Journal of the Intensive Care Society最新文献

{"title":"Recovery from Covid-19 critical illness: A secondary analysis of the ISARIC4C CCP-UK cohort study and the RECOVER trial.","authors":"Ellen Pauley,&nbsp;Thomas M Drake,&nbsp;David M Griffith,&nbsp;Louise Sigfrid,&nbsp;Nazir I Lone,&nbsp;Ewen M Harrison,&nbsp;J Kenneth Baillie,&nbsp;Janet T Scott,&nbsp;Timothy S Walsh,&nbsp;Malcolm G Semple,&nbsp;Annemarie B Docherty","doi":"10.1177/17511437211052226","DOIUrl":"https://doi.org/10.1177/17511437211052226","url":null,"abstract":"<p><strong>Background: </strong>We aimed to compare the prevalence and severity of fatigue in survivors of Covid-19 versus non-Covid-19 critical illness, and to explore potential associations between baseline characteristics and worse recovery.</p><p><strong>Methods: </strong>We conducted a secondary analysis of two prospectively collected datasets. The population included was 92 patients who received invasive mechanical ventilation (IMV) with Covid-19, and 240 patients who received IMV with non-Covid-19 illness before the pandemic. Follow-up data were collected post-hospital discharge using self-reported questionnaires. The main outcome measures were self-reported fatigue severity and the prevalence of severe fatigue (severity >7/10) 3 and 12-months post-hospital discharge.</p><p><strong>Results: </strong>Covid-19 IMV-patients were significantly younger with less prior comorbidity, and more males, than pre-pandemic IMV-patients. At 3-months, the prevalence (38.9% [7/18] vs. 27.1% [51/188]) and severity (median 5.5/10 vs 5.0/10) of fatigue were similar between the Covid-19 and pre-pandemic populations, respectively. At 6-months, the prevalence (10.3% [3/29] vs. 32.5% [54/166]) and severity (median 2.0/10 vs. 5.7/10) of fatigue were less in the Covid-19 cohort. In the total sample of IMV-patients included (i.e. all Covid-19 and pre-pandemic patients), having Covid-19 was significantly associated with less severe fatigue (severity <7/10) after adjusting for age, sex and prior comorbidity (adjusted OR 0.35 (95%CI 0.15-0.76, <i>p</i>=0.01).</p><p><strong>Conclusion: </strong>Fatigue may be less severe after Covid-19 than after other critical illness.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"162-169"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225805/pdf/10.1177_17511437211052226.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10376570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking 'Westernised' medical ethics in end-of-life care.","authors":"Emma Jackson,&nbsp;Mike Charlesworth","doi":"10.1177/17511437221075288","DOIUrl":"https://doi.org/10.1177/17511437221075288","url":null,"abstract":"In early 2021, a High Court judge ruled that a 32-year-old woman with COVID-19 in a coma and on VV-ECMO should be allowed to die. This was counter to clearly expressed and sincere wishes of her husband and sister. Many will have encountered similar scenarios, where there is a moral feeling amongst treating clinicians of when it is correct and appropriate to stop. The recent qualitative study from Reader et al. brings out several themes around end-of-life care in ICU that we believe have not yet been addressed sufficiently. Whilst ‘good communication’ with families is often described as important, defining exactly what this involves is problematic, and getting these discussions right is an art that we all labour at for a lifetime. Conflict probably begins when the medical decision has been made and clinicians have formed their own consensus about withdrawing life sustaining therapies, which then makes the issue about justifying this decision and communicating it. Navigating a path between religion, science and ethics at the end-of-life is a difficult and delicate process, and we rightly fall back on our four pillars of medical ethics: autonomy, beneficence, non-maleficence and justice. These govern how we do right by our patient, but they might also lack the finesse required to incorporate religion, faith and conflict. The work by Reader et al. reminds us of the need not to discount the overarching influence of spirituality and religion, and we believe there is a need for us all to be more informed in this regard. Sometimes, these principles can even feel too Westernised and of less relevance to the relatives and loved ones of our patients. They might simply not work, and the result is that best interests are decided ultimately by a judge in court. Whether or not escalation to legal proceedings is inevitable or avoidable for certain cases, or results directly from poor communication, is unclear. During critical illness, we should open channels of communication with family members and spiritual leaders, which must be maintained. The point at which prolongation of life crosses into harm receives little attention in the acute medical literature and it is time for that to change. Reader et al. should be congratulated for getting ‘under the skin’ of an area of clinical practice that is well suited to a qualitative approach. There is arguably much more to do now to increase our understanding and hopefully reflect on whether traditional teachings in medical ethics remain applicable to 21stcentury practice.