Ma kēia māhele o ka Prioritizing Equity moʻo, e aʻo e pili ana i ka mōʻaukala a me ka like ʻole o kēia manawa i ka hoʻonaʻauao olakino, hana, a me nā manawa alakaʻi.
Ke ʻimi nei ka papahana wikiō Prioritizing Equity i ke ʻano o ke kaulike o ka mālama olakino i ka mālama ʻana i ka wā maʻi maʻi COVID-19.
ʻAʻole i hoʻoholo ʻia ke kūlana o ka mālama ʻana e ke ʻano o ka hāʻawi ʻia ʻana, no laila pono e mālama ʻia nā lawelawe telehealth i nā kūlana like me ka mālama kanaka.
Ma ka 2023 ChangeMedEd®️ Conference, Brian George, MD, MS, ua loaʻa ka 2023 Accelerating Change in Medical Education Award.E aʻo hou aku.
ʻO ka hoʻokomo ʻana i ka ʻepekema ʻōnaehana olakino i loko o nā kula olakino ʻo ia ka ʻimi mua ʻana i hale nona.E aʻo hou mai nā kumu aʻo lapaʻau nāna i hana.
Hoʻopili nā mea hou AMA i nā kumuhana mālama ola e pili ana i ke ola o nā kauka a me nā maʻi.E ʻike pehea e ʻike ai i ka mea huna i kahi papahana noho kūleʻa.
Hoʻopili nā mea hou AMA i nā kumuhana mālama ola e pili ana i ke ola o nā kauka a me nā maʻi.E ʻike pehea e ʻike ai i ka mea huna i kahi papahana noho kūleʻa.
Ua pau ka hoomaha ana i ka uku aie haumana.E ʻike i ke ʻano o kēia no nā kauka a me nā koho i loaʻa iā lākou.
Pehea e hiki ai i kahi haumāna lapaʻau a kamaʻāina paha ke hana i kahi hōʻike hoʻolaha nui?He hoʻomaka maikaʻi kēia mau ʻōlelo aʻoaʻo ʻehā.
AMA i CMS: E hana koke i ka hōʻoia ʻaʻole e loaʻa i nā kauka nā hoʻoponopono uku MIPS ma 2024 e pili ana i ka hana 2022 MIPS a me nā ʻikepili ʻē aʻe i ʻike ʻia ma ka mea hou e kākoʻo ana i ka hoʻoponopono uku Medicare.
E aʻo pehea e paipai ai ka CCB i nā hoʻololi i ke Kumukānāwai a me nā Kānāwai AMA a kōkua i ka hoʻoponopono ʻana i nā lula, nā lula a me nā kaʻina hana no nā ʻāpana like ʻole o ka AMA.
E ʻimi i nā kikoʻī a me ka ʻike hoʻopaʻa inoa no nā hālāwai a me nā hanana ʻo Young Doctors Section (YPS).
E ʻimi i ka papahana, nā palapala a me nā ʻike hou aʻe no ka 2023 YPS Midterm Meeting ma Nowemapa 10th ma ka Gaylord National Resort and Convention Center ma National Harbor, Maryland.
E mālama ʻia ka 2024 American Medical Association Medical Student Advocacy Conference (MAC) ma Malaki 7-8, 2024.
Nā Mea Pono o Sepsis: ʻO ka webinar hope loa ma nā Centers for Disease Control and Prevention (CDC) webinar series e kūkākūkā ana i ka hopena o ka hoʻonaʻauao sepsis i ka hoʻolimalima ʻana i nā limahana mālama ola.Kakau inoa.
Hoʻopili ʻia nā mea hou AMA i nā kumuhana olakino e pili ana i ke ola o nā kauka, kamaʻāina, nā haumāna lapaʻau a me nā maʻi.E hoʻolohe mai ka poʻe loea lapaʻau, mai ka hana pilikino a me nā alakaʻi ʻōnaehana olakino i nā ʻepekema a me nā luna olakino olakino, ma COVID-19, hoʻonaʻauao olakino, kākoʻo, burnout, kano a me nā mea hou aku.
