How does the Choose Well program include and value stakeholders?

case studies case study and need the explanation and answer to help me learn.

read the attached Smith et al. (2022) article. Your response must be a minimum of one page, one-inch margins, double-spaced, and 12-point Times New Roman font. Submit through Blackboard by uploading a Microsoft Word (.doc or .docx) file.
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SouthCarolina’sChooseWellInitiativetoReduceUnintendedPregnancy:Rationale,ImplementationDesign,andEvaluationMethodologyMichaelG.Smith,DrPH,NathanHale,PhD,SarahKelley,MSW,MPH,KatherineSatterfield,MPH,KateE.Beatty,PhD,andAmalJ.Khoury,PhDABOUTTHEAUTHORSMichaelG.Smith,NathanHale,KateE.Beatty,andAmalJ.KhouryarewiththeDepartmentofHealthServicesManagementandPolicyandtheCenterforAppliedResearchandEvaluationinWomen’sHealthatEastTennesseeStateUniversity,JohnsonCity.SarahKelleyandKatherineSatterfieldarewithNewMorninginColumbia,SC.WedescribetheimplementationofChooseWell(CW),astate-widecontraceptiveaccessinitiativeongoinginSouthCarolina,andtheexternalevaluationofCWconductedatEastTennesseeStateUniversity.Theevaluationiswellpositionedtoadvancetheevidencebasesurroundingcontra-ceptiveaccessinitiatives,particularlygiventheuniquenessofCWinthesoutheasternUnitedStates.DESCRIPTIONOFTHECHOOSEWELLINITIATIVEIn2017,thenonprofitorganizationNewMorning(NM)1launchedCW,asix-yearstatewidecontraceptiveaccessinitiative.ThemissionofCWistopro-moteequitableaccesstocontraceptionwithoutjudgmentorcoercion,aimingfora25%reductioninstatewideunin-tendedpregnancyby2023.CWisinformedbycollectiveimpactprinciplesasameanstocentrallycoordi-nategeographicallydistributedstake-holders.2Itscollectiveapproachsupportstransformativechangethroughongoingcommunicationamongstakeholders,partnermeetingsandworkgroups,andshareddatacollectionstandards.NMservesasthecoordinatingagency,man-agingallactivitiesandfundingallpartici-patingagencies.CWisuniqueandinnovativeinkeyways.ItisthefirstandonlycontraceptiveaccessinitiativeofitskindintheUSSoutheast.CW’seffortsaresystemati-callycoordinatedacrossvariousclinicalsectors(federallyqualifiedhealthcen-ters,hospitalinpatientandoutpatientproviders,ruralhealthclinics,freeclinics,collegeanduniversityhealthcenters,andTitleX–fundedpublichealthdepart-ments),communityorganizations,andhighereducationinstitutions.Thesepartnersworkcollaborativelytoimproveaccesstohigh-quality,evidence-based,patient-centeredcontraceptiveservices.Theinclusionoffederallyqualifiedhealthcentersandruralhealthclinics(neitherofwhichreceiveTitleXfundinginSouthCarolina)isparticularlyuniqueinseekingtoexpandaccesstocontraceptivecareatsafetynetclinicsandtointegratecon-traceptiveservicesintoprimarycare.CWisalsocomprehensiveinitsapproachwithkeyinterventionsaddressingdeter-minantsofcontraceptiveaccessanduseatmultiplelevels(individualandcommu-nity,providerandpractice,andsystemandpolicylevels)andprioritizingpatientandproviderknowledge,attitudes,andexperienceofcare.Theseinterventionsleveragecommunity-reachingorganiza-tionsinSouthCarolinaandreputabletrainingproviderswhilegeneratingawealthofdatafortriangulationofevalu-ationfindings.ScopeCWisimplementedstatewideinSouthCarolina,withclinicalsitesin45ofthestate’s46counties.Althoughtheinitia-tiveisdesignedtoaddressgapsinaccessamonguninsuredandunderin-suredpeople,allpatientsatCWclinicsbenefitfromhigh-qualityserviceprovi-sion,regardlessoftheirinsurancesta-tusorabilitytopay.From2017to2021,morethan300000peoplereceivedcontraceptiveservicesataCWclinic.CoreComponentsBeforetheinitiative’slaunchin2017,astatewideneedsassessmentindicatedthattomeetthecontraceptiveneedsofuninsuredandunderinsuredpatientsinSouthCarolina,supportshouldbedirectedtotrainingandpreparingtheworkforce,subsidizingthecostofS484EditorialSmithetal.OPINIONS,IDEAS,&PRACTICEAJPHSupplement5,2022,Vol112,No.S5
