Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Feasibility and utility of the days of antibiotic spectrum coverage (DASC) in national antimicrobial use surveillance in Japan.","authors":"Ichiro Kawamura, Sanae Suzuki, Mio Endo, Masaaki Ogawa, Satoshi Hasegawa","doi":"10.1017/ash.2025.10086","DOIUrl":"10.1017/ash.2025.10086","url":null,"abstract":"<p><strong>Objective: </strong>Days of antibiotic spectrum coverage (DASC) is a novel metric that incorporates the antibiotic spectrum into consumption metrics, addressing the limitations of traditional metrics such as days of therapy (DOT). This study aimed to evaluate the feasibility of integrating DASC into the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Hospitals voluntarily participating in J-SIPHE.</p><p><strong>Participants: </strong>Inpatients from 1,833 hospitals between January 2019 and December 2022.</p><p><strong>Methods: </strong>Antibiotic use was assessed using DOT, DASC, and DASC/DOT. Antibiotic spectrum coverage scores were assigned based on published data or expert consensus. Annual trends were assessed using median values, and hospital-level variation was explored by hospital size. Proportional use of antibiotic classes by DOT and DASC was compared using 2022 data.</p><p><strong>Results: </strong>As the number of hospitals participating in J-SIPHE increased over time-particularly small and medium-sized hospitals-median DOT and DASC per 1,000 patient-days declined by 21.2% and 19.1%, respectively, from 2019 to 2022, while DASC/DOT remained stable. In 2022, proportional use of antibiotic classes varied by hospital size, and rankings differed when comparing DOT- and DASC-based measures. Broad-spectrum agents such as carbapenems and fluoroquinolones ranked higher by DASC than DOT. Hospital-level distributions of DOT and DASC/DOT showed substantial variation across hospital sizes.</p><p><strong>Conclusions: </strong>Integration of DASC metrics into national surveillance is feasible. DASC and DASC/DOT complement DOT by incorporating spectrum breadth, providing more comprehensive insight into antimicrobial use patterns and supporting stewardship benchmarking and intervention planning.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e175"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849939","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":"Outpatient antibiotic stewardship during the COVID-19 era: analysis of prescribing trends and guideline compliance.","authors":"Minji Sohn, Benjamin Pontefract, Kushal Dahal, Michael Klepser","doi":"10.1017/ash.2025.10081","DOIUrl":"10.1017/ash.2025.10081","url":null,"abstract":"<p><strong>Objective: </strong>To analyze antibiotic prescribing trends and guideline concordance in outpatient settings using electronic health records (EHRs).</p><p><strong>Design: </strong>This quality improvement study utilized data from the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM) database, which integrates antibiotic prescribing data extracted from the EHRs of various outpatient facilities.</p><p><strong>Setting: </strong>The study was conducted across 352 outpatient facilities in the United States.</p><p><strong>Participants: </strong>The study included oral antibiotic prescribing data from outpatient encounters from January 2021 to June 2023, encompassing 823,938 prescriptions.</p><p><strong>Methods: </strong>The primary outcomes were the rate of antibiotic prescribing per 1 000 prescription-related outpatient visits and identifying frequently prescribed antibiotics in adults and children. Secondary outcomes were the prescribing patterns for selected diagnoses and the concordance of these prescriptions with published guidelines.</p><p><strong>Results: </strong>The study estimated approximately a 20% increase in antibiotic prescribing per year, with an overall rate of 121.26 prescriptions per 1 000 prescription-related outpatient visits (95% confidence interval 121.01-121.50). Amoxicillin-clavulanate, amoxicillin, doxycycline, and cephalexin were most frequently prescribed. Sinusitis and otitis media were the most common reasons for prescribing antibiotics among adults and children, respectively. Less than 60% of sinusitis-related prescriptions were antibiotic concordant. Duration concordance rates were less than 70% for sinusitis, urinary tract infections, cellulitis, and Group A Streptococci. 51% of ciprofloxacin prescriptions were for patients aged 60 or older.</p><p><strong>Conclusions: </strong>The findings stress the need for strengthened antimicrobial stewardship in outpatient settings. The increasing rate of antibiotic prescriptions and discrepancies in guideline concordance reiterate the importance of ongoing monitoring and targeted interventions.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e168"},"PeriodicalIF":0.