Maarten Nauta, Lasse Engbo Christiansen, Stine Kjær Lefèvre, Charlotte Louise Munkstrup, Johanna Young, Hanne Rosenquist
{"title":"Towards more transparent risk assessment of communicable diseases - Redefining probability and impact.","authors":"Maarten Nauta, Lasse Engbo Christiansen, Stine Kjær Lefèvre, Charlotte Louise Munkstrup, Johanna Young, Hanne Rosenquist","doi":"10.1017/S0950268825000147","DOIUrl":"10.1017/S0950268825000147","url":null,"abstract":"<p><p>Epidemic preparedness requires clear procedures and guidelines when a rapid risk assessment of a communicable disease threat is requested. In an evaluation of past risk assessments, we found that modifications to existing guidelines, such as the European Centre for Disease Prevention and Control's (ECDC) rapid risk assessment operational tool, can strengthen this process. Therefore, we present alternative guidelines, in which we propose a unifying risk assessment terminology, describe how the risk question should be phrased by the risk manager, and redefine the probability and impact dimension of risk, including a methodology to express uncertainty. In our approach, probability refers to the probability of the introduction of a disease into a specified population in a specified time period, and impact combines the magnitude of spread and the severity of the health outcomes. Based on the collected evidence, both the probability of introduction and the magnitude of spread are quantitatively expressed by expert judgements, providing unambiguous risk assessment. We advise not to summarize the risk by a single qualification as 'low' or 'high'. These alternative guidelines, which are illustrated by a hypothetical example on mpox, have been implemented at Statens Serum Institut in Denmark and can benefit other public health institutes.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e31"},"PeriodicalIF":2.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wenhua Lin, Kin Hang Kung, Chung Lam Chan, Shuk Kwan Chuang, Ka Wing Au
{"title":"Characteristics and risk factors associated with COVID-19 reinfection in Hong Kong: a retrospective cohort study.","authors":"Wenhua Lin, Kin Hang Kung, Chung Lam Chan, Shuk Kwan Chuang, Ka Wing Au","doi":"10.1017/S0950268825000172","DOIUrl":"10.1017/S0950268825000172","url":null,"abstract":"<p><p>We aimed to identify risk factors related to COVID-19 reinfection in Hong Kong. We performed a population-based retrospective cohort study and reviewed case-based data on COVID-19 infections reported to the Centre for Health Protection from 8 January 2020 to 29 January 2023. We analyzed the epidemiology of COVID-19 infections and performed a Cox regression analysis. In this period, 3.32% (103,065/3,106,579) of COVID-19 infections recorded were classified as reinfection. Compared with primarily infected cases, a higher proportion of re-infected cases had chronic diseases (33.54% vs. 27.27%) and were residents of residential care homes (RCH) (10.99% vs. 1.41%). The time interval between the two episodes ranged from 31 to 1,050 days (median 282 days). Cox regression analysis of Omicron cases with the adjustment of covariates showed that being female (Hazard Ratio [HR] 1.12, 95% CI 1.11-1.13), chronic diseases (HR 1.18, 95% CI 1.16-1.20) and RCH residents (HR 6.78, 95% CI 6.61-6.95) were associated with reinfection, while additional vaccination after primary infection was protective (HR 0.80, 95% CI 0.79-0.81). Further analytical studies on the risk factors and protectors of COVID-19 reinfection are needed to guide targeted interventions.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e30"},"PeriodicalIF":2.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Jones, Marc Roger Couturier, Andrew T Pavia, Daniel T Leung
{"title":"<i>Dientamoeba fragilis</i> cases identified by molecular detection, Utah, United States, 2014-2024.","authors":"Anna Jones, Marc Roger Couturier, Andrew T Pavia, Daniel T Leung","doi":"10.1017/S0950268825000159","DOIUrl":"10.1017/S0950268825000159","url":null,"abstract":"<p><p><i>Dientamoeba fragilis</i> (<i>D. fragilis</i>) is an intestinal protozoan parasite with uncertain pathogenic potential. In the United States, data on <i>D. fragilis</i> in the era of molecular detection are limited. The aim of this retrospective chart review was to evaluate the epidemiology and clinical characteristics of <i>D. fragilis</i> cases identified using polymerase chain reaction assays between 2016 and 2024 at our academic medical centre located in Utah. We identified 28 unique cases with varying gastrointestinal symptomatology including diarrhoea, abdominal pain, nausea, vomiting, and bloating. Approximately half (52%) of patients with follow-up data demonstrated improvement in symptoms following initial treatment for <i>D. fragilis.</i> The overall prevalence of <i>D. fragilis</i> was low among those tested (0.6% positivity). Additional research, including case-control studies, is needed to better describe the etiologic role of <i>D. fragilis.</i></p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e36"},"PeriodicalIF":2.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christel E Hoeve, Nienke Neppelenbroek, Eric R A Vos, Anne J Huiberts, Stijn P Andeweg, Gerco den Hartog, Robert van Binnendijk, Hester de Melker, Susan van den Hof, Mirjam Knol
