Journal of Endocrinology Metabolism and Diabetes of South Africa最新文献

{"title":"The spectrum of missed lower limb clinical findings at a diabetes clinic in KwaZulu-Natal: red flags for costly complications","authors":"AT Thompson, S. Pillay, C. Aldous","doi":"10.1080/16089677.2022.2083390","DOIUrl":"https://doi.org/10.1080/16089677.2022.2083390","url":null,"abstract":"Including a podiatrist in a multidisciplinary team (MDT) has been shown to reduce the incidence of diabetes-related lower limb amputations by at least 56% to as much as 85%. This reflects podiatry’s role in foot screening and assessment, diagnosis, foot treatment, patient education and timely referral in diabetes care. There is no podiatry post at Edendale Hospital, a state health regional hospital in KwaZulu-Natal. What a podiatrist could contribute to the clinical examination, education and treatment of patients living with diabetes (PLWD) attending the Edendale Hospital diabetes clinic was, therefore, unknown. During the last quarter of 2018 and the first quarter of 2019, as part of a research project into peripheral vascular disease, a podiatrist carried out screening, comprehensive foot assessments and observation on 301 outpatients attending the diabetes clinic at Edendale Hospital. Dermatological, musculoskeletal, cardiovascular and neurological presentations found in the patients’ feet and lower limbs were documented. The podiatrist’s assessments and observations were compared with the attending medical doctor’s clinical notes. More than two-thirds of patients (68.1%, n = 205) had an undocumented clinical presentation of lower limb pathologies requiring treatment, in-depth patient education, further investigation and preventive treatment to avoid further costly and debilitating complications. The results of this study support the dire need for podiatry services at a regional hospital level to provide timeous foot care and trained observation skills for PLWD.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"19 1","pages":"124 - 130"},"PeriodicalIF":0.5,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78823653","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 characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study","authors":"O. Agboghoroma, M. Jobe, K. Forrest","doi":"10.1080/16089677.2022.2083391","DOIUrl":"https://doi.org/10.1080/16089677.2022.2083391","url":null,"abstract":"Background: Diabetic ketoacidosis (DKA) remains an important cause of hospitalisation and death in people with diabetes mellitus (DM) living in low- and middle-income countries. The clinical profile of patients with DKA varies, and maybe contributory to the outcomes observed globally. The aim of this study was to describe the clinical characteristics of people with diabetic ketoacidosis (DKA) seen at a clinic in The Gambia during a one-and-a-half-year period. Methods: This was a retrospective chart review that included people with DM who were seen from June 2017 to December 2018 at the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine. Biodata, anthropometric and admissions data were extracted for all patients from the electronic medical records system. Data were analysed for differences in clinical and biochemical characteristics on admission for DKA. Results: In total, 23 out of 103 admissions for people with DM were for a diagnosis of DKA during the study period. Sixteen of those included were females and the mean age of all patients was 35 ± 13years. Two people had type 1 DM and 15 people were categorised as type 2 DM. DM was diagnosed for the first time during admission for DKA for 12 people and 6 people had confirmed sepsis. There were no significant differences in age at diagnosis of DM or biochemical characteristics. Conclusion: DKA was a common indication for admission for people with DM in the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine and the majority of patients with DKA had type 2 DM. Further studies are needed to describe DKA in this setting more accurately.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"98 1","pages":"14 - 17"},"PeriodicalIF":0.5,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81059708","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":"Association between anthropometry and cardiovascular risk in patients attending a diabetic clinic","authors":"Kylie Divashnee Konar, S. Pillay","doi":"10.1080/16089677.2022.2084901","DOIUrl":"https://doi.org/10.1080/16089677.2022.2084901","url":null,"abstract":"Background Obesity is a well-documented risk factor for cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM), with increasing evidence to suggest visceral adiposity as a greater risk factor for CVD than body mass index (BMI). Objectives To determine a relationship between hypertension (HPT) and anthropometry in people living with diabetes (PLWD) in an HIV endemic area. Methods This was a retrospective study analysing data captured from standardised clinic sheets from the DM clinic at the Harry Gwala Regional Hospital, Pietermaritzburg, South Africa, from January 1, 2019 to December 31, 2019. Results Data from 957 PLWD were used for the study, the majority of whom had T2DM (811; 86.2%). Approximately one-sixth of the cohort had HIV infection (146; 15.3%). There was no significant difference in HPT prevalence between the HIV-uninfected (77.9%) and PLWD who had HIV (PLWDHIV) (78.1%). Multivariate analysis revealed females with increased waist circumference (WC) and waist-to-height ratio (WTHR) were 57.8 (95% CI 3.04–1096.33) (p = 0.007) and 87.2 (95% CI 4.88–1558.28) (p = 0.002) times more likely to be hypertensive respectively. By contrast, only BMI in males was associated with HPT with a AOR 5.294 (95% CI 1.54 - 18.22) (p = 0.008). HIV status was non-contributory to anthropometry in predicting HPT in PLWD. Conclusion Our study found that anthropometric indices are not all equal predictors of HPT. The authors advocate for local guidance on gender-specific cut-offs on anthropometry in PLWD.