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Mahabee-Gittens EM, Merianos AL, Dexheimer JW, Meyers GT, Stone L, Tabangin M, Khoury JC, Gordon JS. Utilization of a Clinical Decision Support Tool to Reduce Child Tobacco Smoke Exposure in the Urgent Care Setting. Pediatr Emerg Care 2020; 36:527-531. [PMID: 30346363 PMCID: PMC6474832 DOI: 10.1097/pec.0000000000001646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical decision support systems (CDSS) may facilitate caregiver tobacco screening and counseling by pediatric urgent care (UC) nurses. OBJECTIVE This study aimed to assess the feasibility of a CDSS to address caregivers' tobacco use and child tobacco smoke exposure (TSE). METHODS We conducted a 3-month prospective study on caregivers screened using a CDSS. Nurses used the CDSS to advise, assess, and assist caregivers to quit. We assessed caregiver sociodemographics, smoking habits, and child TSE. RESULTS We screened 185 caregivers whose children were exposed to TSE for study inclusion; 155 (84%) met the eligibility criteria, and 149 (80.5%) were included in the study. Study nurses advised 35.2% of the caregivers to quit, assessed 35.9% for readiness to quit, and assisted 32.4%. Of the 149 participants, 83.1% were female; 47.0% were white and 45.6% African American; 84.6% had public insurance or were self-pay; 71.1% were highly nicotine dependent; 50.0% and 50.7% allowed smoking in the home and car, respectively; and 81.3% of children were biochemically confirmed to be exposed to tobacco smoke. At follow-up (86.6% retention), 58.9% reported quit attempts at 3 months. There was a significant decrease in nicotine dependence and a significant increase in motivation to quit. Self-reported quit rate was 7.8% at 3 months. CONCLUSIONS An electronic health record-embedded CDSS was feasible to incorporate into busy UC nurses' workloads and was associated with encouraging changes in the smoking behavior of caregivers. More research on the use of CDSS to screen and counsel caregivers who smoke in the UC and other acute care settings is warranted.
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Affiliation(s)
| | | | - Judith W. Dexheimer
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Gabe T. Meyers
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Meredith Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Jose T, McNamara M, Barrone ML, Johnson WS, Larsen HA, Martin EE, Marienau MS, Judd MA, Warner DO. Feasibility of Nurse-Managed Tobacco Use Interventions in Outpatient Surgical Practice. J Perianesth Nurs 2020; 35:307-313.e1. [PMID: 32005603 DOI: 10.1016/j.jopan.2019.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to determine the feasibility of developing and implementing a brief nurse-delivered tobacco intervention in an outpatient surgical practice. DESIGN AND METHODS Initial formative work used a survey and focus groups to determine knowledge, attitudes, and practices of perioperative nurses working in three outpatient surgical practices regarding smoking use and cessation. Based on this work, a brief intervention was designed and implemented in one of the three practices. The documentation of tobacco use and intervention elements was assessed both immediately and approximately 9 months after implementation. FINDINGS Formative work identified not only several barriers to implementation and little current activity but also favorable attitudes toward interventions. Implementation improved self-efficacy for intervention delivery and compliance with documentation of intervention elements that was sustained for at least 9 months. CONCLUSIONS Our results suggest that it is feasible for perioperative nurses to play an important role in the delivery of perioperative tobacco interventions.