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790866","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":"Beyond the basics: rethinking antimicrobial stewardship by targeting cytomegalovirus immune globulin for immunocompromised patients.","authors":"Ritika Prasad, Brian Lu, Daniella Veloria, Emily Mui, Joanna Nelson, Gundeep Dhillon, Stanley Deresinski, Marisa Holubar, William Alegria","doi":"10.1017/ash.2025.10074","DOIUrl":"10.1017/ash.2025.10074","url":null,"abstract":"<p><p>Identifying actionable stewardship targets in immunocompromised patients is challenging due to limited data and high morbidity. One approach could be targeting therapy with limited evidence, like cytomegalovirus immune globulin (CMV-IGIV). We implemented a drug restriction program that increased appropriate use of CMV-IGIV, highlighting a unique stewardship opportunity in immunocompromised populations.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e166"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790863","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":"Clearance of penicillin allergies via direct oral provocation testing (DOPT): a systematic review.","authors":"Michael Dore, Ashley Otto, Annie Wang, Carly Heintz, Sarah Cantrell, Daniel Shields, Allyson Burkhart","doi":"10.1017/ash.2025.10080","DOIUrl":"10.1017/ash.2025.10080","url":null,"abstract":"<p><strong>Objective: </strong>Penicillin allergies are reported in 10-15% of the US population, but the actual rate is less than 1%. Inappropriate penicillin allergies are associated with adverse patient outcomes, poor antimicrobial stewardship, and increased healthcare costs. Direct oral provocation testing (DOPT) is a safe and cost-effective way to remove false penicillin allergy labels (PAL). However, widespread implementation is currently limited due to inadequate safety data and protocol variations. This systematic review evaluates the safety of single-dose, nongraded DOPT by the nonallergist.</p><p><strong>Design: </strong>Systematic review. MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception to May 2025.</p><p><strong>Setting: </strong>Inpatient (Intensive care unit (ICU) and general medical ward) and outpatient.</p><p><strong>Participants: </strong>Adults with self-reported penicillin allergies deemed low risk by a validated scoring system.</p><p><strong>Interventions: </strong>DOPT by nonallergists with single-dose oral amoxicillin 250 mg with a 60-minute observation period.</p><p><strong>Results: </strong>3 352 studies were identified, 15 were included in the analysis. Of the 1786 patients who completed DOPT, 66 (3.7%) experienced any reaction: 27 (1.5%) immediate rashes, 24 (1.3%) delayed rashes, and 15 (.8%) other reactions. No cases of anaphylaxis, angioedema, or epinephrine use were reported.</p><p><strong>Conclusion: </strong>The use of single-dose DOPT in patients deemed low risk, using a validated risk scoring tool, is safe, with low rates of mild reactions and no serious adverse events. A nonallergist can significantly improve penicillin delabeling rates and patient outcomes using this approach.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e167"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790864","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":"Incidence and risk factors for musculoskeletal adverse effects associated with daptomycin in patients receiving outpatient parenteral antimicrobial therapy.","authors":"Meaghen B Wiley, Kiya K Bennett, Emily A Siegrist, Stephen B Neely, Joseph Sassine, Bryan P White","doi":"10.1017/ash.2025.10087","DOIUrl":"10.1017/ash.2025.10087","url":null,"abstract":"<p><strong>Background: </strong>Daptomycin is preferred in outpatient parenteral antimicrobial therapy (OPAT) due to daily dosing. Elevations in creatine phosphokinase (CPK) of 3%-10% and musculoskeletal adverse events have been described with daptomycin, but data regarding risk factors and frequency of monitoring in the OPAT setting is limited. We evaluated the incidence and risk factors for CPK elevation and musculoskeletal adverse effects in patients receiving daptomycin OPAT.</p><p><strong>Methods: </strong>This was a single-center, retrospective cohort study of adults on OPAT with daptomycin and at least two CPK values. The primary outcome was the incidence of CPK values greater than 500 U/L.</p><p><strong>Results: </strong>We included 127 patients. Most patients were male (55.1%), and the median age was 56 years (IQR 46-63). The most common indication was bone/joint infections (73.2%, n = 93). The median daptomycin dose was 7.4 mg/kg/day (IQR 6.1-8.1) and duration of therapy was 37 days (IQR 21-44). Fifteen patients (11.8%) experienced a CPK greater than 500 U/L within a median 13 days (IQR 9-16). Five patients (3.9%) developed rhabdomyolysis. Independent predictors of CPK>500 U/L included male sex (OR, 4.2 [95% CI, 1.05-16.61]; <i>P</i> = .0424) and cerebrovascular disease (OR, 11 [95% CI, 1.21-99.86]; <i>P</i> = .0332).