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Minnesota Public Health Corps: A New Model For Building The Governmental Public Health Workforce. 明尼苏达公共卫生队:建设政府公共卫生队伍的新模式。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00019
Chelsey Kirkland, Henry Stabler, Jaclyn Frank, Alana Stimes, Peter Nelson, Ben Suker, Sarah Sevcik Tummala, Craig Hedberg, Jonathon P Leider, A J Pearlman

Governmental public health agencies in the US are understaffed, and ongoing shortages will have a detrimental effect on their ability to provide basic public health services and protections. Public Health AmeriCorps was established in 2022 to support efforts to create a stronger and more diverse public health workforce nationwide. The Minnesota Public Health Corps, one of the largest Public Health AmeriCorps models, is a capacity-building program that places AmeriCorps members directly into governmental public health settings across the state. We used data from the first year of the Minnesota Public Health Corps (2022-23) to describe the experiences of thirty-five sites participating in the program. We also examined preliminary findings about how it shaped AmeriCorps members' skills and prospects related to career development in public health. Corps members were younger and more diverse than the current public health workforce in Minnesota, and the majority said that they intended to pursue a public health career. Host sites reported improved capacity to deliver public health services and indicated that corps members helped them reach new populations. Our evaluation demonstrates that this statewide program may be a scalable model to address parts of the acute capacity gaps at public health agencies, as well as long-term efforts to revitalize the workforce.

美国政府公共卫生机构人员不足,持续的人员短缺将对其提供基本公共卫生服务和保护的能力产生不利影响。公共卫生美国志愿队成立于 2022 年,旨在支持在全国范围内建立一支更强大、更多元化的公共卫生队伍。明尼苏达公共卫生队是最大的公共卫生美国志愿队模式之一,它是一项能力建设计划,将美国志愿队成员直接安排到全州的政府公共卫生机构中。我们利用明尼苏达公共卫生队第一年(2022-23 年)的数据,描述了参与该计划的 35 个地点的经验。我们还研究了关于该计划如何塑造美国志愿服务队成员在公共卫生领域的技能和职业发展前景的初步发现。与明尼苏达州目前的公共卫生队伍相比,美国志愿服务队成员更年轻、更多元化,大多数成员表示他们打算从事公共卫生职业。主办地报告称,提供公共卫生服务的能力得到了提高,并表示军团成员帮助他们接触到了新的人群。我们的评估结果表明,这项全州范围的计划可以成为一种可扩展的模式,以解决公共卫生机构的部分严重能力缺口,以及振兴劳动力队伍的长期努力。
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引用次数: 0
Indiana's Public Health Investment Holds Insights For Other States. 印第安纳州的公共卫生投资为其他州提供了启示。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2023.01650
Nir Menachemi, Lindsay Weaver, Virginia Caine, D Shane Hatchett, Kristina Box, Paul K Halverson

Indiana has a business-friendly environment, but historical underinvestment in public health has yielded poor health outcomes. In 2023, when trust in governmental public health was strained nationwide, Indiana increased public health spending by 1,500 percent. In this article, we explain how Indiana achieved this unprecedented legislative victory for public health, describing the context, approach, and lessons learned. Specifically, an Indiana University report linking economic vitality and overall health sparked the creation of a governor's commission charged with exploring ways to address Indiana's shortcomings. Working with the Indiana Department of Health, the commission developed multisectoral coalitions and business and government partnerships, and it maintained consistent and coordinated communication with policy makers. Lessons learned included the value of uncoupling public health from partisan narratives, appointing diverse commission membership with strategically selected cochairs, involving local leaders, and ensuring local decision-making control. We believe that Indiana's approach holds insights for other states interested in strengthening public health funding in the current era.

