Infection Prevention in Practice最新文献

{"title":"Investigation of relative humidity distribution and its impact on disinfection using a combination of robotic fogger and hydrogen peroxide","authors":"Prasanna Kumar Sistla,&nbsp;P. Kanaka Raju","doi":"10.1016/j.infpip.2025.100452","DOIUrl":"10.1016/j.infpip.2025.100452","url":null,"abstract":"<div><h3>Background</h3><div>Relative humidity is a key factor in the disinfection process.</div></div><div><h3>Aim</h3><div>To examine the distribution of relative humidity, and the time required to reach its mean value in the target area when using a robotic fogger with 7.4% hydrogen peroxide.</div></div><div><h3>Methods</h3><div>The study evaluated the device in both stationary and mobile operation modes. In each mode, relative humidity sensors, along with chemical, biological, and enzyme indicators, were employed to assess the disinfection's effectiveness and consistency.</div></div><div><h3>Results</h3><div>The device dispersed disinfectant at a rate of 30 mL/min over 45 min in both modes. A shorter time to reach the mean relative humidity is desirable for effective disinfection. It was observed that the mobile mode reached the mean relative humidity 50% faster, maintained this level for an additional 30 min, and achieved an 11% higher relative humidity compared to the stationary mode.</div></div><div><h3>Conclusion</h3><div>These advancements could assist pharmaceutical manufacturing and healthcare facilities in minimizing downtime during periodic disinfection.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 2","pages":"Article 100452"},"PeriodicalIF":1.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of a patient empowerment hand hygiene programme: a single-centre study in Japan","authors":"Yusuke Watanabe ,&nbsp;Asami Okugawa ,&nbsp;Hiroshi Soeda ,&nbsp;Tomohide Shimodaira ,&nbsp;Satoko Sato ,&nbsp;Hiroaki Fujita ,&nbsp;Takehito Kobayashi ,&nbsp;Itaru Nakamura ,&nbsp;Hidehiro Watanabe","doi":"10.1016/j.infpip.2025.100456","DOIUrl":"10.1016/j.infpip.2025.100456","url":null,"abstract":"<div><div>The effectiveness of patient participation in hand hygiene (HH) programmes in Japan is unclear. This study examines the effect of a patient empowerment HH programme at a Japanese hospital. Two periods were analysed: January 2020 to November 2020 as the baseline, and December 2020 to April 2021 as the intervention period. The intervention involved inpatients observing the HH practices of healthcare workers. The average number of HH events per patient-day increased from 23.4 at baseline to 37.3 during the intervention. HH events were positively correlated with the number of patient observations. Patient empowerment programmes may therefore help to improve HH.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 2","pages":"Article 100456"},"PeriodicalIF":1.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to hand hygiene practice among healthcare workers in health centres of Kirkos and Akaki Kality sub-cities, Addis Ababa, Ethiopia: a qualitative study","authors":"Asmamaw Deguale Worku ,&nbsp;Abayneh Melaku","doi":"10.1016/j.infpip.2025.100450","DOIUrl":"10.1016/j.infpip.2025.100450","url":null,"abstract":"<div><h3>Background</h3><div>Hand hygiene is an easy step to reduce healthcare-acquired infections, and improve patient safety. Major progress in facility accessibility was made during the coronavirus disease 2019 (COVID-19) pandemic, and this led to greater adherence to hand hygiene practices. However, handwashing practices have now returned to the pre-COVID-19 era. Most of the studies that have investigated hand hygiene adherence are quantitative. As such, this study aimed to explore barriers to hand hygiene practice in the health centres of Kirkos and Akaki Kality sub-cities in Addis Ababa, Ethiopia.</div></div><div><h3>Methods</h3><div>Twenty-four healthcare professionals employed at the aforementioned health centres were interviewed using the key informant interview method. Data were analysed using a qualitative content analysis technique.</div></div><div><h3>Results</h3><div>Based on the findings, there were three main categories of barriers to hand hygiene practice: barriers related to individuals (including three sub-categories: lack of knowledge and skill, improper attitude, and poor attention and negligence of healthcare workers); leadership barriers (including two sub-categories: lack of dedicated staff and low attention of leaders); and institutional barriers (including three sub-categories: inappropriate infrastructure and lack of resources, shortage of water, and high work load and staff turnover).</div></div><div><h3>Conclusion</h3><div>There were several reasons why hand hygiene guidance was not followed. Hand hygiene barriers can be minimized by displaying colour-coded notice boards, making washing facilities easily accessible, monitoring the availability of soap, offering training, and providing accurate evidence about the need to enhance hand hygiene.