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Sawhney M, Li JS, Patterson M, Gumapac NP, Sau C, Akbari A. Addressing Culturally Based Hidden Bias and RacisM (A-CHARM) Using Simulation Experiences, Nik's Story: A Quasi-Experimental Study. Can J Nurs Res 2024:8445621241253124. [PMID: 38751073 DOI: 10.1177/08445621241253124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND/PURPOSE Racism and hidden bias experienced by underrepresented nursing students contribute to a loss of confidence and anxiety. The A-CHARM nursing project developed virtual simulation experiences for nursing students to practice how to address racism. 'Nik's Story' virtual simulation was created as part of the A-CHARM project. The purpose of this study was to examine the effectiveness of an education intervention, that included Nik's story, on cultural humility and cultural diversity awareness. METHOD This quasi-experimental study included a convenience sample of final year nursing students. After informed consent, participants completed a pre-intervention questionnaire that included the Cultural Humility Scale "context for difference in perspective" subscale, and the Cultural Diversity Awareness questionnaire to assess baseline knowledge. Students participated in an education intervention that included a lecture, Nik's story virtual simulation experience, a debrief and then completed a post-education/simulation questionnaire that included usability/learner engagement questions and the Cultural Humility Scale "context for difference in perspective" subscale, and the Cultural Diversity Awareness questionnaire. RESULTS Forty-seven students consented and completed the pre/post intervention questionnaire. Participants rated the effectiveness, engagement and usability of the simulation experience highly. There was a significant positive change in cultural humility "context for difference in perspective" subscale (pre-scores = 6.9, SD = 3.3; post-scores = 31.0, SD = 3.8, p < 0.001), and cultural diversity awareness (pre-scores = 95.4, SD = 8.9; post-scores = 103.4, SD = 9.8, p < 0.001). DISCUSSION This intervention was effective in improving cultural humility and cultural diversity awareness in nursing students. CONCLUSION Simulation experiences regarding racism in the clinical setting provide a strategy for students to learn how to professionally navigate unwanted experiences.
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Affiliation(s)
- Monakshi Sawhney
- School of Nursing, Faculty of Health Sciences, Queens University, Kingston, ON, Canada
| | - Jenny S Li
- Intensive Care Unit, North York General Hospital, Toronto, ON, Canada
| | - Michaela Patterson
- Cardiovascular Intensive Care Unit, Unity Health, St. Micheal's Hospital, Toronto, ON, Canada
| | - Nathaniel P Gumapac
- Critical Care Resource Pool, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Crystal Sau
- Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Ali Akbari
- School of Nursing, Queen's University, Kingston, ON, Canada
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Kobina A, Gilroy H. Trauma-Informed Professional Development: A Concept Analysis. J Contin Educ Nurs 2024; 55:69-77. [PMID: 37971227 DOI: 10.3928/00220124-20231109-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
GOAL This study reports an analysis of the concept of trauma-informed professional development as it applies to staff nurses in health care organizations. BACKGROUND There is an urgent need for interventions to protect staff nurses from the psychological impact of traumatic events. By integrating the principles of trauma-informed care into professional development practices, nursing professional development practitioners have a unique opportunity to support nurses and help to promote recovery from trauma-related mental health outcomes. Data were obtained from a content searching service. METHOD Walker and Avant's approach to concept analysis was used (2019). RESULTS An operational definition of the concept of trauma-informed professional development as applied to staff nurses in health care organizations was developed. Potential benefits include staff nurse well-being, empowerment, resilience, and enhanced competency. Potential consequences for health care organizations include increased staff morale and retention. CONCLUSION By applying trauma-informed professional development activities, nursing professional development practitioners can minimize negative consequences when teaching topics that could unintentionally adversely affect some participants. [J Contin Educ Nurs. 2024;55(2):69-77.].
