SSM - Health Systems最新文献

{"title":"The power to prioritize the health system resilience agenda: A review of global strategies and guidelines","authors":"Celia Blaas ,&nbsp;Mariano Salazar ,&nbsp;Dell D. Saulnier","doi":"10.1016/j.ssmhs.2025.100148","DOIUrl":"10.1016/j.ssmhs.2025.100148","url":null,"abstract":"<div><div>Power is infrequently explored in health system resilience, yet is integral to understand the choices made that shape what is prioritized and funded for resilience, which actors are given responsibility for resilience, and which health system capacities are emphasized. This review aimed to explore how power is reflected in strategies and guidelines for health system resilience in grey literature from global governance actors. We included 22 health system resilience strategies and guidelines and adapted a power-sensitive framework to extract data related to power in resilience literature. We found that documents prioritized the health system functions of service delivery and resource generation over governance and financing for resilience, and external shocks were a focus over chronic, internal health system stressors, with a lack of strategies to shift power and authority to actors evenly across community, national and global levels. Governance actors framed resilience as a positive adaptation and an intermediary to other health system goals without acknowledgement of negative outcomes of adaptations for resilience. This review draws attention to explicit and implicit reflections of power in the framing of health system resilience and the lack of clear recommendations to address structural, systemic issues or empower actors across all health system levels.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100148"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415484","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":"“Had they been children, we’d probably be tearing our shirts off!”: Canadian long-term care centres as an arena for necropolitics during the COVID-19 crisis","authors":"Hassane Alami ,&nbsp;Lysanne Rivard ,&nbsp;Marietou Niang ,&nbsp;Elsury J. Pérez ,&nbsp;Mathilde Savoldelli ,&nbsp;Racha Soubra ,&nbsp;Mohamed Ali Ag Ahmed ,&nbsp;Richard Fleet ,&nbsp;Joanne Liu ,&nbsp;Léonel Philibert ,&nbsp;Breitner Gomes Chaves ,&nbsp;Michel Dutech","doi":"10.1016/j.ssmhs.2025.100126","DOIUrl":"10.1016/j.ssmhs.2025.100126","url":null,"abstract":"<div><div>The COVID-19 pandemic did not create but rather exposed and exacerbated long-standing vulnerabilities, marginalities, and inequalities deeply embedded in our societies. Moving beyond strictly medical and epidemiological explanations, this article offers a novel perspective on the disproportionate impacts of COVID-19 on dependent elderly people living in Residential and Long-Term Care Centres (CHSLDs) in the Province of Quebec, Canada. To achieve this, we draw on the concept of necropolitics, which refers to the mechanisms through which socio-political power is exercised to control life, death, and the conditions of existence. It reflects the State’s power to determine who is allowed to live and who is left to die. Through this lens, we argue that the high rates of infection and mortality in CHSLDs were not merely attributable to age or comorbidities but were instead the inevitable outcomes of numerous austerity and privatisation reforms that reflect systemic discrimination against the elderly. These reforms chronically underfunded long-term care, commodified essential services, deteriorated working conditions for healthcare professionals and support staff, reduced the quality and quantity of care, and weakened care facility infrastructures. By implicitly determining which lives were to be protected and prioritised, these reform policies had already sealed the fate of dependent elderly individuals long before the pandemic. Using necropolitics as an analytical framework, this article elucidates the structural causes (“the causes of the causes”) of these inequalities, marginalities, and vulnerabilities. It calls for a transformative approach to long-term care policies that can address these systemic issues and prevent such tragedies in the future.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904056","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 work culture delineated by workplace sense of belonging: A comparative qualitative study of clinical support staff","authors":"Petra J. Sprik ,&nbsp;Katherine A. Meese ,&nbsp;Shanequa Roscoe-Nelson ,&nbsp;Leila Sadri ,&nbsp;Samuel O. Boadu ,&nbsp;Feras Olyan ,&nbsp;Laurence M. Boitet","doi":"10.1016/j.ssmhs.2025.100135","DOIUrl":"10.1016/j.ssmhs.2025.100135","url":null,"abstract":"<div><h3>Background</h3><div>Promoting workplace sense of belonging (WSB) is suggested to improve the wellbeing and retention of clinical support staff (CSS), a critical group in healthcare systems. This comparative thematic analysis explored how CSS with and without WSB described their work culture, using the multi-level Job Demands-Resources (JD-R) model. Using an exploratory approach, we aimed to capture the breadth of cultural elements potentially related to WSB among CSS.