Ethics, Medicine and Public Health最新文献

{"title":"Cadaver dissection and biohazard risks under the specter of bioethics","authors":"M. Pettiti ,&nbsp;L. Nogueira ,&nbsp;L. Lupi ,&nbsp;O. Hamel","doi":"10.1016/j.jemep.2025.101126","DOIUrl":"10.1016/j.jemep.2025.101126","url":null,"abstract":"<div><div>The use of fresh, unembalmed specimens is an essential source for anatomy laboratories in France, and raises the preliminary question of the biological risks associated with their handling. In the context of anatomical work, this exposure is major and the risk concerns all recipients of cadavers: anatomists and researchers, as well as students and laboratory technicians, all of whom are required to handle a freshly deceased person. In view of this, we wondered if the regulations governing the body donation for scientific purposes, recently included in the French bioethics laws, have sufficiently taken this risk into account, and what is really the extent of this risk when we explore the literature.</div><div>Data on the prevalence of infections on anatomical models is disparate, dating back to the last century. The persistence of pathogen viability after death, as described in the literature, does not allow us to reach a scientific consensus on the absence of postmortem contagiousness. The lack of obligation to test bodies prior to anatomical work, despite the risks of accidental injury inherent in handling sharp objects or splashing</div><div>human fluids, could lead to infected bodies being made available, without the knowledge of users. The need to incorporate “biological risk prevention” measures linked to anatomical work into the bioethics laws that have governed body donations since 2021 should also be raised, given that the few studies in this field show a wide disparity in the way these risks are understood and managed. Finally, promoting studies to provide solid scientific evidence on the risks of post-mortem transmission of infectious diseases on bodies kept in cold storage for scientific and educational purposes should be encouraged, to provide a clear and definitive answer to the question of post-mortem contagiousness</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101126"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205146","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":"Incorporating Evidence-Based Medicine into health diplomacy: A strategic imperative for equitable global health","authors":"A. Dutta","doi":"10.1016/j.jemep.2025.101175","DOIUrl":"10.1016/j.jemep.2025.101175","url":null,"abstract":"<div><h3>Background</h3><div>Health diplomacy is an emerging domain within international relations, playing a vital role in addressing global health challenges through multilateral cooperation. Integrating Evidence-Based Medicine (EBM) into health diplomacy offers a systematic and scientific foundation for shaping health policies and interventions.</div></div><div><h3>Objective</h3><div>This article aims to explore the role of EBM in health diplomacy, emphasizing its potential to guide evidence-informed decision-making, strengthen international collaborations, and improve healthcare equity and outcomes globally.</div></div><div><h3>Methods</h3><div>A narrative analysis was conducted, drawing upon interdisciplinary literature and case examples to examine the integration of EBM into diplomatic processes. The study also identifies key challenges and strategic approaches for operationalizing EBM within international health frameworks.</div></div><div><h3>Results</h3><div>The incorporation of EBM into health diplomacy can enhance global health security and intervention efficiency. However, implementation faces barriers including political interests, cultural variations, and disparities in scientific literacy. Promising strategies include establishing evidence translation units, embedding scientific advisors in diplomatic missions, and building capacity among diplomats. The article also highlights the need for incorporating traditional medicine within EBM frameworks, through research, regulation, and respect for cultural diversity.</div></div><div><h3>Conclusion</h3><div>The evolving field of health diplomacy stands to benefit significantly from EBM integration. Addressing challenges and leveraging strategic interventions can enable more effective, equitable, and ethical global health governance. The article recommends enhancing global evidence-sharing mechanisms, promoting cross-sectoral expertise, and establishing ethical guidelines for evidence use in diplomatic contexts.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101175"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903859","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":"Focus philosophy: Transgenderism, conceptual and ethical aspects","authors":"P. Le Coz","doi":"10.1016/j.jemep.2025.101163","DOIUrl":"10.1016/j.jemep.2025.101163","url":null,"abstract":"<div><h3>Context</h3><div>Usually, a person’s identity is defined in terms of their physical characteristics. A “man” is someone who looks like a man; a “woman” is someone who looks like a woman. Our spontaneous criteria are a person’s physical appearance, silhouette and mannerisms. “Man” is a gender assigned to “males” based on physical features: XY karyotype, increased body hair and muscle mass, deeper voice, testosterone dominance, penis, testicles, sperm, etc. “Woman” is a gender assigned to “females” identifiable by a different set of traits: XX karyotype, breasts, estrogen dominance, vulva, clitoris, vagina, ovaries, etc. These different elements are now being debated and called into question in the case of gender dysphoria.