Health Policy Open最新文献

{"title":"Variation in Medicaid and commercial coverage of cell and gene therapies","authors":"Molly T. Beinfeld ,&nbsp;Julia A. Rucker ,&nbsp;Nola B. Jenkins ,&nbsp;Lucas A. de Breed ,&nbsp;James D. Chambers","doi":"10.1016/j.hpopen.2023.100103","DOIUrl":"https://doi.org/10.1016/j.hpopen.2023.100103","url":null,"abstract":"<div><p>Growth in the availability of cell and gene therapies (CGTs) promises significant innovation in the treatment of serious diseases, but the high cost and one-time administration of CGTs has also raised concern about strain on health plan budgets and inequity in access. We used coverage information from the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database for 18 large commercial health plans in the US and information from state Medicaid websites to examine variation in coverage of 11 CGTs in August 2021. We found that US commercial and Medicaid health plans imposed restrictions in 53.5 % and 68.3 % of their coverage policies for the 11 included CGTs, respectively. In addition, we identified significant variation in access to CGTs across commercial plans and across Medicaid plans. Coverage restrictions for certain CGTs were more common than others; clinical requirements were often (but not always) consistent with the inclusion criteria for the clinical trial central to the drug’s approval. We conclude that there is variation in access to CGTs, creating differential patient access.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100103"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590229623000151/pdfft?md5=0e2ff485bbf69751b569aff26579e612&pid=1-s2.0-S2590229623000151-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91957387","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":"Out-of-pocket expenditure among patients with diabetes in Bangladesh: A nation-wide population-based study","authors":"Zakir Hossain ,&nbsp;Moriam Khanam ,&nbsp;Abdur Razzaque Sarker","doi":"10.1016/j.hpopen.2023.100102","DOIUrl":"10.1016/j.hpopen.2023.100102","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Diabetes has become one of the fastest growing public health emergencies worldwide. The objective of this study was to estimate the average annual out-of-pocket cost of diabetes treatment as well as to find out the catastrophic health expenditure (CHE) and their determinants in Bangladeshi context.</p></div><div><h3>Data and methods</h3><p>The study utilised data from the most recent nationally representative Household Income and Expenditure Survey 2016–2017. The incidence of CHE was estimated by applying 10% and 25% of the annual total household expenditure threshold levels. The factors associated with CHE was presented as adjusted odds ratio with 95% confidence intervals.</p></div><div><h3>Results</h3><p>The annual average out-of-pocket cost per diabetes patient was US$ 323 (BDT 25,473). The cost of medication was the main cost driver contributed for 75.43% of the total out-of-pocket cost. The incidence of CHE was 14.34%, and 5.86% of the study households for 10% and 25% of the threshold levels, respectively. The patient aged more than 60 (AOR: 4.89; CI 0.82 to 28.95), uneducated (AOR: 1.83; CI 0.25 to 2.12), comorbid condition (AOR: 1.62; CI 0.94 to 2.79), small household size (AOR: 3.20; CI 0.58 to 17.51), rural resident (AOR: 1.85; CI 0.46 to 1.57), poorest asset quintile (AOR: 4.06; CI 1.43 to 13.87) and private facility type (AOR: 8.16; CI 3.46 to 19.;25) were significantly associated with the incidence of CHE due to diabetes treatment.</p></div><div><h3>Conclusions</h3><p>There are considerable out-of-pocket costs needed for diabetes care in Bangladesh. The evidence of catastrophic expenditure suggests the urgent need to improve financial risk protection to ensure access to care.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100102"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/50/main.PMC10514070.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136263","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 impact of funding disruptions on large-scale teen pregnancy prevention research projects","authors":"Gina Gonzalez Hofert ,&nbsp;Genevieve Martinez-Garcia ,&nbsp;Lauren Tingey ,&nbsp;Michele Ybarra ,&nbsp;Ash Philliber ,&nbsp;Jordan Karas ,&nbsp;Melanie Grafals ,&nbsp;Milagros Garrido ,&nbsp;Sarah Parchem ,&nbsp;Erin Yager-DeConcini","doi":"10.1016/j.hpopen.2023.100101","DOIUrl":"10.1016/j.hpopen.2023.100101","url":null,"abstract":"<div><p>To advance the field of teen pregnancy prevention, new interventions must be developed and tested. The federal Teen Pregnancy Prevention program (TPP) funds the evaluation of promising interventions. We report on a funding disruption to 21 TPP Tier 2B research grantees across the US that was unusual for its ideological causation, sudden timing, severity, and ultimately court decisions compelling the agency to reverse the decision. We address the following question: How did challenges presented by the attempted funding termination impact grantees’ ability to continue with their intended research? Results from grantee surveys in 2019 demonstrate the funding disruption negatively impacted participant recruitment, organizational collaboration, program delivery, research rigor, and compromised grantees’ ability to complete high-quality evaluations. Results also show most projects could continue, with modified research goals, when funding was reinstated. We conclude administrations should avoid arbitrarily and prematurely terminating research projects. However, there is merit in reinstating funds to projects should a disruption occur. Results from this work are particularly relevant as we anticipate how health research projects may manage other disruptions to funding or timetables, such as those caused by COVID-19. Results are relevant to policy makers, researchers, government and private funders, grantees, and technical assistance teams.