International journal for quality in health care : journal of the International Society for Quality in Health Care最新文献

{"title":"Comprehension of an artificial intelligence-generated discharge letter versus a traditional discharge letter: two controlled quasi-experimental parallel-group studies.","authors":"Fabrizio Bert, Lorenzo Rosset, Francesco Conrado, Daniele Consoli, Giacomo Scaioli, Giuseppina Lo Moro, Roberta Siliquini","doi":"10.1093/intqhc/mzag133","DOIUrl":"10.1093/intqhc/mzag133","url":null,"abstract":"<p><strong>Background: </strong>Discharge letters are essential for continuity of care, yet patients often misunderstand their content. Poor discharge communication is associated with medication errors, inappropriate healthcare use, and hospital readmissions. Artificial intelligence (AI) language models may improve discharge documentation clarity and accessibility. This study aimed to compare a GPT-4-generated, accessibility-optimized discharge letter with a conventional discharge letter regarding comprehension of key discharge information and to evaluate satisfaction and identify predictors of comprehension.</p><p><strong>Methods: </strong>Two controlled quasi-experimental parallel-group studies were conducted. Study 1 included adults recruited online (n = 341 analysed), while Study 2 involved medical and nursing students at the University of Turin (n = 791 analysed). Allocation was based on age parity. The primary outcome was a structured comprehension score assessing diagnosis, treatment, investigations, and follow-up instructions. Secondary outcomes included readability, clarity, perceived comprehension, organization, and satisfaction. Health literacy (HL) was assessed using the HLS-EU-Q6. Multiple linear regression analyses identified predictors of comprehension.</p><p><strong>Results: </strong>Participants receiving the AI-generated discharge letter achieved significantly higher comprehension scores in both studies (Study 1: median 4 vs. 2; Study 2: median 4 vs. 3; both P < .001). Differences remained significant after adjustment for sociodemographic variables, HL, and healthcare background. AI-generated letters also improved all secondary outcomes (all P < .001). No significant improvement was observed for identification of follow-up appointment dates. Higher comprehension was associated with healthcare background, higher education, sufficient HL, and better perceived health status.</p><p><strong>Conclusion: </strong>AI-generated discharge letters significantly improved measured comprehension and satisfaction in both general and higher-literacy populations; validation using real clinical letters and diverse patients is required.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957804","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":"Quality frameworks in intensive care units: a scoping review of accreditation, certification, and standards-based pathways to safer care.","authors":"Javier Muñoz, José Antonio Peral-Gutiérrez de Ceballos, Raquel Ribón-Liberal, Elena Moreno-Ortega, Lourdes Carmen Visedo","doi":"10.1093/intqhc/mzag157","DOIUrl":"10.1093/intqhc/mzag157","url":null,"abstract":"<p><strong>Background: </strong>Accreditation, certification, recognition, and standards-based quality frameworks are widely implemented across hospitals and intensive care units (ICUs) to promote safety, standardization, and professional excellence. However, the nature and extent of the empirical evidence evaluating these frameworks specifically in critical care settings remain unclear. This scoping review aimed to map and characterize empirical studies evaluating accreditation-, certification-, recognition-, and standards-based programmes relevant to ICU care.</p><p><strong>Methods: </strong>We conducted a scoping review informed by established methodological frameworks and reported according to PRISMA Extension for Scoping Reviews guidance. Structured searches of MEDLINE (via PubMed), Embase, and the Cochrane Library were performed from database inception to 10 April 2026. Eligible studies evaluated organizational accreditation, certification of critical care services, professional recognition programmes, or formal standards-based organizational frameworks relevant to ICU care. Study designs were classified as quasi-experimental studies, observational analytical studies, or structured implementation evaluations. Data were charted descriptively and synthesized narratively.</p><p><strong>Results: </strong>Fourteen empirical studies published between 2006 and 2025 met inclusion criteria. Studies evaluated hospital accreditation or organizational quality management, ICU or critical care service certification, professional recognition or professional certification, and standards-based unit-level frameworks. Outcomes most frequently addressed organizational processes, safety indicators, workforce-related measures, and implementation outcomes, whereas patient-level clinical outcomes such as mortality, length of stay, and ICU readmission were evaluated less consistently.</p><p><strong>Conclusion: </strong>The empirical evidence evaluating accreditation and related quality frameworks in ICU settings is limited and heterogeneous. These frameworks are predominantly assessed as organizational and cultural mechanisms influencing processes, safety, workforce dynamics, and unit-level implementation, with less consistent evaluation of clinical outcomes. A tiered perspective distinguishing hospital-wide accreditation, service-level certification, and professional recognition may better inform future research, policy, and implementation in critical care.