Computing in cardiologyPub Date : 2019-09-01Epub Date: 2020-02-24DOI: 10.22489/cinc.2019.425
Niels F Otani, Dylan Dang, Christopher Beam, Fariba Mohammadi, Brian Wentz, S M Kamrul Hasan, Suzanne M Shontz, Karl Q Schwarz, Sabu Thomas, Cristian A Linte
{"title":"Toward Quantification and Visualization of Active Stress Waves for Myocardial Biomechanical Function Assessment.","authors":"Niels F Otani, Dylan Dang, Christopher Beam, Fariba Mohammadi, Brian Wentz, S M Kamrul Hasan, Suzanne M Shontz, Karl Q Schwarz, Sabu Thomas, Cristian A Linte","doi":"10.22489/cinc.2019.425","DOIUrl":"https://doi.org/10.22489/cinc.2019.425","url":null,"abstract":"<p><p>Estimating and visualizing myocardial active stress wave patterns is crucial to understanding the mechanical activity of the heart and provides a potential non-invasive method to assess myocardial function. These patterns can be reconstructed by analyzing 2D and/or 3D tissue displacement data acquired using medical imaging. Here we describe an application that utilizes a 3D finite element formulation to reconstruct active stress from displacement data. As a proof of concept, a simple cubic mesh was used to represent a myocardial tissue \"sample\" consisting of a 10 × 10 × 10 lattice of nodes featuring different fiber directions that rotate with depth, mimicking cardiac transverse isotropy. In the forward model, tissue deformation was generated using a test wave with active stresses that mimic the myocardial contractile forces. The generated deformation field was used as input to an inverse model designed to reconstruct the original active stress distribution. We numerically simulated malfunctioning tissue regions (experiencing limited contractility and hence active stress) within the healthy tissue. We also assessed model sensitivity by adding noise to the deformation field generated using the forward model. The difference image between the original and reconstructed active stress distribution suggests that the model accurately estimates active stress from tissue deformation data with a high signal-to-noise ratio.</p>","PeriodicalId":72683,"journal":{"name":"Computing in cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373340/pdf/nihms-1602891.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38178324","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}
Jess Tate, Eelco van Dam, Wilson Good, Jake Bergquist, Peter van Dam, Rob MacLeod
{"title":"A Unified Pipeline for ECG Imaging Testing.","authors":"Jess Tate, Eelco van Dam, Wilson Good, Jake Bergquist, Peter van Dam, Rob MacLeod","doi":"10.22489/cinc.2019.437","DOIUrl":"https://doi.org/10.22489/cinc.2019.437","url":null,"abstract":"<p><p>The Consortium for ECG Imaging (CEI) has formed several collaborative projects to evaluate and improve technical aspects of Electrocardiographic Imaging (ECGI), but these efforts are not yet implemented into an integrated software framework. We developed a framework to unify the multiple techniques and stages of ECGI into one pipeline. This framework merges existing open source packages: SCIRun, a problem solving environment; the Forward/Inverse toolkit, a series of SCIRun modules for ECGI; and PFEIFER, a cardiac signal pre-processing tool. The Unified ECGI Toolkit (UETK), combined with the EDGAR dataset, allows users to test and validate a vast array of parameters within each stage of the ECGI pipeline. We expect that this unified tool will help introduce new researchers to ECGI, facilitate interaction between the various groups working on ECGI, and establish a common approach for researchers to test and validate their ECGI techniques.</p>","PeriodicalId":72683,"journal":{"name":"Computing in cardiology","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083590/pdf/nihms-1561966.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9877226","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":"Efficient Segmentation Pipeline Using Diffeomorphic Image Registration: A Validation Study.","authors":"Shalin Parikh, Anupama Goparaju, Riddhish Bhalodia, Bosten Loveless, Alan Morris, Joshua Cates, Evgueni Kholmovski, Nassir Marrouche, Shireen Elhabian","doi":"10.22489/cinc.2019.364","DOIUrl":"10.22489/cinc.2019.364","url":null,"abstract":"<p><p>Functional measurements of the left atrium (LA) in atrial fibrillation (AF) patients is limited to a single CINE slice midway through the LA. Nonetheless, a full 3D characterization of atrial functional measurements would provide more insights into LA function. But this improved modeling capacity comes at a price of requiring LA segmentation of each 3D time point,a time-consuming and expensive task that requires anatomy-specific expertise.We propose an efficient pipeline which requires ground truth segmentation of a single (or limited) CINE time point to accurately propagate it throughout the sequence. This method significantly saves human effort and enable better characterization of LA anatomy. From a gated cardiac CINE MRI sequence we select a single CINE time point with ground truth segmentation, and assuming cyclic motion, we register other images corresponding to all time points using diffeomorphic registration in ANTs. The diffeomorphic registration fields allow us to map a given anatomical shape (segmentation) to each CINE time point, facilitating the construction of a 4D shape model.</p>","PeriodicalId":72683,"journal":{"name":"Computing in cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338038/pdf/nihms-1603172.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38124828","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}
