Advances in simulation (London, England)最新文献

{"title":"A white-box model for real-time simulation of acid-base balance in blood plasma.","authors":"Timothy A J Antonius,&nbsp;Willem W L van Meurs,&nbsp;Berend E Westerhof,&nbsp;Willem P de Boode","doi":"10.1186/s41077-023-00255-2","DOIUrl":"https://doi.org/10.1186/s41077-023-00255-2","url":null,"abstract":"<p><p>Maintaining an optimal acid base is important for the patient. The theory underlying acid-base balance can be challenging for clinicians and educators. These considerations justify creating simulations that include realistic changes to the partial pressure of carbon dioxide, pH, and bicarbonate ion concentration in a range of conditions. Our explanatory simulation application requires a model that derives these variables from total carbon dioxide content and runs in real time. The presented model is derived from the Stewart model, which is based on physical and chemical principles, and takes into account the effects of weak acids and strong ions on the acid-base balance. An inventive code procedure allows for efficient computation. The simulation results match target data for a broad range of clinically and educationally relevant disturbances of the acid-base balance. The model code meets the real-time goals of the application and can be applied in other educational simulations. Python model source code is made available.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":"8 1","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10268443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10010980","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":"Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrest.","authors":"Nathan Bahr, Jonathan Ivankovic, Garth Meckler, Matthew Hansen, Carl Eriksson, Jeanne-Marie Guise","doi":"10.1186/s41077-023-00253-4","DOIUrl":"10.1186/s41077-023-00253-4","url":null,"abstract":"<p><strong>Background: </strong>This methodological intersection article demonstrates a method to measure cognitive load in clinical simulations. Researchers have hypothesized that high levels of cognitive load reduce performance and increase errors. This phenomenon has been studied primarily by experimental designs that measure responses to predetermined stimuli and self-reports that reduce the experience to a summative value. Our goal was to develop a method to identify clinical activities with high cognitive burden using physiologic measures.</p><p><strong>Methods: </strong>Teams of emergency medical responders were recruited from local fire departments to participate in a scenario with a shockable pediatric out-of-hospital cardiac arrest (POHCA) patient. The scenario was standardized with the patient being resuscitated after receiving high-quality CPR and 3 defibrillations. Each team had a person in charge (PIC) who wore a functional near-infrared spectroscopy (fNIRS) device that recorded changes in oxygenated and deoxygenated hemoglobin concentration in their prefrontal cortex (PFC), which was interpreted as cognitive activity. We developed a data processing pipeline to remove nonneural noise (e.g., motion artifacts, heart rate, respiration, and blood pressure) and detect statistically significant changes in cognitive activity. Two researchers independently watched videos and coded clinical tasks corresponding to detected events. Disagreements were resolved through consensus, and results were validated by clinicians.</p><p><strong>Results: </strong>We conducted 18 simulations with 122 participants. Participants arrived in teams of 4 to 7 members, including one PIC. We recorded the PIC's fNIRS signals and identified 173 events associated with increased cognitive activity. [Defibrillation] (N = 34); [medication] dosing (N = 33); and [rhythm checks] (N = 28) coincided most frequently with detected elevations in cognitive activity. [Defibrillations] had affinity with the right PFC, while [medication] dosing and [rhythm checks] had affinity with the left PFC.</p><p><strong>Conclusions: </strong>FNIRS is a promising tool for physiologically measuring cognitive load. We describe a novel approach to scan the signal for statistically significant events with no a priori assumptions of when they occur. The events corresponded to key resuscitation tasks and appeared to be specific to the type of task based on activated regions in the PFC. Identifying and understanding the clinical tasks that require high cognitive load can suggest targets for interventions to decrease cognitive load and errors in care.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":"8 1","pages":"15"},"PeriodicalIF":2.8,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10199511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9500340","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":"Building low-cost simulators for invasive ultrasound-guided procedures using the V-model.","authors":"Vilma Johnsson,&nbsp;Martin Grønnebæk Tolsgaard,&nbsp;Olav Bennike Bjørn Petersen,&nbsp;Morten Bo Søndergaard Svendsen","doi":"10.1186/s41077-023-00254-3","DOIUrl":"https://doi.org/10.1186/s41077-023-00254-3","url":null,"abstract":"<p><p>The use of medical simulators for training technical and diagnostic skills has rapidly increased over the past decade. Yet, most available medical simulators have not been developed based on a structured evaluation of their intended uses but rather out of expected commercial value. Moreover, educators often struggle to access simulators because of cost or because no simulators have been developed for a particular procedure. In this report, we introduce \"the V-model\" as a conceptual framework to illustrate how simulator development can be guided by the intended uses in an iterative fashion. Applying a needs-based conceptual framework when developing simulators is important to increase the accessibility and sustainability of simulation-based medical education. It will minimize the developmental barriers and costs, while at the same time improving educational outcomes. Two new simulators for invasive ultrasound-guided procedures are used as examples, the chorionic villus sampling model and the ultrasound-guided aspiration trainer. Our conceptual framework and the use cases can serve as a template for future simulator development and documentation hereof.