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Serum Biomarker Concentrations upon Admission in Acute Traumatic Brain Injury: Associations with TBI Severity, Toxoplasma gondii Infection, and Outcome in a Referral Hospital Setting in Cameroon. 急性脑外伤患者入院时的血清生物标志物浓度:喀麦隆转诊医院中创伤性脑损伤严重程度、弓形虫感染和预后的相关性。
IF 1.6 4区 医学 Q3 EDUCATION, SPECIAL Pub Date : 2023-07-03 eCollection Date: 2023-09-01 DOI: 10.3390/neurosci4030015
Franklin Chu Buh, Germain Sotoing Taiwe, Firas H Kobeissy, Kevin W Wang, Andrew I R Maas, Mathieu Motah, Basil Kum Meh, Eric Youm, Peter J A Hutchinson, Irene Ule Ngole Sumbele

Despite the available literature on traumatic brain injury (TBI) biomarkers elsewhere, data are limited or non-existent in sub-Saharan Africa (SSA). The aim of the study was to analyse associations in acute TBI between the admission serum biomarker concentrations and TBI severity, CT-scan findings, and outcome, as well as to explore the influence of concurrent Toxoplasma gondii infection. The concentrations of serum biomarkers (GFAP, NFL Tau, UCH-L1, and S100B) were measured and Toxoplasma gondii were detected in the samples obtained <24 h post injury. GOSE was used to evaluate the 6-month outcome. All of the biomarker levels increased with the severity of TBI, but this increase was significant only for NFL (p = 0.01). The GFAP values significantly increased (p = 0.026) in those with an unfavourable outcome. The Tau levels were higher in those who died (p = 0.017). GFAP and NFL were sensitive to CT-scan pathology (p values of 0.004 and 0.002, respectively). The S100B levels were higher (p < 0.001) in TBI patients seropositive to Toxoplasma gondii. In conclusion, NFL was found to be sensitive to TBI severity, while NFL and GFAP were predictive of CT intracranial abnormalities. Increased levels of GFAP and Tau were associated with poorer outcomes 6 months after TBI, and the S100B levels were significantly affected by concurrent T. gondii infection in TBI patients compared with the seronegative patients.

尽管其他地方有关于创伤性脑损伤(TBI)生物标志物的文献,但撒哈拉以南非洲地区(SSA)的数据却很有限或根本没有。本研究旨在分析急性创伤性脑损伤患者入院时血清生物标志物浓度与创伤性脑损伤严重程度、CT 扫描结果和预后之间的关系,并探讨同时感染弓形虫的影响。对血清生物标志物(GFAP、NFL Tau、UCH-L1 和 S100B)的浓度进行了测定,并在样本中检测到弓形虫,结果显示 p = 0.01。)预后不良者的 GFAP 值明显升高(p = 0.026)。死亡患者的 Tau 水平较高(p = 0.017)。GFAP 和 NFL 对 CT 扫描病理很敏感(p 值分别为 0.004 和 0.002)。对弓形虫血清反应呈阳性的创伤性脑损伤患者的 S100B 水平更高(p < 0.001)。总之,NFL 对 TBI 严重程度很敏感,而 NFL 和 GFAP 可预测 CT 颅内异常。GFAP和Tau水平的升高与创伤性脑损伤6个月后较差的预后有关,与血清阴性患者相比,创伤性脑损伤患者同时感染弓形虫会显著影响S100B水平。
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引用次数: 0
Preschool and Childcare Expulsion 学前和儿童保育驱逐
IF 1.1 4区 医学 Q3 EDUCATION, SPECIAL Pub Date : 2023-07-01 DOI: 10.1097/IYC.0000000000000245
Danielle DuShane, SeonYeong Yu
The purpose of this review is to understand what has been learned over the past 20 years of research on preschool and childcare expulsions in the United States. Our literature search identified 16 research studies on this topic. An extensive review of the identified studies was conducted to critically examine the methods used to measure expulsion, the purposes of the reviewed studies, and interventions used to mitigate expulsion rates. Results from this review revealed that researchers have examined the rates of expulsion and factors that could influence expulsion, such as predictive and risk factors (e.g., demographics, disability status), teachers' roles, teacher–family relationships, and interventions. Notably, the reviewed studies highlighted high rates of expulsion among Black male students and students with disabilities. Many teachers reported high stress, limited access to resources, and challenging relationships with administrators and parents during the process of expulsion. Although a variety of methods (e.g., survey, interview, observation) were used to measure expulsion rates, surveys were the primary method of data collection. Interventions targeting teacher well-being, mental health consultation, and classroom-wide interventions (e.g., Pyramid Model) were found to be promising methods for reducing expulsions. Based on the results, gaps in the literature and implications for future research and practice are discussed.