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Affiliation(s)
- Thulasee Jose
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| | | | - Megan L Barrone
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Wendy S Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Heather A Larsen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Erin E Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Mary S Marienau
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Marlea A Judd
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Torok MR, Lowary M, Ziniel SI, Rohde J, Kerby GS, Hovell MF, Winickoff JP, Klein JD, Wilson K. Perceptions of Parental Tobacco Dependence Treatment Among a Children's Hospital Staff. Hosp Pediatr 2019; 8:724-728. [PMID: 30377220 DOI: 10.1542/hpeds.2018-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To assess employee support for and knowledge of smoking cessation programs for patients' parents and staff and employees' level of comfort discussing smoking with patients and their families before and during a hospital-wide study of a tobacco cessation and/or exposure reduction program for inpatients' parents who smoke. METHODS Clinical staff were invited to complete online surveys at the beginning of and 19 months into a randomized controlled trial to test the efficacy of an inpatient tobacco cessation and exposure reduction program for parents of hospitalized children. The program included educating pediatric inpatient clinical staff about available resources, such as the Colorado QuitLine, and smoking cessation interventions for the parents of hospitalized children. Clinical staff were recruited via e-mail listservs, a weekly e-mail newsletter, and posted flyers. Baseline and midstudy results were compared, and χ2 tests were performed. RESULTS At the baseline, 192 clinical staff responded; 235 responded midstudy. At the baseline and midstudy, at least 90% of the respondents believed that the hospital should support parents in quitting smoking, although the support for free nicotine replacement therapy was low (27% at the baseline to 35% at midstudy). One-fifth of the respondents were uncomfortable discussing smoking; this proportion decreased after educational interventions. Knowledge about hospital cessation resources had also increased at midstudy. CONCLUSIONS There was strong support for helping parents and staff quit smoking. Comfort among clinical staff in addressing tobacco dependence in patients and families and awareness of cessation resources increased over the course of the study.
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Affiliation(s)
- Michelle R Torok
- Division of Hospital Medicine.,Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Sonja I Ziniel
- Division of Hospital Medicine.,Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado
| | - Jolene Rohde
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Gwendolyn S Kerby
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado.,The Breathing Institute
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
| | - Jonathan P Winickoff
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.,American Academy of Pediatrics Julius B. Richmond Center of Excellence, Itasca, Illinois
| | - Jonathan D Klein
- American Academy of Pediatrics Julius B. Richmond Center of Excellence, Itasca, Illinois.,Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois; and
| | - Karen Wilson
- American Academy of Pediatrics Julius B. Richmond Center of Excellence, Itasca, Illinois; .,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
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An Electronic Health Record-Based Strategy to Address Child Tobacco Smoke Exposure. Am J Prev Med 2018; 54:64-71. [PMID: 29102458 PMCID: PMC5736447 DOI: 10.1016/j.amepre.2017.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/07/2017] [Accepted: 08/08/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION A high proportion of children presenting to pediatric urgent cares are exposed to tobacco smoke. An electronic health record-based clinical decision support system for nurses to facilitate guideline-based tobacco smoke exposure screening and counseling for caregivers who smoke was designed and evaluated. DESIGN A mixed-methods, 3-month, prospective study that began in November 2015, data were analyzed in June 2016. SETTING/PARTICIPANTS Five urgent cares that were part of a large children's hospital in Cincinnati, OH. Participants were urgent care nurses. INTERVENTION The clinical decision support system prompted nurses to Ask, Advise, Assess, and Assist caregivers to quit smoking. Monthly feedback reports were also provided. MAIN OUTCOME MEASURE Clinical decision support system use rates, nurses' attitudes towards tobacco smoke exposure intervention, and percentage of children screened and caregivers counseled. RESULTS All nurses used the clinical decision support system. Compared with Month 1, nurses were twice as likely to advise and assess during Months 2 and 3. There was significant improvement in nurses feeling prepared to assist caregivers in quitting. Nurses reported that feedback reports motivated them to use the clinical decision support system, and that it was easy to use. Almost 65% of children were screened for tobacco smoke exposure; 19.5% screened positive. Of caregivers identified as smokers, 26% were advised to quit and 29% were assessed for readiness to quit. Of those assessed, 67% were interested in quitting, and of those, 100% were assisted. CONCLUSIONS A clinical decision support system increased rates of tobacco smoke exposure screening and intervention in pediatric urgent cares. Rates might further improve by incorporating all components of the clinical decision support system into the electronic health record. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02489708.
