Frontiers in sleep最新文献

{"title":"Overview of the hypnodensity approach to scoring sleep for polysomnography and home sleep testing","authors":"P. Anderer, M. Ross, A. Cerny, R. Vasko, E. Shaw, P. Fonseca","doi":"10.3389/frsle.2023.1163477","DOIUrl":"https://doi.org/10.3389/frsle.2023.1163477","url":null,"abstract":"Human experts scoring sleep according to the American Academy of Sleep Medicine (AASM) rules are forced to select, for every 30-second epoch, one out of five stages, even if the characteristics of the neurological signals are ambiguous, a very common occurrence in clinical studies. Moreover, experts cannot score sleep in studies where these signals have not been recorded, such as in home sleep apnea testing (HSAT). In this topic review we describe how artificial intelligence can provide consistent and reliable scoring of sleep stages based on neurological signals recorded in polysomnography (PSG) and on cardiorespiratory signals recorded in HSAT. We also show how estimates of sleep stage probabilities, usually displayed as hypnodensity graph, can be used to quantify sleep stage ambiguity and stability. As an example of the application of hypnodensity in the characterization of sleep disordered breathing (SDB), we compared 49 patients with sleep apnea to healthy controls and revealed a severity-depending increase in ambiguity and decrease in stability during non-rapid eye movement (NREM) sleep. Moreover, using autoscoring of cardiorespiratory signals, we show how HSAT-derived apnea-hypopnea index and hypoxic burden are well correlated with the PSG indices in 80 patients, showing how using this technology can truly enable HSATs as alternatives to PSG to diagnose SDB.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80294177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Veterans Health Administration response to 2021 recall of Philips Respironics devices: A case study.","authors":"Jeffrey K Belkora, Barry Fields, Q Afifa Shamim-Uzzaman, Donna Stratford, David Alfandre, Scott Hollingshaus, Edward Yackel, Cynthia Geppert, Penny Nechanicky, Ardene Nichols, Katherine Williams, Jill Reichert, Mary A Whooley, Joe Francis, Kathleen F Sarmiento","doi":"10.3389/frsle.2023.1129415","DOIUrl":"10.3389/frsle.2023.1129415","url":null,"abstract":"<p><p>This case study describes, for the time frame of June 2021 through August 2022, the U.S. Veterans Health Administration (VHA) organizational response to a manufacturer's recall of positive airway pressure devices used in the treatment of sleep disordered breathing. VHA estimated it could take over a year for Veterans to receive replacement devices. Veterans awaiting a replacement faced a dilemma. They could continue using the recalled devices and bear the product safety risks that led to the recall, or they could stop using them and bear the risks of untreated sleep disordered breathing. Using a program monitoring approach, we report on the processes VHA put in place to respond to the recall. Specifically, we report on the strategic, service, and operational plans associated with VHA's response to the recall for Veterans needing replacement devices. In program monitoring, the strategic plan reflects the internal process objectives for the program. The service plan articulates how the delivery of services will intersect the customer journey. The operational plan describes how the program's resources and actions must support the service delivery plan. VHA's strategic plan featured a clinician-led, as opposed to primarily legal or administrative response to the recall. The recall response team also engaged with VHA's medical ethics service to articulate an ethical framework guiding the allocation of replacement devices under conditions of scarcity. This framework proposed allocating scarce devices to Veterans according to their clinical need. The service plan invited Veterans to schedule visits with sleep providers who could assess their clinical need and counsel them accordingly. The operational plan distributed devices according to clinical need as they became available. Monitoring our program processes in real time helped VHA launch and adapt its response to a recall affecting more than 700,000 Veterans.</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10996451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86038251","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":"Distinct cognitive changes in male patients with obstructive sleep apnoea without co-morbidities.","authors":"Valentina Gnoni, Michel Mesquita, David O'Regan, Alessio Delogu, Ivan Chakalov, Andrea Antal, Allan H Young, Romola S Bucks, Melinda L Jackson, Ivana Rosenzweig","doi":"10.3389/frsle.2023.1097946","DOIUrl":"10.3389/frsle.2023.1097946","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnoea (OSA) is a multisystem, debilitating, chronic disorder of breathing during sleep, resulting in a relatively consistent pattern of cognitive deficits. More recently, it has been argued that those cognitive deficits, especially in middle-aged patients, may be driven by cardiovascular and metabolic comorbidities, rather than by distinct OSA-processes, such as are for example ensuing nocturnal intermittent hypoxaemia, oxidative stress, neuroinflammation, and sleep fragmentation.