Journal of Osteopathic Medicine最新文献

{"title":"Key factors for residency interview selection from the National Resident Matching Program: analysis of residency Program Director surveys, 2016-2020.","authors":"Cooper L Stone, Godwin Y Dogbey, John Falls, Yen-Ping Kuo","doi":"10.1515/jom-2022-0144","DOIUrl":"10.1515/jom-2022-0144","url":null,"abstract":"<p><strong>Context: </strong>As the number of medical school graduates continues to outpace the available residency training positions, applying for residency in the United States has become a highly competitive process, often associated with a low rate of selection and invitation for interview. The National Resident Matching Program (NRMP) Program Director survey provides data assessing factors considered by Program Directors (PD) in selecting and inviting candidates for interview. Assessing the evolution of these factors over time is efficacious to inform and guide prospective applicants toward improving preparation for residency application.</p><p><strong>Objectives: </strong>We aim to synthesize NRMP data showing factors that PDs reported and rated as important in their decision to select and invite applicants for interview.</p><p><strong>Methods: </strong>Data from residency PD surveys from 2008 to 2021 were accessed, but after applying inclusion/exclusion criteria, only the data from 2016 to 2020 were reviewed and analyzed. The NRMP survey reports provided two metrics that characterized PDs' evaluation of the residency factors for interview, namely, \"percent citing factor\" and \"average rating\" on a 0 to 5 Likert-type scale. These two metrics were combined into an aggregate measure of importance (AI), and another measure of relative importance (RI) was constructed from normalizing the AI of each individual factor to the sum of the AI within each survey year.</p><p><strong>Results: </strong>The top ranked factors were United States Medical Licensing Examination (USMLE) Step 1/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1, Letter of Recommendation (LOR) in the specialty, Medical Student Performance Evaluation (MSPE/Dean's Letter), and USMLE Step 2 Clinical Knowledge (CK)/COMLEX Level 2 Cognitive Exam (CE) score, any failed attempt in USMLE/COMLEX, and perceived commitment to specialty. Factors rising in importance were Audition Elective/Rotation Within Your Department, Personal Statement (PS), Perceived Commitment to Specialty, Perceived Interest in Program, LOR in the Specialty, Other Life Experience, and Personal Prior Knowledge of the Applicant. Factors with declining importance were Interest in Academic Career, Awards or Special Honors in Basic Sciences, Graduate of Highly Regarded US Medical School, Awards or Special Honors in Clinical Clerkships, Lack of Gaps in Medical Education, Awards or Special Honors in Clerkship in Desired Specialty, and Consistency of Grades. Compared to the 2021 PD survey, our findings show continued predictive consistency, particularly related to specialty and program commitment.</p><p><strong>Conclusions: </strong>The factors identified for the selection of medical school graduates for interview into a residency program reveal that PDs move toward a more integrated approach. Specifically, PDs are placing increasing emphasis on factors that border on subjective qualities more so than t","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"523-530"},"PeriodicalIF":1.5,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10116444","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":"Frontmatter","authors":"","doi":"10.1515/jom-2023-frontmatter9","DOIUrl":"https://doi.org/10.1515/jom-2023-frontmatter9","url":null,"abstract":"","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135237019","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":"Delayed discovery: the COVID-19 pandemic's influence on osteoarthritis clinical trials.","authors":"Nicholas B Sajjadi, Jon Michael Anderson, Griffin K Hughes, Christena E Abraham, Jamal Malik, Micah Hartwell, Matt Vassar","doi":"10.1515/jom-2023-0028","DOIUrl":"10.1515/jom-2023-0028","url":null,"abstract":"<p><strong>Context: </strong>The COVID-19 pandemic disrupted clinical research in many medical and surgical fields, resulting in research waste and loss of treatment for patients. Although other areas have been explored, the extent of the pandemic's influence on osteoarthritis (OA) trials is currently unknown.</p><p><strong>Objectives: </strong>This study aims to explore the reasons for termination of clinical trials investigating OA during the COVID-19 pandemic.</p><p><strong>Methods: </strong>We searched ClinicalTrials.gov for OA trials and characterized their reason for discontinuation, noting where trialists directly cited the COVID-19 pandemic as the reason for trial discontinuation. We also coded other common reasons for trial discontinuation. Descriptive and inferential statistics were performed to determine the difference in enrollment, funding source, trial phase, allocation, and intervention type between the trials terminated early due to pandemic and nonpandemic reasons.</p><p><strong>Results: </strong>Out of 135 clinical trials, 119 were included and 27 (22.7 %) of them reported the COVID-19 pandemic as a primary reason for discontinuation, which was the overall most common reason for OA trial discontinuation during the study period. We found statistically significant differences for trials discontinued due to pandemic vs. non-pandemic-related reasons, with trials having sites outside the United States, randomized allocation, and drug or device intervention type being most affected. However, there was no statistically significant difference between groups regarding trial phase, funding source, or enrollment.