British paramedic journal最新文献

{"title":"A survey of UK emergency medical services' approach to incidental identification of atrial fibrillation.","authors":"Laura Blair, Graham McClelland, Lisa Shaw, Eugene Yee Hing Tang, Chris Price, Chris Wilkinson","doi":"10.29045/14784726.2026.6.11.1.17","DOIUrl":"https://doi.org/10.29045/14784726.2026.6.11.1.17","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial fibrillation (AF) is a condition associated with increased risk of stroke. The risk of stroke can be reduced by oral anticoagulation (OAC) medication, but as AF is often asymptomatic, it can go unrecognised. Given the move away from face-to-face consultations, it is important to take advantage of any opportunities for AF detection and onward evaluation for potential OAC prescription. Emergency medical services (EMS) provide face-to-face assessments that can provide the oppportunity to identify incidental AF. However, little is known about how EMS manage patients with incidental detection of AF or what the optimum approach may be. The aim of this service evaluation was therefore to describe current practice within UK EMS for the detection of and response to incidental AF.</p><p><strong>Methods: </strong>Interview-delivered surveys were conducted by the lead researcher between June and August 2023 with participants from the large UK ambulance trusts. Participants were emailed directly to ask if they would agree to be interviewed. All interviews were conducted via Microsoft Teams. The survey was developed by the co-authors, refined during the project and included all aspects of the patient pathway. Content analysis was used by the lead researcher to analyse the interviews.</p><p><strong>Results: </strong>There were variations in clinical aspects, such as pulse palpation, and only five trusts had a clear process about managing incidental findings. Methods for information sharing with primary care varied between in- and out-of-hours periods, according to the services that were available locally, leading to heterogeneity of care.</p><p><strong>Conclusion: </strong>An EMS encounter can provide an opportunity to identify incidental AF and instigate ongoing care for modification of stroke risk; however, there is variability in practice across the UK. To ensure that opportunities for stroke risk reduction are maximised, a robust mechanism for clinical information sharing with primary care regarding incidental AF is required.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 1","pages":"17-23"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221144","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":"When innovation pootles along: The need for clear stop-go decisions in ambulance-based service evaluations.","authors":"Cath Hodson, Derek Hatley, Chris Harvey, Caitlin Wilson","doi":"10.29045/14784726.2026.6.11.1.66","DOIUrl":"https://doi.org/10.29045/14784726.2026.6.11.1.66","url":null,"abstract":"","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 1","pages":"66-67"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221156","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":"Resuscitation attempts in patients with do not attempt cardiopulmonary resuscitation decisions attended by emergency medical services: contributing factors and predictors.","authors":"Emma Whidborne, Amelia Taylor, Jennifer Scott-Green, Eleanor Jaquet, Sophie Clark, Matthew Vokes, Craig Mortimer, Jack Barrett","doi":"10.29045/14784726.2026.6.11.1.34","DOIUrl":"https://doi.org/10.29045/14784726.2026.6.11.1.34","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Out-of-hospital cardiac arrest (OHCA) is a time-critical emergency in which ambulance clinicians must rapidly decide whether to initiate resuscitation. In the UK, up to 30% of OHCA patients also have a documented do not attempt cardiopulmonary resuscitation (DNACPR) decision. Despite these advance care plans, patients may still receive cardiopulmonary resuscitation (CPR), potentially causing distress to patients, relatives and clinicians, and increasing resource use. The frequency and predictors of such events in UK ambulance services remain poorly described.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective service evaluation was undertaken using one regional ambulance service's OHCA registry (January-December 2024). Adults with a valid DNACPR or recommended summary plan for emergency care and treatment (ReSPECT) recommending against CPR, which was available to crews either electronically or physically at the time of the incident (or crews were informed by another HCP of the presence of a valid form), who suffered an OHCA and were attended by a regional emergency medical services (EMS) were included. The primary outcome was the commencement of any resuscitation attempt, defined as either over-the-phone CPR instructions or on-scene clinical intervention. Descriptive statistics compared cases with and without resuscitation. Univariable and multivariable logistic regression identified factors associated with a resuscitation attempt.