Journal of Nepal Health Research Council最新文献

{"title":"Capacity Building at Nepal Health Research Council for Ethical Research.","authors":"Ramesh Kant Adhikari, Namita Ghimire, Pramod Joshi","doi":"10.33314/jnhrc.v22i02.5376","DOIUrl":"10.33314/jnhrc.v22i02.5376","url":null,"abstract":"<p><p>N/A.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"22 2","pages":"i-iv"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687193","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":"Comparison of Surgical Outcomes Following Percutaneous Pedicle Screw Fixation and Traditional Open Pedicle Screw Fixation for Thoracolumbar Fractures Without Neurological Deficit.","authors":"Kumar Paudel, Somraj Lamichhane, Rajiv Jha","doi":"10.33314/jnhrc.v22i02.5206","DOIUrl":"https://doi.org/10.33314/jnhrc.v22i02.5206","url":null,"abstract":"<p><strong>Background: </strong>Traumatic thoracolumbar fractures are frequently encountered in blunt trauma patients. The Open pedicle screw fixation has been proven to be effective in stabilizing fractures, deformity correction, early mobilization and improving long term quality of life of patients with thoracolumbar fracture. Percutaneous pedicle screw fixation is a minimally invasive approach that minimizes the tissue injury, enhances early recovery and facilitates rehabilitation program.</p><p><strong>Objectives: </strong>To compare the surgical outcomes of percutaneous versus open pedicle screw fixation for thoracolumbar fractures without neurological deficit. Single center, Prospective, Comparative study Methods: A total of 34 patients with thoracolumbar fractures with intact neurology were treated with either percutaneous or open pedicle screw fixation between February 1st 2023 to March 1st 2024 at the National trauma center , Kathmandu. There were 17 patients in each group. The perioperative clinical and radiological parameters were collected using a preformed pro forma. Postoperatively follow-up was conducted at post op day 1, during discharge and 3 months. The clinical and radiological outcomes of percutaneous and open pedicle screw fixation were analyzed and compared.</p><p><strong>Results: </strong>This study included 24(70.6%) males and 10(29.4%) females. The mean age was 40.73 ±15.44 years. There was a statistically significant difference between percutaneous and open pedicle screw with regard to intraoperative blood loss, fluoroscopy time, operative duration, deambulation day and overall hospital stay (p<0.05). Overall, there was a statistically significant improvement in overall pain perception at discharge and three month follow up in both groups. The kyphosis correction in percutaneous group was similar to open pedicle screw fixation technique (mean cobbs angle correction of 4.7 degree).</p><p><strong>Conclusions: </strong>The percutaneous approach has several advantages over the open pedicle screw fixation with regard to less intraoperative blood loss, less postoperative pain, early deambulation, no was a statistically complications and shorter hospital stay Keywords: Open pedicle screw; percutaneous pedicle screw fixation; thoracolumbar fracture.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"22 2","pages":"391-396"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile and Endoscopic Management in Patients with Choledocholithiasis.","authors":"Manoj Lamsal, Anurag Jha, Brindeswari Kafle, Rabin Hamal, Tshering Wangdi Sherpa, Pradip Kumar Kafle, Tulsi Ram Bhattarai, Mohan Bhusal, Dinesh Koirala, Rahul Pathak","doi":"10.33314/jnhrc.v22i02.5390","DOIUrl":"10.33314/jnhrc.v22i02.5390","url":null,"abstract":"<p><strong>Background: </strong>Common bile duct stones is a common medical problem that are usually seen in association with gallstone disease. Endoscopic management of Common bile duct stones involves doing Endoscopic retrograde cholangiography for bile duct clearance which is the primary therapeutic modality of choice. This prospective study was done to identify the clinical characteristics and outcome of patients presenting with Common bile duct stones undergoing Endoscopic retrograde cholangiography.</p><p><strong>Methods: </strong>A prospective observational study was conducted on all patients undergoing Endoscopic retrograde cholangiography in department of Gastroenterology, Tribhuvan University Teaching Hospital, for management of diagnosed or suspected choledocholithiasis from April 2023 to March 2024. Patient demographics, clinical characteristics, Endoscopic retrograde cholangiography findings and post procedure outcome data were collected and analysed.</p><p><strong>Results: </strong>A total of 110 patients (61.8% male and 38.2% female) were included in the final analysis. Successful clearance of Common bile duct was obtained in 76.4% patients with overall adverse events of 18% related to the procedure. Among patients undergoing the procedure, 16.4% couldn’t be managed with Endoscopic retrograde cholangiography and were referred for surgical management.</p><p><strong>Conclusions: </strong>Endoscopic management in form of Endoscopic retrograde cholangiography is a safe and effective method to manage patients with Common bile duct stones.