Journal of Osteopathic Medicine最新文献

{"title":"Public perception of osteopathic manipulative medicine as an effective treatment for musculoskeletal disorders.","authors":"Krina D Patel, Nadiya Amanda Persaud, Sapna Rama","doi":"10.1515/jom-2025-0174","DOIUrl":"https://doi.org/10.1515/jom-2025-0174","url":null,"abstract":"<p><strong>Context: </strong>Musculoskeletal disorders (MSDs) are among the most prevalent causes of disability globally, contributing significantly to diminished quality of life and rising healthcare costs. While pharmacological treatments and physical therapy remain standard, alternative modalities such as osteopathic manipulative medicine (OMM) have emerged as promising nonpharmacologic options. However, public awareness of OMM remains limited, and misconceptions persist, particularly regarding its distinction from chiropractic care. This study aimed to assess public perception of OMM and its effectiveness in treating MSDs, with the goal of informing strategies to enhance understanding and utilization of osteopathic principles.</p><p><strong>Objectives: </strong>The objectives of this study were to evaluate the public's perception, awareness, and experiences with OMM in the treatment of MSDs, and to identify knowledge gaps that can be addressed through educational outreach. This study also examined how demographic and socioeconomic factors influence awareness and utilization of OMM. Insights gained will guide the development of targeted educational materials to enhance public understanding, to promote the distinctiveness of osteopathic medicine, and to clarify the role of OMM in MSD care.</p><p><strong>Methods: </strong>A nationwide, web-based cross-sectional survey was conducted targeting US adults aged 18 years and older. Demographic data collected included age, location, race, ethnicity, income, marital and employment status, and number of children. The survey, administered through Random Device Engagement (RDE) methodology, was distributed within mobile apps to a randomized sample of users who opted in through nonmonetary incentives. Questions assessed knowledge of OMM, previous experiences with osteopathic care, perceived effectiveness in managing MSDs, and interest in nonpharmacological treatments. Quantitative analysis included frequency distributions and descriptive statistics to characterize awareness, perceptions, and utilization of OMM.</p><p><strong>Results: </strong>A total of 174 valid responses were analyzed after the exclusion of incomplete entries. Respondents represented a demographically diverse population across the United States. The most frequently cited uses of OMM were for back pain (n=70, 40.2 %), neck pain (n=58, 33.3 %), arthritis (n=38, 21.8 %), and chronic pain (n=33, 19.0 %). Regarding effectiveness, 68 respondents (39.1 %) rated OMM as \"Very Effective,\" and 30 (17.2 %) rated it as \"Extremely Effective.\" The key benefits included pain relief, improved mobility, reduced medication use, and noninvasiveness. Awareness of osteopathic distinctiveness remained low, with many respondents conflating OMM with chiropractic care.</p><p><strong>Conclusions: </strong>Findings highlight a favorable perception of OMM among those familiar with its use in MSD management, yet widespread knowledge gaps persist among the general publ","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208014","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":"Addressing the weight of the issue: gaps in obesity education among US osteopathic medical students.","authors":"Samantha L Licciardi Gemma, Andrew S Rifkin, Mahi H Basra, Clayton D Rawson, Caitlyn Nguyen, Soumya Malhotra, Sai S Mellacheruvu, Ria Bhasin, Mustafa I Ansari, Hannah M Cornwell, Shreya Vakil, Shane Donahue, Jennifer Hotzman","doi":"10.1515/jom-2025-0073","DOIUrl":"https://doi.org/10.1515/jom-2025-0073","url":null,"abstract":"<p><strong>Context: </strong>Obesity is a significant public health concern, with the United States experiencing some of the highest obesity rates worldwide. Despite the widespread prevalence and negative impacts on patient health, obesity education in medical school curricula remains insufficient. This training deficit contributes to a lack of preparedness among medical students in the management of obesity, leading to healthcare provider bias and inadequate patient care.</p><p><strong>Objectives: </strong>This study aims to identify potential gaps in obesity education within US osteopathic medical schools by assessing current osteopathic medical students' knowledge, confidence, and perceptions of medical school obesity education.</p><p><strong>Methods: </strong>A quantitative cross-sectional survey was distributed to osteopathic medical students across all 42 US osteopathic medical schools through the Student Osteopathic Medical Association (SOMA) weekly emails, SOMA internal chapter emails, and SOMA social media accounts from October 2024 to December 2024. The inclusion criteria were that participants had to be currently enrolled first-, second-, third-, and fourth-year osteopathic medical students and provide informed consent. The responses were summarized utilizing descriptive analysis. Each survey question was analyzed independently, considering the varying number of responses received per question.