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between 1 January and 31 December 2024 there were 7809 OHCAs, of which 1827 patients had a DNACPR; resuscitation by the ambulance service or bystanders occurred in 377 (20%) cases. Call handlers initiated most attempts (87%), and 36% received on-scene interventions. Median age was 80 years (IQR 70-90), and 51% were female. Multivariable analysis showed that each additional clinician on scene was associated with increased odds of resuscitation by 69% (adjusted odds ratio [aOR] 1.69, 95% CI 1.55-1.84; p &lt;0.001). A public location carried a six-fold higher likelihood of resuscitation compared with assisted-living or nursing homes (aOR 6.08, 95% CI 1.47-27.4; p = 0.013). Home OHCAs were common and associated with a resuscitation attempt (aOR 1.41, 95% CI 1.00-2.01). Where dedicated end-of-life care single points of access were available in an area, there were lower odds of a resuscitation attempt (aOR 0.32, 95% CI 0.12-0.81). Patient age, sex and response time were not independent predictors of the outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;One in five patients with a recorded DNACPR received a resuscitation attempt. This likely reflects the real-world complexities of DNACPR recognition in time-critical emergencies, including delayed access to documentation and potentially reversible presentations. Larger on-scene teams and public locations were associated with resuscitation, whereas a dedicated end-of-life care hub was associated with reduced attempts. Improv","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 1","pages":"34-42"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221214","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 national consensus guideline for termination of resuscitation in the out-of-hospital environment.","authors":"Michael A Smyth, Terry P Brown, Rachael Fothergill, Frances Griffiths, Ranjit Lall, John Long, Stavros Petrou, Aloysius Niroshan Siriwardena, Anne-Marie Slowther, Lauren Bettely, Karin Eli, Galina Gardiner, Caroline Huxley, Kamran Khan, Felix Michelet, Gavin D Perkins","doi":"10.29045/14784726.2026.6.11.1.56","DOIUrl":"10.29045/14784726.2026.6.11.1.56","url":null,"abstract":"<p><strong>Introduction: </strong>Ambulance services in England attempted resuscitation in over 34,400 cases in 2022. Of these, 58% had the resuscitation attempt terminated at the scene and only 7.8% survived to hospital discharge. The decision to stop resuscitation is informed by a national guideline that is over 20 years old. This study describes the development of a revised termination of resuscitation (TOR) guideline.</p><p><strong>Methods: </strong>This was a mixed-methods study comprising a diagnostic test accuracy meta-analysis of TOR rules, modelling of multiple TOR rules using data from the Out-of-Hospital Cardiac Arrest Outcomes registry, a survey of ambulance services including a review of national policy documents, qualitative interviews with ambulance and emergency department (ED) clinicians, plus interviews with relatives of patients who did not survive a pre-hospital resuscitation attempt. These work packages informed a national consensus meeting with a wide range of stakeholders, employing nominal group techniques, to draft a revised TOR guideline.</p><p><strong>Results: </strong>The systematic review identified very low-certainty evidence from 43 studies, indicating that TOR rules are unlikely to be suitable for implementation in the UK. When we modelled the performance of TOR rules, the three best performing were the Marsden, KOCARC 1 and GOTO1 TOR rules. We identified considerable variation in practice across UK ambulance services; however, there was consistency across services with respect to perceived risks. Paramedics experienced tension when they felt that guidelines restricted them from acting in the patient's best interests. ED staff felt that paramedics should be empowered to stop resuscitation in some cases. Relatives felt that paramedics did a good job and that they had information that was useful for paramedics. Multiple stakeholders participated in a consensus conference to develop a revised TOR guideline.</p><p><strong>Conclusion: </strong>We iteratively derived updated TOR and verification of death guidelines.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 1","pages":"56-65"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221146","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":"A service evaluation of the recognition, care and management of functional seizures within a UK ambulance service.","authors":"David Williams, Kim Kirby, Elizabeth Mallam, Penny Crawley","doi":"10.29045/14784726.2026.6.11.1.43","DOIUrl":"10.29045/14784726.2026.6.11.1.43","url":null,"abstract":"<p><strong>Introduction: </strong>Functional seizures, a subtype of functional neurological disorder, are frequent presentations within the emergency department and wider hospital setting. There is a lack of research exploring pre-hospital care for this patient group. The aim of this service evaluation was to explore ambulance staff recognition, care and management of functional seizure presentations within a UK ambulance service trust.</p><p><strong>Methods: </strong>An online survey was conducted using a convenience sample of clinical staff from South Western Ambulance Services NHS Foundation Trust. Respondents were asked for a mixture of distinct and free-text answers to questions around identification, care and management of functional seizure presentations. Results were analysed using a mix of descriptive statistics and qualitative content analysis.