Diabetic medicine : a journal of the British Diabetic Association最新文献

{"title":"Diabetes distress and sleep impairment in type 2 diabetes: A population-based cross-sectional study-The HUNT Study, Norway.","authors":"Hilde K R Riise, Anne Haugstvedt, Jannicke Igland, Ane Wilhelmsen-Langeland, Eirik Søfteland, Monica Hermann, Sofia Carlsson, Timothy C Skinner, Bjørn Olav Åsvold, Marjolein M Iversen","doi":"10.1111/dme.70106","DOIUrl":"https://doi.org/10.1111/dme.70106","url":null,"abstract":"<p><strong>Aims: </strong>To examine associations between sleep impairments and diabetes distress in men and women with type 2 diabetes (T2D) by using cross-sectional data from the Trøndelag Health Study (HUNT).</p><p><strong>Methods: </strong>This population-based cross-sectional study consists of individuals ≥20 years with T2D participating in the HUNT4 survey (2017-2019; n = 1954). Sleep impairments (snoring, sleep apnoea, troubles falling asleep, wake up during the night, early wakening, difficulties coping during the daytime due to sleep problems and restless legs) were measured by the sleeping HUNT-Questionnaire, along with a separate question on the number of hours of sleep at night. Diabetes distress was measured using the Problem Areas in Diabetes (PAID-5) questionnaire. Diabetes distress prevalence, grouped by sleep impairment, was estimated with 95% confidence intervals. Multivariable linear regression models with distress as outcome and adjusted for demographic, clinical and mental health factors were used to examine associations with sleep.</p><p><strong>Results: </strong>Overall, sleep impairment was associated with increased diabetes distress. Regression coefficients B (95% CI) for higher distress score were 0.6 (95% CI 0.2, 0.9) for ≤7 h of sleep, 0.6 (95% CI 0.1-1.1) for snoring, 1.4 (95% CI 0.8-2.2) for troubles falling asleep, 1.1 (95% CI 0.6-1.6) for waking up during the night, 1.2 (95% CI 0.7-1.8) for early wakening, 2.6 (95% CI 1.7-3.6) for troubles coping during daytime due to sleep problems and 0.8 (95% CI 0.2-1.3) for restless legs.</p><p><strong>Conclusion: </strong>Multiple components of sleep impairment were significantly associated with high diabetes distress in individuals with T2D.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70106"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719354","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":"Diabetes body project eating disorder prevention program-Descriptive content analysis of participant and facilitator feedback in a multinational randomized controlled trial.","authors":"Severina Haugvik, Shiraz Harel, Heather Shaw, Maartje de Wit, Elena Toschi, Mareille H C L Hennekes, Torild Skrivarhaug, Knut Dahl-Jørgensen, Eric Stice, Line Wisting","doi":"10.1111/dme.70108","DOIUrl":"https://doi.org/10.1111/dme.70108","url":null,"abstract":"<p><strong>Aims: </strong>To examine and describe feedback after participation in a novel eating disorder prevention program for young women with type 1 diabetes (Diabetes Body Project) in a multinational randomised controlled trial.</p><p><strong>Methods: </strong>Written feedback from participants (N = 109) and facilitators (N = 19) at four sites (Europe and US) was analysed using descriptive, manifest content analysis. Open-ended questions included motivation for participation, most/less valuable aspects of the program and suggestions for improvement.</p><p><strong>Results: </strong>\"Community\" was the most important motivator and most valued aspect, reported by one-third of participants. When asked about less valued aspects of the program, participants and facilitators most frequently reported \"none/not sure/everything was valuable\" and \"nothing\" respectively. Suggestions to improve the program common for participants and facilitators were \"more creative exercises\", specific for participants after \"none\" was \"limit homework/obligations\" and specific for facilitators was \"more flexibility to move away from the script\". The three most frequently perceived barriers for participation reported by participants and facilitators were \"requiring personal vulnerability\", \"time and energy constraints\" and the \"group setting\".</p><p><strong>Conclusions: </strong>Participants and facilitators expressed overall high satisfaction with the program, specifically the value of T1D community. Additionally, they suggested incorporating more creative exercises. Future research should aim at widespread implementation and addressing barriers to participation.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70108"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719353","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 new approach to identifying safety measures across transfers of care for people who use insulin for Type 2 diabetes.","authors":"Catherine Leon, Clare Crowley, Helen Hogan, Yogini H Jani","doi":"10.1111/dme.70101","DOIUrl":"https://doi.org/10.1111/dme.70101","url":null,"abstract":"<p><strong>Aims: </strong>When people who use insulin for Type 2 diabetes have a hospital admission and discharge, they are at risk of harm from incorrect, delayed, or missed insulin doses. Leading indicators can highlight potential areas of risk, providing opportunities to improve safety. Modelling the complex transfer of care pathway can provide insight into where leading indicators could be targeted to support improved outcomes.