Clinical Neuropsychiatry最新文献

{"title":"Navigating the \"Mental Health Crisis\" in Adolescents in the Aftermath of Covid-19 Pandemic: Experience and Insights from Frontline Psychiatric Service.","authors":"Federico Mucci,&nbsp;Siham Bouanani,&nbsp;Angelo Cerù,&nbsp;Amelia Mauro,&nbsp;Francesca Diolaiuti","doi":"10.36131/cnfioritieditore20230410","DOIUrl":"https://doi.org/10.36131/cnfioritieditore20230410","url":null,"abstract":"<p><p>The COVID-19 pandemic had a great impact on adolescent mental health, with a dramatic rise in psychiatric emergencies that has challenged healthcare systems worldwide. This paper aims at focusing on reporting the authors' experience and their data collected on adolescent emergencies in 2022 in Tuscan, within the context of the \"Azienda USL Toscana Nord Ovest\", a large department covering about a third of Tuscany's Regional Health Service, in central Italy. The collected findings will be shortly presented and commented on, while providing insights concerning the importance of adapting healthcare systems to adequately respond to this growing crisis and the need for broader strategies to support adolescent mental health in these challenging times.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41134514","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 Impact of Covid-19 Pandemic on Mental Health Services: A Comparison Between First Psychiatric Consultations Before and After the Pandemic.","authors":"Ivano Caselli,&nbsp;Marta Ielmini,&nbsp;Alessandro Bellini,&nbsp;Silvio Marchetti,&nbsp;Giulia Lucca,&nbsp;Erica Vitiello,&nbsp;Manuel Glauco Carbone,&nbsp;Camilla Callegari","doi":"10.36131/cnfioritieditore20230402","DOIUrl":"https://doi.org/10.36131/cnfioritieditore20230402","url":null,"abstract":"<p><strong>Objective: </strong>A high rate of onset or exacerbation of several mental disorders has been observed during the COVID-19 pandemic. However, the risk contributing to mental distress during the pandemic remains unclear. The study aims to evaluate the risk of the onset of mental disorders by comparing the number of requests for the first psychiatric consultation before and after the COVID-19 pandemic at the psychiatric outpatient services of Varese, a small town in Northern Italy.</p><p><strong>Method: </strong>This observational retrospective study aims to compare the requests for the first psychiatric consultation at the outpatient services of Varese during the 14-month period before COVID-19 pandemic (from 1st January 2019 to 28th February 2020) versus the 14-month period after the pandemic (from 1st March 2020 to 31st May 2021) extracted from the server SIPRL-Psicheweb database (Sistema Informativo della Psichiatria, Lombardy Region). For each patient, socio-demographic features and clinical data (psychiatric diagnosis, psychiatric comorbidities, previous psychiatric records, and previous hospitalization in the psychiatric ward) were collected.</p><p><strong>Results: </strong>Three hundred ninety-five consultations were made during the pre-COVID period and 346 during the post-COVID period. No statistically significant difference was found between the number of first consultation requests in the two periods evaluated but a slight decrease in the total number during the pandemic period (395 vs 346; p=0.07) can be noticed. In the subjects of the pre-COVID group, a statistically significant association was detected with no previous psychiatric records (\"absent\") and with stressor-related disorders. In the post-COVID group, a statistically significant correlation between \"present\" previous records and anxiety-depressive disorders emerged.</p><p><strong>Conclusions: </strong>It has been observed that anxiety-depressive disorders increased in the post-COVID-19 period compared to the pre-COVID-19, instead of stressor-related disorders. This might be because stressor-related disorders may be treated by general practitioners with no psychiatric interventions. Most of the first consultations during the period of the COVID-19 pandemic were for patients who already had contact with psychiatric services.The study shows an increasing request for care by more severe patients in the first phase of the SARS-CoV-2 pandemic. Further research is needed to investigate the long-term impact of the COVID-19 pandemic on emergency departments and hospital services.