</p><p><strong>Conclusions: </strong>This study highlights the impact of the COVID-19 pandemic on the clinical trials related to OA. We found that many trials reported discontinuation directly due to the pandemic, which may lead to the loss or delay of novel treatments for OA. To avoid such discontinuation in the future, alternative methods for conducting OA-related clinical trials should be explored and implemented.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"5-11"},"PeriodicalIF":1.5,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10000296","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":"Analysis of alternate material Onyx™ for total knee arthroplasty instrumentation sets.","authors":"Nathan Gregg, Alyssa M Kendrick, Jill M Carter, Mark E Gittins, Sarah C MacNeill","doi":"10.1515/jom-2023-0116","DOIUrl":"10.1515/jom-2023-0116","url":null,"abstract":"<p><strong>Context: </strong>A 25-pound weight limit is currently set on containerized instrumentation sets by the Association of periOperative Registered Nurses (AORN) and the Association for the Advancement of Medical Instrumentation (AAMI), in order to reduce strain on the staff and ensure that the sets are not too crowded in order to preserve sterilization and drying of the instruments. This is pushing companies to reduce the weight and number of instrumentation sets for the operating room. One solution has been to explore the viability of new, lighter materials such as Onyx.</p><p><strong>Objectives: </strong>The goal of this study is to evaluate the novel material Onyx as a viable material utilized in reusable total knee arthroplasty (TKA) instrumentation sets utilizing traditional steam sterilization as the sterilization method.</p><p><strong>Methods: </strong>Mechanical and biocompatibility tests according to the American Society for Testing Materials (ASTM) and International Organization for Standardization (ISO) 10,993 were run to evaluate the Onyx Material to see if it would be a viable alternative to the stainless and martensitic steel that is currently being utilized.</p><p><strong>Results: </strong>Gross warping and cracking after 10 rounds of sterilization was observed. This was qualitatively worse in the Onyx without a carbon fiber component. The Onyx material did not meet biocompatibility standards for its application.</p><p><strong>Conclusions: </strong>Onyx was determined to not be a viable material for TKA instruments regarding multiple high-pressure and -temperature sterilizations and cytotoxic cell testing.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"557-561"},"PeriodicalIF":1.5,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10331778","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":"Emerging treatment of prurigo nodularis with dupilumab.","authors":"Olivia Humpel,&nbsp;Lauren Fill,&nbsp;Robert Hostoffer","doi":"10.1515/jom-2023-0125","DOIUrl":"10.1515/jom-2023-0125","url":null,"abstract":"A 69-year-old woman presented to the allergy and immunology clinic in May 2023 with a recurrent pruritic rash on the arms and legs, which fi rst began within 24 – 48 h of taking Bactrim (sulfamethoxazole and trimethoprim) and persisted for 3 months after antibiotic cessation. The patient had a medical history of osteoarthritis, depression, and insomnia. The patient ’ s symptoms originally improved upon taking prednisone, and she was rash-free for 3 months. The patient was then evaluated by dermatology and was o ff ered a skin biopsy, but she declined in favor of wishing to trial medical management fi rst. Once the symptoms recurred, the patient did not experience symptomatic relief following treatment with topical triamcinolone and clobetasol or oral methyl-prednisolone and prednisone. The patient presented to our outpatient allergy and immunology clinic with excoriated nodular lesions of the extremities while on a current regimen of hydroxyzine. Given her history, biopsy was not advised. The patient was diagnosed with prurigo nodularis (PN), a chronic in fl ammatory skin condition for which dupilumab was recommended every 4 weeks (Figure 1). PN is associated with intensely pruritic and hyperker-atotic nodules that are symmetrically distributed along the extensor surfaces of the extremities [1]. Distinguishing features include light to bright red papules, nodules, and plaques that are excoriated and have hyperpigmented margins. These","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"555-556"},"PeriodicalIF":1.5,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9940311","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":"Preventing quality improvement drift: evaluation of efforts to sustain the cost savings from implementing best practice guidelines to reduce unnecessary electrocardiograms (ECGs) during the preadmisison testing evaluation.","authors":"Rabeel Ahmad,&nbsp;Ellen Hauck,&nbsp;Huaging Zhao,&nbsp;Joseph McComb","doi":"10.1515/jom-2022-0196","DOIUrl":"10.1515/jom-2022-0196","url":null,"abstract":"<p><strong>Context: </strong>Medical professionals commonly fail to follow best practice guidelines. Drift, or a return to previous tendencies, is abundant in healthcare even when guidelines are followed initially. This \"drift\" was found internally at Temple University Hospital with preoperative electrocardiograms (ECGs). Best-practice guidelines were instituted and followed as a first step, but sustaining performance improvement was the ultimate goal.