BMJ Innovations最新文献

{"title":"Disinfectant tunnels: a solution to the problem or a problem on its own?","authors":"Siew Hui Michelle Koh, S. L. Young, H. Z. Chai, A. Chan, Aik Hong Philine Chan, Jun Chun Chia, Frederick Teo, Soh Hui Qing, T. Ong, G. Phua","doi":"10.1136/bmjinnov-2021-000931","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000931","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION The Coronavirus disease 2019 (COVID19) pandemic has impacted the health and socioeconomic status of millions of people worldwide. COVID19– related health policies 2 introduced around the world contain methods to curb the transmission of the virus, and these include border control measures, contact tracing and lockdown. As the world enters the third year of living in the COVID19 pandemic, countries have attempted lifting movement restrictions only to face yet another wave of the virus transmission, resulting in the continuous cycle of transmission, lockdown and reopening. To break this cycle or delay the next wave, Cacciapaglia et al suggested that the key was to limit the number of persons infected during the interwave strolling period. However, aside from the commonly used approach of movement restrictions that has negative impacts on the economy and mental health, 6 another approach that could be considered would be physical devices that can prevent spread of viruses. Novel ideas on automated disinfectant devices have emerged as a means to reduce risks of viral transmission. One such device is a disinfectant booth or tunnel, which has been developed and deployed in as many as 16 countries, including Singapore, China, the middle East and Russia, in an effort to increase sanitisation and minimise transmission of the virus. 9 The type of disinfectant used in these disinfectant tunnels differs, ranging from benzalkonium chloride (BAC) to sodium hypochlorite and even Ayurvedic remedies. 10 BAC is a quaternary ammonium compound, largely used for its properties as an antiseptic and disinfectant. It has reported efficacy against coronaviruses and has been used as one of the main active ingredients in the disinfectant booths or tunnels deployed. However, such disinfectant systems are currently not recommended by WHO. The safety profile of the tunnels is not clear, especially regarding potential pulmonary side effects. In vivo studies suggest pulmonary toxicity associated with BAC. 15 BAC has also been implicated in the development of occupational asthma, as an airway irritant as well WHAT ARE THE NEW FINDINGS ⇒ This is the first pilot study to look at the bronchoconstrictive effects of aerosolised BAC. ⇒ Findings from this pilot study suggest that BAC disinfectant tunnels/booths cause bronchoconstriction even when used with a surgical face mask. With N95 respirators, no conclusive objective evidence of bronchoconstriction was made, but subjective symptoms were reported. ⇒ Hence, conclusion regarding safety cannot be made.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"62 1","pages":"301 - 306"},"PeriodicalIF":2.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90868451","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":"Cultivating design thinking skills through the biodesign process in Japan","authors":"H. Kiriyama, Takaaki Kakihiana, Yujiro Maeda, Munemasa Sugimoto, Megumi Machida, Tomotaka Inoue, Fumiaki Ikeno, I. Komuro, M. Ono","doi":"10.1136/bmjinnov-2021-000923","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000923","url":null,"abstract":"Background The biodesign process, which originated at Stanford University, has had a significant impact on medical device invention. Design thinking skills are core elements in the biodesign process, but there has been no quantitative evaluation of how design thinking is actually affected by a biodesign course. The purpose of this study was to examine the usefulness of the biodesign process by quantifying design thinking ability. Methods We recruited 17 participants who had studied a systematic biodesign process in Japan and 20 participants who were unfamiliar with the biodesign process. All participants took the design thinking test and we evaluated their design thinking skills using a combination of the creation score and the evaluation score. Results The average age of the participants was 34.4 years and 84% were male. Participants who had taken the biodesign program generated more ideas than other participants (5.3±1.9 ideas vs 3.7±2.3 ideas; p=0.01). They also had significantly higher design thinking score, especially creation score, than those who had not taken the program (design thinking score, 220.1±39.7 vs 194.6±32.1; p=0.02; creation score, 91.3±23.0 vs 70.7±20.2; p=0.03). Conclusion The findings suggest that the biodesign process can cultivate design thinking skills, especially the ability to visualise needs and create solutions. Exposure of more people to the biodesign process may accelerate innovation in the medical technology field.