本综述的目的是了解过去20年对美国学前和儿童保育驱逐的研究成果。我们的文献检索确定了关于该主题的16项研究。对已确定的研究进行了广泛的审查,以严格审查用于衡量驱逐的方法、审查研究的目的以及用于降低驱逐率的干预措施。本综述的结果显示,研究人员检查了开除率和可能影响开除的因素,如预测因素和风险因素(如人口统计学、残疾状况)、教师角色、教师与家庭关系和干预措施。值得注意的是,经过审查的研究强调了黑人男学生和残疾学生的开除率很高。许多教师报告说,在被开除的过程中,他们压力很大,获得资源的机会有限,与行政人员和家长的关系也很困难。虽然采用了多种方法(如调查、访谈、观察)来测量开除率,但调查是收集数据的主要方法。针对教师福祉的干预措施、心理健康咨询和班级范围的干预措施(如金字塔模型)被发现是减少驱逐的有希望的方法。在此基础上,讨论了文献中的差距以及对未来研究和实践的影响。
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引用次数: 0
Distance Learning in an Inclusive Preschool Focused on Autism During the COVID-19 Pandemic 2019冠状病毒病大流行期间以自闭症为重点的包容性幼儿园的远程学习
IF 1.1 4区 医学 Q3 EDUCATION, SPECIAL Pub Date : 2023-07-01 DOI: 10.1097/IYC.0000000000000244
M. Siller, Harshini Murthy, Sally Fuhrmeister
Despite the widespread use of distance learning during the coronavirus disease-2019 (COVID-19) pandemic, little is known about the developmental appropriateness of this instructional format for preschoolers, particularly when implemented in inclusive settings. The current research was implemented in a university-affiliated, state-funded inclusive preschool classroom focused on autism spectrum disorder (ASD) where parents were given the option to enroll in a full distance program (FDP) during the first 9 weeks of the 2020/21 school year. Parents of four children, including two children with ASD, selected the FDP option. Synchronous whole group, small group, and individual online sessions were recorded using screen capture and coded for children's maintained attention and directed communication. Further, parents and teachers completed exit interviews or a focus group, which were transcribed and analyzed using qualitative research methods. This is the first study to use observational methods to measure child engagement during preschool FDP sessions. Results from this mixed-method multiple case study paint a rich picture of both opportunities and limitations inherent in distance learning when implemented in inclusive preschool settings. General conclusions, future directions, and study limitations are discussed.
