JAMA Pediatrics最新文献

{"title":"Adverse Obstetric Outcomes in Pregnancies With Major Fetal Congenital Heart Defects","authors":"Gitte Hedermann, Paula L. Hedley, Kasper Gadsbøll, Ida N. Thagaard, Lone Krebs, Mona Aarenstrup Karlsen, Cathrine Vedel, Line Rode, Michael Christiansen, Charlotte K. Ekelund","doi":"10.1001/jamapediatrics.2024.5073","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5073","url":null,"abstract":"ImportanceUnderstanding the risk profile of obstetric complications in pregnancies with fetal major congenital heart defects (MCHDs) is crucial for obstetric counseling and care.ObjectiveTo investigate the risk of placenta-related adverse obstetric outcomes in pregnancies complicated by fetal MCHDs.Design, Setting, and ParticipantsThis cohort study retrieved data from June 1, 2008, to June 1, 2018, from the Danish Fetal Medicine Database, which includes comprehensive data on more than 95% of all pregnancies in Denmark since the database was instituted in 2008. All singleton pregnancies that resulted in a live-born child after 24 weeks’ gestation without chromosomal aberrations were included. A systematic search of the literature was performed in PubMed, Embase, and the Cochrane Library from inception to June 1, 2024, to compile existing knowledge and data on adverse obstetric outcomes among MCHD subtypes.ExposureFetal MCHDs including 1 of 11 subtypes.Main Outcomes and MeasuresThe primary outcome was a composite adverse obstetric outcome defined as preeclampsia, preterm birth, fetal growth restriction, or placental abruption. Secondary outcomes consisted of each adverse obstetric event. Adjusted odds ratios (AORs) were computed using generalized estimating equations adjusted for maternal body mass index, age, smoking, and year of delivery. Meta-analyses were conducted using random-effects models to pool effect sizes for each MCHD subtype and adverse obstetric outcome.ResultsA total of 534 170 pregnancies were included in the Danish cohort, including 745 with isolated fetal MCHDs (median [IQR] maternal age, 29.0 [26.0-33.0] years) and 533 425 without MCHDs (median [IQR] maternal age, 30.0 [26.0-33.0] years). Pregnancies with fetal MCHDs exhibited a higher rate of adverse obstetric outcomes at 22.8% compared with 9.0% in pregnancies without fetal MCHDs (AOR, 2.96; 95% CI, 2.49-3.53). Preeclampsia (AOR, 1.83; 95% CI, 1.33-2.51), preterm birth at less than 37 weeks (AOR, 3.84; 95% CI, 3.15-4.71), and fetal growth restriction (AOR, 3.25; 95% CI, 2.42-4.38) occurred significantly more frequently in pregnancies with MCHDs. Except for fetal transposition of the great arteries (AOR, 1.19; 95% CI, 0.66-2.15), all MCHD subtypes carried a greater risk of adverse obstetric outcomes. The meta-analysis included 10 additional studies that supported these results.Conclusions and RelevanceThese findings suggest that nearly 1 in 4 women expecting a child with an MCHD, except transposition of the great arteries, may be at high risk of adverse obstetric outcomes.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"21 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conditional and Unconditional Social Transfers, Early-Life Nutrition, and Child Growth","authors":"Jordyn T. Wallenborn, Souliviengkham Sonephet, Somphou Sayasone, Latsamy Siengsounthone, Sengchanh Kounnavong, Günther Fink","doi":"10.1001/jamapediatrics.2024.5079","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5079","url":null,"abstract":"ImportanceRates of exclusive breastfeeding are declining despite the numerous benefits to mothers and their children.ObjectiveTo assess the effectiveness of conditional and unconditional social transfers on exclusive breastfeeding rates and child growth.Design, Setting, and ParticipantsThis is a prospective, parallel, 3-armed randomized clinical trial conducted between August 2022 and October 2023. The trial was conducted in 4 districts of Vientiane, Lao People’s Democratic Republic. Mothers identified from a large birth cohort were randomized into 2 intervention groups (conditional social transfer or unconditional social transfer) or a control group at a ratio of 1:1:1. Data analysis was conducted from December 2023 to January 2024.InterventionsTwo interventions were tested: (1) conditional social transfer, in which the mother received the social transfer only if still exclusively breastfeeding at 6 months, and (2) unconditional social transfer, in which the mother received the social transfer at 6 months regardless of breastfeeding status. Mothers in the control group received educational material only.Main Outcomes and MeasuresThe primary outcome was the proportion of women exclusively