Journal of Pediatric Intensive Care最新文献

{"title":"Emergent Bedside Resternotomy: An Innovative Simulation Model for Training Pediatric Cardiac Intensive Care Teams","authors":"Toluwani Akinpelu, N. Shah, Mohammed Alhendy, M. Thangavelu, Karen Weaver, Nicole Muller, James McElroy, U. Bhalala","doi":"10.1055/s-0042-1758453","DOIUrl":"https://doi.org/10.1055/s-0042-1758453","url":null,"abstract":"Cardiac tamponade after cardiac surgery is a life-threatening event that requires simultaneous resuscitation and emergent resternotomy by the intensive care team. A simulated scenario using an innovative mannequin with sternotomy wound has the capability of reproducing cardiac arrest associated with postoperative tamponade. We evaluated the validity of this mannequin to investigate the confidence level and crisis resource management skills of the team during bedside resternotomy to manage postoperative cardiac tamponade. The simulation scenario was developed using the sternotomy mannequin for a pediatric cardiac intensive care unit (CICU) team. The case involved a 3-year-old male, intubated, and mechanically ventilated after surgical repair of congenital heart disease, progressing to cardiac arrest due to cardiac tamponade. We conducted a formative learner assessment before and after each scenario as well as a structured, video debriefing following each encounter. The simulation was repeated in a 6-month interval to assess knowledge retention and improvement in clinical workflow. The data were analyzed using student t-test and chi-square test, when appropriate. Of the 72 CICU providers, a significant proportion of providers (p < 0.0001) showed improved confidence in assessing and managing cardiac arrest associated with postoperative cardiac tamponade. All providers scored ≥3 for the impact of the scenario on practice, teamwork, communication, assessment skills, improvement in cardiopulmonary resuscitation, and opening the chest and their confidence in attending similar clinical situations in future. Most (96–100%) scored ≥3 for the perception on the realism of mannequin, the scenario, reopening the sternotomy, and level of stress. Time to diagnosis of cardiac tamponade (p = 0.004), time to the first dose of epinephrine (p = 0.045), and median number of interruptions to chest compressions (p = 0.006) all significantly decreased between the two sessions. Time to completion of resternotomy improved by 81.4 seconds; however, this decrease was not statistically significant. Implementation of a high-fidelity mannequin for postoperative cardiac tamponade simulation can achieve a realistic and reproducible training model with positive impacts on multidisciplinary team education.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83381799","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 Quality of Life after Pediatric Traumatic Brain Injury.","authors":"Nazan Ulgen Tekerek, Oguz Dursun, Selen Karalok, Alper Koker, Ozgur Duman, Senay Haspolat","doi":"10.1055/s-0042-1758475","DOIUrl":"10.1055/s-0042-1758475","url":null,"abstract":"<p><p><b>Introduction</b>  Pediatric traumatic brain injury (TBI) is a significant cause of death and long-term disability. There is a paucity of data on quality of life in survivors of pediatric TBI. The aim of this study is to determine the factors affecting the quality of life after TBI in children. <b>Methods</b>  Consecutively admitted 104 of 156 patients to the pediatric intensive care unit (PICU) with TBI between 1 month and 18 years were included in the study. Demographics were obtained from electronic records. Injury severity and mortality scores were calculated. The Pediatric Quality of Life Inventory (PedsQL) scale and Glasgow Outcome Scale (GOS) score were evaluated by interview with patient or the caregiving parents. The Rotterdam computed tomography (CT) score was calculated from the radiology images taken within the first 24 hours after admission to the emergency service. <b>Results</b>  Severe TBI, multiple trauma, intracranial hemorrhage from multiple sites, convulsions, high intracranial pressure, emergency operation on admission, and hypotension on admission were associated with low PedsQL values according to results of univariate analysis ( <i>p</i>  < 0.05). There was a negative correlation between PedsQL and GOS, mechanical ventilation duration, PICU length of stay (LOS), and hospital LOS. In the linear regression model made by considering the univariate analysis results, it was shown that Rotterdam CT score and PICU LOS are independent variables that determine low PedsQL score. PedsQL scores were lower in children ≥ 8 years of age and in those evaluated within the first year after discharge ( <i>p</i>  = 0.003). <b>Conclusion</b>  In pediatric TBI, Rotterdam CT score and PICU LOS were found as independent variables determining PedsQL score after discharge.