尽管在2019冠状病毒病(COVID-19)大流行期间广泛使用了远程学习,但人们对这种教学形式对学龄前儿童发展的适宜性知之甚少,特别是在包容性环境中实施时。目前的研究是在一所大学附属的、国家资助的、专注于自闭症谱系障碍(ASD)的包容性学前课堂上进行的,在那里,家长可以选择在2020/21学年的前9周参加一个全距离课程(FDP)。有四个孩子的父母,包括两个患有自闭症的孩子,选择了FDP选项。使用屏幕截图记录同步的整个小组、小组和个人在线会话,并对儿童保持注意力和定向交流进行编码。此外,家长和教师完成了离职访谈或焦点小组访谈,并使用定性研究方法进行了转录和分析。这是第一个使用观察方法来测量学龄前FDP会议期间儿童参与的研究。这一混合方法多案例研究的结果描绘了在包容性学前环境中实施远程学习所固有的机会和局限性的丰富图景。讨论了总体结论、未来发展方向和研究局限性。
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引用次数: 0
Evaluation Strategies for Florida's Early Childhood Comprehensive Systems Impact Project 佛罗里达州幼儿综合系统影响项目的评估策略
IF 1.1 4区 医学 Q3 EDUCATION, SPECIAL Pub Date : 2023-07-01 DOI: 10.1097/IYC.0000000000000241
J. Marshall, Emma Hume, Concha Prieto, Cedrick Ade, Jennifer Delva, Carlene Geffrard, Emanuelle Dias, R. S. Elger
Early Childhood Comprehensive Systems (ECCS) grants help states and communities improve early childhood systems to support child development, equitable access to quality services and supports, and family well-being. Truly interdisciplinary, ECCS promotes cross-sector systems change initiatives that focus on integrating health care, mental health, social services, and family support broadly and within communities with concentrated risk factors that negatively impact child health and development. Florida was 1 of 12 states funded from 2016 to 2021 to use a Collaborative Improvement and Innovation Network (CoIIN) approach to do this work. Through community-driven initiatives that focus on policy, partnerships, and practices, Florida ECCS committed to ensuring equitable opportunities for families and young children who may face barriers due to residing in disenfranchised communities. This article describes the process of evaluating this multiyear community-led, place-based initiative that leveraged cross-sector state-level support and used a variety of methods to track evolving ECCS processes and outcomes.
幼儿综合系统(ECCS)赠款帮助各州和社区改善幼儿系统,以支持儿童发展,公平获得优质服务和支持,以及家庭福祉。ECCS真正是跨学科的,它促进跨部门的系统变革举措,重点是在具有对儿童健康和发展产生负面影响的风险因素集中的社区内广泛整合卫生保健、精神卫生、社会服务和家庭支持。佛罗里达州是2016年至2021年期间使用协作改进和创新网络(CoIIN)方法开展这项工作的12个州之一。通过关注政策、伙伴关系和实践的社区驱动的倡议,佛罗里达ECCS致力于确保由于居住在被剥夺公民权的社区而可能面临障碍的家庭和幼儿获得公平的机会。本文描述了评估这一由社区主导、基于地方的多年倡议的过程,该倡议利用跨部门的国家级支持,并使用各种方法来跟踪不断发展的ECCS过程和结果。
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引用次数: 0
Providing Virtual Support to Children With Mild Developmental Delays in Response to the Pandemic 为轻度发育迟缓儿童提供虚拟支持以应对大流行
IF 1.1 4区 医学 Q3 EDUCATION, SPECIAL Pub Date : 2023-07-01 DOI: 10.1097/IYC.0000000000000243
Melissa Gonzalez, Catherine Rama, Aria Nawab, Emily Robertson, Paulina Maria Partridge, Arielle Ashkenazi, Elana Mansoor, Julie Van Weelden, Kristyna Peña, Ruby A. Natale
The COVID-19 pandemic has had massive impacts across the globe. Children with developmental delays are an increasingly vulnerable population, highlighting the importance of ensuring they have access to high-quality virtual services during this time. The Early Discovery program currently provides therapeutic interventions for children with mild developmental delays. We sought to compare the outcomes of 2 cohorts within the Early Discovery program using different delivery approaches (n = 238 families): children who received services in person before the pandemic (n = 126) and children who received services via telehealth in the acute phase of the pandemic (n = 112). Both groups of children showed significant improvements in language skills posttreatment, and, with regard to auditory comprehension, both groups showed similar rates of improvement. However, children receiving in-person services before the pandemic showed greater improvements in expressive communication skills than children receiving telehealth services during the pandemic. Results indicate that the Early Discovery program was able to make adjustments during the pandemic that assisted families in maintaining progress in improving their child's language skills.
