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Canver B, Liptak A, Clark K, Tetrault JM, Holt SR. Preparing Physicians to Treat Addiction: Inclusion of Dedicated Addiction Training During Internal Medicine Residency. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:408-414. [PMID: 38254274 DOI: 10.1177/29767342231224978] [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: 01/24/2024]
Abstract
BACKGROUND Physicians in internal medicine lack comfort and skills required to diagnose and treat substance use disorder (SUD). Formal training in substance use treatment within primary care training has traditionally been inconsistent and sparse. The purpose of this study is to assess the impact of a longitudinal experiential addiction curriculum on the attitudes and experiences of graduates from a primary care/internal medicine residency program that included formal addiction didactics, rotations in an outpatient addiction clinic embedded within the resident primary care clinic, and exposure to addiction medicine faculty across treatment settings. METHODS A survey was emailed to all graduates from a single academic primary care residency program who graduated between 2016 and 2018 (n = 53). The survey assessed pharmacotherapy for SUD prescribing patterns, comfort with SUD pharmacotherapy, overall comfort treating SUD, experience correcting stigmatizing language, and providing guidance to colleagues on the care of patients with SUD. A subset of respondents (n = 14) were interviewed regarding their experience with the residency program's addiction medicine curriculum and its impact on their current clinical practice. RESULTS Sixty percent (n = 28) of graduates responded to the survey. All respondents felt comfortable using medications to treat SUD. Eighty-four percent perceived themselves as more comfortable using pharmacotherapy to treat SUD than their colleagues. Qualitative interviews revealed that this addiction medicine training shaped participants' attitudes toward patients with SUD and imparted them with the skills to address stigmatizing language. Participants described how they have become ambassadors of addiction medicine in their workplace and a resource to colleagues with less comfort in the management of SUD. CONCLUSION Graduates of a primary care/internal medicine residency with a dedicated addiction medicine curriculum are comfortable prescribing pharmacotherapy for SUD, taking an active role in reducing SUD-related stigma, and serving as a resource for colleagues.
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Affiliation(s)
- Bethany Canver
- Department of Internal Medicine and Addiction Medicine, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, USA
| | - Alayna Liptak
- LifeLong West Berkeley Health Center, Berkley, CA, USA
| | - Katie Clark
- Program in Addiction Medicine and Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jeanette M Tetrault
- Program in Addiction Medicine and Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephen R Holt
- Program in Addiction Medicine and Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Ayu AP, Schellekens AFA, Iskandar S, Pinxten L, De Jong CAJ. Effectiveness and Organization of Addiction Medicine Training Across the Globe. Eur Addict Res 2015; 21:223-39. [PMID: 25966903 DOI: 10.1159/000381671] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 03/16/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Over the past decade, addiction medicine training curricula have been developed to prepare physicians to work with substance use disorder patients. This review paper aimed at (1) summarizing scientific publications that outline the content of addiction medicine curricula and (2) evaluating the evidence for efficacy for training in addiction medicine. METHODS We carried out a literature search on articles about addiction medicine training initiatives across the world, using PubMed, PsychINFO and EMBASE with the following search terms 'substance abuse, addiction medicine, education and training.' RESULTS We found 29 articles on addiction medicine curricula at various academic levels. Nine studies reported on the need for addiction medicine training, 9 described addiction medicine curricula at various academic levels, and 11 described efficacy on addiction medicine curricula. CONCLUSIONS Several key competences in addiction medicine were identified. Efficacy studies show that even short addiction medicine training programs can be effective in improving knowledge, skills and attitudes related to addiction medicine. A more uniform approach to addiction medicine training in terms of content and accreditation is discussed.
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Affiliation(s)
- Astri Parawita Ayu
- Atma Jaya Catholic University of Indonesia, School of Medicine, Jakarta, Indonesia
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Holt SR, Ramos J, Harma MA, Cabrera F, Louis-Ashby C, Dinh A, Tetrault JM, Fiellin DA. Prevalence of unhealthy substance use on teaching and hospitalist medical services: implications for education. Am J Addict 2012; 21:111-9. [PMID: 22332853 DOI: 10.1111/j.1521-0391.2011.00207.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The prevalence of unhealthy substance use (USU) among medical inpatients can vary, and prior research has not characterized the prevalence of USU among patients cared for by a teaching service (TS) and a nonteaching hospitalist service (NTHS). The objective of this study was to compare the prevalence of USU among patients cared for by a TS and an NTHS. We conducted a cross-sectional study from February to June 2009 at a community teaching hospital. Within 24 hours of admission, all eligible internal medicine admissions to the TS or NTHS were screened for USU, using the Alcohol Use Disorders Identification Test-Consumption and Drug Abuse Screening Test. Patients screening positive then underwent a diagnostic interview and blinded chart review to increase case finding and to assess whether each patient's admission was related to USU. There were 414 eligible and consenting patients out of 656 patients identified. Patients on the TS were younger and more likely to be current smokers, male, unmarried, non-white, and unemployed (p<.01 for all comparisons). TS patients were more likely to have evidence of USU (29.2% vs. 12.3%; p<.01). Among all admissions to the TS, 22.2% were deemed to be probably or possibly due to USU, as compared with only 3.7% of admissions to the NTHS (p<.01). Medical TSs care for a greater share of patients with USU as compared with an NTHS. These data highlight the need for expanded medical resident training in the diagnosis and management of USU.