</p><p><strong>Results: </strong>A total of 208 students participated in the survey. Out of the 208 respondents, most students felt somewhat prepared (38.5 %) or unprepared/very unprepared (32.7 %) to manage obesity and provide nutrition education in the clinical setting. Due to the number of participants, the responses are considered in aggregate and not grouped by cohort year. In addition, there was nearly an even split among students regarding comfort in discussing obesity and weight management with patients, with 30.6 % stating that they are uncomfortable or very uncomfortable, 37.4 % reporting being somewhat comfortable, and 32.0 % feeling comfortable or very comfortable. Only 14.1 % of students reported having standardized patient encounters regarding obesity counseling, with most of these encounters (55.2 %) lasting less than 30 min. Regarding comfort discussing weight bias and stigma, 59.8 % of the students reported feeling somewhat comfortable, comfortable, or very comfortable discussing weight bias and stigma, while 40.2 % were slightly uncomfortable or not comfortable addressing the topic with patients. Given the limited sample size and response rate, these findings are exploratory and limited by a low response rate and potential response bias.</p><p><strong>Conclusions: </strong>These findings suggest potential gaps in obesity education among the responding osteopathic medical students. While limited by sample size and possible response bias, the results highlight opportunities for strengthening obesity-related curricula, particularly","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208070","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":"Eagle syndrome treated with the fascial distortion model.","authors":"Yazmin Gamble, Thomas L Kincheloe, Sarah Sander","doi":"10.1515/jom-2025-0125","DOIUrl":"https://doi.org/10.1515/jom-2025-0125","url":null,"abstract":"<p><p>Eagle syndrome is a rare condition characterized by an elongated cranial styloid process (≥30.00 mm), leading to pain and dysfunction in the surrounding anatomy. Current treatment options include styloidectomy, analgesics, corticosteroids, and antidepressants. The fascial distortion model (FDM), a newer osteopathic approach, offers a different perspective on treating Eagle syndrome. This case study examines the use of the FDM to manage Eagle syndrome by treating the cranial styloid elongation as a continuum distortion (CD). A 27-year-old female with a 3-year history of left-sided facial pain and associated symptoms underwent FDM treatment to the cranial styloid tip, performed bi-weekly for 5 weeks. Ultrasonographic measurements of the cranial styloids were taken at weeks 1 and 5, along with somatic dysfunction assessments. Results demonstrated a reduction in sonographically measured cranial styloid length, increased tissue mobility, and symptom relief. True osseous shortening, resorption, or fracture could not be confirmed because posttreatment computed tomography (CT) was not obtained. This case report suggests the FDM may serve as a viable conservative treatment for Eagle syndrome, offering an alternative to invasive or pharmacological interventions.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115833","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":"Cold water exposure therapy and effects on insulin: a scoping review.","authors":"John Gaydos, Brannon Maravich, Douglas Nolan, Micah Hartwell","doi":"10.1515/jom-2026-0083","DOIUrl":"https://doi.org/10.1515/jom-2026-0083","url":null,"abstract":"<p><strong>Context: </strong>Cold water exposure (CWE) is a growing trend among health and wellness communities due to its effects on brown adipose tissue (BAT) activation and neurotransmitter modulation. However, its impact on insulin sensitivity and glucose metabolism in humans remains underexplored.</p><p><strong>Objectives: </strong>This scoping review aims to evaluate the existing literature on the effects of CWE on insulin-related metabolic markers in humans and to identify the knowledge gaps that currently exist in this field of study.</p><p><strong>Methods: </strong>A scoping review was conducted by two authors (JG and BM) according to the Joanna Briggs Institute (JBI) guidelines and framework. A systematic search of PubMed, Embase, and Cochrane databases was conducted on July 11, 2025, utilizing search strings developed by a trained librarian. Title and abstract screening, as well as full-text review and data extraction, were performed in a masked, duplicative fashion. Inclusion criteria required human studies published in English from 2000 onward that utilized CWE and measured insulin, glucose, or related metabolic outcomes.</p><p><strong>Results: </strong>A total of 941 articles were identified, with 67 articles selected for further review. Ultimately, six studies met our inclusion criteria. These studies varied in participant demographics (male, female, mixed cohorts) and age groups ranging from 18 to 55+. The intervention duration included mostly acute sessions. The majority of studies (n=4) reported an improvement in insulin sensitivity and glucose utilization by peripheral tissues, as well as BAT utilization. However, the study by Sellers suggested increased insulin resistance, and the study by Hanssen et al. showed a decrease in cold-stimulated BAT glucose uptake. Only two studies utilized full-body CWE, whereas the remainder utilized cold suits or partial immersion techniques.</p><p><strong>Conclusions: </strong>Current research suggests that non-shivering-inducing CWE can enhance insulin sensitivity and glucose metabolism in healthy humans. Extrapolating these findings to suggest application as an adjunct therapy for insulin resistance is premature. However, methodological variability and a lack of high-quality, long-duration studies highlight the need for further research, particularly distinguishing between cold suits and full-body-immersion protocols, to clarify their efficacy and clinical applicability.