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Bandini JI, Rollison J, Etchegaray J. Understanding Multilevel Factors Related to Retention Among the Direct Care Workforce: Incorporating Lessons Learned in Considering Innovative Interventions. J Healthc Manag 2024; 69:59-73. [PMID: 38175535 DOI: 10.1097/jhm-d-22-00235] [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: 01/05/2024]
Abstract
GOAL This article explores how broad, contextual factors may be influential in the retention of direct care workers (DCWs; i.e., entry-level caregivers) who provide vital support to patients in healthcare settings. We reflect on lessons learned from an evaluation of a multisite intervention to improve retention among DCWs employed primarily in hospital settings at three health systems. METHODS We evaluated a multitiered program for entry-level caregivers that included a risk assessment, a 4-day curriculum, and follow-up sessions, as well as workforce coaching at the three health systems. As part of our evaluation, we collected data on roughly 3,000 DCWs from the three health systems; the information included hiring date, any transfer date, and any termination date for each new DCW, as well as demographic information, position characteristics, and termination status and reasons for any termination. In addition, we collected information about organizational characteristics, including staffing and number of employees. We also conducted interviews with 56 DCWs and 21 staff members who implemented a retention program across each of the three health systems and remotely conducted virtual observations of the curriculum sessions at each system. PRINCIPAL FINDINGS Although the program we evaluated focused on individual-level factors that may affect retention, our findings revealed other broader, contextual challenges faced by DCWs that they said would have an impact on their willingness to stay in their positions. These challenges included (1) job-related factors including limited compensation, aspects of the job itself, and the inability to advance in one's position; (2) health system challenges including the mission, policies, staffing, and organizational culture; and (3) external factors including federal policies and the ongoing COVID-19 pandemic. PRACTICAL APPLICATIONS As the direct care workforce continues to grow, interventions to improve retention should consider the interconnectedness of these multilevel factors rather than solely individual-level factors. In addition, further research is needed to rigorously evaluate any potential intervention and consider how such an approach can target DCWs in hospital-based settings who are most affected by the multilevel challenges identified. Finally, any intervention to improve retention must be also aligned to ensure equity, especially in this population of low-wage DCWs, many of whom are marginalized women and individuals of color.
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Brooks Carthon JM, Aponte R, Mason A, Nikpour J. "I had become fed up": A qualitative study of Black nurse practitioners' experiences fighting against health inequity, racism, and burnout. J Am Assoc Nurse Pract 2023; 35:708-716. [PMID: 37728526 PMCID: PMC10615672 DOI: 10.1097/jxx.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/18/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Increasing diversity in the nurse practitioner (NP) workforce is key to improving outcomes among patients who experience health inequities. However, few studies to date have examined the specific mechanisms by which NPs from diverse backgrounds address inequities in care delivery. PURPOSE To explore Black NPs' efforts in addressing inequities, and the facilitators and barriers they face in doing so. METHODOLOGY We conducted focus groups and interviews of Black NPs ( N = 16) in the greater Philadelphia area in early 2022, just following the height of the COVID-19 pandemic and the social unrest of the early 2020s. Data were analyzed using thematic analysis. RESULTS Emergent themes included: Strategies Utilized to Address Health Inequities ; Burnout & the Minority Tax ; Risks & Rewards of Taking a Stance ; and Uneven Promises of Organizational Engagement . Nurse practitioners prioritized patient-centered, culturally congruent care, taking additional time to explore community resources and learn about patients' lives to facilitate care planning. Participants advocated to administrators for resources to address inequities while simultaneously navigating organizational dynamics, microaggressions, and racism. Finally, NPs identified organizational-level barriers, leading to emotional exhaustion and several participants' intent to leave their roles. CONCLUSIONS Black NPs use a myriad of strategies to improve equity, yet frequently face substantial barriers and emotional exhaustion in doing so with little change to the inequities in care. IMPLICATIONS The NP workforce has a critical role to play in reducing health inequities. The strategies outlined by Black NPs in this study offer a roadmap for all clinicians and health care organizations to prioritize equity in care delivery.