</p><p><strong>Methods: </strong>Thus, we undertook to define cognitive performance in a group of 27 middle-aged male patients with untreated OSA, who had no concomitant comorbidities, compared with seven matched controls (AHI mean ± S.D.: 1.9 ± 1.4 events/h; mean age 34.0 ± 9.3 years; mean BMI 23.8 ± 2.3 kg/m²). Of the 27 patients, 16 had mild OSA (AHI mean ± S.D.:11.7 ± 4.0 events/h; mean age 42.6 ± 8.2 years; mean BMI 26.7 ± 4.1 kg/m²), and 11 severe OSA (AHI 41.8 ± 20.7 events/h; age: 46.9 ± 10.9 years, BMI: 28.0 ± 3.2 kg/m²).</p><p><strong>Results: </strong>In our patient cohort, we demonstrate poorer executive-functioning, visuospatial memory, and deficits in vigilance sustained attention, psychomotor and impulse control. Remarkably, we also report, for the first time, effects on social cognition in this group of male, middle-aged OSA patients.</p><p><strong>Conclusion: </strong>Our findings suggest that distinct, OSA-driven processes may be sufficient for cognitive changes to occur as early as in middle age, in otherwise healthy individuals.</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7615516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80828254","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":"Regulation of dendritic spines in the amygdala following sleep deprivation","authors":"L. Rexrode, Matthew Tennin, Jobi Babu, Caleb Young, R. Bollavarapu, Lamiorkor Ameley Lawson, J. Valeri, H. Pantazopoulos, B. Gisabella","doi":"10.3389/frsle.2023.1145203","DOIUrl":"https://doi.org/10.3389/frsle.2023.1145203","url":null,"abstract":"The amygdala is a hub of emotional circuits involved in the regulation of cognitive and emotional behaviors and its critically involved in emotional reactivity, stress regulation, and fear memory. Growing evidence suggests that the amygdala plays a key role in the consolidation of emotional memories during sleep. Neuroimaging studies demonstrated that the amygdala is selectively and highly activated during rapid eye movement sleep (REM) and sleep deprivation induces emotional instability and dysregulation of the emotional learning process. Regulation of dendritic spines during sleep represents a morphological correlate of memory consolidation. Several studies indicate that dendritic spines are remodeled during sleep, with evidence for broad synaptic downscaling and selective synaptic upscaling in several cortical areas and the hippocampus. Currently, there is a lack of information regarding the regulation of dendritic spines in the amygdala during sleep. In the present work, we investigated the effect of 5 h of sleep deprivation on dendritic spines in the mouse amygdala. Our data demonstrate that sleep deprivation results in differential dendritic spine changes depending on both the amygdala subregions and the morphological subtypes of dendritic spines. We observed decreased density of mushroom spines in the basolateral amygdala of sleep deprived mice, together with increased neck length and decreased surface area and volume. In contrast, we observed greater densities of stubby spines in sleep deprived mice in the central amygdala, indicating that downscaling selectively occurs in this spine type. Greater neck diameters for thin spines in the lateral and basolateral nuclei of sleep deprived mice, and decreases in surface area and volume for mushroom spines in the basolateral amygdala compared to increases in the cental amygdala provide further support for spine type-selective synaptic downscaling in these areas during sleep. Our findings suggest that sleep promotes synaptic upscaling of mushroom spines in the basolateral amygdala, and downscaling of selective spine types in the lateral and central amygdala. In addition, we observed decreased density of phosphorylated cofilin immunoreactive and growth hormone immunoreactive cells in the amygdala of sleep deprived mice, providing further support for upscaling of dendritic spines during sleep. Overall, our findings point to region- and spine type-specific changes in dendritic spines during sleep in the amygdala, which may contribute to consolidation of emotional memories during sleep.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82747591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doctor-diagnosed sleep disorders in the United States: Prevalence and impact of tobacco smoke exposure and vitamin D deficiency. A population-based study","authors":"P. Kum-Nji, Samuel A. Taylor, Bah Tanwi","doi":"10.3389/frsle.2023.1113946","DOIUrl":"https://doi.org/10.3389/frsle.2023.1113946","url":null,"abstract":"Background and purpose: We determined the prevalence of physician-diagnosed sleep disorder and its association with tobacco smoke exposure and vitamin D deficiency. Methods The National Health and Nutrition Examination Survey (NHANES) of 2011–2012 data base was used for the study. Subjects were asked two questions: “Ever told your doctor you had trouble sleeping?” and “Ever told by doctor have sleep disorder?” The answer “yes” to the second question indicated presence of a doctor-diagnosed sleep disorder (DSD) and “no” indicated its absence. Tobacco smoke exposure was defined by serum cotinine levels while vitamin D levels were measured by serum 