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":"8 1","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10186700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9857886","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":"Correction: Effect of repeat refresher courses on neonatal resuscitation skill decay: an experimental comparative study of in-person and video-based simulation training.","authors":"Julia M McCaw,&nbsp;Sarah E Gardner Yelton,&nbsp;Sean A Tackett,&nbsp;Rainier M L L Rapal,&nbsp;Arianne N Gamalinda,&nbsp;Amelia Arellano-Reyles,&nbsp;Genevieve D Tupas,&nbsp;Ces Derecho,&nbsp;Fides Ababon,&nbsp;Jill Edwardson,&nbsp;Nicole A Shilkofski","doi":"10.1186/s41077-023-00252-5","DOIUrl":"https://doi.org/10.1186/s41077-023-00252-5","url":null,"abstract":"","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":"8 1","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10111808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9330993","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":"Data-driven resuscitation training using pose estimation.","authors":"Kerrin E Weiss,&nbsp;Michaela Kolbe,&nbsp;Andrina Nef,&nbsp;Bastian Grande,&nbsp;Bravin Kalirajan,&nbsp;Mirko Meboldt,&nbsp;Quentin Lohmeyer","doi":"10.1186/s41077-023-00251-6","DOIUrl":"https://doi.org/10.1186/s41077-023-00251-6","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary resuscitation (CPR) training improves CPR skills while heavily relying on feedback. The quality of feedback can vary between experts, indicating a need for data-driven feedback to support experts. The goal of this study was to investigate pose estimation, a motion detection technology, to assess individual and team CPR quality with the arm angle and chest-to-chest distance metrics.</p><p><strong>Methods: </strong>After mandatory basic life support training, 91 healthcare providers performed a simulated CPR scenario in teams. Their behaviour was simultaneously rated based on pose estimation and by experts. It was assessed if the arm was straight at the elbow, by calculating the mean arm angle, and how close the distance between the team members was during chest compressions, by calculating the chest-to-chest distance. Both pose estimation metrics were compared with the expert ratings.</p><p><strong>Results: </strong>The data-driven and expert-based ratings for the arm angle differed by 77.3%, and based on pose estimation, 13.2% of participants kept the arm straight. The chest-to-chest distance ratings by expert and by pose estimation differed by 20.7% and based on pose estimation 63.2% of participants were closer than 1 m to the team member performing compressions.</p><p><strong>Conclusions: </strong>Pose estimation-based metrics assessed learners' arm angles in more detail and their chest-to-chest distance comparably to expert ratings. Pose estimation metrics can complement educators with additional objective detail and allow them to focus on other aspects of the simulated CPR training, increasing the training's success and the participants' CPR quality.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":"8 1","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2023-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10105636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9671112","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":"Exploring equity, diversity, and inclusion in a simulation program using the SIM-EDI tool: the impact of a reflexive tool for simulation educators.","authors":"Eve Purdy,&nbsp;Ben Symon,&nbsp;Ruth-Ellen Marks,&nbsp;Chris Speirs,&nbsp;Victoria Brazil","doi":"10.1186/s41077-023-00250-7","DOIUrl":"https://doi.org/10.1186/s41077-023-00250-7","url":null,"abstract":"<p><strong>Background: </strong>There have been increasing calls for awareness and action related to equity, diversity, and inclusion (EDI) in simulation but a lack of practical guidance for how simulation delivery teams (SDTs) might move towards meaningful transformation. The gap between academic conversations about EDI and how to practically impact SDT attitudes, behaviors, and performance remains considerable. We designed a conversational tool, the SIM-EDI, to bridge the gap between theory and practice for SDTs by enhancing reflexivity and studied its impact locally.</p><p><strong>Methods: </strong>We engaged in a collaborative autoethnography to explore EDI within our emergency department SDT shortly after implementing the SIM-EDI. The 12-month ethnography is informed by our team's collection and analysis of data about ourselves and our own experiences using the tool. Data included serial interviews, field notes from simulations and SDT meetings, SDT documents, and self-reflections.