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Affiliation(s)
| | - Ravenne Aponte
- Barbara Bates Center for the Study of the History of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aleigha Mason
- Center for Health Outcome & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacqueline Nikpour
- Center for Health Outcome & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania
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Obichi CC, Omenka O, Perkins SM, Oruche UM. Experiences of Minority Frontline Healthcare Workers During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01833-w. [PMID: 37851241 DOI: 10.1007/s40615-023-01833-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
Minority healthcare worker (MHW) experiences during the COVID-19 pandemic has received little attention in the published literature compared to their majority counterparts. This study describes healthcare systems, mental health, and advocacy challenges that MHWs experienced during the pandemic in the United States. A descriptive cross-sectional design was used to gather data from a convenience sample (n = 74) of MHWs who identified as registered nurses, advanced nurse practitioners, physicians, pharmacists, nursing assistants, dentists, and respiratory therapists. Data were imported into SAS Version 9.4 (Cary, NC) for analysis. Responses to each survey question were tabulated, and percentages of participants responding in the affirmative to each health system, mental health, and advocacy question were displayed. Findings indicate the pandemic both exacerbated old and imposed new challenges. Health systems should offer both tangible and intangible or emotional resources that support resilience; build an inclusive work environment that would consider the experiences and knowledge of MHWs; implement and sustain workplace changes that support and promote self-advocacy without fear of retribution; and increase research on MHWs to inform effective and culturally relevant interventions for challenges experienced by MHWs.
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Affiliation(s)
- Chidiebele Constance Obichi
- Alpha Chapter Campus Counselor, Sigma Theta Tau International, Indiana University Northwest, 3400 Broadway, Gary, IN, 46408, USA.
| | - Ogbonnaya Omenka
- Butler University College of Pharmacy and Health Sciences, 4600 Sunset Avenue, PHSB 404E, Indianapolis, IN, 46208, USA
| | - Susan M Perkins
- Indiana University School of Medicine, 410 W. 10Th Street, Suite 3000, Indianapolis, IN, 46202, USA
| | - Ukamaka M Oruche
- University of South Florida Health College of Nursing, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, FL, 33612, USA
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Scoresby K, Jurney C, Fackler A, Tran CV, Nugent W, Strand E. Relationships between diversity demographics, psychological distress, and suicidal thinking in the veterinary profession: a nationwide cross-sectional study during COVID-19. Front Vet Sci 2023; 10:1130826. [PMID: 37662992 PMCID: PMC10469311 DOI: 10.3389/fvets.2023.1130826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose This study aimed to determine the relationship between demographic diversity and veterinary professionals regarding their psychological distress and suicidal experiences. This study also aimed to determine what demographic factors were associated with psychological distress and suicidal experiences for veterinary professionals. Methods This study used a cross-sectional web-based questionnaire to assess the prevalence of diversity, psychological distress, and suicidality in individuals over 18 working in the veterinary field within the United States. The study received 2,482 responses resulting in 2,208 responses that were included in the analysis. Descriptive statistics were performed to identify the categories with the highest rates of psychological distress, suicidal thoughts, and suicidal behaviors. Binomial logistic regressions were conducted to identify the strongest statistical predictors of psychological distress (Kessler-6-K6), suicidal thinking and suicide behaviors. Results Of the 2,208 respondents included in the analysis, 888 (41%) were experiencing serious psychological distress and 381 (17.3%) had considered suicide in the past 12 months. Results of the binomial regressions indicate gender, social class, age, and disability status were the strongest predictors of psychological distress. When controlling for psychological distress, the strongest predictors of suicidal thinking were sexual orientation, marital status, and professional role. Implications Limited research has been done to explore the relationship between demographic diversity of veterinary professionals and psychological distress, suicidal thoughts, and suicidal behaviors specifically. These results shed light on multiple demographic factors that promote and attenuate mental health, as well as the importance of asking respondents their demographic identities in veterinary medicine research. This research attempts to identify these mental health factors without collapsing categories with small sample sizes, which does cause a limitation in statistical power, yet also demonstrates how to increase inclusivity in research.
