Medical Journal of Malaysia最新文献

{"title":"Ear, nose and throat foreign bodies: A cross sectional study on incidence, clinical factors and dimensions.","authors":"H S Gendeh, B S Goh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Ear, nose and throat (ENT) foreign body (FB) is common problem with significant morbidity and mortality. They are classified into organic or inorganic. Aerodigestive FBs are responsible for suffocation and death up to three years old with a 10% mortality up to 14 years old in Europe. Malaysia lacks local data that quantifies FB in dimensions to predict its risk. The study objectives were to determine the incidence of ENT FBs (paediatric and adult) in a Malaysian tertiary referral center; to determine the association between the FB types and factors contributing to its occurrence (largest dimension, volume, witnessed); to determine the treatment required; and association between hand dominance with ENT FBs.</p><p><strong>Materials and methods: </strong>Prospective data of all children (<18 years old) and adults (≥18 years old) seen by the ENT physicians presenting with ENT foreign body were included over 12 months at Hospital Canselor Tuanku Muhriz (HCTM) from 1st February 2017 to 31st January 2018. All cases are seen by an ENT doctor (specialist and/or medical officer) during on-call, in hospital and outpatient's referrals. FB dislodged in the lower airways (trachea, bronchus and bronchiole) and upper gastrointestinal (GI) tract (oesophagus) were included. Exclusion criteria were FB dislodged in non-ENT orifices such as the stomach and beyond with no other ENT FBs. Bias was reduced by a proforma after obtaining an informed consent and taking the average of three measurements of FB dimensions.</p><p><strong>Results: </strong>The incidence of ENT FB within HCTM was 3.5% (overall), 1.9% (organic), 1.6% (inorganic); 1.65% (children) and 1.85% (adults). Children have a mean age of 5.34 and adults 49.35 years. Among the patient factors; children FB are often inorganic (73.95%; plastic, metal, graphite), males predominant (56.5%), unwitnessed (66.67%), witnessed incidents were by adults (69.5%) at home (91.3%). Adult FB are often organic (77.1%; fish bone, cotton, tick), male to female ratio 1.4:1; not associated with occupation. Mackerel followed by red snapper and tilapia were common fish bones ingested. Common locations of FB among children and adults were throat (35.3%), ear (32.03%) and nose (26.14%). Less than one fifth required hospitalization due to aerodigestive FBs with 6 (72.7%) of hospitalised patients suffering complications of hypoxic brain injury, lung collapse, pneumonia, esophageal perforation and lacerations. Fifty-seven (37.25%) patients (adults predominant) required endoscopic removal under general or local anaesthesia. The side of ear and nose FB to hand dominance was significant (p<0.05).</p><p><strong>Conclusion: </strong>ENT FB are more common in the ear and nose in children; not witnessed, located in the oropharynx and occurred at home and during playtime. Organic FB and fish bones were common among adults in the Malaysian population. Aerodigestive FBs are associated with hospitalization, compli","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"564-571"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713892","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":"Determinants of self-care and psychosocial readiness among hypertensive patients: Implications for nursing in low-resource settings.","authors":"N P A R Dewi, Nursalam, N L P I B Agustini, N W S Wahyuni, K A N Putra","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Self-care behaviour, motivation, and selfefficacy represent related but distinct dimensions of hypertension self-management. Previous Indonesian studies have generally examined self-care behaviour as the primary outcome or treated motivation and self-efficacy as its explanatory factors. Evidence describing the outcomespecific associations of sociodemographic and clinical characteristics with these three domains remains limited. This study examined the associations of selected sociodemographic and clinical characteristics with self-care behaviour, motivation, and self-efficacy among adults with hypertension.</p><p><strong>Materials and methods: </strong>This analytical cross-sectional study included 120 adults with hypertension attending the Gianyar 1 Community Health Centre, Bali, Indonesia, between August and September 2024. Participants were selected from an eligible patient registry using simple random sampling. Self-care behaviour, motivation, and selfefficacy were measured using the validated Indonesian version of the High Blood Pressure Self-Care Profile. Bivariate comparisons were followed by three separate multiple linear regression models.</p><p><strong>Results: </strong>The mean scores were 44.09 (95% confidence interval [CI] 42.44-45.74) for self-care behaviour, 44.64 (95% CI 42.56-46.72) for motivation, and 42.99 (95% CI 41.21- 44.78) for self-efficacy. The self-care behaviour model was statistically significant (R²=0.375; adjusted R²=0.304; p<0.001). Higher self-care behaviour scores were observed among participants aged 41-50 years and private-sector employees, whereas lower scores were observed among participants with no formal schooling, junior high school education, and a hypertension duration of 1-5 years. The motivation model was also statistically significant but had lower explanatory value (R²=0.186; adjusted R²=0.094; p=0.028). Participants aged 41-50 years had higher motivation scores, whereas those with junior high school education had lower scores. The overall self-efficacy model was not statistically significant.