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"22 2","pages":"397-401"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile of Thoracoscopic Bullectomy in Treatment of Pneumothorax.","authors":"Pratima Gautam, Ranjan Sapkota, Suraj Shrestha, Prakash Mainali","doi":"10.33314/jnhrc.v22i02.4477","DOIUrl":"https://doi.org/10.33314/jnhrc.v22i02.4477","url":null,"abstract":"<p><strong>Background: </strong>In pneumothorax patients requiring surgery for various indications, thoracotomy was the traditional approach until the advent of video-assisted thoracoscopic surgery. In the last decade, role of thoracoscopy in the surgical management of pneumothorax has been consolidated and established. In this study, we aim to report our experience of thoracoscopy in the surgical management of pneumothorax.</p><p><strong>Methods: </strong>A descriptive review of prospectively maintained data on all the patients undergoing thoracoscopic bullectomy for pneumothorax was done.</p><p><strong>Result: </strong>Over the period of 9 years, a total of 120 patients underwent thoracoscopic bullectomy. Among them, 95 entered final analysis. Most common age group was 21-40 years, with male predominance (80%); most common diagnosis was primary pneumothorax (67%), first episode (74%), and on the right (65%) side; commonest symptom was shortness of breath (84%) of a median duration of 7 days. A chest tube was placed in 96% of patients before the operation. Commonest radiological finding was multiple bullae (45%) in the apical region (71%). Majority of patients underwent surgery via 3 ports, and a single bulla in the apical region was the most common intraoperative finding. Among the postoperative complications which occurred in 17%, an air leak was present in 9%. The median intensive care stay was 23 hours, the median chest tube duration was 3 days, and the median hospital stay was 9 days.</p><p><strong>Conclusions: </strong>Thoracoscopy can be used as a safe, feasible, and effective procedure in patients presenting with pneumothorax with minimal postoperative complications.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"22 2","pages":"226-230"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686938","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":"Assessment of fluoride level in drinking water sources in Sudurpaschim Province, Nepal.","authors":"Naresh Prasad Joshi, Jagadish Joshi, Abanish Singh","doi":"10.33314/jnhrc.v22i02.5042","DOIUrl":"https://doi.org/10.33314/jnhrc.v22i02.5042","url":null,"abstract":"<p><strong>Background: </strong>Fluoride, a naturally occurring element found in varying concentrations in water, confers preventive effects in dental caries around a concentration of 1 ppm. The study aimed to assess the level of fluoride in drinking water sources in the Sudurpashchim Province of Nepal.</p><p><strong>Methods: </strong>A cross-sectional study was conducted from April to July 2023 with water samples from natural, municipal, and packaged sources collected in polypropylene plastic bottles from all 9 districts of the province. Three samples from each district's two most populous municipalities (one urban and one rural municipality) were taken. Water samples from the only sub-metropolitan city in the province (Dhangadhi) were also included. Fifty-seven samples were sent to a Nepal Standard-certified lab in Kathmandu for fluoride estimation using the American Public Health Association-approved method. Data were entered in Microsoft Excel and analysed using the Statistical Package for Social Sciences v 22. A p-value less than 0.05 was taken as significant.</p><p><strong>Results: </strong>Most of the water samples had fluoride levels below 0.1 ppm. The highest fluoride concentration was seen in a sample from a hand pump in the rural municipality of Kanchanpur (0.9 ppm). No significant differences were observed between water samples according to different water sources, geographical regions, or categories of water resources.</p><p><strong>Conclusions: </strong>Fluoride concentration in water sources of Sudurpashchim is well below the recommended level for caries protection. Measures should be taken to ascertain people get adequate fluoride as needed.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"22 2","pages":"330-335"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687246","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":"Intraoperative Variations of the Gastrocolic Trunk of Henle noted in Gastrointestinal Surgeries.","authors":"Roshan Ghimire, Nishant Thapa, Bidur Prasad Acharya, Bed Prakash Sah, Yugal Limbu, Sujan Regmee, Dhiresh Kumar Maharjan, Prabin Bikram Thapa","doi":"10.33314/jnhrc.v22i02.5132","DOIUrl":"https://doi.org/10.33314/jnhrc.v22i02.5132","url":null,"abstract":"<p><strong>Background: </strong>The gastro-colic trunk of Henle is a venous trunk that comprises the veins draining the stomach and colon and is an important landmark for various gastro-intestinal surgeries. Understanding the anatomy of these vessels may enhance the surgical outcome. The aim of this study is, to assess the Intraoperative variations of the Gastrocolic Trunk of Henle noted in gastrointestinal surgeries in a tertiary care center.