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Article ; Online: Estimating the prevalence of and characteristics associated with prescription opioid diversion among a clinic population living with HIV: Indirect and direct questioning techniques.

Canan, Chelsea E / Chander, Geetanjali / Moore, Richard / Alexander, G Caleb / Lau, Bryan

2020 Volume 219, Page(s) 108398

Abstract: Background: Evidence suggests that over 50 % of individuals who used prescription opioids non-medically obtained their prescription from friends or family. Despite its high consequence, reliable opioid diversion prevalence estimates are lacking due to ... ...

Abstract	Background: Evidence suggests that over 50 % of individuals who used prescription opioids non-medically obtained their prescription from friends or family. Despite its high consequence, reliable opioid diversion prevalence estimates are lacking due to social desirability bias. We used indirect questioning, a technique designed to measure sensitive behaviors, to assess the prevalence of prescription opioid diversion among a cohort of individuals with HIV. Methods: We randomized 581 participants from a large urban HIV clinical cohort to answer either a direct or indirect question about opioid diversion between October 2016-July 2018. We estimated the prevalence of diversion under each method. We also estimated diversion prevalence in subsets of the sample by age, sex, race, HIV risk group, substance use, and mental health co-morbidities. Results: Of 1,285 patients screened, 581 (45.2 %) reported ever having received an opioid prescription. Of these, 252 (43.4 %) directly answered whether they had ever diverted opioids and 313 (53.9 %) answered the indirect question. The prevalence of opioid diversion under direct and indirect questioning was 6.3 % (95 % CI 3.7 %-10.1 %) and 15.3 % (95 % CI 10.4 %-20.3 %), respectively. In unadjusted analyses, males, non-African Americans, and patients with a history of illicit drug use had a higher diversion prevalence. In adjusted analyses, ever having used cocaine was most associated with diversion (OR 15.67, 95 % CI 0.93-263.17). Conclusions: Opioid diversion was common among this population, with the estimated prevalence more than doubling under the indirect questioning method designed to elicit less biased responses.
MeSH term(s)	Adult ; Ambulatory Care Facilities ; Analgesics, Opioid/therapeutic use ; Cohort Studies ; Female ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Humans ; Male ; Middle Aged ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Prescriptions/statistics & numerical data ; Prevalence ; Risk Factors
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2020-11-12
Publishing country	Ireland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2020.108398
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Article ; Online: An Implementation Strategy to Expand Mobile Health Use in HIV Care Settings: Rapid Evaluation Study Using the Consolidated Framework for Implementation Research.

Cohn, Wendy F / Canan, Chelsea E / Knight, Sarah / Waldman, Ava Lena / Dillingham, Rebecca / Ingersoll, Karen / Schexnayder, Julie / Flickinger, Tabor E

JMIR mHealth and uHealth

2021 Volume 9, Issue 4, Page(s) e19163

Abstract: Background: Mobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. PositiveLinks (PL) is a clinic-deployed mHealth app designed to improve ... ...

Abstract	Background: Mobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. PositiveLinks (PL) is a clinic-deployed mHealth app designed to improve the health of people with HIV. In a pilot study, PL users experienced considerable improvements in care engagement and viral load suppression. To promote its expansion to other HIV clinics, we developed an implementation strategy consisting of training resources and on-demand program support. Objective: The objective of our study was to conduct an interim analysis of the barriers and facilitators to PL implementation at early adopting sites to guide optimization of our implementation strategy. Methods: Semistructured interviews with stakeholders at PL expansion sites were conducted. Analysis of interviews identified facilitators and barriers that were mapped to 22 constructs of the Consolidated Framework for Implementation Research (CFIR). The purpose of the analysis was to identify the facilitators and barriers to PL implementation in order to adapt the PL implementation strategy. Four Ryan White HIV clinics were included. Interviews were conducted with one health care provider, two clinic managers, and five individuals who coordinated site PL activities. Results: Ten common facilitators and eight common barriers were identified. Facilitators to PL implementation included PL's fit with patient and clinic needs, PL training resources, and sites' early engagement with their information technology personnel. Most barriers were specific to mHealth, including access to Wi-Fi networks, maintaining patient smartphone access, patient privacy concerns, and lack of clarity on how to obtain approvals for mHealth use. Conclusions: The CFIR is a useful framework for evaluating mHealth interventions. Although PL training resources were viewed favorably, we identified important barriers to PL implementation in a sample of Ryan White clinics. This enabled our team to expand guidance on identifying information technology stakeholders and procuring and managing mobile resources. Ongoing evaluation results continue to inform improvements to the PL implementation strategy, facilitating PL access for future expansion sites.
MeSH term(s)	HIV Infections/therapy ; Health Personnel ; Humans ; Mobile Applications ; Pilot Projects ; Telemedicine
Language	English
Publishing date	2021-04-28
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2719220-9
ISSN	2291-5222 ; 2291-5222
ISSN (online)	2291-5222
ISSN	2291-5222
DOI	10.2196/19163
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Article ; Online: Long term impact of PositiveLinks: Clinic-deployed mobile technology to improve engagement with HIV care.

