SSM - Health Systems最新文献

{"title":"USAID withdrawal and the erosion of development assistance for health: Considerations for health system leadership in LMICs","authors":"Kabir Sheikh ,&nbsp;Helen Schneider","doi":"10.1016/j.ssmhs.2025.100107","DOIUrl":"10.1016/j.ssmhs.2025.100107","url":null,"abstract":"<div><div>Development assistance for health (DAH) is entering a period of retrenchment, exemplified by the withdrawal of USAID from global health. This commentary examines, the implications of a declining DAH landscape for health systems in low- and middleincome, countries (LMICs). The loss of donor support not only creates significant funding gaps but also removes certain benefits that donors have provided - such as sustained financing for high-impact vertical programs (e.g. immunization and disease control) and coordination functions. At the same time, the reduction in DAH may alleviate some longstanding distortions, including the fragmentation caused by vertical initiatives and the internal “brain drain” of talent into donor-funded projects, opening opportunities for countries to reclaim leadership. The immediate challenge for health system leaders is to mitigate service disruptions through short-term measures, while pursuing long-term strategies to increase domestic health investment and strengthen system-wide capacities. We emphasize the need for renewed commitment to the principles of country ownership and alignment - now driven by domestic stewardship rather than donor conditionality. In a changing global context, new arrangements that complement national efforts are needed to ensure that global solidarity and support for shared health goals persist despite a reduced role for traditional aid.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653476","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":"Understanding the initiation, formation, functioning, and performing of networks to change practices – Realist evaluation of a programme to improve newborn care in Kenya","authors":"Katherine Kalaris ,&nbsp;Mike English ,&nbsp;Geoff Wong","doi":"10.1016/j.ssmhs.2025.100101","DOIUrl":"10.1016/j.ssmhs.2025.100101","url":null,"abstract":"<div><div>Networks are increasingly employed to tackle health system challenges by either explicitly or implicitly targeting the relational aspects of health systems. We undertook a Realist evaluation to test a programme theory developed during a previous Realist review on network initiation, formation, and functioning. Our aim was to further develop an understanding of the processes involved in the initiation, formation, functioning, performing, and sustaining change and impact of networks that enable changes in practice to improve quality of care and services. We undertook a multiple-methods single case study of the Newborn Essential Solutions and Technologies programme in Kenya to evolve the programme theory. The revised programme theory explains how a network evolves through three phases: Initiation &amp; Formation, Functioning &amp; Performing, and Sustaining Change &amp; Impact through interrelated processes (identify a problem; collective vision; taking action to solve a problem; identity and culture), activities (knowledge and skills dissemination; cross-learning; resourcing; leadership; champions; adaptability), foundations (teamwork; psychological safe space; commitment; engaged, motivated, empowered, and confident network members; purposeful relationships, linkages, and partnerships), and cross-cutting factors (communication; trust; energy, effort, and passion). This network programme theory provides a roadmap for the relational work those employing networks should perform to promote success in changing practices to improve quality of care, service delivery, and health system functioning.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100101"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604450","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":"Strengths and challenges for implementing non-clinical safe spaces for people experiencing emotional distress and/or suicidal crisis: A mixed-methods study from Australia","authors":"Scott J. Fitzpatrick ,&nbsp;Grenville Rose ,&nbsp;Melanie Giugni ,&nbsp;Louise A. Ellis ,&nbsp;Alyssa R. Morse ,&nbsp;Cassandra Chakouch ,&nbsp;Erin Oldman ,&nbsp;Benn Miller ,&nbsp;Helen T. Oni ,&nbsp;Michelle Banfield","doi":"10.1016/j.ssmhs.2025.100100","DOIUrl":"10.1016/j.ssmhs.2025.100100","url":null,"abstract":"<div><h3>Background</h3><div>‘Safe Spaces’ are novel interventions that provide non-clinical, peer-led services for people experiencing emotional distress and/or suicidal crisis. To date, little empirical research has examined these service models, particularly from the perspectives of peer workers working within these services and health services staff employed in local health systems in which safe spaces have been implemented.</div></div><div><h3>Methods</h3><div>We used a convergent mixed methods study design, collecting both quantitative and qualitative data from safe space staff (18 survey and 31 interview participants) and health services staff (49 survey and two interview participants). An exploratory unidirectional approach to data integration was taken whereby themes developed in the coding of qualitative data guided analysis of the quantitative data.