Journal of the American Psychiatric Nurses Association最新文献

{"title":"Interactions Between Serotonin Transporter Gene and Adverse Childhood Experience in a Generalized Additive Model: A Pilot Study.","authors":"Kosuke Niitsu, Chiyoung Lee, Michael J Rice","doi":"10.1177/10783903241255710","DOIUrl":"10.1177/10783903241255710","url":null,"abstract":"<p><strong>Background: </strong>While most people experience potentially traumatic events (PTEs), including Adverse Childhood Experiences (ACEs), the stress reactions to PTEs on mental health outcomes are highly heterogeneous. Resilience is influenced by a complex biopsychosocial ecological system, including gene serotonin transporter-linked promoter region or <i>5-HTTLPR</i> /rs25531 by ACEs interactions.</p><p><strong>Aims: </strong>This pilot study investigated the gene-by-environment interactions on mental health outcomes in adults enrolled in a health care profession program using a generalized additive model (GAM).</p><p><strong>Methods: </strong>Seventy health care college students (mean age = 27.4 years, 67.1% women) participated in this cross-sectional study. Saliva samples were collected from students to analyze <i>5-HTTLPR</i>/rs25531. Participants completed the ACE Questionnaire and the Mental Health Inventory. GAMs with different interaction terms were built adjusting for age, gender, and race. The value of the effective degree of freedom (EDF) quantifies the curvature of the relationship.</p><p><strong>Results: </strong>Among participants with the long allele of <i>5-HTTLPR</i>/rs25531, a linear pattern was found between the total ACE score and mental health outcomes (EDF = 1). Conversely, among participants with the short allele, EDF was approximately 2, indicating a curved association suggesting that mental health worsens in individuals exposed to up to four types of ACEs.</p><p><strong>Conclusions: </strong>The impact of up to four ACEs on mental health was stronger among individuals with the short allele of <i>5-HTTLPR</i>/rs25531 than those with the long allele. Although this study does not claim to provide a definite approach to analyzing gene-by-environment interactions, we offer a different perspective to explore the relationship.</p>","PeriodicalId":17229,"journal":{"name":"Journal of the American Psychiatric Nurses Association","volume":" ","pages":"55-63"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141179886","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":"Home Health Nurses' Perceptions of Caring for Persons With Severe and Persistent Mental Illnesses.","authors":"Kiernan Riley, Judith E Hupcey","doi":"10.1177/10783903241252165","DOIUrl":"10.1177/10783903241252165","url":null,"abstract":"<p><strong>Background: </strong>Severe and persistent mental illnesses (SPMIs) affect a significant portion of the adult population in the United States. Despite their increased medical disease burden, individuals with SPMIs often lack access to appropriate medical care. Home health services offer cost-effective options for caring for this population in the comfort of their homes. However, little is known about the perceptions of home health nurses providing care to persons with SPMIs, and how they are adjusting care to persons with SPMIs.</p><p><strong>Aims: </strong>This study aimed to explore home health nurses' perspectives on caring for persons with SPMIs.</p><p><strong>Methods: </strong>Using a grounded theory approach, individual semi-structured interviews were conducted with home health and home hospice nurses. The research questions focused on the nurses' experiences, barriers and facilitators to care, and the impact of the home environment on caring for persons with SPMIs. Data analysis followed coding procedures outlined in grounded theory, resulting in the development of an axial coding model.</p><p><strong>Results/conclusions: </strong>The findings provide valuable insights into the challenges and opportunities faced by home health nurses when providing care for individuals with SPMIs. The outcomes of this study are intended to contribute to the understanding of current care practices and can guide the allocation of resources to improve care for this vulnerable population, such as incorporating training specific to persons with severe psychiatric illnesses.