Canan, Chelsea E / Waselewski, Marika E / Waldman, Ava Lena D / Reynolds, George / Flickinger, Tabor E / Cohn, Wendy F / Ingersoll, Karen / Dillingham, Rebecca

PloS one

2020 Volume 15, Issue 1, Page(s) e0226870

Abstract: Background: PositiveLinks (PL) is a smartphone-based platform designed in partnership with people living with HIV (PLWH) to improve engagement in care. PL provides daily medication reminders, check-ins about mood and stress, educational resources, a ... ...

Abstract	Background: PositiveLinks (PL) is a smartphone-based platform designed in partnership with people living with HIV (PLWH) to improve engagement in care. PL provides daily medication reminders, check-ins about mood and stress, educational resources, a community message board, and an ability to message providers. The objective of this study was to evaluate the impact of up to 24 months of PL use on HIV viral suppression and engagement in care and to examine whether greater PL use was associated with improved outcomes. Setting: This study occurred between September 2013 and March 2017 at a university-based Ryan White HIV clinic. Methods: We assessed engagement in care and viral suppression from study baseline to the 6-, 12-, 18- and 24-month follow-up time periods and compared trends among high vs. low PL users. We compared time to viral suppression, proportion of days virally suppressed, and time to engagement in care in patients with high vs. low PL use. Results: 127 patients enrolled in PL. Engagement in care and viral suppression improved significantly after 6 months of PL use and remained significantly improved after 24 months. Patients with high PL use were 2.09 (95% CI 0.64-6.88) times more likely to achieve viral suppression and 1.52 (95% CI 0.89-2.57) times more likely to become engaged in care compared to those with low PL use. Conclusion: Mobile technology, such as PL, can improve engagement in care and clinical outcomes for PLWH. This study demonstrates long-term acceptability of PL over two years and provides evidence for long-term improvement in engagement in care and viral suppression associated with PL use.
MeSH term(s)	Adult ; Ambulatory Care Facilities ; Anti-HIV Agents/pharmacology ; Anti-HIV Agents/therapeutic use ; Female ; HIV Infections/drug therapy ; HIV Infections/virology ; Humans ; Male ; Middle Aged ; Mobile Health Units ; Patient Education as Topic/methods ; Patient Participation/statistics & numerical data ; Smartphone ; Viral Load/drug effects
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2020-01-06
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0226870
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: An application of restricted mean survival time in a competing risks setting: comparing time to ART initiation by injection drug use.

Calkins, Keri L / Canan, Chelsea E / Moore, Richard D / Lesko, Catherine R / Lau, Bryan

BMC medical research methodology

2018 Volume 18, Issue 1, Page(s) 27

Abstract: Background: Restricted mean survival time (RMST) is an underutilized estimand in time-to-event analyses. Herein, we highlight its strengths by comparing time to (1) all-cause mortality and (2) initiation of antiretroviral therapy (ART) for HIV-infected ... ...

Abstract	Background: Restricted mean survival time (RMST) is an underutilized estimand in time-to-event analyses. Herein, we highlight its strengths by comparing time to (1) all-cause mortality and (2) initiation of antiretroviral therapy (ART) for HIV-infected persons who inject drugs (PWID) and persons who do not inject drugs. Methods: RMST to death was determined by integrating the Kaplan-Meier survival curve to 5 years of follow-up. To account for the competing risks of death and loss-to-clinic when estimating time to ART, we calculated RMST to ART initiation by estimating the area between the survival curve for ART initiation and the cumulative incidence curve for death or loss-to-clinic. We standardized all curves using inverse probability of exposure weights. Results: We followed 3044 HIV-positive, ART-naive persons from enrollment into the Johns Hopkins HIV Clinical Cohort from 1996 to 2014. PWID had a - 0.19 year (95% confidence interval (CI): - 0.29, - 0.10) difference in survival over 5 years of follow-up compared to persons who did not inject drugs. There was no difference between the two groups in time not on ART while alive and in clinic (RMST difference = 0.08, 95% CI: -0.10, 0.36). Conclusions: PWID have similar expected time to ART initiation after properly accounting for their greater risk of death and loss-to-clinic.
MeSH term(s)	Adult ; Anti-HIV Agents/therapeutic use ; Cohort Studies ; Female ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Risk Assessment/methods ; Risk Assessment/statistics & numerical data ; Risk Factors ; Substance Abuse, Intravenous/complications ; Survival Rate ; Time Factors
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2018-03-09
Publishing country	England
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural
ISSN	1471-2288
ISSN (online)	1471-2288
DOI	10.1186/s12874-018-0484-z
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: An Implementation Strategy to Expand Mobile Health Use in HIV Care Settings