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100101"},"PeriodicalIF":0.0,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/f6/main.PMC10458667.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10108792","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":"Health-care policies during the COVID-19 pandemic in Mexico: A continuous case of heterogeneous, reactive, and unequal response","authors":"Daniela Bautista-Reyes ,&nbsp;Jimena Werner-Sunderland ,&nbsp;Alondra Coral Aragón-Gama ,&nbsp;José Roberto Cabral Duran ,&nbsp;Karla Daniela Contreras Medina ,&nbsp;Manuel Urbina-Fuentes ,&nbsp;Elysse Bautista-González","doi":"10.1016/j.hpopen.2023.100100","DOIUrl":"10.1016/j.hpopen.2023.100100","url":null,"abstract":"<div><h3>Background</h3><p>The pandemic in Mexico underlined pre-existing health-care system inequalities. Within the first six months of the COVID-19 pandemic, 154 health policies across health institutions were found to be uncoordinated and heterogeneous, leading to health inequalities in access and potential health outcomes.</p></div><div><h3>Data &amp; methods</h3><p>Using a rapid qualitative research methodology, data was collected using purposive sampling of institutional policies published for public access on the official websites of the four public health institutions in Mexico from June 16th, 2020 to October 30th, 2021. This policy review used archival analysis to understand the differences in health-care policies during the COVID-19 pandemic in Mexico. These policies were classified under the RREAL framework and as a continuation of our first publication.</p></div><div><h3>Results</h3><p>During this study, categories of public health response and vaccination dominated the policies enacted. The SSA was the main author of publications. There seems to be a more unified policy response. However, health inequalities persist.</p></div><div><h3>Conclusions</h3><p>The Mexican government continued to be reactive to the increase in cases or the arrival of new variants, rather than preventative. Research and development of policies need to work together in soaring cases like COVID-19 to work more effectively against the economic and epidemiological burden of a pandemic. It is suggested that this “vaccination” should be included in the RREAL classification. Other sectors (i.e. the ministry of foreign affairs) should be considered relevant players in the future management of a pandemic.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100100"},"PeriodicalIF":0.0,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/45/b9/main.PMC10471918.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10149309","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":"Proposal for a national diagnostics action plan for the United States","authors":"Gigi Kwik Gronvall ,&nbsp;Sujeet B. Rao ,&nbsp;Susan Van Meter ,&nbsp;Adam Borden ,&nbsp;Tom Inglesby","doi":"10.1016/j.hpopen.2023.100099","DOIUrl":"10.1016/j.hpopen.2023.100099","url":null,"abstract":"<div><p>Providing a definitive diagnostic test in a disease emergency is critical to limit pathogen spread, develop and deploy medical countermeasures, and mitigate the social and economic harms of a serious epidemic. While major accomplishments have accelerated test development, expanded laboratory testing capacity, and established widespread point-of-care testing, the United States does not have a plan to rapidly respond, to develop, manufacture, deploy, and sustain diagnostic testing at a national scale. To address this gap, we are proposing a <strong>National Diagnostics Action Plan</strong> that describes the steps that are urgently needed to prepare for future infectious disease emergencies, as well as the actions we must take at the first signs of such’ events. These recommendations require substantial collaboration between the US government (USG) and the private sector to solve a series of challenges now, as well as to prepare for the massive and rapid scale-up of laboratory and point-of-care test development and testing capacity in future emergencies. The recommendations include establishing pre-event contracts; ensuring rapid access to clinical samples; creating a permanent public–private testing coordinating body to allow for rapid information sharing and improved cooperation among the USG, test developers, and clinical laboratories; and accelerating testing rollout at the beginning of an event—and thus, the effective public health management of a disease crisis.