Geriatrics最新文献

{"title":"Falls in Persons with Cognitive Impairment-Incidence and Characteristics of the Fallers.","authors":"Per G Farup, Knut Hestad, Knut Engedal","doi":"10.3390/geriatrics9060168","DOIUrl":"https://doi.org/10.3390/geriatrics9060168","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The annual incidence of falls is high in older adults with impaired cognitive function and dementia, and injuries have a detrimental effect on disability-adjusted life-years and public health spending. In this registry-based study, fall incidence and characteristics of the fallers were explored in a large population with cognitive impairment. <b>Methods</b>: NorCog, \"The Norwegian Registry of Persons Assessed for Cognitive Symptoms\", is a national research and quality registry with a biomaterial collection. This study included 9525 persons from the registry who had answered the question about falls. Fall incidence was studied, and the characteristics of fallers and non-fallers were compared. <b>Results</b>: The annual fall incidence was 3774/9525 (39.6%). The incidence varied between types of dementia, from 22.4% in persons with the debut of Alzheimer's disease before 65 years of age to 55.3% in persons with vascular dementia and with increasing degrees of cognitive impairment. A wide range of personal characteristics, symptoms, signs, laboratory tests, and physical, psychological, and cognitive tests differed between fallers and non-fallers, most in disfavour of the fallers. Age, reduced Personal Activities of Daily Living, reduced gait speed, delayed recall, use of a walking aid, and depression were independent predictors of falls. <b>Conclusions</b>: Among cognitively impaired persons with a history of falls, frailty was an independent predictor of falls. Neither the type of dementia nor the degree of cognitive impairment were independent predictors of falls. Prevention of frailty by physical training and social activity may be important in mitigating fall risk among older adults with impaired cognition.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894071","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":"Psychological Impact of Hospital Discharge on the Older Person: A Systematic Review.","authors":"Yasmin Hussein, Sarah Edwards, Harnish P Patel","doi":"10.3390/geriatrics9060167","DOIUrl":"https://doi.org/10.3390/geriatrics9060167","url":null,"abstract":"<p><p><b>Introduction:</b> Hospitalisation and prolonged length of stay is associated with deconditioning that risks adverse outcomes after discharge. Less is known about the psychological impact on older people after hospital discharge. The purpose of this systematic review was to elucidate factors contributing to psychological stress in older patients post-discharge to inform better discharge planning. <b>Methods:</b> A systematic search for studies reporting poor discharge outcomes in older people between 2010 and 2022 was performed in Medline, CINAHL, and PsycINFO. Search terms were 'older patients > 65 year', 'post-discharge', 'psychological distress', 'loneliness', 'anxiety', 'depression', and 'length of hospital stay'. Exclusion criteria included COVID-19 disease, dementia (±severe cognitive impairment), individuals aged <65, and those under palliative care services. <b>Results:</b> A total of 1666 records were identified, of which 878 were excluded as they were outside of our date limits or were not written in the English language, 681 were excluded after application of exclusion criteria, and 699 were excluded because of insufficient details. A total of 31 duplicates were removed, leaving 38 articles that were assessed for eligibility; 7 of these reports were found suitable, comprising 1131 patients. Three highly relevant themes identified relating to post-discharge outcomes were social isolation, lack of support, depression and anxiety. Older patients with a tendency toward depressive symptoms had an increased likelihood of death. <b>Conclusions:</b> It appears that the discharge process from hospital fails to address psychological factors that permit a successful transition from hospital. Pre-discharge screening of psychological symptoms and coping ability may assist in identifying older patients who are at risk of mental as well as subsequent physical deterioration. Better knowledge of positive and negative predictors of a successful transition from hospital to home would enable more holistic, effective, and inclusive discharge planning processes for older adults.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894125","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":"Better Quality of Life in Physically Active Adults Regardless of Age.","authors":"Magdalena Dąbrowska-Galas, Grzegorz Onik, Magdalena Rutkowska, Iwona Nowakowska","doi":"10.3390/geriatrics9060166","DOIUrl":"https://doi.org/10.3390/geriatrics9060166","url":null,"abstract":"<p><p>Quality of life (QOL) has become an important public health issue. Adults presenting better QOL have shown reduced mortality and risk of chronic diseases and better mental health. Regular physical activity (PA) is consistently associated with a number of health benefits in older adults, including betted QOL, which is a key component of healthy aging. The purpose of the study was to examine how physical activity level and age influenced QOL in adults. <b>Material and Methods</b>: A total of 378 adults from Poland participated in the study (mean age of 57.89 ± 12.54). Respondents completed questionnaires to measure QOL (WHOQOL-BREF) and physical activity level (International Physical Activity Questionnaire-short form). Linear regression analysis was used to examine the effect of age and PA on QOL. <b>Results</b>: Weekly energy expenditure associated with recreational physical activity was correlated with better QOL in all domains: physical (R = 0.5, <i>p</i> < 0.001), physiological (R = 0.4, <i>p</i> < 0.001), social (R = 0.3, <i>p</i> < 0.001) and environmental (R = 0.39, <i>p</i> < 0.001). Increases in PA level predicted increases in the physiological domain (β = 0.41, SE = 0.05, <i>p</i> < 0.001), social domain (β = 0.34, SE = 0.05, <i>p</i> < 0.001) and environmental domain (β = 0.39, SE = 0.05, <i>p</i> < 0.001). In the physical domain, increases in both physical activity level (β = 0.41, SE = 0.04, <i>p</i> < 0.001) and age (β = 0.31, SE = 0.04, <i>p</i> < 0.001) predicted better QOL. <b>Conclusions</b>: Our findings emphasize the potential benefits of physical activity on QOL regardless of age. Although aging is combined with various age-related diseases, quality of life improves with age in physically active adults.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894042","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 Relationship Between Reduced Hand Dexterity and Brain Structure Abnormality in Older Adults.","authors":"Anna Manelis, Hang Hu, Skye Satz","doi":"10.3390/geriatrics9060165","DOIUrl":"https://doi.org/10.3390/geriatrics9060165","url":null,"abstract":"<p><strong>Background: </strong>Hand dexterity is affected by normal aging and neuroinflammatory processes in the brain. Understanding the relationship between hand dexterity and brain structure in neurotypical older adults may be informative about prodromal pathological processes, thus providing an opportunity for earlier diagnosis and intervention to improve functional outcomes.</p><p><strong>Methods: </strong>this study investigates the associations between hand dexterity and brain measures in neurotypical older adults (≥65 years) using the Nine-Hole Peg Test (9HPT) and magnetic resonance imaging (MRI).</p><p><strong>Results: </strong>Elastic net regularized regression revealed that reduced hand dexterity in dominant and non-dominant hands was associated with an enlarged volume of the left choroid plexus, the region implicated in neuroinflammatory and altered myelination processes, and reduced myelin content in the left frontal operculum, the region implicated in motor imagery, action production, and higher-order motor functions. Distinct neural mechanisms underlying hand dexterity in dominant and non-dominant hands included the differences in caudate and thalamic volumes as well as altered cortical myelin patterns in frontal, temporal, parietal, and occipital regions supporting sensorimotor and visual processing and integration, attentional control, and eye movements. Although elastic net identified more predictive features for the dominant vs. non-dominant hand, the feature stability was higher for the latter, thus indicating higher generalizability for the non-dominant hand model.</p><p><strong>Conclusions: </strong>Our findings suggest that the 9HPT for hand dexterity might be a cost-effective screening tool for early detection of neuroinflammatory and neurodegenerative processes. Longitudinal studies are needed to validate our findings in a larger sample and explore the potential of hand dexterity as an early clinical marker.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894054","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":"Giant Primary Cutaneous Nodular Melanoma of the Forehead: A Case Report.","authors":"Samantha Montandon, Charles Jefferson-Loveday, Matthew Sommerlad, Harnish P Patel","doi":"10.3390/geriatrics9060164","DOIUrl":"https://doi.org/10.3390/geriatrics9060164","url":null,"abstract":"<p><p><b>Background:</b> The incidence of melanoma is increasing globally. The estimated worldwide incidence is projected to increase from 324,635 cases in 2020 to 510,000 in 2040. In the UK, melanoma accounts for 4% of all new cases of cancer. Melanomas occurring in the skin of the head and neck represent 13% and 23% of cases in women and men, respectively. Prognostic indicators include presence of nodal or distant metastasis, ulceration, and Breslow thickness, where >4 mm thickness predicts poorest overall survival rates. Giant melanomas, a term generally applied to melanomas larger than 5-10 cm, are rare and often have a very poor prognosis. <b>Clinical case:</b> An 82-year-old female presented acutely with a 2-3-day history of delirium and urinary retention in February 2022. In addition, she was noted to have a large fungating growth on her forehead that obscured the bridge of the nose and had been slowly increasing in size for the past year prior to admission. She had initially presented in primary care with a small growth on her forehead but declined further investigations for fear of contracting COVID-19. She consented to having further assessment and management of the forehead mass. A shave biopsy revealed giant nodular melanoma, specifically, the largest melanoma of the face reported in the literature. Remarkably, our patient underwent a successful complete excision and skin grafting, with no evidence of recurrence or distal metastasis after 2 years of follow up. <b>Conclusions:</b> This case highlights the anxieties people felt about contracting COVID-19 when national guidelines recommended shielding that had resulted in further morbidity. Despite poor prognostic factors, clinically and histologically, our patient did not need any systemic anticancer therapy nor radiotherapy. She was well after 2 years follow up without any signs of recurrence.