</p><p><strong>Results: </strong>We found the SIM-EDI tool could be implemented with a team with a high level of readiness. Use of the tool had several meaningful impacts including enhanced team reflexivity, normalization of conversations related to EDI and increased confidence to engage in EDI conversations with participants. Key themes throughout the process included (1) individual and team growth, (2) fear of \"getting it wrong\", and (3) tension between bias towards action and need for slow reflection.</p><p><strong>Conclusion: </strong>The SIM-EDI tool can effectively promote reflexivity among faculty in an emergency department simulation program. The tool is easy to use and implement, impacts attitudes and behaviors, and facilitates individual and team growth.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":"8 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10067255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9593877","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":"Three perspectives on learning in a simulated patient scenario: a qualitative interview study with student, simulated patient, and teacher.","authors":"Sten Erici,&nbsp;Daniel Lindqvist,&nbsp;Mats B Lindström,&nbsp;Christina Gummesson","doi":"10.1186/s41077-023-00249-0","DOIUrl":"https://doi.org/10.1186/s41077-023-00249-0","url":null,"abstract":"<p><strong>Introduction: </strong>Patient simulation can be useful for medical students in developing communication skills for vulnerable situations. Three participants are primarily involved in the patient simulation activities: the student, the simulated patient (SP), and the teacher. We here aimed to explore these participants' perceptions of learning in a patient simulation scenario.</p><p><strong>Methods: </strong>We conducted individual interviews with eight students, three teachers, and one SP at a psychiatry placement of a Medical Doctor Program (5th year). During the interviews we asked the participants to watch a video of their participation in a patient simulation session. Thus, we obtained three perspectives on each of the eight recordings. We analysed our data with qualitative content analysis.</p><p><strong>Results: </strong>Three themes were generated: identity formation, collaborative learning, and learning intentions. This highly emotional scenario forced students out of their comfort zone, to the intersection of their roles as private person and professional. The SP perceived the collaborative creation of the scenario as significant learning. The teacher took a professional position and perceived the learning in the perspective of a future colleague.</p><p><strong>Conclusions: </strong>The mutually created emotionally loaded scenario was found to be important from all three perspectives, forcing the students to identify unexpected ways of communicating. This possibly enhanced their professional identity development. Implications for future research can be to explore the process of skills transfer.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":"8 1","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10029280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9513436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Debriefing Assessment in Real Time (DART) tool for simulation-based medical education.","authors":"Kaushik Baliga,&nbsp;Louis P Halamek,&nbsp;Sandra Warburton,&nbsp;Divya Mathias,&nbsp;Nicole K Yamada,&nbsp;Janene H Fuerch,&nbsp;Andrew Coggins","doi":"10.1186/s41077-023-00248-1","DOIUrl":"https://doi.org/10.1186/s41077-023-00248-1","url":null,"abstract":"<p><strong>Background: </strong>Debriefing is crucial for enhancing learning following healthcare simulation. Various validated tools have been shown to have contextual value for assessing debriefers. The Debriefing Assessment in Real Time (DART) tool may offer an alternative or additional assessment of conversational dynamics during debriefings.</p><p><strong>Methods: </strong>This is a multi-method international study investigating reliability and validity. Enrolled raters (n = 12) were active simulation educators. Following tool training, the raters were asked to score a mixed sample of debriefings. Descriptive statistics are recorded, with coefficient of variation (CV%) and Cronbach's α used to estimate reliability. Raters returned a detailed reflective survey following their contribution. Kane's framework was used to construct validity arguments.</p><p><strong>Results: </strong>The 8 debriefings (μ = 15.4 min (SD 2.7)) included 45 interdisciplinary learners at various levels of training. Reliability (mean CV%) for key components was as follows: instructor questions μ = 14.7%, instructor statements μ = 34.1%, and trainee responses μ = 29.0%. Cronbach α ranged from 0.852 to 0.978 across the debriefings. Post-experience responses suggested that DARTs can highlight suboptimal practices including unqualified lecturing by debriefers.</p><p><strong>Conclusion: </strong>The DART demonstrated acceptable reliability and may have a limited role in assessment of healthcare simulation debriefing. Inherent complexity and emergent properties of debriefing practice should be accounted for when using this tool.