Ateka A. Contractor, Danica C. Slavish, Siyuan Wang, Nicole H. Weiss
{"title":"Posttraumatic stress symptoms and positive autobiographical memory characteristics in everyday life","authors":"Ateka A. Contractor, Danica C. Slavish, Siyuan Wang, Nicole H. Weiss","doi":"10.1002/jts.23064","DOIUrl":"10.1002/jts.23064","url":null,"abstract":"<p>Individuals with posttraumatic stress symptoms (PTSS) report difficulties engaging with positive autobiographical memories. Extending this line of research, we examined daily-level concurrent and lagged associations between PTSS severity and positive memory characteristics (vividness, coherence, accessibility, time perspective, sensory details, visual perspective, emotional intensity, sharing, distancing, and valence). The sample included 88 trauma survivors (<i>M</i><sub>age</sub> = 39.89 years, 59.1% female) who completed seven daily measures of PTSS and positive memory characteristics. Multilevel models examined concurrent and lagged associations between PTSS severity and positive memory characteristics. The results indicated that days with higher PTSS severity were associated with less accessibility, β = −.21, <i>p</i> < .001; less visual perspective, β = −0.13, <i>p</i> = .034; and lower positive valence of the memory, β = −.19, <i>p</i> = .003, as well as more emotional intensity associated with, β = .13, <i>p</i> = .041, and more distancing from, β = .21, <i>p</i> < .001, the memory. Supplemental lagged analyses indicated that higher previous-day PTSS severity was associated with more next-day distancing from, β = .15<i>, p</i> = .042, and sensory details of, β = .17<i>, p</i> = .016, the memory. Findings suggest that individuals with more severe PTSS have difficulties accessing positively valenced memories from a first-person perspective, are more distant from the recalled positive memory, and report more emotional intensity when retrieving the memory. Thus, improving access to and reducing distance from positive autobiographical memories, as well as addressing emotional intensity surrounding the retrieval of these memories, may be potential clinical targets for PTSS interventions.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":"37 6","pages":"936-945"},"PeriodicalIF":2.4,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel Capuia, Maria da Cruz, Ana Masseca, Engracia Marques, Paulo Leite, Alexandra R. Mangus, E. Kate Webb, Caitlin Ravichandran, Kerry J. Ressler, Alisha Moreland-Capuia
{"title":"Trauma-informed systems change training has transcultural, transcontinental transformative healing power: An analysis of leaders in the United States and Angola, Africa","authors":"Daniel Capuia, Maria da Cruz, Ana Masseca, Engracia Marques, Paulo Leite, Alexandra R. Mangus, E. Kate Webb, Caitlin Ravichandran, Kerry J. Ressler, Alisha Moreland-Capuia","doi":"10.1002/jts.23062","DOIUrl":"10.1002/jts.23062","url":null,"abstract":"<p>The Institute for Trauma-Informed Systems Change (ITISC) facilitated a 2-day, 12-hr trauma-informed workshop, delivered virtually, using the Training for Change curriculum. The workshop took place in Portuguese in September 2021 with a group of Angolan leaders (<i>N</i> = 51) and in May 2022, in English, with neonatal intensive care unit (NICU) workers from the United States (<i>N</i> = 73). Surveys were administered before (Time [T] 0) and after the workshop (T1) and consisted of demographic questions and the Survey for Trauma-Informed Systems Change (STISC), which assesses system-wide knowledge and attitudes about trauma-informed systems change and the intersection of culture, safety, and acceptance in the workplace. At T1, 18 (35.3%) participants in the Angolan leaders’ group and 46 (63.0%) in the NICU group completed the surveys. Mean scores on the STISC Self-Assessed Knowledge and Attitudes subscale and STISC System-Wide Knowledge and Attitudes subscale increased significantly in both groups after the training. Effect sizes were large for self-assessed knowledge and attitudes, Angolan leaders: <i>d</i> = 1.11, NICU: <i>d</i> = 1.97, and small-to-medium for system-wide knowledge and attitudes, Angolan leaders: <i>d</i> = 0.52, NICU: <i>d</i> = 0.38. Limitations include the relatively small sample size and low participation rates for survey responses. Future research should examine the efficacy of the curriculum in larger samples that include individuals from diverse professions and additional countries. Together, the findings provide initial support that this training can be directly translated and implemented on a global scale.