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was conducted at Kathmandu Medical College Public Limited, a tertiary center in Nepal during the period of one year (1st January 2022, to 31st December 2022). All patients undergoing right hemicolectomy, gastrectomy, and pancreaticoduodenectomy were included in the study. Based on per-operative findings, the type of The gastro-colic trunk of Henle was noted during surgery.</p><p><strong>Results: </strong>A total of 49 patients underwent the above-mentioned surgeries during the study period. The gastro-colic trunk was found in 45 out of the 49 patients intraoperatively (91.84%), and the variations were distinguished. The most common configuration noted was the union of the right gastro-epiploic vein, the anterior superior pancreaticoduodenal vein, and the superior right colic vein (Type I), which was noticed in 46.67% of the patients.</p><p><strong>Conclusions: </strong>The intraoperative identification of the anatomy of The gastro-colic trunk of Henle is challenging because of its variable combinations of tributaries. Knowledge of variations in The gastro-colic trunk of Henle is important in preventing intraoperative bleeding, and during identification, the meticulousness of surgery is redefined.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"22 2","pages":"366-369"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687242","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":"Prevalence of Coronary Artery Disease among Adults in Nepal.","authors":"Khem Bahadur Karki, Anil Poudyal, Meghnath Dhimal, Ruth Muller, David A Groneberg","doi":"10.33314/jnhrc.v22i02.5216","DOIUrl":"https://doi.org/10.33314/jnhrc.v22i02.5216","url":null,"abstract":"<p><strong>Background: </strong>Coronary Artery Disease is a leading cause of death and a major disorder affecting the heart and blood vessels. The aim of this study is to estimate the prevalence of Coronary Artery Disease and its associated risk factors in Nepal.</p><p><strong>Methods: </strong>This population-based descriptive cross-sectional survey involved 12,557 participants aged 20 years and older, selected through a multistage stratified cluster sampling method. Data on demographics and risk factors were collected via face-to-face interviews, physical examinations, and laboratory tests. The association of different variables with Coronary Artery Disease outcomes was assessed using descriptive statistics.</p><p><strong>Results: </strong>The prevalence of definite Coronary Artery Disease among Nepalese adults aged 20 years and older was found to be 0.5% (95% CI: 0.3-0.7). Possible Coronary Artery Disease had a prevalence of 2.1% (95% CI: 1.6-3.4), and probable Coronary Artery Disease had a prevalence of 0.3% (95% CI: 0.2-0.4). Higher prevalence rates were observed among older individuals, urban residents, those with higher education levels, males, and participants with hypertension, diabetes, and elevated total cholesterol levels.</p><p><strong>Conclusion: </strong>This study represents the first comprehensive national population-based assessment of Coronary Artery Disease in Nepal. The findings indicate a significant burden of Coronary Artery Disease and its risk factors among the adult population. Addressing the high prevalence of Coronary Artery Disease and its risk factors requires both individual and population-level interventions. Keyword: Coronary arterial disease; Nepal; prevalence.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"22 2","pages":"402-409"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687274","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":"Sputum Bacteriology and Antibiotic Sensitivity Pattern of Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Kathmandu Model Hospital.","authors":"Abhinav Dahal, Rajesh Dhoj Joshi, Muna Palikhe, Neelima Maskey, Shyam Sundar Sah, Aastha Onta, Basudha Shrestha","doi":"10.33314/jnhrc.v22i02.5345","DOIUrl":"https://doi.org/10.33314/jnhrc.v22i02.5345","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world and will become the third leading cause of death worldwide by 2020. A study was carried out with an objective to study the sputum bacteriology and antibiotic sensitivity pattern of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease.</p><p><strong>Methods: </strong>A review study was carried out for a sputum culture isolated cases of acute exacerbation of COPD in Kathmandu Model Hospital. The discharged records from Jan 1st 2018 to December 31st, 2022. were analysed for demographic data and antibiotic susceptibility patterns. Any patient records with incomplete information were excluded from this study. An antibiotic susceptibility pattern was further confirmed from the laboratory records. Data were entered and analysed using SPSS version 21.</p><p><strong>Results: </strong>Over the period of five years from Jan 1st 2018 to December 31st, 2022. We found that total 80  of our patients with acute exacerbation of chronic obstructive pulmonary disease had a positive routine sputum culture. Pseudomonas aeruginosa (28.7%), Kleibsella pneumonia (20%), Escherchia coli (17.6%), Acinetobacter baumani complex (13.8%) were the most common bacteria isolated. Most organisms are found to be sensitive to Polymyxin B, Colistin, Tigecycline followed by Piperacillin/Tazobactam while most of them are found to be resistant to Amoxicillin, Amoxicillin/Clavulanic Acid and Cefixime.   