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"5 1","pages":"18 - 28"},"PeriodicalIF":0.5,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86769310","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":"Correspondence: Role of clinical laboratories in reporting results of transgender individuals on hormonal therapy by Phiri-Ramongane and Khine","authors":"M. Bezuidenhout, M. Conradie-Smit, E. de Vries, J. Dave, I. Ross, AE Zemlin","doi":"10.1080/16089677.2022.2079819","DOIUrl":"https://doi.org/10.1080/16089677.2022.2079819","url":null,"abstract":"Division of Chemical Pathology, Department of Pathology, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa Division of Endocrinology, Department of Medicine, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa Division of Family Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa Division of Endocrinology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa *Correspondence: morne.bezuidehout@nhls.ac.za","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"87 1","pages":"131 - 132"},"PeriodicalIF":0.5,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78289053","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":"Contribution of ankle-brachial index measurement in screening for arteriopathy obliterans of the lower limbs in type 2 diabetics","authors":"S. A. Raharinavalona, R. Raherison, Thierry Razanamparany, Dally Rasoaniana, R. Andrianasolo, Andrinirina Dave Patrick Rakotomalala","doi":"10.1080/16089677.2022.2074123","DOIUrl":"https://doi.org/10.1080/16089677.2022.2074123","url":null,"abstract":"Background: Due to the silent and unpredictable nature of obliterating arteriopathy of the lower limbs (OALL) in diabetics, its screening remains essential. The objective of this study was to evaluate the diagnostic performance of the ankle-brachial index (ABI) in the detection of OALL in diabetics. Methods: This was a descriptive and comparative cross-sectional study over a period of one year. Type 2 diabetics seen in the Endocrinology Department of the Joseph Raseta Befelatanana University Hospital Center, on whom it was possible to perform arterial Doppler ultrasound of the lower limbs, were included. Results: A total of 109 cases of type 2 diabetes were included. The average value of the ABI was 1.06 ± 0.14. ABI ≤ 0.90 and > 1.40 was found in 22.4% and 14.9% of cases, respectively. The prevalence of OALL was 29.8% on arterial Doppler. It was asymptomatic in 50% of cases. The diagnostic performance of the ABI to detect OALL was as follows: for a threshold ≤ 0.90 with CI = 95%: Specificity = 100% [95–100] and 100% [94.9–100], Sensitivity = 71.4% [44.9–88.4] and 77.8% [54.1–91.3], left and right respectively; for a threshold > 1.40 with CI = 95%: Specificity = 92.4% [84.8–96.4] and 90% [81.8–94.8], Sensitivity = 0.0% [0. 0–21.1] and 0.0% [0.0–21.1]), left and right respectively. Conclusion: The ABI is a simple and non-invasive tool for early detection of OALL in diabetics. Doppler ultrasound of the lower limbs is always necessary in the event of associated mediacalcosis.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"11 1","pages":"117 - 123"},"PeriodicalIF":0.5,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89427734","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":"Using a nurse-driven and home-based telehealth intervention to improve insulin therapy for people with type 2 diabetes in primary care: a feasibility study","authors":"P. Ngassa Piotie, P. Wood, Jane W. Muchiri, E. Webb, P. Rheeder","doi":"10.1080/16089677.2022.2074122","DOIUrl":"https://doi.org/10.1080/16089677.2022.2074122","url":null,"abstract":"Objectives: A study was undertaken to assess the feasibility and safety of the Tshwane Insulin Project (TIP) intervention, describe patients’ and healthcare professionals’ experiences with the intervention, and determine preliminary treatment effects on glycaemic control. Design: This was a single-group feasibility study. Setting: The study was carried out in the City of Tshwane, South Africa. Subjects: People with type 2 diabetes on maximum oral drugs with suboptimal glycaemic control (HbA1c: 9–12%), and healthcare professionals who were involved in the implementation of the TIP intervention were included. Outcome measures: Implementation outcome measures included satisfaction, acceptability, appropriateness and safety; and efficacy by assessing change in HbA1c levels. Results: Healthcare professionals and patients were satisfied with the intervention. Healthcare professionals agreed that the intervention was acceptable and appropriate. No symptomatic or severe hypoglycaemic events were reported. Improved glycaemic control was recorded with 2.2% lowering of HbA1c values (95% CI, 1.6–2.8%). Conclusions: The TIP intervention was feasible and can be implemented with minor amendments. Most participants recommended scaling up the intervention. Lessons learned from this study include: (1) high rates of insulin refusal should be anticipated, and insulin resistance amongst people with type 2 diabetes in primary care should be addressed; and (2) the challenges of initiating and titrating insulin in primary care can be addressed through task sharing and by involving allied healthcare workers.