I kēia lā AMA News, ʻo Pelekikena AMA kahiko ʻo Gerald Harmon, MD, hui pū i ke kūkākūkā o ka hemahema o ka limahana lapaʻau a me ka waiwai o nā kauka kahiko.Hāʻawi ʻo Kauka Harmon i kāna mau manaʻo e pili ana i kāna hana hou ma ke ʻano he dean interim o ke Kula Lapaʻau o ke Kulanui o South Carolina ma Columbia, kāna hana ma ke ʻano he pelekikena hope o nā ʻoihana olakino ma Tidelands Health ma Pawleys Island, South Carolina, a me nā mea e pono ai ke hoʻokele kahua lapaʻau.kahua ma ke ʻano he kauka.Nā ʻōlelo aʻoaʻo no ka noho ʻana.Nā kauka ma luna o 65 makahiki.Mea hoʻokipa: Luna Hoʻonaʻauao Nui o AMA Todd Unger.
Ma hope o ka hakakā ʻana no nā kauka i ka wā maʻi maʻi, ke hana nei ka American Medical Association i kāna paʻakikī ʻē aʻe: e hōʻoia ana i ka hoʻokō ʻana o ka lāhui i nā kauka.
Unger: Aloha a hoʻokipa i ka wikiō AMA hou a me ka podcast.I kēia lā ke kamaʻilio nei mākou e pili ana i ka hemahema o ka limahana a me ke koʻikoʻi o nā kauka kahiko i ka hoʻoponopono ʻana i kēia pilikia.Kūkākūkā ʻia kēia pilikia ma ʻaneʻi e Kauka Gerald Harmon, dean interim o ke Kula Lapaʻau o ke Kulanui o South Carolina ma Columbia, South Carolina, a me ka pelekikena AMA mua, a i ʻole ma kāna ʻōlelo ponoʻī, "ka pelekikena AMA i hoʻihoʻi ʻia."ʻO wau ʻo Todd Unger, Luna Hoʻonaʻauao Nui o AMA Chicago.E Kauka Harmon, hauʻoli e hālāwai me ʻoe.Pehea ʻoe e hana nei?
Kauka Harmon: Todd, he nīnau hoihoi kēlā.Ma waho aʻe o koʻu kuleana ma ke ʻano he AMA Recovery Chair, ua loaʻa iaʻu kahi kuleana hou.I kēia mahina wale nō, ua hoʻomaka wau i kahi hana hou i kaʻu ʻoihana ma ke ʻano he Luna ʻEpekema Pūnaehana Ola Nui a me Interim Dean o ke Kula Lapaʻau ma ke Kulanui o South Carolina ma Columbia, South Carolina.
Kauka Harmon: ʻAe, he nūhou nui kēlā.He hoʻololi ʻoihana i manaʻo ʻole ʻia iaʻu.Ua hoʻokaʻaʻike mai kekahi iaʻu e pili ana i kā lākou mau pono a me nā mea i manaʻo ʻia.Manaʻo wau he pāʻani kēia i hana ʻia ma ka lani, inā ʻaʻole he pāʻani i hana ʻia ma ka lani a laila ma waena o nā hōkū.
Unger: ʻAe, maopopo iaʻu i ko lākou nānā ʻana i kāu hoʻomau, ua hauʻoli lākou i kekahi o kāu mau hana.He kauka ʻohana hoʻomaʻamaʻa ʻoe no 35 mau makahiki, ʻo ke Kokua Kākoʻo Kauka Nui o ka Air Force o ʻAmelika Hui Pū ʻIa, ʻo Surgeon General o ka National Guard, a, ʻoiaʻiʻo hoʻi, ka Pelekikena o ka AMA.ʻAʻole kēlā i ka hapalua o ke kaua.Ua loaʻa iā ʻoe ke kuleana e hoʻomaha, akā ke hoʻomaka nei ʻoe i kahi mokuna hou.He aha ke kumu o kēia?
Kauka Harmon: Manaʻo wau ʻo wau ka ʻike e loaʻa iaʻu ka manawa kūpono e haʻi aku i koʻu mau ʻike me nā poʻe ʻē aʻe.ʻO ka huaʻōlelo "kauka" mai ka Latin mai a ʻo ke ʻano "e amo a aʻo."Manaʻo maoli wau hiki iaʻu ke aʻo, kaʻana like i koʻu mau ʻike ola, a hāʻawi i ka hoʻonaʻauao a me ke alakaʻi (inā ʻaʻole alakaʻi) i kekahi hanauna o nā kauka i ke aʻo ʻana a me ka hoʻomaʻamaʻa ʻana i nā kauka.No laila, maikaʻi loa ka ʻoiaʻiʻo e lawe i kahi hana kōkua noiʻi ʻoiai e mālama ana i kaʻu hiki ke aʻo lapaʻau.No laila ʻaʻole hiki iaʻu ke hōʻole i kēia manawa kūpono.
