K. Duraccio, Sarah L. H. Kamhout, Isabella Wright, K. Rugh, Jack Miskin, McKenna Amdal
{"title":"Multimodal assessment of circadian sleep health in predicting mental health outcomes in adolescents","authors":"K. Duraccio, Sarah L. H. Kamhout, Isabella Wright, K. Rugh, Jack Miskin, McKenna Amdal","doi":"10.3389/frsle.2023.1177878","DOIUrl":"https://doi.org/10.3389/frsle.2023.1177878","url":null,"abstract":"Aspects of circadian sleep health including circadian alignment, circadian phase, or chronotype may be related to mental health outcomes in adolescents. Using novel and robust data collection methods, this study explored the relationship between adolescents' circadian sleep health and traits related to depression, anxiety, stress, and emotional regulation.Fifty-two healthy 14–18-year-olds (58% female; 94% European American) participated in this study. Across a 10-day period, participants completed wrist-worn actigraphy. Next, participants completed a dim-light melatonin onset (DLMO) protocol where 12 saliva samples were collected over a 6-h period to measure circadian phase. Circadian phase was calculated as the duration of time between DMLO to average sleep onset time across the monitoring period. Social jetlag was measured as the discrepancy between sleep times from weekday to weekend. Participants completed the Depression Anxiety Stress Scales (DASS-21), Emotion Regulation Questionnaire (ERQ), and the Morningness-Eveningness Questionnaire for Adolescents (MEQ). Following dichotomizing sleep outcomes into clinically relevant groups (late vs. early circadian phase, aligned vs. misaligned circadian rhythms, minimal social jetlag vs. presence of social jetlag, intermediate to morningness vs. eveningness chronotype), we conducted general linear models to determine circadian group differences in mental health outcomes (depression, anxiety, stress, expressive suppression, and cognitive reappraisal) while controlling for gender and pubertal development.Circadian phase had a large effect on depression symptoms in adolescents, with adolescents with later DLMO having significantly higher depression scores than those with earlier DLMO (p = 0.031). Chronotype had a medium but non-significant effect on anxiety and stress symptoms in adolescents, with adolescents with eveningness-tendencies having higher anxiety and stress symptoms than those with intermediate to morningness-tendencies (p's = 0.140 and 0.111, respectively).In the first ever study using gold-standard methodologies to examine the relationship between mental health and circadian sleep health in healthy adolescents, we observed that adolescents with later circadian phase had increased depressive symptoms compared to earlier circadian phase. Furthermore, adolescents who endorsed behaviors that suggest eveningness tendencies may have heightened stress/anxiety. These conclusions encourage future experimental research regarding this topic and may help inform interventions aimed to decrease depression, anxiety, and stress in adolescents.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139226280","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}
Ivan Vargas, M. Egeler, Jamie L Walker, Dulce Diaz Benitez
{"title":"Examining the barriers and recommendations for integrating more equitable insomnia treatment options in primary care","authors":"Ivan Vargas, M. Egeler, Jamie L Walker, Dulce Diaz Benitez","doi":"10.3389/frsle.2023.1279903","DOIUrl":"https://doi.org/10.3389/frsle.2023.1279903","url":null,"abstract":"Chronic insomnia is the most common sleep disorder, occurring in ~32 million people in the United States per annum. Acute insomnia is even more prevalent, affecting nearly half of adults at some point each year. The prevalence of insomnia among primary care patients is even higher. The problem, however, is that most primary care providers do not feel adequately knowledgeable or equipped to treat sleep-related concerns. Many providers have never heard of or have not been trained in cognitive behavioral therapy for insomnia or CBT-I (the first line treatment for insomnia). The focus of the current review is to summarize the factors contributing to why sleep health and insomnia treatment have been mostly neglected, identify how this has contributed to disparities in sleep health among certain groups, particularly racial and ethnic minorities and discuss considerations or potential areas of exploration that may improve access to behavioral sleep health interventions, particularly in primary care.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139231333","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}
Yng Miin Loke, Samantha Lim, A. V. Rukmini, Patricia Chen, John C. K. Wang, J. Gooley