breastfeeding at 6 months post partum. Secondary outcomes included exclusive breastfeeding duration (in months) and child growth (height, weight, and head circumference).ResultsA total of 298 mothers (mean [SD] age, 27.2 [6.5] years) were identified from a large birth cohort and randomized into a conditional social transfer group (n = 100), an unconditional social transfer group (n = 97), or a control group (n = 101). The adjusted odds ratio of exclusive breastfeeding at 6 months post partum was 4.60 (95% CI, 2.10-10.07; <jats:italic>P</jats:italic> < .001) for the conditional social transfer group and 2.51 (95% CI, 1.11-5.66; <jats:italic>P</jats:italic> = .03) for the unconditional social transfer group compared with the control group. The risk of early exclusive breastfeeding cessation was lower for participants who received the unconditional social transfer (adjusted hazard ratio [aHR], 0.68; 95% CI, 0.49-0.92; <jats:italic>P</jats:italic> = .02) or conditional social transfer (aHR, 0.60; 95% CI, 0.44-0.83; <jats:italic>P</jats:italic> = .002) compared with participants in the control group. There were no significant differences between groups for child growth at 6 months post partum.Conclusions and RelevanceThe findings suggest that social transfers can substantially improve exclusive breastfeeding rates at 6 months post partum, with particularly large benefits for conditional transfers. Continued evaluation at 1, 2, and 3 years post partum will be conducted to assess the long-term outcomes of social transfers on complementary breastfeeding and child health and development over time.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"47 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US FDA Approval of Pediatric Artificial Intelligence and Machine Learning–Enabled Medical Devices","authors":"Ryan C. L. Brewster, Matthew Nagy, Susmitha Wunnava, Florence T. Bourgeois","doi":"10.1001/jamapediatrics.2024.5437","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5437","url":null,"abstract":"This cross-sectional study analyzes the availability of artificial intelligence and machine learning–enabled devices authorized for children by the US Food and Drug Administration (FDA) and assesses reporting of algorithm validation in the pediatric population.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"252 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The CMS Sickle Cell Gene Therapy Access Model","authors":"Jeromie Ballreich, Ilina C. Odouard, Mariana P. Socal","doi":"10.1001/jamapediatrics.2024.5536","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5536","url":null,"abstract":"This Viewpoint explores and provides policy recommendations for the Cell and Gene Therapy Access Model recently launched by the US Centers for Medicare & Medicaid Services (CMS), which aims to increase access to Medicaid recipiencts with rare and severe diseases.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"22 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State Parental Consent Law and Treatment Use Among Adolescents With Depression","authors":"Jessica Lee Schleider, Amanda Smock, Isaac Lev Ahuvia, Tubanji Walubita, Andy Seth Rapoport, Shannon Hill, Jonathan Purtle","doi":"10.1001/jamapediatrics.2024.5361","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5361","url":null,"abstract":"This cross-sectional study examines the association between mental health treatment uptake and the existence of state laws prohibiting youths to consent to their own care.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"4 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FDA Approval of Orphan Drug Indications for Pediatric Patients, 2011-2023","authors":"Apoorva Kakkilaya, Mahnum Shahzad, Florence T. Bourgeois","doi":"10.1001/jamapediatrics.2024.5280","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5280","url":null,"abstract":"This cohort study assesses Pediatric Research Equity Act amendments that may influence approval of orphan drug indications for pediatric patients under current regulatory programs.