Health Care Transitions最新文献

{"title":"Reflections on directing 25 years of the annual transition conference","authors":"Albert C. Hergenroeder","doi":"10.1016/j.hctj.2024.100092","DOIUrl":"10.1016/j.hctj.2024.100092","url":null,"abstract":"<div><div>Albert C. Hergenroeder, MD, Professor of Pediatrics, Chief, Adolescent Medicine and Sports Medicine, Baylor College of Medicine The paper is based on the author’s opening address for the 25th annual Chronic Illness and Disability: Transition from Pediatric to Adult-based care conference at Baylor College of Medicine/Texas Children’s Hospital conference delivered October 10, 2024</div></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"3 ","pages":"Article 100092"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections on developing a hospital-wide health care transition program","authors":"Ellen Iverson ,&nbsp;Caitlin S. Sayegh ,&nbsp;Courtney Porter ,&nbsp;Diane Tanaka ,&nbsp;Roberta Williams","doi":"10.1016/j.hctj.2024.100090","DOIUrl":"10.1016/j.hctj.2024.100090","url":null,"abstract":"<div><h3>Background</h3><div>Despite the importance of an organized, planned transition to adult healthcare for adolescents with chronic health conditions, pediatric hospitals have struggled to adequately support this process. Particularly over the past two decades, pediatric hospitals have taken different tactics in their efforts to provide systematic transition support and faced unique challenges developing comprehensive, sustainable programs.</div></div><div><h3>Objective</h3><div>The purpose of this article is to reflect on the experience of building transition services through the 2010s decade at a large quaternary pediatric hospital, Children's Hospital Los Angeles (CHLA), which serves a diverse and largely socioeconomically disadvantaged population.</div></div><div><h3>Results</h3><div>At CHLA, hospital-wide efforts began with informal gatherings of advocates who championed transition support. This led to collaboration and pooling of resources to develop a collective approach to transition. CHLA’s transition efforts matured over the 2010’s decade, coinciding with national advances in transition frameworks and transition-focused research. Ultimately, CHLA received a large philanthropic gift which provided resources to expand transition support throughout the institution by creating a cross-disciplinary, formalized program and infrastructure designed to support all adolescents to successfully transition to adult healthcare.</div></div><div><h3>Conclusion</h3><div>This article archives CHLA’s unique path toward developing hospital-wide transition services and lessons learned during these efforts may be informative to others striving to improve transition services.</div></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"3 ","pages":"Article 100090"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community health workers supporting emerging adults with sickle cell disease","authors":"Sadie M. Butcher ,&nbsp;Caren Steinway ,&nbsp;Brahadesh Sivakumar ,&nbsp;Katherine Wu ,&nbsp;Toyosi Oluwole ,&nbsp;Desireé N. Williford ,&nbsp;Sophia Jan ,&nbsp;Symme W. Trachtenberg ,&nbsp;Kim Smith-Whitley ,&nbsp;Tanisha D. Belton","doi":"10.1016/j.hctj.2024.100091","DOIUrl":"10.1016/j.hctj.2024.100091","url":null,"abstract":"<div><h3>Background</h3><div>Community health workers (CHWs) are vital links between communities and health systems, with CHW models facilitating positive health and life outcomes. However, little is known about CHWs’ experiences serving in these roles or their potential to support the transition to adulthood for adolescents and young adults (AYA).</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with CHWs and their supervisors from five recruitment sites affiliated with Community Health Worker and Mobile Health for Emerging Adults Transitioning Sickle Cell Disease Care (COMETS) Trial. COMETS compared the effectiveness of a CHW intervention, mobile health application, or enhanced usual care on the health-related quality of life of AYA with SCD transitioning from pediatric to adult care. To understand CHW and CHW supervisor experiences during the COMETS trial, interviews were analyzed using an integrated inductive and deductive thematic analytic approach.</div></div><div><h3>Results</h3><div>Three key themes emerged as interviewees described the unique aspects of the CHW role: (1) the supports for transition to adulthood that CHWs provided to patients, (2) the experiences of establishing trusting relationships with patients, and (3) the impact of the role on CHWs themselves. All interviewees reported unique contributions made by CHWs in supporting patients’ transition readiness, and CHWs expressed that participating in COMETS impacted them personally and professionally.</div></div><div><h3>Conclusion</h3><div>This study highlights that the CHW role is unique both in how CHWs connect with AYA and how it impacts CHWs. Health systems should explore paths for sustainable funding and workforce development for CHWs and invest in infrastructure for CHW transition programs.