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894090","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":"Physical Exercise Intervention Characteristics and Outcomes in Frail and Pre-Frail Older Adults.","authors":"María Caicedo-Pareja, Diego Espinosa, Jennifer Jaramillo-Losada, Leidy T Ordoñez-Mora","doi":"10.3390/geriatrics9060163","DOIUrl":"https://doi.org/10.3390/geriatrics9060163","url":null,"abstract":"<p><p>(1) Background: Frailty is a multifactorial syndrome that significantly impacts the functional abilities of older adults, making them more vulnerable to falls, disabilities, and dependence. Exercise can serve as an effective intervention for pre-frail and frail older adults, improving muscle strength and reducing the risk of falls. This research aims to clarify the physical exercise protocols and their outcomes for this population. (2) Methods: A scoping review was conducted to summarize the evidence on physical activity parameters for frail and pre-frail older adults. The search included primary evidence sources published in PubMed, PEDro, Biomed, Scopus, and Springer, as well as search engines like Google Scholar and Dialnet. The keywords used were ([frailty] OR [frail] AND [exercise]). The PEDro and MINORS scales were used to assess the quality of the evidence and evaluate the risk of bias. (3) Results: Eighteen studies met the eligibility criteria. The most commonly reported exercise program was multicomponent, which included aerobic activities at 70% of the maximum effort and strength exercises at 20% to 80% of the participants' maximum capacity. This approach proved effective for this population. (4) Conclusions: The studies suggest that exercise is a successful intervention strategy for addressing frailty. However, not all the articles provided adequate information regarding the dosing of their interventions.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894120","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 Between Shopping Assistance and Functional Decline in Older Residents with Support Levels Under the Long-Term Care Insurance System in Japan: A Retrospective, Cross-Sectional Study.","authors":"Akihiko Asao, Toshimasa Sone, Takaaki Fujita, Hiroshi Hayashi, Shigeki Kurasawa, Koshi Sumigawa, Yohko Ishikawa, Hironori Kawamata, Yuhei Mitsuhashi, Yoshinobu Tanaka, Natsumi Kimura, Kazuaki Iokawa","doi":"10.3390/geriatrics9060162","DOIUrl":"https://doi.org/10.3390/geriatrics9060162","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Maintaining functional independence and minimizing disability among older adults living in the community is paramount for mitigating rising care demands. Our study focused on shopping as a critical instrumental activity of daily living (ADL) to explore the association between shopping assistance and functional decline among older individuals receiving support through long-term care insurance (LTCI). <b>Methods:</b> This retrospective, cross-sectional study included 6202 participants aged >65 years living in a Japanese regional town receiving LTCI support, suggesting that they required assistance with local community life. Logistic regression analysis identified several factors associated with shopping assistance among the participants, including physical and cognitive functions, functional ADL, and psychobehavioral symptoms. <b>Results:</b> In male participants, walking dysfunction, short-term memory decline, decreased frequency of going outdoors, and decreased engagement in personal grooming were significantly associated with requiring shopping assistance. Conversely, in female participants, reduced physical function and walking performance were significantly associated with requiring shopping assistance, whereas dependence on personal grooming was less pronounced than in male participants. <b>Conclusions:</b> These findings suggest that, in addition to direct shopping assistance, tailored interventions targeting physical, cognitive, and ADL functions-while considering gender-specific needs-may help older adults maintain independence in shopping activities as part of their daily community life.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893985","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 Qualitative Study of Barriers and Facilitators to the Uptake of Cardiac Rehabilitation in Octogenarians.","authors":"Charlotte Nichol, Rajiv Das, Gill Barry, Michael Kelly, Ioannis Vogiatzis, Nicola Adams","doi":"10.3390/geriatrics9060161","DOIUrl":"https://doi.org/10.3390/geriatrics9060161","url":null,"abstract":"<p><p><b>Introduction:</b> Despite an established evidence-base for cardiac rehabilitation (CR) improving functional outcomes and quality of life and reducing re-hospitalisation, there is limited research on CR for older cardiac patients, who require rehabilitation the most, as they are often very deconditioned due to aortic stenosis (AS). CR uptake in the UK is limited to 52% with national variability of provision and accessibility, and it is a national priority to increase uptake to 85%. Frequently, research has excluded older populations as they are deemed to be too frail or generally not suitable for inclusion. This study aimed to explore factors that can impact the uptake of CR in octogenarians. <b>Methods:</b> Qualitative interviews were carried out with 20 AS patients (12 female, 8 male), from a large NHS Trust in the North East of England. <b>Results:</b> Four main themes were identified in the data: Perceptions and Understanding, Delivery and Accessibility, Perceived Impact of Exercise and Health and Life Changes, and Transportation. <b>Discussion:</b> The findings suggested that the major factors were the understanding of the nature, purpose and relevance of CR to older patients, whether CR was offered, and the role of social support. Barriers and facilitators can impact uptake based on the mode of delivery and the individual circumstances identified. Future research could explore how to develop CR programmes that overcome the barriers identified in the research, such as education, monitoring strategies, use of telehealth, and home-based elements to create an acceptable and accessible programme for octogenarians.