Obesity Pillars最新文献

{"title":"Microdosing of obesity medications: A Perspective Statement from the Access and Policy Working Group","authors":"Christopher Weber , Bharti Shetye , Courtney Younglove , Catherine Varney , Leslie Golden , Harold Edward Bays","doi":"10.1016/j.obpill.2025.100234","DOIUrl":"10.1016/j.obpill.2025.100234","url":null,"abstract":"","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"17 ","pages":"Article 100234"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity pillars roundtable: Better together - combined obesity medicine and metabolic surgery care for the treatment of obesity","authors":"Kirsten Frederiksen ,&nbsp;Reed A. Berger-Fleishman ,&nbsp;Ahmed Jad ,&nbsp;Samer G. Mattar ,&nbsp;Bharti Shetye","doi":"10.1016/j.obpill.2025.100232","DOIUrl":"10.1016/j.obpill.2025.100232","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a chronic, multifactorial, complex, and relapsing disease typically requiring treatment from various medical providers throughout the continuum of care. A natural overlap in medical and procedural obesity treatment therefore often exists during the course of treatment. Given this, the optimal treatment of the medically complex patient population may best be delivered either within multi-disciplinary teams, or through more effective collaboration with diverse specialists sharing the common interest of managing patients with obesity. The aim of this roundtable is to more deeply engage on issues surrounding the multi-disciplinary approach for the treatment of obesity, along with highlighting areas of opportunity for improving collaborative care.</div></div><div><h3>Methods</h3><div>This roundtable review includes perspectives from two obesity medicine specialists and two metabolic bariatric surgeons, all with extensive experience in combining medical and surgical care.</div></div><div><h3>Results</h3><div>While the panelists generally agreed upon core principles of combined obesity medicine and metabolic surgical care for the treatment of obesity, each had their own priorities and approach regarding the best ways to overlap care. Variances in perceptions included importance of procedural care versus use of pharmacotherapy. However, the panelists endorsed more collaborative work as vital for improving outcomes. Further identification of existing barriers and the creation of pathways for action will bring this work forward.</div></div><div><h3>Conclusions</h3><div>Providing guidance on one universal approach to the care of patients with obesity is challenging due to the heterogeneity of patient populations and variance in practice patterns across the spectrum of care. The panel suggested adopting a continuum-of-care mindset, meaning that all available options should be considered for patients, either in sequence, or as adjuvant therapies, or as rescue options for patients who gain tolerance to a particular therapeutic modality. This approach is in keeping with the reality that obesity is a chronic, relapsing multifactorial disease.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"17 ","pages":"Article 100232"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent obesity: Biochemical and dietary disparities in U.S. youth","authors":"John T. Stutts ,&nbsp;Yong S. Choe ,&nbsp;Ashley Lynn Bronston","doi":"10.1016/j.obpill.2025.100239","DOIUrl":"10.1016/j.obpill.2025.100239","url":null,"abstract":"<div><h3>Background</h3><div>Adolescence is a critical period of growth with elevated nutritional demands, yet many U.S. adolescents fail to meet recommended dietary intakes. This study analyzed data from three NHANES cycles (2013–2018) to assess obesity trends among adolescents aged 12–18, compare dietary intake by BMI, and evaluate nutritional biomarkers.</div></div><div><h3>Methods</h3><div>This retrospective observational study analyzed data from three NHANES cycles to estimate obesity prevalence among U.S. adolescents aged 12–18 years. Dietary intake and blood concentrations of micro- and macronutrients were compared between adolescents with and without obesity. Obesity was defined as BMI ≥95th percentile per CDC growth charts. Nutrient intake was assessed against Estimated Average Requirement (EAR) and Adequate Intake (AI) benchmarks, and biomarker levels were evaluated using established clinical thresholds. All statistical analyses were conducted using SAS version 9.4 and SAS Enterprise Guide version 8.3.</div></div><div><h3>Results</h3><div>Obesity prevalence increased slightly from 20.3% to 21.3% across cycles. Among all dietary intake variables analyzed, only one demonstrated a statistically significant difference between those with obesity and those without. The adolescents with obesity were significantly more likely to have protein intakes below the EAR (50.3% vs. 22.9%, <em>P</em> &lt; 0.001). Over half of all adolescents failed to meet recommended intake levels for several nutrients, regardless of their BMI categories. The blood biomarker analysis revealed significantly lower levels of vitamin D, vitamin C, serum iron, albumin, and MCV in those with obesity, alongside higher levels of total protein, globulin, and hs-CRP (<em>P</em> ≤ 0.05). The prevalence of low vitamin D, low hemoglobin, low MCV, and iron deficiency anemia was also significantly higher in the group with obesity.