</div></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"3 ","pages":"Article 100091"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic stability of attention deficit hyperactivity disorder during healthcare transition","authors":"Alberto Rodríguez-Quiroga ,&nbsp;Cristina Bonilla Sanz ,&nbsp;Miguel Ángel Álvarez-Mon ,&nbsp;Fernando Mora Mínguez ,&nbsp;Javier Quintero","doi":"10.1016/j.hctj.2024.100089","DOIUrl":"10.1016/j.hctj.2024.100089","url":null,"abstract":"<div><h3>Background and Aims</h3><div>The belief that ADHD remitted in adulthood and the absence of specific criteria for its diagnosis in adults have led to discrepancies in estimating its persistence, hindering proper treatment. The objective of this study was to evaluate the persistence of diagnosis and subtypes of ADHD in patients transitioning to adulthood in a specialized setting using DSM-5 criteria.</div></div><div><h3>Material and Methods</h3><div>Retrospective data were collected from 59 patients diagnosed with ADHD at the Hospital Universitario Infanta Leonor, Madrid, with symptom onset between 2 and 12 years of age. Subgroups were formed based on diagnosis and initial subtype stability, and descriptive and statistical analysis was performed using SPSS software.</div></div><div><h3>Results</h3><div>The persistence rate was 93.2 %. Persistence was significantly associated with the need for specific follow-up at present, but not with gender, current age, or treatment. High percentages of comorbidity were found in both the persistent and remission groups. The initial inattentive subtype showed greater stability, with a preservation rate of 95.83 %. The combined subtype decreased more over time, with a preservation rate of 71.4 %. The diagnostic consistency for each subtype was high, although overall diagnostic concordance decreased slightly with age.</div></div><div><h3>Conclusions</h3><div>ADHD stability using appropriate criteria is higher than previously described. Comprehensive follow-up is necessary regardless of the current diagnostic status, especially in the period of transition from adolescence to adulthood.</div></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"3 ","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A mixed methods exploratory study assessing youth knowledge, self-efficacy and mental health outcomes in transition to adult healthcare","authors":"Jennifer G. Andrews ,&nbsp;Rena Shifren ,&nbsp;Richard Wahl ,&nbsp;Wendy Parent-Johnson ,&nbsp;Scott Klewer","doi":"10.1016/j.hctj.2025.100096","DOIUrl":"10.1016/j.hctj.2025.100096","url":null,"abstract":"<div><h3>Background</h3><div>Transition from adolescence to adulthood is a change in status yielding self-sufficiency, independence, and participation in adult roles. There are numerous efforts to define transition elements and encourage formalized processes readying youth for adulthood, yet significant challenges remain.</div></div><div><h3>Methods</h3><div>We recruited individuals who were age 12 years or older and not transitioned or 18 years and older who transitioned within 24 months to complete questionnaires and participate in a focus group.</div></div><div><h3>Results</h3><div>25 participants (Mean age 17.9 years) completed questionnaires and 76 % participated in focus groups. Youth 18 years and older had mean scores in the reason for concern range on 7 of 9 NIH Toolbox scales de. Transition readiness was lower in adults across all five categories. Key themes include misunderstanding the concept of transition and self-determination in transition.</div></div><div><h3>Conclusions</h3><div>Few youth understood what “transition” entails. Most considered it a single issue, such as aging out of insurance or leaving their pediatric specialist. Youth self-efficacy and life outlook declines in the late teens and early adulthood, exacerbating perceived inability to self-manage and gain independence. Most concerning is the emotional well-being and self-esteem of our adults who scored in the reason for concern range in 7 of 9 scales whereas adolescent peers did not. A directed attempt to create self-efficacy for youth in transition through training in health management, understanding the meaning of transition and promoting a positive perception prior to transition is needed.</div></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"3 ","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143227652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and parent perspectives on an academic rheumatology transition clinic","authors":"Rebecca S. Overbury ,&nbsp;Devin Eddington ,&nbsp;Katherine Sward ,&nbsp;Aimee Hersh","doi":"10.1016/j.hctj.2024.100094","DOIUrl":"10.1016/j.hctj.2024.100094","url":null,"abstract":"<div><h3>Objectives</h3><div>To better define components of successful Health Care Transition (HCT) we surveyed patients in an academic Rheumatology Transition clinic at the University of Utah. Results can be used to improve HCT over time.</div></div><div><h3>Methodology</h3><div>We asked patients and parents to complete Mind the Gap and the Transition Feedback survey as part of a larger registry dataset collected from said Rheumatology Transition clinic. Results from Mind the Gap and the Transition Feedback survey were analyzed. Survey responses are presented as averages.