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9229785","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":"Recent Trends in Incidence and Outcomes for Acute Myocarditis in Children in the United States","authors":"Kalpana Singh, R. Lutfi, J. Parent, C. Rogerson, Mouhammad Yabrodi","doi":"10.1055/s-0043-1762910","DOIUrl":"https://doi.org/10.1055/s-0043-1762910","url":null,"abstract":"Abstract Lack of defined diagnostic criteria for acute myocarditis makes its diagnosis dependent on clinical suspicion. The objective of this study was to the current trends in demographics, clinical manifestations, treatments, and outcomes in the United States for children hospitalized with acute myocarditis. This retrospective study was conducted using data collected from the Pediatric Health Information System database for the years 2014 to 2020. We included patients 21 years of age or younger with acute myocarditis. The statistical analysis was performed using chi-squared test and continuous variables using Mann–Whitney's U -test for continuous data comparisons. We found 1,199 patients with acute myocarditis. About 60% of patients required admission to the intensive care unit (ICU). The median hospital length of stay was 4 days for all patients and 6 days for ICU patients. Two hundred sixty-five (22.1%) patients required invasive mechanical ventilation, 127 (10.6%) required extracorporeal membrane oxygenation, 33 (2.8%) required ventricular assist device, and 22 (1.8%) required cardiac transplantations. Milrinone was the most used vasoactive agent. The overall hospital mortality was 2.3%. Intravenous immunoglobulin (IVIG) infusion use decreased during the study period. On multivariate analysis, vasoactive medication use ( p  < 0.01) and arrhythmia ( p  = 0.02) were independently associated with increased odds of mortality. IVIG use ( p  = 0.01) was associated with decreased odds of mortality. Despite high morbidity and frequent need for advanced life support measures, the survival outcomes of acute myocarditis in children are favorable. Vasoactive medication support and occurrence of arrythmia were independently associated with mortality, most likely due to disease severity. Administration of IVIG was independently associated with reduced mortality. The Clinical trial registration is not applicable.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82374351","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":"Peri-Intubation Cardiorespiratory Arrest Risk in Pediatric Patients: A Systematic Review","authors":"Rohit S. Loomba, Riddhi D Patel, Elizabeth Kunnel, E. Villarreal, J. S. Farias, S. Flores","doi":"10.1055/s-0042-1758477","DOIUrl":"https://doi.org/10.1055/s-0042-1758477","url":null,"abstract":"Endotracheal intubation is associated with an increased risk of cardiorespiratory arrest. Various factors modulate the risk of peri-intubation cardiorespiratory arrest. The primary objective of this study was to determine the risk of peri-intubation cardiorespiratory arrest in pediatric patients in a hospital setting, and the secondary objective was to determine the effect of various factors on the peri-intubation cardiorespiratory arrest risk. A systematic review was performed to identify eligible manuscripts. Studies were deemed appropriate if they included pediatric patients in a hospital setting not exclusively intubated for an indication of cardiorespiratory arrest. Data were extracted from studies deemed eligible for inclusion. A pooled risk of cardiorespiratory arrest was determined. A Bayesian linear regression was conducted to model the risk of cardiorespiratory arrest. All data used in this were study-level data. A total of 11 studies with 14,424 intubations were included in the final analyses. The setting for six (54.5%) studies was the emergency department. The baseline adjusted risk for peri-intubation cardiorespiratory arrest in pediatric patients was 3.78%. The mean coefficient for a respiratory indication for intubation was −0.06, indicating that a respiratory indication for intubation reduced the per-intubation cardiorespiratory arrest risk by 0.06%. The mean coefficient for use of ketamine was 0.07, the mean coefficient for use of a benzodiazepine was −0.14, the mean coefficient for use of a vagolytic was −0.01, and the mean coefficient for use of neuromuscular blockade was −0.40. Pediatric patients during the peri-intubation period have the risk of developing cardiorespiratory arrest. The pooled findings demonstrate associations that seem to highlight the importance of maintaining adequate systemic oxygen delivery to limit this risk.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90122527","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":"Procedural Sedation in Congenital Heart Disease","authors":"S. Al-Jureidini, Shadi Al-Jureidini, R. Patel, Renuka Peterson, Michael Czajka, A. Fiore","doi":"10.1055/s-0043-1762909","DOIUrl":"https://doi.org/10.1055/s-0043-1762909","url":null,"abstract":"Abstract Procedural sedation in patients with congenital heart disease (CHD) is associated with significant morbidity and mortality. It is vital for the practitioner to fully understand the complexity of lesions, their hemodynamics, and the impact of medications commonly used for procedural sedation on the stability of systemic vascular resistance and pulmonary flow. According to the literature, we explain the interaction of the systemic vascular resistance and pulmonary flow in such lesions and divide them into five categories outlined in this article: (1) CHDs with left-to-right shunt with normal pulmonary arterial pressure and resistance, (2) CHD with left-to-right shunt and moderate to severe elevation of pulmonary arterial pressure with near-normal pulmonary vascular resistance, (3) CHD with pulmonary flow dependent on systemic vascular resistance, (4) patients with congenital coronary stenosis and coronary anomalies, and 5) aortic obstructive lesions.