G. D. Searchfield, Megan J. McAuliffe, Christine Fok, Tin Aung Kyaw, Eric Williams, L. Burton-Harris, Gavin Coad, Jonny Grady, Alice Smith, D. Vajsakovic
{"title":"The CogniAid trial. The impact of two hearing aid signal processing strategies on cognition","authors":"G. D. Searchfield, Megan J. McAuliffe, Christine Fok, Tin Aung Kyaw, Eric Williams, L. Burton-Harris, Gavin Coad, Jonny Grady, Alice Smith, D. Vajsakovic","doi":"10.3389/fauot.2024.1285496","DOIUrl":"https://doi.org/10.3389/fauot.2024.1285496","url":null,"abstract":"Untreated hearing loss is a risk factor for age-related cognitive decline and hearing aids have been shown to slow cognitive decline in a population at risk for dementia. This double-blind multiple site randomized trial tested the hypothesis that for older adults with below-average cognition, a “Simple” hearing aid fitting strategy (based on linear amplification with output limiting compression signal processing) would improve hearing and cognition more than a “Standard” approach (adaptive compression-based processing).Two hundred and fifty-six adults aged over 65 were screened for cognitive function using the NIH toolbox cognitive battery. Participants with below median age-adjusted fluid composite cognitive scores (<100) were eligible to participate (n = 104). Sixty-seven eligible participants proceeded to trial and were randomized 1:1 to a simple or standard hearing aid fitting. Participants in the Standard group were fitted with hearing aids matched to non-linear real-ear prescription targets (either NAL-NL1 or NL2), while participants in the Simple group were fitted with hearing aids matched to linear prescription targets (NAL-R). Participants and researchers not fitting the hearing aids were blinded to allocation.Forty-eight participants completed assessments in 12 months. The Standard hearing aid group improved on measures of fluid cognition and hearing. There was a statistically significant difference in fluid cognition scores between groups. The fluid cognition composite score for participants receiving the Simple fitting changed by 3.5 points. Those with the Standard fitting improved by 10.3 points. Hearing outcomes for each group were improved by the same amount.This is the first study to show that hearing aid fitting strategies using markedly different signal processing result in significantly different cognitive outcomes after 12 months of use. The Standard fitting resulted in greater improvement in cognition than the Simpler fitting which was the opposite result to what had been hypothesized. The results reinforce findings indicating hearing aid benefits for the elderly and that they improve cognition.","PeriodicalId":483207,"journal":{"name":"Frontiers in Audiology and Otology","volume":"3 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139598408","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":"A critical review of established tinnitus patient-reported outcomes as measures of Tinnitus Severity and Tinnitus Distress and exemplar analysis of the Tinnitus Handicap Inventory as a formative or reflective measure","authors":"N. Clarke, Derek J. Hoare, Andrew Trigg","doi":"10.3389/fauot.2023.1325137","DOIUrl":"https://doi.org/10.3389/fauot.2023.1325137","url":null,"abstract":"Tinnitus Severity and Tinnitus Distress are frequently referenced and conflated constructs in research, measured using established tinnitus patient-reported outcome measures (PROs). Confusion regarding these constructs and their relation to fundamental scientific conceptions of tinnitus represents a threat to the validity of PROs as applied in tinnitus research, the conclusions that are reached when applying them, and subsequent progress of theory and clinical interventions for those experiencing tinnitus. Therefore, we critically review relevant literature, providing the Severity of Symptoms (SoS) and Correlates of Complaint (CoC) framework to link tinnitus theory to these constructs. We provide researchers with an overview of latent variable fundamentals (including distinctions between formative and reflective measures, and psychometric and clinimetric measurement traditions). We then provide a synthesis of the relationship between Tinnitus Severity and Tinnitus Distress, the SoS/CoC framework, and latent variable measurement to elucidate their distinctions. Finally, we take the Tinnitus Handicap Inventory (THI) as an exemplar of established tinnitus PROs and use study data (N = 200) to empirically evaluate the appropriateness of the THI as a reflective measure of Tinnitus Distress. Subsequently, conceptual and criterion mediation tests provide evidence that the THI is not a reflective measure of Tinnitus Distress according to the CoC conception and should be considered as a formative measure. Researchers should therefore consider whether established tinnitus PROs, such as the THI, are congruent with the scientific conceptions and subsequent theories that they aim to evaluate.","PeriodicalId":483207,"journal":{"name":"Frontiers in Audiology and Otology","volume":"94 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139612565","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}
