Analysis of Position Papers for Vulnerable Populations
Analysis of Position Papers for Vulnerable Populations
Overview
Develop a 4–6-page position about a specific health care issue as it relates to a target vulnerable population. Include an analysis of existing evidence and position papers to help support your position. Your analysis should also present and respond to one or more opposing viewpoints.
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Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.
Position papers are a method to evaluate the most current evidence and policies related to health care issues. They offer a way for researchers to explore the views of any number of organizations around a topic. This can help you to develop your own position and approach to care around a topic or issue.
This assessment will focus on analyzing position papers about an issue related to addiction, chronicity, emotional and mental health, genetics and genomics, or immunity. Many of these topics are quickly evolving as technology advances, or as we attempt to push past stigmas. For example, technology advances and DNA sequencing provide comprehensive information to allow treatment to become more targeted and effective for the individual. However as a result, nurses must be able to understand and teach patients about the impact of this information. With this great power comes concerns that patient conditions are protected in an ethical and compassionate manner.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
- Competency 1: Design evidence-based advanced nursing care for achieving high-quality population outcomes.
- Evaluate the evidence and positions of others that could support a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.
- Evaluate the evidence and positions of others that are contrary to a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.
- Competency 2: Evaluate the efficiency and effectiveness of interprofessional interventions in achieving desired population health outcomes.
- Explain the role of the interprofessional team in facilitating improvements for a specific issue in a target population.
- Competency 3: Analyze population health outcomes in terms of their implications for health policy advocacy.
- Explain a position with regard to health outcomes for a specific issue in a target population.
- Competency 4: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.
- Communicate an initial viewpoint regarding a specific issue in a target population and a synthesis of existing positions in a logically structured and concise manner, writing content clearly with correct use of grammar, punctuation, and spelling.
- Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.
Position papers are a way for individuals, groups, and organizations to express their views and intentions toward a specific issue. In health care, many position papers address specific policies, regulations, or other approaches to care. As a master’s-prepared nurse, you should feel empowered to express and advocate for your own views on policy and care matters. This is especially important when it comes to populations you or your organization cares for that are not receiving the quality, type, or amount of care that they require.
An important skill in creating a position paper or policy proposal is the ability to analyze and synthesize others’ views about the population or issue of interest to you. By synthesizing the positive and negative views of an issue, you can become better equipped to strengthen your own arguments and to respond to opposing views in an informed and convincing way.
QUESTIONS TO CONSIDER
As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
Assessment 1 will be based on an analysis of position papers that are relevant to a health care issue related to a vulnerable population. Think about your experience working with vulnerable populations, and the issues related to health care you have observed for those populations, or reflect on the two Vila Health simulations in the Resources.
- What is the vulnerable population that most interests you?
- What is the health issue that is most prevalent or severe in the population?
- How does the health issue impact the daily lives of members of the population?
- How does the care environment in your chosen context impact both the population and the level of care related to the health issue?
- What are the biggest challenges that you would need to overcome to improve the outcomes for the population related to the health issue?
- What is your position on how to best work to improve the care and outcomes that the population is receiving?
- What previously published position papers support your position, or the need to work to improve care and outcomes in general for the population?
- How do these position papers support your assertions?
- How could one or more of the position papers help you to form a treatment plan?
- What previously published position papers contradict your position?
- What, if any, of these differences would make your position stronger if you incorporated them?
- How could you respond to any irreconcilable differences in such a way as to encourage buy-in for your position from those opposed?
- What previously published position papers support your position, or the need to work to improve care and outcomes in general for the population?
Assessment Instructions
Scenario
Pretend you are a member of an interprofessional team that is attempting to improve the quality of health care and the outcomes in a vulnerable population. For the first step in your team’s work, you have decided to conduct an analysis of current position papers that address the issue and population you are considering.
In your analysis you will note the team’s initial views on the issue in the population as well as the views across a variety of relevant position papers. You have been tasked with finding the most current standard of care or evidenced-based practice and evaluating both the pros and cons of the issue. For the opposing viewpoints, it is important to discuss how the team could respond to encourage support. This paper will be presented to a committee of relevant stakeholders from your care setting and the community. If it receives enough support, you will be asked to create a new policy that could be enacted to improve the outcomes related to your chosen issue and target population. Analysis of Position Papers for Vulnerable Populations
The care setting, population, and health care issue that you use for this assessment will be used in the other assessments in this course. Consider your choice carefully. There are two main approaches for you to take in selecting the scenario for this assessment:
- You may use one of the issues and populations presented in the Vila Health: Health Challenges in Different Populations and Vila Health: Resources for Topical Research media pieces. For this approach, you may consider the population in the context of the Vila Health care setting, or translate it into the context in which you currently practice or have had recent experience.