</p><p><strong>Conclusions: </strong>The incidence of CPK elevation was similar previously reported rates. This expands the literature to patients with daptomycin doses>6 mg/kg and prolonged durations of therapy. The incidence of CPK elevation and time to onset of 9-16 days supports the current recommendations for weekly lab monitoring.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e169"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790865","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":"Public knowledge and attitudes towards antibiotics and antimicrobial resistance (AMR) in vietnam: a cross-sectional study.","authors":"Van Nhi Tran, Thuc Quyen Huynh, Pham Tuyet Nhi Nguyen, Thi Phuong Truc Nguyen, Hoang An Nguyen, Gregory Hurter, Si Tuan Nguyen, Minh Khoi Le, Minh Thong Le, Chan Khon Huynh, Phuong Thao Nguyen, Thi Thu Hoai Nguyen","doi":"10.1017/ash.2025.10034","DOIUrl":"10.1017/ash.2025.10034","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a significant public health threat. Understanding public knowledge and attitudes toward antibiotic usage is essential for educational campaigns combating AMR. This study evaluates public knowledge and awareness about antibiotics and AMR in Vietnam.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted online in December 2021, featuring 20 questions on antibiotics, AMR, and participants' habits, attitudes, and potential solutions. The survey was distributed via social media platforms such as Facebook, Zalo, Viber, and WhatsApp. The target sample included Vietnamese working adults above 18 years old. Responses were coded and analyzed using SPSS version 21 and Microsoft Excel version 16.5. Participants were categorized into high, intermediate, and low knowledge levels based on their scores (>80%, 51-79%, and <50%).</p><p><strong>Results: </strong>A total of 866 Vietnamese adults participated. Most participants (90%) had moderate to high knowledge of antibiotics and AMR. However, only 32.8% knew that 75% of antibiotics are used in agriculture. Knowledge levels varied significantly across demographics such as gender, age, education, profession, and antibiotic use history. Healthcare-related professionals had significantly higher knowledge of antibiotics and AMR than nonhealthcare professionals (<i>p</i> < 0.001). Those with health-focused educational backgrounds also had higher knowledge levels (<i>p</i> < 0.001). Despite being aware that it was inappropriate, many participants reported discontinuing antibiotics before completing the course prescribed by their doctors.</p><p><strong>Conclusions: </strong>Age, education, profession, and antibiotic use history positively influenced AMR knowledge. However, even among health-related fields, understanding was only moderate. This indicates a need for enhanced public education to improve knowledge and attitudes toward antibiotics and AMR.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e165"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790867","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":"Geographical variation in the clinical profile of patients with <i>Candida auris</i>.","authors":"Taylor Schieber, Kaleb Roemer, Kenneth Sands, Nickie Greer, Julia Moody, Troy Watson, Adam Hasse","doi":"10.1017/ash.2025.10064","DOIUrl":"10.1017/ash.2025.10064","url":null,"abstract":"<p><strong>Objective: </strong>To describe <i>Candida auris</i> infections from two different geographical regions within a large health-system, both of which have experienced a significant increase in the occurrence of <i>C. auris.</i></p><p><strong>Design: </strong>Multicenter, retrospective, descriptive analysis across a large healthcare system.</p><p><strong>Methods: </strong>Patients were included in this study if they were admitted as an inpatient between January 1, 2021 and September 30, 2022 and had a clinical specimen that grew <i>C. auris</i>.</p><p><strong>Results: </strong>A total of 321 patients were included. The clinical outcomes of included patients were comparable between geographical regions (Western and Eastern), with the exception of patients who experienced mortality or transitioned to hospice care at discharge (Western 32.1% vs Eastern 19.1%, <i>P</i> = .014). Over one-third of patients required mechanical ventilation at any point during their admission, while greater than half of the total study population had receipt of a blood transfusion. Approximately 25.2% of all patients received hemodialysis, while 24.3% received total parental nutrition during their hospital stay. More than 50% of patients in both regions required an admission to the intensive care unit at any time-frame during their stay. Fluconazole-resistant isolates were more prevalent in the Western region, but both regions demonstrated a high prevalence of resistance.