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"31 1","pages":"273 - 277"},"PeriodicalIF":2.0,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89347184","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":"Management model of the COVID-19 pandemic in socially vulnerable communities","authors":"G. Marín, Jenny Fonseca, G. Etchegoyen, Lupe Marin, Itziar Kain Aramburu, Rocio Rodriguez, Pablo Vetere, Graciela Mateo, Marcelo Bourgeois, F. Campuzano-Castro, Ignacio Babbini, Gina Marin, Tomás Canevari, H. Bozzano","doi":"10.1136/bmjinnov-2021-000870","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000870","url":null,"abstract":"Introduction Several public policies were proposed to reduce the negative impact of COVID-19 pandemic. This work aimed to determine how a management model is capable of strengthening the community network, providing support, healthcare and channelling public government’s aid during COVID-19 pandemic situation. Methods It is an intervention study that tested the effectiveness of a management model for both healthcare and essential goods access in a socially vulnerable neighbourhood called ‘Puente de Fierro’ in La Plata the capital of Buenos Aires State, Argentina, during the COVID-19 pandemic. Altos de San Lorenzo suburb area was considered as control group. Variables studied were: level of contagion and death due to the SARS-CoV-2 virus; access to food, medicine and other goods; strengthening of community networks; performance of government programmes in territory. Results A new management paradigm was tested by moving essential goods towards the people, instead of making the people move to obtain those benefits. Accessibility to ‘Food Bag’ and ‘Food Bank’ were significantly increased, a reduction of contagion level and mortality rate for COVID-19 was achieved (2.3/100 000 vs 3.6/100 000 inhabitants in control area; and ‘fatality rate’ was 2.8% vs 3.6%, respectively). Support was also provided to installed in local stores virtual payment devices for food cards acceptance. Conclusion The management model based in healthcare and goods and service supplies during COVID-19 pandemic reduced the negative impact of disease and its measures of isolation in socially vulnerable neighbourhoods.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"14 1","pages":"261 - 272"},"PeriodicalIF":2.0,"publicationDate":"2022-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87809508","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":"User-centred innovation to advance safe surgery at the point of need: report on development of the SurgiField system","authors":"D. Teodorescu, Sashidhar Jonnalagedda, A. Rakin, Mike H. M. Teodorescu, Macauley Kenney, Julian Greene, Steven L. Bokshan, H. Mashbari, A. Moten, O. Alser, R. Sinyard, A. Dorken-Gallastegi, Arnav Mahajan, R. Smalley, Daniel Frey, D. R. King, M. Cherian","doi":"10.1136/bmjinnov-2021-000893","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000893","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. Reuse permitted under CC BY. Published by BMJ. INTRODUCTION In conditions ranging from pneumothorax to acute compartment syndrome to fractures to traumatic and degenerative joint disease to appendicitis to obstructed labour to postpartum haemorrhage; safe, timely surgical intervention is the deciding factor among recovery, mortality or longterm disability. Consequently, access to quality surgical care is a global priority across the resource spectrum. Yet despite this, an estimated 18 million people die annually from conditions that safe surgery could address. Even more experience permanent disability from delayed, inaccessible, or unsafe surgery, generating a gross domestic product loss of US$820 billion from lost annual productivity. Far from requiring resourceintensive, sophisticated surgeries, the vast majority of surgical needs globally are captured by the simple, socalled bellwether surgical procedures. Surgical care has traditionally relied on consistent availability of three resource categories: (1) functional equipment and materials, (2) appropriate facility space and (3) medical staff. 4 Given the practical challenges of disseminating these resources consistently in many austere settings, including but not limited to conflict settings, disaster zones, lowtomiddleincome countries and rural regions; surgical care availability is often limited to centralised referral settings. Even higherresource settings regard costcontainment and quality improvement as ongoing challenges to care equity and sustainability. For instance, Californian operating theatres cost an average of US$37 per minute to run. High equipment and facility costs are driven in part by maintaining the sterility WHAT ARE THE NEW FINDINGS","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"14 1","pages":"317 - 322"},"PeriodicalIF":2.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90914076","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":"Development and testing of an intact cord resuscitation trolley","authors":"Jaspreet Singh Raina, Deepak Chawla, Suksham Jain, S. Khurana","doi":"10.1136/bmjinnov-2022-000950","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000950","url":null,"abstract":"Objective To develop a mobile resuscitation platform—intact cord resuscitation (ICR) trolley and to assess the safety, feasibility and acceptability of its use during delayed cord clamping (DCC). Study design Bench-side product development and single-arm experimental study. Participants and methods We first developed a theoretical framework of the specifications required for the platform which can provide resuscitation close to the delivery/operating table. The theoretical framework was then translated into a working model in a series of iterations. After testing and training of healthcare workers in a simulated environment, the trolley was tested to perform DCC in neonates who were born at ≥34 weeks of gestation and were breathing spontaneously at birth. Outcomes measured Primary outcome was the feasibility of DCC using the ICR trolley defined as the proportion of babies successfully completing 180 s of DCC on the trolley. Secondary outcomes included the proportion of babies with 1 min heart rate (HR) and oxygen saturation (SpO2) recorded, neonatal and maternal safety outcomes, and acceptability among care providers. Results Among 50 neonates (gestation: 36.9±1.9 weeks and birth weight: 2544±649 g) enrolled in the study, DCC for ≥180 s was successfully done in 42 (84%) neonates. The mean duration of DCC was 170±27 s. HR and SpO2 at 1 min were recorded successfully in 92% of the babies. The majority of the maternal and neonatal care provider strongly supported the use of ICR trolley. Conclusion We developed an ICR trolley and successfully tested the feasibility and acceptability of its use in healthy neonates undergoing DCC.