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Murray TA. Equity and justice in health. Nurs Outlook 2024; 72:102178. [PMID: 38754268 DOI: 10.1016/j.outlook.2024.102178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/12/2024] [Accepted: 04/20/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND While justice is promised to all U.S. citizens, the truth is that the pathway to equity and justice in health is riddled with obstacles for many marginalized and minoritized groups. The United States ranks lower on crucial health measures than its high-income peer countries, reflecting differences in health outcomes for marginalized and minoritized populations. PURPOSE Promoting equity and justice in health is vital as health shapes the daily experiences of individuals and communities, specifically those from marginalized and minoritized backgrounds. METHOD This paper highlights the health care system and sociopolitical factors contributing to the longstanding structural barriers that impede health and the need for structural competence, advocacy, and activism in the nursing workforce. DISCUSSION Understanding systemic issues underlying health inequities provides an opportunity to develop targeted strategies to eliminate practices perpetuating inequities and pave the way for everyone to have a fair and just opportunity to be as healthy as possible. CONCLUSION Specific education, practice, research, and policy recommendations can advance equity and justice in health.
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Affiliation(s)
- Teri A Murray
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, MO.
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Yartseva MO, Khomiak OV, Avramenko IV. Crisis-ready educational skills of life support in newborns and adults' scenarios: the impact of simulation-based training on student proficiency. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:1033-1038. [PMID: 39008594 DOI: 10.36740/wlek202405124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
OBJECTIVE Aim: To assess the impact of multidisciplinary simulation training on the educational outcomes of medical students in the emergency care of adults and newborns and implement changes in the curriculum to master simulation scenarios more. PATIENTS AND METHODS Materials and Methods: To assess the differences in learning outcomes between medical students who study the same curriculum without simulation interventions and those who undergo multidisciplinary emergency care simulation training. A quasi-experimental approach was used to assign students to the Intervention Group or the Control Group. RESULTS Results: According to individual criteria, the lowest scores in both groups were obtained for the stages that required the greatest accuracy and correct technique. After the appropriate cycle of initiation, the results in both groups improved significantly, but the results of students from the first group were significantly higher than those of students from the second group. Despite the absence of a significant difference in the average overall score for the skills, students in the first group significantly improved the accuracy and correctness of the criteria that assess the technical aspects of performance, while students in the second group mainly improved the quality of the descriptive and communicative parts of the practical skill. CONCLUSION Conclusions: We believe that reallocating curricular time to additional hours dedicated to simulation scenarios will better prepare aspiring healthcare professionals for the demanding and dynamic nature of their career, as we continue to increase our understanding of the potential of simulation-based education.
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Affiliation(s)
- Mariia O Yartseva
- POLISH BRANCH (KMU POLISH CAMPUS) OF PRIVATE HIGHER EDUCATION ESTABLISHMENT "KYIV MEDICAL UNIVERSITY", BYTOM, POLAND
| | - Olena V Khomiak
- POLISH BRANCH (KMU POLISH CAMPUS) OF PRIVATE HIGHER EDUCATION ESTABLISHMENT "KYIV MEDICAL UNIVERSITY", BYTOM, POLAND
| | - Iryna V Avramenko
- POLISH BRANCH (KMU POLISH CAMPUS) OF PRIVATE HIGHER EDUCATION ESTABLISHMENT "KYIV MEDICAL UNIVERSITY", BYTOM, POLAND
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Orr Z, Jackson L, Alpert EA, Fleming MD. Biomedicine and the treatment of difference in a Jerusalem emergency department. Soc Sci Med 2023; 339:116345. [PMID: 38000340 DOI: 10.1016/j.socscimed.2023.116345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/16/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023]
Abstract
Biomedicine has played a key role in the dissemination of modern social norms, such as the emphasis on individual autonomy and the distinction between science and religion. This study examines the way the mostly-Jewish members of the medical staff at an emergency department of a Jerusalem hospital perceive Jewish ultra-Orthodox and Arab patients' behaviors vis-à-vis the existing biomedical norms. We analyzed participants' perceptions in terms of the social constructs they reveal, their meanings, and their implications. Semi-structured in-depth interviews were conducted with 24 staff members and were analyzed using content analysis. The staff described challenges in treating Arab and ultra-Orthodox patients, which they related to both groups' embeddedness in traditional "cultures" and collective identities. According to the participants, in both cases, the patients' cultural affiliations constrained their sense of individual autonomy and rationality. However, in the comparative analysis, two differences emerged. First, while both groups were perceived to diverge from modern norms of individual autonomy, in the case of Arab patients, these characteristics were presented as disruptive and potentially threatening to the hospital staff. By contrast, in the case of ultra-Orthodox patients, adherence to traditional and collective values was more likely to be represented as a risk to the patient, rather than to the staff. Second, staff were more likely to provide accommodations for ultra-Orthodox patients than for Arab patients. These accommodations were often described in the frame of "cultural competency." We suggest that divergences in how staff understood and responded to perceived cultural differences of each group reflect unequal impacts of structural determinants of health, including of political conflict. We recommend moving beyond the conceptual framework of cultural competency to strengthen the staff's structural competency, cultural and structural humility, and critical consciousness.