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 2","pages":"Article 100450"},"PeriodicalIF":1.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Methicillin-Resistant Staphylococcus aureus (MRSA) knowledge and awareness among healthcare workers in South-Lebanon","authors":"Ali El Roz ,&nbsp;Taghrid Chaaban ,&nbsp;Hawraa Issa ,&nbsp;José-Noel Ibrahim ,&nbsp;Zeinab Ezzeddine ,&nbsp;Ghassan Ghssein","doi":"10.1016/j.infpip.2025.100451","DOIUrl":"10.1016/j.infpip.2025.100451","url":null,"abstract":"<div><h3>Background</h3><div>Methicillin-Resistant <em>Staphylococcus aureus</em> (MRSA) is a well-known cause of hospital acquired infections (HAIs), associated with high rates of morbidity and mortality. In healthcare settings, MRSA can spread via contaminated surfaces and direct contact.</div></div><div><h3>Objective</h3><div>This study aims to assess the knowledge and awareness of MRSA risks, prevention methods (such as hand hygiene), proper antibiotics use, and multidrug resistance among various groups of healthcare workers (HCWs) in Southern Lebanon.</div></div><div><h3>Methods</h3><div>A total of 244 HCWs, including those in medical services (MS), paramedical services (PS), and non-medical services (NMS), were conveniently selected for this study. Data was gathered using a structured, validated questionnaire that explored their knowledge and awareness of MRSA risks, prevention measures, hand hygiene practices, and multidrug resistance.</div></div><div><h3>Results</h3><div>The findings revealed that 68% of HCWs were aware of the origin of MRSA infection, and 61.5% and 51.6% were familiar with its treatment and transmission, respectively. Only 24.2% of HCWs were able to differentiate between hospital-acquired and community-acquired MRSA, 14.7% were aware of the institution's written MRSA control protocols, and 17.6% had heard of MRSA infections. Notably, knowledge and hand hygiene practices were significantly better among MS HCWs than PS and NMS groups (<em>P</em>&lt;0.0001). While all HCWs were familiar with antibiotic usage and drug resistance, NMS HCWs were more likely to use antibiotics without a prescription compared to MS and PS groups (<em>P</em>&lt;0.003).</div></div><div><h3>Conclusion</h3><div>HCWs in South-Lebanon demonstrated a knowledge gap regarding MRSA risks and prevention guidelines. These findings underscore the need for targeted educational intervention on MRSA, as well as coordinated efforts by healthcare authorities and centres to control MRSA infections.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 2","pages":"Article 100451"},"PeriodicalIF":1.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compliance with infection control practices among healthcare workers in radiology departments: a participant observation study and adenosine triphosphate assay evaluation of environmental cleanliness","authors":"Leonia Hiu Wan Lau ,&nbsp;Fion Wai Fong Tse ,&nbsp;Lorna Kwai Ping Suen ,&nbsp;Simon Ching Lam","doi":"10.1016/j.infpip.2025.100441","DOIUrl":"10.1016/j.infpip.2025.100441","url":null,"abstract":"<div><h3>Background</h3><div>Increased risk of healthcare-associated infections (HAIs) in radiology departments has been reported in recent years. Optimal infection control practices (ICPs) are the key to controlling HAIs, but few studies have investigated the ICP compliance of healthcare workers (HCWs) in radiology departments.</div></div><div><h3>Aim</h3><div>To assess the level of ICP compliance of HCWs in a radiology department.</div></div><div><h3>Methods</h3><div>A participant observation supplemented with adenosine triphosphate (ATP) bioluminescence assay evaluation of environmental cleanliness was conducted. More than 1000 hand hygiene (HH) opportunities and 960 opportunities for the other core ICP elements were observed in different study units of a radiology department. An online checklist powered by eRub was used to record the HCWs' ICP performance. A total of 125 environmental samples were collected for ATP assay evaluation.</div></div><div><h3>Results</h3><div>In the participants observation, the overall performance score was 41.4%. The lowest score was found in HH (10.4%), followed by use of personal protective equipment (29.4%) and gloves (68.2%). The HH performance was significantly associated with study units (χ² = 42.55, <em>P</em> &lt; 0.001), professional groups (χ² = 110.21, <em>P</em> &lt; 0.001), and patient-to-staff ratio (<em>F</em> = 8.76, <em>P</em> &lt; 0.001). With relative light units of ≤250 set as a pass benchmark, less than two-thirds of the environmental samples passed the ATP assay.</div></div><div><h3>Conclusion</h3><div>The overall ICP compliance among the HCWs in the radiology department was suboptimal. Revisions of current ICP guidelines and policies that are tailored to the setting-specific needs and barriers in radiology departments is necessary.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 2","pages":"Article 100441"},"PeriodicalIF":1.