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"1 1","pages":"323 - 328"},"PeriodicalIF":2.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83235940","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":"Design and development of a clinical decision support system for community health workers to support early detection and management of non-communicable disease","authors":"S. Zaman, Nisal De Silva, Tian Yu Goh, R. Evans, Rajkumari Singh, Rajesh Singh, Ashutosh Kumar Singh, P. Singh, A. Thrift","doi":"10.1136/bmjinnov-2022-000952","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000952","url":null,"abstract":"Background Numerous groups have developed software applications (apps) for use by community health workers (CHWs) in hard-to-reach settings. However, these have either not been based on clinical guidelines or are not freely available. Our objectives were to (1) design and develop an app for use by CHWs; and (2) conduct preliminary testing of the app to identify potential obstacles. Methods We used the principle of human-centred design to develop an app programmed to an Android operating system. We used a mixed-methods approach which included site observations, meetings with stakeholders and the app development team, and laboratory simulation to fine tune the design. The ‘Mobile Application Rating Scale’ (MARS) was used for testing reliability and quality. We also assessed the validity of the app by matching the uploaded data with ‘gold standard’ preset answers. Results Depending on human–computer interactions, the app has reminder, advisor, critic and guide functions which can facilitate CHWs to make clinical decisions. We found the app is usable based on the final score of the MARS tool, and that the entered data were accurate. We present the simple procedures that were followed to develop this Android app. The app, including all of its code, is freely available. Conclusion The app shows promise as a tool for the management of non-communicable disease in a rural setting in India. The next step will be to refine the app in a field setting and then to evaluate its efficacy in a large-scale clinical trial.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"6 1","pages":"49 - 56"},"PeriodicalIF":2.0,"publicationDate":"2022-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81701306","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":"National Institutes of Health Stroke Scale scores obtained using a mobile application compared to the conventional paper form: a randomised controlled validation study","authors":"H. Bugge, M. Guterud, J. Røislien, K. Larsen, H. Ihle-Hansen, M. Toft, M. R. Hov, E. Sandset","doi":"10.1136/bmjinnov-2022-000968","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000968","url":null,"abstract":"Background Prehospital delay contributes to treatment delay in acute stroke. Numerous prehospital stroke scales exist for stroke identification, but they lack the diagnostic accuracy of the in-hospital National Institutes of Health Stroke Scale (NIHSS). We have developed a mobile application to aid paramedics assessing prehospital NIHSS. This study explores agreement between NIHSS scores obtained using the Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) application compared with conventional assessment. Methods 25 physicians working with stroke were randomised to an application group or control. 20 unique videos portraying acute stroke symptoms were scored by both groups. 95% limits of agreement (LoA) were calculated using Bland-Altman’s method, comparing the groups to predefined scores, and each other. LoAs within ±3 NIHSS points were considered acceptable. Cohen’s kappa was calculated on dichotomised NIHSS scores. Results The ParaNASPP application group had 95% LoA of −2.33 to 2.71. The control group had LoA of −2.60 to 2.55. Direct comparison between the groups gave LoA of −3.12 to 3.55. When compared with the dichotomised predefined scores kappa was 0.93 in the application group and 0.89 in the control group. Kappa was 0.84 for direct comparison between the groups. Discussion There was very good agreement between the application and both the predefined score and the control group. Scores from the ParaNASPP application differ slightly more than our predefined goal when compared with the control group, but is well within when compared with the predefined NIHSS scores. We consider this acceptable and the ParaNASPP application validated for further clinical studies.