</div></div><div><h3>Conclusions</h3><div>This study reveals that despite similar caloric intakes, adolescents with obesity exhibited higher rates of nutrient deficiencies and markers of inflammation. This work underscores the importance of recognizing nutrition gaps in adolescent care.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"17 ","pages":"Article 100239"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial for Obesity Pillars: Special Issue “Obesity in Children and Adolescents and Therapy”","authors":"Suzanne E. Cuda MD, FAAP, MFOMA, DABOM (Executive Editor Obesity Pillars)","doi":"10.1016/j.obpill.2026.100250","DOIUrl":"10.1016/j.obpill.2026.100250","url":null,"abstract":"","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"17 ","pages":"Article 100250"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147329011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional status with tirzepatide in obesity: A post hoc analysis of the SURMOUNT-1-4 randomized clinical trials","authors":"Jaime P. Almandoz ,&nbsp;Octavia Pickett-Blakely ,&nbsp;Colleen Tewksbury ,&nbsp;Adam Stefanski ,&nbsp;Sylvia Gonsahn-Bollie ,&nbsp;Georgios K. Dimitriadis ,&nbsp;Ada Leticia Murro ,&nbsp;Dachuang Cao ,&nbsp;Qier Meng ,&nbsp;Lisa M. Neff","doi":"10.1016/j.obpill.2026.100248","DOIUrl":"10.1016/j.obpill.2026.100248","url":null,"abstract":"<div><h3>Background</h3><div>Nutritional deficiencies are common among people with obesity, before and during treatment, such as with very-low-calorie diets and metabolic/bariatric surgery. Obesity management medications (OMMs) can reduce appetite and dietary intake, potentially affecting nutritional status. The impact of OMMs on nutritional outcomes in people with obesity warrants further study.</div></div><div><h3>Methods</h3><div>We conducted a post hoc analysis of available nutritional status-related data from the randomized, placebo-controlled, phase 3 SURMOUNT-1-4 trials of tirzepatide (N = 4726). Descriptive statistics were utilized to explore available nutritional status-related data from clinical trial reports, including investigator-reported treatment-emergent adverse events (TEAEs) based on 14 <em>MedDRA</em> preferred terms, chosen to identify cases of macronutrient malnutrition; investigator-reported vitamin deficiency-related TEAEs; biomarkers assessed systematically during the trials (albumin; total lymphocyte count [TLC]); reasons for early treatment discontinuation; and participants reaching body mass index (BMI) &lt; 18.5 and &lt; 22 kg/m².</div></div><div><h3>Results</h3><div>Investigators reported 3 of 14 TEAEs potentially related to macronutrient malnutrition. TEAE incidence of <em>Abnormal loss of weight</em>, <em>Underweight</em>, and <em>Hypoalbuminemia</em> was 0.03 %, 0.06 %, and 0.03 % with tirzepatide and 0 %, 0 %, and 0.06 % with placebo, respectively. Vitamin deficiency-related TEAEs were reported for 0.99 % and 1.07 % of tirzepatide- and placebo-treated participants, respectively. Albumin &lt;3.3 g/dL occurred in 0.06 % and 0.13 % of tirzepatide- and placebo-treated participants, respectively, while TLC &lt;910/μL occurred in 2.90 % and 1.77 %. Treatment discontinuations potentially related to nutritional status (primarily achievement of desired weight and perceived excessive weight loss) occurred in 0.53 % of participants. Overall, 0.38 % and 0.06 % of tirzepatide- and placebo-treated participants reached BMI &lt;18.5 kg/m².</div></div><div><h3>Conclusions</h3><div>TEAEs and treatment discontinuations due to macronutrient malnutrition were uncommon in the SURMOUNT-1-4 trials of tirzepatide for obesity. Lack of routinely collected vitamin and mineral levels during the trials limited assessment of the impact of tirzepatide treatment on micronutrient status. Systematic assessment of nutritional status before and during OMM treatment would enhance future trials.</div></div><div><h3>Clinicaltrials.gov identifiers</h3><div>NCT04184622 (SURMOUNT-1); NCT04657003 (SURMOUNT-2); NCT04657016 (SURMOUNT-3); and NCT04660643 (SURMOUNT-4).</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"17 ","pages":"Article 100248"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight reduction and treatment adherence with tirzepatide using the Individualized Virtual Integrative Medicine (IVIM) protocol","authors":"Jessica Duncan,&nbsp;Patrick Lee Stevens,&nbsp;Emily Bigby,&nbsp;Courtney Floyd,&nbsp;Josh Malina,&nbsp;Jennifer Nickens,&nbsp;Amber Lambert,&nbsp;Taylor Kantor","doi":"10.1016/j.obpill.2025.100236","DOIUrl":"10.1016/j.obpill.2025.100236","url":null,"abstract":"<div><h3>Introduction</h3><div>Obesity and its downstream effects continue to drive rising rates of chronic disease. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has shown significant potential in supporting weight loss and improving metabolic health. This study examines the use of tirzepatide alongside the Individualized Virtual Integrative Medicine (IVIM) protocol. This is a telehealth-based approach to improving outcomes through consistent access to care and support throughout the weight reduction journey.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of 1166 patients who completed at least 52-weeks of the IVIM clinical protocol while on GLP-1 therapy with tirzepatide overseen by a team of board-certified obesity medicine physicians and nurse practitioners. Only patients with a body mass index (BMI) of 30 or greater were included. Due to the branded tirzepatide shortage, patients were provided with the ability to utilize compounded tirzepatide medications, if medically appropriate.</div></div><div><h3>Results</h3><div>Mean change at 12-weeks for patients both on compounded tirzepatide and branded tirzepatide was −20.12 lbs (−8.80 %), 24-weeks: −35.67 lbs (−15.72 %), 36-weeks: −47.33 lbs (−20.34 %), 52-weeks: −52.28 lbs (−22.74 %). At 72 weeks of therapy, patients had lost an average of −62.79 lbs (−26.54 %). The percentage of patients who lost at least 5 % of their body weight at 52 weeks was: 99.36 %, 10 % or more: 97.12 %, 15 % or more: 84.66 %, 20 % or more: 64.22 %, and 25 % or more: 41.21 %.</div></div><div><h3>Discussion</h3><div>Patients completing 52-weeks of tirzepatide therapy on the IVIM protocol experienced significant weight loss with a high level of treatment adherence and program utilization. The findings suggest that individualized dose titration and frequent access to support may improve outcomes of patients initiated on weight reduction therapy with GLP-1 medications. These findings support the IVIM protocol as a safe, effective and individualized model for delivering obesity treatment through a curated, patient-centered, virtual approach.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"17 ","pages":"Article 100236"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Ethiopian Orthodox Tewahedo Christian fasting on appetite hormones and insulin sensitivity in type-II diabetes and healthy subjects in Ethiopia","authors":"Alemayehu Michael ,&nbsp;Kaleab Baye","doi":"10.1016/j.obpill.2025.100226","DOIUrl":"10.1016/j.obpill.2025.100226","url":null,"abstract":"<div><h3>Background</h3><div>Energy restriction, time-restricted feeding, and vegetarian diet intake each have been linked independently to positive health effects. However, little is known about the religious fasts practiced by Ethiopian Orthodox Tewahedo Christians (EOTC) fasting, which combine energy restriction, time-restricted feeding, and vegetarian diet consumption.</div></div><div><h3>Method</h3><div>This longitudinal study compared the effects of EOTC fasting on appetite hormones, insulin sensitivity, and β-cell function. The fasting cohort comprised both individuals with diabetes and healthy individuals, and was compared against a non-fasting cohort that also included both individuals with diabetes and healthy individuals. We employed pretested structured questionnaire to collect information on fasting patterns, physical activity, and sociodemographic traits. Body weight was measured using an adult digital electronic scale (ASTO), and hormone activity was determined using enzyme-linked immunosorbent assay (ELISA) analyzer.</div></div><div><h3>Results</h3><div>EOTC fast significantly lower serum level of appetite hormones like glucagon (p &lt; 0.0001, p = 0.001), leptin (p = 0.002, p = 0.046) in both type-II diabetes and healthy subjects respectively compared to non-fasting. Insulin increased significantly (p = 0.002) in people with diabetes while decreased (p = 0.003) in healthy subjects. The concentration of ghrelin (p = 0.030) increased significantly in type-II diabetes but insignificantly (p = 0.135) in healthy subjects when compared to non-fasting. Both fasting people with diabetes and healthy subjects showed significant (p = 0.03, 0.010) improvements in insulin sensitivity and β-cell function respectively.</div></div><div><h3>Conclusion</h3><div>Concurrent vegetarian diet and energy restriction practiced among EOTC fasting may improve body weight managements. EOTC fasting improves activities of appetite hormones, increase insulin sensitivity and β-cell function (HOMA-IR) in both people with diabetes and healthy subjects. EOTC fasting practice represents a promising, culturally-accepted, non-pharmacological strategy for diabetes prevention and management.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"17 ","pages":"Article 100226"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New era in obesity medication access: A commentary","authors":"Harold Edward Bays","doi":"10.1016/j.obpill.2025.100244","DOIUrl":"10.1016/j.obpill.2025.100244","url":null,"abstract":"","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"17 ","pages":"Article 100244"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity medications and acquired hypothalamic obesity in adults: A two-case experience","authors":"Henry Lang ,&nbsp;Madisen F. Dorand ,&nbsp;Mahnooor Hassan ,&nbsp;Jesse R. Richards","doi":"10.1016/j.obpill.2026.100246","DOIUrl":"10.1016/j.obpill.2026.100246","url":null,"abstract":"<div><h3>Background</h3><div>Acquired hypothalamic obesity (HO) lacks well-described adult pharmacotherapy outcomes, creating a unique clinical challenge for providers tasked with the treatment of patients with hypothalamic obesity.