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"33 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New-Onset Type 1 and Type 2 Diabetes Among Korean Youths During the COVID-19 Pandemic","authors":"Da Hye Lee, Hwa Young Kim, Ji Young Park, Jaehyun Kim, Jae Hyeon Park","doi":"10.1001/jamapediatrics.2024.5068","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5068","url":null,"abstract":"ImportanceWhether COVID-19 contributes to youth-onset diabetes is controversial, and research in Asia is lacking.ObjectiveTo explore the incidence and severity of diabetes among youths during the COVID-19 pandemic in South Korea.Design, Setting, and ParticipantsThis cohort study used claims data for January 1, 2017, through February 28, 2022, from the National Health Insurance Service database in South Korea. The incidence of type 1 diabetes (T1D) and type 2 diabetes (T2D) in patients younger than 20 years during the pandemic was analyzed and compared with that during the prepandemic period. The study included incident cases of T1D identified by at least 2 diagnosis codes with at least 2 insulin prescriptions within 1 year and T2D identified by at least 2 diagnosis codes with at least 2 prescriptions of diabetes medication within 1 year. Analyses were performed between January 29 and September 2, 2024.ExposuresCOVID-19 pandemic and SARS-CoV-2 infection.Main Outcomes and MeasuresThe primary outcome was incidence of T1D and T2D, and secondary outcomes included the rate of diabetic ketoacidosis (DKA) and association of new-onset diabetes with SARS-CoV-2 positivity.ResultsThe study included 2599 patients with T1D (mean [SD] age, 12.0 [4.8] years; 1235 [47.5%] male) and 11 040 patients with T2D (mean [SD] age, 16.0 [2.8] years; 6861 [62.1%] male). During the pandemic, the incidence rate ratios were 1.19 (95% CI, 1.10-1.29) for T1D and 1.41 (95% CI, 1.36-1.46) for T2D. The incidence rate of DKA at diagnosis increased during the first pandemic year compared with the prepandemic period (T1D, 42.8% [95% CI, 38.5%-47.0%] vs 31.3% [95% CI, 29.0%-33.7%], respectively; T2D, 6.0% [95% CI, 5.0%-7.1%] vs 2.9% [95% CI, 2.5%-3.3%], respectively) but returned to prepandemic levels in the second pandemic year (T1D, 34.5% [95% CI, 30.6%-38.5%]; T2D, 3.2% [95% CI, 2.6%-3.9%]). The hazard ratio for new-onset diabetes associated with SARS-CoV-2 positivity was 0.44 (95% CI, 0.17-1.13) for T1D and 1.08 (95% CI, 0.74-1.57) for T2D.Conclusions and RelevanceThese findings suggest that the incidence and severity of T1D and T2D among South Korean youths increased during the COVID-19 pandemic. The cohort analysis does not support SARS-CoV-2 infection itself as being directly associated with incident diabetes.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"28 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Actionability of Genetic Findings in Cerebral Palsy","authors":"Sara A. Lewis, Maya Chopra, Julie S. Cohen, Jennifer M. Bain, Bhooma Aravamuthan, Jason B. Carmel, Michael C. Fahey, Reeval Segel, Richard F. Wintle, Michael Zech, Halie May, Nahla Haque, Darcy Fehlings, Siddharth Srivastava, Michael C. Kruer","doi":"10.1001/jamapediatrics.2024.5059","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5059","url":null,"abstract":"ImportanceSingle gene variants can cause cerebral palsy (CP) phenotypes, yet the impact of genetic diagnosis on CP clinical management has not been systematically evaluated.ObjectiveTo evaluate how frequently genetic testing results would prompt changes in care for individuals with CP and the clinical utility of precision medicine therapies.Data SourcesPublished pathogenic or likely pathogenic variants in OMIM genes identified with exome sequencing in clinical (n = 1345) or research (n = 496) cohorts of CP were analyzed. A systematic literature review for evidence of effective therapies for specific genetic etiologies was performed.Study SelectionNonstandard interventions that led to a detectable improvement in a defined outcome in individuals with variants in the gene of interest were included.Data Extraction and SynthesisLiterature was evaluated using PRISMA guidelines. A diverse, expert working group was established, scoring rubrics adapted, and scoring consensus built with a modified Delphi approach.Main Outcomes and MeasuresOverall clinical utility was calculated from metrics assessing outcome severity if left untreated, safety and practicality of the intervention, and anticipated intervention efficacy on a scale from 0 to 3.ResultsOf 1841 patients with CP who underwent exome sequencing, 502 (27%) had pathogenic or likely pathogenic variants related to their phenotype. A total of 243 different genes were identified. In 1841 patients with identified genetic etiologies of CP, 140 (8%) had a genetic etiology classified as actionable, defined as prompting a change in clinical management. Also identified were 58 of 243 genes with pathogenic or likely pathogenic variants with actionable treatment options: 16 targeting the primary disease mechanism, 16 with specific prevention strategies, and 26 with specific symptom management. The level of evidence was also graded according to ClinGen criteria; 45 of 101 interventions (44.6%) had evidence class D or below. The potential