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Affiliation(s)
- Zvika Orr
- Selma Jelinek School of Nursing, Jerusalem College of Technology, Tal Campus, 11 Beit Hadfus Street, Jerusalem, Israel.
| | - Levi Jackson
- Selma Jelinek School of Nursing, Jerusalem College of Technology, Tal Campus, 11 Beit Hadfus Street, Jerusalem, Israel.
| | - Evan Avraham Alpert
- Department of Emergency Medicine, Hadassah Medical Center- Ein Kerem, Faculty of Medicine, The Hebrew University of Jerusalem, K.Y. Man Street, Jerusalem, Israel.
| | - Mark D Fleming
- School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, USA.
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Rice BM. Using nursing science to advance policy and practice in the context of social and structural determinants of health. Nurs Outlook 2023; 71:102060. [PMID: 37852871 PMCID: PMC10843015 DOI: 10.1016/j.outlook.2023.102060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/17/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Social and structural determinants of health play a large role in health inequities. PURPOSE To highlight how nursing science can be used to advance policy and practice in the context of social and structural determinants of health. METHODS This paper reports on the author's keynote presentation from the 2022 State of The Science Conference on Social and Structural Determinants of Health presented by the Council for the Advancement of Nursing Science. Key concepts are overviewed and defined, followed by examples of two community-engaged research projects with findings that inform practice and policy. The author concludes with individual-, social- and structural-level recommendations as a clarion call for nurses to use research to eliminate health inequities and promote justice for all. CONCLUSION What we know is, in part, only as good as what we do with that knowledge. When lives are at stake, gone are the days of knowing something and failing to act on that knowledge.
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Affiliation(s)
- Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA.
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Dodson TM. Effects of Expert Modeling Videos on the Development of Nursing Students' Clinical Competence. J Nurs Educ 2023; 62:454-460. [PMID: 37561901 DOI: 10.3928/01484834-20230612-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND Nurse educators are called to develop innovative teaching strategies to build clinical competency. Expert modeling videos (EMVs) promote clinical competency by demonstrating exemplar nursing care. METHODS A quasiexperimental research study was conducted using a prebriefing intervention of a nursing process video for demonstration (experimental) and discussion (control) groups of nursing students. Simulation competency was measured using the Creighton Competency Evaluation Instrument (CCEI). RESULTS Students in the experimental group demonstrated a statistically significant improvement in simulation competency (p = .001) and performed significantly better in the CCEI domains of communication (p = .009) and patient safety (p = .002). CONCLUSION The use of EMVs in simulation prebriefing is an innovative teaching strategy to prepare undergraduate nursing students with the knowledge and skills required to enter the simulated environment. Through watching an exemplar demonstration of desired behaviors, students significantly improved their simulation performance and demonstrated clinically competent care of an acutely ill simulated patient. [J Nurs Educ. 2023;62(8):454-460.].