expensivelong-actingreversiblecontra-ceptive(LARC)devices(includingintra-uterinedevicesandcontraceptiveimplants),hiringhealthcareprovidersinshortageareas,andincreasingcon-sumerawareness.Also,resultsindi-catedmoreresourceswereneededtointegratecontraceptiveservicesintopri-marycareclinics,whichoftenreferredcontraceptive-seekingpatientstoTitleX–fundedpublichealthdepartments.ThesefundingprioritiesandneedsassessmentresultsweretranslatedintoCW’scorecomponents.AsthemanagingandfiscalagentofCW,NMdirectsfundstoallclinicalpart-ners,communityorganizations,andedu-cationalinstitutions.Inaddition,NMmanagesaconsumer-facingmarketingengine;coordinatesandcreatestrain-ings;hostscollaborativemeetings;pro-videsongoingtechnicalassistance;collectsandinterpretsdata;monitorsgrantcompliance;anddirectssustainabil-ityeffortsthroughlobbying,advocacy,development,andfundraising.EveryagencyparticipatinginCWagreestogar-nerleadershipsupportforandmakeanorganizationalcommitmenttocontracep-tiveaccess,implementevidence-basedservices,supportdatacollectionandeval-uation,achievesustainableservicedeliv-ery,andworkcollaborativelywithNMandotherinitiativepartnerstoimprovecontraceptiveaccess.Thesevaluesarealsoinfusedthroughclinicalworkforcetrainings.Messagingfortheconsumer-facingNoDramamarketingcampaignseekstoeducatepatientsandempowerthemtomakeanappointmentatacon-venientlylocatedCW-participatingclinic.CW’sprimaryeffortsinfourkeyareasaredescribedbelow.Infrastructureandworkforce.Clinicsusegrantfundstopurchasecontracep-tivemethodstohaveavailableon-site,whichcanbeprovidedtoeligiblepatientsatlittleornocost.Clinicsalsousefundstobuyequipmentandpayforstafftodeliverhigh-qualityservices.Allclinicsareexpectedtodelivercontraceptiveserv-icesalignedwiththeCentersforDiseaseControlandPrevention’sQualityFamilyPlanningGuidelines,offeringsame-dayservices(includingplacementofLARCmethods)andnoncoercivecounselingonallmethods.3,4Communityagenciesusefundsforstafftoconductcounselingandreferpatientstoclinics.Capacitybuildingandtraining.Nationalandstate-basedconsultantsprovidetrainingsincontraceptivecounseling,LARCprovision,shareddecision-making,revenuecyclemanagement,andothertopicstoclinicalandnonclini-calprofessionalsinpartnerorganiza-tions.Inadditiontothesetrainings,NMprovidesongoingtechnicalassistancetoclinicalpartnersontopicsincludingMedicaidbillingandcodingandelec-tronichealthrecorddevelopment.Part-neringSouthCarolinainstitutionsofhighereducationpreparenursingstu-dentstodeliverqualityservices.Integratedmarketingandcommunica-tions.Consumersaredirectedtoserv-icesthroughtheNoDramaadvertisingcampaign,whichincludesbillboards,radiospots,andsocialmediaadvertis-ing.5Alladvertisementspointconsum-erstoacentralizedWebsiteorphonelineforadditionalinformationandappointmentscheduling.Beginningin2020,apatientadvocateworksdirectlywithpatientstoansweranyquestions,facilitatesschedulingappointments,andensuresqualifyingpatientshavenoout-of-pocketcosts.Strategiclearningandsustainability.ToimproveCWservicedelivery,NMdirectsdatacollectionandmonitoringthroughsharedmeasurement,qualityimprovement,andstrategiclearningprojects.NMsupportssustainablecon-traceptiveservicesbyintegratingserv-icesatclinicsandsecuringfinancialresourcesviapublicfunds,grantseek-ing,andfundraising.NMalsoadvocatesforpublicandlegislativesupportforpoliciesthatexpandandpromoteaccesstoreproductivehealthservicesinSouthCarolina.DESCRIPTIONOFTHECHOOSEWELLEVALUATIONGiventhebroadnatureoftheinterven-tionanddesiretotranslateevidenceintopractice,theRE-AIMFrameworkwasusedtoguidethedesignoftheindependentexternalevaluation.RE-AIMoffersasystematicmeansofevaluatingCWacrossfivekeydimen-sions:reach,effectiveness,adoption,implementation,andmaintenance.6,7KeyevaluationcomponentsaremappedtotheRE-AIMframework,asdescribedinTableA(availableasasup-plementtotheonlineversionofthisarticleathttp://www.ajph.org),andalignwiththebroaderconceptualframe-workforstatewidecontraceptiveaccessinitiatives(Malcolm,p.S473).TheRE-AIMframeworkhasbeenappliedtothisevaluationusingAnder-sen’sBehavioralModelforHealthServiceUse.8,9Thismodelproposesthatpredis-posing,enabling,andneedfactorsattheindividual,practiceorprovider,andpolicyorsystemlevelsinfluencehealthbehav-iorsandoutcomes.Weadaptedthismodeltocharacterizekeyconstructsandrelationshipsunderpinningcontra-ceptiveuseandreproductivehealthout-comes(Figure1).WehypothesizedthatCW,byaddressingmultiplemodifiableOPINIONS,IDEAS,&PRACTICEEditorialSmithetal.S485AJPHSupplement5,2022,Vol112,No.S5
factorsattheindividual,practiceorpro-vider,andpolicyorsystemlevels,willimpactcontraceptiveexperiencesanduseandsubsequentlyhealthandsocialoutcomes.WehypothesizedthatCW’skeycomponentsandinterventionswillinfluencechangesinpopulationandsys-temcharacteristics,includingwomen’sawarenessandattitudesaboutcontra-ceptionandtheiraccesstocontraceptiveservices;providerattitudes,beliefs,skill,andprovisionofperson-centeredcontra-ceptivecounseling;cliniccontraceptivepolicies,practices,andprovision;andhealthpoliciesinSouthCarolina,suchasscopeofpracticeandcontraceptivereimbursementpolicy.Thesechangeswilltranslateintoexpandedcontracep-tiveuseandimprovedcontraceptiveexperiences,resultinginlowerratesofunintendedpregnancy,births,andabor-tionsinSouthCarolina,ultimatelyreduc-inghealthcarecostsandcontributingtothesustainabilityofCW’sefforts.Thismodelguideddevelopmentofevaluationsurveysandexaminingappropriateout-comesattherighttimeandintherightsequence.10DesignandMethodologyTheoverarchingevaluationdesignusesquasi-experimentalstudieswithappro-priatecomparisongroupsfordifferentoutcomesandmixed-methodsintegrat-ingsurveyandqualitativeapproaches.Keyevaluationcomponentsfollowapre–postdifference-in-differencesdesign.Althoughthestatewidestudiessurveyprobability-basedpopulationsamples,otherstudiesfocusonprioritypopulationsforCW,includingMedicaidbeneficiaries,TitleXusers,theuninsuredorunderinsured,andsafetynetclinics.Theevaluationleveragesstateandnationalsecondarydatasets,andextensiveprimarydatacollection,includingalongitudinalstudyoffamilyplanningpatients;multiplestatewidesurveysofwomen,providers,andfam-ilyplanningclinics;andkeyinformantinterviews.StudiesusingsecondarydataincorporatedifferentcomparisongroupswithintheSoutheastregionandnationally.StudiescollectingsurveydataareconductedinSouthCarolinaandacomparisonstatethatisgeographicallyandculturallysimilartoSouthCarolinabutnotimplementingastatewidecon-traceptiveaccessinitiative.BothSouthCarolinaandthecomparisonstatearelocatedintheSoutheastandhavecen-tralizedpublichealthsystems.Thestatesarehighlycomparableatbaseline,withpopulationsize,demographics,incomelevels,healthinsurancerates,unin-tendedpregnancyandbirthrates,Med-icaidfamilyplanningpolicy,women’shealthindicators,andTitleXcontracep-tiveusepatternsbeingsimilar.Thesedatasourcesareleveragedtoexamineavarietyofprogrammaticout-puts,practiceandpolicyoutcomes,individualandcommunityoutcomes,andhealthandsocialoutcomes.ThesearesummarizedinTableB(availableasasupplementtotheonlineversionofthisarticleathttp://www.ajph.org).ProgrammaticOutputsArobustprocessevaluationtracksactivityandoutputmeasuresacrossthedurationofimplementation.ThesemeasuresexaminethenumbersofContraceptive