</div></div><div><h3>Results</h3><div>Sixty-five patients and 42 parents completed Mind the Gap. Patients report that the clinic is outperforming their expectations in 20 of 22 variables. Parents report that the clinic is underperforming their expectations in 23 of 27 variables. Parents value these 22 variables more than the patients. Twenty-four patients and 15 parents completed the Transition Feedback survey. More than 50 % of patients and parents state that the components of HCT curriculum were addressed. 58 % of patients (14 out of 24) reported feeling “very ready” to move to an adult doctor or other health care provider. 53 % of parents (8 out of 15) felt their child was “very ready” to move to an adult doctor or other health care provider.</div></div><div><h3>Conclusion</h3><div>A difficulty in defining a successful transfer is how to simultaneously integrate the perspective and needs of the patient and parents. This research shows that the values of patients and their parents generally align. However, there are important disparities between these groups. We demonstrate that even in a dedicated Transition clinic, not all components of HCT are being administered and that only half of patients and parents feel prepared to transfer.</div></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"3 ","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transition from pediatric to adult health services: A survey of challenges, needs, and preferences of youths and parents","authors":"Eric Racine ,&nbsp;François Ouimet ,&nbsp;Rocio Gissel Gutierrez Rojas ,&nbsp;Marie-José Clermont ,&nbsp;Anne Fournier","doi":"10.1016/j.hctj.2025.100095","DOIUrl":"10.1016/j.hctj.2025.100095","url":null,"abstract":"<div><h3>Aim</h3><div>Transition from pediatric to adult healthcare is a critical period. Recommendations have pointed to greater preparation of youths and families and better coordination. Considerations such as patient values and preferences may – if not taken into consideration – impede uptake of clinical recommendations. This survey-based study aimed to better understand challenges, needs, and intervention preferences of youths and parents during transition.</div></div><div><h3>Methods</h3><div>Two online surveys were designed to investigate challenges, needs, and intervention preferences of youths with a chronic or rare condition and parents during transition. The youth survey included the French translation of the Transition Readiness Assessment Questionnaire (TRAQ). Additional questions were derived from an interview-based study and aimed to grasp issues related to human flourishing in addition to more conventional clinical issues related to the transition process. Descriptive statistics were used and ANOVAs to detect differences between the groups when applicable.</div></div><div><h3>Results</h3><div>86 youths and 94 parents completed the survey. Average scores for TRAQ subscales were high except for “Tracking health issues” and “Appointment keeping”. Youths and parents reported being able to give their opinion. Parents were judged to be slightly over-involved. Ongoing involvement of parents in health management was desired. Awareness of differences between pediatric and adult healthcare was high, but a source of notable concern (e.g., accessibility of different medical and professional services). Information on transition was lacking. Installing a pivot-person, visits to the adult hospital, meeting other youths, and accessing transition videos were supported interventions.</div></div><div><h3>Conclusion</h3><div>Transition readiness can be high, but significant challenges can still be present and salient. Youths and adults want to be involved and informed to prepare actively for transition through meetings or adapted materials.</div></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"3 ","pages":"Article 100095"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“When you’re in the office, it means you managed to get somewhere”: An interpretive descriptive study of the perceptions of adolescents accessing primary care for mental health services","authors":"Lisa De Panfilis RN, MSc ,&nbsp;Rebecca Ganann RN, MSc, PhD ,&nbsp;Gillian Mulvale MA, PhD ,&nbsp;Naomi Thulien NP-PHC PhD ,&nbsp;Ruta Valaitis MA, PhD","doi":"10.1016/j.hctj.2024.100093","DOIUrl":"10.1016/j.hctj.2024.100093","url":null,"abstract":"<div><h3>Objective</h3><div>Primary care offers an entry point into the health care system for adolescents experiencing mental illnesses. This study explored the perceptions of adolescents with an anxiety or mood disorder accessing primary care for mental health services.</div></div><div><h3>Methods</h3><div>Qualitative interpretive descriptive design was employed. Participants ages 15–18 years (n = 10) were recruited from a mid-sized city in Canada utilizing flyers and social media advertisements. Data were collected between August and December 2019. Data generation methods included photo-elicitation, demographic survey, and semi-structured interviews. Analysis was guided by a health care access framework and ecological model.