Alissa DeVaughn, Leonard H T Go, Robert A Cohen, Yuan Shao
{"title":"Investigation of occupational exposure to respirable crystalline silica (RCS) among engineered stone fabricators in Chicago-A pilot study.","authors":"Alissa DeVaughn, Leonard H T Go, Robert A Cohen, Yuan Shao","doi":"10.1080/15459624.2024.2421488","DOIUrl":"https://doi.org/10.1080/15459624.2024.2421488","url":null,"abstract":"<p><p>Engineered stone countertops, popularly known as quartz or artificial stone countertops, have gained significant attraction due to their durability and aesthetic appeal. However, due to their high crystalline silica content, the fabrication of these countertops poses severe health risks to workers, as evidenced by numerous global cases of silicosis. The study aimed to assess occupational exposure to respirable crystalline silica (RCS) among fabricators in Chicago and characterize the elemental composition and physical properties of engineered stone dust. Eight professional fabricators from two local stone workshops were recruited for the study. The exposure levels to RCS were assessed using the NIOSH 7500 method. Bulk dust samples were collected on-site, and the elemental composition of the dust was analyzed using X-ray fluorescence (XRF) and reported in stoichiometric oxide units. A set of real-time air monitors was used to measure particle size distribution, particulate matter (PM) concentrations, and ambient conditions in the workplace. A questionnaire was administered, and worker activities were recorded during the visits. Workers were found to be overexposed to respirable quartz in their workplaces, with time-weighted averaged (TWA) concentrations ranging from 11 to 203 µg/m<sup>3</sup>, with a median concentration of 90 µg/m³. Seven samples (78%) exceeded the 50 µg/m<sup>3</sup> TWA-8 hr occupational exposure limit for RCS. Engineered stone dust samples contain much higher silica content compared to natural stone dust (30%), with silica percentages ranging from 56% to 95%. Over 90% of the particles (90.3-98.7%) emitted from activities involving small hand tools were of size less than 2.5 µm. The use of respiratory protection was not observed during the visits. The study offers firsthand insights into the engineered stone fabrication industry. The findings reveal a combination of risk factors: elevated RCS concentrations, very high silica content in engineered stone, and a high prevalence of fine particles. These factors collectively pose significant health risks to workers that are unequaled in comparison to most other industries. The findings underscore the urgent need for regulatory measures to better protect workers' health in the engineered stone fabrication sector.</p>","PeriodicalId":16599,"journal":{"name":"Journal of Occupational and Environmental Hygiene","volume":" ","pages":"1-9"},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laura Allen, Hannah Fairbanks, Paige Wells, Chloe Stewart, Natalie Suder Egnot, Andrew Maier
{"title":"Measurement of ambient fiber and fibrous glass concentrations near three fiberglass wool manufacturing facilities in the United States.","authors":"Laura Allen, Hannah Fairbanks, Paige Wells, Chloe Stewart, Natalie Suder Egnot, Andrew Maier","doi":"10.1080/15459624.2024.2406229","DOIUrl":"https://doi.org/10.1080/15459624.2024.2406229","url":null,"abstract":"<p><p>A limited number of published studies have evaluated concentrations of airborne fibers in outdoor air, with even fewer assessing typical air concentrations in the ambient air near fiberglass wool manufacturing facilities. Building upon the assessment by Switala et al. (1994), area samples for airborne fiber concentrations (diameters of less than 3 µm, lengths greater than 5 µm, and aspect ratios equal to or greater than 5 to 1) were collected at fixed locations along the fence lines of three fiberglass wool manufacturing facilities in the United States. Samples were analyzed by the National Institute for Occupational Safety and Health (NIOSH) Method 7400, via phase contrast microscopy (PCM) using \"B\" counting rules. A total of 134 samples were collected across the three plants. Overall, 73% of the samples collected were below the limit of quantification (LOQ). Using the Kaplan-Meier (KM) method for estimation of values below the LOQ, the geometric mean fiber concentration for all plants