Computing in cardiologyPub Date : 2019-09-01Epub Date: 2020-02-24DOI: 10.22489/cinc.2019.403
Nathan Angel, Eugene G Kholmovski, Elyar Ghafoori, Derek J Dosdall, Rob S MacLeod, Ravi Ranjan
{"title":"Regions of High Dominant Frequency in Chronic Atrial Fibrillation Anchored to Areas of Atrial Fibrosis.","authors":"Nathan Angel, Eugene G Kholmovski, Elyar Ghafoori, Derek J Dosdall, Rob S MacLeod, Ravi Ranjan","doi":"10.22489/cinc.2019.403","DOIUrl":"https://doi.org/10.22489/cinc.2019.403","url":null,"abstract":"<p><p>Regions within the atria with sustained rapid reentrant or focal activity have been defined as a mechanism of persistent atrial fibrillation (AF). However, the mechanism behind the anchoring of these sites and their stability over time is unknown. We tested the hypothesis that fibrosis anchors sites of high frequency activation during AF and that these sites can be non-invasively determined using cardiac T1 Mapping with MRI. A canine rapid atrial paced model of persistent AF was used (n=12, including 6 controls) for the study. Whole heart T1 Mapping was performed prior to an electrical mapping study. Spatial maps of high dominant frequency (DF) probability were constructed to determine stability of the highest DF sites. These sites were then correlated with fibrotic regions determined by T1 Mapping. The chronic AF animals had at least one site of stable, high DF for at least 22.5 (75%) of 30 minutes of AF. Regions of stable high DF bordered regions of fibrosis as determined by T1 Mapping MRI 82% of the time (p<0.05). Heterogeneous atrial remodeling, specifically fibrosis, arising from chronic AF may provide a substrate that anchors sites of high DF. Cardiac T1 Mapping with MRI may determine such sites non-invasively.</p>","PeriodicalId":72683,"journal":{"name":"Computing in cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065674/pdf/nihms-1563891.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37729137","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}
Computing in cardiologyPub Date : 2019-09-01Epub Date: 2020-02-24DOI: 10.22489/cinc.2019.433
Ilija Uzelac, Shahriar Iravanian, Flavio H Fenton
{"title":"Parallel Acceleration on Removal of Optical Mapping Baseline Wandering.","authors":"Ilija Uzelac, Shahriar Iravanian, Flavio H Fenton","doi":"10.22489/cinc.2019.433","DOIUrl":"https://doi.org/10.22489/cinc.2019.433","url":null,"abstract":"<p><p>Optical mapping measurements on hearts stained with fluorescent dyes is imagining method widely accepted and recognized as a tool to study complex spatial-temporal dynamics of cardiac electro-physiology. One shortcoming of the method is baseline wandering in obtained fluorescence signals as signals relevant to transmembrane potential (V<sub>m</sub>) change and free intracellular calcium concentration ([Ca]<sub>i</sub> <sup>+2</sup>), the two most used dyes, are calculated as a relative signal change in respect to the fluorescence baseline. These changes are small fractional changes often smaller than 10 %. Baseline fluorescence drifts due to dye photo-bleaching, heart contraction/movement artifacts, and stability of the excitation light source over time. Depending on experimental instrumentation, recording duration, signal to noise levels and study aims of the optical imagining, many research groups adopted their own techniques tailored to a specific experimental data. Here we present a technique based on finite impulse response (FIR) filters with paralleled acceleration implemented on GPUs and multi-core CPU, in MATLAB.</p>","PeriodicalId":72683,"journal":{"name":"Computing in cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9202644/pdf/nihms-1765329.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40000058","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}
Computing in cardiologyPub Date : 2019-09-01Epub Date: 2020-02-24DOI: 10.22489/cinc.2019.379
Matthias Schaufelberger, Steffen Schuler, Laura Bear, Matthijs Cluitmans, Jaume Coll-Font, Önder Nazim Onak, Olaf Dössel, Dana Brooks
{"title":"Comparison of Activation Times Estimation for Potential-Based ECG Imaging.","authors":"Matthias Schaufelberger, Steffen Schuler, Laura Bear, Matthijs Cluitmans, Jaume Coll-Font, Önder Nazim Onak, Olaf Dössel, Dana Brooks","doi":"10.22489/cinc.2019.379","DOIUrl":"10.22489/cinc.2019.379","url":null,"abstract":"<p><p>Activation times (AT) describe the sequence of cardiac depolarization and represent one of the most important parameters for analysis of cardiac electrical activity. However, estimation of ATs can be challenging due to multiple sources of noise such as fractionation or baseline wander. If ATs are estimated from signals reconstructed using electrocardiographic imaging (ECGI), additional problems can arise from over-smoothing or due to ambiguities in the inverse problem. Often, resulting AT maps show falsely homogeneous regions or artificial lines of block. As