{"title":"Development and testing of the Sleep Health And Wellness Questionnaire (SHAWQ) in adolescents and university students: composite SHAWQ scores are associated with sleep problems, depression symptoms, and academic performance","authors":"Yng Miin Loke, Samantha Lim, A. V. Rukmini, Patricia Chen, John C. K. Wang, J. Gooley","doi":"10.3389/frsle.2023.1188424","DOIUrl":"https://doi.org/10.3389/frsle.2023.1188424","url":null,"abstract":"Sleep problems frequently arise during adolescence and early adulthood and may contribute to the onset of depression. However, few sleep health instruments have been developed for use in student populations. Here, we developed a brief sleep health questionnaire for identifying adolescents and university students with sleep problems who may be at risk of depression.In Study 1, sleep survey data in adolescents (n = 1,733) were analyzed by best-subsets regression to identify the strongest predictors of self-reported depression symptoms: sleep quality, daytime sleepiness, self-rated health, frequency of staying up until 3:00 am, school day sleep latency, and gender. A 6-item Sleep Health And Wellness Questionnaire (SHAWQ) was developed using these items. Students were categorized into good, fair, and bad sleep health groups based on their composite SHAWQ scores. In Study 2, the SHAWQ was tested in adolescents (n = 1,777) for associations with depression symptoms and excessive daytime sleepiness. In Study 3, the SHAWQ was tested in university students (n = 2,040) for convergent validity with instruments for measuring sleep quality and insomnia severity, and for associations with major depressive disorder symptoms and anxiety disorder symptoms. Test-retest reliability was determined in a subset of 407 students who re-took the SHAWQ several weeks later. In Study 4, we tested whether SHAWQ scores in university freshmen (cohort 1, n = 1,529; cohort 2, n = 1,488) were prospectively associated with grade point average (GPA) over their first year.Across studies, SHAWQ scores were associated with higher depression and anxiety scores, excessive daytime sleepiness, lower sleep quality scores, and higher insomnia severity scores, demonstrating good convergent validity. Associations of SHAWQ scores with depression symptoms were stronger compared with anxiety symptoms. SHAWQ scores showed moderate test-retest reliability. Large effect sizes were observed for bad vs. good sleep health for all sleep and mental health variables. In both cohorts of university freshmen, students with bad sleep health had lower academic performance based on their GPA and percentile rank.Our findings suggest that the SHAWQ could be used to screen for students in their teens and twenties with bad sleep health who would benefit from counseling for sleep and mental health.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139275774","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}
Sara Rodrigues, Luiz Aparecido Bortolotto, Robbie A. Beyl, Prachi Singh
{"title":"Severity of sleep apnea impairs adipose tissue insulin sensitivity in individuals with obesity and newly diagnosed obstructive sleep apnea","authors":"Sara Rodrigues, Luiz Aparecido Bortolotto, Robbie A. Beyl, Prachi Singh","doi":"10.3389/frsle.2023.1295301","DOIUrl":"https://doi.org/10.3389/frsle.2023.1295301","url":null,"abstract":"Introduction Obstructive sleep apnea (OSA) is a common sleep disorder associated with increased risk for the development of type 2 diabetes. While studies have examined the effects of sleep on whole-body insulin sensitivity, little is known about the effects of sleep on adipose tissue insulin sensitivity in patients with OSA. We analyzed if the severity of OSA, measured by apnea-hypopnea index (AHI), is associated with adipose tissue insulin sensitivity. Methods We examined the relationship between sleep parameters and adipose tissue insulin sensitivity in non-diabetic participants with obesity and newly diagnosed OSA who underwent overnight polysomnography and a 2 h oral glucose tolerance test during which circulating free fatty acids were measured. In total, 16 non-diabetic participants with obesity and newly diagnosed OSA (sex, 81.3% males; mean age, 50.9 ± 6.7 y; BMI, 36.5 ± 2.9 kg/m 2 ; AHI, 43 ± 20 events/h) were included in the analysis. Results In our study participants, AHI is inversely associated with free-fatty acid suppression during oral glucose challenge ( R = −0.764, p = 0.001). This relationship persisted even after statistical adjustment for age ( R = −0.769, p = 0.001), body mass index ( R = −0.733, p = 0.002), waist-to-hip ratio ( R = −0.741, p = 0.004), or percent body fat mass ( R = −0.0529, p = 0.041). Furthermore, whole-body insulin sensitivity as determined by the Matsuda index was associated with percent REM sleep ( R = 0.552, p = 0.027) but not AHI ( R = −0.119, p = 0.660). Conclusion In non-diabetic patients with OSA, the severity of sleep apnea is associated with adipose tissue insulin sensitivity but not whole-body insulin sensitivity. The impairments in adipose tissue insulin sensitivity may contribute to the development of type 2 diabetes.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":" 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191711","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":"Psychobiological risk factors for insomnia and depressed mood among hospital female nurses working shifts","authors":"Kochav Bennaroch, Tamar Shochat","doi":"10.3389/frsle.2023.1206101","DOIUrl":"https://doi.org/10.3389/frsle.2023.1206101","url":null,"abstract":"Introduction Despite a vast body of knowledge on the associations between insomnia and depression, and although women and shift workers are at high risk for each of these conditions separately, common psychobiological risk factors for developing insomnia and depressed mood concomitantly in high-functioning shift-working female nurses have yet to be investigated within a comprehensive framework. This study examines the contribution of shift work (disruption of circadian rhythms), stress, analytical rumination, and morningness-eveningness on the development of insomnia and depressed mood among female hospital nurses. Objectives We sought to assess the severity and prevalence of insomnia symptoms and depressed mood among hospital shift-working compared