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Merianos AL, Jandarov RA, Mahabee-Gittens EM. Secondhand Smoke Exposure and Pediatric Healthcare Visits and Hospitalizations. Am J Prev Med 2017; 53:441-448. [PMID: 28532658 PMCID: PMC5610064 DOI: 10.1016/j.amepre.2017.03.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/10/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study assessed the relationship between secondhand smoke exposure (SHSe) as measured by serum cotinine and healthcare utilization among children. METHODS In 2016, the 2009-2012 National Health and Nutrition Examination Survey data were analyzed including 4,985 children aged 3-19 years. Associations between SHSe and having a routine place for healthcare, type of place, and hospital utilization were examined using logistic regression models. Poisson regression analyses assessed the relationship between SHSe and number of hospital admissions. Relationships between SHSe and acute care visits and hospital utilization were examined among asthmatic children. RESULTS SHSe level did not differ by having a routine place for healthcare, although children with high SHSe indicative of active smoking (cotinine ≥3 ng/mL) were 3.49 times (95% CI=1.77, 6.89) more likely to use an emergency department. Children with high SHSe were 2.85 times (95% CI=1.87, 4.34) more likely to have had an overnight hospital stay. Children with high SHSe had 2.05 times (95% CI=1.46, 2.87) the risk of having a higher number of hospital admissions for overnight stays versus children with no SHSe (cotinine <0.05 ng/mL). Among asthmatic children, those with high SHSe and low SHSe (cotinine 0.05-2.99 ng/mL) were more likely to have an acute care visit, overnight hospital stay, and higher number of hospital admissions than asthmatic children with no SHSe. CONCLUSIONS High SHSe is associated with increased healthcare utilization. The emergency department and inpatient settings are important venues in which to routinely offer cessation and SHSe reduction interventions.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, Ohio.
| | - Roman A Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Boykan R, Milana C, Propper G, Bax P, Celestino P. Implementation of an Inpatient Electronic Referral System (Opt-to-Quit) From the Electronic Health Record to the New York State Smokers' Quitline: First Steps. Hosp Pediatr 2016; 6:545-551. [PMID: 27530349 DOI: 10.1542/hpeds.2016-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES (1) To implement a new policy-driven referral program, Opt-to-Quit, using electronic data transfer from the electronic health record (EHR) to the New York State Smokers' Quitline (NYSSQL) and (2) to improve referrals to the NYSSQL for smoking caregivers of children admitted to a children's hospital. METHODS Smoking caregivers of pediatric patients were referred to the NYSSQL through a standardized template built into the EHR, during the child's hospitalization or emergency department encounter. Direct data exchange was based on a point-to-point protocol, without dependence on any external centralized processing service. Input and oversight were provided by a multidisciplinary task force, which included physician and nursing leadership, information technology specialists, Health Insurance Portability and Accountability Act compliance personnel and legal counsel, and NYSSQL staff. The process was refined through several iterative plan-do-study-act cycles, using a single-armed, prospective cohort study design, including surveys of nursing staff and continued input of information technology experts on both hospital and Quitline sides. RESULTS In 2013, 193 smokers were identified in 2 pilot units; 62% (n= 119) accepted referral to the NYSSQL. In 2014, after expansion to all inpatient units and the emergency department, 745 smokers were identified, and 36% (n = 266) accepted referral. Over the 2 years, overall increase in referrals was 124%; as of the first quarter of 2015, referral rate was sustained at 34%. CONCLUSIONS Hospital-wide implementation of the Opt-to-Quit program through our EHR was feasible and sustainable and has significantly improved referrals to the NYSSQL.
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Affiliation(s)
- Rachel Boykan
- Stony Brook Children's Hospital, Stony Brook, New York; and
| | - Carolyn Milana
- Stony Brook Children's Hospital, Stony Brook, New York; and
| | - Grace Propper
- Stony Brook Children's Hospital, Stony Brook, New York; and
| | - Patricia Bax
- Roswell Park Cessation Services, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
| | - Paula Celestino
- Roswell Park Cessation Services, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
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Massaquoi LD, Edwards NC. A Scoping Review of Maternal and Child Health Clinicians Attitudes, Beliefs, Practice, Training and Perceived Self-Competence in Environmental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15769-81. [PMID: 26690461 PMCID: PMC4690954 DOI: 10.3390/ijerph121215018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 10/25/2015] [Accepted: 11/27/2015] [Indexed: 11/16/2022]
Abstract
Clinicians regularly assess, diagnose and manage illnesses which are directly or indirectly linked to environmental exposures. Yet, various studies have identified gaps in environmental assessment in routine clinical practice. This review assessed clinicians' environmental health practices, attitudes and beliefs, and competencies and training. Relevant articles were sought using a systematic search strategy using five databases, grey literature and a hand search. Search strategies and protocols were developed using tailored mesh terms and keywords. 43 out of 11,291 articles were eligible for inclusion. Clinicians' attitudes and beliefs towards environmental health and routine clinical practice were generally positive, with most clinicians believing that environmental hazards affect human health. However, with the exception of tobacco smoke exposure, environmental health assessment was infrequently part of routine clinical practice. Clinicians' self-competence in environmental assessment was reported to be inadequate. Major challenges were the time required to complete an assessment, inadequate training and concerns about negative patients' responses. Clinicians have strong positive attitudes and beliefs about the importance of environmental health assessments. However, more concerted and robust strategies will be needed to support clinicians in assuming their assessment and counselling roles related to a wider range of environmental hazards.