</div></div><div><h3>Methodology</h3><div>The theme addressed here is analyzed from a philosophical and ethical perspective. Attention is paid both to the form, dealing with the notions of sex, gender, transgenderism or transexualism, and to the substance, by mobilizing philosophical and ethical principles that enable us to reflect on the notion of identity.</div></div><div><h3>Results/discussion</h3><div>Society posits that gender identity (man, woman) is a matter of biological characteristics (male, female). From a transgender perspective however, a person’s true identity depends on their personal experience. Nobody is better placed to know whether a person is a man or a woman than the person themself, because gender arises from internal bodily experience. Contrary to conventional wisdom, a transgender individual doesn’t necessarily change sex but asserts a different gender from the one assigned to them by society based on biological criteria. Moral dilemmas arise from the moment the transgender person wishes to benefit from a treatment whose effects are dangerous and irreversible. In this case, decisions depend on the therapeutic alliance, physicians being obliged to not perform acts whose efficacy they consider doubtful. Interventions on a healthy body should only be considered if they are based on a firm will and reiterated over long time scale. They can only be covered by health insurance on the basis of a medical indication.</div></div><div><h3>Conclusion/outlook</h3><div>The issue of transgenderism is increasingly being raised in relation to children, an audience for whom caution is particularly important. Their brain is still developing and their desire may evolve so that they no longer feel out of step with their anatomical characteristics. According to the Hippocratic precept, in medicine it is important above all not to harm.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101163"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878775","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":"Health equity checklist for research","authors":"Nipher Malika ,&nbsp;Stacie Salsbury ,&nbsp;Ian Coulter ,&nbsp;Kieran Cooley ,&nbsp;Margaret Chesney ,&nbsp;Marcia Prenguber ,&nbsp;Kim Tippens ,&nbsp;Michele Maiers","doi":"10.1016/j.jemep.2025.101064","DOIUrl":"10.1016/j.jemep.2025.101064","url":null,"abstract":"<div><div>Health equity is the principle of ensuring that all individuals have optimal opportunities to attain the best health possible, addressing disparities in access, outcomes, costs, quality, and appropriateness of care. This focus on health equity is important in healthcare research, driven by the need to investigate systemic injustices and foster fair health outcomes for all, regardless of background or circumstances. Researchers have an ethical imperative to focus on issues relevant to populations bearing the highest burdens of illness and inequities. To address the gap in structured guidance for incorporating health equity principles in health-related research, this study aims to introduce a comprehensive health equity checklist developed by the RAND Research Across Complementary and Integrative Health Institutions (REACH) Center. The checklist is designed to ensure that every stage of the research process integrates health equity considerations. RAND, in collaboration with complementary and integrative health academic institutions across the United States, Canada and Puerto Rico, developed a health equity checklist. They combed through literature to assess existing guidance and developed the checklist based on gaps in literature and the specific needs identified through consultations with community partners and stakeholders. This checklist emphasizes creating a health equity research culture, involving community partners, designing inclusive research/interventions, securing equitable funding, and engaging diverse participants. It also advocates for equitable intervention delivery, data collection, analysis, and effective dissemination and sustainability of research findings. The health equity checklist provides a practical guide for researchers, community partners, and participants to reflect on inclusivity, cultural relevance, and social justice in health research. By implementing this checklist, researchers can ensure that their studies are both inclusive and impactful in advancing health equity across all areas of health-related research. Achieving health equity in research requires a comprehensive approach and significant investment in building sustainable partnerships. The RAND REACH Center's recommendations provide a guide to ensure research advances scientific understanding while actively contributing to health equity. This paradigm shift necessitates support from funding agencies and a long-term commitment to creating equitable health outcomes.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101064"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429536","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":"Health care workers’ attitude toward Covid-19 vaccination campaign in Armenia — A questionnaire analysis","authors":"A. Brotgandel ,&nbsp;G. Ohan ,&nbsp;D. Samvelian ,&nbsp;M. Sahradyan ,&nbsp;A.Z. Oxner ,&nbsp;M.M. Ter-Stepanyan","doi":"10.1016/j.jemep.2025.101137","DOIUrl":"10.1016/j.jemep.2025.101137","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to measure healthcare workers’ opinions at two clinics in Yerevan, Armenia on the Covid-19 vaccine as well as a hypothetical future pandemic, focusing on their views of the best way to respond to it.</div></div><div><h3>Method</h3><div>A survey was sent to all clinical and non-clinical staff, in 2024 and received 185 responses. The results of the survey given in 2024 were divided based on the profession of the healthcare workers, and they were compared to results from a similar survey given in 2021, that received 300 responses.