with day-working nurses; to examine associations between psychobiological risk factors with insomnia and depressed mood; and to develop a conceptual psychobiological model to describe their co-occurrence among hospital nurses. Methods Using a cross-sectional design, we recruited female hospital nurses, shift workers (SW) and day workers (DW: only morning shifts), and assessed them for insomnia, depressed mood, stress, analytical rumination, and morningness-eveningness through validated self-administered questionnaires delivered online. Using structural equation modeling (SEM), we assessed common pathways between psychobiological factors affecting insomnia and depressed mood. Results 448 nurses completed electronic questionnaires. SW nurses ( n = 358) compared with DW nurses ( n = 90) had significantly higher rates of insomnia and depressed mood. SW nurses also reported significantly higher severity of insomnia, depressed mood, stress, and a tendency to eveningness compared with DW nurses. A positive linear relationship was found between insomnia and depressed mood in both SW and DW nurses. SEM showed that shift work contributed directly to insomnia and indirectly to depressed mood. The overall model showed a good fit between the empirical and the conceptual psychobiological model proposed in the study [χ (1) = 0.16, p = 0.69, CFI = 0.99, RMSEA = 0.0001]. Discussion We found that SW nurses who reported high levels of stress and eveningness are at significantly greater risk for both insomnia symptoms and depressed mood. Findings provide the groundwork in creating a conceptual psychobiological model to examine the co-occurrence of insomnia and depressed mood phenomena in hospital nurses. This research is an important first step toward the development of interventions aimed at improving nurses' health, wellbeing and quality of life by preventing the mental burden associated with insomnia and depressed mood.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"6 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135678819","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}
Ding Zou, Steven Vits, Carlos Egea, Daniela Ehrsam-Tosi, Florent Lavergne, Mikel Azpiazu, Ingo Fietze
{"title":"A new approach to streamline obstructive sleep apnea therapy access using peripheral arterial tone-based home sleep test devices","authors":"Ding Zou, Steven Vits, Carlos Egea, Daniela Ehrsam-Tosi, Florent Lavergne, Mikel Azpiazu, Ingo Fietze","doi":"10.3389/frsle.2023.1256078","DOIUrl":"https://doi.org/10.3389/frsle.2023.1256078","url":null,"abstract":"Obstructive sleep apnea (OSA) is a prevalent condition that negatively impacts cardiovascular, metabolic and mental health. A high proportion of individuals with OSA remain undiagnosed and incur significant healthcare costs. The gold standard OSA diagnostic is in-lab polysomnography, but this is costly and time-consuming. Home sleep apnea tests (HSATs), including cardiorespiratory polygraphy and peripheral artery tonometry technology, provide an alternative. Advances in HSAT technology include non-invasive, easy-to-use medical devices that could allow unobtrusive, accessible, multi-night, cost-effective diagnosis and management of sleep-disordered breathing. One type of these devices is based on determination of peripheral arterial tone, and use photoplethysmography signals from the finger (oxygen saturation, pulse wave amplitude and pulse rate). The devices contain algorithms that use these data to generate the traditional metrics required by the American Academy of Sleep Medicine. They can be used to record sleep parameters over multiple nights at home, and can also provide information on total sleep time (TST) and sleep stages (including time spent in rapid eye movement sleep). The combination of objective measures (apnea-hypopnea index, oxygen desaturation index, respiratory disturbance index, TST) and subjective measures (symptoms and other patient-reported outcome measures) could facilitate the development of a personalized therapeutic plan for OSA patients. It is anticipated that the streamlined digital pathway facilitated by new peripheral artery tone-based technology could contribute to reducing the underdiagnosis of OSA, accelerating access to appropriate treatment, and the optimization of OSA therapy.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"34 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679803","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":"Editorial: Current issues in sleep in children with neurodisability","authors":"J. Chawla, Laurie McLay, Moya Vandeleur","doi":"10.3389/frsle.2023.1317714","DOIUrl":"https://doi.org/10.3389/frsle.2023.1317714","url":null,"abstract":"","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"119 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139306654","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}
Joseph R. Winer, Renske Lok, Adrian Ekelmans, Flavia Bueno, Kathleen L. Poston, Jamie M. Zeitzer, Emmanuel H. During