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894036","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":"Immune-Related Adverse Events in a Patient Treated with Pembrolizumab: A Case Report from the Point of View of a Geriatrician.","authors":"Philipp Oft, Markus Gosch, Francesco Pollari","doi":"10.3390/geriatrics9060160","DOIUrl":"https://doi.org/10.3390/geriatrics9060160","url":null,"abstract":"<p><p>We report the case of a 78-year-old female patient who received palliative immunotherapy with pembrolizumab and lenvatinib as a treatment of pulmonary and osseous metastatic endometrial carcinoma. Under this therapy, the patient developed dysphagia, thyroiditis with hypothyroidism, myositis, and myocarditis, which required, due to third-degree AV block, the installation of a pacemaker. The patient received high-dose cortisone therapy, a thyroid hormone substitution, and pyridostigmine for symptom control. With this therapy, we saw a significant but not complete regression of symptoms. Ultimately, we could discharge the patient home for an outpatient treatment. The case report is followed by a discussion of the management of immune-related adverse events (irAEs) during pembrolizumab therapy from a geriatric perspective. Elderly patients on pembrolizumab therapy require close monitoring for irAEs, which can present atypically or without symptoms and may be fatal. Non-invasive diagnostics and minimizing hospital stays are essential to preserve the fitness of this vulnerable population.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894102","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":"Supporting Nursing Staff During Crises: Impact of Organisational Support Measures and Resources in Job Satisfaction in German Nursing Homes.","authors":"Elisabeth Diehl, Anna Hirschmüller, Aline Wege, Albert Nienhaus, Pavel Dietz","doi":"10.3390/geriatrics9060159","DOIUrl":"https://doi.org/10.3390/geriatrics9060159","url":null,"abstract":"<p><strong>Background/objectives: </strong>The COVID-19 pandemic placed an immense burden on nursing home staff, significantly increasing their workload. How the impact of these challenges on job satisfaction is mitigated by personal and social resources, along with organisational support measures initiated by nursing homes, is investigated in this study.</p><p><strong>Methods: </strong>In 2021, a cross-sectional survey was conducted among nursing home staff in Rhineland-Palatinate (n = 373). The questionnaire contained parts of standardised instruments (parts of the Copenhagen Psychosocial Questionnaire (COPSOQ), Brief Resilience Scale) and self-developed questions related to support measures such as training, psychological support and work organisation changes. The association of these support measures, as well as personal and social resources (e.g., resilience, social support, sense of community), with job satisfaction was explored. Descriptive, bivariate and regression analyses were conducted.</p><p><strong>Results: </strong>While various support measures were offered to the nursing home staff, significant gaps remained. Training on hygiene and COVID-19 care was beneficial but not universally available. Similarly, psychological, pastoral and palliative support was lacking for a large portion of nursing home staff. Surprisingly, in the regression analysis, frequent information updates from supervisors were found to be negatively correlated with job satisfaction (<i>p</i> = 0.002). However, some personal and social resources (resilience (<i>p</i> = 0.002), social support (<i>p</i> = 0.001), sense of community at work (<i>p</i> ≤ 0.001), commitment to the workplace (<i>p</i> = 0.019), recognition by management (<i>p</i> ≤ 0.001)), and various support measures (training programmes (<i>p</i> = 0.005), changes in work organisation (<i>p</i> = 0.008), technical measures (<i>p</i> = 0.025)) were positively correlated with job satisfaction.</p><p><strong>Conclusions: </strong>This study highlights that despite the implementation of various support measures for nursing home staff during the COVID-19 pandemic, significant gaps remained. Notably, a substantial portion of staff members lacked access to crucial support services such as psychological, pastoral and palliative care. Furthermore, healthcare facility managers should prioritise the following support measures, especially during crises: comprehensive training, including resilience training; flexible working arrangements; and recognition for nursing staff. Ultimately, healthcare organisations should aim to create a supportive work environment that fosters a sense of community and belonging among their nursing workforce.</p>","PeriodicalId":12653,"journal":{"name":"Geriatrics","volume":"9 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894130","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}