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  1. Article ; Online: Understanding the Mental Health Impact of Previous Pregnancy Loss Among Currently Pregnant Veterans.

    Shapiro, Mary O / Kroll-Desrosiers, Aimee / Mattocks, Kristin M

    Women's health issues : official publication of the Jacobs Institute of Women's Health

    2023  Volume 33, Issue 4, Page(s) 422–427

    Abstract: Background: Pregnancy loss, including miscarriage and stillbirth, is common and associated with an increased risk for prenatal and postnatal depression, as well as posttraumatic stress disorder (PTSD). Racial disparities have been observed in pregnancy ... ...

    Abstract Background: Pregnancy loss, including miscarriage and stillbirth, is common and associated with an increased risk for prenatal and postnatal depression, as well as posttraumatic stress disorder (PTSD). Racial disparities have been observed in pregnancy loss, with Black women having higher rates of pregnancy loss and postnatal depression. However, no research to date has examined the mental health and demographic correlates of pregnancy loss within a veteran population.
    Method: The current study examined associations between pregnancy loss and mental health and demographic correlates among 1,324 pregnant veterans, of which 368 had a history of at least one stillbirth and/or miscarriage.
    Results: Veterans with a history of pregnancy loss, compared with those without, were more likely to have a diagnosis of anxiety (52.7% vs. 46.4%, p = .04), depression (62.5% vs. 50.8%, p = .0001), or PTSD (46.5% vs. 37.6%, p = .003); were more likely to report receiving mental health care during pregnancy (23.1% vs. 16.8%, p = .01); and were more likely to have experienced military sexual trauma (harassment: 56.5% vs. 49.9%, p = .04; rape: 38.9% vs. 29.3%, p = .0004). Results also indicated that Black veterans were more likely to report a history of pregnancy loss (32.1% vs. 25.3%, p = .01). Further, Black veterans were more likely to experience clinically meaningful prenatal depression symptoms (adjusted odds ratio: 1.90; 95% confidence interval: 1.42-2.54) after accounting for past loss and age in logistic regression models.
    Discussion: Taken together, findings from the present investigation corroborate previous research highlighting the deleterious impact of pregnancy loss and extend prior work by examining these associations among a diverse sample of pregnant veterans.
    MeSH term(s) Pregnancy ; Female ; Humans ; Veterans/psychology ; Mental Health ; Abortion, Spontaneous/epidemiology ; Depression, Postpartum ; Stillbirth ; Stress Disorders, Post-Traumatic/psychology ; Military Personnel/psychology
    Language English
    Publishing date 2023-04-24
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 1085396-0
    ISSN 1878-4321 ; 1049-3867
    ISSN (online) 1878-4321
    ISSN 1049-3867
    DOI 10.1016/j.whi.2023.03.006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Exploring the Acceptability of Expanded Perinatal Depression Care Practices Among Women Veterans.

    Kroll-Desrosiers, Aimee / Kinney, Rebecca L / Marteeny, Valerie / Mattocks, Kristin M

    Journal of general internal medicine

    2022  Volume 37, Issue Suppl 3, Page(s) 762–769

    Abstract: Background: Veterans receive obstetrical care from community-based providers contracted through the Veterans Health Administration (VA); however, Veterans remain eligible for VA mental healthcare in the perinatal period. To date, few studies have ... ...

    Abstract Background: Veterans receive obstetrical care from community-based providers contracted through the Veterans Health Administration (VA); however, Veterans remain eligible for VA mental healthcare in the perinatal period. To date, few studies have focused specifically on the mental health needs of Veterans during the perinatal period.
    Objective: To examine the acceptability of more comprehensive perinatal mental healthcare screening and treatment in VA care, we explored pregnant and postpartum Veteran perspectives of United States Preventive Services Task Force (USPSTF) recommendations that aim to expand mental health counseling for the prevention and treatment of perinatal depression.
    Design: Semi-structured interviews with pregnant and postpartum Veterans enrolled in VA care, integrated with quantitative survey data.
    Participants: Pregnant and postpartum Veterans (n=27) who had delivered infants or were due by February 2020.
    Approach: Framework analysis with an inductive approach was utilized to understand our data, interpret and code our transcripts, and develop themes.
    Key results: Fewer than half (44%) of the women reported seeing a mental health provider at the beginning of their pregnancy. We found that Veterans support USPSTF recommendations in the VA, consider mental healthcare to be very important during the perinatal period, would like better access to mental healthcare resources and peer support networks, and suggest that perinatal depression screening could be more extensive.
    Conclusions: These findings support the implementation of more comprehensive perinatal depression prevention policies and practices within VA care. Understanding the real-world feasibility and prevailing barriers to comprehensive perinatal depression care is needed to inform implementation of the USPSTF recommendations or a similar intervention tailored for VA care.
    MeSH term(s) Counseling ; Depression/diagnosis ; Depression/epidemiology ; Depression/therapy ; Female ; Humans ; Infant ; Mental Health Services ; Pregnancy ; United States/epidemiology ; United States Department of Veterans Affairs ; Veterans/psychology
    Language English
    Publishing date 2022-08-30
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-022-07573-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Care coordination for women veterans: bridging the gap between systems of care.