combined was 0.0028 fibers per cubic centimeter (f/cc), with the 95<sup>th</sup> percentile upper confidence level at 0.0049 f/cc. Of those samples with detectable concentrations of airborne fibers (<i>n</i> = 36), when further analyzed using energy dispersive X-ray (EDX) analysis, only one sample had a detectable glass fiber concentration at 0.0045 f/cc, which was noted as the detection limit for the method. This glass fiber concentration is within the range anticipated for ambient fibrous glass near production facilities, suggesting consistency with measurements made by Switala et al. (1994), despite changes in production methods (i.e., use of different binders) since 1994 and the use of updated methods for treatment of values below the LOQ in the current assessment.</p>","PeriodicalId":16599,"journal":{"name":"Journal of Occupational and Environmental Hygiene","volume":" ","pages":"1-9"},"PeriodicalIF":1.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"\"The Action Level<sup>®</sup>\".","authors":"J Thomas Pierce","doi":"10.1080/15459624.2024.2427560","DOIUrl":"10.1080/15459624.2024.2427560","url":null,"abstract":"","PeriodicalId":16599,"journal":{"name":"Journal of Occupational and Environmental Hygiene","volume":" ","pages":"D21-D22"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vennetia R Danes, Vickers J R Sumakud, Jimmy F Rumampuk, Martha M Kaseke, Fujiyanto, Herry E J Pandaleke
{"title":"The effects of underwater diving on the lung function of divers in coastal areas of tourism destinations: A cross-sectional study in North Sulawesi Province, Indonesia.","authors":"Vennetia R Danes, Vickers J R Sumakud, Jimmy F Rumampuk, Martha M Kaseke, Fujiyanto, Herry E J Pandaleke","doi":"10.1080/15459624.2024.2398749","DOIUrl":"10.1080/15459624.2024.2398749","url":null,"abstract":"<p><p>North Sulawesi is renowned for its captivating underwater tourism, attracting SCUBA divers and traditional divers. Given the potential impact of diving activities on lung function, this study aims to explore differences in lung function among self-contained breathing apparatus (SCUBA) diving tourism workers, traditional divers utilizing breathing air compressors and air lines, and non-divers within the coastal areas of tourism destinations in North Sulawesi. Employing a descriptive comparative study with a cross-sectional approach, 90 subjects were categorized into three groups, and selected through simple random sampling. Spirometry was utilized for data collection, and Analysis of Variance (ANOVA) was employed for comparisons, with post hoc analysis for specific differences. The ANOVA analysis revealed significant variations in FVC Predicted, FVC Measured, FEV1, and obstruction and restriction values among SCUBA divers, traditional divers, and non-divers with a level of significance of <i>p</i> < 0.05. Post hoc analysis exhibited noteworthy distinctions in FVC Predicted, FVC Measured, and FEV1 between traditional divers and non-divers, and between SCUBA divers and traditional divers (<i>p</i> < 0.00). Obstruction values showed differences between SCUBA divers and traditional divers (<i>p</i> = 0.012), while restriction values indicated disparities between traditional divers and non-divers (<i>p</i> = 0.019). In conclusion, there were significant variations in lung function among SCUBA diving tourism workers, traditional divers using compressors and air lines, and non-divers within the coastal areas of tourism destinations in North Sulawesi.</p>","PeriodicalId":16599,"journal":{"name":"Journal of Occupational and Environmental Hygiene","volume":" ","pages":"788-794"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The role of personal protective equipment (PPE) in reducing firefighter exposure to chemical hazards: A systematic review.","authors":"Nicole Chakr, Adem Sav","doi":"10.1080/15459624.2024.2400237","DOIUrl":"10.1080/15459624.2024.2400237","url":null,"abstract":"<p><p>This paper aims to investigate the effectiveness of personal protective equipment (PPE) in reducing firefighter exposure to various hazardous chemicals from the smoke emitted during fires. A systematic review of peer-reviewed articles was undertaken utilizing five databases: Medline, Embase, Web of Science, Scopus, and CINHAL. Studies published between 2013 and 2023 that investigated the effectiveness of PPE in reducing