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"235"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227904/pdf/10.1177_17511437221075288.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A critical care follow-up service evaluation: Acquired peripheral nerve injury after admission with COVID-19 respiratory disease.","authors":"Ellen C Barton,&nbsp;Gearoid Crosbie,&nbsp;Sophie Hobson,&nbsp;Janis Harvey,&nbsp;Ahmad Abu-Arafeh,&nbsp;John A Livesey,&nbsp;Elizabeth Wilson","doi":"10.1177/17511437221075291","DOIUrl":"https://doi.org/10.1177/17511437221075291","url":null,"abstract":"<p><p>Anticipated sequelae of critical care admission for COVID-19 disease remain unclear. Our Edinburgh-based critical care follow-up service identified patterns with nerve injury in 13 of 35 patients who attended following a critical care admission between 15/03/2020 and 25/12/2020. This included 7 cases of meralgia parasthetica, 1 brachial plexopathy, 2 common peroneal neuropathies and 3 ulnar neuropathies. All cases of upper limb neuropathy and foot drop occurred in patients in whom prone positioning was used, with meralgia parasthetica occurring additionally in patients who remained supine.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"230-231"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8804711/pdf/10.1177_17511437221075291.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9908561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORONA (COre ultRasOund of covid in iNtensive care and Acute medicine) study: National service evaluation of lung and heart ultrasound in intensive care patients with suspected or proven COVID-19.","authors":"Prashant Parulekar,&nbsp;James Powys-Lybbe,&nbsp;Thomas Knight,&nbsp;Nicholas Smallwood,&nbsp;Daniel Lasserson,&nbsp;Gavin Rudge,&nbsp;Ashley Miller,&nbsp;Marcus Peck,&nbsp;Jonathon Aron","doi":"10.1177/17511437211065611","DOIUrl":"https://doi.org/10.1177/17511437211065611","url":null,"abstract":"<p><strong>Background: </strong>Combined Lung Ultrasound (LUS) and Focused UltraSound for Intensive Care heart (FUSIC Heart - formerly Focused Intensive Care Echocardiography, FICE) can aid diagnosis, risk stratification and management in COVID-19. However, data on its application and results are limited to small studies in varying countries and hospitals. This United Kingdom (UK) national service evaluation study assessed how combined LUS and FUSIC Heart were used in COVID-19 Intensive Care Unit (ICU) patients during the first wave of the pandemic.</p><p><strong>Method: </strong>Twelve trusts across the UK registered for this prospective study. LUS and FUSIC Heart data were obtained, using a standardised data set including scoring of abnormalities, between 1^st February 2020 to 30th July 2020. The scans were performed by intensivists with FUSIC Lung and Heart competency as a minimum standard. Data was anonymised locally prior to transfer to a central database.</p><p><strong>Results: </strong>372 studies were performed on 265 patients. There was a small but significant relationship between LUS score >8 and 30-day mortality (OR 1.8). Progression of score was associated with an increase in 30-day mortality (OR 1.2). 30-day mortality was increased in patients with right ventricular (RV) dysfunction (49.4% vs 29.2%). Severity of LUS score correlated with RV dysfunction (<i>p</i> < 0.05). Change in management occurred in 65% of patients following a combined scan.</p><p><strong>Conclusions: </strong>In COVID-19 patients, there is an association between lung ultrasound score severity, RV dysfunction and mortality identifiable by combined LUS and FUSIC Heart. The use of 12-point LUS scanning resulted in similar risk score to 6-point imaging in the majority of cases. Our findings suggest that serial combined LUS and FUSIC Heart on COVID-19 ICU patients may aid in clinical decision making and prognostication.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"186-194"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225798/pdf/10.1177_17511437211065611.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9908563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective multicentre observational study to quantify nocturnal light exposure in intensive care.","authors":"Thomas Craig,&nbsp;Steve Mathieu,&nbsp;Clare Morden,&nbsp;Mitul Patel,&nbsp;Lewis Matthews","doi":"10.1177/17511437211045325","DOIUrl":"https://doi.org/10.1177/17511437211045325","url":null,"abstract":"<p><strong>Background: </strong>Disrupted circadian rhythms can have a major effect on human physiology and healthcare outcomes, with proven increases in ICU morbidity, mortality and length of stay.