{"title":"Isolated REM sleep behavior disorder is associated with altered 24-h rest-activity measures","authors":"Joseph R. Winer, Renske Lok, Adrian Ekelmans, Flavia Bueno, Kathleen L. Poston, Jamie M. Zeitzer, Emmanuel H. During","doi":"10.3389/frsle.2023.1286124","DOIUrl":"https://doi.org/10.3389/frsle.2023.1286124","url":null,"abstract":"Introduction Isolated REM sleep behavior disorder (iRBD), the loss of motor inhibition during REM sleep, is a symptom of prodromal Lewy body disease, with over 80% of iRBD patients progressing to Parkinson's disease or dementia with Lewy bodies. Disruption of rest-activity patterns, an established predictor of Parkinson's disease, has not been well characterized in patients with iRBD. Here, we tested the hypothesis that accelerometer-based measures of 24-h activity would indicate greater fragmentation and variability in patients with iRBD relative to matched healthy controls. Materials and methods Patients with iRBD ( N = 38) had 24-h activity monitored for (mean ± SD) 24.6 ± 8.8 days using an Axivity wrist-worn accelerometer. Age, sex, and body mass index matched healthy older adults ( N = 119) were selected as controls. Raw accelerometer data were processed and nonparametric and cosinor measures of 24-h activity were calculated. Functional principal component analyses (fPCA) were applied to detect differences in 24-h activity patterns. Results Compared to matched controls, individuals with iRBD had significantly lower cosine amplitude, mesor, and activity during their most active 10 hours, reflecting overall lower levels of activity and disrupted activity. They also had significantly increased movement during the night (L5). FPCA indicated that decreased daytime and increased nighttime activity may explain overall differences observed in iRBD. Conclusion Multiple metrics of rest-activity rhythms support the hypothesis that 24-h activity measures are altered in iRBD. This dysfunction may reflect degeneration of sleep-wake regulating circuits, representing a symptom of iRBD and indicating the early stages of Lewy body disease.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"47 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136067613","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}
Renske Lok, Sonia Ancoli-Israel, Kristine E. Ensrud, Susan Redline, Katie L. Stone, Jamie M. Zeitzer
{"title":"Timing of outdoor light exposure is associated with sleep-wake consolidation in community-dwelling older men","authors":"Renske Lok, Sonia Ancoli-Israel, Kristine E. Ensrud, Susan Redline, Katie L. Stone, Jamie M. Zeitzer","doi":"10.3389/frsle.2023.1268379","DOIUrl":"https://doi.org/10.3389/frsle.2023.1268379","url":null,"abstract":"Introduction A consolidated sleep-wake pattern is essential for maintaining healthy cognition in older individuals, but many suffer from sleep fragmentation that exacerbates age-related cognitive decline and worsens overall mental and physical health. Timed light exposure (light therapy) has been explored as a countermeasure, but mixed results have been obtained. To determine whether the timing of light exposure is important for sleep-wake consolidation, we analyzed the natural light diets of a cohort of community-dwelling older men. Methods The degree of sleep-wake fragmentation and light exposure patterns were obtained over a week using wrist actigraphy. Correlations between fragmentation, light patterns, and various physical and mental health measures were examined ( n = 877). Results Our findings revealed that higher sleep-wake fragmentation correlated with poorer physical and mental health and reduced cognition. Moreover, reduced daytime light exposure was associated with increased sleep-wake fragmentation. Interestingly, morning and evening light exposure (>1,000 lux) were not useful in distinguishing between low and high sleep-wake fragmentation scores, while increased afternoon light exposure showed much better discrimination. Specifically, optimal discrimination between low and high fragmentation occurred 6.7 h after habitual sleep offset. This suggests that afternoon light therapy might be more efficient in consolidating sleep and wake in older adults, particularly in those with low-amplitude circadian rhythms. Discussion This study highlights the significance of properly-timed light exposure in promoting consolidated sleep and cognitive health among older individuals. Tailored light-based strategies may have the potential to enhance physical, mental, and cognitive well-being in the aging population.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135730576","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":"Associations between sleep and circadian disruption in shift work and perpetration of interpersonal violence","authors":"Rosalie B. Flinn, Rebecca M. C. Spencer","doi":"10.3389/frsle.2023.1220056","DOIUrl":"https://doi.org/10.3389/frsle.2023.1220056","url":null,"abstract":"Research has uncovered substantial consequences of shift work on health outcomes through disruption of sleep and circadian rhythms. Less explored is how the effects of shift work on sleep and circadian rhythms can facilitate interpersonal aggression and violence within the home (i.e., intimate partner violence, child abuse). Given challenges in direct studies on this topic, integration across related literature is critical. In this narrative review, we identify compounding variables centered around sleep and circadian rhythms that place shift workers at an increased risk of perpetrating interpersonal violence. Shift workers have impaired sleep and altered circadian rhythms. Associated alternations in executive functioning, stress, and alcohol use provide pathways to increase risk for interpersonal violence. A model of interactions facilitating the relationship between shift work and interpersonal violence is proposed to promote prevention efforts and motivate policy change.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135730947","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}