</p><p><strong>Objectives: </strong>The objectives are to improve and maintain adherence to published guidelines for preoperative ECG testing at Temple University Hospital in a physician-led, nurse practitioner (NP)-staffed preadmission testing (PAT) clinic.</p><p><strong>Methods: </strong>To start this quality improvement (QI) project, a retrospective chart review was completed to determine the number of ECGs performed in PAT at Temple University Hospital in 2017. New guidelines for ordering preoperative ECGs were then implemented, and Plan-Do-Study-Act (PDSA) cycles were performed over 3 years. A repeat retrospective chart review was completed and looked at ECGs ordered from 2018 through 2020. The number of ECGs completed in PAT before and after implementation of the new guidelines was then compared. In addition, the complexity of our surgical patients was estimated by looking at the yearly average American Society of Anesthesiology Physical Health Status (American Society of Anesthesiology [ASA] status) values assigned. Finally, the cost of performing each ECG was calculated, and the cost savings to the hospital over 4 years was determined.</p><p><strong>Results: </strong>The baseline ECG rate for PAT in 2017, 2018, 2019, and 2020 at Temple University Hospital was 54.0 , 20.7, 22.3, and 21.9 %, respectively, which was a statistically significant decrease in ECG performance rate in the years after implementation of the PDSA project. The ASA status average remained constant, demonstrating that while patients' medical diagnoses remained on average the same, reinforced training had been effective in preventing a return to previous liberal ordering tendencies. Over the course of 4 years, the reduction in unnecessary ECGs led to an estimated direct cost savings of $213,000.</p><p><strong>Conclusions: </strong>Self-adoption of best-practice guidelines among clinicians is often poor; however, the barriers to adoption can be overcome with education and individual feedback. Sustaining performance improvement gains is challenging, but possible, as shown by example in one urban, academic teaching hospital's physician-led, NP-staffed outpatient clinic.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"547-554"},"PeriodicalIF":1.5,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9918140","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":"Assessing patient experience of the tenets of osteopathic medicine.","authors":"Glenn E Davis,&nbsp;Walter Carl Hartwig,&nbsp;Richard B Riemer,&nbsp;Chandra Char,&nbsp;Adam McTighe,&nbsp;David Kremelberg","doi":"10.1515/jom-2023-0038","DOIUrl":"https://doi.org/10.1515/jom-2023-0038","url":null,"abstract":"<p><strong>Context: </strong>Previous studies document that both osteopathic physicians and third-party observers identify an approach to the patient that is consistent with the philosophy and tenets of osteopathic medicine, often without investigating whether patients identify or are satisfied with it. Osteopathic physicians and the medical education community understand the distinctiveness of an osteopathic approach to the patient. Understanding the outcomes of an osteopathic approach to patient care includes confirming whether patients experience the tenets of osteopathic medicine in physician visits and, if so, how it relates to their experience of physician empathy and satisfaction with the visit.</p><p><strong>Objectives: </strong>The objectives of this study were to assess patient experience of the tenets of osteopathic medicine, physician empathy, and satisfaction with the visit and to compare the results for patients who saw DOs with those who saw MD physicians.</p><p><strong>Methods: </strong>More than 2000 patients at four outpatient clinic facilities were surveyed after a clinical visit on 22 prompts regarding their experiences of physician behaviors, physician empathy, and their own satisfaction with the encounter. Adult patients who were treated by an osteopathic or allopathic physician for a nonemergency encounter and who were not pregnant were included in the analysis. Survey results for 1,330 patient-physician encounters were analyzed utilizing linear regression models comparing constructs representing patient experiences of the tenets of osteopathic medicine (Tenets), physician empathy (Physician Empathy), satisfaction (Satisfaction) with the encounter, as well as additional demographic and encounter variables.</p><p><strong>Results: </strong>Approximately 23.8 % of patients approached during the study period completed a survey (n=2,793), and among those, 54.7 % of patients who consented to the study and who saw a physician provider (n=1,330/2,431) were included. Significant (p≤0.01), positive associations among patient experiences of Satisfaction with the visit and Physician Empathy were observed among those who saw both DO and MD physicians. Patients experienced the Tenets during encounters with both DO and MD physicians, but linear regression showed that their experience of the Tenets was significantly (p≤0.01) and positively explained by their experience of Physician Empathy (β=0.332, p=0.00, se=0.052) and Satisfaction with the visit (β=0.209, p=0.01, se=0.081) only when the physician was a DO.