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and impact of a structured training module for surgical painting and draping among interns","authors":"Tharun Ganapathy Chitrambalam ,&nbsp;Abinayaah Suresh ,&nbsp;Nidhi Mariam George ,&nbsp;Sharmila Aristotle","doi":"10.1016/j.infpip.2025.100439","DOIUrl":"10.1016/j.infpip.2025.100439","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infections (SSIs) are a global concern affecting patient recovery, prolonging hospital stay and raising healthcare costs.</div></div><div><h3>Aim</h3><div>To address this, a structured training module was implemented to enhance the efficacy of surgical painting and draping among the interns, reducing SSI risk.</div></div><div><h3>Methods</h3><div>A questionnaire was distributed to 194 interns, covering fundamental inquiries on SSIs, aseptic practices and an assessment of the participant's knowledge regarding preoperative skin preparation and draping. Students then attended lectures, demonstrations, hands-on sessions and an operating room workshop dedicated to surgical painting and draping techniques. Proficiency was evaluated through a follow-up questionnaire.</div></div><div><h3>Results</h3><div>There was a significant increase in the percentage of good score from 27.6% to 86.9%. A comparative analysis of surgical site infection (SSI) rates at our institution was performed before and after integrating a cohort of trained clinicians.</div></div><div><h3>Conclusion</h3><div>Although a significant reduction in SSI rates was observed, it cannot be definitively attributed solely to the introduction of the trained personnel. Nonetheless, the findings underscore the potential impact of rigorous training in aseptic techniques on reducing SSI incidence.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 2","pages":"Article 100439"},"PeriodicalIF":1.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of disposable pull-through brush types for reprocessing of flexible endoscopes in clinical environment","authors":"Remus O. Anders ,&nbsp;Adriana M. Airo ,&nbsp;Eve Capistran ,&nbsp;Anita Chin ,&nbsp;Garry Bassi ,&nbsp;Tony Mazzulli","doi":"10.1016/j.infpip.2025.100445","DOIUrl":"10.1016/j.infpip.2025.100445","url":null,"abstract":"<div><div>Evaluating the effectiveness of different brush types used during the cleaning and reprocessing of flexible endoscopes is challenging. This study compared the yield of microbial growth from endoscopes that had been used clinically before and after cleaning with different brush types (bristle, squeegee, and hybrid). Endoscopes used to perform a total of 91 medical procedures on 82 patients were included. Quantitative bacterial cultures yielded no statistical differences between the different brushes used. Colonoscopes and gastroscopes surveyed after rigorous cleaning steps resulted in a drop in colony counts between pre- and post-cleaning from 1.45E+8 (±5.21E+07) to 2.5 (±0.13) individual colonies suggesting that the overall cleaning process was effective regardless of the brush type used.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100445"},"PeriodicalIF":1.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143200033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection control Surveillance of dialysis events at outpatient hemodialysis centers in Saudi Arabia: A 3-year national data","authors":"Mohammed ALQahtani ,&nbsp;Aiman El-Saed ,&nbsp;Faisal Alsheddi ,&nbsp;Ahlam H. Alamri ,&nbsp;Atef M. Shibl ,&nbsp;Khalid H. Alanazi","doi":"10.1016/j.infpip.2025.100447","DOIUrl":"10.1016/j.infpip.2025.100447","url":null,"abstract":"<div><h3>Background</h3><div>Monitoring dialysis events is very important in evaluating the risk of infection and antimicrobial use among this group of vulnerable patients. The objective was to calculate rates of dialysis events at outpatient hemodialysis centers in Saudi Arabia.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of dialysis events collected from 152 outpatient hemodialysis centers in 20 Saudi regions between January 2019 and December 2021. The Saudi Health Electronic System Network (HESN) was used to report data from participating centers. Dialysis events included in-unit intravenous antimicrobial start, positive blood culture, and infection (pus, redness, and swelling) at the vascular access site.</div></div><div><h3>Results</h3><div>A total of 125,761 patient months of surveillance were monitored. The most frequent type of dialysis event was the in-unit intravenous antimicrobial start at 0.75 per 100 patient months, followed by positive blood culture at 0.41, and finally, local access of the infection site at 0.34. The rates of dialysis events were highest, with temporary central lines at 4.36, permanent central lines at 1.87, arteriovenous graft at 0.35, and finally, arteriovenous fistula at 0.17. After adjusting for the differences in the type of vascular access, the rates of dialysis events in the Saudi HESN were lower, 54%–83%, than those of the American National Healthcare Safety Network (NHSN, <em>P</em>&lt;0.001 for each) and a less extent 27%–55% lower when compared with the published results from Chinese people.