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Knowledge, Attitudes, And Practices (Kap) Of Parents Regarding The Prevention And Control Of Childhood Iron Deficiency Anemia In Egypt: A Cross-Sectional Study, Omnia Soliman

Theses and Dissertations

Childhood Iron Deficiency Anemia (IDA) remains a major public health challenge in Egypt, where its persistently high and rising prevalence carries substantial consequences for child growth, cognitive development, immunity, and long-term health outcomes. Globally, approximately 40% of children aged 6–59 months are affected by anemia (World Health Organization, 2025), and Egypt mirrors this burden, with national data showing a worsening trend in recent years. In Egypt, national strategies have traditionally focused on biomedical interventions such as iron supplementation and food fortification, while less attention has been directed toward behavioral and household-level determinants, particularly parental knowledge, attitudes, and practices (KAP) related …

Building Health Resilience Against The Threat Of “Jakarta Sinking”: A Scoping Review, Risky Kusuma Hartono, Dewi Shinta

Journal of Indonesian Health Policy and Administration

In Jakarta, land subsidence amplifies flood risks—often described as the city “sinking”—which increases exposure to waterborne and vector-borne diseases, disrupts essential health services, and undermines health system resilience. This review examines how subsidence-induced flood amplification impacts health and its implications for system resilience. This study employs a literature review approach that combines narrative synthesis with scoping-oriented evidence mapping. Peer-reviewed articles in English or Indonesian (2015–2025) were searched across PubMed, Scopus, ScienceDirect, Google Scholar, and Portal Garuda using the following terms: flooding, Jakarta land subsidence, health impacts, and health system resilience. Data on hazards, populations, health outcomes, and resilience functions were …

Burden And Prioritization Of Airborne Diseases In Bogor City, 2024: A Situational Analysis, Tuti Alawiyah, Helda Helda, Menikha Maulida

Jurnal Epidemiologi Kesehatan Indonesia

Indonesia, particularly urban agglomeration areas such as Bogor, continues to face major challenges related to air quality, resulting in an increased risk of airborne disease transmission. This study aimed to assess the burden of airborne diseases and determine health problem priorities in Bogor City using surveillance data from 2022 to October 2024. A descriptive epidemiological study was conducted in Bogor City using surveillance data from 2022 to 2024. Health problem prioritization was performed using the Pan American Health Organization (PAHO)-adapted Hanlon method through structured questionnaires administered to an expert panel consisting of health office officials and heads of primary healthcare …

Factors Associated With Hiv Infection Among People Who Inject Drugs In Jakarta, Igo Cahya Negara, Mondastri Korib Sudaryo, Helwiah Umniyati

Jurnal Epidemiologi Kesehatan Indonesia

HIV infection among people who inject drugs (PWID) remains a substantial public health burden, with Jakarta consistently reporting among the highest PWID-associated HIV prevalence in Indonesia. This study aimed to identify factors associated with HIV infection among PWID in Jakarta, utilizing secondary data from the 2023 Integrated Biological and Behavioral Survey (IBBS 2023). A cross-sectional study design was employed using secondary data from 261 PWID recruited in Jakarta. Bivariate associations were examined using Chi-square tests, and multivariate analysis was performed using modified Cox regression with a constant time parameter to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals. The …

Faktor-Faktor Yang Berhubungan Dengan Kepatuhan Minum Obat Anti Tuberkulosis (Oat) Di Kota Samarinda, Fahmi Nur Indah Sari, Irfansyah Baharuddin Pakki, Nur Rohmah, Siswanto Siswanto, Muhamad Z. Saefurrohim

Jurnal Epidemiologi Kesehatan Indonesia

Latar Belakang: Tuberkulosis (TB) merupakan penyakit menular yang masih menjadi masalah kesehatan masyarakat utama di Indonesia. Keberhasilan pengobatan sangat bergantung pada kepatuhan pasien dalam mengonsumsi Obat Antituberkulosis (OAT) .

Tujuan . Untuk mengetahui hubungan antara persepsi kerentanan, keparahan, manfaat, hambatan (stigma), isyarat untuk bertindak (peran tenaga kesehatan), dan efikasi diri dengan kepatuhan minum OAT pada pasien TB di Kota Samarinda.