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152769","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 Missing Ingredient: How Misogyny and the Patriarchy Sabotage our Clinical Practice and Research.","authors":"Christine Forner","doi":"10.36131/cnfioritieditore20230412","DOIUrl":"https://doi.org/10.36131/cnfioritieditore20230412","url":null,"abstract":"<p><p>Discussing massive, unrelenting trauma, especially during a global pandemic, when the threat is not only personally affecting you, but also everyone else, is not an easy thing to do. We can see the consequences of two years of being locked inside. People's trauma responses literally came flooding out. It seems that the pandemic tipped us over an abyss that is hard to comprehend. In so many countries there are protests, laws rolling back basic human rights, the threat of fascism, and actual war. There seems to be widespread governmental corruption that cannot stop the favouritism of those who have wealth, and perpetually admonish those who do not. Our world seems very unstable. Change is deeply desired. Yet, this instability is predictable. It is predictable because the systems that created the structures that \"run and rule\" us are fundamentally destructive and violent. In never-ending ways, the only way that change happens is by utilizing violence as the only way to achieve change. This is the legacy of patriarchy. A system that not only is ruled by one group of people but also tends to be controlled by a very specific type of person. It is a system that cultivates human cruelty, selfishness, and violence. It is a system that is managed by those who do the \"best\" in violence. Most of us do not work this way but are forced to live this way because of the belief that humans are innately violent, selfish, and self-serving; a myth based on the traumatic reaction of fight. It is a dissociated, relational injury that is a direct result of not having our mothers and fathers able to be mothers and fathers. It is formed in misogyny. There are ways to heal, if one can comprehend what misogyny does to human beings, and what we would be like in its absence.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152770","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 Contributions of a Mental Health Research Process Concomitant with the Covid-19 Crisis.","authors":"Laurence Fond-Harmant,&nbsp;Hélène Kane,&nbsp;Jade Gourret Baumgart,&nbsp;Gaetan Absil,&nbsp;Anne Philippart,&nbsp;Jocelyn Deloyer,&nbsp;Serge Mertens de Wilmars,&nbsp;Vinciane de Moffarts,&nbsp;Marguerite Moraitou,&nbsp;Mihaela Gavrilă-Ardelean,&nbsp;Wissam El Hage,&nbsp;Donatella Marazziti,&nbsp;Frédéric Denis","doi":"10.36131/cnfioritieditore20230407","DOIUrl":"https://doi.org/10.36131/cnfioritieditore20230407","url":null,"abstract":"<p><p>This article takes stock of the research work carried out in Europe over the period 2020-2022 by a multidisciplinary consortium of specialists in psychiatry and mental health that brings together university research laboratories, psychiatric hospitals, universities, and training centers. Our work focuses on the difficulties encountered by care and psycho-social support professionals during the COVID-19 period. These difficulties are individual and organizational to ensure a service of accompaniment and follow-up of psychiatric users. What synthesis can we achieve of our successes, our failures, our limitations, and for which avenues of work for the future? After presenting the methodological protocol, we conduct a self-critical reflection of the achievements in 3 main axes of analysis: 1. Evolution of working conditions in a context of uncertainty, 2. Organizational dimensions and hindered care, 3. Digital technologies. From these results emerges a set of controversies and ethical questions relating to the legitimacy of remote care, confidentiality and protection of personal data, and equity in access to care. It appears that the professional practices deployed during the COVID-19 health crisis question the way in which the organization of care and social support integrate the possibilities offered by digital applications. They are about promoting the autonomy and empowerment of mental health service users and professionals. From this perspective, the extension of this work develops a forward-looking approach included in Community digitization policies for new European projects. It appears necessary to carry out multidisciplinary in-depth work, by 2030 on hospital psychiatry and \"outside the walls\", the care pathway of the user, social support, digitalization, data management, and the training of professionals in technological changes.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41154759","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":"Article Highlights.","authors":"Federico Mucci","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152124","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":"Understanding Problematic Gaming During the Covid-19 Pandemic in Adolescents and Adults: A Systematic Review of the Literature.","authors":"Laura Salerno,&nbsp;Alessandro Pepi,&nbsp;Maria Teresa Graffeo,&nbsp;Gaia Albano,&nbsp;Cecilia Giordano,&nbsp;Gianluca Lo Coco,&nbsp;Maria Di Blasi","doi":"10.36131/cnfioritieditore20230418","DOIUrl":"https://doi.org/10.36131/cnfioritieditore20230418","url":null,"abstract":"<p><strong>Objective: </strong>A growing body of evidence suggests that online gaming increased during the COVID-19 outbreak. This systematic review aims to summarize extant literature that reported on problematic gaming among both adolescents and adults during the pandemic and to identify available research on the bidirectional association between problematic gaming and mental health outcomes.