Kauka Harmon: ʻAe, ʻo ke kuleana o ka provost kahi mea aʻu i ʻike ʻole ai ma mua.He polopeka kulanui au a ua aʻo aku au i nā papa (aʻo maoli ʻia) ma ke kino ma mua o ka hāʻawi ʻana i nā māka a me nā loiloi i kākau ʻia i nā haumāna, kamaʻāina, a me nā ʻoihana mālama ola ʻē aʻe (nā kahu hānai, radiologists, sonographers, kōkua kauka).No ka hapa nui o kaʻu mau makahiki 35-40 o ka hoʻomaʻamaʻa, he kumu wau, he kumu hana.No laila, ʻaʻole malihini kēia kuleana.
ʻAʻole hiki ke hoʻohaʻahaʻa ʻia ka hoʻopiʻi o ke kula.Ke aʻo nei au – Ke hoʻohana nei au i kēia hoʻohālikelike ʻaʻole me ka hose ahi, akā me nā bākeke.Noi au i nā kānaka e aʻo mai iaʻu i hoʻokahi ʻāpana ʻike i ka manawa.No laila lawe mai kekahi ʻoihana i kā lākou bakeke, lawe mai kekahi ʻoihana i kā lākou bakeke, lawe mai ka luna i kā lākou bakeke.A laila, lawe au i ka bākeke ma mua o ka hoʻopiha ʻia ʻana o ka wai me ka paipu ahi a me ka make ʻana.No laila hiki iaʻu ke hoʻomalu iki i nā helu ʻikepili.E ho'āʻo mākou i kekahi bākeke i kēia pule aʻe.
Unger: Kauka Harmon, he mea hoihoi nā ʻōlelo āu e wehe nei i kahi mokuna hou.I ka manawa like, ʻike mākou he nui nā kauka e koho e hoʻomaha mua a wikiwiki paha ma muli o ka maʻi maʻi.Ua ʻike a lohe paha ʻoe i kēia hana ma waena o kāu mau hoa hana?
Kauka Harmon: Ua ʻike wau i kēlā pule i hala, Todd, ʻae.Loaʻa iā mākou ka ʻikepili waena waena, ʻo ka AMA's 2021-2022 data survey, e hōʻike ana he 20%, a i ʻole hoʻokahi o ʻelima mau kauka, i ʻōlelo lākou e hoʻomaha.E hoʻomaha lākou i loko o nā mahina 24 e hiki mai ana.ʻIke mākou i kēia ma waena o nā limahana mālama olakino ʻē aʻe, ʻoi aku hoʻi nā kahu hānai.ʻO 40% o nā kahu hānai (ʻelua i loko o ʻelima) i ʻōlelo e haʻalele wau i kaʻu hana kahu hānai i loko o nā makahiki ʻelua e hiki mai ana.
ʻAe, e like me kaʻu i ʻōlelo ai, ʻike wau i kēia pule i hala.Ua loaʻa iaʻu kahi kauka waena i hoʻolaha i kona hoʻomaha.He kauka lapaau, he 60 makahiki.Ua ʻōlelo ʻo ia: Ke haʻalele nei au i ka hana ikaika.Ua aʻo mai kēia maʻi maʻi iaʻu e noʻonoʻo pono i nā mea ma mua o kaʻu hana.Aia wau i kahi kūlana kālā maikaʻi.Ma ka home, pono ʻo ia e hoʻonui i ka manawa me kona ʻohana.No laila ua hoʻoholo ʻo ia e hoʻomaha loa.