</div></div><div><h3>Results</h3><div>The results showed that healthcare workers’ reasons for getting vaccinated have changed as the pandemic has progressed from mainly being focused on government regulations in 2021 to the need to prevent infections and complications of infections in 2024. Additionally, healthcare workers in Armenia were still mostly hesitant about vaccination in the case of a future pandemic, with only 54.6% having heard of the need to prepare for the next pandemic.</div></div><div><h3>Discussion</h3><div>The significance of this study stems from the understanding that specific cultural and historical factors impact vaccine hesitancy in a society. By considering what local factors affect acceptance of new vaccines in Armenia, new public health interventions can be developed for meeting the WHO goals of preparedness for “Pandemic X.” This study additionally emphasizes that the Armenian healthcare system is not prepared for the next pandemic, especially in reaching the expected threshold for herd immunity.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101137"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280058","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":"Short report: Surrogacy reforms in the Netherlands","authors":"A. den Exter","doi":"10.1016/j.jemep.2025.101133","DOIUrl":"10.1016/j.jemep.2025.101133","url":null,"abstract":"<div><h3>Background</h3><div>In July 2023, a revised draft Law regulating non-commercial surrogacy in the Netherlands was presented to Parliament. The Bill aims to create greater legal certainty for the surrogate mother and intended parents while emphasising the child’s best interests. Key elements of the proposal include: 'surrogacy agreements' that are recorded prior to conception and submitted to the court for approval, and the child’s right to information about parentage. To facilitate this right, a register will be established containing the donor details, information about the surrogate mother, details regarding domestic and foreign adoption, and other general information about biological parentage.</div></div><div><h3>Methodology</h3><div>This brief report examines the proposed normative framework for regulating surrogacy arrangements in the Netherlands from a legal perspective, questioning whether it provides greater legal certainty for the surrogate mother and intended parents.</div></div><div><h3>Results/discussion</h3><div>Key elements of the surrogacy bill are the non-commercial character of surrogacy, judicial review of the surrogacy agreement, and the child's right to parentage information. This draft Law complies with the protective interests of the child under Article 8 of the ECHR and various provisions of the Convention on the Rights of the Child. It also guarantees the reproductive autonomy of the surrogate mother and her right to protection against exploitation. For the intended parents, on the other hand, there is no absolute human rights protection for having a child. In this sense, there is no right of access to surrogacy.</div></div><div><h3>Conclusion</h3><div>The bill leaves some questions unanswered, which would be better addressed by judicial discretion.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101133"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270834","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":"Commercial determinants of infant and child health: A focus on Nestlé’s baby food products marketed in Africa","authors":"E.W. Dumbili ,&nbsp;J. Bwalya ,&nbsp;A. Osborne","doi":"10.1016/j.jemep.2025.101186","DOIUrl":"10.1016/j.jemep.2025.101186","url":null,"abstract":"<div><h3>Background</h3><div>The transnational baby food industry (TBFI), which operates in Africa, engages in aggressive marketing and deploys corporate practices to maximise profits. However, there is a paucity of studies examining the impact and ethical implications of TBFI’s practices on the health of African children. Using the Commercial Determinants of Health (CDoH) framework, we reviewed the recent investigation by Public Eye and the International Baby Food Action Network (IBFAN) on Nestlé’s double-standard practices in Africa, drawing on other published literature to discuss the implications.</div></div><div><h3>Results</h3><div>Nestlé promotes commercial milk formulas and other baby food products with added sugar in Africa, while the same products in Europe are sugar-free. For example, Nestlé’s biscuit-flavoured cereals for babies 6 months plus, available in Switzerland, contain no added sugar. Still, Cerelac cereals with the same flavour sold in Senegal and South Africa contain 6 g of added sugar per serving. Furthermore, Nestlé’s Cerelac wheat-based cereals for six-month-old babies sold in Germany and the UK contain no added sugar. However, the same product available in Ethiopia contains 5.2 g per serving. The investigation further shows that of 114 Nestlé products examined, 93% (106) contained added sugar. Regarding Nestlé’s commercial milk formula for babies aged 1–3 years sold in Africa, 21 out of 29 (i.e., 72%) contained added sugar. Nestlé also practices misinformation because while its product labels in Ethiopia, Nigeria and Senegal provide no information about the added sugar, they “prominently highlighted the vitamins, minerals and other nutrients… using idealizing imagery”.</div></div><div><h3>Conclusion</h3><div>We discuss the implications of this, recommending ways to mitigate Nestlé’s commercial and corporate practices that undermine the health of infants and young children.