Infection Prevention in Practice最新文献

{"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":"Utilizing an adenosine triphosphate bioluminescence assay as an indicator of instrument and environmental cleanliness in the radiology department: a pilot study","authors":"Y.-C. Wang ,&nbsp;W.-C. Chen ,&nbsp;K.-P. Lin ,&nbsp;W.-C. Tseng","doi":"10.1016/j.infpip.2025.100449","DOIUrl":"10.1016/j.infpip.2025.100449","url":null,"abstract":"<div><h3>Background</h3><div>Controlling healthcare-associated infections (HAIs) remains one of the major challenges faced by healthcare systems worldwide. Effective management of HAIs has become a critical indicator for evaluating the quality of services provided by medical institutions.</div></div><div><h3>Aim</h3><div>This study aims to compare the outcomes of environmental and instrument cleaning audits using an adenosine triphosphate (ATP) bioluminescence assay to prevent the spread of micro-organisms within medical environments.</div></div><div><h3>Methods</h3><div>The ATP monitoring system employs a cold light instrument integrated with bioluminescence enzyme detection technology. One hundred and ninety-one points were evaluated in 2020, 158 points in 2021, and 146 points in 2022.</div></div><div><h3>Findings</h3><div>From 2020 to 2022, the rate of environmental cleaning compliance (&lt;200 relative light units (RLU)) in the radiology department increased from 82% to 92%, while the rate of excellent cleanliness (&lt;100 RLU) improved significantly from 58% to 86% (<em>P</em>&lt;0.001). Our findings indicate that medical instruments and high-touch clinical instrument surfaces (HTCIS) in areas frequently contacted by patients are the primary contributors to the spread of pathogenic bacteria.</div></div><div><h3>Conclusions</h3><div>HTCIS should remain a focal point for improving environmental cleanliness and subsequent inspections in the radiology department. Enhancing the cleanliness of these surfaces is a vital strategy to prevent further nosocomial transmission.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 2","pages":"Article 100449"},"PeriodicalIF":1.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437843","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":"CO2 concentration testing as a quick estimate of natural ventilation effectiveness in primary healthcare: experience in war-affected, resource-limited settings","authors":"M. Dolynska ,&nbsp;A. Aleksandrin ,&nbsp;O. Vlasenko ,&nbsp;S. Gorischak ,&nbsp;G. Dolynskyi ,&nbsp;A. Vodianyk","doi":"10.1016/j.infpip.2025.100448","DOIUrl":"10.1016/j.infpip.2025.100448","url":null,"abstract":"<div><div>Ventilation remains an important component of infection prevention and control programmes. Natural ventilation, as the most affordable measure to control airborne transmission of pathogens, is a crucial area of focus. However, applying natural ventilation encounters challenges in routine practice, especially in emergencies. This study, which aimed to review the most efficient natural ventilation regimen, was performed in Autumn 2023 in two heavily war-affected primary care facilities in Ukraine. The study demonstrated the operational advantage of a regimen built upon a simple approach, where personnel opened windows only after observing an increased CO₂ concentration. This solution has obvious disadvantages, being reactive rather than proactive and requiring continuous monitoring of CO₂ concentration; it turned out to be more acceptable to busy healthcare workers than regimens developed explicitly for each office, considering ventilation rate and workload. Patients' complaints about feeling cold in the offices may be a substantial obstacle to the formal use of natural ventilation. Reported results were considered an acceptable temporary compromise for initiating a natural ventilation policy. Further improvement will require personnel training and raising awareness about reasonable prevention interventions for airborne pathogens among patients.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 2","pages":"Article 100448"},"PeriodicalIF":1.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452859","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}

{"title":"Determinants of non-compliance with hand hygiene using a covert direct observation methodology","authors":"Majid M. Alshamrani ,&nbsp;Aiman El-Saed ,&nbsp;Fatmah Othman ,&nbsp;Mohammed Al Zunitan ,&nbsp;Seema Noushad ,&nbsp;Ayham Albadawi ,&nbsp;Eman Alghamdi ,&nbsp;Saad Almohrij","doi":"10.1016/j.infpip.2025.100442","DOIUrl":"10.1016/j.infpip.2025.100442","url":null,"abstract":"<div><h3>Background</h3><div>The Hawthorne effect may result in an overestimation of hand hygiene (HH) compliance during routine observations, which may weaken the significance of factors associated with non-compliance. The aim of this study was to examine professional and healthcare determinants of HH non-compliance using covert observation.