Fabrice Bardy, Laure Jacquemin, Cara L. Wong, Michael R. D. Maslin, Suzanne C. Purdy, Hung Thai-Van
{"title":"Delivery of internet-based cognitive behavioral therapy combined with human-delivered telepsychology in tinnitus sufferers through a chatbot-based mobile app","authors":"Fabrice Bardy, Laure Jacquemin, Cara L. Wong, Michael R. D. Maslin, Suzanne C. Purdy, Hung Thai-Van","doi":"10.3389/fauot.2023.1302215","DOIUrl":"https://doi.org/10.3389/fauot.2023.1302215","url":null,"abstract":"While there is no cure for tinnitus, research has shown that cognitive behavioral therapy (CBT) is effective in managing clinical sequelae. Although traditional CBT is labor-intensive and costly, new online consultations may improve accessibility. Moreover, there is promise in an engaging conversational agent, or a “chatbot,” delivering CBT in a conversation-like manner and allowing users to work through complex situations with the guidance of a virtual coach. Currently, there is little research examining a possible hybrid model using iCBT and tele consultation with a psychologist.A randomized, 2 parallel-group trial was conducted to compare the clinical effectiveness of (1) iCBT delivered through a chatbot mobile app (i.e., Tinnibot only group) (2) Tinnibot combined with telepsychology (i.e., hybrid-intervention group). A total of 30 eligible adults with tinnitus were included. After an 8-week intervention period, participants were followed up for 2 months. The primary outcome measure, the Tinnitus Functional Index (TFI), and the secondary outcome measures, Hyperacusis Questionnaire (HQ), Generalized Anxiety Disorder 7-item (GAD-7), and Patient Health Questionnaire (PHQ-9), were assessed before treatment, post-treatment, and at follow-up.The TFI decreased significantly over time in both groups, with a trend for a larger improvement in the group that received telepsychology. At post-treatment, a clinically significant improvement was observed in 42% of the Tinnibot-only group and 64% of the hybrid-intervention group. At follow-up, this was 64% for both groups. The secondary outcome measures, PHQ-9 and GAD-7 improved significantly over time, but the HQ did not.Internet-based delivery of CBT is effective in decreasing tinnitus distress, and levels of anxiety and depression, which is more relevant today than ever in the context of a global pandemic that has challenged the delivery of face-to-face intervention. The addition of telepsychology might be beneficial, but not essential for the effectiveness of treatment. There is a need for further research to determine whether there is any relationship between the characteristics of tinnitus patients and the success of the different modes of delivery of therapy.","PeriodicalId":483207,"journal":{"name":"Frontiers in Audiology and Otology","volume":"33 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443963","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}
Lisa Jane Burton-Harris, Philip J. Sanders, Grant D. Searchfield
{"title":"An implementation science systematic review of neurophysiological evidence indicates the tinnitus core network as a therapeutic target","authors":"Lisa Jane Burton-Harris, Philip J. Sanders, Grant D. Searchfield","doi":"10.3389/fauot.2023.1311186","DOIUrl":"https://doi.org/10.3389/fauot.2023.1311186","url":null,"abstract":"Identifying and implementing an effective tinnitus treatment has been a challenge. Despite efforts over many decades, there is no definitive cure for tinnitus yet. Implementation science may assist audiology practitioners and end-user patients in their pursuit of a cure by identifying ways to maximize the use of research findings. Within the context of therapeutic interventions, implementation science is the study of a successful treatment–system fit evidenced by use. Research evidence for tinnitus treatment efficacy is dominated by behavioral questionnaires as they are a pragmatic source of patient-driven data. Neurophysiological evidence of the underlying neural network change correlated with these behavioral findings enhances research conclusions