    Mattocks, Kristin M

    Medical care

    2015  Volume 53, Issue 4 Suppl 1, Page(s) S8–9

    MeSH term(s) Comprehensive Health Care/organization & administration ; Female ; Health Services Accessibility ; Health Services Needs and Demand ; Humans ; Organizational Policy ; Quality of Health Care ; United States ; United States Department of Veterans Affairs/organization & administration ; Veterans Health ; Women's Health
    Language English
    Publishing date 2015-04
    Publishing country United States
    Document type Editorial ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 411646-x
    ISSN 1537-1948 ; 0025-7079
    ISSN (online) 1537-1948
    ISSN 0025-7079
    DOI 10.1097/MLR.0000000000000339
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Evaluating an Enterprise-Wide Initiative to enhance healthcare coordination for rural women Veterans using the RE-AIM framework.

    Relyea, Mark R / Kinney, Rebecca L / DeRycke, Eric C / Haskell, Sally / Mattocks, Kristin M / Bastian, Lori A

    Frontiers in health services

    2024  Volume 3, Page(s) 1237701

    Abstract: Introduction: The Veterans Health Administration (VA) Office of Rural Health (ORH) and Office of Women's Health Services (OWH) in FY21 launched a three-year Enterprise-Wide Initiative (EWI) to expand access to preventive care for rural, women Veterans. ... ...

    Abstract Introduction: The Veterans Health Administration (VA) Office of Rural Health (ORH) and Office of Women's Health Services (OWH) in FY21 launched a three-year Enterprise-Wide Initiative (EWI) to expand access to preventive care for rural, women Veterans. Through this program, women's health care coordinators (WHCC) were funded to coordinate mammography, cervical cancer screening and maternity care for women Veterans at selected VA facilities. We conducted a mixed-methods evaluation using the RE-AIM framework to assess the program implementation.
    Materials and methods: We collected quantitative data from the 14 program facilities on
    Results: Reach
    Implications: In rural areas, WHCCs can play a critical role in increasing
    Language English
    Publishing date 2024-01-12
    Publishing country Switzerland
    Document type Journal Article
    ISSN 2813-0146
    ISSN (online) 2813-0146
    DOI 10.3389/frhs.2023.1237701
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Examining Veterans' Experiences With In Vitro Fertilization Provided Under P.L. 114-223.

    Mattocks, Kristin M / Marteeny, Valerie / Walker, Lorrie / Kroll-Desrosiers, Aimee / Mengeling, Michelle

    Medical care

    2023  Volume 61, Issue 4, Page(s) 192–199

    Abstract: Background: Until recently, the Department of Veterans Affairs (VA) medical benefits package has expressly excluded in vitro fertilization (IVF) services for Veterans experiencing fertility problems. However, P.L. 114-223 (2016) allows VHA to provide ... ...

    Abstract Background: Until recently, the Department of Veterans Affairs (VA) medical benefits package has expressly excluded in vitro fertilization (IVF) services for Veterans experiencing fertility problems. However, P.L. 114-223 (2016) allows VHA to provide Assisted Reproductive Technology, including IVF, to certain eligible Veterans. Little is known regarding Veterans' experiences accessing IVF through VA Community Care contracts with IVF providers.
    Objective: To examine Veterans' experiences with IVF services provided under the auspices of P.L. 114-223.
    Research design: Telephone or video interviews were conducted with male and female Veterans and opposite-sex spouses of Veterans who had been approved for IVF. Interviews were recorded, transcribed, and analyzed using content analysis techniques. Major themes and representative quotes were derived from the analyses.
    Results: Ninety-six Veterans and 14 spouses participated in our interviews. Six major themes arose from these interviews, including (1) the need for improved communication regarding IVF benefits, (2) the need for expanded IVF benefits, (3) the lack of a comprehensive care coordination program, (4) poor access to IVF providers in some areas of the country, (5) special services needed for Veterans with spinal cord injuries, and (6) the IVF policy may be discriminatory in nature to single and LGBTQ Veterans.
    Conclusions: Many Veterans with service-connected conditions related to reproductive health have taken advantage of the IVF benefit, though limitations on these benefits have prevented other Veterans from taking advantage of the IVF benefit. Further attention needs to be paid to improving communication and coordination of IVF services with ongoing VA care and ensuring special populations, including those living in rural areas and Veterans with spinal cord injuries, have access to IVF services as needed.
    MeSH term(s) United States ; Humans ; Male ; Female ; Veterans ; United States Department of Veterans Affairs ; Veterans Health ; Fertilization in Vitro ; Fertilization ; Health Services Accessibility
    Language English
    Publishing date 2023-01-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 411646-x
    ISSN 1537-1948 ; 0025-7079
    ISSN (online) 1537-1948
    ISSN 0025-7079
    DOI 10.1097/MLR.0000000000001831
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  6. Article ; Online: Infertility Services for Veterans Enrolled in Veterans Health Administration Care.