Cohn, Wendy F / Canan, Chelsea E / Knight, Sarah / Waldman, Ava Lena / Dillingham, Rebecca / Ingersoll, Karen / Schexnayder, Julie / Flickinger, Tabor E

JMIR mHealth and uHealth, Vol 9, Iss 4, p e

Rapid Evaluation Study Using the Consolidated Framework for Implementation Research

2021 Volume 19163

Abstract: BackgroundMobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. PositiveLinks (PL) is a clinic-deployed mHealth app designed to improve the ... ...

Abstract	BackgroundMobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. PositiveLinks (PL) is a clinic-deployed mHealth app designed to improve the health of people with HIV. In a pilot study, PL users experienced considerable improvements in care engagement and viral load suppression. To promote its expansion to other HIV clinics, we developed an implementation strategy consisting of training resources and on-demand program support. ObjectiveThe objective of our study was to conduct an interim analysis of the barriers and facilitators to PL implementation at early adopting sites to guide optimization of our implementation strategy. MethodsSemistructured interviews with stakeholders at PL expansion sites were conducted. Analysis of interviews identified facilitators and barriers that were mapped to 22 constructs of the Consolidated Framework for Implementation Research (CFIR). The purpose of the analysis was to identify the facilitators and barriers to PL implementation in order to adapt the PL implementation strategy. Four Ryan White HIV clinics were included. Interviews were conducted with one health care provider, two clinic managers, and five individuals who coordinated site PL activities. ResultsTen common facilitators and eight common barriers were identified. Facilitators to PL implementation included PL’s fit with patient and clinic needs, PL training resources, and sites’ early engagement with their information technology personnel. Most barriers were specific to mHealth, including access to Wi-Fi networks, maintaining patient smartphone access, patient privacy concerns, and lack of clarity on how to obtain approvals for mHealth use. ConclusionsThe CFIR is a useful framework for evaluating mHealth interventions. Although PL training resources were viewed favorably, we identified important barriers to PL implementation in a sample of Ryan White clinics. This enabled our team to expand guidance on identifying information technology stakeholders and procuring and managing mobile resources. Ongoing evaluation results continue to inform improvements to the PL implementation strategy, facilitating PL access for future expansion sites.
Keywords	Information technology ; T58.5-58.64 ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2021-04-01T00:00:00Z
Publisher	JMIR Publications
Document type	Article ; Online
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Article ; Online: Toward understanding the impact of mHealth features for people with HIV: a latent class analysis of PositiveLinks usage.

Canan, Chelsea E / Flickinger, Tabor E / Waselewski, Marika / Tabackman, Alexa / Baker, Logan / Eger, Samuel / Waldman, Ava Lena D / Ingersoll, Karen / Dillingham, Rebecca

Translational behavioral medicine

2019 Volume 11, Issue 1, Page(s) 172–181

Abstract: PositiveLinks (PL) is a multi-feature smartphone-based platform to improve engagement-in-care and viral suppression (VS) among clinic patients living with HIV. Features include medication reminders, mood/stress check-ins, a community board, and secure ... ...