</p><p><strong>Methods: </strong>We performed a multicentre observational study to study the nocturnal lux exposure of patients in 3 intensive care units.</p><p><strong>Results: </strong>The median light intensity recorded was 1 lux over the 6-hour recording period; however, this is deceptive as it hides short periods of high lux. When looked at in shorter time segments of 30 minutes, there were significant periods of lux higher than a crude median, especially in higher acuity patients. There was a positive correlation between acuity (as estimated by SOFA score) and maximum lux (R = 0.479, <i>p</i> = .0001), median lux (R = 0.35, <i>p</i> = .006) and cumulative lux (R = 0.55, <i>p</i> = .000001). There was no relationship between neighbouring patient acuity and lux.</p><p><strong>Conclusions: </strong>Clinicians should practice vigilance at night to provide optimal environmental conditions for patients to minimise potential harm.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"133-138"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227891/pdf/10.1177_17511437211045325.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care echocardiography and thoracic ultrasound in the management of critically ill patients with COVID-19 infection: Experience in three regional UK intensive care units.","authors":"Helen Jordan,&nbsp;Hannah Preston,&nbsp;David P Hall,&nbsp;Hugh Gifford,&nbsp;Michael A Gillies","doi":"10.1177/17511437211045326","DOIUrl":"https://doi.org/10.1177/17511437211045326","url":null,"abstract":"<p><strong>Introduction: </strong>Point-of-care ultrasound (POCUS) has an established role in the management of the critically ill. Information and experience of its use in those with COVID-19 disease is still evolving. We undertook a review of cardiac and thoracic ultrasound examinations in patients with COVID-19 on the intensive care unit (ICU). Our aim was to report key findings and their impact on patient management.</p><p><strong>Methods: </strong>A retrospective evaluation of critically ill patients with COVID-19 was undertaken in three adult ICUs, who received point-of-care cardiac and/or thoracic ultrasound during the 2019-2020 COVID-19 pandemic. We recorded baseline demographic data, principal findings, change in clinical management and outcome data.</p><p><strong>Results: </strong>A total of 55 transthoracic echocardiographic examinations scans were performed on 35 patients. 35/55 (64%) echocardiograms identified an abnormality, most commonly a dilated or impaired right ventricle (RV) and 39/55 (70%) scans resulted in a change in management. Nine patients (26%) were found to have pulmonary arterial thrombosis on CTPA or post-mortem. More than 50% of these patients showed evidence of right ventricular dilatation or impairment. Of the patients who were known to have pulmonary arterial thrombosis and died, 83% had evidence of right ventricular dilatation or impairment. 32 thoracic ultrasound scans were performed on 23 patients. Lung sliding and pleural thickening were present bilaterally in all studies. Multiple B-lines were present in all studies, and sub-pleural consolidation was present bilaterally in 72%.</p><p><strong>Conclusion: </strong>POCUS is able to provide useful and clinically relevant information in those critically ill with COVID-19 infection, resulting in change in management in a high proportion of patients. Common findings in this group are RV dysfunction, multiple B-lines and sub-pleural consolidation.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"147-153"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225795/pdf/10.1177_17511437211045326.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9679431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical illness aspects of heatstroke: A hot topic.","authors":"Jesal Patel,&nbsp;Naomi Boyer,&nbsp;Kwabena Mensah,&nbsp;Syeda Haider,&nbsp;Oliver Gibson,&nbsp;Daniel Martin,&nbsp;Edward Walter","doi":"10.1177/17511437221148922","DOIUrl":"https://doi.org/10.1177/17511437221148922","url":null,"abstract":"<p><p>Heatstroke represents the most severe end of the heat illness spectrum, and is increasingly seen in those undergoing exercise or exertion ('exertional heatstroke') and those exposed to high ambient temperatures, for example in heatwaves ('classical heatstroke'). Both forms may be associated with significant thermal injury, leading to organ dysfunction and the need for admission to an intensive care unit. The process may be exacerbated by translocation of bacteria or endotoxin through an intestinal wall rendered more permeable by the hyperthermia. This narrative review highlights the importance of early diagnosis, rapid cooling and effective management of complications. It discusses the incidence, clinical features and treatment of heatstroke, and discusses the possible role of intestinal permeability and advances in follow-up and recovery of this condition. Optimum treatment involves an integrated input from prehospital, emergency department and critical care teams, along with follow-up by rehabilitation teams and, if appropriate, sports or clinical physiologists.