</p><p><strong>Methods: </strong>Multiple qualitative methods were used, and a framework approach was applied to identify activities (termed functions) involved in managing insulin during the transfer of care, and how factors involving people, equipment and environments (local, organisational and external) impacted these. The Functional Resilience Analysis Method was used to map the transfer of care pathway, and key areas of variability were identified. These areas of variability and two example functions were validated and discussed with key/representative stakeholders in an online seminar.</p><p><strong>Results: </strong>A total of 59 functions were mapped, and 21 were identified as key functions for potential new measures. These 21 functions were validated at a seminar, and two example functions, empowering people with diabetes who use insulin to manage their diabetes and arranging self-administration of insulin in hospital, were discussed in detail. A selection of potential measures was identified.</p><p><strong>Conclusions: </strong>Many potential areas for new leading indicators were identified, and examples of potential measures were described. A coproduction approach is required to expand, define and validate these. Such measures provide an opportunity for proactively improving insulin safety during care transfers.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70101"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693004","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":"Understanding women's sex hormone physiology-A priority in diabetes care.","authors":"Céline Isabelle Laesser, Bettina Weber, David Studer, Reem Jalal Alshareef, Lia Bally","doi":"10.1111/dme.70109","DOIUrl":"https://doi.org/10.1111/dme.70109","url":null,"abstract":"","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70109"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661733","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":"\"It is a constant battle\": A qualitative study of the lived experience of individuals with diabetic foot ulcer and post-healing challenges in primary care.","authors":"Xiaoli Zhu, Eng Sing Lee, Phoebe X H Lim, Frederick H F Chan, Yee Chui Chen, Konstadina Griva","doi":"10.1111/dme.70096","DOIUrl":"https://doi.org/10.1111/dme.70096","url":null,"abstract":"<p><strong>Aim: </strong>To explore the lived experiences of primary care patients with active diabetic foot ulcer (DFU) and post-healing in remission (PHIR) to inform tailored interventions.</p><p><strong>Methods: </strong>A qualitative interview study was conducted with primary care patients with DFU and PHIR in Singapore. In-depth interviews were held with 27 participants (15 with active DFU and 12 with PHIR) from April to July 2022. Transcripts were analysed using thematic analysis.</p><p><strong>Results: </strong>The lived experiences of individuals with DFU across its stages (active DFU and PHIR) were encapsulated in the notion of 'a cyclical lifelong illness threat alongside a vicious foot cycle', reflected in three key themes. The first theme, Making Sense of DFU, captured participants' varied perceptions of their condition-from misattributing in DFU management to seeing it as a constant battle, an unavoidable terminal disease (active DFU) or a wake-up call (PHIR). The second theme, Emotional Consequences, highlighted the significant psychological burden experienced by participants, encompassing emotional exhaustion leading to self care burnout, as well as chronic anxiety and persistent fear of recurrence. The third theme, Behavioural Challenges, illustrated the complexities of self management, with participants describing their efforts as a constant struggle to maintain self care routines, often marked by ambivalence towards long-term adherence.</p><p><strong>Conclusions: </strong>This study highlights the persistent psychosocial and behavioural challenges faced by individuals with DFU and PHIR, underscoring the need for autonomy-supportive and empowerment-focused interventions to reshape perceptions of DFU, alleviate emotional distress and enhance adherence to self care.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70096"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661732","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":"THR1VE!: Randomized controlled trial to reduce diabetes distress in adolescents with type 1 diabetes.","authors":"Sarah S Jaser, Karishma Datye, James C Slaughter, Lauren LeStourgeon, Randi Streisand","doi":"10.1111/dme.70107","DOIUrl":"https://doi.org/10.1111/dme.70107","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the effects of a positive psychology intervention to treat diabetes distress (DD) and improve glycaemic outcomes among adolescents with type 1 diabetes.</p><p><strong>Methods: </strong>Adolescents ages 13-17 with elevated DD and their caregivers from 2 sites (n = 198 dyads) were randomized to receive enhanced usual care (Diabetes Education) or a Diabetes Education + Positive Affect intervention, delivered via automated text messages. Psychosocial and glycaemic data were collected at baseline, 3 months, 6 months and 12 months. The primary outcomes were changes in diabetes distress (DD) and HbA1c over 12 months.