JACC advances最新文献

{"title":"Implementing a Cardiology Quality Incentive Program to Improve Guideline-Directed Medical Therapy","authors":"David J. Cho MD, MBA ,&nbsp;Pooya I. Bokhoor MD ,&nbsp;Anna Dermenchyan PhD, RN ,&nbsp;Nicholas Brownell MD ,&nbsp;Nina Lou Delavin MS ,&nbsp;Sean Furlong BA ,&nbsp;Juyea Hoo BS ,&nbsp;Tristan Tibbe MS ,&nbsp;Lucia Y. Chen MS ,&nbsp;Sitaram Vangala MS ,&nbsp;Benjamin A. Waterman MD ,&nbsp;Maria Han MD, MS, MBA ,&nbsp;Gregg C. Fonarow MD ,&nbsp;Priscilla Y. Hsue MD ,&nbsp;Chidinma Chima-Melton MD, MBA","doi":"10.1016/j.jacadv.2025.101879","DOIUrl":"10.1016/j.jacadv.2025.101879","url":null,"abstract":"<div><h3>Background</h3><div>Adherence to guideline-directed medical therapy (GDMT) is central to quality-improvement programs, although the impact of financial incentive programs has been mixed.</div></div><div><h3>Objectives</h3><div>Assess the impact of a cardiovascular population health initiative that integrates financial incentives, robust data infrastructure, and electronic health record clinical decision support on improving GDMT for cardiovascular disease (CVD).</div></div><div><h3>Methods</h3><div>The program was implemented across 15 ambulatory clinics with 54 cardiologists in an academic health system. Individualized CVD patient panels were created for each provider, and providers received quarterly performance and incentive reports. Quality metrics included antiplatelet and statin or proprotein convertase subtilisin/kexin type 9 inhibitor therapy for atherosclerotic cardiovascular disease prevention, blood pressure control, and GDMT for heart failure with reduced ejection fraction (HFrEF; specified beta blockers; ACEI, ARB, or ARNI; mineralocorticoid receptor antagonist). An interrupted time series analysis evaluated monthly, 1-year, and 2-year changes in the odds of adhering to each specific metric associated with the implementation of the cardiovascular population health program.</div></div><div><h3>Results</h3><div>After the intervention, the composite HFrEF therapy metric improved significantly (2-year odds ratio [OR]: 2.285; 95% confidence interval [CI]: 1.653-3.158; <em>P</em> &lt; 0.001). Individual metrics also improved, including mineralocorticoid receptor antagonist (2-year OR: 3.039; 95% CI: 2.520-3.663; <em>P</em> &lt; 0.001); specified beta blockers (2-year OR: 1.430; 95% CI: 1.129-1.810; <em>P</em> = 0.003); angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or angiotensin receptor-neprilysin inhibitor therapy for HFrEF (2-year OR: 1.228; 95% CI: 1.001-1.505; <em>P</em> = 0.049); statin or proprotein convertase subtilisin/kexin type 9 inhibitor therapy for atherosclerotic cardiovascular disease (2-year OR: 1.146; 95% CI: 1.092-1.202; <em>P</em> &lt; 0.001); and blood pressure control (2-year OR: 1.496; 95% CI: 1.444-1.550; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Our program was associated with sustained improvements in GDMT adherence for CVD. It may serve as a scalable model for enhancing the quality of cardiovascular care.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101879"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321110","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":"Exposing Inequality","authors":"Ritu Thamman MD ,&nbsp;Samar A. Nasser PhD ,&nbsp;Keith C. Ferdinand MD ,&nbsp;Sadeer Al-Kindi MD ,&nbsp;Eric Brandt MD, MHS","doi":"10.1016/j.jacadv.2025.101875","DOIUrl":"10.1016/j.jacadv.2025.101875","url":null,"abstract":"<div><div>This review explores the intersection between environmental injustice and cardiovascular (CV) health disparities, highlighting how climate change, pollution, and environmental exposures disproportionately impact vulnerable populations. It delves into environmental racism, showing how non-Hispanic Black, Hispanic, and Native American communities face higher exposure to pollutants and climate-related hazards. This increased exposure contributes to greater CV morbidity and mortality, exacerbated by historical practices such as redlining and insufficient exposure regulations. The review points out the limitations of traditional CV risk models that overlook these environmental factors. Promoting transparency, community-driven solutions, and linking macro policies with local implementation are crucial to combating environmental injustice. It suggests that the emerging field of environmental cardiology can adopt eco-friendly sustainable practices and remote care solutions to reduce health care's carbon footprint, integrate environmental risks into prevention and treatment plans, and advocate for policies that reduce disparities in CV disease outcomes.