印第安纳州拥有良好的商业环境,但历史上对公共卫生的投资不足却导致了糟糕的健康结果。2023 年,当全国范围内对政府公共卫生的信任度下降时,印第安纳州将公共卫生支出增加了 1,500%。在本文中,我们将介绍印第安纳州是如何在公共卫生领域取得这一前所未有的立法胜利的,并介绍其背景、方法和经验教训。具体来说,印第安纳大学的一份报告将经济活力与整体健康联系在一起,促使州长成立了一个委员会,负责探索解决印第安纳州不足之处的方法。该委员会与印第安纳州卫生部合作,建立了多部门联盟以及企业和政府伙伴关系,并与政策制定者保持一致和协调的沟通。汲取的经验教训包括:将公共卫生与党派言论分离开来、任命多元化的委员会成员并战略性地挑选联合主席、让地方领导人参与进来以及确保地方决策控制权。我们相信,印第安纳州的做法对其他有意在当今时代加强公共卫生资助的州具有启示意义。
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引用次数: 0
Not Only How Much But How: The Importance Of Diversifying Funding Streams In A Reimagined Public Health System. 不仅要多少,还要如何:在重新构想的公共卫生系统中实现资金流多样化的重要性。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00037
J Mac McCullough, Umesh Ghimire, Jason M Orr, Sezan O Onal, Ashley Edmiston, Krishna Patel, Timothy C McCall, Jonathon P Leider

Revenue diversification may be a synergistic strategy for transforming public health, yet few national or trend data are available. This study quantified and identified patterns in revenue diversification in public health before and during the COVID-19 pandemic. We used National Association of County and City Health Officials' National Profile of Local Health Departments study data for 2013, 2016, 2019, and 2022 to calculate a yearly diversification index for local health departments. Respondents' revenue portfolios changed fairly little between 2016 and 2022. Compared with less-diversified local health departments, well-diversified departments reported a balanced portfolio with local, state, federal, and clinical sources of revenue and higher per capita revenues. Less-diversified local health departments relied heavily on local sources and saw lower revenues. The COVID-19 period exacerbated these differences, with less-diversified departments seeing little revenue growth from 2019 to 2022. Revenue portfolios are an underexamined aspect of the public health system, and this study suggests that some organizations may be under financial strain by not having diverse revenue portfolios. Practitioners have ways of enhancing diversification, and policy attention is needed to incentivize and support revenue diversification to enhance the financial resilience and sustainability of local health departments.

收入多样化可能是转变公共卫生的一种协同战略,但目前几乎没有全国性或趋势性数据。本研究量化并确定了 COVID-19 大流行之前和期间公共卫生收入多样化的模式。我们使用全美县市卫生官员协会的《全国地方卫生部门概况》研究中 2013、2016、2019 和 2022 年的数据,计算出地方卫生部门的年度多元化指数。受访者的收入组合在 2016 年至 2022 年间变化不大。与多元化程度较低的地方卫生部门相比,多元化程度较高的部门的收入组合较为均衡,包括地方、州、联邦和临床收入来源,人均收入也较高。多元化程度较低的地方卫生部门则严重依赖地方来源,收入较低。COVID-19 期间加剧了这些差异,从 2019 年到 2022 年,多元化程度较低的部门的收入几乎没有增长。收入组合是公共卫生系统中一个未得到充分研究的方面,这项研究表明,一些组织可能因为没有多样化的收入组合而面临财务压力。从业人员有办法加强多元化,而政策方面也需要关注激励和支持收入多元化,以增强地方卫生部门的财务弹性和可持续性。
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引用次数: 0
The United States Needs A Better Testing Playbook For Future Public Health Emergencies. 美国需要一本更好的测试手册来应对未来的公共卫生突发事件。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00038
Jennifer B Nuzzo, Aquielle Person, Elizabeth Cameron, Jill Taylor, Ewa King, Mara Aspinall, Scott Becker

The absence of a comprehensive national playbook for developing and deploying testing has hindered the United States' ability to rapidly suppress recent biological emergencies (for example, the COVID-19 pandemic and outbreaks of mpox). We describe here the Testing Playbook for Biological Emergencies, a national testing playbook we developed. It includes a set of decisions and actions for US officials to take at specific times during infectious disease emergencies to implement testing rapidly and to ensure that available testing meets clinical and public health needs. Although the United States had multiple plans at the federal level for responding to pandemic threats, US leaders were unable to quickly and efficiently operationalize those plans to deploy different types of tests during the COVID-19 pandemic in 2020-21, and again during the US mpox outbreak in 2022. The playbook fills a critical gap by providing the necessary specific and adaptable guidance for decision makers to meet this need.