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"109 1","pages":"108 - 116"},"PeriodicalIF":0.5,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74277332","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":"Practical aspects of insulin administration: what the healthcare provider knows","authors":"Nousheen Parker, A. Coetzee, L. van Wyk, M. Conradie","doi":"10.1080/16089677.2022.2057692","DOIUrl":"https://doi.org/10.1080/16089677.2022.2057692","url":null,"abstract":"Background: Diabetes self-management education (DSME), a prerequisite for diabetes care, is mostly unstructured and inaccessible in the public health sector in South Africa (SA). Patient education is often delivered by healthcare professionals (HCPs) with limited time and proficiency, resulting in preventable errors with insulin administration. A study was undertaken to assess the knowledge of HCPs on the practical aspects of insulin administration and it was hypothesised that their expertise was insufficient. The unmet needs of DSME often transpire when preventable errors with insulin administration become clinically evident at higher levels of care. Methods: A prospective, descriptive study of HCPs’ knowledge before and after attending a ‘Diabetes 101’ workshop was performed. Four workshops at Tygerberg Hospital (TH) and Worcester Provincial Hospital (WPH) were assessed between 2016 and 2019. A total of 146 participants completed a questionnaire before and after the workshops. Knowledge was scored on the correct responses per question and overall. The mean pre- and post-test scores were compared using two sample t-tests. Chi-square tests were used to analyse differences between pre- and post-training responses. Results: Of 146 participants, the majority were medical doctors (n = 116; 80%), mostly junior (n = 75; 65%) with 21% nursing practitioners. Before training there were significant deficiencies identified with only 3 of the 19 question items answered correctly by more than 50% of HCPs. The greatest knowledge deficits were with regard to insulin re-suspension and the injection technique and priming of the insulin pen. Following training there was a significant improvement between the pre-test mean percentage score of 36.0% (15) and post-test mean percentage score of 68% (16) (p < 0.001). Conclusion: Knowledge on the practical aspects of insulin administration is insufficient amongst HCPs but improved after structured education. Further research is needed to assess the long-term retention of knowledge and the impact of knowledge translation into clinical care.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"28 1","pages":"100 - 107"},"PeriodicalIF":0.5,"publicationDate":"2022-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73981529","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":"Hypertension and diabetes mellitus: a collision of two heavyweight non-communicable diseases","authors":"S. Pillay","doi":"10.1080/16089677.2021.2002585","DOIUrl":"https://doi.org/10.1080/16089677.2021.2002585","url":null,"abstract":"Introduction: Patients living with type 2 diabetes mellitus (PLWD) are at an increased risk of developing hypertension (HPT). The presence of HPT in PLWD (PLWDH) accelerates diabetes-related complications (DRC). Scarce data exist from South Africa on the impact of HPT in PLWD. Methods: Data werecaptured from Edendale Hospital diabetes clinic datasheets from January 1, 2019 to December 31, 2019 and analysed to determine differences in demographic, clinical and biochemical variables between PLWD and PLWDH. Results: Data from 822 PLWD were analysed, the majority having HPT (713,86.74%). The prevalence of HPT, resistant HPT (RHPT) and the number of antihypertensives used increased with age and diabetes duration. PLWDH had statistically poorer lipid control (LC), higher creatinine, waist circumference (WC), increased prevalence of sensory peripheral neuropathy, non-proliferative and proliferative retinopathy, cerebrovascular accidents, proteinuria and renal impairment. The significant majority of PLWDH were not meeting diabetes targets (glycaemic, lipid, BMI, WC). The bulk of PLWDH were on combination antihypertensive therapy (p < 0.001) and performed significantly better than monotherapy for glycaemia, LC, BMI and WC. Proteinuria and blood pressure (BP) improved significantly as the number of antihypertensives increased. One-fifth (151, 18.37%) of PLWDH had RHPT; this was more common in females (p < 0.001). PLWD with RHPT had a significantly higher LDL cholesterol, BMI, and urine protein–creatinine ratio (p < 0.001). Over one-quarter (29.87%) of the PLWD without HPT had a BP over 140/90mmHg. Conclusion: It was shown that HPT, RHPT and obesity are significant comorbidities in PLWD and increase the risk of DRC. The majority of PLWDH are not meeting targets, which places them at increased risk of DRC. BP, glycaemic and LC and proteinuria improved in those on combination antihypertensive therapy. A significant proportion of PLWD without HPT had elevated BP, and thus were potentially undiagnosed hypertensives needing intervention.