Metode . Penelitian ini menggunakan desain potong lintang dengan pendekatan kuantitatif yang melibatkan 121 pasien TB dari empat Puskesmas di Samarinda. Sampel dipilih menggunakan teknik multistage sampling. Data dikumpulkan melalui wawancara terstruktur menggunakan kuesioner dan dianalisis menggunakan uji Chi-Square.

Hasil …

Plasmodium Falciparum Parasite Density And Its Association With Malaria Rapid Diagnostic Test Positivity Among School-Aged Children Across Diverse Malaria Transmission Settings In Mainland Tanzania, Felista Mwingira

Tanzania Journal of Science

Malaria rapid diagnostic tests (mRDTs) are widely used for malaria diagnosis and surveillance; however, their performance is influenced by parasite density. This study assessed the relationship between parasite density and mRDT positivity among school-aged children (SAC) across diverse malaria transmission settings in mainland Tanzania. Data were obtained from 17,131 school-aged children participating in a nationwide malaria survey. Malaria infection was assessed using mRDT and quantitative polymerase chain reaction (qPCR) targeting the Plasmodium falciparum lactate dehydrogenase (PfLDH) gene. Parasite density distributions were examined across demographic, environmental, and epidemiological characteristics. Malaria prevalence was 19.5% by malaria rapid diagnostic test (mRDT) and 19.2% …

Evaluation Of Disaster Mitigation Policy Implementation And Public Health Integration Through The “Sipatokkong” Program In Strengthening Tourism Village Resilience, Nurul Azisah Sahrani, Andi Alif Raihan Analta

Journal of Indonesian Health Policy and Administration

Disaster risks in tourism villages are increasing, generating multidimensional impacts on environmental, economic, institutional, and public health. In late 2024, Mattabulu Tourism Village experienced an 83% decline in tourist visits following a series of disasters, disrupting tourism activities and weakening local governance capacity. This study uses a qualitative case study design to evaluate disaster mitigation policy implementation through the “Sipatokkong” Program. Evaluation applied four Organisation for Economic Co-operation and Development–Development Assistance Committee (OECD-DAC) criteria: relevance, effectiveness, impact, and sustainability, operationalized through policy implementation, street-level bureaucracy, and collaborative governance frameworks. Data were obtained from five documents and non-participatory field observations conducted …

Intimate Partner Violence And Child Wasting Across Countries: An Ecological Cross-Sectional Study, Wanri Lumbanraja, I Ketut Kasta Arya Wijaya, Ruben Cornelius Siagian

Journal of Indonesian Health Policy and Administration

Intimate partner violence (IPV) is a public health issue that can affect the well-being of women, their families, and the child-rearing environment. Meanwhile, wasting in under-five children reflects acute malnutrition linked to food insecurity, infectious diseases, poverty, and access to healthcare services. This study aimed to analyze the relationship between the prevalence of IPV among women in the past 12 months and the prevalence of wasting in children under the age of five at the national level. This study addresses the gap in cross-national research, which remains limited in linking IPV as an indicator of social vulnerability with wasting as …

Perceived Susceptibility And Automatic Compliance In Indonesia's Triple Elimination Screening: A Mixed-Methods Study, Ratna Dewi Puspita Sari, Josef Maria Seno Adjie

Journal of Indonesian Health Policy and Administration

Despite global commitments to eliminating mother-to-child transmission of human immunodeficiency virus, syphilis, and hepatitis B, gaps remain in understanding the behavioral and systemic drivers of screening coverage in decentralized health systems such as Indonesia. This study aimed to analyze individual behavioral determinants and structural health system barriers affecting triple elimination screening coverage among pregnant women, focusing on perceived susceptibility and automatic compliance. A mixed-methods sequential explanatory study was conducted in Central Jakarta, Surabaya, and Karawang. The quantitative phase involved a cross-sectional survey of 1,224 pregnant women, with Health Belief Model variables analyzed using logistic regression. The qualitative phase comprised three …

From Advisory To Action: The Case For Preserving Paccarb In The Fight Against Antimicrobial Resistance, Leila S. Hojat, Muhammad Dhanani, Amy Y. Kang, Salome O. Chitavi, Robert A. Weinstein, Edward Stenehjem