</p><p><strong>Conclusion: </strong>Associations were observed mainly for selfcare behaviour and motivation, whereas the examined characteristics did not collectively explain self-efficacy. These findings support individualised assessment of behavioural, motivational, and confidence-related needs in primary care. Causal relationships cannot be inferred from this cross-sectional study.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"577-585"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713940","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":"Comparing failure rate and complications between Seldinger and conventional chest drainage techniques in pneumothorax: A retrospective cohort study.","authors":"S K Ing, Y H Lee, J S Y Lee, N H Ngu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Chest drainage remains an important intervention for pneumothorax when conservative or ambulatory management is not suitable. Although chest drain techniques have been widely studied, contemporary real-world data from Southeast Asia remain limited, particularly in populations with a high burden of secondary pneumothorax related to infectious lung disease.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study of adult pneumothorax patients who underwent intercostal chest drain insertion at Sibu Hospital, Sarawak, Malaysia, between January 2021 and February 2024. Patients were managed with either conventional trocar chest tubes or Seldinger wire-guided drains. The primary outcome was chest drain-related complications. Secondary outcomes included chest drain duration, hospital length of stay, persistent air leak (PAL >5 days) and mortality. Continuous variables were analysed using independent ttests and categorical variables using chi-square or Fisher's exact tests. Multivariate logistic regression was performed to identify predictors of subcutaneous emphysema, and multiple linear regression was used to evaluate factors associated with chest drain duration.</p><p><strong>Results: </strong>A total of 123 patients were included (86 conventional and 37 Seldinger). Subcutaneous emphysema occurred significantly less frequently in the Seldinger group (5.4% vs 55.8%, p<0.001). Mean chest drain duration was shorter in the Seldinger group (8.86 ± 7.10 vs 10.34 ± 11.96 days, p=0.032). Differences in insertion failure (0% vs 8.1%, p=0.074), tube dislodgement (2.7% vs 11.6%, p=0.112), persistent air leak >5 days (67.6% vs 54.7%, p=0.182) and mortality (10.8% vs 15.1%, p=0.518) were not statistically significant. Multivariate logistic regression identified conventional chest drainage as an independent predictor of subcutaneous emphysema (OR 27.6, 95% CI 5.24-145.94; p<0.001). Multiple linear regression demonstrated that conventional drainage, non-tension pneumothorax, smoking and persistent air leak were independently associated with longer chest drain duration.</p><p><strong>Conclusion: </strong>In this retrospective cohort, the Seldinger technique was associated with lower complication rates and shorter drainage duration compared with conventional chest drainage. Prospective multicentre studies are required to confirm these findings.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"548-553"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713992","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":"Awareness and disposal practices of unused or expired medications among patients with type 2 diabetes in Ipoh, Malaysia.","authors":"M M Theingi, S P Aung, M A Win, R Yusuf, A Z Arman, E S Satar, H N Badrul","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Improper disposal of unused or expired medications poses significant public health and environmental risks. Despite Malaysia's \"Return Your Medicines Program,\" improper disposal practices persist, particularly among Type 2 diabetic patients on long-term therapies. This study aimed to determine awareness and disposal practices of unused or expired medications among Type 2 diabetic patients in Ipoh and identify factors influencing improper disposal.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted at three government clinics in the Kinta District of Ipoh, Malaysia. Data were collected from 241 participants using structured questionnaires and analysed using descriptive statistics and Pearson's chi-square tests.</p><p><strong>Results: </strong>A total of 34.4% of respondents reported having unused or expired medications, primarily due to overprescription (36.1%). Among the diabetic patients surveyed, 68% demonstrated satisfactory awareness regarding the disposal of unused prescribed medications, while 32% showed unsatisfactory awareness. In terms of disposal practices, 43.37% of participants followed proper methods, whereas 56.63% engaged in poor disposal practices. A statistically significant association was observed between the level of awareness and the disposal practices adopted by the participants(p=0.000). It is recommended that health authorities enhance public education campaigns and implement accessible, wellpublicized medication take-back programs to promote proper disposal of unused or expired medicines.</p><p><strong>Conclusion: </strong>The study identifies a strong association between awareness levels and proper disposal practices of unused or expired medications, emphasizing the need for targeted educational initiatives to promote safe disposal among patients.