25(OH) D. Eight selected variables included in the analyses were BMI, age, gender, smoking exposure, vitamin D levels, income, insurance, and race. Univariate and multivariate analyses were conducted to determine if tobacco smoke exposure and Vitamin D were each predictive of DSD. Results Of 5,470 subjected aged 16 to 80+ years about 9% had doctor-diagnosed sleep disorder (DSD). In a multiple regression analysis, active tobacco smoking was predictive of DSD (OR 1.92; 95% CI = 1.38–2.69), while passive smoke exposure was not, even after controlling for all the other significant variables (OR 0.93; 95% CI = 0.57–1.52). The other variables significantly associated with DSD were by order of importance BMI (P < 0.001), Age (P < 0.001) and race (P ≤ 0.001). Vitamin D deficiency was not predictive of DSD. Conclusion The prevalence of physician-diagnosed DSD was about 9%. Active smoking but not passive smoking as defined by cotinine levels was significantly associated with DSD. Vitamin D was not predictive of DSD. Future studies are therefore needed to demonstrate whether smoking cessation could help reduce DSD.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77920134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and diagnosis of pediatric obstructive sleep apnea—An update","authors":"Taylor B. Teplitzky, Audrey J. Zauher, A. Isaiah","doi":"10.3389/frsle.2023.1127784","DOIUrl":"https://doi.org/10.3389/frsle.2023.1127784","url":null,"abstract":"Purpose Formal overnight polysomnography (PSG) is required to diagnose obstructive sleep apnea (OSA) in children with sleep disordered breathing (SDB). Most clinical guidelines do not recommend home-based tests for pediatric OSA. However, PSG is limited by feasibility, cost, availability, patient discomfort, and resource utilization. Additionally, the role of PSG in evaluating disease impact may need to be revised. There is a strong need for alternative testing that can stratify the need for PSG and improve the time to diagnosis of OSA. This narrative review aims to evaluate and discuss innovative approaches to pediatric SDB diagnosis. Findings Methods to evaluate pediatric SDB outside of PSG include validated questionnaires, single-channel recordings, incorporation of telehealth, home sleep apnea testing (HSAT), and predictive biomarkers. Despite the promise, no individual metric has been found suitable to replace standard PSG. In addition, their use in combination to diagnose OSA diagnosis still needs to be defined. Summary When combined with adjunct assessments, HSAT advancements may accurately evaluate SDB in children and thus minimize the need for overnight in-laboratory PSG. Further studies are required to confirm diagnostic validity vis-à-vis PSG as a reference standard.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85043990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of non-completion of sleep apnea testing during pregnancy","authors":"K. Antony, A. L. Rice, Sakshi Bajaj, Abigail M. Wiedmer, N. Jacobson, Julia Nick, Allison Eichmann, A. K. Stanic, M. Bazalakova","doi":"10.3389/frsle.2023.1144213","DOIUrl":"https://doi.org/10.3389/frsle.2023.1144213","url":null,"abstract":"Study objectives Completion of testing during pregnancy for those who screen positive for obstructive sleep apnea (OSA) is imperative for the diagnosis and treatment of OSA, as the latter may reduce the risk of developing hypertensive disorders of pregnancy. To identify potential barriers, we assessed predictors of non-completion of sleep apnea testing by people identified to be at high risk of OSA by screening during pregnancy. We hypothesized that non-completion of sleep apnea testing would be predicted by insurance status and obstetric factors, such as gestational age at time of testing. Methods We performed a retrospective analysis of the first 500 people in our sleep pregnancy database which includes both pregnant and preconception patients who screened positive for OSA; those screened preconception were excluded. Multivariable Poisson regression was used to determine which factors were independently associated with non-completion. Results Of 445 referred, 214 (48.1%) completed sleep apnea testing. Factors associated with non-completion of testing on univariate analysis included referral in the third trimester, higher parity, one or more living children, history of preterm birth, history of preeclampsia, type 2 diabetes mellitus, non-partnered status, race, and payor. Symptoms of loud snoring or witnessed apneas were associated with increased incidence of sleep apnea testing completion. Multivariable Poisson regression demonstrated that having public insurance predicted non-completion of sleep apnea testing during pregnancy. Conclusion In this small study, public insurance was an independent predictor of non-completion of sleep apnea testing during pregnancy. These findings aid efforts to improve patient completion of sleep apnea testing during pregnancy.