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Chinese Pediatrician Attitudes and Practices Regarding Child Exposure to Secondhand Smoke (SHS) and Clinical Efforts against SHS Exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5013-25. [PMID: 26006117 PMCID: PMC4454951 DOI: 10.3390/ijerph120505013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 11/16/2022]
Abstract
Background: Secondhand Smoke (SHS) exposure is a leading cause of childhood illness and premature death. Pediatricians play an important role in helping parents to quit smoking and reducing children’s SHS exposure. This study examined Chinese pediatricians’ attitudes and practices regarding children’s exposure to SHS and clinical efforts against SHS exposure. Methods: A cross-sectional survey of pediatricians was conducted in thirteen conveniently selected hospitals in southern China, during September to December 2013. Five hundred and four pediatricians completed self-administered questionnaires with a response rate of 92%. χ2 tests were used to compare categorical variables differences between smokers and non-smokers and other categorical variables. Results: Pediatricians thought that the key barriers to encouraging parents to quit smoking were: lack of professional training (94%), lack of time (84%), resistance to discussions about smoking (77%). 94% of the pediatricians agreed that smoking in enclosed public places should be prohibited and more than 70% agreed that smoking should not be allowed in any indoor places and in cars. Most of the pediatricians thought that their current knowledge on helping people to quit smoking and SHS exposure reduction counseling was insufficient. Conclusions: Many Chinese pediatricians did not have adequate knowledge about smoking and SHS, and many lacked confidence about giving cessation or SHS exposure reduction counseling to smoking parents. Lack of professional training and time were the most important barriers to help parents quit smoking among the Chinese pediatricians. Intensified efforts are called for to provide the necessary professional training and increase pediatricians’ participation in the training.
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Kruse GR, Rigotti NA. Routine screening of hospital patients for secondhand tobacco smoke exposure: a feasibility study. Prev Med 2014; 69:141-5. [PMID: 25284258 PMCID: PMC4312174 DOI: 10.1016/j.ypmed.2014.09.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/25/2014] [Accepted: 09/24/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Secondhand tobacco smoke (SHS) exposure causes over 40,000 deaths per year, but healthcare systems rarely address this risk factor. In September 2012, Massachusetts General Hospital initiated routine inpatient screening for SHS exposure by adding a question to the nurses' computerized admission assessment form ("Is smoking allowed in your home or car?"). We measured the implementation of this screening question over 1year. METHODS Multivariable analysis of hospital records of adult and pediatric admissions (N=35,701) from September 1, 2012 to August 31, 2013, to assess screening question completion and identify characteristics of nonsmokers who may be exposed to SHS. RESULTS Nurses entered "Yes" or "No" to the screening question for 91% of 34,295 adult admissions and 86% of 1406 pediatric admissions. Among nonsmokers, smoking in the home or car was allowed for 3% of adult admissions and 4% of pediatric admissions. Adults admitted for psychiatric diagnoses, children admitted for asthma, and patients with Medicaid insurance had higher odds of exposure to SHS in their home or car. CONCLUSION Routine screening of SHS among hospitalized patients by nurses is feasible. Doing so offers hospitals an opportunity to intervene and to promote smoke-free policies in patients' homes and cars.
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Affiliation(s)
- Gina Rae Kruse
- Division of General Internal Medicine Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
| | - Nancy A Rigotti
- Division of General Internal Medicine Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Braillon A, Croghan E. The cobbler's children go barefoot: pediatric nurses counseling about risks of secondhand smoke. Prev Med 2014; 63:116. [PMID: 24704134 DOI: 10.1016/j.ypmed.2014.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/19/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
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