{"title":"Using SARS-CoV-2 nucleoprotein antibodies to detect (re)infection.","authors":"Christel E Hoeve, Nienke Neppelenbroek, Eric R A Vos, Anne J Huiberts, Stijn P Andeweg, Gerco den Hartog, Robert van Binnendijk, Hester de Melker, Susan van den Hof, Mirjam Knol","doi":"10.1017/S095026882500010X","DOIUrl":"10.1017/S095026882500010X","url":null,"abstract":"<p><p>We assessed the validity of serum total anti-nucleoprotein Immunoglobulin (<i>N</i>-antibodies) to identify SARS-CoV-2 (re)infections by estimating the persistence of <i>N</i>-antibody seropositivity and boosting following infection. From a prospective Dutch cohort study (VASCO), we included adult participants with ≥2 consecutive self-collected serum samples, 4-8 months apart, between May 2021-May 2023. Sample pairs were stratified by <i>N</i>-seropositivity of the first sample and by self-reported infection within the sampling interval. We calculated the proportions of participants with <i>N</i>-seroconversion and fold-increase (1.5, 2, 3, 4) of <i>N</i>-antibody concentration over time since infection and explored determinants. We included 67,632 sample pairs. Pairs with a seronegative first sample (70%) showed 89% <i>N</i>-seroconversion after reported infection and 11% when no infection was reported. In pairs with a seropositive first sample (30%), 82%-65% showed a 1.5- to 4-fold increase with a reported reinfection, and 19%-10% without a reported reinfection, respectively. After one year, 83% remained <i>N</i>-seropositive post-first infection and 93%-61% showed a 1.5-fold to 4-fold increase post-reinfection. Odds for seroconversion/fold increase were higher for symptomatic infections and Omicron infections. In the current era with limited antigen or PCR testing, <i>N</i>-serology can be validly used to detect SARS-CoV-2 (re)infections at least up to a year after infection, supporting the monitoring of COVID-19 burden and vaccine effectiveness.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e38"},"PeriodicalIF":2.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sustaining transformative change in public health in Africa to achieve health development goals.","authors":"Benido Impouma, Lindiwe Makubalo, Kasonde Mwinga, Joseph Cabore, Matshidiso Rebecca Moeti","doi":"10.1017/S0950268825000123","DOIUrl":"10.1017/S0950268825000123","url":null,"abstract":"<p><p>In 2015, the WHO African Region was responding to the largest Ebola virus disease outbreak in history while at the same time working to contain a wild poliovirus outbreak [1]. The 2030 Agenda for Sustainable Development had recently been endorsed, reflecting new global development priorities. By 2016, the Ebola outbreak was under control, and a new approach to reform and priority setting was in place in the region; the Transformation Agenda [2]. This agenda, introduced by the new Regional Director for Africa, Dr Matshidiso Moeti, set up a robust system for improving the efficiency and accountability of the WHO Secretariat for the African Region, which has been instrumental in the transformative changes that have been seen across the region in the past 10 years. This commentary discusses significant contributions to public health in the WHO African Region in the past decade, in the context of the Transformation Agenda, and the contributions of major investment in health security in the region. It is important to understand the need to sustain particular initiatives and elements of the transformative change that has taken place in the region.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e39"},"PeriodicalIF":2.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ian Simms, André Charlett, Felipe J Colón-González, Paula B Blomquist, Iain R Lake, Asad Zaidi, Stephanie Shadwell, James Sedgwick, Karthik Paranthaman, Roberto Vivancos