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"41 1","pages":"57 - 63"},"PeriodicalIF":2.0,"publicationDate":"2022-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86903358","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":"Social innovation in health, community engagement, financing and outcomes: qualitative analysis from the social innovation in health initiative","authors":"Patricia Moscibrodzki, Emmanuel Ahumuza, Jingjing Li, Xiaoming Sun, Yusha Tao, L. van Niekerk, U. Amazigo, B. Halpaap, P. Awor, Joseph D. Tucker","doi":"10.1136/bmjinnov-2021-000902","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000902","url":null,"abstract":"Background Social innovation in health is a community-engaged process that links social change and health improvement, drawing on the diverse strengths of local individuals and institutions. However, there are few studies that examine community engagement, financing and outcomes. The purpose of this study is to use a qualitative descriptive analysis to assess 40 social innovations in health identified through a global open call. Methods This qualitative analysis examined social innovation case studies from low- and middle-income countries identified by a global social innovation network. A crowdsourcing open call identified projects and key components of each social innovation were evaluated by an independent panel. We used a US Centers for Disease Control and Prevention framework to measure community engagement as shared leadership, collaboration, involvement, consultation or informing. We used descriptive statistics to examine key aspects of community engagement, financing, health outcomes and non-health outcomes. Results Data from 40 social innovations were examined. Social innovations were from Africa (21/40), Asia (11/40), and Latin America and the Caribbean (8/40). Community engagement was diverse and robust across the cases and 60% (24/40) had either shared leadership or collaboration. Financing for social innovation came from research grants (23), national or provincial government support (15), revenues from sales (13), donations (13) and local government support (10). Social innovations reported health and non-health outcomes. Conclusion Our data demonstrate social innovations had robust community engagement. Innovative financing mechanisms provide mechanisms for sustaining social innovations. Further research on health and non-health outcomes of social innovation is needed.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"125 1","pages":"216 - 223"},"PeriodicalIF":2.0,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80435752","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":"Structured digital care pathway for systemic acne treatment using isotretinoin","authors":"Amandip Sangha, M. Rizvi","doi":"10.1136/bmjinnov-2021-000917","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000917","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Acne is a condition that affects a large portion of the population, especially younger people. The condition is well documented as being a formidable burden on the patient, psychologically and socially. Moreover, the severe forms of acne can leave permanent scars on the skin, if not properly treated. Treatments of acne consist of a range of various topical treatments sometimes combined with antibiotics administered orally. Among the most potent systemic treatment options, there is isotretinoin, which is a vitamin Aderivative. In treating acne, isotretinoin works by ► Reducing sebum production. ► Shrinking the sebaceous glands. ► Reducing follicular occlusion. ► Inhibiting the growth of bacteria. ► Having antiinflammatory effects. Isotretinoin is administered orally in the form of capsules that are ingested daily over a longer period of time, typically over a course of 6–12 months. In most cases, the effect of the treatment is prolonged and sometimes permanent. The treatment of acne using isotretinoin includes regular followups and blood tests. Female patients need to be strongly advised against pregnancy due to the severe teratogenic effect. Among other known side effects are liver toxicity and elevated blood lipids. (Depression and other psychological problems are possible, although much debated side effects). 4 Hence, liver enzymes and lipid panels should be monitored. A safe treatment plan will include checkups with the doctor for blood work, patient– doctor conversation and guidance during the treatment. Though the frequency of blood tests need not be monthly for standard doses. In our service design research phase, we identified some key challenges that acne patients meet, when being considered for isotretinoin treatment. ► General practitioners (GPs) sometimes lack the knowledge of isotretinoin for acne treatment. It is a specialised task better left WHAT ARE THE NEW FINDINGS ⇒ Digital care pathway for treatment of acne using isotretinoin aims to streamline both patient and dermatologist user experience. ⇒ The digital service is built with care for medical soundness and treatment safety. ⇒ Communication between patient and doctor is facilitated through frequent message exchanges. ⇒ Knowledge transfer to patient is addressed. ⇒ The digital care pathway aims to make the treatment more accessible, and the digital experience more user friendly and efficient. ⇒ Provides a working example of a modern, teledermatological, digital care pathway for systemic treatment of acne using isotretinoin.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"2 1","pages":"312 - 316"},"PeriodicalIF":2.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83561494","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":"Development of a real time ultrasound guided lumbar puncture device","authors":"B. Fan, Chuang Kiat Desmond Soh, Hee Chuan Darryl Heng, Lee Long Eddie Woo, W. H. Bin","doi":"10.1136/bmjinnov-2021-000921","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000921","url":null,"abstract":"Department of Haematology, Tan Tock Seng Hospital, Singapore Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore Medulla Pro Technology Pte Ltd, Trendlines Medical Singapore, Singapore Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"21 1","pages":"307 - 311"},"PeriodicalIF":2.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89267513","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}