- You may select a population and issue that is of interest to you and set them in the context of your current or desired future care setting. While you are free to choose any population of interest, the issue you choose should fall within one of the following broad categories:
- Genetics and genomics.
- Sickle cell, asthma, multiple sclerosis, myasthenia gravis.
- Immunity.
- Type 1 diabetes, systemic lupus erythematosus (SLE), congenital neutropenia syndrome.
- Chronicity.
- Arthritis, any type of cancer or lung or heart disease, obesity.
- Addiction.
- Abuse of alcohol, prescription drugs, tobacco, illegal substances.
- Emotion and mental health.
- Post-traumatic stress disorder (PTSD), depression, eating disorders, psychosis.
- Genetics and genomics.
Note: If you choose the second option, contact the FlexPath faculty for your section to make sure that your chosen issue and population will fit within the topic areas for this course.
Instructions
For this assessment you will develop a position summary and an analysis of relevant position papers on a health care issue in a chosen population. The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your submission addresses all of them. You may also want to read the Analysis of Position Papers for Vulnerable Populations Scoring Guide and Guiding Questions: Analysis of Position Papers for Vulnerable Populations to better understand how each grading criterion will be assessed.
- Explain a position with regard to health outcomes for a specific issue in a target population.
- Explain the role of the interprofessional team in facilitating improvements for a specific issue in a target population.
- Evaluate the evidence and positions of others that could support a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.
- Evaluate the evidence and positions of others that are contrary to a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.
- Communicate an initial viewpoint regarding a specific issue in a target population and a synthesis of existing positions in a logically structured and concise manner, writing content clearly with correct use of grammar, punctuation, and spelling.
- Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.
Example Assessment: You may use the assessment example, linked in the Assessment Example section of the Resources, to give you an idea of what a Proficient or higher rating on the scoring guide would look like.
Additional Requirements
- Length of submission: 4–6 double-spaced, typed pages, not including the title and reference pages. Your plan should be succinct yet substantive. No abstract is required.
- Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that support your initial position on the issue, as well as a minimum of 2–3 sources of scholarly or professional evidence that express contrary views or opinions. Resources should be no more than five years old.
- APA formatting: Use the APA Style Paper Template linked in the Resources. An APA Style Paper Tutorial is also provided to help you in writing and formatting your analysis.
GRADING RUBRIC:
1- Explain a position with regard to health outcomes for a specific issue in a target population.
Passing Grade: Explains a position with regard to health outcomes for a specific issue in a target population, and identifies assumptions on which the plan is based.
2- Explain the role of the interprofessional team in facilitating improvements for a specific issue in a target population.
Passing Grade: Explains the role of the interprofessional team in facilitating improvements for a specific issue in a target population. Acknowledges challenges that the team may face in working together or in facilitating improvements.
3- Evaluate the evidence and positions of others that could support a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.
Passing Grade: Evaluates the evidence and positions of others that could support a team’s approach to improving the quality and outcomes of care for a specific issue in a target population. Identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the evaluation).
4- Evaluate the evidence and positions of others that are contrary to a team’s approach for improving the quality and outcomes of care for a specific issue in a target population.
Passing Grade: Evaluates the evidence and positions of others that are contrary to a team’s approach to improving the quality and outcomes of care for a specific issue in a target population. Impartially responds to conflicting data and other perspectives in a way that creates buy-in.
5- Communicate an initial viewpoint regarding a specific issue in a target population and a synthesis of existing positions in a logically structured and concise manner, writing content clearly with correct use of grammar, punctuation, and spelling.
Passing Grade: Communicates an initial viewpoint regarding a specific issue in a target population and synthesis of existing positions in a logically structured and concise manner, writing content clearly with correct use of grammar, punctuation, and spelling. Identifies specific strategies or approaches used to ensure clear communication.
6- Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.
Passing Grade: Integrates relevant sources to support assertions, correctly formatting citations and references using current APA style. Citations are free from all errors.