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Affiliation(s)
- Kristel Scoresby
- College of Social Work, University of Tennessee, Knoxville, TN, United States
| | - Carrie Jurney
- Not One More Vet, San Francisco, CA, United States
- Remedy Veterinary Specialists, San Francisco, CA, United States
| | - Amanda Fackler
- College of Social Work, University of Tennessee, Knoxville, TN, United States
| | - Christina V. Tran
- Multicultural Veterinary Medical Association, Silverdale, WA, United States
- College of Veterinary Medicine, University of Arizona, Tucson, AZ, United States
| | - William Nugent
- College of Social Work, University of Tennessee, Knoxville, TN, United States
| | - Elizabeth Strand
- Veterinary Social Work, Colleges of Veterinary Medicine and Social Work, University of Tennessee, Knoxville, TN, United States
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Nikpour J, Carthon JMB. Characteristics, work environments, and rates of burnout and job dissatisfaction among registered nurses in primary care. Nurs Outlook 2023; 71:101988. [PMID: 37329590 PMCID: PMC10592661 DOI: 10.1016/j.outlook.2023.101988] [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: 02/06/2023] [Revised: 04/05/2023] [Accepted: 04/30/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Although more people than ever are seeking primary care, the ratio of primary care providers to the population continues to rapidly decline. As such, registered nurses (RNs) are taking on increasingly central roles in primary care delivery. Yet little is known about their characteristics, their work environments, and the extent to which they experience poor job outcomes such as nurse burnout. PURPOSE The purpose of this study was to examine the characteristics of the primary care RN workforce and analyze the association of the nurse work environment with job outcomes in primary care. METHODS Cross-sectional analysis of survey data representing N = 463 RNs who worked in 398 primary care practices, including primary care offices, community clinics, retail/urgent care clinics, and nurse-managed clinics. Survey questions included measures of the nurse work environment and levels of burnout, job dissatisfaction, and intent to leave. DISCUSSION Approximately one-third of primary care RNs were burnt out and dissatisfied with their jobs, with the highest risk of these outcomes among RNs in community clinics. Community clinic RNs were also significantly more likely to be Black or Hispanic/Latino, hold a Bachelor of Science in Nursing, and speak English as a second language (all p < .01). Across all settings, better nurse work environments were significantly associated with lower levels of burnout and job dissatisfaction (both p < .01). CONCLUSION Primary care practices must be equipped to support their RN workforce. Adequate nursing resources are especially needed in community clinics, as patients receiving primary care in these settings frequently face structural inequities.
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Affiliation(s)
- Jacqueline Nikpour
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | - J Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
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Kimani RW. Racism, colonialism and the implications for nursing scholarship: A discussion paper. J Adv Nurs 2023; 79:1745-1753. [PMID: 36882970 PMCID: PMC10389119 DOI: 10.1111/jan.15634] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/23/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
AIM A critical discussion of the intersections between racism and colonialism as social determinants of health and explore how these discriminatory ideologies shape nursing inquiry. DESIGN Discussion paper. DATA SOURCES A review of pertinent discourse on racism and colonialism in nursing from 2000 to 2022. IMPLICATIONS FOR NURSING The failure to address health inequity plaguing racialized and marginalized populations locally and globally affects all groups, as illustrated in the COVID-19 pandemic. Racism and colonialism are inextricably linked, creating potent forces that influence nursing scholarship and adversely affect the health of a culturally and racially diverse society. Power differentials exist within and between countries creating structural challenges that lead to inequitable distribution of resources and othering. Nursing cannot be abstracted from the sociopolitical context in which it exists. There have been calls to address the social drivers that influence the health of the communities. More still needs to be done to support an antiracist agenda and decolonize nursing. CONCLUSION Nurses, as the largest healthcare workforce, can be critical in addressing health disparities. However, nurses have failed to eliminate racism within their ranks, and essentialism ideology has been normalized. A multidimensional approach that includes interventions aimed at nursing education, direct patient care, community health, nursing organizations and policy is needed to address problematic nursing discourse rooted in colonialism and racism ideologies. Since knowledge generated from scholarship informs nursing education, practice and policy, it is imperative to implement antiracist policies that eliminate racist assumptions and practices from nursing scholarship. NO PATIENT OR PUBLIC CONTRIBUTION The paper is a discursive paper using pertinent nursing literature. IMPACT For nursing to attain its potential as a leader in healthcare, standards of scientific vigour should be embedded within history, culture and politics. Recommendations are provided on possible strategies to identify, confront and abolish racism and colonialism in nursing scholarship.