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Affiliation(s)
- Stephen R Holt
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA.
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Yoast RA, Wilford BB, Hayashi SW. Encouraging physicians to screen for and intervene in substance use disorders: obstacles and strategies for change. J Addict Dis 2008; 27:77-97. [PMID: 18956531 DOI: 10.1080/10550880802122687] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The scientific literature was reviewed to identify obstacles and effective ways to improve primary care physician screening, interventions, and management of patient substance use disorders (SUDs). Major obstacles identified are physician lack of skills and self-efficacy in patient counseling, inadequate training at all levels of medical education, and lack of reimbursement and other health care systems support for services to patients. Physician abuse of drugs does not appear to be a major obstacle. Physician attitudes about patients with SUDS and the effectiveness of treatment services need to be addressed. Research points to the use of a multifaceted change strategy. Key components include practice-based training emphasizing screening and counseling skills throughout medical education, clinical systems to ensure regular SUD services (screening, intervention, and referral) to patients, and reimbursement and coverage systems to support physician interventions and patient services.
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Affiliation(s)
- Richard A Yoast
- Department of Public Policy and Primary Prevention, American Medical Association, 515 North State Street, Chicago, IL 60610, USA.
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Abstract
The importance of training physicians to effectively assess and manage substance use disorders has become increasingly recognized. Studies highlighting the effort to enhance curricula are described and common practices identified. Preferable curricula incorporate interactive teaching methods along with experiential and didactic components. Addiction specialists serve an important role in training programs designed for medical students and residents (ie, role models) and practicing physicians (ie, clinical support). Further integration of online training into current programs may expand and enhance training opportunities.
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Affiliation(s)
- Soteri Polydorou
- Columbia University Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, Unit 66, New York, NY 10032, USA
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Vadlamudi RS, Adams S, Hogan B, Wu T, Wahid Z. Nurses’ attitudes, beliefs and confidence levels regarding care for those who abuse alcohol: Impact of educational intervention. Nurse Educ Pract 2008; 8:290-8. [DOI: 10.1016/j.nepr.2007.10.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 09/30/2007] [Accepted: 10/17/2007] [Indexed: 10/22/2022]
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Ramirez-Cacho WA, Strickland L, Beraun C, Meng C, Rayburn WF. Medical students' attitudes toward pregnant women with substance use disorders. Am J Obstet Gynecol 2007; 196:86.e1-5. [PMID: 17240247 DOI: 10.1016/j.ajog.2006.06.092] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 06/21/2006] [Accepted: 06/21/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether medical students' attendance at a clinic designed for pregnant substance users would yield changes in their attitudes toward the special needs of this population. STUDY DESIGN This prospective study involved 104 consecutive third-year students rotating on our obstetrics-gynecology clerkship. Students were assigned to attend either a half day prenatal clinic designed specifically for women with substance use disorders during the first 4 weeks (study group) or during the second 4 weeks (control group). Each answered a confidential 24-question survey (using a 5-point scale from "strongly agree" to "strongly disagree"), dealing with comfort levels and attitudes, at the beginning and midway points of the 8-week clerkship. Student t tests were used for comparisons of averaged scores. RESULTS At the beginning of the clerkship, no differences were found between the study (n = 52) and control groups (n = 52) in their responses to the survey. Regardless of gender, students who attended the clinic reported they became more comfortable in talking with patients about their substance use (P < .001) and more nonjudgmental in treating these patients (P < .02). Compared with before the clerkship, the control group became less comfortable in talking with these patients about their habits (P < .01), less aware about the prevalence of substance abuse during pregnancy (P < .02), and less aware about the efficacy of counselors (P < .05). CONCLUSION Medical students became more comfortable and better informed about pregnant women with substance use disorders after attending a clinic dedicated toward this population's special needs.