</p>","PeriodicalId":17229,"journal":{"name":"Journal of the American Psychiatric Nurses Association","volume":" ","pages":"46-54"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Institutional Betrayal in Military and Veteran Populations: A Systematic Scoping Review [Formula: see text].","authors":"Mikayla McAdams, Matthew W Henninger, Katharine Bloeser, Kelly K McCarron","doi":"10.1177/10783903241299720","DOIUrl":"10.1177/10783903241299720","url":null,"abstract":"<p><p><b>BACKGROUND:</b> Institutional betrayal (IB) refers to the wrongdoings, encompassing both action and inaction, committed by institutions against their affiliated individuals. Military members are particularly vulnerable to IB due to strong social identification with the military, values of loyalty and self-sacrifice, dependence on the institution, the military power structure and legal system, and the complexity of morality in an occupation centered around war. <b>AIMS:</b> This review examines the state of IB literature within the military/Veteran population, identifying research gaps and implications for future policy and clinical care. <b>METHODS:</b> Conducting a systematic scoping literature review across seven databases resulted in 16 eligible publications out of 44 found. <b>RESULTS:</b> Findings indicate a high prevalence of IB experiences within the studied population, correlating with increased psychiatric symptoms and clinical features. The existing literature primarily focuses on military sexual trauma, with limited exploration of IB in the context of combat, politics, return from deployment, illness, military exposures, and moral injury. <b>CONCLUSIONS:</b> Future research should expand on IB in other military experiences, evaluate intervention efficacy and policies, and validate a standardized IB measure. These insights highlight the need for provider education, revised assessments, and interventions tailored to address the complex impact of IB on military and Veteran populations.</p>","PeriodicalId":17229,"journal":{"name":"Journal of the American Psychiatric Nurses Association","volume":" ","pages":"8-22"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791768","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":"Evaluating De-Escalation Training for Direct and Indirect Employees Caring for Residents With Huntington's Disease.","authors":"Brandon Rogers, Barbara St Marie, Daniel Wesemann, Peg Nopoulos","doi":"10.1177/10783903231211558","DOIUrl":"10.1177/10783903231211558","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known about reducing the challenges for caregivers and patients with Huntington's disease (HD). HD creates behavioral disturbances, cognitive decline, and motor disorder progression over the lifetime requiring some individuals to need long-term facility care.</p><p><strong>Aims: </strong>There are concerns about safety and confidence of employees caring for residents with HD.</p><p><strong>Methods: </strong>Nursing staff, administrators, and auxiliary employees were recruited from a long-term care (LTC) facility in rural Iowa, from July 2020 to August 2020. A de-escalation training intervention was delivered. The 1-day intervention included resident behaviors, planning and safety, teamwork, communication, and included role play and simulation. A pre- and post-survey measured confidence and competence in caring for people with HD before and after a training intervention. A resident medical record audit explored challenging behaviors before and after the training intervention.</p><p><strong>Results: </strong>Of 25 participants, six were registered nurses/licensed practical nurses (RNs/LPNs; 24%), four administrators (16%), eight nursing assistants (32%), and seven auxiliary employees (28%). There was improvement in employees perceived safety (33.3%), co-workers enjoyment working with HD residents (54%), understanding symptoms of HD (44.4%), confidence in job abilities (21.0%), and confidence in ability to care for patients with HD (26.3%). A medical record audit showed decreased documentation of resident aggression and care refusal post-intervention.</p><p><strong>Conclusions: </strong>These findings suggest de-escalation training in LTC facilities increased perception of job safety, co-workers' enjoyment, understanding HD symptoms, confidence in ability to care for patients with HD, and decreased resident agitation and care refusal.</p>","PeriodicalId":17229,"journal":{"name":"Journal of the American Psychiatric Nurses Association","volume":" ","pages":"76-82"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138047238","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":"Chatbot-Based Mindfulness-Based Stress Reduction Program for University Students With Depressive Symptoms: Intervention Development and Pilot Evaluation.","authors":"Yan Li, Tsz Yu Chung, Wenze Lu, Mengqi Li, Ying Wai Bryan Ho, Mengting He, Xiaoxiao Mei, Dapeng Chen, Daniel Bressington","doi":"10.1177/10783903241302092","DOIUrl":"https://doi.org/10.1177/10783903241302092","url":null,"abstract":"<p><strong>Background: </strong>Depression is a growing concern among university students. Chatbots provide flexible, accessible, personalized psychosocial support. Delivering Mindfulness-Based Stress Reduction (MBSR) sessions via chatbots may reduce depressive symptoms in university students.