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Affiliation(s)
- Rachel Wangari Kimani
- Laboratory of the Neurogenetics of Language, Rockefeller University, New York, New York, USA
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Fahey DM. Racial Discrimination in Patient Care-Preserving Relationships With Integrity. J Hosp Palliat Nurs 2023; 25:5-11. [PMID: 36224714 DOI: 10.1097/njh.0000000000000910] [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: 02/01/2023]
Abstract
The following case study describes what is known as the health care system's open secret of allowing a patient or family to refuse care from a clinician of another race. This article explores the ethical tension between autonomy, nonmaleficence, justice, and duty to treat as it relates to racism and the potential harm to clinicians, health care teams, and organizations. When racism is experienced within the clinical setting, clinician knowledge, organizational training, and moral character are essential for identifying and addressing it effectively. Racial discrimination and related mistreatment are not part of a responsive and proactive moral community. This article explores creative solutions that preserve patient-clinician relationships without sacrificing personal integrity when racism is encountered.
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Affiliation(s)
- Donna M Fahey
- Donna M. Fahey, MSN, MFA, RN, CHPN, AHN-BC, CNL, is director of the Samaritan Institute for Education, Research & Innovation, Mt Laurel, New Jersey, and adjunct faculty within the Complementary & Integrative Health program at Drexel University, Philadelphia, Pennsylvania
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Turpin R, Giorgi S, Curtis B. Pandemic distress associated with segregation and social stressors. Front Public Health 2023; 11:1092269. [PMID: 37033081 PMCID: PMC10080044 DOI: 10.3389/fpubh.2023.1092269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Background Racial/ethnic minorities are disproportionately impacted by the COVID-19 pandemic, as they are more likely to experience structural and interpersonal racial discrimination, and thus social marginalization. Based on this, we tested for associations between pandemic distress outcomes and four exposures: racial segregation, coronavirus-related racial bias, social status, and social support. Methods Data were collected as part of a larger longitudinal national study on mental health during the pandemic (n = 1,309). We tested if county-level segregation and individual-level social status, social support, and coronavirus racial bias were associated with pandemic distress using cumulative ordinal regression models, both unadjusted and adjusted for covariates (gender, age, education, and income). Results Both the segregation index (PR = 1.19; 95% CI 1.03, 1.36) and the coronavirus racial bias scale (PR = 1.17; 95% CI 1.06, 1.29) were significantly associated with pandemic distress. Estimates were similar, after adjusting for covariates, for both segregation (aPR = 1.15; 95% CI 1.01, 1.31) and coronavirus racial bias (PR = 1.12; 95% CI 1.02, 1.24). Higher social status (aPR = 0.74; 95% CI 0.64, 0.86) and social support (aPR = 0.81; 95% CI 0.73, 0.90) were associated with lower pandemic distress after adjustment. Conclusion Segregation and coronavirus racial bias are relevant pandemic stressors, and thus have implications for minority health. Future research exploring potential mechanisms of this relationship, including specific forms of racial discrimination related to pandemic distress and implications for social justice efforts, are recommended.
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Affiliation(s)
- Rodman Turpin
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, United States
- *Correspondence: Rodman Turpin, ; Brenda Curtis,
| | - Salvatore Giorgi
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Brenda Curtis
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Rodman Turpin, ; Brenda Curtis,
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