    Kroll-Desrosiers, Aimee / Copeland, Laurel A / Mengeling, Michelle A / Mattocks, Kristin M

    Journal of general internal medicine

    2023  Volume 38, Issue 10, Page(s) 2347–2353

    Abstract: Background: Infertility care is provided to Veterans through the Veterans Health Administration (VHA) medical benefits package and includes infertility evaluation and many infertility treatments.: Objective: Our objective was to examine the incidence ...

    Abstract Background: Infertility care is provided to Veterans through the Veterans Health Administration (VHA) medical benefits package and includes infertility evaluation and many infertility treatments.
    Objective: Our objective was to examine the incidence and prevalence of infertility diagnoses and the receipt of infertility healthcare among Veterans using Veterans Health Administration (VHA) healthcare from 2018 to 2020.
    Methods: Veterans using the VHA and diagnosed with infertility during October 2017-September 2020 (FY18-20) were identified in VHA administrative data and through VA-purchased care (i.e., community care) claims. Infertility was categorized among men as azoospermia, oligospermia, and other and unspecified male infertility, and among women as anovulation, infertility of tubal origin, infertility of uterine origin, and other and unspecified female infertility using diagnosis and procedure codes (ICD-10, CPT).
    Key results: A total of 17,216 Veterans had at least one VHA infertility diagnosis in FY18, FY19, or FY20, including 8766 male Veterans and 8450 female Veterans. Incident diagnoses of infertility were observed in 7192 male Veterans (10.8/10,000 person (p)-years) and 5563 female Veterans (93.6/10,000 p-years). A large proportion of Veterans who were diagnosed with infertility received an infertility-related procedure in the year of their incident diagnosis (males: 74.7, 75.3, 65.0%, FY18-20 respectively; females: 80.9, 80.8, 72.9%, FY18-20 respectively).
    Conclusions: In comparison to a recent study of active duty servicemembers, we found a lower rate of infertility among Veteran men and a higher rate among Veteran women. Further work is needed to investigate military exposures and circumstances that may lead to infertility. Given the rates of infertility among Veterans and active duty servicemembers, enhancing communications between Department of Defense and VHA systems regarding sources of and treatment for infertility is essential to help more men and women benefit from infertility care during military service or as Veterans.
    MeSH term(s) United States/epidemiology ; Female ; Humans ; Male ; Veterans ; Veterans Health ; United States Department of Veterans Affairs ; Military Personnel ; Infertility
    Language English
    Publishing date 2023-02-21
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-023-08080-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Musculoskeletal Pain During Pregnancy Among Veterans: Associations With Health and Health Care Utilization.

    Kroll-Desrosiers, Aimee / Wallace, Kate F / Higgins, Diana M / Martino, Steve / Mattocks, Kristin M

    Women's health issues : official publication of the Jacobs Institute of Women's Health

    2023  Volume 34, Issue 1, Page(s) 90–97

    Abstract: Introduction: Musculoskeletal (MSK) pain is more likely to be diagnosed in veterans compared with the general population; however, MSK pain during pregnancy has not been studied in veterans. This study examined health and health care use differences ... ...