Pharmacy Faculty Articles and Research

The Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) was established to advise the government on strategies to mitigate antimicrobial resistance (AMR) and its increasing threat to public health and national security. Its members included experts from diverse disciplines such as healthcare, veterinary medicine, industry, public health, and agriculture who were positioned to interface with key stakeholders and the public in an aspirational multidisciplinary approach to combating AMR. The council was successful in elevating AMR as a national priority and played a crucial role in watershed events for antimicrobial stewardship (AS) such as the development of the second National Action …

Degree Assortativity And Estimation Of Degree Distribution In A Contact Network Of People Who Inject Drugs, Peter Geissert

Dissertations and Theses

This dissertation analyzes data from a respondent driven sampling (RDS) study of people who inject drugs in Portland, OR.  The objective was to assess assumptions for the use of weighted estimators to estimate a population physical contact (syringe sharing) network degree distribution.

Visualization of degree distribution for social and physical networks, Kolmogorov-Smirnov tests of difference, and kernel tests of equivalence were used for comparison of distributions. Spearman's rho and GAM non-parametric regression models were used to test for association and assess non-monotonic relationship. The validity of Markov chain assumptions for RDS was assessed using a transition matrix, Markov chain graphs, …

“I Was Not Wonder Woman And Required Help”: Black, Latina, And White Women’S Recovery From The Covid-19 Pandemic, J. Mitchell Vaterlaus, Colton Pierce, Harry Foster, Alison Brennan, Nicole Wanago

Journal of Social, Behavioral, and Health Sciences

The COVID-19 pandemic disproportionately affected women, particularly women of color, yet less is known about their recovery experiences following the end of the public health emergency. This exploratory mixed-methods study examined recovery from the COVID-19 pandemic among Black, Latina, and White women in the United States. Participants (N = 133) completed a survey that included a self-reported recovery measure and open-ended questions regarding their recovery experiences. A chi-square analysis indicated a significant association between race/ethnicity and recovery status, with Latina women more likely to report ongoing recovery than Black and White women. Codebook thematic analysis identified four themes: (1) …

The Ramifications Of Covid-19 On Young Adults With Ocd, Clare E. Mcintosh

Dissertations

The coronavirus disease of 2019 (COVID-19) pandemic was a profound event in modern history, contributing to significant disruptions on a societal and individual level. This period of time was marked by elevated uncertainty and fear among individuals. COVID-19 contributed to deterioration in not only physical health but also psychological well-being. One mental health condition frequently under-examined and saturated with misconceptions is obsessive-compulsive disorder. Obsessive-compulsive disorder is a condition characterized by the presence of obsessions and/or compulsions. Intolerance of uncertainty is a core component of the condition, and the pandemic was riddled with unpredictability. The purpose of this study was to …

Responding To Medetomidine In Philadelphia: Narrative Summary Of The Public Health Response To A New Psychoactive Substance, Tareva Warrick-Stone, Serge-Emile Simpson, Phil Durney, Dennis Goodstein, Catherine Abrams, Raymond Bobb, Kory London, Daniel Teixeira Da Silva

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND: Despite the emergence of medetomidine as the dominant adulterant in Philadelphia's illicit opioid supply, coordinated public health responses are limited or non-existent in the literature. Thus, we summarize a recent Summit in Philadelphia of outpatient and inpatient service providers who specialize in the care of persons who use drugs to discuss medetomidine response readiness and building ongoing community readiness for potential destabilizing drug supply changes.

PURPOSE: Describe a public health intervention that distributed information about practices across health care settings and mobilized key informants to identify and address barriers to treatment.

METHODS: Descriptive summary of the in-person Summit organized …

Spatial Association Of Acute Respiratory Infection, Diarrhea, And Low Birth Weight With Stunting Prevalence In Indonesia, 2024, Dian Rosadi, Husaini Husaini, Triawanti Triawanti, Musafaah Musafaah

Kesmas

Stunting remains unevenly distributed across Indonesia, but national evidence integrating spatial analysis and spatial regression is limited. This study examined the spatial distribution of stunting and its associations with acute respiratory infection (ARI), diarrhea, and low birth weight (LBW) across Indonesian provinces. An ecological cross-sectional study used data from the 2024 Indonesian Nutritional Status Survey. Stunting-only analyses included all 38 provinces, whereas analyses involving ARI, diarrhea, and LBW included 37 provinces with complete data. Spatial analyses used a row-standardized symmetric four-nearest-neighbor spatial weights matrix and included Global Moran’s I, bivariate spatial analysis, Local Indicators of Spatial Association, ordinary least squares, …