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":"8 1","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2023-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10013984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9129157","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":"Simulation device for shoulder reductions: overview of prototyping, testing, and design instructions.","authors":"Sorab Taneja,&nbsp;Will Tenpas,&nbsp;Mehul Jain,&nbsp;Peter Alfonsi,&nbsp;Abhinav Ratagiri,&nbsp;Ann Saterbak,&nbsp;Jason Theiling","doi":"10.1186/s41077-023-00246-3","DOIUrl":"https://doi.org/10.1186/s41077-023-00246-3","url":null,"abstract":"<p><strong>Background: </strong>Shoulder dislocations are common occurrences, yet there are few simulation devices to train medical personnel on how to reduce these dislocations. Reductions require a familiarity with the shoulder and a nuanced motion against strong muscle tension. The goal of this work is to describe the design of an easily replicated, low-cost simulator for training shoulder reductions.</p><p><strong>Materials and methods: </strong>An iterative, stepwise engineering design process was used to design and implement ReducTrain. A needs analysis with clinical experts led to the selection of the traction-countertraction and external rotation methods as educationally relevant techniques to include. A set of design requirements and acceptance criteria was established that considered durability, assembly time, and cost. An iterative prototyping development process was used to meet the acceptance criteria. Testing protocols for each design requirement are also presented. Step-by-step instructions are provided to allow the replication of ReducTrain from easily sourced materials, including plywood, resistance bands, dowels, and various fasteners, as well as a 3D-printed shoulder model, whose printable file is included at a link in the Additional file 1: Appendix.</p><p><strong>Results: </strong>A description of the final model is given. The total cost for all materials for one ReducTrain model is under US $200, and it takes about 3 h and 20 min to assemble. Based on repetitive testing, the device should not see any noticeable changes in durability after 1000 uses but may exhibit some changes in resistance band strength after 2000 uses.</p><p><strong>Discussion: </strong>The ReducTrain device fills a gap in emergency medicine and orthopedic simulation. Its wide variety of uses points to its utility in several instructional formats. With the rise of makerspaces and public workshops, the construction of the device can be easily completed. While the device has some limitations, its robust design allows for simple upkeep and a customizable training experience.</p><p><strong>Conclusion: </strong>A simplified anatomical design allows for the ReducTrain model to serve as a viable training device for shoulder reductions.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":"8 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9999631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9144831","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":"Effect of repeat refresher courses on neonatal resuscitation skill decay: an experimental comparative study of in-person and video-based simulation training.","authors":"Julia M McCaw,&nbsp;Sarah E Gardner Yelton,&nbsp;Sean A Tackett,&nbsp;Rainier M L L Rapal,&nbsp;Arianne N Gamalinda,&nbsp;Amelia Arellano-Reyles,&nbsp;Genevieve D Tupas,&nbsp;Ces Derecho,&nbsp;Fides Ababon,&nbsp;Jill Edwardson,&nbsp;Nicole A Shilkofski","doi":"10.1186/s41077-023-00244-5","DOIUrl":"https://doi.org/10.1186/s41077-023-00244-5","url":null,"abstract":"<p><p>Neonatal deaths are a major contributor to global under-5-year-old mortality. Training birth attendants can improve perinatal outcomes, but skills may fade over time. In this pilot study, we assessed skill decay of nursing students after remote video versus in-person resuscitation training in a low-resource setting. Filipino nursing students (n = 49) underwent traditional, in-person simulation-based Helping Babies Breathe (HBB) training in Mindanao, Philippines. Participants were then assigned to receive refresher training at 2-month intervals either in-person or via tele-simulation beginning at 2 months, 4 months, or 6 months after initial training. A knowledge examination and practical examination, also known as objective structured clinical examination B in the HBB curriculum, were administered before retraining to assess knowledge and skill retention at time of scheduled follow-up. Time to initiation of bag-mask ventilation (BMV) in seconds during simulated birth asphyxia was the primary outcome. Skill decay was evident at first follow-up, with average time to BMV increasing from 56.9 (range 15-87) s at initial post-training to 83.8 (range 32-128) s at 2 months and 90.2 (range 51-180) s at 4 months. At second follow-up of the 2-month group, students showed improved pre-training time to BMV (average 70.4; range 46-97 s). No statistical difference was observed between in-person and video-trained students in time to BMV. Because of COVID-19 restrictions, the 6-month follow-up was not completed. We conclude that remote video refresher training is a reasonable alternative to traditional in-person HBB training. Our study also suggests that refreshers may be needed more frequently than every 2 months to mitigate skill decay. Additional studies are necessary to assess the longitudinal impact of tele-simulation on clinical outcomes.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":"8 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2023-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9959951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9676349","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}