由于缺乏制定和部署测试的国家综合手册,美国迅速制止最近发生的生物突发事件(如 COVID-19 大流行病和麻疹疫情)的能力受到了阻碍。我们在此介绍《生物突发事件检测手册》(Testing Playbook for Biological Emergencies),这是我们制定的国家检测手册。它包括美国官员在传染病突发事件期间的特定时间内应采取的一系列决策和行动,以迅速实施检测并确保现有检测满足临床和公共卫生需求。尽管美国在联邦层面制定了多种应对大流行威胁的计划,但在 2020-21 年 COVID-19 大流行期间,以及 2022 年美国麻疹疫情爆发期间,美国领导人无法快速、高效地实施这些计划,部署不同类型的检测。该手册为决策者提供了必要的具体和可调整的指导,填补了这一关键空白,以满足这一需求。
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引用次数: 0
Oregon's Approach To Demonstrating The Value Of A Modern Public Health System Through Accountability Metrics. 俄勒冈州通过问责指标展示现代公共卫生系统价值的方法。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00012
Kusuma Madamala, Sara Beaudrault, Timothy Menza, Cara Biddlecom

Oregon's public health system uses accountability metrics to improve health, eliminate inequities, and practice stewardship. First enacted into law during the 2015 legislative session, with additions and clarifications made in the 2017 session, these metrics promote collective action across sectors, bring attention to the root causes of health inequities, and hold public health authorities accountable for performance improvement as they carry out core public health functions. This article describes the development of Oregon's accountability metrics and implications for future practice. In 2023, Oregon's public health leaders adopted a new set of health outcome indicators and process measures for communicable disease control and environmental health, with performance tied to financial incentives. Oregon's process is a model for other states developing an accountability framework in their pursuit of public health transformation. Oregon's work contributes to legislative and other policy decisions for measuring the success of approaches to eliminating health inequities and for applying performance-based incentives within the public health system.

俄勒冈州的公共卫生系统利用问责指标来改善健康状况、消除不公平现象并践行管理。这些指标在 2015 年的立法会议上首次成为法律,并在 2017 年的会议上进行了补充和澄清,它们促进了跨部门的集体行动,引起了人们对健康不平等根源的关注,并使公共卫生机构在履行核心公共卫生职能时对改善绩效负责。本文介绍了俄勒冈州问责指标的发展情况以及对未来实践的影响。2023 年,俄勒冈州的公共卫生领导者采用了一套新的健康结果指标以及传染病控制和环境健康的过程衡量标准,并将绩效与经济激励挂钩。俄勒冈州的进程为其他州在追求公共卫生转型的过程中制定问责框架树立了典范。俄勒冈州的工作有助于立法和其他政策决策,以衡量消除健康不平等的方法是否成功,并在公共卫生系统内实施基于绩效的激励措施。
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引用次数: 0
Reimagining Public Health: Mapping A Path Forward. 重新构想公共卫生:绘制前进之路。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00007
Jonathan Samet, Ross C Brownson

The COVID-19 pandemic and other ongoing public health challenges have highlighted deficiencies in the US public health system. The United States is in a unique moment that calls for a transformation that builds on Public Health 3.0 and its focus on social determinants of health and partnerships with diverse sectors while also acknowledging how the pandemic altered the landscape for public health. Based on relevant literature, our experience, and interviews with public health leaders, we describe seven areas of focus within three broad categories to support transformational change. Contextual areas of focus include increasing accountability and addressing politicization and polarization. Topical areas of focus highlight prioritizing climate change and sharpening the focus on equity. Technical areas of focus include advancing data sciences, building the workforce, and enhancing communication capacity. A transformed public health system will depend highly on leadership, funding incentives, and both bottom-up and top-down approaches. A broad effort is needed by public health agencies, governments, and academia to accelerate the transition to a next phase for public health.

