Ethics and EconomicsPub Date : 2020-09-07DOI: 10.1183/13993003.congress-2020.2739
S. Schließmann, S. Rödig
{"title":"Late Breaking Abstract - Consultation difficulties and service shortages of medicinal products used by home ventilated patients have been already detected during the first two weeks of social distancing and pandemic’s quarantine","authors":"S. Schließmann, S. Rödig","doi":"10.1183/13993003.congress-2020.2739","DOIUrl":"https://doi.org/10.1183/13993003.congress-2020.2739","url":null,"abstract":"450 adult individuals for this study provided feedback via an anonymous online questionnaire The research has been approved by the local ethics committee (#MS01/2020) To reach isolated people in quarantine and in self-isolation at home, too, participants for the survey were recruited online through social media The posts were placed on public social media pages and in non-public group sites For the investigation of consultation difficulties and service shortages for medicinal product we included using of any kind of medicinal product following the German Medicinal Product Act (MPG) by patients with mechanical ventilation in a home setting (31 ;14 after quarantine or isolation) Pandemic related difficulties in problem-solving home ventilated patients have already been identified in the first two weeks of contact restrictions, isolation or quarantine Non-user-solvable device problems encountered systemic difficulties in isolation A replacement cable could not be prescribed due the isolation;after a turbine failure, the device could not be replaced because the supplier's replacement devices had to be returned for new home ventilation stations Several hygiene deficiencies have been reported, caused by the lack of disinfectant or ventilation tubes In individual cases, material had to be used beyond the recommended maximum service life First detected bottlenecks during the initial two weeks of social distancing in Germany require more medicinal product related help for patients' safety in quarantine","PeriodicalId":243267,"journal":{"name":"Ethics and Economics","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129800917","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}
Ethics and EconomicsPub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1968
B. Szentes, L. Schwarzkopf, M. Schuler, N. Lehbert, D. Nowak, M. Wittmann, H. Faller, K. Schultz
{"title":"How does EQ-5D-5L perform in asthma patients?","authors":"B. Szentes, L. Schwarzkopf, M. Schuler, N. Lehbert, D. Nowak, M. Wittmann, H. Faller, K. Schultz","doi":"10.1183/13993003.congress-2019.pa1968","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1968","url":null,"abstract":"Background: EQ-5D-5L is a widely used generic health related quality of life (HRQL) tool, for evaluating interventions. Its performance in asthma patients has been sparsely investigated. Methods: We used data from 371 patients participating in the EPRA randomized controlled trial with waiting group design for pulmonary rehabilitation (PR). We assessed the EQ-5D and the visual analogue scale (VAS) at randomization (T0), at start (T1) and end of PR (T2), and three months post PR (T3). We calculated floor and ceiling effects (T0, T1, T2, T3), intraclass correlation (ICC) (T0-T1) and responsiveness to changes measured with the asthma control test (ACT) (T0-T1, T1-T2, T2-T3) through regression analysis. Our outcome variable was HRQL change adjusted for change on ACT (minimally important difference=3) in 5 categories (ACT change ≥3, 0 ACT change> -3, ACT change ≤ - 3), age, sex, BMI, smoking status, group, employed before PR (yes/no) and previous HRQL. Results: EQ-5D showed no floor effects but ceiling effects at T2 and T3 (32%) whereas VAS showed none of them. ICC was 0.85 for VAS and 0.82 for EQ-5D. EQ-5D was not responsible to changes in any of the waves. VAS detected ACT-changes bigger equal |MID| (T1: Δ VAS 5.67 (p=0.01) vs -7.05 (p=0.05), T2: Δ VAS 5.83 (p=0.02) vs -7.77 (p=0.01) and T3: Δ VAS 5.96 (p=0.01) vs -8.97 (p Discussion: EQ-5D showed good reliability but unsatisfactory responsiveness to changes. This could be an issue for the health economic evaluation of interventions. Considering an additional domain or using additional outcome variables (e.g. VAS) might mitigate the problem.","PeriodicalId":243267,"journal":{"name":"Ethics and Economics","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131659478","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}
Ethics and EconomicsPub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1971
H. Cherif, S. Hantous, M. Attia, M. Affes, H. Neji, I. Baccouche, K. B. Miled