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":"37 6","pages":"1021-1027"},"PeriodicalIF":2.4,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A functional approach to defining and repairing moral injury: Evidence, change agents, clinical strategies, and lessons learned","authors":"Brett T. Litz","doi":"10.1002/jts.23063","DOIUrl":"10.1002/jts.23063","url":null,"abstract":"<p>This is a conceptual overview of a premeeting institute (PMI) I presented at the 39th International Society for Traumatic Stress Studies (ISTSS) annual meeting in November 2023 entitled, “A Functional Approach to Repairing Moral Injury and Traumatic Loss in Context: Evidence, Change Agents, Clinical Strategies, and Lessons Learned.” This paper was invited by the co-chairs of the Scientific Program Committee, Isaac Galatzer-Levy and Katharina Schultebraucks. I first describe the aims of the PMI and then summarize the foundational assumptions that led me to expand adaptive disclosure and create adaptive disclosure–enhanced (AD-E). The foundational assumptions are that (a) moral injury is a unique measurable potential clinical problem, (b) moral injury damages the sustaining building blocks to personal and collective humanity, and (c) repairing moral injury requires corrective humanizing and virtuous experiences and connections. I then provide an overview of AD-E and describe two new change agents— loving–kindness meditation and letter writing—that augment the original AD in service of promoting corrective experiences in the social world that are valued, valuing, and promote the experience of belonging.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":"37 5","pages":"775-783"},"PeriodicalIF":2.4,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katinka Hooyer, Jessica Hamblen, Shannon M. Kehle-Forbes, Sadie E. Larsen
{"title":"“Pitching” posttraumatic stress disorder treatment: A qualitative study of how providers discuss evidence-based psychotherapies with patients","authors":"Katinka Hooyer, Jessica Hamblen, Shannon M. Kehle-Forbes, Sadie E. Larsen","doi":"10.1002/jts.23058","DOIUrl":"10.1002/jts.23058","url":null,"abstract":"<p>The two widely available evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) are cognitive processing therapy and prolonged exposure. Although the U.S. Department of Veterans Affairs (VA) has invested in intensive clinical training to provide these first-line treatments, most military veterans do not receive these therapies. Prior research indicates that patient interest and motivation depend on how patients are educated, and differences in how information is presented shape their decision-making. To our knowledge, no studies have addressed how clinicians “pitch” EBPs for PTSD and examined whether certain approaches are more effective than others. We recorded and thematically analyzed 25 treatment planning sessions across 10 VA sites in the United States to better understand how providers talk to patients about treatment options. Five themes were identified: using rich description, integrating various forms of questioning to engage the patient, sharing prior patient success stories, using inviting and direct language, and tailoring therapy talk to fit patient needs. Providers learning to offer EBPs can use these strategies to serve as a “menu” of options that will allow them to present EBPs in a way that appeals to a particular patient.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":"37 6","pages":"901-912"},"PeriodicalIF":2.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eileen P. Barden, Richard E. Mattson, Nadine Mastroleo, Christina Balderrama-Durbin
{"title":"The impact of emotion regulation and dyadic coping within posttraumatic stress symptoms and risky drinking patterns on relationship distress among trauma-exposed individuals","authors":"Eileen P. Barden, Richard E. Mattson, Nadine Mastroleo, Christina Balderrama-Durbin","doi":"10.1002/jts.23057","DOIUrl":"10.1002/jts.23057","url":null,"abstract":"<p>Individuals with posttraumatic stress symptoms (PTSS) often consume alcohol to manage PTSS-related discomfort, which can negatively impact individual and interpersonal functioning. Processes including emotion regulation and dyadic coping may influence the effects of PTSS and drinking patterns on relationship functioning. The present study examined how PTSS and risky drinking may function through the associations between maladaptive individual and interpersonal coping strategies and relationship distress among trauma-exposed individuals. Participants were 237 adults in a romantic relationship who endorsed lifetime trauma exposure and alcohol consumption within the past year and completed an online battery of self-report measures. Path analyses showed mixed support for the hypothesized theoretical causal model. PTSS was associated with maladaptive emotion regulation, β = .537, <i>p</i> = .010, and negative dyadic coping, β = .264, <i>p</i> = .009, whereas risky drinking was only related to negative dyadic coping, β = .193, <i>p</i> = .024. Negative dyadic coping was significant in the pathways between PTSS and relationship distress, β = .021, <i>p</i> = .009, and risky drinking and relationship distress, β = .030, <i>p</i> = .014. Exploratory analyses based on trauma type did not significantly change the overall model; however, a direct path suggested PTSS may have a stronger negative impact on relationship distress among individuals who experienced assault trauma (e.g., physical or sexual assault), β = .340, <i>p</i> = .012. Findings highlight the interrelations among intra- and interpersonal regulation and provide clinical targets of maladaptive emotion regulation and dyadic coping strategies for individuals with PTSS and harmful drinking.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":"37 6","pages":"890-900"},"PeriodicalIF":2.4,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brittany E. Blanchard, Ellen J. Bluett, Morgan Johnson, Anya Zimberoff, John C. Fortney