</p><p><strong>Conclusions: </strong>Patients identified physician behaviors consistent with the Tenets and positively associated their experiences of Physician Empathy and Satisfaction with the visit regardless of physician training background. Patient experience of the Tenets significantly explained their experiences of Physician Empathy and Satisfaction after visits with a DO but not after visits with an MD.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 8","pages":"371-378"},"PeriodicalIF":1.5,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10212962","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":"Associations of intimate partner violence and maternal comorbidities: a cross-sectional analysis of the Pregnancy Risk Assessment Monitoring System.","authors":"Micah Hartwell,&nbsp;Ashley Keener,&nbsp;Kristyn Robling,&nbsp;Mackenzie Enmeier,&nbsp;Nicholas B Sajjadi,&nbsp;Benjamin Greiner,&nbsp;Jameca Price","doi":"10.1515/jom-2023-0018","DOIUrl":"https://doi.org/10.1515/jom-2023-0018","url":null,"abstract":"<p><strong>Context: </strong>Intimate partner violence (IPV) occurs when an intimate partner inflicts physical, sexual, and/or emotional assault with coercive control and is a traumatic experience with repercussions that can be exacerbated when a woman is pregnant. While screening for IPV during pregnancy is recommended to occur regardless of risk, less than 50% of pregnant women are screened.</p><p><strong>Objectives: </strong>Identifying clinical factors commonly associated with IPV during pregnancy may improve screening rates, thus our primary objective was to examine associations between IPV and maternal comorbidities.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 spanning 2016 through 2019. Bivariate and multivariable logistic regression was utilized to calculate adjusted odds ratios (AORs) to determine associations between IPV and diabetes, anxiety, hypertension, depression, asthma, polycystic ovary syndrome (PCOS), and thyroid disease.</p><p><strong>Results: </strong>More than 40% of women experiencing IPV reported a history of depression or anxiety. The occurrence of IPV was higher among women with depression (AOR 3.48, CI 3.14-3.85), anxiety (AOR 2.98, CI 2.64-3.37), hypertension (AOR 1.21, CI 1.02-1.44), and asthma (AOR 1.37; CI 1.17-1.59) than women without those respective conditions, but not among diagnoses of diabetes, PCOS, or thyroid disorders.</p><p><strong>Conclusions: </strong>Our findings show that pregnant individuals reporting having experienced IPV were more likely to report having certain comorbidities compared to those who did not report experiencing IPV. Given the low rates of screening, knowing clinically relevant associations may increase screening sensitivity among clinicians and, in turn, increase the likelihood that individuals experiencing IPV receive supportive care.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 8","pages":"405-410"},"PeriodicalIF":1.5,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9856675","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":"Superior-medial pole of the bipartate patella.","authors":"Pin-Yi Tu,&nbsp;Chao-Hsin Huang,&nbsp;Paul Pei-Hsi Chou","doi":"10.1515/jom-2023-0041","DOIUrl":"https://doi.org/10.1515/jom-2023-0041","url":null,"abstract":"","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 8","pages":"413-414"},"PeriodicalIF":1.5,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9904209","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":"Rotator cuff injuries: improving identification with bedside ultrasound.","authors":"Casey McGillicuddy,&nbsp;Douglas Haus","doi":"10.1515/jom-2022-0227","DOIUrl":"https://doi.org/10.1515/jom-2022-0227","url":null,"abstract":"In May 2021, a 53-year-old woman reported falling off her sofa and injuring her right shoulder 4 h before arrival in the emergency department (ED). Since her injury, she has been unable to utilize or raise her right arm. Physical examination demonstrated that the patient was holding her shoulder in an internally rotated position, with limited active and passive range of motion of the shoulder due to pain. The patient was unable to participate in shoulder maneuvers, such as the Empty Can Test, due to pain. The rest of the neurovascular examination of her upper extremity was within the normal limits. An X-ray and bedside ultrasound utilizing a linear probe was performed. For the sonographic image, the patient was sitting upright with her elbow extended and her shoulder internally rotated. The linear probe was placed inferior to the acromion with the marker faced to the anterior and then again to the cephalad. Findings are found in Figure 1. The patient was subsequently diagnosed with a supraspinatus tendon rupture and sent for outpatient MRI and orthopedic follow-up. Because her orthopedic surgeon’s outpatient and procedure notes are unable to be seen from the ED’s electronicmedical record, there is no information on her follow-up. Rotator cuff injuries can be difficult to definitely diagnose within the ED without MRI capabilities. Point-ofcare ultrasound (POCUS) is a valuable tool to accurately determine the presence of full-tendon ruptures, with high sensitivity and specificity of over 90 % [1, 2]. Hypo-echoic fluid disrupting the tendon, which was seen in two different ultrasound orientations, suggests full-thickness tears [3]. These hypo-echoic defects need to disrupt the hyper-echoic tendon fibers through the entire muscle [4].","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 8","pages":"411-412"},"PeriodicalIF":1.5,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10213001","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}