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Dopelt K, Shevach I, Vardimon OE, Czabanowska K, De Nooijer J, Otok R, Leighton L, Bashkin O, Duplaga M, Levine H, MacLeod F, Malowany M, Okenwa-Emegwa L, Zelber-Sagi S, Davidovitch N, Barach P. Simulation as a key training method for inculcating public health leadership skills: a mixed methods study. Front Public Health 2023; 11:1202598. [PMID: 37483956 PMCID: PMC10359821 DOI: 10.3389/fpubh.2023.1202598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Background Successful management of public health challenges requires developing and nurturing leadership competencies. We aimed to evaluate the effectiveness of training simulations to assess public health leadership and decision-making competencies during emergencies as an effective learning and training method. Methods We examined the effects of two simulation scenarios on public health school students in terms of their experience (compared to face-to-face learning) and new skills acquired for dealing with similar emergent situations in the future. A mixed-methods design included developing a validated and pre-tested questionnaire with open-and closed-ended questions that examined the simulation impact and the degree of student satisfaction with the conditions in which it was conducted. Semi-structured in-depth interviews were conducted with the students after going through the simulations. The questionnaire results were evaluated using descriptive analytics. The interviews were analyzed using thematic analyses. All data were collected during June 2022. Results The questionnaire results indicate that students strengthened their interpersonal communication skills and learned about the importance of listening to the opinions of others before formulating their positions. Four themes emerged from 16 in-depth interviews, according to Kolb's experimental learning cycle. Students emphasized the effectiveness of experiential learning versus traditional classroom learning. The simulation scenarios were felt to realistically convey critical issues regarding leadership, decision-making, and teamwork challenges. They effectively conveyed the importance of building a culture of conducting substantive and respectful discussions. Conclusion Simulation is a powerful pedagogical training tool for public health leadership competencies. Simulations were seen to be advantageous over face-to-face learning in imparting a range of leadership skills and hands-on practice. We recommend integrating simulations in all public health leadership training programs.
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Affiliation(s)
- Keren Dopelt
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Itamar Shevach
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ofek Eliad Vardimon
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jascha De Nooijer
- Department of Health Promotion, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Robert Otok
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Lore Leighton
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Mariusz Duplaga
- Department of Health Promotion and e-Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Hagai Levine
- The Israeli Association of Public Health Physicians (IPAPH), Israeli Medical Association, Ramat-Gan, Israel
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Fiona MacLeod
- School of Public Health, University College Cork, Cork, Ireland
| | - Maureen Malowany
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Leah Okenwa-Emegwa
- Department of Health Sciences, The Swedish Red Cross University (SRCU), Huddinge, Sweden
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Nadav Davidovitch
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- The Israeli Association of Public Health Physicians (IPAPH), Israeli Medical Association, Ramat-Gan, Israel
| | - Paul Barach
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University Vienna, Vienna, Austria
- Department of Surgery, Imperial College School of Medicine, London, United Kingdom
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Orr Z, Fleming MD. Medical neutrality and structural competency in conflict zones: Israeli healthcare professionals’ reaction to political violence. Glob Public Health 2023. [DOI: 10.1080/17441692.2023.2171087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Zvika Orr
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Mark D. Fleming
- School of Public Health, University of California, Berkeley, CA, USA
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Unger S, Orr Z, Alpert EA, Davidovitch N, Shoham-Vardi I. Social and structural determinants of emergency department use among Arab and Jewish patients in Jerusalem. Int J Equity Health 2022; 21:156. [DOI: 10.1186/s12939-022-01698-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/02/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
A growing body of research demonstrates that economic conditions and racial and ethnic disparities result in excessive overuse of emergency departments (EDs) by a small group of socioeconomically marginalized residents. Knowledge and understanding of these issues on the part of the healthcare team can promote equality by providing structurally competent care. This study aims to identify the major social and structural factors related to patterns of ED visits by Arab and Jewish patients in Israel, where access to health services is covered by universal national health insurance.
Methods
A cross-sectional study was conducted using questionnaires of ED patients in a tertiary care medical center in Jerusalem. The hospital is the largest of the three EDs in Jerusalem with over 90,000 adult patient visits a year. The sample was stratified by ethnicity, including 257 Jewish patients and 170 Arab patients. The outcome variable was repeat visits for the same reason to the ED within 30 days.
Results
There were differences between Jewish and Arab patients’ social and structural characteristics, including health status, socioeconomic status, feeling of safety, and social support. There were also significant differences in some of the characteristics of health service utilization patterns, including ED repeat visits, language barriers when seeking healthcare in the community, and seeking information about medical rights. The variables associated with repeat visits were different between the two groups: among the Arab patients, repeat visits to the ED were associated with concerns about personal safety, whereas among the Jewish patients, they were associated with poverty.