firsthand exposure to at least one chemical were included. Extracted data were grouped into two overarching themes related to PPE: (a) Respiratory Protection and (b) Personal Protective Clothing (PPC). Overall, 21 studies met the inclusion criteria and were considered for further analysis. Respiratory protection, particularly self-contained breathing apparatus (SCBA), offered the most protection in preventing inhalation exposure to chemical hazards. There was limited evidence on the effectiveness of firefighter turnout gear in reducing skin contamination. Combustion contaminants, especially highly volatile compounds like benzene, were found to permeate and penetrate through and around the protective clothing. In conclusion, certain respirators, particularly SCBA, provided the best protection against inhalation exposure to chemicals; however, PPC did not appear to provide complete protection, particularly against the more volatile chemicals like benzene.</p>","PeriodicalId":16599,"journal":{"name":"Journal of Occupational and Environmental Hygiene","volume":" ","pages":"831-841"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mude Arjun Naik, Adarsh Kumar, Suman Gupta, Dilip Kumar Kushwaha, Hari Lal Kushwaha, Awani Kumar Singh, Ramasubramanian Vaidhyanathan, Murtaza Hasan
{"title":"Potential dermal exposure and ergonomic assessment in greenhouse spraying.","authors":"Mude Arjun Naik, Adarsh Kumar, Suman Gupta, Dilip Kumar Kushwaha, Hari Lal Kushwaha, Awani Kumar Singh, Ramasubramanian Vaidhyanathan, Murtaza Hasan","doi":"10.1080/15459624.2024.2400241","DOIUrl":"10.1080/15459624.2024.2400241","url":null,"abstract":"<p><p>Greenhouses are space-efficient structures used in the production of produce. However, occupational health issues like exposure to chemicals, and physiological and postural stresses are experienced by operators while performing farm activities due to the enclosed environment of the greenhouse. This study assesses chemical exposure and physiological and postural parameters of operators during spraying with two different types of sprayers (Battery-powered knapsack sprayer [Battery sprayer] and AC-powered stationary sprayer [Stationary sprayer]) with two different application techniques (continuous and alternate row). The mean Potential Dermal Exposure (PDE) for a continuous row of spraying was 54 and 70 mL h<sup>-1</sup> with battery and stationary sprayers, respectively. However, PDE in alternate row spraying was approximately 16 and 25% less in battery and stationary sprayers than in a continuous row. The upper and left portions of the body had higher exposure compared to the lower and right half portions in all treatments. The ergonomic parameters (physiological and postural assessment) in continuous and alternate row spraying techniques did not differ but varied with the type of sprayer used. Mean values of energy expenditure rate, body part discomfort score, overall discomfort score, and risk index were 210 ± 35 W, 27 ± 2.0, 6.1 ± 0.4, and 1.0, respectively, in the battery sprayer compared to 290 ± 80 W, 35 ± 4.1, 8.3 ± 1.0, and 2.0 in the stationary sprayer. This study concluded that the use of a battery sprayer with an alternate row spraying technique resulted in lower dermal exposure (45 mL h<sup>-1</sup>) and was ergonomically less demanding.</p>","PeriodicalId":16599,"journal":{"name":"Journal of Occupational and Environmental Hygiene","volume":" ","pages":"817-830"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Airborne trichloramine in indoor swimming pools in Sweden.","authors":"Sandra Johannesson, Kåre Eriksson, Gunilla Wastensson, Jessica Westerlund, Pål Graff","doi":"10.1080/15459624.2024.2400231","DOIUrl":"10.1080/15459624.2024.2400231","url":null,"abstract":"<p><p>Trichloramine is a disinfection by-product in chlorinated swimming pools. It can evaporate into the air and irritate eyes and airways among swimmers and pool workers. This study aimed to evaluate airborne concentrations of trichloramine in different types of indoor swimming pools. Altogether, 72 swimming pools across Sweden were included; 36 exercise pools, 16 instruction pools, seven adventure pools, and 13 rehabilitation pools. In total, 167 sampling sessions were performed with the majority (<i>N</i> = 91) conducted in public exercise pools. Repeated sampling sessions on different days were