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cf_exemplar_MSN-FP6026_Assessment_1.pdfANALYSIS OF POSITION PAPERS 1
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Analysis of Position Papers for Vulnerable Populations
Learner’s Name
Capella University
Biopsychosocial Concepts for Advanced Nursing Practice II
Analysis of Position Papers for Vulnerable Populations
October, 2018
ANALYSIS OF POSITION PAPERS 2
Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
Analysis of Position Papers for Vulnerable Populations
As a group, veterans present a complicated, vulnerable population for the health care
industry. Reports show that more than half of the U.S. Department of Veterans Affairs’ primary
care patients state that they have pain, several of whom report chronic pain. Patients suffering
from chronic pain often have higher levels of medical utilization, more disability claims,
diminished productivity at work, and a poorer quality of life compared to patients who do not
suffer from chronic pain. Further, it has been observed that the latter present with higher rates of
alcohol and substance use disorders (Lovejoy, Dobscha, Turk, Weimer, & Morasco, 2016).
The need for pain management was advocated and discussed in the 1980s and 1990s.
Groups such as the WHO took a stand on how to address pain as a health care issue, particularly
with reference to how cancer and cancer treatment affects patient lives. It was argued that it is
unethical for any patient to be dying in pain, even if the treatment hastens death. This mandate
was initially meant for cancer patients with chronic pain; however, over time, it has been
extended to include chronic noncancer pain as well (Sullivan & Howe, 2013). One of the
treatments recommended at the time was using opioids to manage pain. However, studies have
since confirmed that a significant link exists between prescription opioid treatment and opioid
addiction (Compton, Jones, & Baldwin, 2016; Kolodny, Courtwright, Hwang, Kreiner, Eadie,
Clark, & Alexander, 2015; Volkow & McLellan, 2016). Veterans as a population are particularly
vulnerable in this situation given that many of them deal with both physiological pain and
psychological issues including post-traumatic stress disorder and substance abuse disorder
(Sullivan & Howe, 2013). It is then necessary to look for a solution that allows veterans dealing
with pain to manage it effectively and, further, to regulate and control the use of opioids to
minimize the risk of addiction as well as the potentially dangerous side effects of opioid use.
ANALYSIS OF POSITION PAPERS 3
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Pain Relief Management and the Opioid Crisis
The guidelines issued by the WHO and the Declaration of Montreal issued by the
International Association for the Study of Pain state that if patients suffer from chronic pain, it is
unethical to let them remain in pain (Sullivan & Howe, 2013). However, there is a line that
separates the management of pain and the abuse of medication. Studies have shown that opioids
do provide significant pain relief in modest doses over a short period of treatment. However, the
long-term efficacy of opioids for pain relief management has not been proven to be clinically
significant (Sehgal, Colson, & Smith, 2013).
The management of pain to improve quality of life and the possibility of medication
abuse and addiction are two sides of the opioid issue. The position that the American Academy
of Neurology takes on the issue reiterates earlier studies that show that the efficacy of opioid
medication might not extend to a long-term prescription of opioids. The current state of opioid
prescription practices has been associated with significant morbidity and high rates of mortality
(Franklin, 2014). On a similar note, The American Osteopathic Academy of Addiction Medicine
(n.d.) issued a public policy statement on the use of naloxone, an opioid antagonist that blocks
opioid receptor activation and, through this, reverses opioid overdoses by preventing or reversing
respiratory arrest.
The American Society of Addiction Medicine (2016) also suggests a similar course of
action in terms of educating individuals on the use of naloxone. It also encourages those close to
the individual experiencing an opioid overdose to educate themselves on how to detect the onset
of an overdose. The same association presents the rising statistics associated with prescription
opioids and the necessity of raising awareness about the dangers associated with opioids and
educating people on the treatment of an opioid overdose. The American Society of Addiction
ANALYSIS OF POSITION PAPERS 4
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Medicine recommends co-prescribing naloxone with opioids for people who might be at risk of
overdose and educating both the patient and those close to the patient on how to properly use a
naloxone kit.
Ethical Pain Management versus the Possibility of Addiction
The above papers focus on ensuring that the public and individuals prescribed opioids are
made aware of the dangers associated with the use of opioids. The addictive properties of opioids
and the epidemic of opioid overdoses that has spread over the past few decades are indicators of
the severity of the situation (Kolodny et al., 2015). The other side of the argument is that opioid
treatment is a necessity for many in chronic pain. In Sullivan and Howe’s 2013 study on opioid
therapy for chronic pain, the authors recount the history of the opioid crisis. The shift toward the
use of opioids in the treatment of pain was marked by the WHO issuance of guidelines for the
use of opioids in the context of pain relief for cancer patients in 1985 and 1996. This was
eventually extended to noncancer pain as well. The underlying logic at work was that chronic
noncancer pain could be debilitating to the same extent as cancer pain over longer periods of
time and with greater rates of prevalence. Analysis of Position Papers for Vulnerable Populations
There are two aspects to the counterargument presented by supporters of opioid
treatment. The first is that pain as a symptom or consequence of injury or illness can lead to
inferior quality of life, resulting in psychological difficulties and even impeding recovery
(Manjiani, Paul, Kunnumpurath, Kaye, & Vadivelu, 2014). The second aspect is that opioid
treatment potentially provides a long-term solution for chronic pain. This claim is made largely
as an extension of the efficacy that can be seen in short-term studies of opioid treatment
(Franklin, 2014).