</p><p><strong>Aim: </strong>This study aims to evaluate the feasibility, acceptability, safety, and preliminary efficacy of a chatbot-based MBSR intervention for university students with depressive symptoms.</p><p><strong>Methods: </strong>A rule-based MBSR chatbot was developed and evaluated with a single-group pretest-posttest study for university students in Hong Kong (<i>N</i> = 30) reporting depressive symptoms, followed by the collection of their subjective feedback. The intervention lasted eight weeks. The primary clinical outcome was depression levels, with a range of secondary outcomes.</p><p><strong>Results: </strong>The chatbot-based MBSR program demonstrated satisfying recruitment, retention, and adherence rates. The safety of the program was confirmed by the absence of any adverse events directly related to the intervention, tracked from the onset of the intervention to the completion of data assessment. Significant improvements were observed in both primary and secondary outcomes. Participant feedback highlighted the benefits of the program and its effects on depressive symptoms.</p><p><strong>Conclusions: </strong>The program has shown feasibility, acceptability, safety, and preliminary efficacy in reducing depressive symptoms among 30 university students in Hong Kong. The intervention should now be evaluated in a randomized controlled trial with follow-up. This study highlights the potential role of chatbot-based interventions in mental health promotion, nursing, and clinical practice and will inform the subsequent development of innovative digital interventions to address mental health challenges faced by university students.</p>","PeriodicalId":17229,"journal":{"name":"Journal of the American Psychiatric Nurses Association","volume":" ","pages":"10783903241302092"},"PeriodicalIF":1.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864709","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 Novel Training Modality for Providers in the Emergency Department Using a Computer-Based Scenario: A Pilot Study.","authors":"Stephanie A Kehler, Bassema Abufarsakh, Sarret Seng, Chizimuzo T C Okoli","doi":"10.1177/10783903241303516","DOIUrl":"https://doi.org/10.1177/10783903241303516","url":null,"abstract":"<p><strong>Background: </strong>Individuals with substance use disorders (SUD) are increasingly admitted in emergency departments (EDs) nationwide. However, ED providers often have limited knowledge about and lack confidence in treating SUDs. This limited knowledge often results in poor treatment outcomes among patients with SUD in the ED setting.</p><p><strong>Aims: </strong>The aims of this pilot study were to (a) assess the desirability, applicability, and acceptability of a computer-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) education scenario and (b) examine changes in SUD knowledge scores among ED providers before and after engaging in the computer-based SBIRT education scenario.</p><p><strong>Methods: </strong>A tailored computer-based education scenario was developed based on the SBIRT framework for ED providers in an academic medical center. Participants (<i>N</i> = 15) evaluated the desirability, applicability, and acceptability of the education tool. Also, a single-group pre-/post-design was used to examine changes in participants' SUD knowledge and proficiency scores.</p><p><strong>Results: </strong>Participants rated the computer-based SBIRT education scenario as desirable, applicable, and acceptable based on 4.0/5.0 or greater evaluation scores for each component. Overall knowledge scores increased from 3.5 to 3.8, albeit non-significantly. Proficiency score percentages increased by 25%.</p><p><strong>Conclusion: </strong>Computer-based SBIRT education scenario training may be acceptable by ED providers and may improve proficiency in addressing SUD for patients. Future studies should evaluate this training method with a larger sample size.</p>","PeriodicalId":17229,"journal":{"name":"Journal of the American Psychiatric Nurses Association","volume":" ","pages":"10783903241303516"},"PeriodicalIF":1.