</div></div><div><h3>Findings</h3><div>Peer workers described their work as multifaceted, challenging, and highly responsive to meeting diverse guests’ needs. Lived experience was expressed through ways of being and doing, yet a range of professional competencies, training, and support needs were identified as critical to this work. High demand and insufficient resourcing, along with negative perceptions of peer work, the risk of vicarious trauma and burnout, and low levels of integration within existing health systems resulted in clear challenges to the ongoing feasibility, effectiveness, and sustainability of safe spaces.</div></div><div><h3>Conclusion</h3><div>Safe spaces fill a critical gap in existing healthcare systems, offering after-hours crisis and preventative care and support. Greater resourcing and attention to the broader organisational and system-level barriers that impact their adoption and integration within local health systems is needed to maximise the service model’s effectiveness.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100100"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596749","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":"Experiences of maternity care (MC): Perspectives among women, partners and service providers in Trinidad","authors":"Arlene James-Euin ,&nbsp;Whitney Arneaud ,&nbsp;Marcia Rollock ,&nbsp;Debrah Lewis ,&nbsp;Shirley Curtis ,&nbsp;Suzanne Stalls ,&nbsp;Susan Moffson ,&nbsp;Shanon McNab ,&nbsp;Jim Ricca ,&nbsp;Pooja Sripad ,&nbsp;Oscar Noel Ocho","doi":"10.1016/j.ssmhs.2025.100099","DOIUrl":"10.1016/j.ssmhs.2025.100099","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite the growing global literature around Respectful Maternal and Newborn Care (RMNC), there has been limited information on reducing mistreatment and promoting RMNC in the Latin American and Caribbean (LAC) region. This formative study conducted in Trinidad and Tobago aimed to describe the current experiences of maternity care in the public and private sectors from the perspectives of women, their male partners, service providers and managers/administrators.</div><div><strong>Principal results</strong></div><div>Nested in a wider mixed methods study undertaken in four of five regions in Trinidad and Tobago, this paper focuses on qualitative findings from 45 interviews, six focus groups (n = 54) and insights from a co-design workshop to contextualize findings. We found that experiences of care sit along a continuum of respectful care to mistreatment, centering around five broad themes: 1) communication with healthcare staff, 2) judgment and/or discrimination; 3) decision-making and autonomy; 4) partner involvement; and 5) privacy and confidentiality. While open communication, enabling environments, birth planning, partner support and safeguarding personal information determined RMNC; non-verbal cues, provider preconceptions, and tensions between extant policy and practice led to experiences of mistreatment. Complexities identified across often convergent perspectives require broader systems solutions.</div></div><div><h3>Major conclusions</h3><div>This study expands the learning on women’s experience of childbirth by triangulating perceptions of women, their partners, health workers, and policymakers. Addressing mistreatment of both women and health workers and strengthening RMNC in Trinidad and Tobago and similar settings requires moving beyond interpersonal provider-client interactions to a culturally sensitive, multi-component, health systems approach.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100099"},"PeriodicalIF":0.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604372","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":"Clinical, organisational and policy factors influencing the implementation of nurse-led models of long-acting reversible contraception and medication abortion care in Australian general practice: A qualitative exploration","authors":"Jessica E. Moulton ,&nbsp;Noushin Arefadib ,&nbsp;Jessica R. Botfield ,&nbsp;Karen Freilich ,&nbsp;Danielle Mazza","doi":"10.1016/j.ssmhs.2025.100095","DOIUrl":"10.1016/j.ssmhs.2025.100095","url":null,"abstract":"<div><h3>Background</h3><div>Access to sexual and reproductive healthcare in rural and regional areas is often limited, particularly for contraception and abortion care. Nurse-led models of care offer a promising solution, yet their implementation and evaluation in Australian primary care remain underexplored. We therefore examined stakeholders’ perceptions of clinical, organisational and policy factors influencing the adoption of nurse-led contraception and abortion care in rural and regional Australian general practice.</div></div><div><h3>Methods</h3><div>A secondary analysis of qualitative data from a co-design workshop, aimed at developing a nurse-led model of care, was conducted. Participants included consumers, nurses, physicians, practice managers, community and advocacy organisation representatives, academics, and policymakers. The secondary analysis focused solely on data related to clinical, organisational, and policy factors that may influence the implementation of nurse-led contraception (involving contraceptive implant insertion) and medication abortion in rural and regional general practice. The Consolidated Framework for Implementation Research guided data analysis to enrich our understanding of implementation factors.</div></div><div><h3>Results</h3><div>Fifty-two stakeholders participated in the workshop. Five themes were constructed: 1) the influences on nurses' capability to work to their full scope of practice<em>,</em> 2) formalising general practitioner-nurse partnerships for model sustainability, 3) integrating practice-based nurse training, 4) medico-legal implications for collaborative care and 5) leveraging funding models to support nurse-led care.