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"206-214"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227888/pdf/10.1177_17511437221148922.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9570827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinical frailty scale - does it predict outcome of the very-old in UK ICUs?","authors":"Dagan O Lonsdale,&nbsp;Liting Tong,&nbsp;Helen Farrah,&nbsp;Sarah Farnell-Ward,&nbsp;Chris Ryan,&nbsp;Ximena Watson,&nbsp;Maurizio Cecconi,&nbsp;Hans Flaatten,&nbsp;Jesper Fjølner,&nbsp;Christian Jung,&nbsp;Bertrand Guidet,&nbsp;Dylan de Lange,&nbsp;Wojciech Szczeklik,&nbsp;Johanna M Muessig,&nbsp;Susannah K Leaver","doi":"10.1177/17511437211050789","DOIUrl":"https://doi.org/10.1177/17511437211050789","url":null,"abstract":"<p><strong>Introduction: </strong>The age of patients admitted into critical care in the UK is increasing. Clinical decisions for very-old patients, usually defined as over 80, can be challenging. Clinicians are frequently asked to predict outcomes as part of discussions around the pros and cons of an intensive care unit (ICU) admission. Measures of overall health in old age, such as the clinical frailty scale (CFS), are increasingly used to help guide these discussions. We aimed to understand the characteristics of the very-old critically unwell population in the UK and the associations between frailty and outcome of an ICU admission in our healthcare system (National Health Service, NHS).</p><p><strong>Methods: </strong>Baseline characteristics, ICU interventions and outcomes (ICU- and 30-day mortality) were recorded for sequential admissions of very old patients to UK ICUs as part of the European VIP 1 and 2 studies. Patient characteristics, interventions and outcome measures were compared by frailty group using standard statistical tests. Multivariable logistic regression modelling was undertaken to test association between baseline characteristics, admission type and outcome.</p><p><strong>Results: </strong>1858 participants were enrolled from 95 ICUs in the UK. The median age was 83. The median CFS was 4 (IQR 3-5). 30-day survival was significantly lower in the frail group (CFS > 4, 58%) compared to vulnerable (CFS = 4, 65%) and fit (CFS < 4 68%, <i>p</i> = .004). Sequential organ failure assessment (SOFA) score, reason for admission and CFS were all independently associated with increased 30-day mortality (<i>p</i> < .01).</p><p><strong>Conclusion: </strong>In the UK, frailty is associated with an increase in mortality at 30-days following an ICU admission. At moderate frailty (CFS 5-6), three out of every five patients admitted survived to 30-days. This is a similar mortality to septic shock.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"154-161"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227901/pdf/10.1177_17511437211050789.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10290684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous renal replacement therapy in patients receiving extracorporeal membrane oxygenation therapy.","authors":"Meera Raja,&nbsp;Ricardo Leal,&nbsp;James Doyle","doi":"10.1177/17511437211067088","DOIUrl":"https://doi.org/10.1177/17511437211067088","url":null,"abstract":"<p><p>Methods of continuous renal replacement therapy (CRRT) in extracorporeal membrane oxygenation (ECMO) patients include dedicated central venous cannula (CVC) (vCRRT), in-series with filter connected to ECMO circuit (eCRRT) or in-line with haemodiafilter incorporated within ECMO circuit. We assessed the efficacy and safety of eCRRT versus vCRRT in 20 ECMO-CRRT patients. Average filter lifespan was 42 vs 28 hours and filter runs completing 72hours were 40% vs 13.8% (eCRRT vs vCRRT, respectively). One incidence of ECMO circuit air embolus occurred (vCRRT). eCRRT achieved adequate filtration and increased filter lifespan, and has become our default for ECMO-CRRT if a pre-existing dialysis CVC is not present.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"227-229"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227899/pdf/10.1177_17511437211067088.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10290685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical illness related cardiac arrest: Protocol for an investigation of the incidence and outcome of cardiac arrest within intensive care units in the United Kingdom.","authors":"Robert Darnell,&nbsp;Christopher Newell,&nbsp;Julia Edwards,&nbsp;Emma Gendall,&nbsp;David Harrison,&nbsp;Stefan Sprinckmoller,&nbsp;Paul Mouncey,&nbsp;Doug Gould,&nbsp;Matt Thomas","doi":"10.1177/17511437221086890","DOIUrl":"https://doi.org/10.1177/17511437221086890","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"222-223"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227896/pdf/10.1177_17511437221086890.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}