The Association Of Age, Race, And Gender And Novel Interventions In The Prevention Of Catheter-Associated Urinary Tract Infection, In Washington State, Lamin Darboe

Walden Dissertations and Doctoral Studies

Delayed removal of indwelling urinary catheters (IUCs) contributes to catheter-associated urinary tract infections, a leading healthcare-associated infection. A dot/smart-phrase communication tool, guided by the Health Belief Model construct of cues to action, to promote timely IUC removal interventions was evaluated in this quantitative, cross-sectional study. Secondary data from N = 372 adult patients with acute urinary retention in acute and critical care settings in Washington State were analyzed using SPSS Version 30. Binary logistic regression examined relationships among demographic variables, intervention-related factors (adherence within 48 hours, cosignature within 24 hours, and secure chat communication), and clinical outcomes (IUC removal and/or …

Countering Hpv Vaccine Misinformation On Social Media: Practical Strategies For Healthcare Providers, David Baldwin

Lynchburg Journal of Medical Science

Human papillomavirus (HPV) vaccination is a highly effective strategy for preventing cervical and other HPV-related cancers; however, vaccine hesitancy remains a significant barrier to optimal vaccination rates. Social media has become a major source of health information while simultaneously amplifying misinformation that influences parental attitudes toward HPV vaccination. This narrative literature review examined the relationship between social media misinformation and HPV vaccine hesitancy and identified evidence-based strategies healthcare providers can use to improve vaccine confidence.

A literature search of PubMed and Google Scholar identified 31 articles published between 2016 and 2025, of which 19 met inclusion criteria. The literature demonstrates …

Post-Pandemic Telebehavioral Health: Sustaining And Regulating Remote Mental Health Care As A Core Modality, Weiqiao Dong

Dartmouth College Master’s Theses

The United States continues to face a persistent mental health crisis after the COVID-19 pandemic, raising a policy question about the long-term role and regulation of telebehavioral health as a core modality of care. This thesis examines that question through a case study of New York State, an early center of the pandemic and a leader in telehealth policy reform.

Guided by the Health Policy Triangle framework, this thesis integrates longitudinal data from all 62 New York counties for 2010-2025 with a 2025 cross-sectional dataset covering 61 counties. Seventeen standardized indicators are organized into four dimensions: geographic, economic, demographic, and …

The Cul-De-Sac Paradox: The Relationship Between Walkability, Playability, And Children’S Physical Activity, Lydia Reader

McKelvey School of Engineering Graduate Student Theses & Dissertations

Walkability and playability are two constructs on how the built environment can support physical activity, the former most relevant to adults and the latter designed with children in mind. There are concerns that walkability and playability are intrinsically in competition with one another, with urban forms supportive of physical activity for adults detrimental toward the physical activity of children and vice versa. This thesis explores this conflict using agent-based modeling as a tool for refining the theoretical constructs behind playability and children’s physical activity. We examine the state of the current evidence for the relationship between walkability and children’s physical …

Frailty As A Framework To Understand Tuberculosis Severity, Recovery, And Sequelae, Yoscelina Estrella Martinez-Lopez, Benjamin W. Black, Jessica Lee, Brian J. Buta, Lisa Y. Armitige, William A. Fountain, Rafael Samper, Aanand D. Naik, Joanne Turner, Blanca I. Restrepo

School of Medicine Publications

Tuberculosis (TB) causes profound systemic illness, and many survivors experience long-term sequelae associated with disability and premature mortality. Current TB severity indicators capture isolated aspects of disease and may not reflect the integrated physiological impact of infection on the host. Frailty, a multidimensional syndrome characterized by reduced physiological reserve and increased vulnerability to stressors, predicts adverse outcomes and guides clinical management in geriatrics. We propose frailty as an integrative framework for understanding the systemic effects of TB across the life course, encompassing disease severity, recovery, and long-term sequelae. We discuss biological mechanisms through which Mycobacterium tuberculosis infection may erode physiological …