ATs are not only important clinically, but are also commonly used for evaluation of ECGI methods, it is important to understand where these errors come from. We present results from a community effort to compare methods for AT estimation on a common dataset of simulated ventricular pacings. ECGI reconstructions were performed using three different surface source models: transmembrane voltages, epi-endo potentials and pericardial potentials, all using 2nd-order Tikhonov and 6 different regularization parameters. ATs were then estimated by the community participants and compared to the ground truth. While the pacing site had the largest effect on AT correlation coefficients (CC larger for lateral than for septal pacings), there were also differences between methods and source models that were poorly reflected in CCs. Results indicate that artificial lines of block are most severe for purely temporal methods. Compared to the other source models, ATs estimated from transmembrane voltages are more precise and less prone to artifacts.</p>","PeriodicalId":72683,"journal":{"name":"Computing in cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079739/pdf/nihms-1562060.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37752810","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}
Computing in cardiologyPub Date : 2019-01-01Epub Date: 2020-02-24DOI: 10.22489/cinc.2019.420
Wilson W Good, Karli K Gillette, Jake A Bergquist, Brian Zenger, Jess Tate, Lindsay C Rupp, Devan Anderson, Gernot Plank, Rob S MacLeod
{"title":"Validation of Intramural Wavefront Reconstruction and Estimation of 3D Conduction Velocity.","authors":"Wilson W Good, Karli K Gillette, Jake A Bergquist, Brian Zenger, Jess Tate, Lindsay C Rupp, Devan Anderson, Gernot Plank, Rob S MacLeod","doi":"10.22489/cinc.2019.420","DOIUrl":"10.22489/cinc.2019.420","url":null,"abstract":"<p><strong>Introduction: </strong>Changes in conduction velocity are indicative of a wide variety of cardiac abnormalities yet measuring conduction velocity is challenging, especially within the myocardial volume. In this study we investigated a novel technique to reconstruct activation fronts and estimate three-dimensional (3D) conduction velocity (CV) from experimental intramural recordings.</p><p><strong>Methods: </strong>From the intermittently sampled electrograms we both reconstruct the activation profile and compute the reciprocal of the gradient of activation times and a series of streamlines that allows for the CV estimation.</p><p><strong>Results: </strong>The reconstructed activation times agreed closely with simulated values, with 50% to 70% of the nodes ≤ 1ms of absolute error. We found close agreement between the CVs calculated using reconstructed versus simulated activation times. Across the reconstructed stimulation sites we saw that the reconstructed CV was on average 3.8% different than the ground truth CV.</p><p><strong>Discussion: </strong>This study used simulated datasets to validate our methods for reconstructing 3D activation fronts and estimating conduction velocities. Our results indicate that our method allows accurate reconstructions from sparse measurements, thus allowing us to examine changes in activation induced by experimental interventions such as acute ischemia, ectopic pacing, or drugs.</p>","PeriodicalId":72683,"journal":{"name":"Computing in cardiology","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051050/pdf/nihms-1561971.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9877223","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}
Computing in cardiologyPub Date : 2019-01-01Epub Date: 2020-02-24DOI: 10.22489/cinc.2019.200
Riddhish Bhalodia, Archanasri Subramanian, Alan Morris, Joshua Cates, Ross Whitaker, Evgueni Kholmovski, Nassir Marrouche, Shireen Elhabian
{"title":"Does Alignment in Statistical Shape Modeling of Left Atrium Appendage Impact Stroke Prediction?","authors":"Riddhish Bhalodia, Archanasri Subramanian, Alan Morris, Joshua Cates, Ross Whitaker, Evgueni Kholmovski, Nassir Marrouche, Shireen Elhabian","doi":"10.22489/cinc.2019.200","DOIUrl":"https://doi.org/10.22489/cinc.2019.200","url":null,"abstract":"<p><p>Evidence suggests that the shape of left atrium appendages (LAA) is a primary indicator in predicting stroke for patients diagnosed with atrial fibrillation (AF). Statistical shape modeling tools used to represent (i.e., parameterize) the underlying LAA variability are of crucial importance to learn shape-based predictors of stroke. Most shape modeling techniques use some form of alignment either as a data pre-processing step or during the modeling step. However, the LAA is a joint anatomy along with left atrium (LA), and the relative position and alignment plays a crucial part in determining risk of stroke. In this paper, we explore different alignment strategies for statistical shape modeling and how each strategy affects the stroke prediction capability. This allows for identifying a unified approach of alignment while analyzing the LAA anatomy for stroke. Here, we study three different alignment strategies, (i) global alignment, (ii) global translational alignment and (iii) cluster based alignment. Our results show that alignment strategies that take into account LAA orientation, i.e., (ii), or the inherent natural clustering of the population under study, i.e., (iii), provide significant improvement over global alignment in both qualitative as well as quantitative measures.</p>","PeriodicalId":72683,"journal":{"name":"Computing in cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338006/pdf/nihms-1603164.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38124827","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}