{"title":"Cost Calculations of CT guided biopsy of lung lesions in an emergent country","authors":"H. Cherif, S. Hantous, M. Attia, M. Affes, H. Neji, I. Baccouche, K. B. Miled","doi":"10.1183/13993003.congress-2019.pa1971","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1971","url":null,"abstract":"A correct understanding of the true costs of a procedure is necessary to make informed decisions in cost-effectiveness analyses. The actual comprehensive costs of performing CT guided biopsy of lung lesions (CTGLB) were analyzed. Methods: Costs included labor, equipment, administration, facility establishment and maintenance, overhead, and consumable supplies. Cost identification was performed with use of an hourly rate that reflected the labor cost of CTGLB. The costs of the consumable supplies used during the procedure were calculated. From august to December 2018, 65 CTGLB were studied in 61 consecutive patients to determine mean procedure duration and supplies consumption. Variable costs include consumable supplies and salaries of the personnel involved in the procedures. Fixed direct costs include the purchase, depreciation, maintenance, and repair costs of the CT scanner and other related equipment. The indirect costs which include transfer and overhead costs were not calculated due to the absence of an analytical accounting of the hospital. Costs were calculated in Tunisian Dinars (TND) then converted into dollars: 1$=3TND Results: the average duration of the procedure was estimated at 30 minutes. Total inclusive direct cost of labor was 8 $ per procedure (Radiologist, resident, Radiology nurse, Technologist). Average cost by procedure, including consumable supplies was 45 $ . Fixed direct cost was 33 $ per CTGLB (depreciation 18$, maintenance and repair costs 10$). The average direct cost of a CTGLB was 86 $. Conclusion: The average direct cost of CTGLB was established, showing that the cost remains very low under our skies. This is due mostly to underpayment of hospital medical staff in our country","PeriodicalId":243267,"journal":{"name":"Ethics and Economics","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124013618","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}
Ethics and EconomicsPub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1966
D. Yi, Anna Johnston, Evelyne Burssens, M. Teixeira, W. Gao, C. Reilly, I. Higginson
{"title":"Where and by whom do patients want to be cared for: Preferences for the Breathlessness Support Service in England?","authors":"D. Yi, Anna Johnston, Evelyne Burssens, M. Teixeira, W. Gao, C. Reilly, I. Higginson","doi":"10.1183/13993003.congress-2019.pa1966","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1966","url":null,"abstract":"Background: Chronic breathlessness is associated with reduced health related quality of life and high service utilisation. Breathlessness Support Service (BSS), combining palliative and respiratory medicine, was developed to address the unmet needs of patients with chronic breathlessness. Aims: To identify factors of BSS valued by potential users (older patients (65≥) and families) and suggest models of BSS to be prioritised. Method: Face to face interviews among patients with COPD, lung cancer or interstitial lung disease, and carers. Discrete choice experiment attributes were determined from literature, expert consultation and interviews. Regression was used to analyse the data and free text answers to open-ended questions were thematically analysed. Results: 6 attributes (consultation; review; additional support; expectation for mobility & health service use; waiting time) were identified. There were 190 patients and 68 carers from 9 sites in England. Any BSS was preferred to no service. BSS with a consultant was preferred but BSS with a GP or nurse at GP clinic was not. Expectation for mobility or health service use was not important but review of medicinal treatments and waiting time was. Carers preferred additional support and patients preferred a consultant. GPs were thought to lack breathlessness specialism. GP surgery was avoided by some patients due to infection risk. Conclusion: Older patients and carers want services provided by consultant, review of medicinal treatments, home visit by a therapist and support from a social worker. GP’s role in caring for this population needs reconsidering. BSS based on user’s preferences will improve acceptance and outcomes.","PeriodicalId":243267,"journal":{"name":"Ethics and Economics","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123450000","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}
Ethics and EconomicsPub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1975
M. Bourne, S. Parker, S. Terry, R. Free
{"title":"The impact of a new recruitment strategy to improve recruitment of participants to research studies","authors":"M. Bourne, S. Parker, S. Terry, R. Free","doi":"10.1183/13993003.congress-2019.pa1975","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1975","url":null,"abstract":"Introduction and Background: Historically, respiratory research recruitment in Leicester has been inefficient; driven manually through clinics, word-of-mouth, advertisements and participant lists. To improve this, we implemented a new recruitment strategy, in line with local and national guidelines. Aims and Objectives: To determine how a new recruitment strategy affected patient recruitment in a respiratory research group. Methods: A recruitment strategy was created requiring patient consent, followed by entry of basic clinical details onto an ethically approved recruitment database. Staff training was provided and weekly recruitment meetings held. Data analysis was undertaken using qualitative staff and nurse surveys, and data/access logs recorded in the recruitment database. Results: Our analysis indicated that the new strategy and database streamlined the recruitment process. Not only by creating a steadily increasing pool of patients available for contact (Figure 1), but saving nurse time and allowing nurses to record/access clinical research data to confirm eligibility for studies. Additionally, it prevented patient re-contact and enabled more targeted recruitment. Conclusion: The implementation of a new strategy underpinned by an ethically approved recruitment database has become central to recruitment and identification of potentially eligible research participants.","PeriodicalId":243267,"journal":{"name":"Ethics and Economics","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124431034","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}