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122800","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":"We are confused-are you? Towards terminology clarity in care delivery: pathway, journey, process, or chain?","authors":"Diaz M Prameyllawati, Evelien S van Hoorn","doi":"10.1093/intqhc/mzag148","DOIUrl":"10.1093/intqhc/mzag148","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013480","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":"ISO 9001 and JCI preparedness as drivers of quality improvement at a tertiary cardiac care center: a 5-year analysis from Pakistan.","authors":"Huma Shakoor, Waqas Naseem, Syed Shahkar Ahmed Shah, Naveed Shah, Abdul Karim, Tabish Rasool","doi":"10.1093/intqhc/mzag154","DOIUrl":"10.1093/intqhc/mzag154","url":null,"abstract":"<p><strong>Background: </strong>External quality frameworks such as ISO 9001 certification lay the foundation for healthcare quality, patient safety, and operational efficiency, but sustained improvement depends on leadership, a culture of safety, and systems that translate assurance into ongoing learning. Evidence on this transition from low- and middle-income countries, particularly in specialized cardiac care, remains limited.</p><p><strong>Methods: </strong>A retrospective longitudinal analysis of quality assurance data from January 2020 to December 2025 was conducted at the Peshawar Institute of Cardiology (PIC-MTI), Pakistan. Independent-samples t-tests, one-way ANOVA, and Difference-in-Differences (DiD) modeling were applied, with three regional hospitals of similar bed capacity and patient volume serving as a comparison group.</p><p><strong>Results: </strong>Following ISO 9001 certification (February 2022), monthly mortality within 48 h declined from 2.8% (SD ± 0.4%) to 1.9% (SD ± 0.3%) (t = 3.21, df = 58, P = .004). Hospital-acquired infections (HAIs) fell from 3.2% to 2.0% (t = 4.15, P = .002), reaching 1.3% by 2025, with zero CLABSIs recorded in the final quarter following the mid-period intensification of the infection-control bundle. Mean length of stay decreased from 6.2 to 4.7 days [ANOVA: F(2,57) = 8.76, P < .001]. Patient satisfaction rose from 78% to above 90%. DiD modeling found a net 30% reduction in HAIs and 20% reduction in length of stay (LOS) associated with the certification process relative to the comparison trajectory.</p><p><strong>Conclusions: </strong>ISO 9001 certification, undertaken alongside deliberate investment in leadership, a culture of safety, and structured use of data, is associated with sustained improvements in clinical outcomes and operational efficiency at a resource-limited cardiac care center that has not yet pursued formal Joint Commission International (JCI) accreditation but is using JCI's standards, as one example of an internationally recognized framework, to guide its preparation. The pattern observed here suggests that a learning quality management system, and not any single certificate or accreditation status, is what converts external standards into measurable gains, offering a replicable model for institutions considering how to move from quality assurance toward continual quality improvement.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027299","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":"Patient perspectives on transdisciplinary models of care in allied health: a qualitative study.","authors":"Casey L Peiris, Aruska N D'Souza, Jacqueline Van Groningen, James Seymour, Keith Donohoe, Alisha da Silva, Celia Marston, James Lewis, Jennifer Langford, Leanne Rees","doi":"10.1093/intqhc/mzag149","DOIUrl":"10.1093/intqhc/mzag149","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Demand for allied health services continues to grow, driven by rising chronic disease, multimorbidity, and workforce shortages. Although allied health professions each maintain distinct disciplinary expertise, overlap in assessment, treatment, and discharge planning may lead to duplication. Transdisciplinary care, where professionals work across traditional disciplinary boundaries to provide integrated, streamlined care, has emerged as a potential approach to address workforce and duplication challenges. While early studies suggest transdisciplinary models may improve satisfaction and efficiency, patients' perspectives remain underexplored. This study aimed to explore patient experiences of allied health care across hospital settings and their perspectives on transdisciplinary care to inform future service design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A qualitative study guided by interpretive description was conducted at a large metropolitan tertiary hospital. Adults who had received care from at least two allied health disciplines were recruited using purposive sampling to ensure diverse care experiences. Fifteen participants completed semi‑structured interviews in person, via telephone or videoconference. Interviews were audio‑recorded, transcribed verbatim and analysed inductively using thematic analysis. Four researchers independently coded transcripts, met to refine themes, and returned to the data to ensure coherence and representation of participant perspectives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three