</div></div><div><h3>Conclusion</h3><div>Successful implementation of nurse-led contraception and medication abortion care requires improved funding models to ensure adequate nurse and practice remuneration, strengthened nurse-general practitioner partnerships, and employer support for ongoing nurse education. Policies fostering collaborative, multidisciplinary care will enhance the sustainability and effectiveness of these models in general practice.</div></div><div><h3>Reporting method</h3><div>Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist.</div></div><div><h3>Patient or public contribution</h3><div>Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100095"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572695","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":"Does the DRG reform help alleviate the challenge of \"difficult and expensive healthcare\" in China?","authors":"Dan Qu,&nbsp;Jiahui Chen","doi":"10.1016/j.ssmhs.2025.100098","DOIUrl":"10.1016/j.ssmhs.2025.100098","url":null,"abstract":"<div><div>This paper examines the impact of DRG reform on healthcare outcomes by analyzing city-level data from China from 2011 to 2020. An empirical research model was developed based on the goals of the payment reform. The difference-in-differences analysis revealed that the CN-DRG payment reform significantly reduced the percentage change in rural per capita healthcare expenditures, decreased the average length of hospitalization by about 0.9 days, and increased hospital activity at higher-level hospitals. However, it did not significantly encourage patients to utilize primary hospitals. The robustness tests indicate that the findings remain consistent across various methodologies, offering policymakers valuable theoretical support for advancing DRG reforms.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557368","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":"Towards social enterprises that digitally engage citizens for integrated people-centred health services: Organisational case studies and a framework analysis of community health alliances","authors":"Myron Anthony Godinho (Research Fellow) ,&nbsp;Siaw-Teng Liaw (Emeritus Professor) ,&nbsp;Padmanesan Narasimhan ,&nbsp;Md Mahfuz Ashraf","doi":"10.1016/j.ssmhs.2025.100096","DOIUrl":"10.1016/j.ssmhs.2025.100096","url":null,"abstract":"<div><h3>Introduction</h3><div>Globally, social enterprises are being explored for their potential to act as socially responsible, privately-owned providers of community-focused primary care. In this study, we tested a framework on how social enterprises could use digital health and citizen engagement to actualise the WHO strategies for integrated people-centred health services (IPCHS) using case studies of two Community Health Alliances (CHAs) in Sydney, Australia.</div></div><div><h3>Methodology</h3><div>We constructed cases studies of two CHAs using a combination of documentary analysis (57 documents), and semi-structured interviews (14 participants) that were coded using both inductive and deductive approaches. Case study findings were used to conduct a framework analysis to test, validate, and revise the framework, based on a recommended approach for organisational case study research.</div></div><div><h3>Results</h3><div>Our case analysis demonstrated that CHAs use digital health and citizen engagement to co-produce services in ways that actualise the IPCHS strategies. Framework analysis demonstrated that enterprise, digital health, and citizen engagement enable each other and co-create IPCHS. The framework was revised to reflect novel observations. Findings indicated that the CHAs we studied do not yet operate as social enterprises, with ongoing challenges related to value capture, their ownership model, and their formalisation as independent entities.</div></div><div><h3>Conclusion</h3><div>Stakeholders attributed CHAs’ operational challenges to the early stage of maturity. To address this, our future work will develop a maturity model and toolkit to implement and evaluate social enterprises that use digital health and citizen engagement to co-produce IPCHS.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491800","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":"A system dynamics model of community-based health insurance system in Bangladesh","authors":"Nurnabi Sheikh ,&nbsp;Susan Howick ,&nbsp;Shehrin Shaila Mahmood ,&nbsp;Syed Manzoor Ahmed Hanifi ,&nbsp;Alec Morton","doi":"10.1016/j.ssmhs.2025.100097","DOIUrl":"10.1016/j.ssmhs.2025.100097","url":null,"abstract":"<div><div>Community-based health insurance (CBHI), also known as micro or mutual health insurance, is managed by local non-government organization, hospitals and cooperative societies to mobilize local resources to provide healthcare services to the underserved marginalized population. The effectiveness of voluntary CBHI as a financing mechanism for achieving universal health coverage (UHC) is widely debated and remains a global concern, with many experts questioning its long-term sustainability and feasibility. Overcoming the barriers to implement a sustainable CBHI is a policy priority for Bangladesh and will reflect on a global debate about the role of CBHI in attaining UHC. The goal of this study is to identify appropriate policies which support a sustainable CBHI and to assess the impact of these policies over time. A System Dynamics approach is used to build a model, simulate, and evaluate policy scenarios. The model was parameterized using data from the literature, primary data collected from a CBHI scheme in Bangladesh and expert opinion. Although there is potential for a sustainable CBHI scheme in Bangladesh, achieving this requires coverage of over 60 % of the target population to ensure risk sharing among insured members, external or mandatory public financing as a seed money until attaining self-sufficiency (i.e., ability to generate enough revenue to maintain the scheme without external funding), and a robust regulatory framework. Even though Bangladesh is known as the birthplace of microfinance and the land of non-governmental organizations with many successful community initiatives, it is unlikely that CBHI would achieve sustainability in the long run without these essential components. The challenging conditions for the financial sustainability of CBHI in Bangladesh raise significant concerns about its feasibility as a financing mechanism for achieving UHC in any other settings.