Hospital pediatrics最新文献

{"title":"Mistreatment Among Pediatric Faculty in the United States and Association With Organizational Culture.","authors":"Heidi M Kloster, Samudragupta Bora, Ariella Slovin, Stephen R Rogers, Arvin Garg, Kathi Kemper, Steven M Selbst, Janet R Serwint, Sylvia Lim","doi":"10.1542/hpeds.2024-008243","DOIUrl":"10.1542/hpeds.2024-008243","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to examine self-reported rates of workplace mistreatment among pediatric faculty from a national academic organization and explore the association between organizational culture and faculty mistreatment.</p><p><strong>Design/methods: </strong>This cross-sectional analysis used data from the Academic Pediatric Association Well-Being Survey administered in November 2019. Faculty reported mistreatment experiences and sources in the prior 12 months, categorized into bullying, discrimination, sexual harassment, other harassment, and violence. Sources included supervisors, colleagues, trainees, patients, and others. Organizational culture was assessed through 7 adapted items: perceived appreciation, value alignment, support from colleagues and leadership, schedule control, and chaotic environment. Responses were recorded on a 4-point Likert scale. Overall organizational culture score was calculated, and correlation analysis was performed to assess the relationship with mistreatment rates.</p><p><strong>Results: </strong>Of 349 survey respondents (a 19% response rate), the study population included 320 faculty (77% women, 77% non-Hispanic white), with 43% at Instructor/Assistant Professor rank. Twenty-three percent experienced at least 1 type of mistreatment, and 14% experienced 2 or more types. The most common was bullying (23%), followed by discrimination (17%). Despite 61% reporting a chaotic work environment, most faculty perceived their environment as collaborative (92%), felt appreciated (79%), and supported by peers (94%) and leadership (80%). A negative correlation was found between organizational culture quality and mistreatment frequency (Pearson correlation = -0.43, P < .001).</p><p><strong>Conclusions: </strong>More than one-third of pediatric faculty reported mistreatment, an unacceptably high rate. Although organizational culture was generally positive, a chaotic environment was common. Better organizational culture was associated with lower mistreatment rates, suggesting that improving culture may help reduce mistreatment and enhance faculty well-being.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"814-820"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041860","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":"Prevalence of Serious Infection Among Hypothermic Young Infants Across Medical Settings.","authors":"Tran H P Nguyen, Beverly R Young, Lea M Bornstein, Zahra Samiezade-Yazd, Tara L Greenhow","doi":"10.1542/hpeds.2024-008257","DOIUrl":"10.1542/hpeds.2024-008257","url":null,"abstract":"<p><strong>Objective: </strong>We aim to determine the prevalence of urinary tract infection (UTI) and invasive bacterial infection (IBI) (bacteremia or bacterial meningitis) in hypothermic young infants presenting to outpatient clinics and emergency departments (EDs) and to identify associated risk factors.</p><p><strong>Method: </strong>This is a retrospective cohort study of infants aged 0 to 60 days presenting with a temperature of 36 °C or below to any medical facility in a large integrated health care delivery organization from 2010 to 2022. The proportion of infants with UTI, IBI, and herpes simplex virus (HSV) were calculated. Multivariable logistic regression analysis identified risk factors for UTI or IBI.</p><p><strong>Results: </strong>Of 3783 infants, 15 (0.40%; 95%, CI 0.22%-0.65%) had UTI, 11 (0.29%; 95% CI, 0.15%-0.52%) had IBI, and 2 (0.05%; 95% CI 0.01%-0.19%) had HSV infection. Only 0.38% of infants presenting to outpatient clinics had UTI or IBI vs 1.48% of infants presenting to EDs (P < .001). Ill appearance (adjusted odds ratio [aOR], 7.3; 95% CI, 3.1-17.4), repeated low temperature (aOR, 6.7; 95% CI 2.7-16.6), and chief concern of hypothermia (aOR, 4.2; 95% CI, 1.8-10.0) were identified as clinical risk factors for UTI or IBI. Twelve of 15 infants with UTI and all 11 infants with IBI presented with at least 1 of these 3 risk factors.</p><p><strong>Conclusion: </strong>The prevalence of UTI and IBI among our cohort of hypothermic infants presenting to any medical setting was low. Regardless of the setting, infants with clinical symptoms of ill appearance, repeated low temperature, or chief concern of hypothermia had significantly increased risk of infection. Hypothermic infants lacking these risk factors may not require extensive infectious evaluation.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"795-803"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065929","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":"Implementing a Quality Improvement Writing Program to Increase Scholarly Productivity.","authors":"Prabi Rajbhandari, Samantha M Gunkelman, Thomas P Wolski, Kerwyn C Jones, Michael T Bigham","doi":"10.1542/hpeds.2025-008405","DOIUrl":"10.1542/hpeds.2025-008405","url":null,"abstract":"<p><strong>Background: </strong>Quality improvement (QI) is essential in health care systems across the United States. Despite numerous QI projects and methodologies being utilized, the publication and dissemination of these findings are often inadequate. The objective was to develop and implement a QI writing program to enhance the dissemination of ongoing QI projects at a children's hospital.