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72417462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovations in mandibular advancement splint therapy for obstructive sleep apnoea","authors":"A. Mohammadieh, B. Tong, P. de Chazal, P. Cistulli","doi":"10.3389/frsle.2023.1144327","DOIUrl":"https://doi.org/10.3389/frsle.2023.1144327","url":null,"abstract":"Mandibular advancement splint (MAS) therapy emerged as an effective therapy for obstructive sleep apnoea (OSA) in the mid 1990s, and is now the leading treatment alternative for OSA. Since its inception, the field has seen a suite of revisions and advances in relation to design and customisation, fabrication, titration methods, response prediction models and the integration of data collection technology. This paper reviews these current and emerging innovations in MAS therapy and their impact upon sleep apnoea management.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87582355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mindfulness-based therapy for insomnia alleviates insomnia, depression, and cognitive arousal in treatment-resistant insomnia: A single-arm telemedicine trial","authors":"D. Kalmbach, P. Cheng, J. Ong, A. Reffi, D. Fresco, C. Fellman-Couture, Melissa K. Ruprich, Zain Sultan, C. Sagong, C. Drake","doi":"10.3389/frsle.2023.1072752","DOIUrl":"https://doi.org/10.3389/frsle.2023.1072752","url":null,"abstract":"Objectives Cognitive-behavioral therapy and pharmacotherapy are effective insomnia treatments, yet half of patients do not remit. Emerging evidence indicates refractory cognitive arousal is associated with poor insomnia treatment outcomes, giving rise to the concept that therapeutic approaches directly aimed at reducing cognitive arousal may benefit patients with a history of inadequate response to intervention. This proof-of-concept study examined the effects of mindfulness-based therapy for insomnia (MBTI) delivered individually via telemedicine on insomnia, depression, and cognitive arousal in patients with treatment-resistant insomnia. Methods A single-arm trial wherein 19 patients whose insomnia did not remit with prior psychotherapy and/or pharmacotherapy received a course of MBTI as second-stage therapy, which included eight weekly 1-h sessions in an individual format via telemedicine video. Study outcomes included the 15-item version of the five-facet mindfulness questionnaire (FFMQ-15), insomnia severity index (ISI), Patient Health Questionnaire-9 to assess depression (PHQ-9), and three cognitive arousal indices: pre-sleep arousal scale's cognitive factor, perseverative thinking questionnaire, and the daytime insomnia symptom response scale. Results Patients reported increased mindfulness from pretreatment to posttreatment (FFMQ-15: 52.95 ± 8.30 to 57.47 ± 9.82, p = 0.008). Patients also reported large reductions in ISI (16.42 ± 3.95 to 8.37 ± 4.19, p < 0.001, Cohen's dz = 1.73; 57.9% remission), PHQ-9 (6.42 ± 3.47 to 3.32 ± 2.93, p = 0.001, Cohen's dz = 0.93), and all cognitive arousal indices (Cohen's dzs = 0.82–1.30) at posttreatment. Six months later, ISI scores and cognitive arousal levels remained significantly lower than pretreatment, although effect sizes decreased for ISI (Cohen's dz = 1.11) and cognitive arousal (Cohen's dzs = 0.63–0.68). Antidepressant effects were no longer significant at follow-up. Conclusion Treatment-resistant insomnia patients are engaged in MBTI, which produces large acute reductions in insomnia, depression, and cognitive arousal. MBTI effects on insomnia and cognitive arousal were moderate to large 6 months after treatment. These findings support the concept and feasibility of MBTI for treatment-resistant patients along with indication that longer-term strategies are needed to help maintain acute treatment gains. Clinical trial registration ClinicalTrials.gov, identifier NCT03724305.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85854011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a combination of noradrenergic and antimuscarinic drugs for the treatment of obstructive sleep apnea: Challenges and progress","authors":"L. Taranto-Montemurro, H. Pho, D. White","doi":"10.3389/frsle.2023.1148282","DOIUrl":"https://doi.org/10.3389/frsle.2023.1148282","url":null,"abstract":"Obstructive sleep apnea (OSA) is a disorder characterized by repetitive collapse of the upper airway during sleep, leading to intermittent hypoxia and sleep fragmentation. The combination of noradrenergic and antimuscarinic drugs has emerged as a potential pharmacological treatment option for OSA, with the most promising combination being atomoxetine plus aroxybutynin. This combination is currently undergoing extensive experimentation and will be soon tested in phase 3 studies. Other noradrenergic drugs including reboxetine, and other antimuscarinics including fesoterodine, hyoscine butylbromide, solifenacin, and biperiden have been tested. The increasing interest in OSA pharmacotherapy is driven by advances in our understanding of the pathophysiology of the disease and accumulating evidence of the surprising effectiveness of this drug combination. However, challenges remain in accurately measuring the severity of OSA, which can impact our ability to fully understand the efficacy of these medications. Further research is ongoing to address these challenges and to optimize the use of noradrenergic and antimuscarinic drugs for the treatment of OSA.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78271879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}