Loaʻa iaʻu kekahi hoa hana maikaʻi ma ka lāʻau lapaʻau ʻohana.ʻOiaʻiʻo, hele mai kāna wahine iaʻu i kekahi mau mahina i hala aku nei a ʻōlelo mai, "Ua ʻike ʻoe, ua hoʻokau nui kēia maʻi maʻi i ko mākou ʻohana."Ua noi au iā Kauka X, kāna kāne, a me kekahi hoa hana i kaʻu hana e hoʻohaʻahaʻa i ka dosage.No ka mea, hoʻonui ʻo ia i ka manawa ma ke keʻena.I kona hoʻi ʻana i ka home, noho ʻo ia ma ke kamepiula a hana i nā hana kamepiula ʻole i loaʻa iā ia ka manawa.Ua luhi ʻo ia i ka ʻike ʻana i ka nui o nā maʻi.No laila ʻoki ʻo ia i hope.Ua pilikia ʻo ia mai kona ʻohana.He ʻelima āna keiki.
ʻO kēia mau mea a pau ke kumu nui o ke koʻikoʻi no nā kauka kahiko, akā ʻo ka poʻe ma waena o ka ʻoihana, 50 makahiki a ʻoi aku ka nui o ka pilikia, e like me kā mākou mau hanauna ʻōpio.
Unger: ʻO ka liʻiliʻi loa e hoʻopiʻi i ke kūlana hemahema o ke kauka a mākou e ʻike nei.ʻO ka ʻoiaʻiʻo, ʻo kahi noiʻi a ka Association of American Medical Colleges e hoʻolālā i ka hemahema o ke kauka a hiki i 124,000 e 2034, e komo pū ana i ka hui pū ʻana o nā mea a mākou i kamaʻilio ai, ka heluna kanaka ʻelemakule a me kahi limahana kauka ʻelemakule.
Ma ke ʻano he kauka lāʻau lapaʻau ʻohana ma mua e lawelawe ana i ka lehulehu kuaʻāina, he aha kou manaʻo no kēia?
Kauka Harmon: Todd, pololei ʻoe.Ke piʻi nui nei ka hemahema o ke kauka, a i ʻole ma ka logarithmically, ʻaʻole wale ma ka hoʻohui a me ka unuhi ʻana.Ke elemakule nei na kauka.Ke kamaʻilio nei mākou e pili ana i ka ʻoiaʻiʻo i loko o nā makahiki he ʻumi e hiki mai ana, ʻo nā mea maʻi ma US he 65 mau makahiki a ʻoi paha, a ʻo 34% o lākou e koi i ka mālama olakino.I nā makahiki he ʻumi e hiki mai ana, 42% a 45% o nā kānaka e koi i ka mālama olakino.Pono lākou e mālama.Ua ʻōlelo ʻoe i ka hemahema o nā kauka.Pono kēia mau poʻe maʻi ʻelemakule i kahi kūlana kiʻekiʻe o ka mālama ʻana, a nui ka poʻe e noho ana ma nā wahi kuaʻāina kakaʻikahi.
No laila, i ka makahiki o nā kauka, ʻaʻole e waiho ka hoʻomaha ʻana ma hope o ka nui o nā kauka a me nā limahana mālama ola e makemake ana e hele i nā kuaʻāina, makemake lākou e hele i nā wahi i nele.No laila, e pi'i nui ana ke kūlana ma nā kua'āina.Me he mea lā ua ʻelemakule ka poʻe maʻi ma ia wahi a ʻaʻole i ulu ka poʻe ma nā kuaʻāina.ʻAʻole mākou e ʻike i ka piʻi ʻana o ka nui o nā limahana mālama olakino e neʻe nei i kēia mau kuaʻāina.
No laila, pono mākou e hana i nā ʻenehana hou, nā manaʻo hou, telemedicine, ka mālama ʻana i ka hui e kōkua i ka hoʻokō ʻana i nā pono o ke kuaʻāina ʻo ʻAmelika.
Unger: Ke ulu nei ka heluna kanaka a ʻelemakule paha, a ke ʻelemakule nei nā kauka.Hoʻokumu kēia i kahi ākea nui.Hiki iā ʻoe ke nānā wale i ka ʻikepili maka i ke ʻano o kēlā āpau?