</p><p><strong>Conclusion: </strong>Patients identified with <i>C. auris</i> were characterized by significant underlying morbidity and disease burden. Further studies are warranted to identify infection prevention best practices to reduce transmission and reduce mortality through earlier identification and appropriate antifungal therapy.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e163"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755175","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":"Let's doff: a gown conservation strategy for multidrug-resistant organism colonization during the COVID-19 pandemic and beyond.","authors":"Kelsey L Rowe, Josephine Fox, Carole Leone, Lydia J Grimes, Kenneth Whalen, David K Warren, Jonas Marschall","doi":"10.1017/ash.2025.10069","DOIUrl":"10.1017/ash.2025.10069","url":null,"abstract":"<p><p>A COVID-19 pandemic gown conservation strategy for methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) and vancomycin-resistant enterococci (VRE) asymptomatically colonized patients caused no significant difference in healthcare-associated MRSA (HA-MRSA) bacteremia, healthcare-associated VRE (HA-VRE) bacteremia, or healthcare-associated <i>Clostridioides difficile</i> infections (HA-CDI) versus prepandemic contact precautions (CP). Postpandemic HA-VRE and HA-CDI rates mirrored national trends.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e164"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755176","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":"Development of a semi-automated stewardship approach for prescriber-specific antibiotic consumption report cards.","authors":"Shemual Tsai, Natalie Finch, Wesley Hoffmann, Shivani Patel, Evan Steere, Fadi Shehadeh, Muhammad Yasser Alsafadi","doi":"10.1017/ash.2025.10068","DOIUrl":"10.1017/ash.2025.10068","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e162"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755174","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 risk of contaminated ultrasound gels in the intensive care unit: lessons from an outbreak of <i>Burkholderia cenocepacia</i>.","authors":"Beevifatimah Ahamed Sha, Paul Anantharajah Tambyah, Shi Poh Li, Sarathamani Rethenam, Lilibeth Silagan Alenton, Ling Chee Poh, Yuan Sun Yong, Peng Sii Yong, Gabriel Yan Zherong, Lasantha Ratnayake, Michelle Ang, Gerald Chua, Surinder Kaur Pada","doi":"10.1017/ash.2025.182","DOIUrl":"10.1017/ash.2025.182","url":null,"abstract":"<p><strong>Background: </strong><i>Burkholderia cenocepacia</i> is an environmental Gram-negative bacterium, resistant to many antibiotics and antiseptics, that can survive in aqueous hospital environments. We investigated an outbreak of <i>B. cenocepacia</i> in the intensive care unit (ICU) of Ng Teng Fong General Hospital, aiming to identify the source and prevent further transmission.</p><p><strong>Methods: </strong>The outbreak was detected after two ICU patients developed <i>B. cenocepacia</i> bacteremia. Environmental samples, including ultrasound gels, and disinfectants, were collected. Whole genome sequencing (WGS) was used to determine clonality between clinical and environmental isolates. Immediate actions were taken, including a recall of ultrasound gel batches and the use of sterile gel sachets for high-risk procedures.</p><p><strong>Results: </strong>Ultrasound gels from opened and unopened bottles from multiple hospital areas, including ICU and Radiology, were found to be contaminated with <i>B. cenocepacia</i>, with a specific batch (Brand A) linked to the outbreak. WGS analysis confirmed the genetic relatedness of clinical and environmental isolates. A hospital-wide recall of affected gel batches was implemented. Through our regional networks, notification of countries in our immediate region along with alerting our local health authorities for further investigation was also undertaken. Additionally, we continued surveillance of gels and identified further contaminated products.</p><p><strong>Conclusions: </strong>This outbreak highlights the risks of contaminated medical products, specifically ultrasound gels. Effective environmental sampling, rapid identification, and clear communication with health authorities were key to controlling the outbreak. We have since revised our protocols to mandate the use of sterile gel for invasive procedures and continue monitoring for potential contamination in ultrasound gels.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e161"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692558","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}