</div></div><div><h3>Results</h3><div>Adolescents perceived the process of accessing primary care for mental health services as complex and beginning prior to entering the primary care environment; a novel conceptual framework was developed to depict the process. Adolescents described three stages in this process: feeling uncertain about their concerns and requiring help; seeking informal support from parents and friends to initiate help-seeking; and receiving mental health services through primary care.</div></div><div><h3>Discussion</h3><div>A novel conceptual framework to depict the process of access for adolescents is proposed. Primary care practitioners require awareness of the access process adolescents conceptualize prior to deciding to seek help in primary care, as well as the need to foster their emerging adulthood in care. Targeted interventions to enable early intervention include providing information about mental health services available during routine interactions.</div></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"3 ","pages":"Article 100093"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associated factors that contribute to readiness for healthcare transition in a population of adolescents and young adults with special healthcare needs","authors":"Benedicta C. Anikputa ,&nbsp;Sharon D. Horner ,&nbsp;Cecily L. Betz ,&nbsp;Megan Thomas-Hebdon ,&nbsp;Cara Young","doi":"10.1016/j.hctj.2024.100081","DOIUrl":"10.1016/j.hctj.2024.100081","url":null,"abstract":"<div><h3>Background</h3><div>Children with special health care needs (SHCN) are a growing population in the United States, who because of advancements in medicine, are surviving into adulthood and are expected to transition from pediatric care to adult care. The purpose of this study was to identify and describe which ecological variables (internal locus of control, self-efficacy, self-advocacy, adolescent responsibility, parental responsibility, or perceived healthcare provider communication) are most influential in preparing adolescents and young adults (AYA) with SHCN to transition into the adult healthcare system.</div></div><div><h3>Methods</h3><div>A convenience sample of AYA with SHCN between the ages of 18–25, were recruited from specialty clinics, universities, local and national organizations. Flyers were placed at local establishments and businesses. The researcher also reached out to AYA with SHCN and those that worked with AYA with SHCN. Participants completed an online survey and multiple linear regression was used to answer the research question.</div></div><div><h3>Results</h3><div>Self-advocacy (p=.013), self-efficacy (p=.007), adolescent responsibility (p&lt;.001), and communication with healthcare provider (p=.014) significantly predicted transition readiness. The resultant model was significant (F (1, 78) =6.39, P=.014, Adj R 2 =.540 and R 2 =.573).</div></div><div><h3>Conclusion</h3><div>This study addresses the gap in literature by examining factors from multiple domains that are theoretically seen as potentially influencing transition readiness. By determining which transition variables are the most important and necessary for transition readiness, then programs can be created to bolster them.</div></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"3 ","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transition experiences of adolescents and young adults working with a patient navigator","authors":"Daniella San Martin-Feeney ,&nbsp;Sophie Samborn ,&nbsp;Brooke Allemang ,&nbsp;Megan Patton ,&nbsp;Zoya Punjwani ,&nbsp;Ken Pfister ,&nbsp;Laurel Ryan ,&nbsp;Gregory M.T. Guilcher ,&nbsp;Lorraine Hamiwka ,&nbsp;Scott Klarenbach ,&nbsp;Eddy Lang ,&nbsp;Kerry McBrien ,&nbsp;Alberto Nettel-Aguirre ,&nbsp;Danièle Pacaud ,&nbsp;Jorge Pinzon ,&nbsp;Shannon D. Scott ,&nbsp;Lonnie Zwaigenbaum ,&nbsp;Curtis Perrott ,&nbsp;John Andersen ,&nbsp;Gail Andrew ,&nbsp;Gina Dimitropoulos","doi":"10.1016/j.hctj.2024.100088","DOIUrl":"10.1016/j.hctj.2024.100088","url":null,"abstract":"<div><h3>Introduction</h3><div>The transition from pediatric to adult care poses challenges for adolescents and young adults (AYA) with chronic conditions and their caregivers. A patient navigator (PN) intervention may mitigate transition-related barriers.</div></div><div><h3>Methods</h3><div>A qualitative study was conducted within a pragmatic randomized controlled trial. A purposive sample was recruited of AYA with diverse diagnostic and demographic characteristics who worked with the PN and/or their caregivers. Seventeen participants completed semi-structured interviews at baseline and post-intervention and optional journal entries. Thematic analysis was used inductively.</div></div><div><h3>Results</h3><div>Analysis yielded two themes from baseline interviews: 1) uncertainty and hesitation with leaving a place of support, 2) navigator assistance with post-secondary education, and three themes from post-intervention interviews: 1) emotional support, 2) informational and task-focused support, 3) navigator guidance to become more independent.</div></div><div><h3>Discussion</h3><div>Our findings describe the needs of AYA and the experience of PN support; our findings may guide future implementation of PNs in transition care.</div></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"3 ","pages":"Article 100088"},"PeriodicalIF":0.0,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}