Conclusion
The study illustrates the gaps that exist between the Arab and Jewish population in Israel. The findings demonstrated significant differences between populations in both health status and access to health services. In addition, an association was found in each ethnic group between different structural factors and repeat ED requests. This study supports previous theories and findings of the relationship between structural and social factors and patterns of health services utilization.
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Orr Z, Romem A. Holocaust and Genocide Studies in Nursing Education: Nurse Practitioners as Critical Intellectuals. J Nurs Educ 2022; 61:624-632. [DOI: 10.3928/01484834-20220912-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Orr Z, Jackson L, Alpert EA, Fleming MD. Neutrality, conflict, and structural determinants of health in a Jerusalem emergency department. Int J Equity Health 2022; 21:89. [PMID: 35751059 PMCID: PMC9233380 DOI: 10.1186/s12939-022-01681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical neutrality is a normative arrangement that differentiates a zone of medical treatment disconnected from the field of politics. While medical neutrality aims to ensure impartial healthcare for all and to shield the healthcare personnel from political demands, it can also divert attention away from conflicts and their effects on health inequity. This article analyzes how healthcare professionals understand and negotiate the depoliticized space of the emergency department (ED) through their views on neutrality. It also examines how medical staff use depoliticized concepts of culture to account for differences in the health status of patients from disadvantaged groups. These questions are examined in the context of the Israeli-Palestinian conflict. METHODS Twenty-four in-depth, semi-structured interviews were conducted with healthcare personnel in a Jerusalem hospital's ED. All but one of the participants were Jewish. The interviews were analyzed using qualitative content analysis and Grounded Theory. RESULTS The ED staff endorsed the perspective of medical neutrality as a nondiscriminatory approach to care. At the same time, some medical staff recognized the limits of medical neutrality in the context of the Israeli-Palestinian conflict and negotiated and challenged this concept. While participants identified unique health risks for Arab patients, they usually did not associate these risks with the effects of conflict and instead explained them in depoliticized terms of cultural and behavioral differences. Culture served as a non-controversial way of acknowledging and managing problems that have their roots in politics. CONCLUSIONS The normative demand for neutrality works to exclude discussion of the conflict from clinical spaces. The normative exclusion of politics is a vital but under-appreciated aspect of how political conflict operates as a structural determinant of health. Healthcare personnel, especially in the ED, should be trained in structural competency. This training may challenge the neglect of issues that need to be solved at the political level and enhance health equity, social justice, and solidarity.
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Affiliation(s)
- Zvika Orr
- Department of Nursing, Jerusalem College of Technology, 11 Beit Hadfus Street, Jerusalem, Israel.
| | - Levi Jackson
- Department of Nursing, Jerusalem College of Technology, 11 Beit Hadfus Street, Jerusalem, Israel
| | - Evan Avraham Alpert
- Department of Emergency Medicine, Shaare Zedek Medical Center; Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Bait Street, Jerusalem, Israel
| | - Mark D Fleming
- School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, USA
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Unger S, Orr Z, Avraham Alpert E, Davidovitch N, Shoham-Vardi I. Social and structural determinants and their associations with patient experience in the emergency department. Int Emerg Nurs 2022; 61:101131. [PMID: 35217412 DOI: 10.1016/j.ienj.2021.101131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Improving patient experience and satisfaction in the emergency department (ED) is challenging but beneficial. Previous studies have shown an association between social and structural factors and patient satisfaction. This study examined the structural and social factors related to the ED patient experience among Jewish and Arab patients in a Jerusalem hospital. METHODS A cross-sectional study was conducted among ED patients in a Jerusalem hospital. Data were collected via questionnaires. The sample included 257 Jewish patients and 170 Arab patients. The outcome variable was a positive or negative ED experience. RESULTS Jewish and Arab patients had different factors related to ED experience. Cultural differences, including a language barrier and access to information, were associated with a negative experience among Arab patients. Among Jewish patients, frequent use of community health services was associated with a negative ED patient experience. CONCLUSION This study shows an association between social and structural factors and patient experience, illustrating gaps for and vulnerability of different ethnic groups that affect their experience with healthcare services. Understanding these issues and implementing solutions formulated at the institutional and national levels can promote equity by providing structurally competent care.
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Affiliation(s)
- Shifra Unger
- Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel; Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - Zvika Orr
- Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel
| | - Evan Avraham Alpert
- Department of Emergency Medicine, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Nadav Davidovitch
- Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Ilana Shoham-Vardi
- Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beersheba, Israel
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