Canadian Journal of Respiratory Therapy最新文献

{"title":"Effect of the EzPAP system on tidal volume and airway pressures in healthy adults.","authors":"Kerrie Saliba, Felicity Blackstock, Bredge McCarren, Clarice Tang","doi":"10.29390/001c.163541","DOIUrl":"10.29390/001c.163541","url":null,"abstract":"<p><p>The EzPAP system generates positive inspiratory and expiratory pressures to increase lung volumes, yet limited evidence describes how different flow settings influence its physiological effects. This study examined the impact of EzPAP on tidal volume (VT), minute ventilation (VE), airway pressures, and physiological responses in healthy adults. # Methods A prospective repeated‑measures study was conducted in 26 healthy adults. VT, VE, airway pressures, respiratory rate, perceived exertion, discomfort, and hemodynamic variables were recorded at baseline and during EzPAP use across seven flow settings, flowEzPAP (0-15 L/min). Generalized linear mixed models evaluated the effects of flowEzPAP on all outcomes. # Results Compared to zero flowEzPAP, VT increased with higher flowEzPAP, with a mean difference of 0.35 L at 15 L/min (<i>p</i> < .001). VE decreased, with the greatest mean reduction of 0.84 L/min at 13 L/min (<i>p</i> < .001). Peak inspiratory (PIP), peak expiratory (PEP), and end‑expiratory (PEEP) pressures rose significantly with flowEzPAP, with greatest mean increases of 5.40, 15.06, and 13.33 cmH₂O at 15 L/min (all <i>p</i> < .001). PIP and PEP predicted VT, and all pressures predicted VE (<i>p</i> < .001). Respiratory rate decreased, while exertion and discomfort increased at higher flows. One transient adverse event occurred at the highest flowEzPAP. # Discussion EzPAP produced clinically relevant increases in lung volumes and airway pressures with minimal physiological disturbance in healthy adults. Threshold flowEzPAP settings were identified for achieving therapeutic expiratory pressures. # Conclusion EzPAP safely increased VT and airway pressures in healthy adults, supporting further evaluation in clinical populations with reduced lung volumes or risk of atelectasis.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"62 ","pages":"117-126"},"PeriodicalIF":1.8,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13310550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346245","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":"Asynchrony index modified: An improved tool for estimating the quality of patient-ventilator interaction.","authors":"Andres Mauricio Enriquez Popayan, Longxiang Su","doi":"10.29390/001c.161382","DOIUrl":"10.29390/001c.161382","url":null,"abstract":"<p><strong>Background: </strong>Patient-ventilator asynchronies are a common occurrence among patients receiving ventilatory support. Their clinical relevance has been explored for decades, most often through the Asynchrony Index, a simple and widely applicable tool. However, this index, it seems, may have some limitations and might not fully capture recent advances in understanding ventilatory asynchronies.</p><p><strong>Methods: </strong>Propose a novel index, the Asynchrony Index Modified (AIM), as an alternative conceptual approach intended to better reflect current understanding in this field. This index incorporates additional dimensions, including the type, intensity, and duration of asynchrony events, which could allow for a more nuanced estimation of the overall burden of patient-ventilator mismatch.</p><p><strong>Results: </strong>The AIM is conceived as a practical, non-invasive, and reproducible tool that can be applied at the bedside. The AIM could be quantified and may provide a complementary approach for exploring differences between distinct types of patient-ventilator asynchrony, with possible variation according to exposure time and asynchrony intensity.</p><p><strong>Conclusion: </strong>The AIM is consistent with the principles of precision mechanical ventilation and may represent a step forward in adapting assessment strategies to the evolving understanding of patient-ventilator asynchronies. However, it is important to consider that this proposal is based on a conceptual model, and further research may be necessary to evaluate the AIM, explore its clinical applicability, and establish clinically relevant cutoff values.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"62 ","pages":"110-116"},"PeriodicalIF":1.8,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017787","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":"Content validation of a structured questionnaire to assess the knowledge, attitudes, and practices of respiratory therapists regarding education for COPD self-management.","authors":"Jhojan Sebastian Herrera-Vargas, Carlos Alberto Rojas Arbeláez, Juan Camilo Méndez Rendón, Alfredo Hernández-Ruíz","doi":"10.29390/001c.161832","DOIUrl":"10.29390/001c.161832","url":null,"abstract":"<p><strong>Introduction: </strong>Self-management education is a fundamental pillar in the non-pharmacological management of chronic obstructive pulmonary disease (COPD), and respiratory therapists (RTs) play a central role in this process. In Colombia, the heterogeneity of training programs may lead to differences in the knowledge, attitudes, and practices (KAP) of RTs. In this context, the present study aimed to validate the content of an instrument designed to assess RTs' KAP regarding self-management education.