and potential use. This implementation science review systematically sourced and analyzed neurophysiological evidence from 29 studies to find that targeting tinnitus core network neuroplasticity may be the most effective tinnitus treatment. Narrow-band sound treatment has the greatest body of correlated neurophysiological-behavioral evidence. This is the first tinnitus implementation science systematic review. It is hoped that new or improved treatments may emerge from pivoting the evidential lens toward the pragmatic use of neurophysiological evidence.https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022335201.","PeriodicalId":483207,"journal":{"name":"Frontiers in Audiology and Otology","volume":"38 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139010448","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}
Vinaya Manchaiah, S. Chundu, Pierre Ratinaud, Gerhard Andersson, Eldré W. Beukes
{"title":"Internet-based cognitive behavioral therapy positively influences the social representations of tinnitus","authors":"Vinaya Manchaiah, S. Chundu, Pierre Ratinaud, Gerhard Andersson, Eldré W. Beukes","doi":"10.3389/fauot.2023.1302005","DOIUrl":"https://doi.org/10.3389/fauot.2023.1302005","url":null,"abstract":"The aim of the current study was to examine changes in social representations of tinnitus as a result of Internet-based cognitive behavioral therapy (ICBT).The study used a pretest-posttest design. A total of 106 individuals with tinnitus (mean age 57.5 years) completed a series of questionnaires before and after undertaking ICBT. A free association task was used to collect data. The data were analyzed using qualitative content analysis and also series of quantitative analyses using the IraMuTeQ software.The most common categories reported by individuals with tinnitus before and after ICBT intervention varied. Examination of valance showed that the negative associations decreased from 81 to 56% and the positive and neutral connotations were increased after the intervention. Examination of the frequency of responses and similarities analysis did not reveal major changes following the intervention. However, the prototypical analysis, which considers both the frequency of categories as well as their ranking, showed that more positive and less negative categories appeared in the central zone and in the first periphery following the ICBT intervention.The study suggests that ICBT reduces the negativity associated with tinnitus and increases positivity. The results are consistent with what is seen in patient-reported outcome measures in clinical trials.","PeriodicalId":483207,"journal":{"name":"Frontiers in Audiology and Otology","volume":"1 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138601316","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":"Improving the stimulation selectivity in the human cochlea by strategic selection of the current return electrode","authors":"Ozan Cakmak, Saikat Pal, Mesut Sahin","doi":"10.3389/fauot.2023.1259852","DOIUrl":"https://doi.org/10.3389/fauot.2023.1259852","url":null,"abstract":"The hearing quality provided by cochlear implants is poorly predicted by computer simulations. A high-resolution, human-specific cochlear anatomy is crucial for the accuracy of predictions. In this study, the standard multipolar stimulation paradigms are revisited and Rattay's Activating Function is evaluated in a finite element model of a realistic cochlear geometry that is based on μ-CT images and a commercial lead. The stimulation thresholds across the cochlear fibers were investigated for monopolar, bipolar, tripolar, and a novel (distant) bipolar electrode configuration using an active compartmental nerve model based on Schwartz-Eikhof-Frijns membrane dynamics. The results suggest that jumping of the stimulation point from the vicinity of the cathodic electrode to distant fibers, especially to the low frequency (apical) region of the basilar membrane that is most critical to hearing, occurs more often with monopolar stimulation than other electrode configurations. Bipolar and tripolar electrodes near the apical region did not provide a large threshold margin either. On the other hand, the threshold margin could be improved by proper selection of the electrode for the return current with bipolar stimulation, a technique named here as distant bipolar. The results also demonstrate the significance of having a realistic cochlear geometry in computer models for accurate interpretation for multipolar stimulation paradigms. More selective and focal stimulation may be possible by designing the electrode carrier shape and