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88555456","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":"Practice Variability and Unplanned Extubation Rates across Pediatric Intensive Care Units","authors":"K. Wollny, A. Metcalfe, K. Benzies, S. Parsons, T. Sajobi, D. Mcneil","doi":"10.1055/s-0042-1757625","DOIUrl":"https://doi.org/10.1055/s-0042-1757625","url":null,"abstract":"The purpose of this study was to describe the care of intubated patients in pediatric critical care. Acknowledging there are several perceived factors that contribute to unplanned extubations, a secondary objective was to describe how practice variation may relate to observed differences in unplanned extubation rates. A survey about practices related to the care of intubated patients was distributed to all pediatric intensive care units (PICUs) participating in the Virtual Pediatric Systems (VPS, LLC). Unplanned extubation rates for 2019 to 2020 were obtained from VPS. Univariate and bivariate analyses were performed to describe the responses, with unplanned extubation rates calculated as means. The text responses about perceived causes of unplanned extubation in participants' sites were explored using thematic content analysis. A total of 44 PICUs were included in this study (response rate 37.0%). The mean unplanned extubation rate for the sample was 0.41 (95% confidence interval: 0.31–0.50) per 100 intubation days. Variability was found across several aspects that impact care, including staffing, the frequency of procedures (e.g., chest radiography), and treatment-related goals (e.g., sedation and mobilization). The perceived causes of unplanned extubations in the sample included patient-, staff-, and equipment-related factors. We found practice variability in pediatric critical care units related to the care of intubated patients, which may contribute to the frequency of adverse events. As evidence emerges and professional associations and organizations recommend the best practices, knowledge translation will be required for the implementation and deimplementation of practices to improve the quality of care in PICUs.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84893329","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":"Correlation of Nonthyroidal Illness Syndrome with Extubation Outcome in Mechanically Ventilated Children: A Prospective Cohort Study","authors":"Tarek A. Abdelaziz, M. Romih, W. Ismail, Khadija A.L. Mabrouk Emhalhal, E. Baz","doi":"10.1055/s-0042-1757477","DOIUrl":"https://doi.org/10.1055/s-0042-1757477","url":null,"abstract":"This study aimed to assess the relationship between non-thyroidal illness syndrome (NTIS) and extubation outcomes in pediatric patients requiring mechanical ventilation. This prospective cohort study included 59 patients who underwent mechanical ventilation in the pediatric intensive care unit of a tertiary care university hospital from July 2020 to June 2021. Each patient underwent laboratory testing including serum levels of thyroid-stimulating hormone (TSH), free T3 (fT3), free T4 (fT4), and reverse T3 (rT3) on the first and third days of mechanical ventilation. On the first day of mechanical ventilation, 62.7% of patients had low fT3, which significantly increased to 78% of patients on the third day. In comparison to values on day one, median levels of fT3 and fT4 significantly decreased and rT3 significantly increased on day three. However, no significant differences were found in the median TSH levels over the same time span. Thirty-five patients (59%) survived while 24 patients (41%) did not survive. Compared with survivors, non-survivors had significantly higher median serum TSH levels on day one, while all other thyroid function tests assays did not significantly differ between days one and three. Of note, serum TSH, fT3, fT4, and rT3 levels, on the first and third days, did not differ significantly between patients who experienced extubation failure and extubation success. To the best of our knowledge, this is the first study to examine thyroid function values in mechanically ventilated children to determine their correlation with extubation outcomes. In this study, NTIS did not correlate with extubation outcomes in critically ill children undergoing mechanical ventilation.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77398146","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":"Fluid Overload in Pediatric Acute Respiratory Distress Syndrome after Allogeneic Hematopoietic Cell Transplantation","authors":"C. J. Sallee, J. Fitzgerald, L. Smith, Joseph R. Angelo, M. Daniel, S. Gertz, D. Hsing, K. Mahadeo, J. McArthur, C. Rowan","doi":"10.1055/s-0042-1757480","DOIUrl":"https://doi.org/10.1055/s-0042-1757480","url":null,"abstract":"The aim of the study is to examine the relationship between fluid overload (FO) and severity of respiratory dysfunction in children post-hematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS). This investigation was a secondary analysis of a multicenter retrospective cohort of children (1month to 21 years) post-allogeneic HCT with PARDS receiving invasive mechanical ventilation (IMV) from 2009 to 2014. Daily FO % (FO%) and daily oxygenation index (OI) were