk;Lel, Sude;Gurbulak, Esin Kabul;Caz, Esra;Kostek, Mehmet;Mihmanli, Mehmet;Yazici, Pinar;Oba, Sibel;Kırkan, Emre Furkan;Ulgur, Hanife Seyda;Kalın, Murat;Dinkci, Mustafa Deniz;Duzgun, Ozgul;Ozturk, Sevgi;Zengin, Abdullah Kağan;Aşkar, Ahmet;Şanlı, Ahmet Necati;Erginöz, Ergin;Özçelik, Mehmet Faik;Ergün, Sefa;Uludağ, Server Sezgin;Kara, Dilek;Yılmaz, Gülseren;Sarıcı, Inanç Şamil;Kara, Yasin;Incesu, Aylin;Arican, Can;Atici, Semra Demirli;Kaya, Tayfun;Gezer, Turna;Kirmizi, Yasemin;Aydin, Gaye;Namdaroglu, Ozan;Adakaya, Sıla;Canda, Aras Emre;Ozzeybek, Deniz;Coskun, Nurcan;Sokmen, 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2024

Abstract

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates.

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				Settore MED/18 - Chirurgia Generale
			
	Data di pubblicazione
	
				2024
			
	Rivista in ANCE
	
				BRITISH JOURNAL OF SURGERY
			
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				https://dx.doi.org/10.1093/bjs/znad370
			
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				01 - Articolo su periodico

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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/1040090

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