新冠肺炎疫情在全球范围内产生了巨大影响。发育迟缓儿童是一个日益脆弱的群体,这凸显了确保他们在此期间获得高质量虚拟服务的重要性。早期发现项目目前为轻度发育迟缓的儿童提供治疗干预。我们试图比较早期发现项目中使用不同交付方式的两个队列(n = 238个家庭)的结果:大流行前亲自接受服务的儿童(n = 126)和大流行急性期通过远程医疗接受服务的儿童(n = 112)。两组儿童在治疗后的语言技能上都有了显著的改善,在听觉理解方面,两组儿童的改善速度相似。然而,在大流行之前接受面对面服务的儿童在表达沟通技巧方面比在大流行期间接受远程保健服务的儿童表现出更大的改善。结果表明,早期发现计划能够在大流行期间做出调整,帮助家庭在提高孩子的语言技能方面保持进步。
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引用次数: 0
Exploring Parents' Perceptions of an Early Intervention for Toddlers With Autism 探讨父母对自闭症幼儿早期干预的看法
IF 1.1 4区 医学 Q3 EDUCATION, SPECIAL Pub Date : 2023-07-01 DOI: 10.1097/IYC.0000000000000242
Jessica Amsbary, H. Able
Early intervention (EI) services are intended to be delivered in a family-centered manner. Thus, it is important to obtain family perspectives as they relate to implementation experiences in EI. Using an implementation science framework to guide the questioning. Twelve interviews were conducted with parents who participated in 1 EI program to explore their perceptions of challenges and successes around the intervention practice components, parent coaching processes, and contextual factors in which the intervention was delivered. Parents perceived many of the aspects of the intervention such as specific strategies, strong relationships with their interventionists, and intervention delivery in home and clinic settings as useful and beneficial. They reported challenges related to embedding the intervention into daily activities, feelings of discomfort when practicing intervention strategies, and struggles with scheduling sessions. Implications for research and practice are discussed.
早期干预服务旨在以家庭为中心的方式提供。因此,获得家庭观点是很重要的,因为它们与EI的实施经验有关。使用实施科学框架来指导提问。我们对参与1个EI项目的家长进行了12次访谈,以探讨他们对干预实践组成部分的挑战和成功的看法,家长指导过程,以及干预实施的背景因素。家长认为干预的许多方面都是有用和有益的,例如具体的策略,与他们的干预医生的牢固关系,以及在家庭和诊所环境中实施干预。他们报告了将干预融入日常活动的挑战,练习干预策略时的不适感,以及安排会议的困难。讨论了对研究和实践的启示。
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引用次数: 0
From the Editor 来自编辑
4区 医学 Q3 EDUCATION, SPECIAL Pub Date : 2023-04-01 DOI: 10.1097/iyc.0000000000000240
Actions speak louder than words. Another adage that challenges us to walk the walk, rather than just talk the talk. That is, we should do something rather than just talk about something. Most recently, the need for action has been illustrated through the focus on equity in early childhood service delivery. This is challenging because the word “equity” is contextual, sometimes misapplied, and many times not defined. For example, equity is illustrated differently across populations of young children and their families, service sectors, and targeted outcome. Early childhood intervention (ECI) for infants and young children with disabilities is one service delivery sector where inequity and disparities have been evident. Although our field espouses service components such as interdisciplinary teams, accessible screening protocols, authentic assessments, individualized service delivery plans, inclusive classrooms and communities, and data-based instructional and intervention protocols, many families and their children have been excluded from ECI service delivery models that use these practices. In many cases, these are families who are marginalized in society because of their diverse backgrounds. There are many reasons for these exclusions from appropriate and individualized intervention services. They range from an undertrained workforce who is facing unprecedented shortages of personnel, to systems that are underfunded and uncoordinated, to practices that are not accessible, appropriate, nor available to families and children from diverse backgrounds. One can also blame the aftermath (we hope) of an unprecedented pandemic that shifted society in many ways and created disequilibrium across all service sectors, including ECI. No matter what the reason, it is time to address such challenges so that we can create and implement equitable ECI systems for all infants and young children and families eligible for ECI services. For too long, the system has been complacent about service delivery to marginalized populations who represent diverse backgrounds. We must move beyond a call for equity and instead implement actions to correct disparities across systems, programs, and families. We know what we need to do; Equity must be seen as an action verb rather than just a word we embed into our rhetoric. CURRENT ISSUE Our first article by Loraine Swanson, Meera Menon, Amber Minogue, Rebecca Russell, and Scott Berns describes an early childhood system framework developed through observations of system work in states and communities participating in the Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network (ECCS CoIIN). The Network focused on building systems that support increased developmental promotion and screening of young children who experience inequities related to race, place, and income. The proposed framework recognized the individual needs and operations of different service sectors and disciplines, as well as the comple