Numerical Analysis Of The Sir Model For Predicting Disease Spread, Victoria Gaibor, Isabel Tejada, Kate Moore

Discovery Day - Daytona Beach

This project, Numerical Solutions of the SIR Model for Predicting Disease Spread, investigates the application of numerical methods to analyze the dynamics of infectious diseases using the classical Susceptible–Infected–Recovered (SIR) model. The SIR model, a system of nonlinear ordinary differential equations, is widely used to describe how diseases such as COVID-19 propagate through a population. The primary objective of this study is to solve the SIR initial value problem using multiple numerical techniques, including Euler’s method, Runge–Kutta methods, and multistep methods, and to compare their accuracy and efficiency. The model is implemented using given initial conditions and parameters, and additional …

The Effectiveness Of "Little Doctor" Training On Health Knowledge And Behavior Of Karawang Primary Students (2025), Aurelia A. Erawan, Shahnaz F. Azzahra, Rubee P. Risdiyanto, Patricia Andini, Muhammad K. Ramadhan, Ailsa T. Kirana, Istingadah Desiana Md, Raden M. Rifada Md

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. Acute respiratory infection (ARI) remains a major public health problem in Indonesia, with West Java reporting the highest incidence. Poor Health-Related Behavior (HRB) practices are associated with increased ARI risk. The "Little Doctor" program is a government initiative that focuses on school health and aims to promote HRB among students. Along with this goal, this study aimed to determine the effectiveness of the program in improving knowledge of HRB and ARI among elementary school students in Pancawati Village, Karawang Regency.

Methods. This study employs a quasi-experimental one-group pretest-posttest design. Participants were selected based on inclusion criteria referring to the …

Nurses' Perceptions Of Medical Services In Acute Care Hospitals In The Post-Covid-19 Era, Yoko Nakano, Tomoya Yokotani, Rika Nakajima, Hidemi Yoshii

Patient Experience Journal

Purpose: This study aimed to clarify nurses' perceptions of healthcare services in acute care hospitals. Methods: A cross-sectional, anonymous, web-based questionnaire was conducted using SurveyMonkey. Participants were selected using convenience sampling. The survey included questions about the participants' basic attributes and the 22-item M-SERVQUAL scale (a modified multiple-item scale for measuring consumer perceptions of medical service quality). Data analysis involved age-based comparisons using the Kruskal–Wallis test, followed by multiple comparisons using the Bonferroni method. The significance level was set at p < 0.01. Results: The survey was distributed to 1,542 participants, yielding 566 valid responses, with an effective response rate of 36.7%. …

Centering Community Voices To Address Healthcare Inequities In Underserved Utah Populations, Karishma Shah, Jazmine Abril, May Shaaban, Silvia Soule, Sonia Sehgal, Rawad Farhat, Jeannette Villalta, Oreta Tupola, Valentine Mukundente, Cathy Wolfsfeld, Ivana Holiday, Walter Watchman, Carrie Olvera, Lauren Gleave, Kamaile Tripp, Alexander Sperber, Rita Osborn

Patient Experience Journal

Persistent disparities in health outcomes across the United States are often driven by systemic inequities and social determinants of health. In Utah, these inequities are particularly pronounced among racially, ethnically, and geographically underserved populations. Community healthcare workers (CHWs) who share lived experiences with these communities are uniquely positioned to bridge the gap between patients and a fragmented healthcare system. This study aimed to explore how underserved communities in Utah perceive and interact with the healthcare system, centering their lived experiences to inform more equitable care models. We conducted eight focus groups with 73 participants from six medically underserved communities: African …

The 2025 Measles Outbreak In Texas, Tamer Oraby, Martial L. Ndeffo-Mbah

School of Mathematical & Statistical Sciences Faculty Publications

Background: In 2025, Texas experienced its largest measles outbreak in decades, reporting 762 cases by mid-August. Measles is a highly contagious but vaccine-preventable infection transmitted mainly among unvaccinated individuals and capable of causing severe outcomes.