positioning of the current return electrodes more strategically. This is needed particularly in the apical turn of the cochlea where the current stimulation methods are the least selective.","PeriodicalId":483207,"journal":{"name":"Frontiers in Audiology and Otology","volume":"17 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136104371","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":"Tinnitus as central noise revealed by increased loudness at thresholds","authors":"Fan-Gang Zeng, Katie E. Turner","doi":"10.3389/fauot.2023.1272880","DOIUrl":"https://doi.org/10.3389/fauot.2023.1272880","url":null,"abstract":"Tinnitus is an auditory sensation in the absence of external sounds; its neural mechanisms remain unclear. An active loudness model suggests that tinnitus is a result of increased central noise while hyperacusis is that of increased central gain. To the extent that loudness reflects the system-level neural activities, this active model predicts that tinnitus increases loudness at thresholds but does not increase the slope of loudness function. To test this prediction, the present study compared loudness growth of various stimuli between tinnitus and non-tinnitus subjects. The stimuli were tested at frequencies without hearing loss and both tinnitus and non-tinnitus subjects had unremarkable hyperacusis. Consistent with the prediction, the loudness at threshold in tinnitus subjects were 2.3 times greater than that in non-tinnitus subjects; there was no significant difference in the slope of loudness growth between these two groups of subjects. The present result shows that traditional psychophysics, originally developed to investigate relationships between subjective sensation and physical stimulation, can also help delineate neural mechanisms underlying tinnitus and other disorders.","PeriodicalId":483207,"journal":{"name":"Frontiers in Audiology and Otology","volume":"188 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135731743","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}
Rahul Mittal, Nathanael Camick, Joana R. N. Lemos, Giacomo Lanzoni, Christopher A. Fraker, Khemraj Hirani
{"title":"Hearing loss in type 1 diabetes mellitus: a need to understand precise pathological mechanisms and develop novel therapeutic approaches","authors":"Rahul Mittal, Nathanael Camick, Joana R. N. Lemos, Giacomo Lanzoni, Christopher A. Fraker, Khemraj Hirani","doi":"10.3389/fauot.2023.1279818","DOIUrl":"https://doi.org/10.3389/fauot.2023.1279818","url":null,"abstract":"This integrative review and perspective article synthesizes current knowledge about the co-morbidity of Type 1 Diabetes (T1D) and sensorineural hearing loss (SNHL), affecting an estimated 9.2 per 1,000 T1D patients annually. Combining data from clinical, preclinical, and mechanistic studies, the article elucidates the complex pathological mechanisms contributing to SNHL in T1D. It is established that T1D accelerates age-related SNHL and brings about detrimental changes in the auditory system, including damage to outer hair cells (OHCs), inner hair cells (IHCs), the stria vascularis (SV), and the spiral ligament (SL). Furthermore, T1D-associated peripheral neuropathy, microvascular damage, and chronic inflammation in the inner ear contribute to auditory deficits. Although some consistency exists between animal models and human conditions, notable discrepancies warrant the refinement of preclinical models to more accurately mirror human clinical scenarios. This perspective article highlights the need for targeted research to bridge existing knowledge gaps and accelerate the development of early-stage interventions for SNHL in T1D patients. Advancements in this field hold the promise of enhancing clinical prognosis and improving the quality of life of individuals having T1D.","PeriodicalId":483207,"journal":{"name":"Frontiers in Audiology and Otology","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135246204","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}
Dhruv Vyas, Erik Jorgensen, Yu-Hsiang Wu, Octav Chipara