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065018","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":"Symptomatic heterozygous Gitelman syndrome in a professional baseball player: a case report.","authors":"John J Dougherty, Anthony C Medina, John J Dougherty, Caleb J Hoover","doi":"10.1515/jom-2025-0185","DOIUrl":"https://doi.org/10.1515/jom-2025-0185","url":null,"abstract":"<p><p>Gitelman syndrome (GS) is an inherited renal salt wasting tubulopathy caused by variants in <i>SLC12A3</i> and classically associated with hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria. We describe an 18-year-old professional baseball player with an approximately 6-month history of recurrent, exertional muscle cramping, fatigue, and profuse sweating that persisted despite hydration and commercial electrolyte supplementation. Laboratory evaluation demonstrated blood urea nitrogen (BUN) levels of 24-27 mg/dL, creatinine levels of 1.20-1.38 mg/dL, bicarbonate of 29-31 mmol/L, and 24-h urinary sodium of 163 mmol/L. The serum potassium measurements did not indicate levels below 3.5 mmol/L. Persistent symptoms and the urinary sodium finding raised concern for abnormal renal salt handling. Evaluation was complicated by limited, episodic access to the athlete while he trained and competed in the Dominican Republic, restricting opportunities for serial biochemical testing. Genetic sequencing identified a heterozygous <i>SLC12A3</i> gene c.2990C>T variant. Management included individualized potassium and magnesium supplementation, naproxen sodium 220 mg daily, and pre-exercise iontophoresis to reduce sweating. At the 6-month follow-up, the athlete reported less cramping and improved endurance; BUN was 17.4 mg/dL, creatinine was 1.20 mg/dL, and potassium was 4.59. This case highlights the diagnostic challenge posed by an incomplete GS phenotype in a high-performance athlete and the importance of correlating clinical, biochemical, and genetic findings. Heterozygous <i>SLC12A3</i>-associated salt-wasting physiology should be considered in athletes with persistent compatible symptoms and evidence of inappropriate renal electrolyte loss, while alternative acquired and endocrine causes are evaluated.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026149","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":"Treatment-resistant hypertension in the primary care setting.","authors":"Vijay Joshi, Shreepriya Mangalgi, Kunal Chaudhary, Adam Whaley-Connell","doi":"10.1515/jom-2026-0011","DOIUrl":"https://doi.org/10.1515/jom-2026-0011","url":null,"abstract":"<p><strong>Context: </strong>Rates of treatment-resistant hypertension in the United States are increasing despite our better understanding of underlying mechanisms, lifestyle and pharmacologic approaches, and with refinement of treatment goals. Distinguishing treatment resistance from pseudo-resistance or even refractory hypertension is increasingly clinically difficult, and understanding the influences that dictate resistance in the primary care setting is needed to improve patient outcomes.</p><p><strong>Objectives: </strong>Herein, we will review current definitions of treatment resistance, pseudo-resistance, and refractory hypertension, and we will discuss patient- and provider-related factors that influence resistance, facilitating a more holistic approach to care.</p><p><strong>Methods: </strong>We conducted a comprehensive narrative review utilizing PubMed as the basis for our medical literature search. We employed a combination of Medical Subject Headings (MeSH) terms and free-text keywords, including \"treatment resistant hypertension,\" \"resistant hypertension,\" \"refractory hypertension,\" and \"pseudo-resistance.\" No language or date restrictions were applied for the initial search to help with wide capture of available literature that included a broad range of study designs, clinical guidelines, and consensus statements.</p><p><strong>Results: </strong>Resistance is classically defined as blood pressure (BP) >130/80 mm Hg despite the use of three or more antihypertensives including a diuretic at optimized doses and with appropriate combination of drugs having complementary mechanisms of action, or with controlled BP requiring four or more anti-hypertensive drugs. Improper BP measurement techniques, underdosing antihypertensives, therapeutic inertia, nonadherence, and even a white coat effect contribute to pseudo-resistance.</p><p><strong>Conclusions: </strong>Addressing factors that contribute to pseudo-resistance is of utmost significance in managing a patient with apparent treatment resistance or even refractory hypertension in the primary care setting. Recent strategies for managing true resistance include ambulatory BP monitoring or out-of-office home BP measurement, assessing underlying secondary causes, rational drug design to optimize the drug regimen, and a collaborative multidisciplinary approach with guidance from hypertension specialists. Addressing the factors that underlie pseudo-resistance and treatment resistance is consequential to improve not only major cardiovascular morbidity and mortality but also quality of life and tolerability of complex treatment regimens. Herein, we aim to address factors to improve care for hypertension in the primary care setting.