</p><p><strong>Methods: </strong>A structured 10-session, biweekly QI writing program was implemented, with each session lasting 1 hour. Participants were selected through a nomination process and paired with mentors in a dyadic model. Feedback was systematically collected through evaluation forms and postcohort in-person sessions. Time intervals from program completion to manuscript submission and subsequent publication were tracked to assess program outcomes.</p><p><strong>Results: </strong>Four cohorts of the QI writing program were conducted, delivering 40 hours of instruction to 13 participants. Feedback was received from 92% (12/13) of participants, with 90% rating their overall satisfaction and likelihood to recommend the course as \"very positive.\" Of the participants, 92.3% (12/13) submitted their manuscripts to peer-reviewed journals. Of these, 9 are published, and 3 are under review at the time of this manuscript. The median time for completion of the program to manuscript submission was 46 days.</p><p><strong>Conclusion: </strong>A QI writing program was successfully implemented to facilitate the dissemination of QI projects. Participants found the course valuable in enhancing their writing skills and supporting successful publication.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e495-e499"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151390","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":"Pediatric Order Set Utilization and Infrastructure Within a Regional Care Network.","authors":"Kaitlyn McQuistion, Allison Markowsky, Sonal Kalburgi, Laura O'Neill, Lauren McGovern, Stacey Stokes, Padmaja Pavuluri","doi":"10.1542/hpeds.2024-008192","DOIUrl":"10.1542/hpeds.2024-008192","url":null,"abstract":"<p><strong>Objective: </strong>To describe institutional variation in standardized order set (SOS) utilization and SOS infrastructure within a regional pediatric care network.</p><p><strong>Patients and methods: </strong>This preliminary cross-sectional study explores SOS utilization and infrastructure at 5 pediatric hospital medicine services across a regional network. SOS utilization was calculated as the proportion of patient encounters where a diagnosis-based SOS was used for patients admitted with a diagnosis of asthma, bronchiolitis, skin and soft tissue infection, gastroenteritis, or pneumonia between July 1, 2019, and June 30, 2023. SOS infrastructure was measured by a novel survey based on the Clinical Decision Support (CDS) Operations Maturity Model and the Unified Theory of Acceptance and Use of Technology.</p><p><strong>Results: </strong>Average SOS utilization ranged between 53% and 86% of patient encounters by site and between 45% and 79% of patient encounters by diagnosis, with higher utilization for more common diagnoses. SOS infrastructure varied by construct. Most sites had guideline-based content creation attentive to user feedback. Data access was via ad hoc request and self-service access. Data analytics were limited to basic SOS usage, with opportunities for improvement in association with clinical outcomes, identifying errors, and interorganizational benchmarking. SOS governance and management varied widely, with only the freestanding children's hospital having a robust, interdisciplinary SOS committee. Integration with other CDS and required triennial review were also inconsistent.</p><p><strong>Conclusions: </strong>We found opportunities for improvement in both SOS utilization and SOS infrastructure. Future research is needed to validate the SOS infrastructure survey, explore the relationship between SOS utilization and infrastructure in a national sample, and investigate the impact on clinical outcomes.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e478-e486"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993864","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":"Impact of Body Mass Index on Adverse Events in Children Undergoing Sedation for MRI.","authors":"Jaimee S Holbrook, Jason M Kane, Mei Han, Nick Barrowman, Lara Bencsics, Mark K Abe, Daniel S Tsze","doi":"10.1542/hpeds.2025-008455","DOIUrl":"10.1542/hpeds.2025-008455","url":null,"abstract":"<p><strong>Objectives: </strong>More than 20% of children in the United States have a nonhealthy body mass index (BMI). Magnetic resonance imaging is a common procedure necessitating sedation in children, including those with nonhealthy BMI values. We aimed to determine the risk of adverse events (AEs) and airway interventions associated with BMI in this population.</p><p><strong>Methods: </strong>A retrospective cross-sectional study of children undergoing sedation for MRI at 66 centers participating in the Pediatric Sedation Research Consortium was conducted. BMI values were categorized as underweight, healthy weight, overweight, obesity, and severe obesity. Outcomes were AEs and airway interventions. AEs were categorized as major, moderate, or minor, and airway interventions were categorized as major or minor. We used multivariable logistic regression to determine the risk of AEs and airway interventions associated with BMI.