{"title":"Evaluating and optimizing hearing-aid self-fitting methods using population coverage","authors":"Dhruv Vyas, Erik Jorgensen, Yu-Hsiang Wu, Octav Chipara","doi":"10.3389/fauot.2023.1223209","DOIUrl":"https://doi.org/10.3389/fauot.2023.1223209","url":null,"abstract":"Adults with mild-to-moderate hearing loss can use over-the-counter hearing aids to treat their hearing loss at a fraction of traditional hearing care costs. These products incorporate self-fitting methods that allow end-users to configure their hearing aids without the help of an audiologist. A self-fitting method helps users configure the gain-frequency responses that control the amplification for each frequency band of the incoming sound. This paper considers how to guide the design of self-fitting methods by evaluating certain aspects of their design using computational tools before performing user studies. Most existing fitting methods provide various user interfaces to allow users to select a configuration from a predetermined set of presets. Accordingly, it is essential for the presets to meet the hearing needs of a large fraction of users who suffer from varying degrees of hearing loss and have unique hearing preferences. To this end, we propose a novel metric for evaluating the effectiveness of preset-based approaches by computing their population coverage. The population coverage estimates the fraction of users for which a self-fitting method can find a configuration they prefer. A unique aspect of our approach is a probabilistic model that captures how a user's unique preferences differ from other users with similar hearing loss. Next, we propose methods for building preset-based and slider-based self-fitting methods that maximize the population coverage. Simulation results demonstrate that the proposed algorithms can effectively select a small number of presets that provide higher population coverage than clustering-based approaches. Moreover, we may use our algorithms to configure the number of increments of slider-based methods. We expect that the computational tools presented in this article will help reduce the cost of developing new self-fitting methods by allowing researchers to evaluate population coverage before performing user studies.","PeriodicalId":483207,"journal":{"name":"Frontiers in Audiology and Otology","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135582145","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}
François Voruz, Aurélie Vuilleumier, Denis Migliorini, German Nacher-Soler, Francis Rousset, Thibault De Maesschalck, Pascal Senn
{"title":"Incidence of cisplatin-induced ototoxicity in adult cancer patients based on audiometric confirmation of patient self-report","authors":"François Voruz, Aurélie Vuilleumier, Denis Migliorini, German Nacher-Soler, Francis Rousset, Thibault De Maesschalck, Pascal Senn","doi":"10.3389/fauot.2023.1239119","DOIUrl":"https://doi.org/10.3389/fauot.2023.1239119","url":null,"abstract":"Introduction Robust clinically relevant epidemiological and audiological data are needed to prepare for future clinical trials aiming at preventing cisplatin-induced ototoxicity in this suffering cancer population. We assessed the incidence, severity, and potential risk factors of symptomatic cisplatin-induced hearing loss in a large cohort of adults. Methods Retrospective cohort study at a tertiary care university hospital. The study group included consecutive patients over 18 years old treated with cisplatin-based chemotherapy without concomitant inner ear radiotherapy or other ototoxic medication. Every participant underwent baseline pretreatment audiometry and was asked for audiological symptoms (tinnitus or subjective hearing loss) during the treatment. If symptomatic, comparative standard audiometry (0.125 to 8 kHz) was performed. Hearing loss was defined by a threshold shift ≥15 dB HL in at least one of the tested frequencies. Results A total of 401 cancer patients (59% males) with a mean age of 56 years (range 18-80) were included. Eighty-one patients (20%) developed symptomatic hearing loss, predominantly affecting the high frequencies from 4 to 8 kHz. Among them, 49 (60%) experienced simultaneous new-onset tinnitus. None of the analyzed potential risk factors (age, sex, smoking, hypertension, diabetes, dyslipidemia, chemotherapeutic regimen, and cumulative cisplatin dose) was statistically correlated with hearing loss. Discussion At least 1 out of 5 patients treated with cisplatin developed audiological symptoms associated with audiometric hearing loss within the 0.125 to 8 kHz range, for which new-onset tinnitus is a sensitive symptom. Not all audiological symptoms are accompanied by audiometric change. No predisposing factor could be identified. Standardized audiological monitoring before and during cisplatin-based chemotherapy allows quantitative assessment of early audiometric signs of ototoxicity, offering to optimize anticancer therapy while minimizing morbidity in a multidisciplinary setting.","PeriodicalId":483207,"journal":{"name":"Frontiers in Audiology and Otology","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136314840","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}