    Abstract Introduction: Musculoskeletal (MSK) pain is more likely to be diagnosed in veterans compared with the general population; however, MSK pain during pregnancy has not been studied in veterans. This study examined health and health care use differences between pregnant veterans with and without MSK pain (MSK-).
    Methods: Veterans who delivered a newborn before June 1, 2021, were identified from an existing cohort (n = 1,181). Survey and Veterans Health Administration (VA) electronic health record data were obtained on participants. Veterans meeting inclusion criteria were identified as those with MSK pain (MSK+) and were compared with MSK- participants. We examined differences between primary outcomes of VA health care engagement (including mental health diagnoses, health care visits, receipt of prescription opioids, and complementary and integrative health use) and secondary outcomes (including postpartum variables) between MSK pain groups. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.
    Results: There were 172 veterans (14.6%) who met MSK pain eligibility criteria. In adjusted models, MSK+ veterans were more likely to be diagnosed with major depressive disorder (aOR, 1.76; 95% CI, 1.22-2.53) and post-traumatic stress disorder (aOR, 1.79; 95% CI, 1.21-2.64) during pregnancy compared with MSK- veterans. The use of VA mental health care (aOR, 1.52; 95% CI, 1.09-2.12) and the odds of receiving an opioid prescription during pregnancy (aOR, 2.76; 95% CI, 1.53-5.00) was higher in MSK+ veterans compared with MSK- veterans. Only a small proportion (3.6%) of our entire cohort used complementary and integrative health approaches during pregnancy. MSK+ veterans were more likely to deliver by cesarean section compared with MSK- veterans (36% vs. 26%).
    Conclusions: MSK+ veterans were more likely to be diagnosed with mental health conditions and to use VA mental health care during pregnancy compared with MSK- veterans. Because veterans receive their obstetrical care in the community, understanding the unique needs of pregnant MSK+ veterans in comparison with MSK- veterans is important to provide comprehensive care during the perinatal period.
    MeSH term(s) United States/epidemiology ; Infant, Newborn ; Humans ; Female ; Pregnancy ; Veterans/psychology ; Musculoskeletal Pain/epidemiology ; Cesarean Section ; Depressive Disorder, Major ; United States Department of Veterans Affairs ; Patient Acceptance of Health Care ; Analgesics, Opioid/therapeutic use ; Veterans Health
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2023-08-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1085396-0
    ISSN 1878-4321 ; 1049-3867
    ISSN (online) 1878-4321
    ISSN 1049-3867
    DOI 10.1016/j.whi.2023.07.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Perinatal Symptoms and Treatment Engagement in Female Veterans.

    Anderson, Elizabeth H / Morrow, Carolyn / Mattocks, Kristin M / Shivakumar, Geetha

    Military medicine

    2021  Volume 188, Issue 3-4, Page(s) e468–e472

    Abstract: Introduction: Women veterans using Veterans Health Care Administration maternity benefits have a high prevalence of mental health disorders, including depression, PTSD, and anxiety. Additionally, women with psychiatric histories often experience a ... ...

    Abstract Introduction: Women veterans using Veterans Health Care Administration maternity benefits have a high prevalence of mental health disorders, including depression, PTSD, and anxiety. Additionally, women with psychiatric histories often experience a relapse or worsening of symptoms during pregnancy and postpartum. Adequate perinatal mental healthcare engagement is critical to optimizing outcomes for mother and child.
    Materials and methods: This study evaluated psychiatric symptom severity and predictors of women veteran's mental health treatment engagement during pregnancy and postpartum at the VA North Texas Health Care System. Seventy women using Veterans Health Administration were assessed longitudinally via chart review and interviews (including the Edinburgh Postnatal Depression Scale) during pregnancy and postpartum. A Friedman test was used to evaluate the change in symptom severity during (1) the 6 months before pregnancy, (2) pregnancy, and (3) postpartum. Multivariate logistic regressions were used to determine predictors of attending outpatient mental health appointments. Potential predictors examined included sociodemographic factors, symptoms of depression, history of military sexual assault, presence of a pre-pregnancy psychiatric diagnosis, and attendance of mental health appointments before pregnancy.
    Results: Approximately 40% of participants demonstrated at least mild psychiatric symptoms before pregnancy, and symptom severity did not significantly change across the perinatal period (pre-pregnancy, pregnancy, and postpartum) X2 (2, n = 70) = 3.56, P = .17. Depressive symptoms during the 2nd or 3rd trimester were a significant predictor for attendance of mental health appointments during both pregnancy (OR = 1.18, 95% CI, 1.04 to 1.34) and postpartum (OR = 1.18, 95% CI, 1.02 to 1.36). An active psychiatric diagnosis during the 6 months before pregnancy was also a significant predictor of attendance following delivery (OR = 14.63, 95% CI, 1.55 to 138.51).
    Conclusion: Our results demonstrate that women with prior histories of mental health conditions will continue to be symptomatic, and this is a good predictor of mental health treatment engagement during the perinatal period.
    MeSH term(s) Child ; Female ; Pregnancy ; Humans ; Veterans/psychology ; Parturition ; Anxiety/psychology ; Postpartum Period/psychology ; Anxiety Disorders ; Psychiatric Status Rating Scales ; Depression/epidemiology ; Depression/psychology
    Language English
    Publishing date 2021-07-09
    Publishing country England
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usab278
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  9. Article ; Online: Medications with Potential for Fetal Risk Prescribed to Veterans.