Abstract	PositiveLinks (PL) is a multi-feature smartphone-based platform to improve engagement-in-care and viral suppression (VS) among clinic patients living with HIV. Features include medication reminders, mood/stress check-ins, a community board, and secure provider messaging. Our goal was to examine how PL users interact with the app and determine whether usage patterns correlate with clinical outcomes. Patients (N = 83) at a university-based Ryan White clinic enrolled in PL from June 2016 to March 2017 and were followed for up to 12 months. A subset (N = 49) completed interviews after 3 weeks of enrollment to explore their experiences with and opinions of PL. We differentiated PL members based on 6-month usage of app features using latent class analysis. We explored characteristics associated with class membership, compared reported needs and preferences by class, and examined association between class and VS. The sample of 83 PL members fell into four classes. "Maximizers" used all app features frequently (27%); "Check-in Users" tended to interact only with daily queries (22%); "Moderate All-Feature Users" used all features occasionally (33%); and "As-Needed Communicators" interacted with the app minimally (19%). VS improved or remained high among all classes after 6 months. VS remained high at 12 months among Maximizers (baseline and 12-month VS: 100%, 94%), Check-in Users (82%, 100%), and Moderate All-Feature Users (73%, 94%) but not among As-Needed Communicators (69%, 60%). This mixed-methods study identified four classes based on PL usage patterns that were distinct in characteristics and clinical outcomes. Identifying and characterizing mHealth user classes offers opportunities to tailor interventions appropriately based on patient needs and preferences as well as to provide targeted alternative support to achieve clinical goals.
MeSH term(s)	HIV Infections/drug therapy ; Humans ; Latent Class Analysis ; Mobile Applications ; Smartphone ; Telemedicine
Language	English
Publishing date	2019-12-06
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2586893-7
ISSN	1613-9860 ; 1869-6716
ISSN (online)	1613-9860
ISSN	1869-6716
DOI	10.1093/tbm/ibz180
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Article: Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator Model.

Sherbuk, Jacqueline E / McManus, Kathleen A / Kemp Knick, Terry / Canan, Chelsea E / Flickinger, Tabor / Dillingham, Rebecca

Frontiers in public health

2019 Volume 7, Page(s) 362

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2019-11-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711781-9
ISSN	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2019.00362
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Article ; Online: Computer delivered intervention for alcohol and sexual risk reduction among women attending an urban sexually transmitted infection clinic: A randomized controlled trial.

Chander, Geetanjali / Hutton, Heidi E / Xu, Xiaoqiang / Canan, Chelsea E / Gaver, Jennifer / Finkelstein, Joseph / Lesko, Catherine R / McCaul, Mary E / Lau, Bryan

Addictive behaviors reports

2021 Volume 14, Page(s) 100367

Abstract: Objective: We sought to determine if a computer delivered brief alcohol intervention (CBI) with or without interactive voice response counseling and text messages (CBI-IVR-TM), reduced alcohol use and sexual risk behaviors compared to attention control.! ...

Abstract	Objective: We sought to determine if a computer delivered brief alcohol intervention (CBI) with or without interactive voice response counseling and text messages (CBI-IVR-TM), reduced alcohol use and sexual risk behaviors compared to attention control. Methods: We conducted a 3-arm RCT among women (n = 439) recruited from Baltimore City Sexually Transmitted Infection (STI) Clinics. Eligibility included: 1) consumption of >7 drinks per week or 2) ≥2 episodes of heavy episodic drinking or ≥2 episodes of sex under the influence of alcohol in the prior three months. Research assessments conducted at baseline, 3, 6 and 12 months included a 30-day Timeline Followback querying daily alcohol use, drug use, and sexual activity. We used the MINI International Neuropsychiatric Interview-DSM-IV to ascertain drinking severity. Primary alcohol outcomes included: drinking days, heavy drinking days, drinks per drinking day. Secondary sexual risk outcomes included number of sexual partners, days of condomless sex, and days of condomless sex under the influence of drugs and alcohol. Results: Median age was 31 (IQR 25-44 years), 88% were African American, 65% reported current recreational drug use, and 26% endorsed depressive symptoms. On the MINI 66% met criteria for alcohol use disorder (49% alcohol dependence, 18% abuse). At follow-up, all three groups reduced drinking days, heavy drinking days, drinks per drinking day and drinks per week with no significant differences between study arms. There was no difference in sexual risk outcomes among the groups. Conclusions: Among women attending an urban STI clinic single session CBI with or without IVR and text message boosters was insufficient to reduce unhealthy alcohol use or sexual risk behaviors beyond control. The high severity of alcohol use and the prevalence of mental health symptoms and other substance use comorbidity underscores the importance of developing programs that address not only alcohol use but other determinants of STI risk among women.
Language	English
Publishing date	2021-07-06
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2831558-3
ISSN	2352-8532 ; 2352-8532
ISSN (online)	2352-8532
ISSN	2352-8532
DOI	10.1016/j.abrep.2021.100367
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Article ; Online: High-Risk Prescription Opioid Use Among People Living With HIV.

Canan, Chelsea E / Chander, Geetanjali / Monroe, Anne K / Gebo, Kelly A / Moore, Richard D / Agwu, Allison L / Alexander, G Caleb / Lau, Bryan

Journal of acquired immune deficiency syndromes (1999)

2018 Volume 78, Issue 3, Page(s) 283–290

Abstract: Background: Prescription opioid use is greater among people living with HIV (PLWH), yet little is known about the prevalence of specific types of high-risk use among these individuals.: Setting: We analyzed clinical and demographic data from the HIV ... ...