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013030","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":"Firearm safety and suicide prevention in older adults: a primary care clinical framework.","authors":"Rebecca Delp, Erik Langenau","doi":"10.1515/jom-2026-0155","DOIUrl":"https://doi.org/10.1515/jom-2026-0155","url":null,"abstract":"<p><p>Firearm-related injury and suicide represent a critical public health challenge in the United States, with older adults experiencing the highest rates of firearm suicide. Approximately 70 % of suicides among older adults involve a firearm, with white males over age 70 at the highest risk. Despite high household firearm access and unsecured storage, standardized screening and counseling in primary care remain underutilized. Primary care physicians are uniquely positioned to identify clinically vulnerable patients and evaluate lethal means safety through longitudinal relationships during routine encounters. This clinical practice report presents an evidence-based framework for firearm suicide risk assessment, clinical communication, and safe storage counseling tailored to older adults. Clinicians should evaluate key vulnerabilities, including depression, cognitive decline or dementia, substance use disorder, veteran status, living alone, recent bereavement, and serious medical diagnoses. Utilizing nonjudgmental language rooted in motivational interviewing builds trust and reduces defensiveness. Validated clinical tools provide structured guidance for lethal means safety discussions. Recommending practical storage devices, such as biometric safes, rapid-access lockboxes, or cable locks, balances patient autonomy with risk reduction. Incorporating firearm safety discussions into routine visits, like Medicare Annual Wellness Visits, through team-based care and community partnerships makes workflow implementation feasible while respecting local and personal firearm culture. Normalizing firearm safety counseling within routine health maintenance supports whole-person care, preserves patient dignity, and ultimately helps prevent firearm suicide among older adults.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013035","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":"Self-perceptions of medical students and educators regarding LGBTQ+ and sexual and gender minority (SGM) healthcare and SGM patients: cross-sectional survey.","authors":"Sarah J Muder, Karan Malik, Megan Maguire, Christine Hutak, Min-Kyung Jung, Donna McMahon, Allison Walker, Luis Alvarado","doi":"10.1515/jom-2025-0259","DOIUrl":"https://doi.org/10.1515/jom-2025-0259","url":null,"abstract":"<p><strong>Context: </strong>Providing adequate clinical training to care for patients of all demographics remains an important goal of medical education. Sexual and gender minority (SGM) patients are a population with consistently unmet clinical needs.</p><p><strong>Objectives: </strong>The objective of this study is to assess baseline knowledge of SGM topics and perception toward treating SGM patients at a large osteopathic medical school.</p><p><strong>Methods: </strong>A cross-sectional survey of faculty and osteopathic medical students at a large osteopathic medical school in the Northeast was administered. The survey contained 41 items regarding the comfort, knowledge, and preparedness to treat SGM patients. Data were collected from June 2021 to December 2021. The conventional cutoff to accept the null hypothesis was set at a p value of 0.05 for statistical hypothesis testing.</p><p><strong>Results: </strong>The response rate was 24.3 %. Medical student respondents achieved higher knowledge scores than faculty respondents (p<i>=</i>0.04), and younger respondents achieved higher knowledge scores than older respondents (p<i>=</i>0.013). Heterosexual respondents reported lower aggregate comfort (p<i>=</i>0.002) in treating SGM patients, whereas nonheterosexual respondents reported higher aggregate comfort in treatment of SGM patients. Clinical faculty perceived the medical curriculum to be less inclusive in addressing SGM topics in clinical medicine than nonclinical faculty (p<i>=</i>0.001*), who overall felt that the medical curriculum was inclusive.</p><p><strong>Conclusions: </strong>Among those surveyed, there were discrepancies in comfort treating SGM patients between heterosexual and nonheterosexual respondents, and younger respondents had increased knowledge on SGM health topics than older respondents. This research supports that osteopathic medical schools consider adopting the SGM medical education competencies published by the Association of American Medical Colleges (AAMC).</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956598","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":"The national academy of medicine fellowship in osteopathic medicine: an investment in the future.","authors":"Breanne Jaqua","doi":"10.1515/jom-2026-0144","DOIUrl":"https://doi.org/10.1515/jom-2026-0144","url":null,"abstract":"","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931425","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":"Missing button batteries in bilateral ear canals.","authors":"Lindsay V Kantor, Andrew C Miller, Maxwell D Newby, Susan K Yaeger","doi":"10.1515/jom-2026-0142","DOIUrl":"10.1515/jom-2026-0142","url":null,"abstract":"","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891444","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}