experiencesContraceptive use NeedWoman’s perceived needPerson-centered counselingPopulation health indicesEnablingWoman’s access to contraceptionProvider skillClinic policies and practicesContraceptiveprovisionHealth policiesCommunity resourcesPredisposingWoman’s awareness & attitudesProvider attitudes/beliefsProvider training Cultural normsPolitical environmentCHOOSE WELLSustainabilityIndividual/CommunityLevelPractice/ProviderLevelPolicy/SystemLevel Population and System CharacteristicsHealth and Social Outcomes Health Service UseUnintended pregnanciesBirthsAbortionsHealth care costs FIGURE1—ConceptualModelfortheChooseWellEvaluationSource.ThisconceptualmodelisadaptedfromAndersen’sBehavioralModelforHealthServiceUse.8,9OPINIONS,IDEAS,&PRACTICES486EditorialSmithetal.AJPHSupplement5,2022,Vol112,No.S5
participatingclinicsovertime,reachoftraining,reachandperceptionsoftheNoDramacampaign,expansionofhos-pitalpostpartumcontraception,andstaffperceptionsofCWimplementationacrossparticipatingorganizations.Theprocessevaluationusesprogrammaticnotes,reports,andkeyinformantinter-viewswithCWpartnerstaff,trainingorganizations,andotherparticipants.PracticeandPolicyOutcomesKnowledge,skills,attitudes,andbeliefsaboutcontraceptionamongprovidersandprovisionofperson-centeredcare.Theevaluationassessestrainingandprovider-relatedoutcomesatthestatelevelandalsospecificallyamongtrain-ingparticipants.State-leveldataarederivedfromstatewidesurveysofpro-vidersconductedinSouthCarolinaandacomparisonstateassessingproviderattitudes,beliefs,skills,andpracticesrelatedtocontraceptivecounselingandprovision.Theinitialsurveywascon-ductedin2017–2018,andtheendlinewillbeconductedin2023.Aregression-baseddifference-in-differencesapproachwillbeusedtoestimatetheeffectsofCWonoutcomesofinterest.Inaddition,theprocessevaluationcollecteddatafromtrainingparticipantsacrossSouthCaro-linain2017–2019togaugetheimmedi-ateimpactofthetrainingonintenttochangepractices,knowledge,andskills.11Clinic-levelpoliciesandprocedurestoincreaseaccesstocontraception.Thestatewidesurveyoffamilyplanning(healthdepartmentandfederallyquali-fiedhealthcenters)clinics,conductedinSouthCarolinaandacomparisonstate,assessesclinic-levelcontraceptivepolicies,practices,trainings,andservicedelivery.Threesurveysareplanned,Thebaselineandmidlinesurveyswereconductedin2017and2020,respec-tively.Theendlinesurveyisplannedfor2023.Surveymethodsandbaselinedatahavebeenpublishedelsewhere.12Aregression-baseddifference-in-differ-encesapproachwillbeusedtoassesstheoveralleffectofCWoncontracep-tiveaccessandprovisionatclinics.Mixedmodelsincorporatingfixedandrandomeffectswillalsobeusedtoexaminetheeffectofcliniccharacteris-ticsandpoliciesonchangesinout-comes.Outcomesincludetheprovisionofthefullrangeofcontraceptivemeth-odsandpatientcontraceptiveuse.Policychangesthatenablecontracep-tiveaccess.ApolicymonitoringprotocolhasbeendevelopedtotrackchangesaffectingcontraceptiveuseduringandafterCW,includingscopeofpracticelawsfornursepractitionersandphar-macists,insurancecoverage,andcon-traceptivereimbursementpoliciesinSouthCarolinaandcomparisonstates.Suchpolicieshaveimplicationsforinterpretingevaluationfindingsandforthesustainabilityoftheinitiative.Medicaidexpendituresoncontraception.TheevaluationassessestheeconomicimpactofchangesincontraceptiveuseandassociatedoutcomesamongMedic-aidbeneficiaries.Findingshaveimplica-tionsfortheMedicaidprogram,statebudget,andthesustainabilityofCW.IndividualandCommunityOutcomesContraceptiveuse.Multiplestudiesexaminestate-levelcontraceptiveuseandamongprioritypopulations.Con-traceptiveuseatthepopulationlevelisestimatedusingthestatewideSur-veyofWomen(SoW).TheSoWusesanaddress-basedsampletoderivepopulation-levelestimatesofkeyrepro-ductivehealthmeasuresinSouthCaro-linaandacomparisonstate.Womenofreproductiveageweresurveyedatbaselineandfollowedlongitudinally,withanothercross-sectionalsurveyconductedpost-CW.Thesurveymeth-odsandselectbaselineresultshavebeenpublishedelsewhere.13MedicaidclaimslinkedwithvitalrecordswereusedtoconstructacohortofMedicaid-eligiblewomenreceivingfamilyplanningservicesspanninga12-yearperiodsurroundingCW(2012–2024).Baselinedatahavebeenpub-lishedelsewhere.14Changesincontra-ceptiveuseandassociatedoutcomeswillbeexaminedusinglongitudinalanalyseswithfixedandrandomeffects,time-to-eventanalysis,andmixedmodelsforlon-gitudinalpanel-structureddata.ToexaminechangesincontraceptiveuseovertimeamongSouthCarolinaTitleXuserscomparedwithTitleXusersnationallyandwithinthesouth-easternregion,weusenationalFamilyPlanningAnnualReportdata15begin-ningin2012andmovingforward.Thisanalysisusesaninterruptedtime-seriesdesignwitharegression-baseddifference-in-differencesapproachandmultiplenonequivalentcomparisongroupstoexaminechangesovertime.WeexaminecontraceptiveuseamongpatientsofCW-participatingclinicsrela-tivetothoseatnonparticipatingclinicsusingdatafromthelongitudinalstudyoffamilyplanningpatients.Thisstudyusesaquasi-experimentaldesigninvolvingCW-participatingclinics,pairmatchedwithnonparticipatingclinics.Eligiblepatientsseekingcontraceptiveservicesatclinicsarerecruitedandsurveyedatrecruitmentandinfollow-upsurveysOPINIONS,IDEAS,&PRACTICEEditorialSmithetal.S487AJPHSupplement5,2022,Vol112,No.S5
overtwoyears.Surveysassesscontra-ceptivedecision-making,experiences,use,andoutcomes.Analysesfollowintention-to-treatmethodsusinggener-alizedestimatingequationsthataccountforclusteringtoestimatetheeffectofCWonoutcomesofinterest.Contraceptivecareexperiencesandreceiptofperson-centeredcare.BoththeSoWandthelongitudinalstudyoffamilyplanningpatientsassesswomen’sexperiencesandsatisfactionwithcontra-ceptivecare,includingcontraceptivechoiceperceivedcontrolandreceiptofperson-centeredcounseling.16Attitudesandbeliefsaboutcontracep-tionamongwomenofreproductiveage.Thisoutcomeisexaminedatthestatelevel,usingdatafromtheSoW,andalsoamongwomenseekingservicesatCW-participatingclinicsusingdatafromthelongitudinalstudyoffamilyplan-ningpatients.HealthandSocialOutcomesUnintendedpregnancy.Toanalyzestate-levelchangesinunintendedpreg-nancy,weexaminedatafromthePreg-nancyRiskAssessmentMonitoringSystem(PRAMS)forSouthCarolinaandothersoutheasternstatesanddatafromtheSoW.PRAMSisanongoingpopulation-basedsurveillancesystemofmotherswhorecentlygavebirthtoalive-borninfant.17Aregression-baseddifference-in-differencesapproachwillbeusedtoestimateCWeffectsonunin-tendedpregnancyandotheroutcomes.Births,teenbirths,andabortions.ToexamineCW’simpactonbirths,weusebirthcertificatedatafromallUSstateslinkedwiththeAreaHealthServicesResourcesFiletoaccountfortheinflu-enceofsocialandcommunitycontextsontheoutcomes.18Abortionisexam-inedinvitalrecordsdataatthestatelevel.Wewilluseaninterruptedtime-seriesstudydesignwithmultiplenon-equivalentormatchedcomparisongroupstomeasurepopulation-basedshiftsintheseoutcomes.Reproductivewell-being.Contraceptivedecision-makingandaccesstoinforma-tion,services,andsupportstomakethesedecisionswillbeexaminedwithinthelongitudinalstudyoffamilyplan-ningpatients.PUBLICHEALTHSIGNIFICANCEStatewidecontraceptiveaccessinitia-tiveshaveshownpromiseinincreasingtheavailabilityofafullrangeofcontra-ceptivemethods,resultinginincreasedcontraceptiveuse.19–21Thereisalsoevi-dencethattheseinitiativescanimpactoutcomes,includingabortions,teenbirths,andpretermbirths.19,21,22SouthCarolinaisthefirstsoutheastern,politi-callyconservativestatetoinstituteastatewidecontraceptiveaccessinitiativeofthismagnitude.CWcontinuesunderitscurrentfund-ingstructurethroughtheendof2022.TheevaluationofCWcontinuesinto2025.TheevaluationiswellpositionedtoassesskeyoutputsandimpactsassociatedwithCWandtocontributetotheevidencebaseforcontraceptiveaccessinitiatives.CORRESPONDENCECorrespondenceshouldbesenttoMichaelG.Smith,POBox70264,JohnsonCity,TN37614(e-mail:smithmg1@etsu.edu).Reprintscanbeorderedathttp://www.ajph.orgbyclickingthe“Reprints”link.PUBLICATIONINFORMATIONFullCitation:SmithMG,HaleN,KelleyS,SatterfieldK,BeattyKE,KhouryAJ.SouthCarolina’sChooseWellinitiativetoreduceunintendedpreg-nancy:rationale,implementationdesign,andevalua-tionmethodology.AmJPublicHealth.2022;112(S5):S484–S489.AcceptanceDate:April7,2022.DOI:https://doi.org/10.2105/AJPH.2022.306889CONTRIBUTORSM.G.Smithcoordinatedthedevelopmentofthemanuscript,wrotethefirstdraftoftheChooseWellevaluationcomponents,criticallyeditedallsectionsofthemanuscript,andapprovedthefinalmanuscript.S.KelleyandK.SatterfieldwrotethefirstdraftoftheChooseWellimplementationcomponents,criticallyeditedthemanuscript,andapprovedthefinalmanuscript.N.Halecontrib-utedtotheevaluationframework,criticallyeditedallsectionsofthemanuscript,andapprovedthefinalmanuscript.K.E.Beattycriticallyeditedallsectionsofthemanuscriptandapprovedthefinalmanuscript.A.J.Khouryconceptualizedandover-seestheChooseWellevaluation,contributedtotheevaluationframework,criticallyeditedallsec-tionsofthemanuscript,andapprovedthefinalmanuscript.ACKNOWLEDGMENTSThisworkwasfundedbyaprivatephilanthropicfoundation.TheauthorsthankBonnieKappforhereffortsindevelopingandleadingtheChooseWellinitia-tive.TheauthorsalsothankKatieBaker,JoelHill-house,andDebbiSlawsonfortheireffortsinleadingmajorcomponentsoftheChooseWellevaluation.Finally,theauthorsthankthepeopleofreproductiveage,healthcareproviders,andadministratorswhohavecontributedtotheeffortstodevelop,implement,andevaluatetheChooseWellinitiative.CONFLICTSOFINTERESTS.KelleyandK.SatterfieldareemployedbyNewMorning,thenonprofitorganizationthatisimple-mentingChooseWellinSouthCarolina.Theotherauthorshavenoconflictsofinteresttodeclare.HUMANPARTICIPANTPROTECTIONAllevaluationeffortsdescribedhavebeenreviewedandapprovedorexemptedbytheinstitutionalreviewboardatEastTennesseeStateUniversity.REFERENCES1.NewMorning.Homepage.Availableat:https://newmorning.org.AccessedMarch10,2022.2.KaniaJ,KramerM.Collectiveimpact.StanfordSocInnovationRev.Winter2011.Availableat:https://ssir.org/articles/entry/collective_impact.AccessedNovember18,2021.OPINIONS,IDEAS,&PRACTICES488EditorialSmithetal.AJPHSupplement5,2022,Vol112,No.S5
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