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846955","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":"Earthquake From the Perspectives of Amputee Children and Their Parents/Caregivers: A Phenomenological Study.","authors":"Yeliz Suna Dağ, Mürşide Zengin, Emriye Hilal Yayan, Erdoğan Suna","doi":"10.1177/10783903241302094","DOIUrl":"https://doi.org/10.1177/10783903241302094","url":null,"abstract":"<p><strong>Background: </strong>Earthquakes cause significant psychological and physical trauma in children, especially when leading to amputations, as they disrupt physical, emotional, and social well-being.</p><p><strong>Aim: </strong>This study was conducted phenomenologically to explore the experiences of children amputated in the Kahramanmaraş earthquake and their parents/caregivers.</p><p><strong>Method: </strong>This study was conducted as a phenomenological study with children who were amputated in the Kahramanmaraş earthquake and their parents/caregivers between August and October 2023. The sample of the study consisted of seven children and their parents/caregivers who met the inclusion criteria and volunteered to participate in the study through purposive sampling method. Data were collected through in-depth interviews using an introductory information form and a semistructured interview form developed by the researcher.</p><p><strong>Results: </strong>It was found that 57.2% of the children who participated in our study were male and their mean age was 11.25 ± 4.02 years. It was found that all the children's houses were destroyed in the earthquake, they were trapped under the debris, and they experienced losses in their family members and relatives. As a result of data analysis, nine themes were identified as apocalypse, pain, fear, and hopelessness for children and apocalypse, helplessness, pain, anger, and hopelessness for parents/caregivers.</p><p><strong>Conclusions: </strong>This study found that earthquake-affected amputee children perceived the earthquake as an apocalypse, experienced prolonged pain during hospitalization, continued to fear the earthquake, and felt hopeless about the future. The children's parents/caregivers also reported that they perceived the earthquake as an apocalypse, that they felt helpless and hopeless for themselves and the children, and that the children had angry/irritable behavior with pain after the disaster.</p>","PeriodicalId":17229,"journal":{"name":"Journal of the American Psychiatric Nurses Association","volume":" ","pages":"10783903241302094"},"PeriodicalIF":1.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846956","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":"Parents' Role as Care Managers During and After Adolescent Suicide Crises.","authors":"Guy M Weissinger, Voulda A Bluteau-James, Janell L Mensinger","doi":"10.1177/10783903241302258","DOIUrl":"https://doi.org/10.1177/10783903241302258","url":null,"abstract":"<p><strong>Background: </strong>Adolescent suicide crises usually require mental health services (inpatient and/or outpatient) to address their needs. Navigating the health care system, especially around suicide crises, is difficult and parents of adolescents usually manage their treatment access and engagement. Little research has examined how parents take on this care management role, vital to maintaining safety and improving adolescent menta health, and the barriers and facilitators they experience in these processes.</p><p><strong>Aims: </strong>To explore parents' experiences around adolescent suicide crises, with a focus on care management and barriers/facilitators to this role.</p><p><strong>Methods: </strong>Interviews were conducted with 18 parents of adolescents in the United States who had suicide crises in the previous 3 years. Using a family-systems lens and thematic analysis, researchers identified three themes and three subthemes.</p><p><strong>Results: </strong>Relevant themes and subthemes were <u>Care Manager Role Transition</u> (subtheme: <i>Home Safety)</i>; <u>Barriers after Barriers</u> (subthemes: <i>Logistical and System Barriers; Poor Communication</i>); and <u>Facilitating Engagement</u>. Parents had a sudden transition to the role of care manager during the adolescent's suicide crisis. They experienced difficulty in managing safety and navigating health care systems. Parents of adolescents with eating disorders had more difficulty in navigating systems and managing safety.</p><p><strong>Conclusions: </strong>Policies and clinical practice must recognize the role and value of parents as care managers of adolescent's mental health services, especially around transitions out of acute care settings. Psychiatric nurses are well positioned to assist parents with this role transition so that parents can better support adolescents during and after suicide crises.