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Affiliation(s)
- William A Ramirez-Cacho
- Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
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Abstract
Addiction training in psychiatric residency programs needs expansion. Epidemiology research has shown that patients with substance use disorders and co-occurring mental health disorders are the norm in nearly all clinical settings. Unfortunately, traditional training approaches built around brief rotations on detoxification or intensive substance abuse rehabilitation units do not adequately train psychiatrists in long-term management skills, and may reinforce misperceptions that these patients do not respond to treatment. An enhanced addiction curriculum coupled with an extended outpatient clinic rotation is an ideal model for teaching the skills needed to successfully care for these patients. Training must include an adequate knowledge base, an opportunity to cultivate positive attitudes toward these patients, and recognition that psychiatrists must take responsibility for treating the addiction problem and any co-occurring psychiatric disorders. The program developed at Boston University Medical Center successfully integrates expanded addiction psychiatry training into the general psychiatry residency.
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Affiliation(s)
- John A Renner
- VA Outpatient Clinic, 251 Causeway Street, Boston, MA 02114, USA.
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Renner JA. How to train residents to identify and treat dual diagnosis patients. Biol Psychiatry 2004; 56:810-6. [PMID: 15556127 DOI: 10.1016/j.biopsych.2004.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2004] [Revised: 04/12/2004] [Accepted: 04/16/2004] [Indexed: 12/01/2022]
Abstract
Medical training has failed to address the needs of patients with comorbid substance use and psychiatric disorders. Addiction teaching is limited and often fails to change the negative attitudes of many physicians. In many psychiatry residencies, addiction training occurs on inpatient or detoxification units and the focus is on screening, detoxification, and referral. Most residents do not gain adequate experience in the long-term management of dual-diagnosis patients. Successful clinical care is based on three critical elements (the "clinician's triad"): an adequate knowledge base, a positive attitude toward the patient and the benefits of treatment, and a sense of responsibility for the clinical problem. The Boston University Psychiatry Residency has designed an addiction training program to address these three issues. In addition to a comprehensive addiction seminar series, there are several unique features. The required clinical rotation occurs in an outpatient dual-diagnosis clinic and permits residents to follow a caseload of patients for 12 months. Extensive experience is gained in motivational interviewing, cognitive behavioral therapy, and pharmacotherapy. Self-directed learning approaches are used to maximize the educational experience on services that lack addiction faculty. Guidelines are provided for establishing a similar program and for more effective approaches to resident teaching.
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Affiliation(s)
- John A Renner
- Division of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 02114, USA
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Christison GW, Haviland MG. Requiring a one-week addiction treatment experience in a six-week psychiatry clerkship: effects on attitudes toward substance-abusing patients. TEACHING AND LEARNING IN MEDICINE 2003; 15:93-97. [PMID: 12708066 DOI: 10.1207/s15328015tlm1502_04] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Medical education shapes students' attitudes toward substance-abusing patients, often in negative ways. Curricular interventions to foster more positive attitudes toward such patients and their treatment can have lasting effects on clinical practice. The nature and duration of such interventions, however, requires clarification. PURPOSE To test the hypothesis that spending 1 week of a 6-week psychiatry clerkship on an addication treatment site would improve attitudes toward substance-abusing patients without reducing the clerkship's benefits on attitudes toward, and knowledge about, psychiatry patients. METHOD Using the Medical Condition Regard Scale, preclerkship and postclerkship attitudes toward patients with alcoholism, major depression, and emphysema (a control condition) were examined in 3rd-year medical students following the conversion of 1 of the clerkship's weeks to an addiction treatment site assignment. Psychiatric knowledge was assessed by comparing scores on the Psychiatry Subject examination before and after the change. RESULTS Mean regard scores increased significantly for patients with alcoholism and for patients with major depression but did not change for patients with emphysema. Subject examination scores before and after the curriculum change were not significantly different. CONCLUSIONS Spending 1 week of a 6-week psychiatry clerkship on an addiction treatment site increased regard for patients with alcoholism without adversely affecting measures of attitudes toward, and knowledge about, psychiatric patients.
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Affiliation(s)
- George W Christison
- Department of Psychiatry, Loma Linda University School of Medicine, 11374 Mountain View Avenue, Loma Linda, CA 92354-3842, USA.