</p><p><strong>Results: </strong>Adolescents demonstrated high levels of engagement in the trial; overall response to text messages was 91%, and retention was 90% over 12 months. Adolescents in both groups reported reductions in DD from baseline to 12 months (effect size d = 0.40), and they were significantly more likely to move from clinically relevant levels into the normal range of DD than to report increased DD (OR = 2.2, p = 0.002). Adolescents' HbA1c was stable over 12 months. We did not observe significant differences in outcomes between groups. Improvement in DD was associated with decreased HbA1c over time (β = 1.89, p = 0.02).</p><p><strong>Conclusions: </strong>There was no significant intervention effect on DD or HbA1c. Adolescents in both the Diabetes Education and Diabetes Education + Positive Affect arms reported reduced DD over 12 months. Future studies are needed to determine how to employ the least burdensome, engaging intervention for distressed adolescents.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70107"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652031","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":"Type 2 diabetes risk communication following a diagnosis of gestational diabetes mellitus: A qualitative study.","authors":"Molly Caba, Alison Northern, Amar Virdee, Kamlesh Khunti, Melanie Jane Davies, Michelle Hadjiconstantinou","doi":"10.1111/dme.70105","DOIUrl":"https://doi.org/10.1111/dme.70105","url":null,"abstract":"<p><strong>Background: </strong>Gestational diabetes mellitus (GDM) increases women's risk of developing type 2 diabetes (T2DM) tenfold. Understanding of T2DM risk in women with GDM is variable and can impact health behaviours. To better understand how T2DM risk is communicated by healthcare professionals, we explored women's experiences of T2DM risk communication and support following a diagnosis of GDM.</p><p><strong>Methods: </strong>A qualitative study was conducted utilising semi-structured interviews. Participants were 10 women previously diagnosed with GDM. Transcripts were analysed following reflexive thematic analysis guidelines.</p><p><strong>Results: </strong>Three themes and four sub-themes were created to describe women's experiences of, and responses to, T2DM risk communication and support following a diagnosis of GDM. Minimal T2DM risk communication during GDM and postnatally was a common experience, and as a result, women forgot about their increased risk and felt forgotten by the health service. The lack of correspondence and support further fostered a dearth of knowledge and misunderstandings regarding what T2DM is, how it affects a person's body, and the necessity of preventative actions, all of which could impact women's management of their risk. Several strategies were suggested by women to remedy the currently absent communication and support. This included group education sessions, tangible and digital support resources, providing individualised information, and continuous and harmonious T2DM risk communication from healthcare professionals and health services.</p><p><strong>Conclusions: </strong>Current deficiencies for communicating T2DM risk and providing avenues of support following a diagnosis of GDM leaves many women feeling under-supported. Improvements to current care are recommended to ameliorate this.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70105"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645183","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":"Residual insulin secretion in long-standing type 1 diabetes.","authors":"Petra Augstein, Natalie Buschmann, Janik Riese, Sabine Bochnig, Peter Heinke, Michael Schlosser, Wolfgang Kerner","doi":"10.1111/dme.70104","DOIUrl":"https://doi.org/10.1111/dme.70104","url":null,"abstract":"<p><strong>Aims: </strong>Studies involving the use of sensitive C-peptide assays have revealed that a significant number of persons with long-standing type 1 diabetes have measurable serum C-peptide concentrations. We investigated meal-stimulated C-peptide levels in persons with diabetes duration of more than 30 years and whether they were associated with the presence of diabetes-associated autoantibodies.</p><p><strong>Methods: </strong>This was an observational study of 105 participants with a clinical diagnosis of type 1 diabetes and a diabetes duration ≥30 years. Participants underwent mixed-meal tolerance tests (MMTTs) with measurements of C-peptide at 0 and 90 min. The levels of autoantibodies against GAD, IA-2 and ZnT8 were measured with radio-binding assays.</p><p><strong>Results: </strong>Participants were divided into tertiles of post-meal (90 min) C-peptide values as non-responders (NR), low-responders (LR) and high-responders (HR). Compared with the NRs and HRs, the LRs had significantly lower BMI values (p < 0.001), plasma triglyceride concentrations (p = 0.010) and triglyceride/HDL-cholesterol ratios (p = 0.004). Twenty-nine and eight participants were positive for one or 2-3 antibodies, respectively. The presence of antibodies was not associated with post-meal C-peptide levels, as evidenced by the fact that the proportions of antibody-positive participants did not differ between the groups.</p><p><strong>Conclusions: </strong>We conclude that a subgroup of type 1 diabetes participants with long-standing diabetes (>30 years) has residual beta-cell function. Participants with type 1 diabetes and low stimulated C-peptide concentrations are characterized by lower BMI, triglyceride concentrations and higher insulin sensitivity.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70104"},"PeriodicalIF":0.