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"1 1","pages":"57 - 69"},"PeriodicalIF":0.5,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86507480","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":"Face validity and content assessment of a diabetes nutrition education DVD for low literacy adults living with diabetes: a mixed-method study","authors":"Dianré Kapp, G. Gericke, Jane W. Muchiri","doi":"10.1080/16089677.2022.2048470","DOIUrl":"https://doi.org/10.1080/16089677.2022.2048470","url":null,"abstract":"Aim: A study was undertaken to assess the face validity and content correctness of a diabetes nutrition education (DNE)-DVD developed for low literacy adults living with diabetes. Setting: The study was undertaken in the city of Tshwane Municipality, Gauteng province. Participants: Adults living with diabetes (n = 73, 18–65 years) attending a tertiary hospital diabetes outpatient clinic and 18 health professionals (HPs) with expertise in diabetes from three healthcare-related organisations were included. Methods: A mixed-methods approach was used. Quantitative data were collected from patients (n = 63) using a Likert scale questionnaire, and from HPs using ‘Yes/No’ and Likert-scale questions. Qualitative data were collected using three focus-group discussions with patients (n = 10) and comments from HPs. Results: Quantitative results indicated that patients perceived the visuals to be clear, appealing, culturally appropriate, contained familiar images and aided in their understanding of diabetes. Both patients and HPs found the language, length and layout of the DVD to be suitable. The HPs perceived the content to be accurate and concise. The qualitative data supported the quantitative findings. Participants perceived the DNE-DVD to be useful for patients and families, and provided suggestions for improving the DVD. Conclusion: Quantitative and qualitative results agreed that the face validity and content correctness of the DNE-DVD was appropriate. Improving the DNE-DVD could further enhance its utility and effectiveness for the target population.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"28 1","pages":"83 - 92"},"PeriodicalIF":0.5,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86554646","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":"Total testosterone level may have no influence on the occurrence and severity of erectile dysfunction in males aged between 30 and 60 years living with type 2 diabetes","authors":"Martine Claude Etoa Etoga, Doris Bibi Essama, A. Mbassi, J. Nkeck, Francine Mendane Mekobe, M. Dehayem, A. Vicky, E. Sobngwi, J. Mbanya","doi":"10.1080/16089677.2022.2031464","DOIUrl":"https://doi.org/10.1080/16089677.2022.2031464","url":null,"abstract":"Background: Erectile dysfunction is the most common sexual disorder in type 2 diabetes. Its pathogenesis may involve various disturbances including endothelial dysfunction and dysautonomia. The involvement of a low testosterone level is still debated. The aim of this study was to evaluate the contribution of total testosterone during erectile dysfunction in patients living with type 2 diabetes. Method: A cross-sectional study was conducted in a population of male with type 2 diabetes, aged 30–60 years, and enrolled at the National Obesity Centre of the Yaoundé Central Hospital. Non-diabetic conditions that could affect testosterone level were excluded. Erectile dysfunction was assessed using the IIEF-5 questionnaire. Total testosterone was measured by ELISA. The relationship between erectile dysfunction and total testosterone has been explored through correlation using Pearson’s coefficient. The significance threshold was set at 0.05. Results: A total of 83 participants were included, with an average age of 47.9 ± 7.8 years. The median duration of diabetes was 24 (5; 72) months. The frequency of ED was 65.1%, severe for 50% of cases and significantly associated with the duration of diabetes (OR = 7.5 [2.4; 22.8]). The mean testosterone level was 14.3 ± 5.1 nmol/l. A low level of testosterone was found in 8.4% (7/83) of participants, and sedentary lifestyle was significantly associated with low testosterone level (OR = 4.1 [1; 15.4]). There was no difference between the mean total testosterone level of patients with ED (14.1 ± 4.7 nmol/l) and those without (14.3 ± 5.9 nmol/l) (p = 0.8). No association was found between total testosterone level and IIEF-5 score (r = −0.05; p = 0.5). Conclusion: Erectile dysfunction occurs in two out of three people living with type 2 diabetes and is severe for half of the cases. Total testosterone level does not seem to have an influence on the onset or severity of ED in male under 60 years with type 2 diabetes, but it is associated with a sedentary lifestyle.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"66 1","pages":"78 - 82"},"PeriodicalIF":0.5,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74843016","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}