</p><p><strong>Results: </strong>There were 96 responses to the survey. Eighty-two per cent (n = 81) of respondents reported that they attend functional seizures at least once monthly, with 18% (n = 17) of those attending functional seizures weekly. Ambulance staff confidence in the recognition and management of functional seizures is high, but notably 66% (n = 63) have received no previous training or education for functional seizure care. Definitions and causes of functional seizures reportedly relied predominantly on a psychological component. Identification was based on history, seizure features and clinical guidelines. Management of functional seizures focused on reassurance. Challenges identified by ambulance staff included stigma, perceived diagnostic complexity, fear and limited education.</p><p><strong>Conclusion: </strong>Ambulance staff frequently attend functional seizures but receive limited training, leading to misconceptions, stigma and diagnostic challenges. Identification depends on unreliable signs and complex histories. Management aligns with clinical guidance, yet uncertainty remains for prolonged events. Fear of misdiagnosis, harmful attitudes and poor education highlight the urgent need for targeted education and future research.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 1","pages":"43-49"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221163","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":"Editorial: paramedic careers and research - why it matters and how to start.","authors":"Larissa Prothero, Helen Pocock, Caitlin Wilson, Julia Wolfe","doi":"10.29045/14784726.2026.6.11.1.1","DOIUrl":"10.29045/14784726.2026.6.11.1.1","url":null,"abstract":"","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221180","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":"Student paramedic sexual safety in ambulance placement: a critical exploration.","authors":"Jennifer Dod, Peter Phillips, Chloe Kate Keeping, Ellie Stowe","doi":"10.29045/14784726.2026.6.11.1.50","DOIUrl":"https://doi.org/10.29045/14784726.2026.6.11.1.50","url":null,"abstract":"<p><p>Sexually inappropriate behaviour within UK ambulance services has become an increasingly visible and pressing concern, yet little is known about how these behaviours impact student paramedics during practice-based learning. This article examines existing evidence relating to sexual misconduct, harassment and sex-based discrimination in UK ambulance trusts, with specific attention to the likely under-reported experiences of student paramedics. Interest in this issue is grounded in the authors' combined professional and personal experiences as educators, practitioners and recent students who have directly observed or encountered these behaviours. The paramedic culture in which these clinical ambulance placements occur has been repeatedly characterised by entrenched misogyny, hierarchical structures and normalisation of potentially inappropriate 'banter', all of which may mask or trivialise harmful behaviour. Existing literature and national reviews highlight substantial barriers to reporting such issues, including fear of reprisals, lack of confidentiality, distrust of management and organisational cultures that minimise concerns. Although recent policy attention has improved recognition of sexual safety as a systemic problem within ambulance services, student paramedics remain largely excluded from major data sources, such as the NHS Staff Survey. Early indicators, including National Education and Training Survey findings and professional body initiatives, suggest that paramedic students may be disproportionately exposed to sexualised behaviour, yet may lack safe mechanisms to disclose concerns. To contextualise these issues, this article draws on sociological perspectives, particularly social identity theory, to explore how group dynamics, power structures and gendered norms may perpetuate inappropriate sexual behaviour and inhibit speaking up. This analysis underscores the need for evidence-based interventions that address both individual and organisational contributors to sexual misconduct. The article concludes by identifying a critical evidence gap regarding UK student paramedic experiences and outlining the authors' forthcoming research study, which aims to provide the first in-depth exploration of this issue from the student perspective.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 1","pages":"50-55"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221148","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":"Advanced airway management in out-of-hospital cardiac arrest: a service evaluation from a regional English ambulance service.","authors":"Andrew Cole, Jessica Lynde, Sarah Black","doi":"10.29045/14784726.2026.6.11.1.24","DOIUrl":"https://doi.org/10.29045/14784726.2026.6.11.1.24","url":null,"abstract":"<p><strong>Introduction: </strong>Following national changes to airway management practice in out-of-hospital cardiac arrest (OHCA), endotracheal intubation (ETI) is no longer a core paramedic skill in many English ambulance services. This service evaluation assessed airway practice and success rates in OHCA, focusing on supraglottic airways (SGAs) and ETI, following the restriction of ETI to advanced airways clinicians (AACs) within a regional ambulance service.