calculated for each patient up to the first week of IMV (day 0 = intubation). Linear mixed-effect regression was employed to examine whether FO% and OI were associated on any day during the study period. In total, 158 patients were included. Severe PARDS represented 63% of the cohort and had higher mortality (78 vs. 42%, p <0.001), fewer ventilator free days at 28 (0 [IQR 0–0] vs. 14 [IQR 0–23], p <0.001), and 60 days (0 [IQR 0–27] v. 45 [IQR 0–55], p <0.001) relative to non-severe PARDS. Increasing FO% was strongly associated with higher OI (p <0.001). For children with 10% FO, OI was higher by nearly 5 points (adjusted β 4.6, 95% CI [2.9, 6.3]). In subgroup analyses, the association between FO% and OI was strongest among severe PARDS (p <0.001) and during the first 3 days elapsed from intubation (p <0.001). FO% was associated with lower PaO2/FiO2 (adjusted β −1.92, 95% CI [−3.11, −0.73], p = 0.002), but not mean airway pressure (p = 0.746). In a multicenter cohort of children post-HCT with PARDS, FO was independently associated with oxygenation impairment. The associations were strongest among children with severe PARDS and early in the course of IMV.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80721263","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":"Metabolic Abnormalities in Association with Clinical Neonatal Seizures in an Indian Tertiary Care Centre","authors":"R. Y., Sandeep Pd","doi":"10.1055/s-0042-1757479","DOIUrl":"https://doi.org/10.1055/s-0042-1757479","url":null,"abstract":"Metabolic disturbances frequently occur in neonatal seizures either as an underlying cause or as an associated abnormality. A prompt recognition of metabolic abnormalities and early therapy are necessary to avoid poor neurological outcome. Neonates with clinical seizures were enrolled in the study. Diagnostic evaluation included complete blood count, sepsis screen, and estimation of blood glucose, serum sodium, calcium and magnesium before instituting any specific treatment. Metabolic abnormalities were considered as isolated when hypoxic ischemic encephalopathy (HIE), sepsis, intracranial hemorrhage, and polycythemia were ruled out. Among 80 newborns with clinical seizures, one metabolic abnormality was detected in 46 (57.5%) newborns. The commonest metabolic abnormality observed was hypoglycemia, noted in 22/80 (27.5%) newborns. Hypocalcemia was the second common abnormality, noted in 10/80 (12.5%) newborns. Isolated metabolic abnormalities were observed in 23.8% (19/80) of newborns with seizures. Associated morbidities with seizures included HIE in 21 (26.3%) and sepsis in 28 (35%). Hypoglycemia was the commonest isolated metabolic abnormality (12.5%). Metabolic abnormalities co-existed with HIE in nine out of 21 neonates and with sepsis in eight out of 28 neonates. Hypoglycemia was the common abnormality associated with both the conditions. Inborn errors of metabolism constituted 8.8% of the cohort studied (7 of 80 patients). A metabolic abnormality was detected in more than 50% neonates with clinical seizures enrolled in our study. Metabolic abnormality also co-exists in neonates with HIE as well as sepsis-related seizures.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83499499","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":"Complications of Peripheral Arterial Access in Preterm and Term Neonates: A Systematic Review","authors":"Yangmyung Ma, A. Salem, A. Jester","doi":"10.1055/s-0042-1757476","DOIUrl":"https://doi.org/10.1055/s-0042-1757476","url":null,"abstract":"The aim of the study is to provide a comprehensive review of vascular complications secondary to peripheral arterial catheterization in preterm and term neonates. The systematic review consisted of searching PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews, and references of journals using pre-trialed MeSH terms and articles. Eight studies were included for full text analysis from 2,369 initial articles: six retrospective reviews and two prospective studies. Rate of complication was 8.6% and all complications were ischemic in nature. Complications most often occurred in neonates with pulmonary/cardiac comorbidities and lower gestational ages. No association was found for weight and sex of neonates. The radial artery site presented with lower rates of complication of 6% and the femoral presented with the highest (16%). Complications predominately occurred in catheter sizes larger than 22 gauge and most often within 1 day of insertion. A low rate of complications (7.4%) was observed in studies that used heparinized saline at the time of catheterization. This study demonstrates an increasing overall rate of complications with ischemia presenting as the most common complication. There seems to be an association between gestational age, comorbidities, site of catheter, size of catheter, and duration of catheter with such complications. This study also demonstrates the association between the use of heparinized saline and a reduction in rate of complications. The authors advocate for a national data collection tool of all pediatric arterial catheters and its complications to be able to analyze and work on best practice to minimize life changing iatrogenic complications.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72606547","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}