</p><p><strong>Results: </strong>We analyzed 39 393 children; 3132 (8%) were underweight, 5476 (13.9%) were overweight, 4446 (11.2%) had obesity, and 1123 (2.9%) had severe obesity. Risk of major and moderate AEs in children categorized as underweight, overweight, obesity, and severe obesity were adjusted odds ratio (aOR) 1.22 (95% CI: 1.04-1.4), 1.58 (95% CI 1.41-1.74), 1.8 (95% CI 1.55-2.04), and 1.86 (95% CI 1.59-2.13), respectively. Risk of major airway interventions in those with BMI values in the overweight, obesity, and severe obesity categories were aOR 1.61 (95% CI 1.44-1.78), 1.83 (95% CI 1.58-2.09), and 1.9 (95% CI 1.62-2.18).</p><p><strong>Conclusions: </strong>Children undergoing sedation for MRI categorized as overweight, obesity, and severe obesity are at increased odds of AEs and airway interventions. Children who are underweight have increased odds of AEs.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"852-860"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186775","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":"Implementation of Emergency Information Forms and Impact on Health Outcomes: A Long Time Coming.","authors":"Christian D Pulcini","doi":"10.1542/hpeds.2025-008623","DOIUrl":"10.1542/hpeds.2025-008623","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e446-e448"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776417","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":"What Happens When We Miss? Effect of Initial Lumbar Puncture Success on Infant Sepsis Evaluation.","authors":"Amanda Dube, Manaswitha Khare, Michael Levy, Michelle Edmunds, Aarti Patel, Begem Lee, Tiranun Rungvivatjarus, Elizabeth Mannino Avila","doi":"10.1542/hpeds.2024-008289","DOIUrl":"10.1542/hpeds.2024-008289","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lumbar punctures (LPs) are a common part of infant sepsis evaluations. Failures are estimated at 12% to 40%. Given limited literature on this topic, we describe characteristics, management, and outcomes for infants undergoing sepsis workup with successful vs unsuccessful initial LPs, including those who underwent repeat LP attempt.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study of infants aged 0 to 60 days with LP performed during sepsis evaluation. Infants admitted to intensive care units, transferred from another hospital's inpatient unit, or with medical complexity were excluded. Descriptive statistics and logistic regression were performed.</p><p><strong>Results: </strong>Of 468 infants, 386 had a successful initial LP (82%). Length of stay (LOS) was longer in infants with an unsuccessful initial LP (P = 0.02). Demographics, length of antibiotics, and readmission rate did not differ between groups. Infants with successful initial LPs were less likely to have viral testing (P = 0.019) and had shorter acyclovir courses (P = 0.026). Only 43% of infants with an unsuccessful initial LP underwent repeat LP attempt. Increased inflammatory markers were associated with repeat LP attempt.</p><p><strong>Conclusions: </strong>Infants with unsuccessful initial LPs had increased LOS and resource use. Elevated inflammatory markers were associated with repeat LP attempt, and infants with repeat LPs had higher medical utilization. Prospective or multicenter studies are needed to further investigate outcomes and decision-making for infants with unsuccessful LPs and inform guidelines regarding repeat LPs.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"758-768"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795798","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":"Rising Incidence of Pediatric Catatonia and Medical Etiology: Multiyear Trends.","authors":"Stephanie A Lichtor, Erin Dunn, Aliza Ray, Charles Wulff, Yohanis Anglero-Diaz, Ryan O'Connor, Maggie Schneider, Amanda B Warwick, Chase B Samsel","doi":"10.1542/hpeds.2025-008373","DOIUrl":"10.1542/hpeds.2025-008373","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric catatonia is a neuropsychiatric syndrome due to a medical diagnosis and/or psychiatric disorder and is often underrecognized and undertreated, with significant morbidity and mortality. Given limited published data, we examine its presentation, assessment, and treatment by etiology. We hypothesized increased incidence over time.</p><p><strong>Methods: </strong>Retrospective medical record review of patients younger than age 19 years diagnosed with catatonia at a quaternary care pediatric hospital from 2018 to 2023 admitted to the hospital's emergency department and/or hospital. Sociodemographic and clinical data, including laboratory tests, imaging, and treatment, were reported and subcategorized and compared by catatonia etiology and presence or absence of a neurodevelopmental disorder.</p><p><strong>Results: </strong>Fifty-two patients met inclusion criteria. There was a statistically significant increase in catatonia over the study period, particularly among catatonia associated with a medical diagnosis (P = .002), with more than double the number of catatonia cases from 2021 to 2023 (9.7 per 1000 psychiatry consults) compared with cases identified from 2018 to 2020 (3.9 per 1000 psychiatry consults; P = .002). Diagnostic work up was generally similar regardless of etiology. Most patients with medical etiology alone had autoimmune encephalitis (70%) and abnormal electroencephalograms (P = .006). Higher average lorazepam doses were used to treat catatonia associated with a medical etiology (P = .007).