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100099"},"PeriodicalIF":0.0,"publicationDate":"2023-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10336495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9820458","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":"COVAX – Time to reconsider the strategy and its target","authors":"David Bell ,&nbsp;Garrett W. Brown ,&nbsp;Wellington A. Oyibo ,&nbsp;Samiratou Ouédraogo ,&nbsp;Blagovesta Tacheva ,&nbsp;Elena Barbaud ,&nbsp;Andreas Kalk ,&nbsp;Valéry Ridde ,&nbsp;Elisabeth Paul","doi":"10.1016/j.hpopen.2023.100096","DOIUrl":"10.1016/j.hpopen.2023.100096","url":null,"abstract":"<div><p>COVAX, the international initiative supporting COVID-19 vaccination campaigns globally, is budgeted to be the costliest public health initiative in low- and middle-income countries, with over 16 billion US dollars already committed. While some claim that the target of vaccinating 70% of people worldwide is justified on equity grounds, we argue that this rationale is wrong for two reasons. First, mass COVID-19 vaccination campaigns do not meet standard public health requirements for clear expected benefit, based on costs, disease burden and intervention effectiveness. Second, it constitutes a diversion of resources from more cost-effective and impactful public health programmes, thus reducing health equity. We conclude that the COVAX initiative warrants urgent review.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"4 ","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/b1/main.PMC10098302.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9709358","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":"Whether or not to enroll, and stay enrolled? A Tanzanian cross-sectional study on voluntary health insurance","authors":"Alphoncina Kagaigai ,&nbsp;Amani Thomas Mori ,&nbsp;Amani Anaeli ,&nbsp;Sverre Grepperud","doi":"10.1016/j.hpopen.2023.100097","DOIUrl":"10.1016/j.hpopen.2023.100097","url":null,"abstract":"<div><p>Lower-middle income countries (LMICs) have invested significant effort into expanding insurance coverage as a means of improving access to health care. However, it has proven challenging to fulfill these ambitions. This study investigates to what extent variables associated with the enrollment decision (stay never-insured or enroll) differ from variables associated with the dropout decision (stay insured or drop out). A cross-sectional survey that included 722 households from rural districts in Tanzania was conducted and multinomial logistic regressions were performed to determine the associations between independent variables and membership status (never-insured, dropouts, or currently insured). Both the decision to enrollment and the decision to drop out were significantly associated with the presence of chronic disease and perceptions about the quality of services provided, insurance scheme management, and traditional healers. The effect of other variables, such as age, gender and educational level of the household head, household income, and perceptions about premium affordability and benefit-premium ratios, varied across the two groups. To improve voluntary health insurance coverage, policymakers must simultaneously increase the enrollment rate among the never-insured and reduce the dropout rate among the insured. Our conclusions suggest that policies to increase insurance scheme enrollment rates should differ for the two uninsured groups.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"4 ","pages":"Article 100097"},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7e/11/main.PMC10297742.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9735931","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":"A SWOT analysis of the complex interdependencies of the Maltese reimbursement processes","authors":"Katharina Abraham,&nbsp;Margreet Franken","doi":"10.1016/j.hpopen.2023.100095","DOIUrl":"10.1016/j.hpopen.2023.100095","url":null,"abstract":"<div><h3>Background</h3><p>The processes that operationalize the evaluation framework for new medicines are implemented to reach the system objectives of public health, financial sustainability, and equitability. However, when the activities and procedures of these processes are misaligned, the objectives of the system may be at risk.</p></div><div><h3>Objectives</h3><p>To evaluate the supporting processes for introducing new medicines in public healthcare services in Malta.</p></div><div><h3>Methods</h3><p>We first reviewed literature on the Maltese reimbursement system and subsequently conducted semi-structured interviews based on the Hutton Framework. Interviewees included policy makers, committee members, procurement staff, medical specialists, pharmacists, and pharmaceutical industry representatives. After validation, we analysed the data with a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis.</p></div><div><h3>Results</h3><p>Most medicines are assessed for introduction on the Government Formulary List. Exceptional requests fall outside this policy and pass through the Exceptional Medicinal Treatment route. Efficiency, quality, and transparency are major weaknesses across the supporting processes. Taking up responsibility, however, is considered the most important factor in reaching system objectives. Stakeholders tend to shift responsibilities to other processes, start/stop activities that impact the activities of subsequent processes whilst dismissing any contribution to the weaknesses of the system. Consequently, system objectives cannot be reached in an optimum manner.