ANALYSIS OF POSITION PAPERS 5
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However, as there exists very little evidence on the long-term efficacy of opioid
treatment, it becomes problematic that opioid treatment is already in practice to relieve chronic
noncancer pain. In the American Academy of Neurology’s position paper on the use of opioids
for chronic noncancer pain, Franklin (2014) analyzes both the rise of opioids as a treatment as
well as the epidemic of addiction and overdose that came about as a result of the advocacy for
opioid treatment. Aside from the dangers of addiction that individuals face, Franklin also
addresses the significant side effects that opioids present when taken over long durations,
including opioid-induced hyperalgesia, immunosuppression, infertility, and hypogonadism.
Newhouse states that opioid drugs were prescribed to over 400,000 veterans for pain
relief, which correlates to approximately 1.7 million opioid prescriptions (as cited in Snow &
Wynn, 2018). The effort to manage the chronic pain that veterans face, however, presents with
its own unique set of complications, particularly because of how widespread the use of opioid
treatment has become. Baser, Xie, Mardekian, Schaaf, Wang, and Joshi state that veterans are
approximately seven times more likely to abuse opioids than civilians (as cited in Snow &
Wynn, 2018). Further, opioids are more likely to be prescribed to individuals who have a history
of substance abuse and mental health issues, and this would result in unfavorable or harmful
outcomes such as drug abuse or opioid overdose (Howe & Sullivan, 2014). When considering
this with the prevalence of psychological issues and chronic physiological pain that many
veterans present with, it becomes apparent that long-term treatment with opioids for veterans is
not advisable.
Kissin found that 35% of veterans who were admitted to Tuscaloosa Veterans Affairs
Medical Center’s acute inpatient psychiatric unit presented with severe post-traumatic stress
disorder symptoms, coupled with issues such as suicidal ideation and mood disturbances. Kissin
ANALYSIS OF POSITION PAPERS 6
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also found that 25% of these veterans had an underlying case of opioid use disorder (as cited in
Snow & Wynn, 2018). To treat veterans such as these who are comorbid with chronic pain and
behavioral issues, it is necessary to integrate the psychological and the psychiatric into the model
of care to sufficiently address the overall health of the patient (Snow & Wynn, 2018). Such a
model would require physicians, psychologists, and psychiatrists to simultaneously address the
needs of the patient. One of the issues they might encounter is managing the patient’s
prescriptions. Denenberg and Curtis and Hawkins et al. note that opioids are contraindicated for
patients with substance-abuse issues (as cited in Snow & Wynn, 2018); physicians and mental
health specialists would have to come to some resolution to mediate the patient’s need for pain
relief and the patient’s potential for abuse of his or her medication.
Weiss et al. (2014) note that individuals who present with post-traumatic stress disorder
and substance abuse disorder are likely to use opioids to relieve negative emotional states, aid
sleep, or relieve pain. Crowley, Kirschner, Dunn, and Bornstein (2017) suggest that behavioral
health should be taken into consideration while evaluating the overall health of the individual.
The purpose of opioid treatment is to improve the patient’s quality of life with respect to the
reduction of pain. Therefore, there should be a simultaneous push toward counseling to address
the overall health of the individual and not solely focus on pain. This would involve coordination
between counselors and physicians who specialize in pain management to effectively improve
the quality of life for these patients. Analysis of Position Papers for Vulnerable Populations
Conclusion
The management of chronic pain with long-term opioid treatment involves significant
risk and does not have clinically significant evidence to support its use. Veterans present a
complicated population because many of them deal with mental health issues such as post-
ANALYSIS OF POSITION PAPERS 7
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traumatic stress disorder and substance abuse disorder as well as chronic pain. An analysis of
policies of various institutions and position papers on the use of opioids for pain management
brings into focus the severity of the opioid crisis. Most position papers take the stance that long-
term opioid treatment would not be advisable given the lack of evidence to support it. Further,
the abundance of public policy statements that advocate educating individuals on the use of
naloxone, an opioid antagonist, indicates the severity of the crisis in the present context. One
effective response to the existing crisis might be to simultaneously provide counseling along
with opioid treatment to address the individual’s overall health. The comorbidity of behavioral
issues and chronic pain in veterans indicates that they are a particularly vulnerable population,
with a high risk of addiction and prescription drug misuse. Therefore, to provide efficient,
holistic care, it is necessary to evaluate the efficacy of long-term opioid treatment and the
guidelines associated with it.