{"title":"Trauma exposure correlates among patients receiving care in federally qualified health centers","authors":"Brittany E. Blanchard, Ellen J. Bluett, Morgan Johnson, Anya Zimberoff, John C. Fortney","doi":"10.1002/jts.23055","DOIUrl":"10.1002/jts.23055","url":null,"abstract":"<p>Over 80% of adults in the general population experience trauma. Rates of patients with posttraumatic stress disorder (PTSD) are high in primary care settings and are likely to be even higher in federally qualified health centers (FQHCs). Trauma exposure has been linked to psychiatric symptoms and physical health comorbidities, though little research has focused on FQHC patients. This study addresses this by examining clinical and sociodemographic correlates of specific trauma types among FQHC patients. We analyzed secondary data from patients who screened positive for PTSD and were receiving health care in FQHCs in a clinical trial (<i>N</i> = 978). Individuals who did versus did not experience a specific trauma type were compared using between-group tests. In the sample, 91.3% of participants were exposed to a <i>DSM-5</i> Criterion A traumatic event, with 79.6% experiencing two or more trauma types. Witnessing a life-threatening event (57.3%) and physical assault (55.7%) were the most common traumatic experiences. Physical health comorbidities and worse physical health functioning were associated with a higher likelihood of exposure to all trauma types, with effect sizes larger than PTSD, <i>d</i>s = 0.78–1.35. Depressive and anxiety symptoms were also associated with a higher likelihood of experiencing nearly all trauma types to a lesser magnitude. People of color, <i>OR</i> = 2.45, and individuals experiencing financial inequities, <i>OR</i> = 1.73, had higher odds of experiencing serious accidents as well as other trauma types. The findings highlight the need for trauma-informed care, including routine trauma and PTSD screening, for FQHC patients.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":"37 6","pages":"864-876"},"PeriodicalIF":2.4,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michelle P. Brown, Chad E. Shenk, Brian Allen, Emily D. Dunning, Metzli A. Lombera, Ashley M. Bucher, Nancy A. Dreschel
{"title":"The influence of pretreatment respiratory sinus arrhythmia dimensions on trauma-focused cognitive behavioral therapy outcomes: Findings from a randomized controlled feasibility trial","authors":"Michelle P. Brown, Chad E. Shenk, Brian Allen, Emily D. Dunning, Metzli A. Lombera, Ashley M. Bucher, Nancy A. Dreschel","doi":"10.1002/jts.23053","DOIUrl":"10.1002/jts.23053","url":null,"abstract":"<p>Child maltreatment is associated with respiratory sinus arrhythmia (RSA) dysregulation, a physiological indicator of emotion regulation that predicts elevated posttraumatic stress disorder (PTSD) symptoms and may be a mechanism of action for exposure-based therapies, such as trauma-focused cognitive behavioral therapy (TF-CBT). Animal-assisted therapy (AAT) has been proposed as an adjunct to TF-CBT for improving emotion regulation following maltreatment. The current study reports findings from a randomized controlled feasibility trial (<i>N</i> = 33; <i>M</i><sub>age</sub> = 11.79 years, <i>SD</i> = 3.08; 63.6% White; 66.7% female) that measured youths’ resting RSA, RSA reactivity, and RSA recovery in response to a pretreatment laboratory challenge. We tested whether (a) lower pretreatment resting RSA was associated with blunted RSA during the challenge; (b) either of the pretreatment RSA dimensions predicted more severe pretreatment PTSD symptoms; and (c) either of the pretreatment RSA dimensions predicted less severe posttreatment PTSD symptoms and, as an exploratory aim, whether this was moderated by treatment group (i.e., TF-CBT vs. TF-CBT + AAT). Results from multiple linear regression indicated that, after controlling for pretreatment symptom severity, there was a large effect size for higher resting RSA predicting less severe caregiver-reported posttreatment PTSD symptoms, β = −.52, <i>p</i> = .058, and higher RSA during recovery predicting less severe child-reported posttreatment PTSD symptoms, β = −.70, <i>p</i> = .056, although these findings were not significant. These preliminary results offer important insights for future studies to investigate how the ability to regulate RSA informs which children need additional support to benefit from psychotherapeutic treatment.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":"37 6","pages":"850-863"},"PeriodicalIF":2.4,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shira Maguen, Brandon J. Griffin, Robert H. Pietrzak, Carmen P. McLean, Jessica L. Hamblen, Sonya B. Norman