</p><p><strong>Conclusions: </strong>Our study identified significantly increased pediatric catatonia incidence and frequency of medical etiology over the study period. There were also differences in the presentation, diagnostic results, and treatment by catatonia etiology. Protocols accounting for these differences and more comprehensive etiologic surveillance in pediatric patients could be valuable.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"711-720"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875730","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":"A Quality Improvement Initiative to Improve the Discharge Process for Spanish-Speaking Patients.","authors":"Chloe Kupelian, Begem Lee, Sarah Gray, Aarti Patel, Tiranun Rungvivatjarus, Maria Huang, Michelle Polich, Heather Pierce","doi":"10.1542/hpeds.2024-008227","DOIUrl":"10.1542/hpeds.2024-008227","url":null,"abstract":"<p><strong>Objective: </strong>Patients with a primary language of Spanish are more likely to receive inequitable care at hospital discharge (DC). National quality measures advocate for language concordance in verbal and written communication. Our aim was to increase the percentage of Spanish-speaking patients (SSPs) discharged from the hospital medicine service with translated documents from 65.5% to 82% in 5 months.</p><p><strong>Methods: </strong>We formed an interdisciplinary quality improvement team and created a process map to highlight each step of DC. Ishikawa diagrams completed by key stakeholders identified lack of standardized DC translation workflow and informed interventions. Primary measure: percentage of patients with translated DC documents. Process measures: percentage of SSPs who had DC translation orders placed and percentage ordered by providers. Balancing measure: length of stay (LOS). Our cycles of intervention included education and electronic medical record (EMR) modifications. We reviewed and analyzed measures biweekly using established rules for statistical process control charts.</p><p><strong>Results: </strong>Baseline data showed 65.5% of SSPs received translated DC instructions. We noted special-cause variation starting at intervention 2 with a centerline shift to 88%. The percentage of SSPs with DC translation orders increased from 54% to 82%. The percentage of DC translation ordered by providers increased from 11% to 75%. There was no difference in LOS for SSPs with translated documents pre-interventions and post-interventions.</p><p><strong>Conclusion: </strong>Using the Model for Improvement, we achieved our aim and successfully increased the percentage of SSPs with translated DC documents. Future studies should focus on automaticity within the EMR to increase reliability.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"721-729"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822813","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 the Educational Landscape of Culturally Responsive Education in Pediatric Critical Care Fellowships.","authors":"Christine Joyce, Cody Gathers, Anireddy Reddy, Adrian D Zurca, Marianne E Nellis, Nonye Acholonu, Angela Czaja, Erika Abramson, Katie R Nielsen, Joy Howell, Monica Koncicki, Donald L Boyer","doi":"10.1542/hpeds.2024-008255","DOIUrl":"10.1542/hpeds.2024-008255","url":null,"abstract":"<p><strong>Objective: </strong>Health disparities persist among marginalized racial, ethnic, and lower socioeconomic status groups, extending to pediatric intensive care units. Complex interactions between structural forces and provider biases influence patients' risk for critical illness, access, timing, and quality of care. An understanding of how these social influencers of health directly impact health outcomes should be necessary components of pediatric critical care medicine (PCCM) fellowship. Currently, no uniform guidelines exist that provide training in diversity, equity, and inclusion (DEI) in PCCM. We therefore sought to describe the current state of DEI education in PCCM fellowship programs from the program director (PD) perspective.</p><p><strong>Methods: </strong>A national survey was conducted among Accreditation Council for Graduate Medical Education-accredited PCCM fellowship PDs to evaluate the state of DEI education. The survey, developed collaboratively and iteratively, encompassed program details, DEI teaching modalities, barriers, and PD perspectives. Statistical analysis was performed using descriptive statistics.</p><p><strong>Results: </strong>Of the 76 PDs surveyed, 47 responded (62% response rate). Although 57% of PDs recognized DEI education as a divisional priority, only 34% had a formal DEI curriculum. Barriers to DEI education included lack of trained faculty, attending time, and engagement. Notably, PDs expressed concerns about faculty competence in delivering DEI education and the scarcity of underrepresented in medicine physicians across trainees and faculty.</p><p><strong>Conclusions: </strong>The findings reveal significant gaps in DEI education within PCCM fellowship programs. Despite recognition of DEI importance, formalized curricula are lacking. The study underscores the necessity for tailored educational interventions and strategies to optimize care.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e440-e445"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838040","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}