</p></div><div><h3>Conclusions</h3><p>The Maltese case showed that recommendations for introducing new medicines in the public healthcare setting are influenced beyond the choice of HTA tools and criteria. Earmarked budgets, political steering, delays, and uninformed applicants as well as HTA capacity are impeding on system goals of public health, equity, and sustainability.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"4 ","pages":"Article 100095"},"PeriodicalIF":0.0,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10297753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9735937","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":"Proposing the “Value- and Evidence-Based decision making and Practice” (VEDMAP) framework for Priority-Setting and knowledge translation in low and Middle-Income Countries: A novel framework for Decision-Making in Low-and middle income countries like Malawi","authors":"Joseph Mfutso-Bengo ,&nbsp;Nthanda Nkungula ,&nbsp;Emmanuel Mnjowe ,&nbsp;Wingston Ng'ambi ,&nbsp;Faless Jeremiah ,&nbsp;Florence Kasende- Chinguwo ,&nbsp;Fanuel Meckson Bickton ,&nbsp;Dominic Nkhoma ,&nbsp;Jobiba Chinkhumba ,&nbsp;Sebastian Mboma ,&nbsp;Lucky Ngwira ,&nbsp;Mercy Juma ,&nbsp;Isabel Kazanga-Chiumia ,&nbsp;Pakwanja Twea ,&nbsp;Gerald Manthalu","doi":"10.1016/j.hpopen.2023.100094","DOIUrl":"10.1016/j.hpopen.2023.100094","url":null,"abstract":"<div><p>The existence and availability of evidence on its own does not guarantee that the evidence will be demanded and used by decision and policy makers. Decision and policy-makers, especially in low-income settings, often confront ethical dilemmas about determining the best available evidence and its utilization. This dilemma can be in the form of conflict of evidence, scientific and ethical equipoise and competing evidence or interests. Consequently, decisions are made based on convenience, personal preference, donor requirements, and political and social considerations which can result in wastage of resources and inefficiency. To mitigate these challenges, the use of “Value- and Evidence-Based Decision Making and Practice” (VEDMAP) framework is proposed. This framework was developed by Joseph Mfutso-Bengo in 2017 through a desk review. It was pretested through a scoping study under the <em>Thanzi la Onse</em> (TLO) Project which assessed the feasibility and acceptability of using the VEDMAP as a priority setting tool for Health Technology Assessment (HTA) in Malawi. The study used mixed methods whereby it conducted a desk review to map out and benchmark normative values of different countries in Africa and HTA; focus group discussion and key informant interviews to map out the actual (practised) values in Malawi. The results of this review confirmed that the use of VEDMAP framework was feasible and acceptable and can bring efficiency, traceability, transparency and integrity in decision- policy making process and implementation.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"4 ","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ec/f0/main.PMC10297823.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9735939","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 impact of external reference pricing on pharmaceutical costs and market dynamics","authors":"Dominic Voehler ,&nbsp;Benjamin C. Koethe ,&nbsp;Patricia G. Synnott ,&nbsp;Daniel A. Ollendorf","doi":"10.1016/j.hpopen.2023.100093","DOIUrl":"10.1016/j.hpopen.2023.100093","url":null,"abstract":"<div><p>Growth in the cost of prescription drugs in the US has generated significant interest in the use of external reference pricing (ERP) to tie prices paid for drugs to those in other countries. We used data from the Pricentric ONE™ database, an international drug pricing database, to examine product launch timing, launch price, and price changes from January 2010 – October 2021 in both ERP and non-ERP settings, with a focus on 100 high-priced drugs of interest to Medicare and Medicaid. We found that ERP policies were associated with a 73% reduction in the likelihood of drug launch within 9 months of regulatory approval relative to non-ERP settings. In addition, while ERP was associated with statistically significant reductions in annual drug price changes, such policies did not impact launch price. In addition, no single ERP feature (e.g., number of countries referenced, ERP calculation) was materially associated with the outcomes of interest. We conclude that ERP policies do not appear to impact drug launch price and may delay access to new therapies, raising questions about the utility of such policies in the US and potential consequences abroad.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"4 ","pages":"Article 100093"},"PeriodicalIF":0.0,"publicationDate":"2023-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/46/main.PMC10297733.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9735934","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}