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review to evaluate clinical outcomes in two patients who developed hypothalamic obesity following treatment for tumors of the central nervous system. Medical records from the research center were systematically examined to identify individuals meeting criteria for acquired hypothalamic obesity, defined by significant weight gain associated with hypothalamic injury secondary to tumor therapy.</div></div><div><h3>Results</h3><div>Two individuals with acquired hypothalamic obesity were identified, both of whom achieved clinically significant weight loss taking tirzepatide with phentermine, and tirzepatide with phentermine/topiramate combination therapy. In case 1, the patient presented with cirrhosis, dyslipidemia, and transaminitis. Tirzepatide was initiated and escalated to 7.5 mg weekly, without weight response, prompting the addition of phentermine 8 mg daily. Dual therapy yielded 12.26 % weight loss over 7 months. In case 2, the patient presented with hypertension and obstructive sleep apnea (OSA). Tirzepatide 2.5 mg weekly combined with phentermine/topiramate was initiated. Tirzepatide was escalated to 5 mg, with phentermine/topiramate subsequently increased to 37.5/50 mg daily, producing 35.10 % weight loss over 11 months.</div></div><div><h3>Conclusion</h3><div>Tirzepatide-based combination therapy was associated with clinically meaningful weight loss and comorbidity improvement in adults with HO. These cases support further study of targeted, multimodal regimens in patients with acquired HO.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"17 ","pages":"Article 100246"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporting the effectiveness of dietary intervention on weight loss outcomes in patients with obesity and overweight: a retrospective chart review at a Center of Excellence in UAE","authors":"Mona Joumaa ,&nbsp;Madeeha Kalsekar ,&nbsp;Momina Malik ,&nbsp;Fatemeh Akbarpoor ,&nbsp;Dana Abdelrahim ,&nbsp;Sara El Ghandour","doi":"10.1016/j.obpill.2025.100241","DOIUrl":"10.1016/j.obpill.2025.100241","url":null,"abstract":"<div><h3>Background</h3><div>A modest weight loss of ≥5 % among patients with obesity is associated with a reduced risk of type 2 diabetes, hypertension, and other obesity-related complications. Dietary interventions play a central role in obesity management and improving metabolic health, yet region-specific data from the United Arab Emirates (UAE) remains limited.</div></div><div><h3>Methods</h3><div>This retrospective chart review aims to assess effectiveness of dietary intervention on weight loss outcomes in patients with overweight and obesity attending a Center of Excellence for Weight Reduction and Obesity Management in UAE. This study included adult patients with BMI ≥25 kg/m² who received individualized dietary counseling between September 2018 and September 2021. Patients who had undergone bariatric procedures or on obesity medications were excluded. Anthropometric and body composition data were collected before and after intervention. Outcomes included changes in weight, BMI, fat mass, visceral fat, and other metabolic parameters. Statistical analyses included paired t-tests, correlation coefficients, and multivariate regression to assess associations between intervention frequency, duration, and weight-related outcomes.</div></div><div><h3>Results</h3><div>A total of 266 patients (mean age 44.46 ± 8.18 years; 63.9 % female) were included. Following the intervention, participants achieved significant mean weight loss of 5.12 % (p &lt; 0.001), with corresponding reductions in BMI (4.93 %, p &lt; 0.001), fat mass (10.11 %, p &lt; 0.001), and visceral fat (34.34 %, p = 0.014). More frequent sessions and longer follow-up durations were significantly associated with greater improvements in BMI, fat mass, and fat percentage. Gender-based analysis revealed that males experienced greater reductions in fat mass and resting energy expenditure compared to females.</div></div><div><h3>Conclusion</h3><div>The dietary intervention resulted in significant improvements in anthropometric and body composition indices. These findings support the efficacy of individualized, dietitian-led interventions in managing obesity. The observed gender differences highlight the importance of tailored approaches in obesity care. This study contributes to the limited body of evidence on effective, non-pharmacological obesity management strategies in UAE.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"17 ","pages":"Article 100241"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}