overarching themes reflected how good communication, co‑ordination, and compassionate care fostered trust and confidence in allied health professionals. First, participants valued care that was continuous, well‑co‑ordinated, and centred around their individual goals. They perceived transdisciplinary care to reduce duplication, delays, and the burden of repeating their histories. Second, clear, honest communication between treating staff, and with patients, was essential to feeling informed and heard. Participants noted that transdisciplinary approaches could enhance communication and allow professionals more time to listen. Third, patients deeply valued the empathy and interpersonal qualities of allied health clinicians, while also emphasizing the importance of discipline‑specific expertise. They supported transdisciplinary care provided clinicians practised within their competence and sought specialist input when required.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients across hospital settings were accepting of transdisciplinary allied health models provided quality, expertise, and person‑centredness were maintained. Findings highlight that trust, communication and continuity underpin positive patient experience, and that transdisciplinary models may enhance efficiency and timeliness. Successful implementation will require organizational support, workforce development and careful evaluation to ensure new models enhance","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027320","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":"Postnatal contact is not enough: measuring and improving care for women and newborns.","authors":"Reece Hinchcliff","doi":"10.1093/intqhc/mzag161","DOIUrl":"10.1093/intqhc/mzag161","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070842","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":"Mitigating climate-related health risks in Lebanon: implementation of national standards for climate-ready hospitals.","authors":"Elie Matta, Emile Whaibeh, Lea Kai, Jowy Abi Hanna, Alicia Abi Nader, Fadi Hindi, Riham Sanjakdar, Habib Abdo, Rouba El Khatib, Wael Al-Delaimy, Fayez Abdulla, Mazen Malkawi, Farah Jradi, Rana Amer, Joseph Zgheib, Myriam Mrad, Georges Abi Tayeh","doi":"10.1093/intqhc/mzag150","DOIUrl":"10.1093/intqhc/mzag150","url":null,"abstract":"<p><strong>Background: </strong>Climate change increasingly disrupts healthcare systems worldwide by simultaneously increasing service demand and undermining infrastructure reliability. Hospitals face escalating risks from extreme weather, energy insecurity, and water scarcity, while contributing nearly 5% of global greenhouse gas emissions. These challenges are particularly acute in the Middle East and North Africa (MENA) region, where fragile health systems and resource constraints heighten vulnerability. Lebanon's health sector exemplifies this intersection of climate risk and systemic fragility. This study aimed to develop nationally tailored standards for climate-resilient and environmentally sustainable healthcare facilities in Lebanon, translating international climate-health frameworks into actionable, context-specific guidance aligned with national legal and operational realities.</p><p><strong>Methods: </strong>A multiphase methodology was applied, including a scoping review of international standards and guidance (WHO, ISO 14001, ISO 9001, ISO 26000), structured consultations with key national and international stakeholders, and synthesis of draft standards into thematic areas. Clauses were aligned with existing Lebanese environmental and health legislation to ensure compliance and to prioritize urgent mandatory actions over longer-term strategic actions.</p><p><strong>Results: </strong>The resulting standards comprise 10 thematic areas covering governance, environmental management, climate emergency preparedness, community engagement, sustainable procurement, and performance monitoring. Legal screening enabled phased implementation, distinguishing urgent compliance-driven actions from longer-term strategic enhancements. Implementation assessment demonstrated that the standards could guide gap identification, cost estimation, and prioritization of climate-resilience investments at facility level.</p><p><strong>Conclusion: </strong>Climate-resilient healthcare standards for Lebanon provide a practical framework for strengthening service continuity during climate shocks while reducing the sector's carbon footprint. Institutionalization and MoPH-led enforcement will be essential for long-term uptake.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043129","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":"Report quality is not investigation quality: strengthening patient safety learning.","authors":"Lis Parida, Sudarwan Danim, Rendy Wikrama Wardana, Fitri April Yanti, Rikas Saputra","doi":"10.1093/intqhc/mzag158","DOIUrl":"10.1093/intqhc/mzag158","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070829","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":"The I'-chart: a preliminary investigation of an improved individuals chart for quality improvement and control.","authors":"Jacob Anhøj, Wayne A Taylor, Mohammed A Mohammed","doi":"10.1093/intqhc/mzag159","DOIUrl":"https://doi.org/10.1093/intqhc/mzag159","url":null,"abstract":"<p><strong>Background: </strong>Statistical Process Control (SPC) charts are widely used in healthcare to monitor and improve quality. Selecting the appropriate chart can be challenging because healthcare data often comprise subgroup summary measures derived from varying numbers of observations. The traditional Individuals (I-) chart is popular because of its simplicity but assumes constant subgroup sizes, an assumption frequently violated in practice. This can lead to inappropriate control limits and misleading interpretation. We describe the I'-chart, an extension of the traditional I-chart that accommodates varying subgroup sizes while remaining applicable to both measurement and attribute data and present a preliminary evaluation of its performance.