    Copeland, Laurel A / Kinney, Rebecca L / Kroll-Desrosiers, Aimee R / Shivakumar, Geetha / Mattocks, Kristin M

    Journal of women's health (2002)

    2022  Volume 31, Issue 10, Page(s) 1450–1458

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Child ; Humans ; Female ; Pregnancy ; Veterans/psychology ; Serotonin and Noradrenaline Reuptake Inhibitors/therapeutic use ; Selective Serotonin Reuptake Inhibitors/therapeutic use ; Antidepressive Agents/therapeutic use ; Depressive Disorder, Major/drug therapy ; Norepinephrine/therapeutic use
    Chemical Substances Serotonin and Noradrenaline Reuptake Inhibitors ; Serotonin Uptake Inhibitors ; Antidepressive Agents ; Norepinephrine (X4W3ENH1CV)
    Language English
    Publishing date 2022-03-23
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 1139774-3
    ISSN 1931-843X ; 1059-7115 ; 1540-9996
    ISSN (online) 1931-843X
    ISSN 1059-7115 ; 1540-9996
    DOI 10.1089/jwh.2021.0529
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  10. Article ; Online: Understanding opportunities and challenges with telemedicine-delivered buprenorphine during the COVID-19 pandemic.

    Mattocks, Kristin M / Moore, David T / Wischik, Dora Lendvai / Lazar, Christina M / Rosen, Marc I

    Journal of substance abuse treatment

    2022  Volume 139, Page(s) 108777

    Abstract: Introduction: Opioid use disorder (OUD) is a debilitating illness that remains a serious public health issue in the United States. Use of telemedicine to deliver medications for the treatment of OUD (MOUD) was limited until the confluence of the COVID- ... ...

    Abstract Introduction: Opioid use disorder (OUD) is a debilitating illness that remains a serious public health issue in the United States. Use of telemedicine to deliver medications for the treatment of OUD (MOUD) was limited until the confluence of the COVID-19 and opioid addiction epidemics in spring 2020. Starting in spring 2020, the Department of Veterans Health Affairs (VHA) transitioned from in-person to mostly telemedicine-delivered OUD care to reduce COVID-19 transmission among veterans and providers. To gain a nuanced understanding of provider perspectives on MOUD care delivery using telemedicine, we conducted semi-structured interviews with VHA providers who were using telehealth to deliver MOUD care.
    Methods: We conducted semi-structed Zoom interviews with VA clinicians at nine VA Medical Centers (VAMCs) in eight states. Potential study participants were identified as providers who were involved in referrals and provision of buprenorphine treatment for chronic pain and opioid addiction. Audio-recordings of all interviews were transcribed and entered into Atlas. Ti qualitative analysis software. The study team analyzed the transcripts for major themes related to tele-prescribing practices for buprenorphine.
    Results: Twenty-three VA providers participated in the study, representing 32% of all providers invited to participate in the study. The research team identified the following four themes: (1) COVID-19 spurred a seismic shift in OUD treatment; (2) Video calls provided a rare window into veterans' lives; (3) Providers experienced numerous challenges to virtual visits; and (4) Providers wrestled with paternalism and trust.
    Conclusions: The pandemic accelerated the movement toward harm reduction approaches. Prior to the pandemic, stringent requirements existed for patients receiving MOUD care. Providers in this study reflected on the need for these requirements (e.g., in-person visits, toxicology screens) and how reducing this monitoring implied more trust in patients' autonomous decisions. Providers' observation that videoconferencing offered them a window into patients' lives may offer some ways to improve rapport, and research should explore how best to incorporate the additional information conveyed in virtual visits.
    MeSH term(s) Buprenorphine/therapeutic use ; COVID-19 ; Humans ; Opioid-Related Disorders/drug therapy ; Pandemics ; Telemedicine ; United States
    Chemical Substances Buprenorphine (40D3SCR4GZ)
    Language English
    Publishing date 2022-03-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605923-5
    ISSN 1873-6483 ; 0740-5472
    ISSN (online) 1873-6483
    ISSN 0740-5472
    DOI 10.1016/j.jsat.2022.108777
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