performed within all pool categories. Airborne trichloramine was measured stationary by the poolside using active sampling on quartz filters. In total, 434 air samples were collected. The geometric mean (GM) concentration of trichloramine for the exercise pools was 0.12 mg/m<sup>3</sup> (range GM<sub>pool</sub>: 0.02-0.29 mg/m<sup>3</sup>) and for about 30% the GM<sub>pool</sub> exceeded the Swedish public health guideline value (0.2 mg/m<sup>3</sup>). The geometric mean for instruction pools was 0.18 mg/m<sup>3</sup> and for adventure pools 0.20 mg/m<sup>3</sup>. Trichloramine concentrations were statistically significantly lower in rehabilitation pools (GM: 0.03 mg/m<sup>3</sup>) compared with the other pool categories. A statistically significant effect of time of the day for sampling was found for the exercise and instruction pools, with higher trichloramine levels during evenings compared with mornings and afternoons. For the rehabilitation pools, trichloramine was significantly higher during the cold season compared with the warm season. Variability in trichloramine concentrations was attributed to between-pool as well as within-pool variances. The within-pool variability encourages a repeated sampling strategy to capture the variation between different days. These findings have implications for exposure assessment in epidemiological studies as well as for indoor air quality monitoring. Trichloramine can cause acute irritative effects at elevated levels, and since trichloramine concentrations may differ depending on the time of the day it is recommended that full-day stationary measurements are supplemented with short-term samplings to capture these variations.</p>","PeriodicalId":16599,"journal":{"name":"Journal of Occupational and Environmental Hygiene","volume":" ","pages":"805-816"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephanie Ziembicki, Tracy L Kirkham, Paul A Demers, Victoria H Arrandale
{"title":"Updating a diesel engine exhaust job-exposure matrix with published measurement data.","authors":"Stephanie Ziembicki, Tracy L Kirkham, Paul A Demers, Victoria H Arrandale","doi":"10.1080/15459624.2024.2400227","DOIUrl":"10.1080/15459624.2024.2400227","url":null,"abstract":"<p><p>A job-exposure matrix (JEM) is a tool that can estimate diesel engine exhaust (DEE) exposures. JEMs based on expert judgment or measurement data are limited by the information available at the time of development. Over time, more information about hazardous exposures is understood through additional measurements and peer-reviewed publications. This study presents a systematic approach to updating an existing DEE JEM using published data to better reflect current scientific knowledge. The literature was searched for occupational exposure studies that measured DEE as elemental carbon (EC) between January 2010 and May 2022. Four-digit North American Industry Classification System (NAICS) 2002 and National Occupational Classification-Statistics (NOC-S) 2006 codes were assigned to each identified subgroup within the studies. EC exposures were categorized as low (0-10 µg/m<sup>3</sup>), moderate (10-20 µg/m<sup>3</sup>), or high (>20 µg/m<sup>3</sup>). Weighted arithmetic means were calculated for each industry-occupation intersection (IOI) identified in the literature. These means were used to adjust, or retain, the existing exposure level within the JEM cells using a decision tree based on the number of studies, workplace locations, and pooled sample size of the weighted mean. Concordance was measured between the updated JEM (Diesel Exhaust in Canada JEM (DEC-JEM)), the previous (existing) JEM, and the Canadian Job-Exposure Matrix (CANJEM). Thirty-seven studies were identified from the published literature reporting on 53 unique IOIs (20 NAICS and 34 NOC-S codes), including occupations in the mining, construction, and transportation industries. Exposure levels for 66% of identified IOIs increased, most in construction and mining. After the decision tree's results were expanded to the full DEC-JEM, the exposure level of 486 IOIs (12.5% of DEC-JEM) and 286,710 workers (15.8% of DEE-exposed workers) increased. There was a significant correlation between qualitative exposure levels in the updated DEC-JEM and CANJEM (Kendall's τ = 0.364, <i>p</i> < 0.001). This study describes a systematic approach to updating an existing JEM to incorporate new scientific knowledge. The updated DEC-JEM better reflects existing exposure knowledge in several industries, particularly construction. Future analyses include investigating its use as an exposure assessment tool in disease surveillance.