</div></div><div><h3>Methods</h3><div>An anonymous employee engagement survey from a large academic medical center in the Southeastern United States was analyzed using hybrid thematic analysis. Responses to an open-ended question about work culture were inductively coded, then codes were deductively sorted into multi-level JD-R categories. Matrix coding explored differences in code frequency and content between those who agreed/strongly agreed with a WSB and those who disagreed/strongly disagreed.</div></div><div><h3>Results</h3><div>Among 385 analyzed respondents, 77 % indicated WSB. Respondents described positive and negative elements of work culture; those with WSB highlighted positive aspects more frequently (64 %) and negative aspects less frequently (56 %), whereas the opposite pattern was more pronounced for those without WSB (22 % positive, 89 % negative). Code and content differences emerged across organizational, team, and individual level themes. Those without WSB uniquely described being treated as inferior based on their profession, directly experiencing discrimination, and more intensely experiencing team conflict, among others. Those with WSB more saliently describe workplace diversity, inclusion, and collegial relationships, among others.</div></div><div><h3>Conclusion</h3><div>Findings suggest that work culture experiences differ by WSB, warranting further research to better understand and support this understudied population.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100135"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094925","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":"What does it take to learn from patient and caregiver experiences to improve healthcare? Key considerations from patients, caregivers, and healthcare professionals at a Canadian hospital","authors":"Emily Cordeaux ,&nbsp;Michelle Marcinow ,&nbsp;Kelly M. Smith ,&nbsp;Kerry Kuluski","doi":"10.1016/j.ssmhs.2025.100091","DOIUrl":"10.1016/j.ssmhs.2025.100091","url":null,"abstract":"<div><div>Healthcare systems face ongoing challenges in improving patient experience – an integral component of care quality. Patients and caregivers can play a critical role in identifying ways to improve experience. However, organisations tend to only learn from their experiences using a narrow set of approaches – typically patient experience surveys and complaints data – instead of drawing from a variety of methods such as focus groups or staff rounding. While surveys can yield a large sample and general trends, they tend to only provide a snapshot of a person’s healthcare experiences, are insufficient in fully capturing feedback, and are less likely to be completed by people from equity-deserving groups. As a result, survey data alone do not typically reflect the experiences of communities served by healthcare organisations. In this paper, we share findings from a qualitative exploratory study where we asked twenty-three patient and caregiver partners and healthcare professionals (e.g., leaders and staff) at a Canadian hospital about strategies to learn from experiential data to improve healthcare. We interviewed participants from a large, urban, academically affiliated community hospital in southern Ontario, which serves one of the most diverse communities in Canada. Using thematic analysis, we identified five important conditions for optimal collection of patient experience data: the need for organisations to communicate a clear purpose, create psychological safety, continuously learn throughout the patient journey, collect community level data, and use multiple approaches to learn about experience. Adopting these conditions has the potential to widen the breadth of experience data collected by organisations, ensuring that no voices are excluded from shaping quality improvement initiatives.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100091"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280284","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":"Improving health care through the U.S. Veterans Health Administration’s nationwide LGBTQ+ Veteran Care Coordinator Program","authors":"Rajinder Sonia Singh ,&nbsp;Dana P. Brunson ,&nbsp;Monica M. Matthieu ,&nbsp;JoAnn E. Kirchner ,&nbsp;Michael R. Kauth ,&nbsp;Jillian C. Shipherd ,&nbsp;Sarah E. Valentine ,&nbsp;Sara J. Landes","doi":"10.1016/j.ssmhs.2025.100113","DOIUrl":"10.1016/j.ssmhs.2025.100113","url":null,"abstract":"<div><div>Lesbian, gay, bisexual, trans-identifying, queer (LGBTQ+) veterans experience health and health care disparities. Health care organizations play a critical role in supporting recipients of care, particularly for underserved communities, such as LGBTQ+ patients. To improve health and reduce health care disparities for LGBTQ+ veterans, the Veterans Health Administration (VHA) in the United States (U.S.) created the LGBTQ+ Health Program, a national program that includes local coordinators called the LGBTQ+ Veteran Care Coordinator (VCC) Program. The LGBTQ+ VCC Program was established through VA policy and illustrates one example of how policy implementation can push forward health equity for marginalized populations. We conducted a process program evaluation of the LGBTQ+ VCC Program (launched in 2016) to assess the barriers and facilitators of the program as well as provide recommendations and tools to assist in program implementation. Guided by the Consolidated Framework for Implementation Research and enhanced by two health equity domains, we collected data from local coordinators (n = 172) and regional network leads (n = 15) from January–March 2022. Qualitative data were collected through focus groups and individual interviews with local coordinators (n = 41), former local coordinators (n = 3), and regional network leads (n = 6) from July–December 2022. A mixed-methods design was used for triangulation, analyzing quantitative data using descriptive statistics and qualitative data using template analysis. Findings indicate local coordinators and network leads value their work. They struggle navigating the VHA system including difficulty engaging local and network leadership as well as navigating interpersonal situations with staff and veterans. Although local coordinators and network leads are dedicated to the VCC program mission, systemic changes are necessary. Based on local coordinator and network lead feedback, it would be beneficial for health care facility and network leadership to increase their awareness of LGBTQ+ health policy and create systems of accountability related to program implementation.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100113"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739381","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":"The development of private health insurance in Malaysia: A case study analysis exploring its influence on financial risk protection","authors":"Rui Jie Ng,&nbsp;Wan Yuen Choo,&nbsp;Noran Naqiah Hairi,&nbsp;Chiu-Wan Ng","doi":"10.1016/j.ssmhs.2025.100142","DOIUrl":"10.1016/j.ssmhs.2025.100142","url":null,"abstract":"<div><div>Since the 1980s, private health insurance (PHI) in Malaysia has undergone significant changes, closely linked to the increased healthcare privatisation driven by government policies. Given the rising number of insured individuals and ongoing government encouragement efforts, this study aims to assess how the development of PHI has influenced financial risk protection. This research adopts a case study approach, combining document analysis and key informant interviews to gain a comprehensive understanding of PHI development. A total of 210 documents detailing PHI development from 1980 to 2023 were analysed. Additionally, stakeholder mapping using the Mendelow matrix identified ten key informants, focusing on those within the high-power, high-interest quadrant. Framework analysis was applied, using an adapted model encompassing five key themes: public policy, demand, market structure, market conduct, and performance. Under \"public policy\", the study examined government plans, industry governance, and relevant legislation. Analysis of \"demand\" identified a complex interplay of factors driving PHI uptake. The \"market structure\" revealed characteristics of an oligopolistic market, with a small number of insurers dominating. Under \"market conduct,\" the evolution of benefit designs largely strengthened financial risk protection. Finally, the \"performance\" analysis focused on PHI coverage, claims inflation, equity, and financial risk protection. This study revealed the dual effect of PHI development in Malaysia, with certain aspects enhancing financial risk protection while others undermine it. Assessing PHI’s financial protective effect is vital as Malaysia embarks on health system reforms and offers valuable insights for other countries exploring PHI as an alternative financing strategy.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100142"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319760","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":"Global health governance in transition: A time for new leadership, new ideas, new partnerships","authors":"Gerald Bloom ,&nbsp;Lewis Husain ,&nbsp;Minghui Ren","doi":"10.1016/j.ssmhs.2025.100110","DOIUrl":"10.1016/j.ssmhs.2025.100110","url":null,"abstract":"<div><div>Recent decisions by the US Government signal a need for major changes to the way global health is organised. As the contribution of development assistance to financing health services falls, there is a need to ensure that national strategies are respected and that countries have access to affordable drugs and a variety of health-related technologies. Leaders of aid-recipient countries, the traditional donors and large middle-income countries will need to take joint responsibility for making this possible. Despite a context of global competition and contestation, there is a lot of agreement on key global health objectives, so that it could be an important arena for establishing more inclusive governance. This will involve changes to current institutional arrangements. These changes are likely to take place in a piecemeal manner, whereby new approaches for tackling a problem will be tested at a relatively small scale before agreements are reached for more ambitious reforms and the capacity to implement them is built. The transition that is needed will be difficult and will take