</p><p><strong>Methods: </strong>The instrument, consisting of 25 items distributed across three components (knowledge, attitudes, and practices), was developed by an interdisciplinary team and evaluated by experts in respiratory therapy with experience in COPD and teaching. The evaluation was conducted using an online questionnaire that assessed the dimensions of Relevance, Clarity, Coherence, and Vocabulary on a 0-to-5 Likert scale. To complement the analysis, the I-CVI, S-CVI/Ave, and Aiken's V coefficient were calculated.</p><p><strong>Results: </strong>Ten of the twelve invited experts completed the evaluation (83.3%). All had training in respiratory therapy and extensive clinical and teaching experience in the management of patients with COPD (<i>n</i> = 10, 100%). Ninety-six percent of the items obtained an I-CVI ≥ 0.78, with Aiken's V values ranging from 0.84 to 1.00. At the scale level, the S-CVI/Ave was 0.96 for Relevance, 0.88 for Clarity and Coherence, and 0.98 for Vocabulary, with a global S-CVI/Ave of 0.94. The lowest scores were observed in the Clarity and Coherence dimension of the Knowledge component (items Q1, Q3, and Q8).</p><p><strong>Discussion: </strong>The results showed that the instrument has high content validity for assessing the KAP of RTs regarding self-management education for COPD. Although some items in the Knowledge component within the Clarity and Coherence dimension had an I-CVI < 0.78, Aiken's V values indicated a positive evaluation by the experts, which justified not making any modifications. The differences observed in the Clarity and Coherence dimension are consistent with previous findings regarding the complexity of technical knowledge items. This instrument can guide the implementation of educational strategies, professional training, and future psychometric studies, such as construct validity and reliability assessments.</p><p><strong>Conclusion: </strong>The designed instrument demonstrated excellent content validity in Relevance and Vocabulary components and good validity in the Clarity and Coherence component, with items that were relevant, clear, coherent, and used appropriate vocabulary, as supported by I-CVI, S-CVI/Ave, and Aiken's V.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"62 ","pages":"99-109"},"PeriodicalIF":1.8,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13192495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017833","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":"Home mechanical ventilator device transitions: A narrative review of clinical considerations to create a transition tool.","authors":"Nisha Cithiravel, Samantha Mekhuri, Carmel Baratz, Jessie Cunningham, Andrews Tawiah, Reshma Amin","doi":"10.29390/001c.160696","DOIUrl":"10.29390/001c.160696","url":null,"abstract":"<p><strong>Objective: </strong>Home mechanical ventilation (HMV) provides chronic respiratory support through invasive or non-invasive ventilation. Ventilator assisted individuals (VAI) represent a complex population with highly specialized care needs and increased healthcare utilization. The global Phillips Respironics recall resulted in the need to transition many VAI in Ontario to the alternative ResMed Astral 150 ventilator device. HMV device transitions are complex and require careful planning. The purpose of this narrative review is to assess clinical considerations for ventilator transition in patients receiving HMV in exisiting literature over the past 20 years to support the build of a ventilator key consideration checklist tool.</p><p><strong>Methods: </strong>A narrative review of literature from two online databases (Ovid MEDLINE(R) ALL and EBSCOhost CINAHL Plus) was conducted to identify relevant articles. The review was completed in a systematic approach via Covidence.</p><p><strong>Results: </strong>Evidence and key considerations were grouped into four themes: Patient Ventilator Synchrony, Equipment Selection, Interface and Circuit Considerations, Bench Testing and Ventilator Performance, and Standardization and Interdisciplinary Approach. Successful transitions require a standardized, interdisciplinary approach with appropriate readiness assessments, clearly defined failure criteria, a patient-centered approach, and strong knowledge of ventilator performance and available adjunctive supports. There is limited existing literature in providing guidance for safety switching ventilators for HMV patients. Further research is needed to guide data-driven development and implementation of standardized protocols as well as assessment of long-term patient and family outcomes.</p><p><strong>Conclusion: </strong>Switching home mechanical ventilator devices for VAI is a complex process and requires careful planning with interdisciplinary collaboration, patient-centred focus, and evidence-based guidelines.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"62 ","pages":"87-98"},"PeriodicalIF":1.8,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964942","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 hybrid in-person and online group singing program for older adults with breathing limitations: A pilot mixed-methods study.","authors":"Nicole Marquis, Pamela Tanguay, Louise Drouin, Jane Gosine, Yves Couturier, Vincent Martel-Sauvageau, Véronique Provencher","doi":"10.29390/001c.161383","DOIUrl":"10.29390/001c.161383","url":null,"abstract":"<p><strong>Introduction: </strong>Group singing (GS) programs have emerged as a promising option to address both the respiratory and psychological needs of patients with breathing limitations. No study has documented a hybrid delivery mode that simultaneously combines in-person and online modalities. This study aims to explore participants' experiences and the effects on respiratory control, quality of life, and social inclusion of a hybrid GS program that includes in-person and online groups.</p><p><strong>Methods: </strong>Using a mixed-method convergent design, we recruited twenty individuals with breathing limitations. The GS program was delivered weekly over 12 weeks, with sessions lasting two hours. Participants joined either in person (<i>n</i> = 12) or online (<i>n</i> = 8). Pulmonary health, quality of life, and social inclusion were assessed using questionnaires at baseline, post-intervention, and 3 months post-intervention. Semi-structured interviews explored participants' experiences and perceived effects, analyzed thematically and inductively.</p><p><strong>Results: </strong>Participants primarily attended either in person or online. Both groups reported a sense of connection with the other participants but expressed concerns about using the technology. Online participants valued the opportunity to engage despite mobility or health limitations, though technological challenges affected feedback and group cohesion. Quantitative and qualitative findings revealed perceived improvements in pulmonary health and social inclusion, despite mixed outcomes regarding overall quality of life.</p><p><strong>Conclusion: </strong>Hybrid GS programs are well-received and beneficial for individuals with breathing limitations. They offer a promising complement to traditional pulmonary rehabilitation by enhancing accessibility and supporting long-term engagement.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"62 ","pages":"74-86"},"PeriodicalIF":1.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13157229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869817","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":"Association of inhalation injury with ventilator-associated pneumonia and clinical outcomes in critically ill patients with burns: A retrospective study.","authors":"Tatiana C Normann, Priscila Bellaver, Bianca I Limeira, Gabrielle B Dorneles, Mariane S Oliveira, Tatiana H Rech","doi":"10.29390/001c.159978","DOIUrl":"10.29390/001c.159978","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of inhalation injury on the outcomes of patients with burns, especially ventilator-associated pneumonia (VAP) and mortality.</p><p><strong>Methods: </strong>Single-center retrospective study of patients admitted to the intensive care unit (ICU) with burn injuries. Data were obtained from medical records. The primary outcome was VAP incidence in patients with or without inhalation injury. Secondary outcomes included need and duration of mechanical ventilation (MV), incidence of acute respiratory distress syndrome (ARDS), rates of reintubation and tracheostomy, need for vasopressors and renal replacement therapy (RRT), length of ICU and hospital stay, hospital mortality, and comparison between survivors and non-survivors.</p><p><strong>Results: </strong>From January 2017 to December 2023, 242 patients with a median burn surface area of 23% (15%-37%) were included. The incidence of inhalation injury was 9.9% (<i>n</i> = 24). The overall incidence of VAP was 23%. VAP incidence was significantly higher in patients with inhalation injury than in those without inhalation injury (RR 2.1, CI 1.9-3.8) (<i>p</i> < 0.012). After adjustment for age, burn surface area, and duration of MV, the RR remained significant (2.1, CI 1.2-3.7) (<i>p</i> = 0.009). Patients with inhalation injury had higher rates of reintubation (12.5% vs. 2.8%, <i>p</i> = 0.048) and tracheostomy (54.2% vs. 21.6%, <i>p</i> < 0.001). The incidence of inhalation injury was similar in survivors and non-survivors (11.2% vs. 5.6%, <i>p</i> = 0.305), but non-survivors had a higher burn surface area than survivors (40% vs. 20%, <i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>The incidence of VAP was higher in patients with inhalation injury than in those without inhalation injury; however, the mortality was similar.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"62 ","pages":"64-73"},"PeriodicalIF":1.8,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624054","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 effect of kinesiology tape on respiratory function in adults: A systematic review and meta-analysis.","authors":"Charlene du Plessis, Rubine De Beer-Brandon, Diphale Joyce Mothabeng, Anri Human","doi":"10.29390/001c.156353","DOIUrl":"10.29390/001c.156353","url":null,"abstract":"<p><strong>Background: </strong>Kinesiology taping may enhance respiratory function in various adult populations; however, current evidence remains limited. This systematic review aimed to review the existing literature on the effects of kinesiology tape on respiratory function in two adult cohorts.</p><p><strong>Methods: </strong>Studies involving adults (≥18 years), including healthy individuals and those with respiratory conditions, were considered. A comprehensive search was conducted using Cochrane methodology across eight electronic databases, a search engine, grey literature sources, and reference lists, guided by PICOS-based keywords. The Cochrane Risk of Bias tool, ROBINS-I, and Grades of Recommendation Assessment, Development, and Evaluation (GRADE) criteria were used to assess the risk of bias and evidence certainty.