</p><p><strong>Method: </strong>A systematic search was carried out through PubMed, Web of Knowledge and AGRIS, Embase, Medline, PsychINFO (from January 2020 to January 2023), using keywords related to problematic gaming and mental health outcomes. Both cross-sectional and longitudinal empirical studies which used validated measures of problematic gaming and mental health outcomes during the COVID-19 pandemic were included.</p><p><strong>Results: </strong>Twenty-five empirical articles were eligible for the current review, comprising 28,978 participants. The majority of the selected studies had cross-sectional designs. Overall, most eligible studies showed significant association between problematic gaming and negative mental health outcomes during the pandemic. Correlations were mostly found between problematic gaming, depression and anxiety.</p><p><strong>Conclusions: </strong>Future research focusing on the relationship between problematic gaming and mental health outcomes should go beyond the considerable weaknesses due to methodological limitations of cross-sectional design, sampling and measures.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157922","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":"I Got it. Perceived Infectability and Germ Aversion after Covid-19 Infection.","authors":"Alfonso Troisi,&nbsp;Valeria Carola,&nbsp;Roberta Croce Nanni","doi":"10.36131/cnfioritieditore20230413","DOIUrl":"https://doi.org/10.36131/cnfioritieditore20230413","url":null,"abstract":"<p><strong>Objective: </strong>The COVID-19 pandemic has offered a unique opportunity to test evolutionary hypotheses on the functionality of the behavioral immune system. The aim of the present study was to ascertain if a previous infection with COVID-19 was associated with increased levels of perceived infectability and germ aversion. Based on the calibration hypothesis, we predicted that the activation of the behavioral immune system was greater in those participants who had been infected compared to those who reported no previous COVID-19 infection.</p><p><strong>Method: </strong>The sample included 2072 participants who completed an online survey between March 1 and April 10, 2022 when the Italian population was facing the third wave of the COVID-19 pandemic. To measure the activation of the behavioral immune system, we used the Perceived Vulnerability to Disease (PVD) scale.</p><p><strong>Results: </strong>Perceived infectability was significantly greater in those participants who had been infected compared to those who reported no previous COVID-19 infection but there was no significant difference between the two groups in terms of germ aversion.<i>Conclusions</i> Overall, our findings suggest that individual differences in the activation of the behavioral immune system were marginally affected by a personal history of COVID-19 infection. A possible explanation is that the environmental sensitivity of the behavioral immune system is tuned more on chronic disease threat (i.e., ecologies with higher pathogen load) than on situational disease threat (e.g., a pandemic or disease outbreak like the COVID-19 pandemic).</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161739","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 Impact of the Covid-19 Pandemic on Patients with Obsessive Compulsive Disorder (OCD).","authors":"Fatimah N AlDandan,&nbsp;Laila H Aldandan,&nbsp;Ali A Sulais,&nbsp;Sara T Alshaikh,&nbsp;Abdullah H Alqahtani,&nbsp;Mohamed S Khalil","doi":"10.36131/cnfioritieditore20230416","DOIUrl":"https://doi.org/10.36131/cnfioritieditore20230416","url":null,"abstract":"<p><strong>Objective: </strong>An intense desire to avoid contamination is one of the most common symptoms of Obsessive-Compulsive Disorder (OCD). In March 2020, when the COVID-19 outbreak was classified as a pandemic, authorities announced measures to control its spread, including hand washing, quarantine, social distancing and lockdowns. The disease spreads rapidly and has potentially serious complications, and adherence to the recommendations was strongly encouraged. These measures, both by their direct effect and as a consequence of their impact on care provision may trigger complications in patients with OCD.</p><p><strong>Method: </strong>An online survey was completed by 102 patients with a confirmed OCD diagnosis. The survey collected demographic data, medical and psychiatric history, and asked COVID-19 related questions, OCD-related questions, and included the Self-reported Yale-Brown Obsessive-Compulsive Symptom Checklist (Y-BOCS-II).</p><p><strong>Results: </strong>The results reveal that new OCD patterns started during the COVID-19 pandemic, including pathological doubt/checking (2.0%), a need for symmetry, order or precision (2.9%), religious pattern (2.9%), somatic/health pattern (4.9%), and a contamination/washing pattern (5.9%), which was the most reported among all patterns. The results also show an increase in overall severity of OCD (36.3%), and (27.5%) of participants also reported an increase in the overall severity of anxiety.