Ethics and EconomicsPub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1967
J. Londhe, K. Mudliar, K. Powar, N. Dhadge, S. Gaikwad, Mahavir Modi, B. Pawar, M. Bargaje, Gauri Godbole, P. Khatavkar, Yogesh Agrawal, H. Pophale, Y. Badhe, S. Toke, S. Madas, S. Salvi
{"title":"Direct and indirect costs of COPD treatment in Pune city, India","authors":"J. Londhe, K. Mudliar, K. Powar, N. Dhadge, S. Gaikwad, Mahavir Modi, B. Pawar, M. Bargaje, Gauri Godbole, P. Khatavkar, Yogesh Agrawal, H. Pophale, Y. Badhe, S. Toke, S. Madas, S. Salvi","doi":"10.1183/13993003.congress-2019.pa1967","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1967","url":null,"abstract":"COPD is the 2nd leading cause of deaths and DALYs in India and likely contributes to a huge economic burden. Most health care expenditure in India is out-of-pocket and little is contributed by the government and medical insurance. In this study, we aimed to examine out-of-pocket expenditure for patients of COPD visiting government, semi-private and private hospitals/clinics. Methods: 239 doctor diagnosed and spirometry confirmed (168 Males, Mean age 66.9 ± 8.9 years) mild-to-very severe COPD patients (8 mild, 76 moderate, 130 severe-very severe) on medications for at least one year were recruited from different hospital settings. One year expenditure was calculated retrospectively which included direct costs (physician consultation, Investigations, drugs and hospitalization costs) and indirect costs (travel, work days lost and professional caretaker cost) were captured using a detailed questionnaire. Results: The annual mean out-of-pocket expenditure for patients visiting government hospital was Indian Rupees (INR) 11835.85 ± 10799.64, Semi-private hospitals was INR 44003.02 ± 54146.75, private hospitals & clinics was INR 50805.24 ± 172916.43 (Fig). 49.3% of the out-of-pocket expenditure was accounted for by hospitalization cost. Conclusion: Out-of-pocket expenditure for COPD in India is very high and is largely driven by hospitalisaiton costs and drug costs.","PeriodicalId":243267,"journal":{"name":"Ethics and Economics","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115372625","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":"Late Breaking Abstract - Economics burden and healthcare utilization in chronic obstructive pulmonary disease patients with or without sepsis","authors":"Yu-Mu Chen, Hsuan-Feng Wu, Wen-Feng Fang, Hung-Chen Chen, Chiung-Yu Lin, Meng-Chih Lin","doi":"10.1183/13993003.congress-2019.pa1965","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1965","url":null,"abstract":"Background: Although sepsis has prognostic implications to patients with chronic obstructive pulmonary disease (COPD), its economics burden, healthcare utilization remains uncertain. We conducted a population-level study to answer these questions. Methods: We excerpted data relevant to sepsis (ICD-9 coding 995.91, 995.92) from 609,281 patients with COPD (ICD-9 coding 491, 492, 496) and registered by the Taiwan National Health Insurance Administration System between 2010 and 2015. Propensity-score matching was applied to balance the age and gender between patients with or without sepsis. Results: Among them, 13.4%(81,466/609,281) of the COPD patients had been suffered from sepsis. Patients who suffered from sepsis were more likely to have hypertension (64.8% vs. 60.2%, P Conclusions: COPD patients who encountered sepsis were associated with higher economics burden and healthcare utilization.","PeriodicalId":243267,"journal":{"name":"Ethics and Economics","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130787656","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}
Ethics and EconomicsPub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1973
Beatriz Morales Chacón, G. V. Centanaro, I. A. García, María Teresa Río Ramírez, N. Santamaría, A. G. Velando, M. Patrón, B. Steen