</p><p><strong>Results: </strong>Eighteen studies were included: eight involving healthy adults and athletes, and 10 focusing on adults with respiratory conditions. A total of 684 participants were enrolled in these studies, comprising 316 healthy individuals and 368 adults with respiratory conditions.</p><p><strong>Discussion: </strong>Respiratory function, cough efficacy, and muscle strength improved mainly in healthy adults, with clinical benefits noted in those with respiratory conditions. The meta-analysis showed no significant effect of kinesiology tape on respiratory function in either healthy adults or those with respiratory conditions. Most of the included studies presented a high risk of bias, and the certainty of evidence was very low.</p><p><strong>Conclusion: </strong>Evidence supporting the use of kinesiology taping to enhance respiratory function in healthy adults and individuals with respiratory conditions remains limited. Further well-designed, condition-specific clinical trials are needed before routine inclusion in respiratory care can be recommended.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"62 ","pages":"53-63"},"PeriodicalIF":1.8,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12967087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379097","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":"Feasibility of electrical impedance tomography-guided PEP in children with CF and TBM.","authors":"Hasan Nawaz Tahir, Dr Khansa Rehman, Mohammad Idrees, Dr Umema Tariq, Mursala Tahir, Yousaf Ali","doi":"10.29390/001c.158225","DOIUrl":"10.29390/001c.158225","url":null,"abstract":"","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"62 ","pages":"50-52"},"PeriodicalIF":1.8,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327602","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":"Optimizing the gift of life: Respiratory therapist-led, EIT-guided donor lung management.","authors":"Jiaxiao Li","doi":"10.29390/001c.158139","DOIUrl":"10.29390/001c.158139","url":null,"abstract":"","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"62 ","pages":"47-49"},"PeriodicalIF":1.8,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12945394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327607","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":"How can the collaboration between manufacturers of medical devices and bedside clinicians lead to improved applications of the devices?","authors":"Soumaya Osen, Ryan Echols, Darcy Crayton, Tryon Stalinescu","doi":"10.29390/001c.155277","DOIUrl":"10.29390/001c.155277","url":null,"abstract":"<p><strong>Introduction: </strong>In late 2019, the leaders of a respiratory department at an academic medical center (AMC) in the Southeastern United States (U.S.) decided to change the humidity delivered to patients via invasive and noninvasive mechanical ventilation from passive to active in the intensive care units (ICUs). The AMC purchased the humidifiers that were new in the U.S. market. The manufacturer provided education and training. Almost a year after implementation, the leaders found the humidifiers turned off or on standby, with a heat moisture exchanger (HME) placed in-line and a water trap by the expiratory filter.</p><p><strong>Approach: </strong>The leaders requested help from the manufacturer. The manufacturer sent its clinical specialist (CS) twice to the AMC to re-educate and re-train in real time at the bedside. Plan-Do-Study-Act (PDSA) cycles were implemented to troubleshoot problems and improve adherence to active humidity.</p><p><strong>Findings: </strong>The respiratory therapists (RTs) did not recall the appropriate steps for setting up the heaters. Instead of asking the leaders for help, the RTs took it upon themselves to turn off the humidifiers, use HMEs, and add a water trap by the expiratory filter to collect excess humidity in the circuit and reduce the need for frequent expiratory filter changes. In addition, other issues were discovered during the process. Those issues exacerbated the alarm situations.</p><p><strong>Discussion: </strong>A knowledge gap and a breakdown in communication led to inappropriate use of humidifiers and the implementation of active humidity in the ICUs. PDSA cycles and the involvement of the manufacturer's CS in real-time training and troubleshooting at the bedside resulted in the intended outcomes.</p><p><strong>Conclusion: </strong>The process was a learning experience for both the bedside clinicians and the manufacturer. The process led to improvements in the heater's design, its placement on the ventilator cart, the circuit design, and the development of educational materials to guide clinicians.<b>Practice Implications</b> The true test of a product is its release to the market for widespread use. The outcomes of the process improvement demonstrated the importance of collaboration among all stakeholders and that breaking silos across research, design, testing, and implementation is crucial for a successful new device launch.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"62 ","pages":"37-46"},"PeriodicalIF":1.1,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203267","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}