Abstract	Background: Prescription opioid use is greater among people living with HIV (PLWH), yet little is known about the prevalence of specific types of high-risk use among these individuals. Setting: We analyzed clinical and demographic data from the HIV Research Network and prescribing data from Medicaid for noncancer patients seeking HIV treatment at 4 urban clinics between 2006 and 2010. Methods: HIV Research Network patients were included in the analytic sample if they received at least one incident opioid prescription. We examined 4 measures of high-risk opioid use: (1) high daily dosage; (2) early refills; (3) overlapping prescriptions; and (4) multiple prescribers. Results: Of 4605 eligible PLWH, 1814 (39.4%) received at least one incident opioid prescription during follow-up. The sample was 61% men and 62% African American with a median age of 44.5 years. High-risk opioid use occurred among 30% of incident opioid users (high daily dosage: 7.9%; early refills: 15.9%; overlapping prescriptions: 16.4%; and multiple prescribers: 19.7%). About half of the cumulative incidence of high-risk use occurred within 1 year of receiving an opioid prescription. After adjusting for study site, high-risk opioid use was greater among patients with injection drug use as an HIV risk factor [adjusted hazard ratio (aHR) = 1.39, 95% confidence interval: 1.11 to 1.74], non-Hispanic whites [aHR = 1.61, (1.21 to 2.14)], patients age 35-45 [aHR = 1.94, (1.33 to 2.80)] and 45-55 [aHR = 1.84, (1.27 to 2.67)], and patients with a diagnosis of chronic pain [aHR = 1.32, (1.03 to 1.70)]. Conclusions: A large proportion of PLWH received opioid prescriptions, and among these opioid recipients, high-risk opioid use was common. High-risk use patterns often occurred within the first year, suggesting this is a critical time for intervention.
MeSH term(s)	Adult ; Analgesics, Opioid/administration & dosage ; Female ; HIV Infections/physiopathology ; Humans ; Incidence ; Male ; Middle Aged ; Risk Factors
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2018-03-27
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	645053-2
ISSN	1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
ISSN (online)	1944-7884 ; 1077-9450
ISSN	0897-5965 ; 0894-9255 ; 1525-4135
DOI	10.1097/QAI.0000000000001690
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Article ; Online: Health-related quality-of-life scores, spine-related symptoms, and reoperations in young adults 7 to 17 years after surgical treatment of adolescent idiopathic scoliosis.

Spanyer, Jonathan M / Crawford, Charles H / Canan, Chelsea E / Burke, Lauren O / Heintzman, Sara E / Carreon, Leah Y

American journal of orthopedics (Belle Mead, N.J.)

2015 Volume 44, Issue 1, Page(s) 26–31

Abstract: The goal of surgical treatment of adolescent idiopathic scoliosis (AIS) is to prevent disability associated with curve progression. Few investigators have considered whether the function of patients with AIS becomes adversely affected by major spine ... ...

Abstract	The goal of surgical treatment of adolescent idiopathic scoliosis (AIS) is to prevent disability associated with curve progression. Few investigators have considered whether the function of patients with AIS becomes adversely affected by major spine fusion surgery. Tertiary referral center patients (age, 10-17 years) who underwent spinal deformity correction a minimum of 5 years earlier were identified. Scoliosis Research Society-22R (SRS-22R) and Short Form-12 (SF-12) were administered. Data were available for 118 patients. Mean age was 14.1 years at surgery and 26.8 years at follow-up. Mean outcome scores were 50.9 (SF-12 physical composite summary), 49.4 (SF-12 mental composite summary), and 4.0 (SRS-22R total). One hundred patients (85%) were working. Common symptoms included occasional back pain (90, 76%), limited range of motion (52, 44%), activity limitations (54, 46%), waistline imbalance (41, 35%), rib prominence (28, 24%), wound/scar problems (18, 15%), and shortness of breath (18, 15%). Prominent implants were reported by 11 patients (9%). Seven of 14 reoperations were for instrumentation removal. There was a high incidence of occasional back pain and activity complaints after surgery for AIS in our cohort. However, normal SF-12 scores suggested that these symptoms did not lower the patients' general health.
MeSH term(s)	Adolescent ; Adult ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Quality of Life ; Radiography ; Recovery of Function ; Reoperation ; Scoliosis/complications ; Scoliosis/diagnostic imaging ; Scoliosis/surgery ; Spinal Fusion/adverse effects ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2015-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2365753-4
ISSN	1934-3418 ; 1078-4519
ISSN (online)	1934-3418
ISSN	1078-4519
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