Y S Dogrusoz, L R Bear, J Bergquist, R Dubois, W Good, R S MacLeod, A Rababah, J Stoks
{"title":"Effects of Interpolation on the Inverse Problem of Electrocardiography.","authors":"Y S Dogrusoz, L R Bear, J Bergquist, R Dubois, W Good, R S MacLeod, A Rababah, J Stoks","doi":"10.22489/cinc.2019.100","DOIUrl":"https://doi.org/10.22489/cinc.2019.100","url":null,"abstract":"<p><p>Electrocardiographic Imaging (ECGI) aims to reconstruct electrograms from the body surface potential measurements. Bad leads are usually excluded from the inverse problem solution. Alternatively, interpolation can be applied. This study explores how sensitive ECGI is to different bad-lead configurations and interpolation methods. Experimental data from a Langendorff-perfused pig heart suspended in a human-shaped torso-tank was used. Epicardial electrograms were acquired during 30 s (31 beats) of RV pacing using a 108-electrode array, simultaneously with torso potentials from 128 electrodes embedded in the tank surface. Six different bad lead cases were designed based on clinical experience. Inverse problem was solved by applying Tikhonov regularization i) using the complete data, ii) bad-leads-removed data, and iii) interpolated data, with 5 different methods. Our results showed that ECGI accuracy of an interpolation method highly depends on the location of the bad leads. If they are in the high-potential-gradient regions of the torso, a highly accurate interpolation method is needed to achieve an ECGI accuracy close to using complete data. If the BSP reconstruction of the interpolation method is poor in these regions, the reconstructed electrograms also have lower accuracy, suggesting that bad leads should be removed instead of interpolated. The inverse-forward method was found to be the best among all interpolation methods applied in this study in terms of both missing BSP lead reconstruction and ECGI accuracy, even for the bad leads located over the chest.</p>","PeriodicalId":72683,"journal":{"name":"Computing in cardiology","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051038/pdf/nihms-1561961.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9877222","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}
Jake A Bergquist, Wilson W Good, Brian Zenger, Jess D Tate, Rob S MacLeod
{"title":"Optimizing the Reconstruction of Cardiac Potentials Using a Novel High Resolution Pericardiac Cage.","authors":"Jake A Bergquist, Wilson W Good, Brian Zenger, Jess D Tate, Rob S MacLeod","doi":"10.22489/cinc.2019.441","DOIUrl":"https://doi.org/10.22489/cinc.2019.441","url":null,"abstract":"<p><strong>Introduction: </strong>Experimental preparations in which cardiac and torso recordings are made simultaneously typically do not have uniform sampling around the entire surface of the heart. To fill in the resulting gaps in coverage, signals captured from the sampled region are extended to the unsampled region of the heart before being utilized in computational models. The resulting errors have never been evaluated systematically. We explored this relationship using a novel experimental preparation, and compared the resulting measurements against a set of interpolation and optimization methods.</p><p><strong>Methods: </strong>Measurements came from a modified Langenorff preparation in which we placed a rigid, heart shaped pericardiac cage electrode array around an isolated canine heart within an electrolytic torso-tank. Using the measured cage potentials we optimized a reconstruction from the subset of the cage below the base of the heart (ventricular) to the subset above it (atrial). This optimization minimized the difference between the reconstructed and measured signals. We then compared the reconstruction to a spatial Laplacian interpolation of the same potentials.</p><p><strong>Results: </strong>Qualitative results show a high degree of agreement between optimized reconstructed potentials and measured potentials whereas the Laplacian interpolation resulted in poorer reconstructions in most cases. Calculated mean and maximum error were lower for optimization based approaches than spatial Laplacian interpolation.</p><p><strong>Discussion: </strong>In this study we aimed to utilize novel pericardiac cage recordings to investigate interpolation strategies from sampled signals to unsampled signals. We demonstrate that the sampled ventricular subset of signals is sufficient to reconstruct the atrial subset but that Laplacian interpolation does not achieve the level of accuracy that is possible.</p>","PeriodicalId":72683,"journal":{"name":"Computing in cardiology","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051051/pdf/nihms-1561969.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9877224","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}