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621702","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":"Effectiveness of dietary interventions in individuals with diabetes for preventing and healing chronic wounds; a systematic review with meta-analysis.","authors":"Hailey R Donnelly, Clare E Collins, Erin D Clarke, Prudence I Morrissey, Natalie Gilbertson-Viljevac, Lucy Leigh, Peta E Tehan","doi":"10.1111/dme.70100","DOIUrl":"https://doi.org/10.1111/dme.70100","url":null,"abstract":"<p><strong>Background: </strong>Optimising the nutritional status of individuals with diabetes is essential to optimise glycaemic control, as well as to prevent and promote wound healing. A variety of nutrition interventions are available. This systematic review and meta-analysis aimed to describe and synthesise the effectiveness of nutrition interventions for the prevention and management of chronic wounds in people with diabetes.</p><p><strong>Methods: </strong>Five databases and four clinical trial registries were searched for nutrition intervention studies. Included studies involved a nutrition intervention, such as personalised medical nutrition therapy, education and/or nutrient supplementation for those with diabetes and a chronic wound. Meta-analysis was completed utilising mean wound size at follow-up and non-adjusted data where available. Quality was appraised using RoB 2 and ROBINS, and certainty of evidence was assessed using GRADE.</p><p><strong>Results: </strong>Twenty-three studies were included; all included studies were in diabetes-related foot ulcer populations. Meta-analyses demonstrated nutrient supplements, including single and multi-nutrient supplements, significantly reduced wound depth (MWD -0.200 [95% CI -0.364, -0.035], p = 0.0172), width (WMD -0.466 [95% CI -0.724, -0.208], p = 0.0004) and length (-0.443 [95% CI -0.841, -0.045], p = 0.0292), the quality of included studies was low and the certainty of evidence was very low. While substantial heterogeneity was detected (I² = 56%-68%), a random-effects meta-analysis was conducted to account for between-study variability, providing an overall estimate while acknowledging differences in study characteristics. Two studies evaluating the effect of nutrition education demonstrated significant wound size reduction (n = 1) and proportion of people healed (n = 1).</p><p><strong>Conclusion: </strong>There is low-quality evidence that nutrient supplementation improves wound healing. Nutrition education may have a role in enhancing wound size reduction. Further studies are needed using robust methodologies to comprehensively determine the effectiveness of nutrition interventions for wound healing.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70100"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593765","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":"Concordance of molecular microbiology and conventional culture techniques for infected diabetic foot ulcer management.","authors":"Angela Oates, Sarah T Brown, Colin C Everett, Fran Game, Jane E Nixon, Tim Sloan, Michelle M Lister, Michael Backhouse, Benjamin A Lipsky, David Russell, Howard Collier, Joanna Dennett, Rachael Gilberts, E Andrea Nelson","doi":"10.1111/dme.70089","DOIUrl":"https://doi.org/10.1111/dme.70089","url":null,"abstract":"<p><strong>Aim: </strong>The management of infected diabetic foot ulcers (DFUs) requires balancing the need for timely interventions against the desire for targeted antibiotic therapy, which relies on laboratory results. This study aimed to evaluate concordance between molecular and conventional culture and sensitivity (C&S) methods in identifying bacteria from infected DFUs.</p><p><strong>Methods: </strong>This study was conducted alongside CODIFI2, a Phase III randomised controlled trial comparing tissue sampling with wound swabbing. It assessed C&S and metagenomic 16S rRNA gene sequencing (M16S) in DFUs with suspected mild or moderate infections using both tissue and swab samples.</p><p><strong>Results: </strong>In 145 participants, C&S identified 248 microorganisms across 25 genera including eight anaerobic genera. M16S identified a greater number and diversity of microorganisms, detecting 455 across 40 genera, including 173 anaerobes from 15 distinct genera. No bacterial growth was reported in 25.5% (95% CI: 18.0%-32.3%) of C&S samples, whereas M16S identified at least one organism in all samples. While the observed agreement between methods was high (75%), Cohen's Kappa revealed low concordance overall, except for Pseudomonas spp. and Streptococcus spp. (Kappa ≥ 0.5).</p><p><strong>Conclusions: </strong>M16S detected a broader microbial spectrum, including fastidious anaerobes, but its low concordance with C&S and lack of antibiotic sensitivity data, challenge its suitability as a replacement for C&S in mild or moderate DFU infections. It may offer advantages in infections where increased sensitivity is beneficial, particularly where extended culture approaches are recommended to detect fastidious or low-abundance organisms. For mild to moderate DFU infections, our findings support continued reliance on conventional C&S testing.</p>","PeriodicalId":520603,"journal":{"name":"Diabetic medicine : a journal of the British Diabetic Association","volume":" ","pages":"e70089"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602776","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}