结果使用前/后测试设计进行测量,证明了父母的能力感和授权感的积极变化。家长也认为干预是可以接受的,表明干预的社会有效性和可行性。我们的下一篇文章由Sophia D' agostino, Sarah Douglas和Hedda Meadan撰写,描述了一项专注于早期干预提供者的感知和报告在指导护理人员时使用同情护理能力的研究。尽管在其他学科中,同情心指导是一种备受重视和研究的实践,但在早期干预领域并不普遍。这种模式中的实践和行为优先考虑人际交往能力和与家庭的关系,作为增加儿童和家庭成果的手段。75名早期干预者完成了一份在线问卷,以评估早期干预中同情护理能力的重要性、使用频率和信心。结果表明,大多数同情护理能力被受访者评为高重要性,尽管有些能力不经常实施,提供者报告缺乏信心来实施它们。提供了关于在早期干预中使用同情护理能力的建议。我们的上一篇文章是由张雅致、南希·亨特和罗宾·多兹撰写的,主要讨论了不同文化背景的父母和服务提供者从早期干预过渡到早期儿童特殊教育的挑战。采用焦点小组的方法,从8个不同文化背景的家庭(2组)、5名早期干预者(1组)和6名早期儿童特殊教育教师(1组)中收集有关过渡的信息。通过广泛而集中的问题,各小组确定了关于过渡的几个主题。其中包括:(1)在过渡时期感到迷失;(2)有限制性选择,导致限制性(非包容性)安置;(3)服务和模式的中断。本文讨论了这些问题,并提出了改善多元文化家庭和服务提供者过渡过程的建议,包括加强教师培训计划。与往常一样,我要感谢作者将他们的作品提交给IYC,以及协助编辑过程的审稿人,他们为这些手稿的出版提供了建议。——mary Beth Bruder,博士编辑
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引用次数: 0
Project ECHO 项目的回声
IF 1.1 4区 医学 Q3 EDUCATION, SPECIAL Pub Date : 2023-04-01 DOI: 10.1097/IYC.0000000000000236
Katherine J. Bateman, I. Schwartz, Ryan P. Grimm
Children with intellectual and developmental disabilities engage in higher rates of challenging behavior (CB) than their typically developing peers. Effective and sustainable intervention and supports designed to reduce CB, as well as promote the development of positive, prosocial behavior, are urgently needed. One approach to targeting CB is providing parents with education and support to serve as the agents of behavior change. The purpose of this study was to examine the effectiveness of a parent education (PE) program focused on the principles of applied behavior analysis delivered using the Project ECHO service delivery model. Results demonstrate positive outcomes in parents' senses of competency and empowerment. In addition, parents identified the intervention as acceptable, suggesting this model as a highly effective and sustainable PE model for this population.
有智力和发育障碍的儿童比正常发育的同龄人有更高的挑战性行为(CB)。迫切需要有效和可持续的干预和支持,旨在减少CB,并促进积极,亲社会行为的发展。针对CB的一种方法是向父母提供教育和支持,使他们成为行为改变的推动者。本研究的目的是检验家长教育(PE)项目的有效性,该项目关注使用ECHO项目服务交付模型交付的应用行为分析原则。结果表明,父母的能力和授权意识取得了积极的成果。此外,家长认为干预是可以接受的,这表明这种模式对这一人群来说是一种非常有效和可持续的体育模式。
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引用次数: 26
Compassionate Care Within Early Intervention Caregiver Coaching 关爱在早期干预照顾者辅导
IF 1.1 4区 医学 Q3 EDUCATION, SPECIAL Pub Date : 2023-04-01 DOI: 10.1097/IYC.0000000000000238
Sophia R. D’Agostino, Sarah N. Douglas, H. Meadan
The practice of coaching caregivers requires early intervention (EI) providers to build relationships using compassionate care while implementing coaching practices to increase outcomes for caregivers and children. Coaching with compassion is highly valued and studied within other disciplines, yet investigations focused on interpersonal skills within the field of EI are just emerging. With the rise of families enrolled in Part C programs along with the increasing emphasis of caregiver coaching, it is critical to explore the approach of coaching with compassion. The aim of this study was to examine EI providers' perceptions and reported use of compassionate care competencies within caregiver coaching. We report findings from an online questionnaire that contained closed and open-ended questions. The results of this study indicate that most compassionate care competencies were ranked highly whereas some were not implemented as often and EI providers reported less confidence in using them. Early intervention providers also identified benefits and challenges to implementation. In addition, EI providers noted the importance of integrating compassionate care competencies into the practice of caregiver coaching. Results provide critical insights related to including compassionate care competencies into preparation for EI providers. Training recommendations and resources for EI providers are discussed.