{"title":"Using the Moral Injury and Distress Scale to identify clinically meaningful moral injury","authors":"Shira Maguen, Brandon J. Griffin, Robert H. Pietrzak, Carmen P. McLean, Jessica L. Hamblen, Sonya B. Norman","doi":"10.1002/jts.23050","DOIUrl":"10.1002/jts.23050","url":null,"abstract":"<p>Despite the proliferation of moral injury studies, a remaining gap is distinguishing moral injury from normative distress following exposure to potentially morally injurious events (PMIEs). Our goal was to leverage mental health and functional measures to identify clinically meaningful and functionally impairing moral injury using the Moral Injury and Distress Scale (MIDS). Participants who endorsed PMIE exposure (<i>N</i> = 645) were drawn from a population-based sample of military veterans, health care workers, and first responders. Using signal detection methods, we identified the optimally efficient MIDS score for detecting clinically significant posttraumatic stress and depressive symptom severity, trauma-related guilt, and functional impairment. The most efficient cut scores across outcomes converged between 24 and 27. We recommend a cut score of 27 given that roughly 70% of participants who screened positive on the MIDS at this threshold reported clinically significant mental health symptoms, and approximately 50% reported severe trauma-related guilt and/or functional impairment. Overall, 10.2% of respondents exposed to a PMIE screened positive for moral injury at this threshold, particularly those who identified as a member of a minoritized racial or ethnic group (17.9%) relative to those who identified as White, non-Hispanic (8.0%), a<i>OR</i> = 2.52, 95% CI [1.45, 4.42]. This is the first known study to establish a cut score indicative of clinically meaningful and impairing moral injury. Such scores may enhance clinicians’ abilities to conduct measurement-based moral injury care by enabling them to identify individuals at risk of negative outcomes and better understand risk and protective factors for moral injury.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":"37 4","pages":"685-696"},"PeriodicalIF":2.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"State of the Science: Prolonged exposure therapy for the treatment of posttraumatic stress disorder","authors":"Carmen P. McLean, Edna B. Foa","doi":"10.1002/jts.23046","DOIUrl":"10.1002/jts.23046","url":null,"abstract":"<p>Prolonged exposure therapy (PE) is a well-established first-line treatment for posttraumatic stress disorder (PTSD) that is based on emotional processing theory. PE has been rigorously evaluated and tested in a large number of clinical trials in many countries covering a wide range of trauma populations. In this review, we summarize the evidence base supporting the efficacy of PE across populations, including adults with sexual assault–related PTSD and mixed trauma–related PTSD, military populations, and adolescents. We highlight important strengths and gaps in the research on PE with individuals from marginalized communities. We discuss the efficacy of PE on associated psychopathology and in the presence of the most commonly comorbid conditions, either alone or integrated with other treatments. In addition, we provide an overview of research examining strategies to augment PE. Much of this work remains preliminary, but numerous trials have tested PE in combination with other psychological or pharmacological approaches, interventions to facilitate extinction learning, and behavioral approaches, in the hopes of further increasing the efficiency and efficacy of PE. There are now several trials testing PE in novel formats that may have advantages over standard in-person PE, such as lower dropout and increased scalability. We examine this recent work on new models of delivering PE, including massed treatment, telehealth, and brief adaptations for primary care, all of which have the potential to increase access to PE. Finally, we highlight several promising areas for future research.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":"37 4","pages":"535-550"},"PeriodicalIF":2.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The contributions of social network support and reciprocity to posttraumatic stress symptoms across time among parents and caregivers impacted by the ABC Day Care Center fire in Hermosillo, Mexico","authors":"Austin Arceneaux, Eric C. Jones, Arthur D. Murphy","doi":"10.1002/jts.23041","DOIUrl":"10.1002/jts.23041","url":null,"abstract":"<p>In 2009, a fire occurred in the ABC Day Care Center in Hermosillo, Mexico, that killed and injured many children who were in attendance that day. This study investigated the association between the posttraumatic stress symptoms (PTSS) of socially connected parents and caregivers whose children were affected by the fire. Parents and caregivers of the children who were in attendance the day of the fire were interviewed 8–11 months and 20–23 months postfire. Linear network autocorrelation modeling was used to test for autocorrelations of the outcome variable count of PTSS within different configurations of the network of caregivers. No significant network effects appeared in models from the first interview period, but effects did appear in the second period, specifically in the three models in which network ties consisted of “receive informational support” (.220), “give and receive emotional support” (.167), and “give and receive both informational and emotional support” (.213). The findings suggest that in these three network configurations, as relationships grew in strength from the first interview to the second, the level of one's own PTSS was more comparable to the level of PTSS of one's social connections. Two theoretical mechanisms that may explain this result are homophily and social influence.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":"37 4","pages":"631-642"},"PeriodicalIF":2.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}