Kauka Harmon: E ʻōlelo kākou ua lawelawe ka waihona kauka i kēia manawa i 280,000 mau maʻi.E like me ka nui o ka heluna kanaka US, he 34% i kēia manawa a he 42% a 45% i nā makahiki he ʻumi, no laila e like me kāu i ʻike ai, manaʻo wau aia kēlā mau helu ma kahi o 400,000 mau kānaka.No laila, he hakahaka nui kēia.Ma waho aʻe o ka manaʻo i manaʻo ʻia no nā kauka hou aʻe, pono ʻoe i nā kauka hou aʻe e lawelawe i ka poʻe ʻelemakule.
e hai aku au ia oe.ʻAʻole nā kauka wale nō.He radiologist kēia, he kahu hānai kēia, ʻaʻole e haʻi i ka hoʻomaha ʻana o nā kahu.ʻAʻole lawa ka poʻe sonographers, radioologists, a me nā ʻenehana hale hana.ʻO kēlā me kēia ʻōnaehana mālama olakino ma ʻAmelika Hui Pū ʻIa ua hoʻolōʻihi ʻia e ka hapa o nā limahana mālama olakino o nā ʻano āpau.
Unger: ʻO ka hoʻoponopono ʻana a i ʻole ka hoʻoponopono ʻana i ka pilikia hemahema o ke kauka i kēia manawa e pono ai kahi hopena multilateral.Akā, e kamaʻilio pū kākou.Pehea kou manaʻo e kūpono nā kauka kahiko i kēia hopena?No ke aha lākou i kūpono ai no ka mālama ʻana i ka poʻe ʻelemakule?
Kauka Harmon: He mea hoihoi ia.Manaʻo wau ʻaʻohe kānalua e aloha lākou, inā ʻaʻole aloha, me nā maʻi e hele mai.E like me kā mākou kamaʻilio e pili ana i nā ʻAmelika 65 a ʻoi aku ka nui o 42% o ka heluna kanaka, ʻike ʻia kēia demographic i ka limahana kauka: 42-45% o nā kauka he 65 mau makahiki. No laila e loaʻa iā lākou nā ʻike ola like.Hiki iā lākou ke hoʻomaopopo inā he musculoskeletal joint limitation, he cognitive a sensory-cognitive emi ʻana, a i ʻole ka lohe a me ka ʻike palena, a i ʻole he comorbidity i loaʻa iā mākou i ko mākou mau makahiki, ka maʻi puʻuwai.diabetes..
Ua kamaʻilio mākou e pili ana i ke ʻano o ka podcast aʻu i hōʻike ai ma kahi o 90 miliona ʻAmelika i loaʻa i ka prediabetes, a ʻo 85 a 90 ka nui o lākou ʻaʻole maopopo iā lākou he maʻi diabetes.ʻO ka hopena, ke kau nei ka poʻe ʻelemakule o ʻAmelika i ke kaumaha o ka maʻi maʻi.Ke komo mākou i ka papa o nā kauka, e ʻike ʻoe he empathetic lākou, akā loaʻa iā lākou ka ʻike ola.He mākaukau ko lākou.ʻIke lākou i ka hana ʻana i kahi hōʻailona.
I kekahi manawa makemake au e noʻonoʻo hiki iaʻu ke noʻonoʻo a me nā kauka i koʻu mau makahiki a hana i nā diagnoses me ka ʻole o kekahi ʻenehana.ʻAʻole pono mākou e noʻonoʻo e pili ana i ka ʻoiaʻiʻo inā pilikia iki kēia kanaka me kēia a i kēlā ʻōnaehana okana, ʻaʻole pono wau e hana i kahi MRI a i ʻole PET scan a i ʻole kekahi hoʻokolohua hoʻokolohua.Hiki iaʻu ke haʻi aku he shingles kēia ʻūhū.ʻAʻole kēia he dermatitis contact.Akā, no koʻu ʻike ʻana i nā maʻi no nā makahiki 35 a i ʻole 40, ua loaʻa iaʻu kahi papa kuhikuhi noʻonoʻo e kōkua iaʻu e hoʻohana i ka mea aʻu i kapa ai ʻo ka naʻauao kanaka maoli, ʻaʻole ka naʻauao hana, i ka maʻi.
No laila ʻaʻole pono wau e hana i kēia mau hoʻāʻo a pau.Hiki iaʻu ke hoʻomaʻamaʻa mua, mālama a hōʻoluʻolu i ka poʻe ʻelemakule.