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101186"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026862","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":"Delivery of perinatal mental health services in India, and the National Nursing and Midwifery Commission Act, 2023: The connotations","authors":"R. Behl","doi":"10.1016/j.jemep.2025.101130","DOIUrl":"10.1016/j.jemep.2025.101130","url":null,"abstract":"<div><h3>Background</h3><div>The WHO recently recommended regular screening of postnatal depression and anxiety, and delivery of treatment interventions, which can be competently undertaken by non-specialist health workers as well. In India, the National Nursing and Midwifery Commission (NNMC) Act, 2023 has been recently enforced to regulate, and maintain standards of education, and services prescribed for nursing and midwifery professionals, and the development and adoption of scientific advancements in healthcare models.</div></div><div><h3>Aim</h3><div>To understand if delivery of perinatal mental health (PMH) services in the context of provisions of the NNMC Act, 2023 can be feasibly undertaken by nursing and midwifery personnel in India, and which group of the personnel can feasibly deliver the same.</div></div><div><h3>Methods</h3><div>Normative Juridical method was used to identify the provisions of the NNMC Act relating to nursing and midwifery personnel, and a comparative interpretative method was utilized to analyze the feasibility of delivery of PHM services by these personnel.</div></div><div><h3>Results</h3><div>The NNMC Act, 2023 expansively differentiates between nursing, and midwifery, and provides for different cadres under the nursing, and midwifery groups of personnel. The Nurse Practitioner in Midwifery (NPM) can most optimally deliver PMH services, and in their absence, Midwifery Professionals can undertake the task through an integrated approach. However, an acute shortage of nursing and midwifery personnel exists at the nationwide level.</div></div><div><h3>Conclusion</h3><div>The NNMC Act, 2023 can facilitate the delivery of PMH services but the number of available human resources must be increased, and the existing healthcare personnel must be sufficiently trained.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101130"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220804","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":"Protection of the elderly patient and preservation of decision-making autonomy at the end of life in Belgian law","authors":"G. Genicot","doi":"10.1016/j.jemep.2025.101046","DOIUrl":"10.1016/j.jemep.2025.101046","url":null,"abstract":"<div><h3>Context</h3><div>In Belgian law, medical decisions are placed under the banner of the patient's <em>self-determination</em>, expressed, if necessary, in the form of <em>binding</em> advance directives or conveyed by a representative – freely chosen, or designated by the law or the judge – who has <em>decision-making powers</em>.</div></div><div><h3>Methodology</h3><div>The way in which the law understands reality differs from that of other disciplines, including the humanities and social sciences. For this subject, reality is studied through the development of rules (issues, content, spirit), but also through their practical application, especially in the case of litigation, through the study of court decisions that may be handed down. This method is used here in relation to end of life.</div></div><div><h3>Results/discussion</h3><div>The patient's decision-making autonomy is the cornerstone of Belgian medical law, and it remains – simply exercised in a different way – when patients are no longer able to exercise their rights themselves. Belgian law provides for (i) an absolute right of an adult patient to refuse any treatment, including in the form of advance directives; (ii) the right to appoint a health proxy whose decision will be binding both on (other) family members and on the doctor; (iii) and, failing that, a \"cascade\" mechanism designating <em>in any event</em> a person empowered to exercise the rights of a patient who is incapable of doing so, and giving the immediate family a decision-making role rather than a merely advisory one, with a hierarchy among family members (priority being given to the spouse, whether married or not).</div></div><div><h3>Conclusion/outlook</h3><div>In medical matters, and especially at the end of life, the crucial point which is illustrated by the legal framework is probably <em>the decision-making model itself</em>. The law should suggest a model which, in this field, is as much societal (and ethical) as strictly legal. In this respect, the scheme set up in Belgian law has the salutary effect to adequately meet the needs of healthcare practice, and the legitimate aspirations of citizens. By placing the centre of gravity of medical decisions on the side of the <em>patient</em> and not the doctor, including at the end of life, it is fundamentally different from a <em>consultation scheme</em>, which results in a decision that is certainly concerted, but remains medical.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101046"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099345","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":"Concerns regarding patient’s safety and oral health risks associated with counterfeit dental materials","authors":"Shalini Kushwaha ,&nbsp;Pooja Puri ,&nbsp;Kavita Goyal ,&nbsp;Christine Jeyaseelan","doi":"10.1016/j.jemep.2024.101038","DOIUrl":"10.1016/j.jemep.2024.101038","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101038"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099353","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}