Methods: We investigate counterfactual measles control scenarios based on daycare and school closures and reactive vaccination of infants and children, including mixed interventions. We analyze the 2025 Texas outbreak using an age-structured multi-stage SEIR model formulated as a system of ordinary differential equations. The model is fit to case data using Bayesian inference to estimate the effective reproduction number and generate posterior predictive trajectories under …

Public Perceptions Regarding Surveillance Of Lyme Disease In Tennessee, Shaheena Yasmin Asad

Walden Dissertations and Doctoral Studies

Lyme disease (LD), a tick-borne illness, has been a growing concern in the state of Tennessee. Studies have established environmental concerns regarding a growing tick population and identified a gap between reported cases and disease burden in Tennessee. Despite this information, it remains classified as a low-incidence reporting state, raising concerns about underreporting that indicate an ineffective current surveillance system. Because the public perception regarding surveillance of LD is unknown, the purpose of this qualitative study was to explore how adults in Tennessee perceived LD as a credible public health threat within the context of the current surveillance system. Guided …

Measuring Health System Readiness In Saint Lucia Using International Health Regulations Capacity Indicators, Melissa Steele

Walden Dissertations and Doctoral Studies

Emerging infectious diseases continue to challenge national health systems, particularly in small island developing states with limited preparedness resources. Limited evidence comparing the International Health Regulations (2005) State Party Self-Assessment Annual Reporting (IHR SPAR) capacities of small island developing states with those of high-income countries limits efforts to identify preparedness gaps and strengthen health systems. The purpose of this quantitative comparative study was to evaluate Saint Lucia's preparedness using IHR SPAR indicators, compare its preparedness with the United States, and assess changes between 2023 and 2024. Guided by the World Health Organization Health System Framework, a quantitative cross-sectional design using …

Expression Levels Of Heat Shock Protein 72 And Their Correlation With Biomarkers Of Renal Function Among Hispanic Construction Workers Exposed To Ambient Heat In El Paso, Texas, Maria Fuentes

Open Access Theses & Dissertations

Heat shock proteins (HSP) are intracellular molecular proteins that are upregulated in response to cellular stress, including heat exposure. Through their protective functions, HSP help maintain protein structure, prevent protein denaturation, and preserve cellular homeostasis during states of physiological stress. Because of their cytoprotective properties, HSP have emerged as potential biomarkers for detecting early signs of tissue injury and predicting clinical outcomes associated with heat related illnesses (HRI), including acute kidney injuries (AKI). AKI is a leading cause of hospitalizations due to heat stress exposure and heat stroke. In the absence of early detection and effective therapeutic interventions, AKI may …

Essays On Opioid Prescription Limit Policy Diffusion, Evaluation, And Opioid Use Disorder Treatment Utilization, Md Ashiqur Rab

All Dissertations

The drivers of the opioid epidemic in the United States include the oversupply of prescription opioids, the availability of illicit drugs, under-resourced healthcare settings, and several socio-economic factors. Federal and state-level initiatives, including policy interventions to curb the oversupply of prescription opioids, providing access to healthcare, prevention and recovery support services, and community-level engagement, have been adopted to combat the opioid epidemic. Motivated by the need to better understand the policy and recovery efforts to address the epidemic, this dissertation examines opioid prescription limit policy diffusion, evaluation, and treatment utilization patterns. This dissertation comprises three manuscripts that offer a comprehensive …

Computable Phenotypes For Research Using Real-World Data: Experiences From The Nih Pragmatic Trials Collaboratory, Marisa L Conte, Judith M Schlaeger, Guilherme Del Fiol, James R Campbell, Andrea L Cheville, Keith Marsolo, Kari A Stephens, Miriam O Ezenwa, Andrew D Boyd, Juanita E Darby, Nadine S Matthie, P Michael Ho, Alice Pressman, Morgan Justice, Carol Reynolds Geary, Keturah R Faurot, Alex Fist, Karen Staman, Hulin Wu, Rachel L Richesson

Faculty, Staff and Student Publications

Objectives: Embedded pragmatic clinical trials (ePCTs) are conducted as part of routine clinical care and therefore use data collected from real-world data sources, such as electronic health record systems and administrative claims. A common approach for using these types of data across all phases of trial conduct is to create a computable phenotype (an explicitly defined data query data, including specified data types, data codes, and logical parameters) to capture patients with a clinical condition, exposure, symptom, characteristic, treatment, or outcome of interest.

Materials and methods: The Electronic Health Record (EHR) Core Working Group of the NIH Pragmatic Trials Collaboratory …