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"455-460"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714021","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":"Psychosocial and health system factors associated with tuberculosis treatment adherence in Kota Kinabalu, Sabah.","authors":"V Ganesan, H G Jastin, S Jayaraman, S Gangatharan, R Avoi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment adherence remains a major challenge in tuberculosis (TB) control and may be influenced by psychosocial and health system factors that remain underexplored in many settings. This study aimed to examine the association between psychosocial and health system factors and treatment adherence among TB patients in Kota Kinabalu, Sabah.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted among 351 TB patients registered in the National TB Registry between 2023 and 2024. Data were collected using structured, validated, and translated questionnaires, including the TB Stigma Scale and the Patient Health Questionnaire-9 (PHQ-9). Variables included sociodemographic characteristics, TB knowledge, treatment-related factors, and healthcare system factors. Simple and multivariable logistic regression analyses were performed to identify factors of treatment adherence.</p><p><strong>Results: </strong>Stigma was negatively associated with treatment adherence (AOR=0.90; 95% CI: 0.86-0.95; p<0.001), whereas higher TB knowledge was associated with higher treatment adherence (AOR=1.20; 95% CI: 1.06-1.35; p=0.004). Compared with video directly observed therapy (VDOT), healthcare worker (HCW)-supervised direct observed treatment short-course (DOTS) was associated with lower treatment adherence (AOR=0.23; 95% CI: 0.06-0.90; p=0.030). Longer clinic waiting time was associated with higher treatment adherence (AOR=1.09; 95% CI: 1.05-1.13; p<0.001). Depression was negatively associated with adherence in univariate analysis but was not statistically significant in the multivariable model (AOR=0.58; 95% CI: 0.21-1.58; p=0.285).</p><p><strong>Conclusion: </strong>Stigma, TB knowledge, DOTS modality, and clinic waiting time were independently associated with TB treatment adherence in this setting. These findings highlight the importance of integrated, patient-centered TB care that addresses stigma, strengthens patient education, and incorporates digital approaches such as VDOT. Strengthening multifaceted interventions targeting both psychosocial and health system factors may improve TB treatment outcomes in Malaysia and similar high-burden settings.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"413-420"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714152","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":"Clinical presentation of aspergillus and candida in otomycosis: A cross-sectional study at a tertiary hospital in Central Java, Indonesia.","authors":"A B Darmawan, N Krisniawati, B J Darmayan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Otomycosis is a common fungal infection of the external auditory canal, particularly in tropical regions. Aspergillus and Candida are the main causative agents, yet their clinical differentiation remains challenging due to overlapping manifestations. This study aimed to identify the distribution of fungal etiologies, and to compare clinical manifestations and predisposing factors between Aspergillus and Candida infections in a tertiary hospital in Central Java, Indonesia.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted at a tertiary hospital, including patients aged 17 years and above with clinically and microbiologically confirmed otomycosis. Demographic data, symptoms, physical findings, and predisposing factors were collected. Fungal identification was performed using culture and microscopy. Comparative analyses were conducted using chi-square or Fisher's exact test.</p><p><strong>Results: </strong>A total of 41 patients (56 fungal isolates) were included. Aspergillus spp. accounted for 58.9% of isolates, while Candida spp. comprised 41.1%, with mixed infections observed in 16.1%. Itching, hearing loss, and ear fullness were the most common symptoms in both groups. No statistically significant differences were found in clinical manifestations or physical examination findings between Aspergillus and Candida infections (all p>0.05). Although whitish debris was more frequent in Candida and brownish debris in Aspergillus, these patterns were not discriminatory. Ear drop use and cotton bud manipulation were significantly associated with Aspergillus infections (p<0.05).</p><p><strong>Conclusion: </strong>Substantial clinical overlap exists between Aspergillus and Candida otomycosis, underscoring the importance of microbiological confirmation for accurate diagnosis.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"477-482"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714045","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":"Beyond the treatment episode: Closing gaps across the continuum of care.","authors":"K S Chew, B S Liew","doi":"","DOIUrl":"","url":null,"abstract":"<p><p></p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"407-408"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713981","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":"Exploring the integration of Islamic practice in a tertiary shariah-compliant hospital: A qualitative study.","authors":"N Mohd Yusof, S Saidi, M A Mahmood, S S Suhaimey, A Anuar, A Padela","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Shariah-compliant and ibadah-friendly hospitals have been established in the Malaysian healthcare system for nearly two decades to support the religious needs of Muslim patients. In parallel, the Islamic input in the medical program curriculum has been designed to train healthcare professionals, particularly doctors, to integrate Islamic principles into their medical expertise, as they are expected to incorporate Islamic values into their daily practice. However, the practice of doctors with this Islamic integrated medical curriculum has not been thoroughly investigated. Thus, to what extent they embodied the Islamic values within their practice and the challenges they faced in realising this is not known. Therefore, this study aimed to explore the experiences of doctors and patients related to the integration of Islamic principles within Shariahcompliant hospital services.