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Abrams Weintraub T, Saitz R, Samet JH. Education of preventive medicine residents: alcohol, tobacco, and other drug abuse. Am J Prev Med 2003; 24:101-5. [PMID: 12554029 DOI: 10.1016/s0749-3797(02)00567-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Generalist physicians' addiction training is inadequate, but general preventive medicine residency (PMR) programs have not been studied. We determined PMR programs' alcohol, tobacco, and other drug abuse (ATOD) training from 1995 to 2000 and identified barriers to this education. METHODS Interviewer-administered telephone survey of program directors (PDs) of accredited PMR programs in the United States. RESULTS We interviewed all 41 PMR PDs. While 78% of PMR PDs reported interest in increasing ATOD education, for 68% it was not a high educational priority. Tobacco ranked in the top third of preventive medicine topics by 58%, while alcohol and other drugs ranked in the bottom third by 48% and 52%, respectively. Twenty-two percent of programs required a clinical ATOD rotation, most commonly smoking-cessation clinics. Only 29% of PMR PDs felt that residents were well prepared in clinical aspects of ATOD, while 60% felt that residents were prepared in ATOD research and public health issues. The most commonly reported barriers to ATOD training were lack of resident interest and defined competencies (64% each); limited faculty time (59%); limited teaching time (54%); lack of available teaching materials (53%); and lack of faculty expertise (51%). CONCLUSIONS While the majority of PMR PDs recognize the importance of incorporating teaching about addictions into training, much of the ATOD education in PMRs focuses on tobacco alone. Setting educational standards, defining competencies, investing in faculty development, and creating ATOD curricular modules are important next steps toward preparing preventive medicine physicians to effectively reduce the public health toll of addictions.
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Affiliation(s)
- Toni Abrams Weintraub
- Clinical Addiction Research and Education (Care) Unit, Section of General Internal Medicine, Development of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA
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May JA, Warltier DC, Pagel PS. Attitudes of anesthesiologists about addiction and its treatment: a survey of Illinois and Wisconsin members of the American Society of Anesthesiologists. J Clin Anesth 2002; 14:284-9. [PMID: 12088813 DOI: 10.1016/s0952-8180(02)00359-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To survey practicing anesthesiologists about their attitudes about addiction and its treatment by means of a previously validated instrument. DESIGN Anonymous mail survey. SETTING Metropolitan medical college. PARTICIPANTS Active members of the American Society of Anesthesiologists in Illinois and Wisconsin. MAIN RESULTS The survey consisted of 50 statements presented in a five item Likert (agreement-disagreement) format that evaluated five attitude factors: permissiveness, nonstereotypes, treatment interventions, treatment optimism, and nonmoralism. Five hundred twelve completed and 21 undeliverable surveys were returned from 1,656 surveys mailed (response rate = 31%). The raw scores for the five attitude factors were permissiveness 25 +/- 6, nonstereotypes 34 +/- 6, treatment interventions 32 +/- 4, treatment optimism 19 +/- 3, and nonmoralism 31 +/- 5 (means +/- SD). Anesthesiologists with a personal history of addiction recorded attitude scores that were significantly (p < 0.05) higher than those of their colleagues. Formal training in substance abuse management, attendance at a Twelve Step meeting as either a participant or an observer, and experience with a friend, relative, or colleague with addiction were also associated with significantly higher attitude scores. The attitude scores of anesthesiologists were consistently below those previously reported for clinicians who regularly care for patients with addiction. CONCLUSIONS Personal experience with, or education about, addiction contributes to a more positive attitude about addiction. Anesthesiologists have less positive attitudes about addiction than do physicians who regularly manage the disease.
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Affiliation(s)
- Judith A May
- Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Bobo WV, Miller SC. Complicated dual diagnosis: a case for physician involvement in addictions treatment. Int J Psychiatry Med 2002; 31:233-5. [PMID: 11760866 DOI: 10.2190/8yrg-3wcb-rydx-gd5h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite the high prevalence of substance use disorders, the prevention and treatment of such illnesses seem to receive little attention during physician training. This provides cause for concern, as physician involvement in addiction treatment has been relatively sparse. We present the case of a patient whose successful treatment likely relied upon her physicians' intensive training in each of the biological, psychological, and social aspects of her clinical presentation. The case illustrates the need for added emphasis on the assessment and treatment of addictive disorders during medical training, and for more active physician involvement in addictions treatment.
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Affiliation(s)
- W V Bobo
- National Capital Area Military Psychiatry Residency, Washington, DC, USA
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May JA, White HC, Leonard-White A, Warltier DC, Pagel PS. The Patient Recovering from Alcohol or Drug Addiction: Special Issues for the Anesthesiologist. Anesth Analg 2001; 92:1601-8. [PMID: 11375854 DOI: 10.1097/00000539-200106000-00050] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J A May
- Department of Anesthesiology, Medicine, the Medical College of Wisconsin, Milwaukee, 53226, USA
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Modestolowe V, Boornazian A. Screening and Brief Intervention in the Management of Early Problem Drinkers. ACTA ACUST UNITED AC 2000. [DOI: 10.2165/00115677-200008030-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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