</p><p><strong>Methods: </strong>This retrospective observational service evaluation included all OHCA incidents between April and September 2024 where resuscitation was attempted. Data were extracted from structured and free-text fields within the ambulance service's OHCA registry. Variables analysed included the airway device used, ETI success and the number of attempts prior to success or subsequent change to an alternative airway strategy. SGA outcomes and basic demographic and survival data were also analysed. A sub-analysis explored documented SGA difficulties and associated themes.</p><p><strong>Results: </strong>SGAs were used in 85.8% of incidents, with an overall success rate of 84.3%. Success was higher in paramedic-led cases (91.4%) compared to those where AACs attended (77.8%). ETI was performed in 37.1% of AAC-attended incidents, with overall success of 97.7% and first-pass success of 92.6%. ETI success was higher when following return of spontaneous circulation compared to intra-arrest intubation (99.0% versus 96.8%, respectively). In 8.6% of incidents, SGAs were initially documented as successful but subsequently replaced. SGA failure was commonly associated with airway contamination requiring suction (67.3%). ETI use was more frequent in younger patients and those surviving to 30 days, though findings may reflect service evaluation limitations rather than outcome-driven benefit.</p><p><strong>Conclusion: </strong>SGAs remain an effective first-line airway device in OHCA, particularly for frontline clinicians, although success may be reduced in contaminated airways. ETI first-pass and overall success rates were high when delivered within an AAC model, characterised by robust clinical governance and regular clinical exposure.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 1","pages":"24-33"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221150","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":"End-tidal carbon dioxide monitoring to predict hypovolaemic shock and the subsequent need for blood transfusions in adult pre-hospital trauma patients: a systematic review.","authors":"Laura Stevenson, Mary Halter","doi":"10.29045/14784726.2026.3.10.4.34","DOIUrl":"https://doi.org/10.29045/14784726.2026.3.10.4.34","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic haemorrhage is a major cause of preventable death, and blood transfusion is a crucial component of damage control resuscitation. Several diagnostic strategies exist to anticipate hypovolaemic shock and subsequent blood transfusion requirements, but their pre-hospital utility is inconsistent. Capnography or end-tidal carbon dioxide (EtCO₂) measurement has received growing recognition for prognostic capability in metabolic, respiratory and cardiac disease. This systematic review examines EtCO₂ efficacy in predicting hypovolaemic shock and subsequent blood transfusion in pre-hospital adult trauma patients.The aims and objectives of this study were, first, to determine if early EtCO₂ measurement in pre-hospital adult trauma patients can reliably predict hypovolaemic shock and/or blood transfusion when compared to existing strategies and scoring tools and, second, to identify if an EtCO₂ predictive threshold can facilitate this.</p><p><strong>Methods: </strong>A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted. Seven electronic databases were searched using relevant indexed terms and keywords. Inclusion criteria were adult (>13 years) trauma patients with suspected or confirmed haemorrhage and with early (pre-diagnostic) EtCO₂ data from mainstream or side-stream devices, as related in peer-reviewed publications. All articles (n = 1932) were double-blind screened at abstract and title, then at full-text stage by two reviewers. Issues were discussed by the authors. Critical Appraisal Skills Programme (CASP) tools were used. Findings were narratively synthesised.</p><p><strong>Results: </strong>Thirteen articles were included. Significant heterogeneity, quality limitations and inconsistent reporting hindered direct comparison of results. Nevertheless, 10 comparator strategies/tools were identified and most studies demonstrated EtCO₂'s efficacy in predicting hypovolaemic shock / blood transfusion, with thresholds below 35 mmHg consistently suggested as predictive.</p><p><strong>Conclusion: </strong>A universal definition for major blood transfusion is still lacking. Further research is needed to identify accurate markers of haemorrhage, including EtCO₂ as a potential predictor. A high index of suspicion for haemorrhage and need for blood transfusion is recommended for adult trauma patients with EtCO₂ levels below 35 mmHg (4.7 kPa).</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"10 4","pages":"34-52"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12969950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438094","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":"Editorial: a year of growth and opportunity.","authors":"Julia Williams, Caitlin Wilson, Graham McClelland","doi":"10.29045/14784726.2026.3.10.4.1","DOIUrl":"10.29045/14784726.2026.3.10.4.1","url":null,"abstract":"","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"10 4","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12969951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438049","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}