</p><p><strong>Materials and methods: </strong>A single-site qualitative case study design was employed, recruiting 20 doctors and 18 adult patients receiving treatment in the Orthopaedic wards and clinic of a Shariah-compliant teaching hospital. In addition, 19 relevant documents have been sampled and included. The study was conducted using multiple data collection methods including individual in-depth interviews, nonparticipant observations and document analysis between June 2023 and February 2024. The data analysis was done according to framework technique facilitated by NVivo software version 5.</p><p><strong>Results: </strong>Four key themes emerged: (1) fulfilling religious and spiritual needs through clinical interactions and services; (2) practising therapeutic communication guided by Islamic values such as compassion, honesty, and patience; (3) upholding privacy, dignity, and autonomy in patient care; and (4) the importance of an effective training program and a sustainable working environment. Doctors expressed varying levels of confidence and consistency in applying Islamic principles, often influenced by personal understanding, workload, and institutional support. Patients generally appreciated the effort to integrate religious values but noted inconsistencies in delivery and expectations.</p><p><strong>Conclusion: </strong>This study highlights both the perceptions and actual practices of doctors in integrating Islamic principles into their clinical roles, as well as how patients perceive and respond to such efforts. While both groups value the integration of Islamic values, variations in interpretation and practice reveal gaps between the intended Shariahcompliant model and its implementation on the ground.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"533-539"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713881","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":"Precision medicine in Malaysia: Aligning genomics research, policy and translation.","authors":"W N S Shahidan, M N A Patar, S Sulong, M N Hassan, I Mohamad, B A Zilfalil","doi":"","DOIUrl":"","url":null,"abstract":"<p><p></p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"409-412"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714157","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":"Quantifying the risk of tuberculosis recurrence in Asia: A systematic review of hazard estimates.","authors":"M R Isa","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrence of tuberculosis (TB) is a major challenge to its control in Asia, even though there is a high treatment success rate of drug-susceptible diseases. TB recurrence contributes to ongoing disease transmission in the community, increases drug resistance and leads to higher TB mortality rates. The study aimed to examine and synthesise the current evidence on determinants of TB recurrence occurring after completed treatment in the Asian setting.</p><p><strong>Materials and methods: </strong>The PRISMA 2020 framework is used as a guide for this systematic review. A systematic search in PubMed/MEDLINE, Scopus and Web of Science (WOS) until September 30, 2025 was conducted. The eligible studies were cohort studies implemented in Asian countries and reported post-treatment TB recurrence and adjusted risk estimates. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Since the methodological heterogeneity is rather significant, a narrative synthesis was conducted.</p><p><strong>Results: </strong>The review included a total of 15 cohort studies with sample sizes ranging from 508 to more than 10 million individuals. TB recurrence was 1.5 to 15.1% or 0.47 to 6.5 per 1,000 person-years, with the highest rates seen within two years of post-treatment. Recurrence risk was higher when there were comorbidities like diabetes, chronic lung or kidney disease, low body mass index and behavioural factors like smoking. Additionally, environmental exposure to fine particulate matter (PM_2.5) and socioeconomic disadvantage were also significant variables. Protective variables observed were high levels of treatment compliance, extended treatment period, the use of fixeddose combination (FDC) therapy, treatment during the directly observed therapy (DOT) era, smoking cessation, and residential greenness. The quality of the included study was moderate to high.</p><p><strong>Conclusion: </strong>Multiple determinants drive TB recurrence; thus, improving post-treatment surveillance as well as integrating clinical, behavioural and environmental interventions are important to reduce the incidence and mortality of TB recurrence cases.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"81 4","pages":"610-620"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714139","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}