ANALYSIS OF POSITION PAPERS 8
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References
American Society of Addiction Medicine. (2016). Use of naloxone for the prevention of opioid
overdose deaths. Retrieved September 27, 2018, from https://asam.org/advocacy/find-a-
policy-statement/view-policy-statement/public-policy-statements/2014/08/28/use-of-
naloxone-for-the-prevention-of-drug-overdose-deaths
Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship between nonmedical
prescription-opioid use and heroin use. The New England Journal of Medicine, 374(2),
154–163. Retrieved from http://floridahealth.gov/statistics-and-data/e-forcse/news-
reports/_documents/NEJM-opioid-heroin-use.pdf
Crowley, R., Kirschner, N., Dunn, A. S., & Bornstein, S. S. (2017). Health and public policy to
facilitate effective prevention and treatment of substance use disorders involving illicit
and prescription drugs: An American College of Physicians position paper. Annals of
Internal Medicine, 166(10), 733–736. http://dx.doi.org/10.7326/M16-2953
Franklin, G. M. (2014). Opioids for chronic noncancer pain: A position paper of the American
Academy of Neurology. Neurology, 83(14), 1277–1284. Retrieved from
https://doi.org/10.1212/WNL.0000000000000839
Howe, C. Q., & Sullivan, M. D. (2014). The missing ‘P’ in pain management: How the current
opioid epidemic highlights the need for psychiatric services in chronic pain care. General
Hospital Psychiatry, 36(1), 99–104. https://doi.org/10.1016/j.genhosppsych.2013.10.003
Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., &
Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health
approach to an epidemic of addiction. Annual Review of Public Health, 36(1), 559–574.
https://doi.org/10.1146/annurev-publhealth-031914-122957
ANALYSIS OF POSITION PAPERS 9
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Lovejoy, T. I., Dobscha, S. K., Turk, D. C., Weimer, M. B., & Morasco, B. J. (2016). Correlates
of prescription opioid therapy in veterans with chronic pain and history of substance use
disorder. Journal of Rehabilitation Research and Development, 53(1), 25–36.
http://dx.doi.org/10.1682/JRRD.2014.10.0230
Manjiani, D., Paul, D. B., Kunnumpurath, S., Kaye, A. D., & Vadivelu, N. (2014). Availability
and utilization of opioids for pain management: Global issues. Ochsner Journal, 14(2),
208–215. Retrieved from
http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocvie
w%2F1541487990%3Faccountid%3D27965
Sehgal, N., Colson, J., & Smith, H. S. (2013). Chronic pain treatment with opioid analgesics:
Benefits versus harms of long-term therapy. Expert Review of Neurotherapeutics, 13(11),
1201–1220. http://dx.doi.org/10.1586/14737175.2013.846517
Snow, R., & Wynn, S. T. (2018). Managing opioid use disorder and co-occurring posttraumatic
stress disorder among veterans. Journal of Psychosocial Nursing and Mental Health
Services, 56(6), 36–42. http://dx.doi.org/10.3928/02793695-20180212-03
Sullivan, M. D., & Howe, C. Q. (2013). Opioid therapy for chronic pain in the US: Promises and
perils. Pain, 154(Suppl 1), S94–100. Retrieved from
https://ncbi.nlm.nih.gov/pmc/articles/PMC4204477/
The American Osteopathic Academy of Addiction Medicine. (n.d.). Naloxone public policy
statement: The use of naloxone for the prevention of opioid overdose deaths. Retrieved
from
https://c.ymcdn.com/sites/www.aoaam.org/resource/resmgr/Docs/AOAAM_NALOXON
E_POLICY_2015.pdf
ANALYSIS OF POSITION PAPERS 10
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Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain — misconceptions and
mitigation strategies. The New England Journal of Medicine, 374(13), 1253–1263.
Retrieved from http://pcpr.pitt.edu/wp-content/uploads/2018/01/Volkow-McLellan-
2016.pdf
Weiss, R. D., Potter, J. S., Griffin, M. L., McHugh, R. K., Haller, D., Jacobs, P., Rosen, K. D.
(2014). Reasons for opioid use among patients with dependence on prescription opioids:
The role of chronic pain. Journal of Substance Abuse Treatment, 47(2), 140–145.
http://doi.org/10.1016/j.jsat.2014.03.004
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