Unger: He mea hahai nui kēia.Makemake au e kamaʻilio hou aku iā ʻoe e pili ana i kēia pilikia e pili ana i ka ʻenehana.He lālā ikaika ʻoe o ka Māhele Kauka Nui, e hōʻike ana i nā manaʻo a me nā ʻōlelo aʻoaʻo no nā mea e pili ana i nā kauka kiʻekiʻe.ʻO kekahi o nā mea i ulu nui mai i kēia mau lā (ʻoiaʻiʻo, ua kamaʻilio nui wau e pili ana i ka naʻauao artificial i nā pule i hala iho nei) ʻo ia ka nīnau e pili ana i ke ʻano o nā kauka kahiko e hoʻololi i nā ʻenehana hou.He aha kāu mau manaʻo e pili ana i kēia?Pehea e hiki ai i ka AMA ke kōkua?
Kauka Harmon: ʻAe, ua ʻike mua ʻoe iaʻu - ua ʻōlelo au ma ka lehulehu ma nā haʻi'ōlelo a me nā panela - pono mākou e apo i kēia ʻenehana hou.ʻAʻole e hele.ʻO ka mea a mākou e ʻike ai i ka naʻauao hana (e hoʻohana ana ka AMA i kēia huaʻōlelo a ke ʻae nei au me ia) ʻo ia ka naʻauao hoʻonui.No ka mea, ʻaʻole ia e hoʻololi loa i kēia kamepiula ma aneʻi.Loaʻa iā mākou nā mana hoʻoholo a me ka hoʻoholo ʻana i hiki ʻole i nā mīkini maikaʻi ke aʻo.
Akā pono mākou e haku i kēia ʻenehana.ʻAʻole pono mākou e hoʻopaneʻe i kona holomua.ʻAʻole pono mākou e lohi i ka hoʻohana ʻana.ʻAʻole pono mākou e hoʻopau i kekahi mau leo uila a mākou e kamaʻilio nei me ka hoʻowahāwahā.He ʻenehana hou kēia.ʻAʻole e hele.E hoʻomaikaʻi kēia i ka hāʻawi ʻana i nā lawelawe mālama.E hoʻomaikaʻi kēia i ka palekana, e hōʻemi i nā hewa a, manaʻo wau, e hoʻomaikaʻi i ka pololei diagnostic.
No laila pono nā kauka e ʻae i kēia a nānā.He mea hana ia, e like me nā mea ʻē aʻe.Ua like ia me ka hoʻohana ʻana i kahi stethoscope, ka hoʻohana ʻana i kou mau maka, hoʻopā a nānā aku i nā kānaka.He mea ia e hoʻonui ai i kou akamai, ʻaʻole ia he mea keakea.
Unger: Kauka Harmon, nīnau hope.He aha nā ala ʻē aʻe e hiki ai i nā kauka ke hoʻoholo ʻaʻole hiki iā lākou ke mālama hou i nā poʻe maʻi e noho ikaika i kā lākou ʻoihana?No ke aha he mea pono i nā kauka a me ka ʻoihana ke mālama i kahi pilina ikaika?
Dr. Harmon: Todd, hana nā kānaka a pau i kā lākou mau hoʻoholo ponoʻī ma ko lākou ao holoʻokoʻa me ka hoʻohana ʻana i kā lākou ʻikepili ponoʻī.No laila, ʻoiai he nīnau paha ke kauka e pili ana i kona mākaukau, kona palekana, inā paha i loko o ke keʻena hana a i ʻole ma waho kahi e hana ai ʻoe i kahi maʻi maʻi, ʻaʻole pono ʻoe e hana i nā mea kani a i ʻole ke ʻoki ʻana.Aia kekahi loli maʻamau.Pono kākou a pau e hopohopo no kēia.
ʻO ka mea mua, inā hopohopo maoli ʻoe, inā kānalua ʻoe i kou hiki, noʻonoʻo a kino paha, e kamaʻilio me kahi hoa hana.Mai hilahila.Loaʻa iā mākou ka pilikia like me ke ola kino.Ke kamaʻilio wau me nā pūʻulu kauka, ʻike wau e kamaʻilio mākou e pili ana i ka burnout kauka.Ke kamaʻilio nei mākou e pili ana i nā pilikia hana a me ke ʻano o ko mākou huhū.Hōʻike kā mākou ʻikepili ma luna o 40% o nā kauka e noʻonoʻo nei i kā lākou koho ʻoihana-ʻo wau hoʻi, he helu weliweli kēlā.
Ka manawa hoʻouna: ʻOkakopa-13-2023