COVID-19 大流行和其他持续的公共卫生挑战凸显了美国公共卫生系统的缺陷。美国正处于一个独特的时刻,需要在公共卫生 3.0 及其关注健康的社会决定因素和与不同部门合作的基础上进行转型,同时也要认识到大流行如何改变了公共卫生的格局。根据相关文献、我们的经验以及与公共卫生领导人的访谈,我们描述了三大类七个重点领域,以支持转型变革。背景重点领域包括加强问责制以及解决政治化和两极分化问题。重点专题领域包括优先考虑气候变化和加强对公平的关注。重点技术领域包括推进数据科学、建设劳动力队伍和提高沟通能力。公共卫生系统的转型将在很大程度上取决于领导力、资金激励以及自下而上和自上而下的方法。公共卫生机构、政府和学术界需要做出广泛努力,加快向公共卫生的下一阶段过渡。
{"title":"Reimagining Public Health: Mapping A Path Forward.","authors":"Jonathan Samet, Ross C Brownson","doi":"10.1377/hlthaff.2024.00007","DOIUrl":"10.1377/hlthaff.2024.00007","url":null,"abstract":"<p><p>The COVID-19 pandemic and other ongoing public health challenges have highlighted deficiencies in the US public health system. The United States is in a unique moment that calls for a transformation that builds on Public Health 3.0 and its focus on social determinants of health and partnerships with diverse sectors while also acknowledging how the pandemic altered the landscape for public health. Based on relevant literature, our experience, and interviews with public health leaders, we describe seven areas of focus within three broad categories to support transformational change. Contextual areas of focus include increasing accountability and addressing politicization and polarization. Topical areas of focus highlight prioritizing climate change and sharpening the focus on equity. Technical areas of focus include advancing data sciences, building the workforce, and enhancing communication capacity. A transformed public health system will depend highly on leadership, funding incentives, and both bottom-up and top-down approaches. A broad effort is needed by public health agencies, governments, and academia to accelerate the transition to a next phase for public health.</p>","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":"43 6","pages":"750-758"},"PeriodicalIF":8.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Colocating Syringe Services, COVID-19 Vaccination, And Infectious Disease Testing: Baltimore's Experience. 集中注射器服务、COVID-19 疫苗接种和传染病检测:巴尔的摩的经验。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00032
Omeid Heidari, Diane Meyer, Kelly Lowensen, Amita Patil, Katie J O'Conor, Jessica LaRicci, Derrick Hunt, Adam P Bocek, Victoria Cargill, Jason E Farley

People who inject drugs face many challenges that contribute to poor health outcomes, including drug overdose, HIV, and hepatitis C infections. These conditions require high-quality prevention and treatment services. Syringe services programs are evidence-based harm reduction programs, and they have established track records with people who inject drugs, earning them deep trust within this population. In Baltimore, Maryland, although many syringe support services were limited during the COVID-19 pandemic, the health department's syringe services programs remained operational, allowing for the continuation of harm reduction services, including naloxone distribution. This evaluation describes a collaborative effort to colocate infectious disease testing and COVID-19 vaccination with a syringe services program. Our evaluation demonstrated that colocation of important services with trusted community partners can facilitate engagement and is essential for service uptake. Maintaining adequate and consistent funding for these services is central to program success. Colocation of other services within syringe services programs, such as medications for opioid use disorder, wound care, and infectious disease treatment, would further expand health care access for people who inject drugs.