</div></div><div><h3>Methods</h3><div>A cross-sectional study design was conducted among healthcare workers (HCWs) at a tertiary care hospital in Saudi Arabia. HH observations were conducted discreetly by trained observers, followed by a questionnaire and an audit to identify possible determinants of HH non-compliance. HH non-compliance was assessed according to the World Health Organisation's (WHO) five-moments for HH, while inappropriate compliance was evaluated by additionally considering incorrect HH technique.</div></div><div><h3>Results</h3><div>A total of 6580 HH opportunities were observed by 502 HCWs. The overall non-compliance rate was 54.1% with inappropriate compliance at 71.1%. Significant factors associated (<em>P</em>&lt;0.05) with non-compliance included lack of HH education/training, lack of job promotion, working in the emergency department, lack of HH auditing, absence of pocket-sized alcohol-based handrub (ABHR) bottles, inconveniently placed hand washing sinks and ABHR wall dispensers, infrequent replacement of empty ABHR wall dispensers, and lack of nearby promoting posters. With few exceptions, the determinants of HH inappropriate compliance were similar to those of HH non-compliance, when objectively audited by the researcher.</div></div><div><h3>Conclusions</h3><div>The findings underscore the importance of HH training and supportive healthcare infrastructures. These insights may assist decision-makers in identifying specific work environment factors that could improve HH compliance through appropriate interventions. Further research is required to evaluate the impact of these suggested modifications on HH compliance.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100442"},"PeriodicalIF":1.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143395039","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":"Intrahospital dissemination of multidrug-resistant Acinetobacter baumannii at a teaching hospital in Northeast of Mexico","authors":"Samantha Villarreal-Cruz ,&nbsp;Adrián Camacho-Ortiz ,&nbsp;Samantha Flores-Treviño ,&nbsp;Licet Villarreal-Treviño ,&nbsp;Paola Bocanegra-Ibarias","doi":"10.1016/j.infpip.2025.100443","DOIUrl":"10.1016/j.infpip.2025.100443","url":null,"abstract":"<div><h3>Background</h3><div><em>Acinetobacter baumannii</em> is an opportunistic drug-resistant Gram-negative coccobacillus associated with nosocomial infections, representing a worldwide public health problem.</div></div><div><h3>Aim</h3><div>The aim of this study was to analyse the dissemination of <em>A. baumannii</em> in two hospital buildings in Mexico through phenotypic and genotypic characterization of clinical isolates obtained for three years.</div></div><div><h3>Methods</h3><div>Clinical strains were collected from two buildings in a tertiary-care hospital in Monterrey, Mexico. After species identification by MALDI-TOF MS and PCR, antimicrobial susceptibility was determined by disk diffusion and microdilution methods, carbapenemase-encoding genes (OXA-23, -24, -51, and -58) were searched, and clonal diversity was analysed by PFGE and MLST.</div></div><div><h3>Findings</h3><div>Among 204 specimens, 87.3% and 50.5% of the isolates were classified as multidrug-resistant (MDR) and difficult-to-treat-resistant (DTR), respectively. The OXA-24 gene was detected in 95% of the isolates. Most isolates (n=181) were grouped into 15 clones, four which predominated and disseminated after five months. Among ST detected (ST1694, ST758, ST124, and ST490), ST124, which belongs to the high-risk CC636 clonal complex, is reported for the first time in Mexico.</div></div><div><h3>Conclusions</h3><div>Long-term persistence and dissemination of <em>A. baumannii</em> clones were observed in specific hospital wards from two buildings in a tertiary-care hospital in Mexico. High antimicrobial resistance, such as MDR and DTR, were observed in this hospital. DTR surveillance and early recognition of MDR <em>A. baumannii</em> clones should be performed routinely to prevent their dissemination.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100443"},"PeriodicalIF":1.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372664","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":"Clinical and economic impact of ventilator-associated pneumonia in intensive care units in Japan","authors":"Taikan Nanao ,&nbsp;Koichi Benjamin Ishikawa ,&nbsp;Shunya Ikeda ,&nbsp;Tsutomu Yamazaki","doi":"10.1016/j.infpip.2025.100440","DOIUrl":"10.1016/j.infpip.2025.100440","url":null,"abstract":"<div><div>Ventilator-associated pneumonia (VAP) has a considerable impact on both clinical outcomes and healthcare costs. This study compared 40 patients having VAP with 40 matched controls from a Japanese ICU dataset. Patients with VAP experienced significantly longer ICU and hospital stays, fewer ventilator-free days, and a higher incidence of tracheostomies. VAP cases also required more broad-spectrum antimicrobials, leading to an additional cost of approximately USD 24,410 per case. These results highlight the importance of implementing effective infection control strategies to mitigate VAP's clinical and economic consequences.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100440"},"PeriodicalIF":1.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143104737","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}