</p><p><strong>Conclusions: </strong>The questionnaire completed by patients previously diagnosed with OCD revealed that during the COVID-19 pandemic there was an increase in the severity of symptoms, with the greatest effect being in individuals with contamination/ washing patterns.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41173317","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":"Poor Sleep Quality May Independently Predict Suicidal Risk in Covid-19 Survivors: A 2-Year Longitudinal Study.","authors":"Laura Palagini,&nbsp;Gaspare Alfi,&nbsp;Diletta Dazzi,&nbsp;Angelo Gemignani,&nbsp;Valerio Caruso,&nbsp;Pierre A Geoffroy,&nbsp;Mario Miniati,&nbsp;Sofia Straudi","doi":"10.36131/cnfioritieditore20230406","DOIUrl":"https://doi.org/10.36131/cnfioritieditore20230406","url":null,"abstract":"<p><strong>Objective: </strong>Multiple symptoms of psychiatric, neurological, and physical illnesses may be part of Post-COVID conditions and may pose COVID-19 survivors a high suicidal risk. Accordingly, we aimed to study factors contributing to suicidal risk in Post COVID-19 patients.</p><p><strong>Method: </strong>Consecutive patients with post COVID-19 conditions were followed for 2 years at the University Hospital of Ferrara at baseline (T0), 6 (T1), 12 (T2), and 24 (T3) months. Demographics, and clinical data for all patients included: disease severity, hospital length of stay, comorbidity, clinical complications, sleep quality, cognitive complaints, anxiety and stress-related symptoms, depressive symptoms, and suicidal ideation.</p><p><strong>Results: </strong>The final sample included 81 patients with post COVID survivors. The mean age was 64 + 10,6 years, 35,8% were females, 65,4% had medical comorbidities, and 69,1% had WHO severe form of COVID forms. At T0 more than 90% of patients showed poor sleep quality, 59.3% reported moderate/severe depressive symptoms, and 51.% experienced anxiety, 25.9% experienced post-traumatic stress symptoms. At T0 suicidal ideation, interested 6.1% and at T3 it increased to 7.4%. In the regression analysis, suicidal ideation at baseline was best predicted by poor sleep quality (O.R. 1.71, p=0.044) and, after 2 years, suicidal ideation was best predicted by poor sleep quality experienced at baseline (OR 67.3, p=0.001).</p><p><strong>Conclusions: </strong>Poor sleep quality may play as an independent predictor of suicidal risk in post-COVID survivors. Evaluating and targeting sleep disturbances in COVID survivors is important to prevent the consequences of disrupted sleep in mental health.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41151839","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":"Alexithymia and Interoceptive Confusion in Covid-19 Pandemic Distress.","authors":"Mario Miniati,&nbsp;Chiara Poidomani,&nbsp;Ciro Conversano,&nbsp;Graziella Orrù,&nbsp;Rebecca Ciacchini,&nbsp;Donatella Marazziti,&nbsp;Giulio Perugi,&nbsp;Angelo Gemignani,&nbsp;Laura Palagini","doi":"10.36131/cnfioritieditore20230405","DOIUrl":"https://doi.org/10.36131/cnfioritieditore20230405","url":null,"abstract":"<p><strong>Objective: </strong>Alexithymic traits are associated with the difficulty of perceiving <i>'non-affective interoceptive signals</i>', and are related to a problematic management of stressful life events (SLEs). The main purpose of this study was to quantify the psychological response of the general population to COVID-19 pandemic stress and to evaluate potential correlations with the presence of <i>'alexithymic traits</i>' and <i>'interoceptive confusion</i>' (study protocol # 0077794/2022).</p><p><strong>Method: </strong>175 subjects from general population were assessed with the Toronto-Alexithymia Scale (TAS-20), the Event-Revised Impact Scale (IES-R), the Interoceptive Accuracy Scale (IAS), and the Interoceptive Confusion Questionnaire (ICQ).</p><p><strong>Results: </strong>a significant relationship emerged between alexithymic traits (assessed with the TAS-20), the ICQ '<i>interoceptive confusion</i>', and the domain of '<i>hyper-arousal</i>' as assessed with IES-R. Logistic regression model showed that ICQ-Total Score and IES-R '<i>hyper-arousal</i>' domain were significantly correlated with TAS-20 total score, with DR value (R2 corrected) explaining the 36.8% of the variability (standard error: 10.7).</p><p><strong>Conclusions: </strong>This study, albeit with the limitations of a cross-sectional experimental design with self-evaluation tools in a general population sample, showed a vulnerability to COVID-19 pandemic stress due to high levels of hyper-arousal in subjects with alexithymic traits and interoceptive confusion.</p>","PeriodicalId":46700,"journal":{"name":"Clinical Neuropsychiatry","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41119999","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}