</p><p><strong>Methods: </strong>The I'-chart was evaluated using a range of simulated and real-world healthcare datasets to address three practical questions: (a) How does the I'-chart compare with the traditional I-chart when subgroup sizes are constant? (b) How does the I'-chart accommodate varying subgroup sizes? (c) How does the I'-chart compare with other established SPC charts?</p><p><strong>Results: </strong>(a) The I'-chart produced identical results to the traditional I-chart when subgroup sizes were constant, confirming that it generalises the conventional I-chart. (b) When subgroup sizes varied, the I'-chart adjusted the control limits according to subgroup size, making differences in data precision explicit and, in a healthcare example, changing an apparent special-cause signal into expected common-cause variation. (c) The control limits produced by the I'-chart using simulated data were broadly comparable with those from established SPC charts, including the Xbar-chart for measurement data and Laney's P'- and U'-charts for attribute data.</p><p><strong>Conclusion: </strong>The I'-chart has superior design properties to the traditional I-chart while retaining its simplicity and ease of interpretation. By explicitly accounting for varying subgroup sizes, it addresses an important limitation of the traditional I-chart. Our findings support replacing the traditional I-chart whenever subgroup summary data with varying subgroup sizes are analysed. Although further methodological and empirical evaluation is required to establish its operating characteristics and define its role alongside other SPC charts, the examples presented suggest that the I'-chart produces results comparable with established SPC methods while providing a single, generalisable framework for analysing subgroup summary data.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070853","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":"Comparing methodological approaches for outlier detection: a cross-sectional study of older persons in 2,744 Australian long-term care facilities.","authors":"Dylan Harries, Johannes Schwabe, Robert N Jorissen, Brian W Pulling, Gillian E Caughey, Tracy Comans, Maria C Inacio","doi":"10.1093/intqhc/mzag144","DOIUrl":"https://doi.org/10.1093/intqhc/mzag144","url":null,"abstract":"<p><strong>Background: </strong>Detection of outliers is a common feature of quality monitoring programs, with the goal of identifying unwarranted variation in quality of care. However, there remains limited agreement on the most appropriate methods for detecting outliers, in particular in long-term care facilities. This study aimed to compare methods for outlier detection among long-term care facilities and assess the suitability of each method for use in monitoring quality and safety of care.</p><p><strong>Methods: </strong>A cross-sectional population-based study of Australian long-term care facilities during 2019 was conducted using the Registry of Senior Australians National Historical Cohort. Outlier detection methods differing in control limits, handling of overdispersion, and use of multiple testing adjustments identified outlier long-term care facilities on four quality indicators (emergency department presentations, antipsychotic use, fall-related hospitalizations, and pressure injury-related hospitalizations). The number of outliers identified using each method and the agreement between methods was examined. Simulation studies were undertaken to assess reasons for differences between methods.</p><p><strong>Results: </strong>A total of 234,890 persons (241,925 person-episodes) at 2,744 long-term care facilities were included. The indicator with the highest event rate was emergency department presentations (37.9% of person-episodes), followed by antipsychotic use (21.5%), fall-related hospitalizations (13.6%), and pressure injury-related hospitalizations (3.4%). Most indicators exhibited some overdispersion. Differences between confidence interval based and prediction interval-based methods were largest for low event rate indicators, where the number of outliers with higher-than-expected event rates identified differed by up to a factor of four. Methods that did not address overdispersion had high false positive rates.</p><p><strong>Conclusion: </strong>These results indicate that the number of long-term care facility outliers identified can vary widely between methods. Quality monitoring programs in long-term care should use appropriate prediction interval-based methods for constructing control limits and take steps to address overdispersion.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027039","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}