注射吸毒者面临着许多挑战,这些挑战导致了不良的健康后果,包括吸毒过量、艾滋病毒和丙型肝炎感染。这些情况需要高质量的预防和治疗服务。注射器服务计划是以证据为基础的减低伤害计划,它们在注射吸毒者中建立了良好的记录,在这一人群中赢得了深厚的信任。在马里兰州巴尔的摩市,尽管在 COVID-19 大流行期间许多注射器支持服务受到限制,但卫生部门的注射器服务计划仍在运行,从而使包括纳洛酮分发在内的减低危害服务得以继续。本评估介绍了将传染病检测和 COVID-19 疫苗接种与注射器服务计划同地进行的合作努力。我们的评估表明,将重要的服务与值得信赖的社区合作伙伴集中在一起可以促进参与,对服务的吸收至关重要。为这些服务保持充足、稳定的资金是计划成功的关键。在注射器服务计划内提供其他服务,如治疗阿片类药物使用障碍的药物、伤口护理和传染病治疗,将进一步扩大注射吸毒者获得医疗保健的机会。
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引用次数: 0
Erratum. 勘误。
IF 9.7 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00623
{"title":"Erratum.","authors":"","doi":"10.1377/hlthaff.2024.00623","DOIUrl":"https://doi.org/10.1377/hlthaff.2024.00623","url":null,"abstract":"","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":"43 6","pages":"899"},"PeriodicalIF":9.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prescription Digital Therapeutics: Assertions. 处方数字疗法:断言。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00152
Andrew Molnar
{"title":"Prescription Digital Therapeutics: Assertions.","authors":"Andrew Molnar","doi":"10.1377/hlthaff.2024.00152","DOIUrl":"10.1377/hlthaff.2024.00152","url":null,"abstract":"","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":"43 6","pages":"897"},"PeriodicalIF":8.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reimagining Rural Health Equity: Understanding Disparities And Orienting Policy, Practice, And Research In Rural America. 重新认识农村卫生公平:了解差距并指导美国农村地区的政策、实践和研究。
IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-01 DOI: 10.1377/hlthaff.2024.00036
Anne N Sosin, Elizabeth A Carpenter-Song

A narrative has taken hold that public health has failed the US. We argue instead that the US has chronically failed public health, and nowhere have these failures been more apparent than in rural regions. Decades of underinvestment in rural communities, health care, and public health institutions left rural America uniquely vulnerable to the COVID-19 pandemic. Rural communities outpaced urban ones in deaths, and many rural institutions and communities sustained significant impacts. At the same time, the pandemic prompted creative actions to meet urgent health and social needs, and it illuminated opportunities to address long-standing rural challenges. This article draws on our cross-disciplinary expertise in public health and medical anthropology, as well as our research on COVID-19 and rural health equity in northern New England. In this Commentary, we articulate five principles to inform research, practice, and policy efforts in rural America. We contend that advancing rural health equity beyond the pandemic requires understanding the forces that generate rural disparities and designing policies and practices that account for rural disadvantage.

有一种说法认为,美国的公共卫生工作已经失败。而我们认为,美国的公共卫生事业长期处于失败状态,这种失败在农村地区表现得最为明显。几十年来对农村社区、医疗保健和公共卫生机构的投资不足,使得美国农村地区在 COVID-19 大流行时显得格外脆弱。农村社区的死亡人数超过了城市社区,许多农村机构和社区受到了严重影响。与此同时,大流行促使人们采取创造性的行动来满足迫切的健康和社会需求,并为解决农村长期面临的挑战提供了机会。本文借鉴了我们在公共卫生和医学人类学方面的跨学科专业知识,以及我们对 COVID-19 和新英格兰北部农村健康公平的研究。在这篇评论中,我们阐述了美国农村地区研究、实践和政策工作的五项原则。我们认为,要想在大流行病之后促进农村地区的健康公平,就必须了解造成农村地区差异的各种力量,并制定考虑到农村地区不利条件的政策和实践。
{"title":"Reimagining Rural Health Equity: Understanding Disparities And Orienting Policy, Practice, And Research In Rural America.","authors":"Anne N Sosin, Elizabeth A Carpenter-Song","doi":"10.1377/hlthaff.2024.00036","DOIUrl":"10.1377/hlthaff.2024.00036","url":null,"abstract":"<p><p>A narrative has taken hold that public health has failed the US. We argue instead that the US has chronically failed public health, and nowhere have these failures been more apparent than in rural regions. Decades of underinvestment in rural communities, health care, and public health institutions left rural America uniquely vulnerable to the COVID-19 pandemic. Rural communities outpaced urban ones in deaths, and many rural institutions and communities sustained significant impacts. At the same time, the pandemic prompted creative actions to meet urgent health and social needs, and it illuminated opportunities to address long-standing rural challenges. This article draws on our cross-disciplinary expertise in public health and medical anthropology, as well as our research on COVID-19 and rural health equity in northern New England. In this Commentary, we articulate five principles to inform research, practice, and policy efforts in rural America. We contend that advancing rural health equity beyond the pandemic requires understanding the forces that generate rural disparities and designing policies and practices that account for rural disadvantage.</p>","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":"43 6","pages":"791-797"},"PeriodicalIF":8.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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