{"title":"Adapting the Flexible Farrington Algorithm for daily situational awareness and alert system to support public health decision-making during the SARS-CoV-2 epidemic in England.","authors":"Ian Simms, André Charlett, Felipe J Colón-González, Paula B Blomquist, Iain R Lake, Asad Zaidi, Stephanie Shadwell, James Sedgwick, Karthik Paranthaman, Roberto Vivancos","doi":"10.1017/S0950268825000160","DOIUrl":"10.1017/S0950268825000160","url":null,"abstract":"<p><p>The Flexible Farrington Algorithm (FFA) is widely used to detect infectious disease outbreaks at national/regional levels on a weekly basis. The rapid spread of SARS-CoV-2 alongside the speed at which diagnostic and public health interventions were introduced made the FFA of limited use. We describe how the methodology was adapted to provide a daily alert system to support local health protection teams (HPTs) working in the 316 English lower-tier local authorities. To minimize the impact of a rapidly changing epidemiological situation, the FFA was altered to use 8 weeks of data. The adapted algorithm was based on reported positive counts using total tests as an offset. Performance was assessed using the root mean square error (RMSE) over a period. Graphical reports were sent to local teams enabling targeted public health action. From 1 July 2020, results were routinely reported. Adaptions accommodated the impact on reporting because of changes in diagnostic strategy (introduction of lateral flow devices). RMSE values were relatively small compared to observed counts, increased during periods of increased reporting, and were relatively higher in the northern and western areas of the country. The exceedance reports were well received. This presentation should be considered as a successful proof-of-concept.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e28"},"PeriodicalIF":2.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patrizia Pasculli, Michele Antonacci, Maria Antonella Zingaropoli, Federica Dominelli, Federica Ciccone, Francesco Pandolfi, Yann Collins Fosso Ngangue, Giorgio Maria Masci, Roberta Campagna, Franco Iafrate, Valeria Panebianco, Carlo Catalano, Ombretta Turriziani, Gioacchino Galardo, Paolo Palange, Claudio Maria Mastroianni, Maria Rosa Ciardi
{"title":"SARS-CoV-2 vaccination influence in the development of long-COVID clinical phenotypes.","authors":"Patrizia Pasculli, Michele Antonacci, Maria Antonella Zingaropoli, Federica Dominelli, Federica Ciccone, Francesco Pandolfi, Yann Collins Fosso Ngangue, Giorgio Maria Masci, Roberta Campagna, Franco Iafrate, Valeria Panebianco, Carlo Catalano, Ombretta Turriziani, Gioacchino Galardo, Paolo Palange, Claudio Maria Mastroianni, Maria Rosa Ciardi","doi":"10.1017/S0950268825000093","DOIUrl":"10.1017/S0950268825000093","url":null,"abstract":"<p><p>Although SARS-CoV-2 vaccination reduces hospitalization and mortality, its long-term impact on Long-COVID remains to be elucidated. The aim of the study was to evaluate the different development of Long-COVID clinical phenotypes according to the vaccination status of patients. Clinical and demographic characteristics were assessed for each patient, while Long-COVID symptoms were self-reported and later stratified into distinct clinical phenotypes. Vaccination was significantly associated with the avoidance of hospitalization, less invasive respiratory support, and less alterations of cardiopulmonary functions, as well as reduced lasting lung parenchymal damage. However, no association between vaccination status and the development of at least one Long-COVID symptom was found. Nevertheless, clinical phenotypes were differently associated with vaccination status, as neuropsychiatric were more frequent in unvaccinated patients and cardiorespiratory symptoms were reported mostly in vaccinated patients. Different progression of disease could be at play in the different development of specific Long-COVID clinical phenotypes, as shown by the different serological responses between unvaccinated and vaccinated patients. A higher anti-Spike (<i>S</i>) antibody titre was protective for vaccinated patients, while it was detrimental for unvaccinated patients. A better understanding of the mechanism underlying the development of Long-COVID symptoms might be reached by standardized methodologies and symptom classification.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e40"},"PeriodicalIF":2.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wioleta Kitowska, Ana Cristina Gonzalez-Perez, Joana Sequeira Neto, Mari Kanerva, Heikki Kaukavuori, Irmeli Lindström, Heikki Frilander, Timothée Dub, Lotta Siira
{"title":"Second reported outbreak of pneumococcal pneumonia among shipyard employees in Turku, Finland, August-October 2023: a case-control study.","authors":"Wioleta Kitowska, Ana Cristina Gonzalez-Perez, Joana Sequeira Neto, Mari Kanerva, Heikki Kaukavuori, Irmeli Lindström, Heikki Frilander, Timothée Dub, Lotta Siira","doi":"10.1017/S0950268824001870","DOIUrl":"10.1017/S0950268824001870","url":null,"abstract":"<p><p>In August 2023, the Finnish Institute for Health and Welfare received reports of a potential cluster of pneumococcal pneumonia cases among shipyard employees in Turku, Finland. Considering a similar outbreak in the same shipyard in 2019, we initiated a case-control study to investigate individual and environmental risk factors specific to this occupational