</div></div><div><h3>Conclusions</h3><div>The current findings provide benchmarking data for different dialysis events that can promote fair comparisons and interest in dialysis event surveillance.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100447"},"PeriodicalIF":1.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium dichloroisocyanurate: a promising candidate for the disinfection of resilient drain biofilm","authors":"Abbie Martin ,&nbsp;Natasha Doyle ,&nbsp;Tom F. O'Mahony","doi":"10.1016/j.infpip.2025.100446","DOIUrl":"10.1016/j.infpip.2025.100446","url":null,"abstract":"<div><h3>Background</h3><div>Biofilms are complex multicellular communities of microorganisms embedded within a protective matrix which confers resistance to various antimicrobials, including biocides. Biofilms can cause a range of human diseases and are responsible for 1.7 million hospital-acquired infections in the US annually, providing an economic burden of $11.5 billion in treatment costs. Biofilm contained within drain and plumbing systems may contain pathogenic viruses and bacteria which pose a significant risk to patient safety within healthcare environments.</div></div><div><h3>Aim</h3><div>The aim of this study was to determine if three hospital-grade disinfectants (sodium dichloroisocyanurate, peracetic acid and sodium hypochlorite) were capable of killing microorganisms within biofilm, and thus, determining their potential as candidates for drain biofilm disinfection.</div></div><div><h3>Methods</h3><div><em>Pseudomonas aeruginosa</em> biofilms were cultivated using the CDC biofilm reactor, a standardised method for determining disinfectant efficacy against biofilm within the United States of America. Each disinfectant was tested using a one-minute contact time, using the highest concentration available on the product label.</div></div><div><h3>Findings</h3><div>The sodium dichloroisocyanurate product was successful in killing biofilm microorganisms, resulting in a log reduction of ≥ 8.70. Peracetic acid reduced biofilm by 3.82 log₁₀ units, followed by sodium hypochlorite, which produced a reduction of 3.78 log₁₀ units.</div></div><div><h3>Conclusions</h3><div>The use of a highly effective disinfectant with proven biofilm efficacy can help ensure patient safety and reduce infection levels. Drains and plumbing systems provide a reservoir for potential pathogens and biofilm; thus, drain disinfection is critical in reducing the instance of hospital-acquired infections. Sodium dichloroisocyanurate may provide a reliable solution for drain applications and subsequently, patient wellbeing and safety.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100446"},"PeriodicalIF":1.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing epidemic prevention in nursing homes using clinical surveillance of respiratory infections","authors":"Philippe Gaspard ,&nbsp;Martin Martinot","doi":"10.1016/j.infpip.2025.100444","DOIUrl":"10.1016/j.infpip.2025.100444","url":null,"abstract":"<div><h3>Background</h3><div>Respiratory tract infections (RTIs) pose a significant risk in nursing homes (NHs), which makes surveillance crucial for timely intervention.</div></div><div><h3>Aim</h3><div>To monitor the impacts of seasonal RTIs in NHs, which include frequency, the use of rapid diagnostic tests and antibiotics, mortality, and cluster dynamics, with the use of clinical surveillance.</div></div><div><h3>Methods</h3><div>During the winter periods from 2015 to 2019 (22 weeks), data on general signs (GSs), and respiratory signs (RSs) were collected to define three respiratory clinical sign patterns (CSPs): GS+/RS+, GS−/RS+, and GS+/RS−. Clusters (≥2 cases) were identified and classified into three intensity levels, namely, L1, L2, and L3 (2, 3–5, and ≥6 GS+/RS+/4 days, respectively). CSP frequencies and the 28-day all-cause mortality were calculated.</div></div><div><h3>Findings</h3><div>In 13 NHs (N = 3,628 resident inclusions, median age: 87.2 years), 1,538 GS+/RS+, 1,482 GS−/RS+, and 233 GS+/RS− cases were observed, with mortality rates of 8.5%, 2.8%, and 6%, respectively. Among the GS+/RS+ cases, 63% received an antimicrobials. GS+/RS+ cluster analysis identified 141 clusters with L1, 100 with L2, and 26 with L3.</div><div>A total of 209 rapid diagnostic tests for influenza were carried out, with 72.2% conducted in L2 or L3 clusters. Within clusters, the first case must be identified promptly with rapid outbreak development taking place within the first 2–3 days, and potentially less effective containment efforts following delayed detection.</div></div><div><h3>Conclusion</h3><div>Clinical surveillance is a comprehensive method that can be utilized for the rapid implementation of preventive measures and appropriate use of antibiotics.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100444"},"PeriodicalIF":1.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}