interventions have clinical utility with 98 of 101 outcomes (97%) being moderate-high severity if left untreated and 63 of 101 interventions (62%) predicted to be of moderate-high efficacy. Most interventions (72 of 101 [71%]) were considered moderate-high safety and practicality.Conclusions and RelevanceThe findings indicate that actionable genetic findings occurred in 8% of individuals referred for genetic testing with CP. Evaluation of potential efficacy, outcome severity, and intervention safety and practicality indicates moderate-high clinical utility of these genetic findings. Genetic sequencing can identify precision medicine interventions that provide clinical benefit to individuals with CP. The relatively limited evidence base underscores the need for additional research.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory Benefits of Multisetting Air Purification in Children","authors":"Jian Lei, Qinghua Sun, Renjie Chen, Yixiang Zhu, Lu Zhou, Xiaowei Xue, Jianlong Fang, Yanjun Du, Yanwen Wang, Tiantian Li, Haidong Kan","doi":"10.1001/jamapediatrics.2024.5049","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5049","url":null,"abstract":"ImportanceParticulate matter exposure has been linked to impaired respiratory health in children, but the respiratory benefits of air purification have not been fully elucidated.ObjectivesTo assess the respiratory health outcomes among children exposed to multisetting air purification vs sham purification.Design, Setting, and ParticipantsThis cluster randomized, double-blind, crossover trial was conducted among healthy school-aged children (10-12 years) in China from April to December 2021. Data were analyzed from December 2021 to July 2024.InterventionsA multisetting (both in classrooms and bedrooms) air purification intervention compared with sham purification in a 2-stage intervention with more than 2 months (76 days) for each period and a washout period (88 days) to estimate the respiratory benefits of air purification.Main Outcomes and MeasuresThe primary outcomes were pulmonary function, airway inflammation markers, and metabolites in exhaled breath condensate (EBC) before and after the air purification intervention. Linear mixed-effects models were used to estimate the respiratory benefits of children related to air purification. Differential metabolites in EBC were identified using metabolomics analysis to explore their possible mediation roles.ResultsA total of 79 children (38 male [48%]; mean [SD] age, 10.3 [0.5] years) were included in the statistical analyses. During the study period, the mean (SD) concentration of outdoor fine particulate matter (PM<jats:sub>2.5</jats:sub>) at the school site was 32.53 (24.06) μg/m<jats:sup>3</jats:sup>. The time-weighted personal PM<jats:sub>2.5</jats:sub> concentration decreased by 45.14% during the true air purification period (mean [SD], 21.49 [8.72] μg/m<jats:sup>3</jats:sup>) compared with the sham air purification period (mean [SD], 39.17 [14.25] μg/m<jats:sup>3</jats:sup>). Air purification improved forced expiratory volume in 1 second by 8.04% (95% CI, 2.15%-13.93%), peak expiratory flow by 16.52% (95% CI, 2.76%-30.28%), forced vital capacity (FVC) by 5.73% (95% CI, 0.48%-10.98%), forced expiratory flow at 25% to 75% of FVC by 17.22% (95% CI, 3.78%-30.67%), maximal expiratory flow at 75% of FVC by 14.60% (95% CI, 0.35%-28.85%), maximal expiratory flow at 50% of FVC by 17.86% (95% CI, 3.65%-32.06%), and maximal expiratory flow at 25% of FVC by 18.22% (95% CI, 1.73%-34.70%). Fractional exhaled nitric oxide in the true air purification group decreased by 22.38% (95% CI, 2.27%-42.48%). Several metabolites in EBC (eg, L-tyrosine and β-alanine) were identified to mediate the effect of air purification on respiratory health.Conclusions and RelevanceThis randomized clinical trial provides robust and holistic evidence that indoor air purification notably improved pulmonary health in children, highlighting the importance of intensified indoor air purification in regions with high air pollution levels.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xl","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"66 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portal Confidentiality Concerns and Health Information Sharing and Access.","authors":"Marianne Sharko, Stephanie Niño de Rivera, Natalie Benda, Meghan Reading Turchioe, Xiaoyue Ma, Ruth Masterson Creber, Erika L Abramson","doi":"10.1001/jamapediatrics.2024.3688","DOIUrl":"10.1001/jamapediatrics.2024.3688","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1373-1375"},"PeriodicalIF":24.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}