setting in order to inform targeted prevention measures. In total, 14 hospitalized cases were identified from 19 August to 15 October 2023. <i>Streptococcus pneumoniae</i> serotypes 4 and 9 V were isolated from blood cultures of seven cases. Eleven cases and 67 controls working at the shipyard were included in the case-control study. Compared with controls, cases were more likely to be living in an apartment/studio or a hotel/hostel, and less likely in a house or with family. Furthermore, cases were more likely to have a shorter duration of employment (< 1 year) at the shipyard compared to controls. Control measures, including an information and a vaccination campaign, were implemented. We emphasize shipyard-wide hygiene improvements and recommend nationwide consideration of expanding pneumococcal vaccination eligibility to all shipyard construction employees as an occupational high-risk group.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e32"},"PeriodicalIF":2.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Impact of temperatures on malaria incidence in vulnerable regions of Pakistan: empirical evidence and future projections.","authors":"Syeda Hira Fatima, Farrah Zaidi, Javeria Rafiq, Dinesh Bhandari, Asad Ali, Peng Bi","doi":"10.1017/S0950268825000111","DOIUrl":"10.1017/S0950268825000111","url":null,"abstract":"<p><p>Malaria remains a major health challenge in developing countries, with climate change intensifying its impact. Pakistan is among the most vulnerable nations. This study examines the relationship between temperature and malaria cases in two highly affected districts, Bannu and Lakki Marwat, to inform climate-adaptive interventions.We analyzed monthly malaria cases (2014-2022) from the Integrated Vector Control/Malaria Control Program in Khyber Pakhtunkhwa, combined with gridded meteorological data from Copernicus ERA5-Land. Time-series analysis using distributed lag nonlinear models and quasi-Poisson regression was applied to assess the associations.The findings suggest that as temperatures exceed 22.4°C, malaria transmission increases by 9 to 10% for every 1°C rise in both districts. In Bannu, up to 39.8% of reported malaria cases could be attributed to heat, while in Lakki Marwat, 54.1% of cases were attributable to heat. Under high emission scenarios, heat-related malaria cases could increase by 0.8 to 3.5% by the 2060s. Relationship between temperature and malaria transmission is complex and is influenced by environmental factors such as precipitation and humidity.Given Pakistan's limited healthcare infrastructure, addressing climate-driven malaria risks is urgent. Recent severe floods and malaria surges highlight the need for climate adaptation measures and strengthened healthcare systems to enhance community resilience.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e33"},"PeriodicalIF":2.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Global climate change and seasonal variation of cellulitis in hospitalized children: a 30 year retrospective study.","authors":"Orli Megged, Allon Raphael, Amalia Burstyn, Noy Deri, Shepard Schwartz, Rachel Eisenberg, Ori Toker","doi":"10.1017/S0950268825000032","DOIUrl":"10.1017/S0950268825000032","url":null,"abstract":"<p><p>Cellulitis, a common subcutaneous infection, is influenced by host, pathogen, and environmental factors. Previous studies have shown seasonal patterns in adult cellulitis, suggesting temperature as a risk factor. This study investigated seasonal patterns in paediatric cellulitis in Jerusalem's semi-arid climate. A single-center retrospective cohort study reviewed medical records of 2,219 hospitalized children under 18 with cellulitis between 1990 and 2020. Demographic, clinical, temperature, and humidity data were collected. Results revealed a significant sinusoidal pattern for limb cellulitis (LC) but for other body sites, with summer peaks and winter nadirs (<i>P</i> < 0.01). August showed the highest incidence, tripling that of February. Age groups 1-6 and 6-12 demonstrated the largest seasonal differences (<i>P</i> = 0.004, <i>P</i> = 0.008). Over three decades, paediatric hospitalized LC cases increased by 71% (<i>P</i> < 0.001), correlating with rising temperatures. Elevated ambient temperature seven days prior to diagnosis was a risk factor for LC development (OR = 1.02, <i>P</i> = 0.03). This study highlights the cyclic seasonal pattern of paediatric LC, peaking in summer. The significant increase in cases over time, coupled with rising temperatures, suggests climate change as a contributing factor. These findings could inform public health strategies for cellulitis prevention and management in children.</p>","PeriodicalId":11721,"journal":{"name":"Epidemiology and Infection","volume":" ","pages":"e24"},"PeriodicalIF":2.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}