</p>","PeriodicalId":16599,"journal":{"name":"Journal of Occupational and Environmental Hygiene","volume":" ","pages":"795-804"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A physiologically based pharmacokinetic model for the transdermal uptake of semivolatile organic compounds from the atmosphere and through clothing.","authors":"Laurent Simon, Abishek Biswas","doi":"10.1080/15459624.2024.2398024","DOIUrl":"10.1080/15459624.2024.2398024","url":null,"abstract":"<p><p>This study focuses on the semivolatile organic compound (SVOC) absorption through clothing and the skin. SVOCs are ubiquitous in daily life, in products like personal care items, plastics, and building materials. Understanding their permeation through the skin barrier is crucial for evaluating potential health risks of complete exposure. A PBPK model was developed to comprehend the dynamic interplay between SVOCs and human skin and to estimate tissue distribution throughout the body. The framework incorporated parameters such as skin permeability, physicochemical properties of the chemicals, and the impact of protective clothing and adsorbents. This model predicted the rate and extent of SVOC absorption under diverse scenarios. The PBPK predictions matched the experimental amount of mono-ethyl phthalate (MEP), a phthalate metabolite, when urine samples were collected for bare-skinned and clothed participants. Urine concentrations of MEP during a 6-hr exposure and for the next 48 hr show that clean clothing effectively decreased dermal uptake and the buildup of chemicals in the body. Additional removal of MEP was achieved through adsorption on activated carbon fabric. An increase in the maximum monolayer adsorption capacity or the Langmuir equilibrium constant further reduced the amount of MEP in the urine.</p>","PeriodicalId":16599,"journal":{"name":"Journal of Occupational and Environmental Hygiene","volume":" ","pages":"778-787"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Development of rapid prediction model for silicosis risk among stone carvers in Nakhon Ratchasima, Thailand.","authors":"Ratchapong Chaiyadej, Arroon Ketsakorn","doi":"10.1080/15459624.2024.2398009","DOIUrl":"10.1080/15459624.2024.2398009","url":null,"abstract":"<p><p>Exposure to silica dust presents a risk for the development of lung disease for stone carvers in Nakhon Ratchasima province, Thailand. This study aimed to develop a rapid prediction model for the assessment of silicosis risk among 243 stone carvers who were exposed to silica at work from August and October 2023 in Nakhon Ratchasima, Thailand. Demographic characteristics collected in questionnaires were work information; basic health information; health behavior data, including prevention and control of silicosis; knowledge; attitude; and practices for surveillance, prevention, and control of silicosis. Respirable crystalline silica (RCS) exposures were measured by conducting personal air sampling. Risk scores of silicosis were calculated and a rapid prediction model for assessment of silicosis risk among stone carvers was determined. It was found that 11 variables were significantly associated with silicosis risk scores (<i>p</i> < 0.05). However, it was demonstrated that only four significant influential variables, including the concentration of silica dust exposure (mg/m<sup>3</sup>), working hours per day, underlying diseases, and separation of residence from a workplace were acceptable for conducting a silicosis risk assessment using multiple regression analysis (R<sup>2</sup> = 0.675). This study indicated that a prediction model can be used for the assessment of silicosis risk among stone carvers. Therefore, the use of this prediction model is recommended to evaluate the risk associated with exposure to RCS of stone carvers in Nakhon Ratchasima province, Thailand due to its simplicity, accuracy, and time-saving attributes.</p>","PeriodicalId":16599,"journal":{"name":"Journal of Occupational and Environmental Hygiene","volume":" ","pages":"765-777"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}