{"title":"Quality indicators in pleural pathology. Pre and post publication study","authors":"Beatriz Morales Chacón, G. V. Centanaro, I. A. García, María Teresa Río Ramírez, N. Santamaría, A. G. Velando, M. Patrón, B. Steen","doi":"10.1183/13993003.congress-2019.pa1973","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1973","url":null,"abstract":"Introduction: Neumomadrid published in March 2017 the guide of quality indicators in respiratory diseases. Objective: To measure the level of compliance of two quality indicators in pleural pathology before and after this publication and to know if the elaboration of the guide has influenced our usual clinical practice. The chosen indicators are presence of informed consent in thoracentesis (TIC) and in transthoracic needle biopsy (TTNBIC). Material and Methods: Retrospective study carried out in 6 hospitals of the Community of Madrid. All thoracocentesis (T) and transthoracic needle biopsy (TTNB) performed by the Pneumology Service between 1/12/2016 to 28/02/2017 (before guide´s publication) and from 1/12/2017 to 28/02/2018 (after one) were selected. Exclusion criteria: patients 90% of the CR. Subsequently both results were compared. Statistic analysis by Stata v.12 (Pearson chi2 and Fisher’s exact). Results: are showen in tables and figures. Conclusions: The publication has not improved our level of compliance. To improve these results proactive measures should be established such as homogenizing and simplifying IC.","PeriodicalId":243267,"journal":{"name":"Ethics and Economics","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129617030","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}
Ethics and EconomicsPub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1974
A. Bragantini, G. Passalacqua, D. Bagnasco
{"title":"A phone call shortens waiting list. Interventions to reduce waiting lists and improve the performance of a pneumological clinic","authors":"A. Bragantini, G. Passalacqua, D. Bagnasco","doi":"10.1183/13993003.congress-2019.pa1974","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1974","url":null,"abstract":"Background: Missed appointments in medical clinics are one of the most relevant factors that increase the waiting lists. This is reflected in an increase in the waiting time for visits, being not only a disservice to citizens but also an economic loss for the hospital. With this trial we wanted to evaluate the effectiveness of a phone call as a tool to remind an already fixed appointment. Methods: From February the 1st 2016 to January the 31st 2017 the nursing staff of the respiratory physiopathology clinic has daily contacted patients who had a spirometry planned in the following days to remind them of the appointment. Results: In comparison to the previous year, a 14.2% increase in appointments has been observed, for a total amount of 4916 visits (p Conclusions: With this trial we wanted to highlight the importance of patient involvement in the path towards his diagnosis, making him feel at the center of a project of care. The choice of the phone call turned out to be crucial as a direct communication tool which makes patients feel the support of healthcare and the involvement in a project. This method has therefore reached three goals: reducing missed appointments, improving service to patients and increasing the profits of the clinic.","PeriodicalId":243267,"journal":{"name":"Ethics and Economics","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129769849","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}
Ethics and EconomicsPub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1964
J. FitzGerald, S. Arnetorp, C. Smare, D. Gibson, K. Coulton, K. Hounsell, M. Sadatsafavi
{"title":"Late Breaking Abstract - Cost effectiveness of as-needed budesonide/formoterol vs low-dose ICS maintenance therapy in mild asthma patients: A UK perspective","authors":"J. FitzGerald, S. Arnetorp, C. Smare, D. Gibson, K. Coulton, K. Hounsell, M. Sadatsafavi","doi":"10.1183/13993003.congress-2019.pa1964","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1964","url":null,"abstract":"Objective: To estimate the cost-effectiveness of as-needed budesonide/formoterol (BUD/F; Symbicort® Turbuhaler®) vs daily low-dose inhaled budesonide (BUD) + short-acting s2-agonist (SABA) as reliever in mild asthma patients for whom low-dose ICS maintenance therapy is appropriate. Methods: This analysis was based on SYGMA 2 (NCT02224157), a 52-week, double-blind trial of patients aged ≥12 years with mild asthma, using a Markov model (weekly cycles) and a UK healthcare (lifetime) perspective. Comparisons were as-needed BUD/F 200/6µg or BUD 200µg twice daily (bid) + terbutaline 0.5mg as needed. Health states in the model were exacerbation (≥3 days of oral steroid alone or combined with hospitalisation and/or ER visit), death and non-exacerbation. Quality adjusted life years (QALY) gained was based on EQ-5D-5L (mapped to 3L). Extrapolation was based on UK published literature and cost estimates were based on NHS unit cost values (£). Probabilistic results are presented to control for parameter uncertainty. Results: Over a patient’s lifetime, as-needed BUD/F was dominant with a small cost saving of £290/patient and marginal QALY gains of 0.0011; key drivers were lower total medication cost (0.52 vs. 2 inhalations/day) and lower exacerbation rate (0.11 vs 0.12) with as-needed BUD/F vs daily BUD, respectively. Cost-effectiveness acceptability curve showed that, across a wide range of willingness to pay for QALY (including £20,000/QALY threshold), likelihood of as-needed BUD/F being cost-effective vs daily BUD therapy + SABA was >90%. Conclusion: From a UK perspective, as-needed BUD/F offers an economic benefit for the treatment of patients with mild asthma.","PeriodicalId":243267,"journal":{"name":"Ethics and Economics","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132054420","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}