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100097"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588193","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":"‘Violence against women is not a public health problem’: Barriers and facilitators to providing health care for survivors of intimate partner violence in Mexico City","authors":"Sophie M. Morse ,&nbsp;Daniela C. Rodríguez ,&nbsp;Erin C. Lentz ,&nbsp;Carolina Dotoreo Soriano ,&nbsp;Ana Jocelyn Mejía Morales ,&nbsp;Claudia Diaz Olavarrieta ,&nbsp;Manuela Colombini","doi":"10.1016/j.ssmhs.2025.100094","DOIUrl":"10.1016/j.ssmhs.2025.100094","url":null,"abstract":"<div><div>Violence against women (VAW) remains an urgent public health crisis globally. In Mexico, 39.9 % of women over age 15 have reported experiencing intimate partner violence (IPV) in their current or past relationships. Although Mexico has made significant progress toward addressing this issue through numerous policies and regulations, the status of implementing those policies is unknown. This study identifies the facilitators of and barriers to providing health services for survivors of IPV in Mexico City at the policy, facility, and individual health care worker (HCW) levels. Seventy-six qualitative interviews were conducted with key informants, including policymakers, facility managers, and health care workers. Data were analyzed thematically and organized across health system levels. We found that the Federal Ministry of Health was not considered a leader in VAW response, and facility managers displayed limited prioritization of VAW. The greatest facilitator of care was having a Specialized Service unit with dedicated staff to support IPV survivors. HCWs reported some knowledge and skills for addressing IPV in patients, but many did not feel prepared, especially for the emotional aspects of care, and burnout was common. A significant barrier to care was HCW’s reluctance to engage with IPV patients or their cases for reasons such as the normalization of violence or hesitance to participate in the justice system. Despite progress towards addressing IPV in Mexico, addressing barriers to service delivery would improve the effectiveness of the health system's response to IPV, ultimately improving health outcomes for survivors of violence.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297304","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":"Conflicts and complexities around intellectual property and value sharing of artificial intelligence healthcare solutions in public-private partnerships: A qualitative study","authors":"Hassane Alami ,&nbsp;Lysanne Rivard ,&nbsp;Pascale Lehoux ,&nbsp;Mohamed Ali Ag Ahmed ,&nbsp;Racha Soubra ,&nbsp;Ronan Rouquet ,&nbsp;Richard Fleet ,&nbsp;Jean-Paul Fortin","doi":"10.1016/j.ssmhs.2025.100093","DOIUrl":"10.1016/j.ssmhs.2025.100093","url":null,"abstract":"<div><h3>Background</h3><div>Public healthcare systems are increasingly relying on artificial intelligence (AI) technologies to meet growing healthcare needs. Because AI technologies are complex and costly to develop, public-private partnerships (PPPs) between digital companies and university hospital centres are being promoted as a key for the successful development and implementation of AI solutions. This article aims to shed light on stakeholders’ perspectives on the intellectual property (IP) and value sharing of AI technologies developed by PPPs and how their practical experiences can affect the success or failure of such PPPs.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with 29 stakeholders concerned with and/or involved in digital health technologies in a large Canadian university hospital centre. Data were collected and analysed through a mixed deductive-inductive approach.</div></div><div><h3>Results</h3><div>The analysis revealed three key themes highlighting AI IP issues of concern for PPP stakeholders. First, the collaborations and contributions required from all stakeholders to develop AI technologies of clinical and commercial value are highly complex and often unclear. Second, the lack of institutional and commercial recognition of clinicians’ essential contributions to AI solution development results in competing academic and business imperatives that hinder their engagement in PPPs. Finally, public healthcare systems’ strategic use of AI requires new policies adapted to the digital economy where IP plays a central role in value generation and sharing.</div></div><div><h3>Conclusion</h3><div>For PPPs developing AI healthcare technologies to be successful, updated policies clarifying public healthcare systems’ strategic use of AI are required as well as clear value-sharing frameworks between stakeholders.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100093"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223304","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}