Conclusions: Pseudomonas aeruginosa, Klebsiella pneumonia and Escherchia coli accounted for most common bacteria isolated in our study. These bacteria were found to be sensitive to polymyxin B, colistin and tigecycline. Most of them were resistant to amoxicillin, amoxicillin clavulanic acid and cefixime. Our study concluded acute exacerbation of chronic obstructive pulmonary disease is associated with bacterial isolates in sputum culture and highly sensitive to broad spectrum antibiotics   Keywords: Bacteria, COPD, exacerbation, sputum culture, antibiotics, Nepal.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"22 2","pages":"437-440"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687328","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":"Socioeconomic, Behavioural, and Health-related Characteristics of Older Adults.","authors":"Bal Krishna Suvedi, Isha Karmacharya, Shiba Bahadur Karkee, Salau Din Myia, Saruna Ghimire, Kshitij Karki, Devendra Raj Singh, Shishir Paudel, Nirmal Raj Marasine, Saloni Pandey, Raksha Adhikari, Bhawana Kafle, Naveen Shrestha","doi":"10.33314/jnhrc.v22i02.5392","DOIUrl":"https://doi.org/10.33314/jnhrc.v22i02.5392","url":null,"abstract":"<p><strong>Background: </strong>The global aging population is growing rapidly, and Nepal is no exception. This increase is driven by changes in socioeconomic conditions, health behaviours, and advancements in the health system. In Nepal, almost a quarter of the national population are older adults (≥45 years), whose health status is rarely elaborated. This study was carried out to assess the socioeconomic, behavioural, and health-related characteristics of older adults in Nepal.</p><p><strong>Methods: </strong>A community-based cross-sectional study was conducted among 4,179 randomly selected older adults residing in Bagmati Province from July 2022 to June 2023, via a multi-stage sampling technique. A semi-structured questionnaire including Geriatric Depression Scale, Activity of Daily Living, and Instrumental Activity of Daily Living along with sociodemographic and health profiles were used for the data collection through face-to-face interviews. The data were described in frequency and percentage across the local levels (urban/rural) and gender. Chi-square tests were done for bivariate analyses.</p><p><strong>Results: </strong>The mean age of the population was 61.66±11.1 years. The prevalence of multimorbidity, disability, and depression was found to be 27.6%, 23.3%, and 35.1% respectively. There was no significant difference between multimorbidity and depression across local levels, while there was a significant difference across disability status. There was a significant difference between multimorbidity and depression across genders.</p><p><strong>Conclusions: </strong>This study provides comprehensive insights into the socioeconomic status, behavioural factors, and health status of older adults in Nepal. Study findings can inform interventions and policies at local levels to consider the unique needs of the older population in Nepal.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"22 2","pages":"419-429"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile of Peripheral Artery Disease of Patients Attending Shahid Gangalal National Heart Center, Janakpurdham, Nepal.","authors":"Amit Kumar Singh, Pranil Man Pradhan, Rajesh Kumar Shah, Aditya Mahaseth","doi":"10.33314/jnhrc.v22i02.4874","DOIUrl":"https://doi.org/10.33314/jnhrc.v22i02.4874","url":null,"abstract":"<p><strong>Background: </strong>Peripheral artery disease is an important vascular disease. There is an increased incidence of acute limb ischemia in cases of peripheral artery disease. Objective of this study was to assess the prevalence of peripheral artery disease among high-risk patients attending out patient department in Shahid Gangalal National Heart Center, Janakpurdham.</p><p><strong>Methods: </strong>A total of 386 high risk patients for Peripheral Artery Disease were included in the study. Informed consent was taken from patients undergoing the study. Patients underwent ankle brachial index calculation to make a diagnosis of peripheral artery disease. Patients having ankle brachial index of <= 0.9 was considered to have peripheral artery disease. Patients diagnosed with peripheral artery disease further underwent doppler study.</p><p><strong>Results: </strong>The study showed the prevalence of peripheral artery disease to be 17.4% among high-risk patients attending Shahid Gangalal National Heart Centre, Janakpurdham. The prevalence of peripheral artery disease was more in females as compared to male which was statistically significant. Most of the high-risk patients were patients with hypertension at Shahid Gangalal National Heart Centre.</p><p><strong>Conclusions: </strong>Peripheral artery disease prevalence is significant among high-risk patients attending Shahid Gangalal National Heart Centre, Janakpurdham. High risk patients should undergo evaluation of peripheral artery disease for early detection and treatment.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"22 2","pages":"231-236"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686507","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}