</p>","PeriodicalId":17229,"journal":{"name":"Journal of the American Psychiatric Nurses Association","volume":" ","pages":"10783903241302258"},"PeriodicalIF":1.5,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807189","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":"Exploring Nurses' Perceptions of Nursing Presence in the Mental Health Setting.","authors":"Joy Scharfman","doi":"10.1177/10783903241295795","DOIUrl":"https://doi.org/10.1177/10783903241295795","url":null,"abstract":"<p><strong>Background: </strong>Nursing presence is a core relational phenomenon in nursing. It is the process of devoting attention to being with and connecting with another, requisite to providing quality, holistic, person-centered care. Presence has been incorporated in the newly revised scope and standards of nursing, as an intervention. There is a paucity of research on the experience of nurses practicing in mental health settings who employ presence to provide unique, relational care.</p><p><strong>Aims: </strong>The aim of this research is to understand the lived experience of nurses providing nursing care and engaging with presence in the mental health setting.</p><p><strong>Methods: </strong>The tenets of hermeneutic phenomenology proposed by Heidegger and Gadamer were used to guide this inquiry. Twelve nurses practicing mental health were interviewed on Zoom using a semistructured interview guide and the interview time ranged from 45 min to 1 hr. Data were analyzed using the interpretative phenomenological analysis (IPA) process outlined by Smith et al.</p><p><strong>Results: </strong>Four themes are identified: <i>A powerful intervention which fuels healing, Building the bridge, Transcending barriers</i>, and <i>Preserving the well</i>.</p><p><strong>Conclusions: </strong>Nursing presence is implicated as essential to improving the quality of holistic health care, positively impacting patients and nurses. These findings may influence nursing leaders, educators, and administrators to incorporate nursing presence in nursing curricula, develop policies respecting presence, and alter the culture of the health care environment.</p>","PeriodicalId":17229,"journal":{"name":"Journal of the American Psychiatric Nurses Association","volume":" ","pages":"10783903241295795"},"PeriodicalIF":1.5,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807106","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":"Improving Oral Nutrition Intake Through One-on-One Meal Support for Patients With Eating Disorders.","authors":"Terence Yuyun Dzelambong","doi":"10.1177/10783903241299044","DOIUrl":"https://doi.org/10.1177/10783903241299044","url":null,"abstract":"<p><p><b>INTRODUCTION:</b> Treatment for eating disorders (EDs) after hospitalization requires structured environments such as residential care programs where treatment options such as meal support therapy can help manage the physical and psychological effects of their illness. The residential center for this project follows a multidisciplinary approach that uses cognitive behavior therapy (CBT) as a treatment modality for ED. Structured meal support is an essential part of implementing the center's CBT program. <b>AIM(S):</b> The project aimed to determine if one-on-one mealtime support training for staff can help increase oral nutrition intake in adolescents with ED. <b>METHODS</b>: Meal consumption data for five residents of the ED center was used for this project. First, 2 weeks of meal consumption data were collected (210 meals). Then residential center staff were trained on using meal support strategies adapted from the Auckland Eating Disorder Manual. After training the staff and having them implement the strategies with ED clients for a week, another 2 weeks of meal consumption data were collected (210 meals). The preimplementation and postimplementation data were compared to determine if the intervention had an impact on the overall meal intake by residents of the ED center. <b>RESULTS:</b> Before implementing the project, patients completed 122 meals in 2 weeks, representing 58.1% of their meals and after the intervention, patients completed 141 meals representing 67.14% of their meals. <b>CONCLUSION:</b> Project findings show that the use of mealtime support strategies while providing one-on-one support for patients with EDs led to an increase in the overall oral intake.</p>","PeriodicalId":17229,"journal":{"name":"Journal of the American Psychiatric Nurses Association","volume":" ","pages":"10783903241299044"},"PeriodicalIF":1.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770219","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}