指导照顾者的实践要求早期干预(EI)提供者在实施指导实践以增加照顾者和儿童的结果的同时,使用富有同情心的护理建立关系。同情心指导在其他学科中受到高度重视和研究,但在情商领域中关注人际交往技巧的调查才刚刚出现。随着越来越多的家庭参加C部分项目,以及对护理人员指导的日益重视,探索用同情心指导的方法至关重要。本研究的目的是检查情商提供者的看法和报告的使用同情护理能力在照顾者辅导。我们报告了一份包含封闭式和开放式问题的在线问卷调查结果。本研究的结果表明,大多数慈悲关怀能力排名很高,而有些则没有经常实施,并且EI提供者对使用它们的信心不足。早期干预提供者还确定了实施的好处和挑战。此外,情商提供者注意到将同情心护理能力整合到护理人员指导实践中的重要性。结果提供了与将同情心护理能力纳入EI提供者准备相关的关键见解。讨论了EI提供者的培训建议和资源。
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引用次数: 0
Exploring a Framework for Early Childhood Systems Maturity 探索儿童早期系统成熟的框架
IF 1.1 4区 医学 Q3 EDUCATION, SPECIAL Pub Date : 2023-04-01 DOI: 10.1097/IYC.0000000000000235
Loraine Swanson, Meera Menon, Amber Minogue, R. Russell, S. Berns
Given the proportion of young children experiencing disadvantages in achieving optimal health due to inequities related to race, place, and income, there is increasing attention to developing effective early childhood (EC) systems. As EC leaders embrace methods such as collective impact in driving systems change, there is a growing recognition that a one-size-fits-all approach to developing integrated EC systems may be inappropriate as systems-building efforts may differ in their “maturity.” Systems maturity, as we define, refers to the ability of child-focused organizations, across disciplines and sectors, to successfully collaborate toward continuous improvement in supporting optimal child well-being. A flexible, developmental framework of systems building accounting for maturity better articulates the nuances of EC systems-building work. This article describes an emergent framework of EC systems development observed from states and communities participating in the Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network (ECCS CoIIN) and aiming to build systems for increased developmental promotion and screening. The framework depicted both acknowledges the complexity of systems building while providing a simplified frame for assessing the status of a system to drive further system development. This framework can be utilized to guide effective implementation and evaluation of EC systems-building initiatives.
由于与种族、地域和收入有关的不平等,幼儿在实现最佳健康方面处于不利地位的比例越来越大,因此越来越重视发展有效的幼儿(EC)系统。随着电子商务领导者接受诸如推动系统变革的集体影响等方法,越来越多的人认识到,开发集成电子商务系统的一刀切方法可能不合适,因为系统构建工作的“成熟度”可能不同。正如我们所定义的,系统成熟度是指以儿童为中心的组织,跨学科和部门,成功地合作,以支持最佳儿童福祉的持续改进的能力。考虑成熟度的灵活的、发展性的系统构建框架更好地阐明了电子商务系统构建工作的细微差别。本文描述了从参与幼儿综合系统协作改进和创新网络(ECCS CoIIN)的州和社区观察到的EC系统发展的新兴框架,旨在建立促进发展和筛选的系统。所描述的框架承认了系统构建的复杂性,同时为评估系统状态提供了一个简化的框架,以推动进一步的系统开发。该框架可用于指导有效实施和评估电子商务系统建设倡议。
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引用次数: 0
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Infants & Young Children
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