time. However, it is important that it succeed, in order to make effective responses to major health threats possible and to ensure progress towards universal access to effective health care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694692","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":"2025-12-01","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":"Kenya’s path to Universal Health Coverage: Insights from policy and practice","authors":"Evaline Langat ,&nbsp;Paul R. Ward ,&nbsp;Hailay Abrha Gesesew ,&nbsp;Lillian Mwanri","doi":"10.1016/j.ssmhs.2025.100141","DOIUrl":"10.1016/j.ssmhs.2025.100141","url":null,"abstract":"<div><h3>Background</h3><div>Universal health coverage (UHC) is a globally endorsed commitment aimed at ensuring equitable access to affordable healthcare services. Kenya's journey toward UHC has been marked by significant reforms, including the 2018 pilot phase and ongoing implementation phase (2020–2030). Using qualitative insights from policymakers and practitioners, this study explored Kenya’s progress, challenges, and opportunities to achieve UHC.</div></div><div><h3>Methods</h3><div>Key informant interviews were conducted with 44 stakeholders across seven counties in Kenya. Data were collected in English using a semi-structured interview guide, audio-recorded with consent, and transcribed verbatim. Thematic analysis, guided by the WHO health system framework, identified achievements, challenges, and areas for improvement across six health system building blocks.</div></div><div><h3>Results</h3><div>The pilot phase improved healthcare access for vulnerable populations by eliminating user fees in public health facilities but faced challenges such as staff shortages, inadequate supplies, financial constraints, and limited stakeholder engagement. The implementation phase introduced structural reforms, including Primary Care Networks (PCNs) to strengthen primary healthcare, mandatory social health insurance for financial protection, and legal frameworks to support service delivery and facility autonomy. Despite these advancements, challenges remain, including workforce shortages, financial barriers, and limited stakeholder participation. Sustaining UHC requires strengthened health systems, reduced out-of-pocket costs, and inclusive stakeholder engagement, with political commitment as a key enabler.</div></div><div><h3>Conclusion</h3><div>Achieving equitable, efficient, and sustainable UHC in Kenya demands more than political commitment. It requires strengthened workforce capacity, equitable financing, efficient supply chains, stakeholder engagement, reduced out-of-pocket costs, and strategic private sector involvement within inclusive policies.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100141"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265265","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":"Assessing antenatal care access among Afghan women migrants, refugees, and asylum-seekers in France: A mixed methods study","authors":"Saha Naseri ,&nbsp;Valéry Ridde ,&nbsp;Sara Naseri ,&nbsp;Léna Bonin ,&nbsp;Marie-Anne Durand","doi":"10.1016/j.ssmhs.2025.100128","DOIUrl":"10.1016/j.ssmhs.2025.100128","url":null,"abstract":"<div><div>Despite the growing number of Afghan women migrants, refugees and asylum-seekers (AWMRA) in France, little is known about their access to maternal healthcare services. This study examines AWMRA’s access to and experience of antenatal care (ANC) services in France. A convergent parallel mixed-methods design was employed, combining a quantitative online survey with qualitative in-depth semi-structured interviews and focus groups among AWMRA (18–49 years) who were pregnant or gave birth in France within the last 24 months. Data collection was conducted through snowball sampling supported by a participatory community network, involving 21 Afghan associations and over 100 community members. Framework analysis was applied to qualitative data, while quantitative data were analyzed using descriptive and inferential statistics. The two data components were analyzed separately and then merged for integration. The findings suggested that limited information on pregnancy-related healthcare services left many women navigating the health system on their own. Nearly one-third of participants reported incomplete ANC visits, with adverse outcomes reported by 15 %. From the system's perspective, long waiting times were identified as a barrier to completing ANC. Additionally, the lack of culturally sensitive care, confusing administrative procedures, discrimination, and inadequate interpreter services exacerbated these challenges. Despite these obstacles, some healthcare workers’ efforts to ensure clear communication highlighted the potential for improving ANC completion. Improving access to linguistically and culturally tailored information, expanding interpreter services, and fostering culturally competent care are critical steps to support equitable ANC access for this population.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100128"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925618","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}