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101875"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321220","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":"Severe Visual-Auditory Impairments and Heart Failure Readmissions","authors":"Melvin R. Echols MD, MSCR ,&nbsp;Ndausung Udongwo MD ,&nbsp;Makoto Ikamato DSW, LCSW ,&nbsp;Temidayo Abe MD, PhD ,&nbsp;Anekwe Onwuanyi MD ,&nbsp;Joseph Heaton MD ,&nbsp;Jesus Almendral MD","doi":"10.1016/j.jacadv.2025.101895","DOIUrl":"10.1016/j.jacadv.2025.101895","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101895"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321222","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":"Giving Women What They Want","authors":"Nisha I. Parikh MD, MPH ,&nbsp;Jean M. Cacciabaudo MD ,&nbsp;Varinder P. Singh MD ,&nbsp;Nina S. Vincoff MD","doi":"10.1016/j.jacadv.2025.101914","DOIUrl":"10.1016/j.jacadv.2025.101914","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101914"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314131","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":"Artificial Intelligence–Enabled Analysis of Thermography to Diagnose Acute Decompensated Heart Failure","authors":"Andrés Nicolás Atamañuk MD, MSc ,&nbsp;Ignacio Javier Gandino MD ,&nbsp;María Noralí Miranda MD ,&nbsp;Leandro Martín Cardozo MD ,&nbsp;Sergio Exequiel Escalante MD ,&nbsp;Cesar Villalba MD ,&nbsp;David Abalovich Bernal ,&nbsp;Gustavo Ross ,&nbsp;Eduardo Perna MD ,&nbsp;Diego Delgado MD","doi":"10.1016/j.jacadv.2025.101888","DOIUrl":"10.1016/j.jacadv.2025.101888","url":null,"abstract":"<div><h3>Background</h3><div>Analyzing skin temperature in heart failure is an important medical practice that could assist to identify poor perfusion. Thermography, a technique that captures infrared radiation from tissues, could quantify these temperatures and thermal gradients. It has not been evaluated in patients with acute decompensated heart failure (ADHF) before.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to assess the performance of thermography in the diagnosis of ADHF.</div></div><div><h3>Methods</h3><div>A cross-sectional study was performed, including consecutive patients hospitalized with ADHF diagnosed by an expert heart failure team. Patients hospitalized for other cardiac disorders without ADHF were included as controls. Ten thermal photos of each patient were taken within the first 4 hours after admission in a cardiac care unit. Specific thermal spots, averages, and gradients were analyzed. Thermography's diagnostic properties for ADHF detection were evaluated using machine learning with the extreme gradient boosting model.</div></div><div><h3>Results</h3><div>Sixty patients were included: 30 cases with ADHF and 30 controls. The mean age was 63.4 years (SD: 13.3), and 38 (63.3%) were males. Thermal points and averages showed lower temperature, while gradients were higher in the ADHF group, being all statistically significant between groups. The properties of the blend between thermography and artificial intelligence to detect ADHF had 84% sensitivity and 52% specificity. The area under the curve was 0.82 (95% CI: 0.73-0.91).</div></div><div><h3>Conclusions</h3><div>Thermography demonstrated differences between patients with ADHF and those with other cardiological disorders. In this proof of concept, combining thermography with artificial intelligence enabled the detection of ADHF in subjects hospitalized in a cardiac care unit.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101888"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321223","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":"Global Trends in Ischemic Heart Disease-Related Mortality From 2000 to 2019","authors":"Vikash Jaiswal MD ,&nbsp;Jef Van den Eynde MD ,&nbsp;Yusra Mashkoor MBBS ,&nbsp;Helen Huang MBBCh ,&nbsp;Vamsi Garimella MD ,&nbsp;Sulochana Khadka MD ,&nbsp;Tushar Kumar MD ,&nbsp;Akash Jaiswal MD ,&nbsp;Wilbert Aronow MD ,&nbsp;Maciej Banach MD, PhD ,&nbsp;Gregg C. Fonarow MD","doi":"10.1016/j.jacadv.2025.101904","DOIUrl":"10.1016/j.jacadv.2025.101904","url":null,"abstract":"<div><h3>Background</h3><div>Ischemic heart disease (IHD) remains one of the leading causes of morbidity and mortality across the globe, and disparities exist based on sex and geographic region.</div></div><div><h3>Objectives</h3><div>This study investigates global trends in IHD mortality and examines disparities based on sex and geographic regions.</div></div><div><h3>Methods</h3><div>IHD mortality data from 105 countries were obtained from the World Health Organization Mortality Database. Crude mortality rates (CMRs) and age-standardized mortality rates (ASMRs) per 100,000 individuals were calculated, with average annual percentage change (AAPC) analyzed using joinpoint regression. Regional and sex-specific trends were assessed using stratified analyses of CMR and ASMR.</div></div><div><h3>Results</h3><div>Globally, CMR declined from 138 per 100,000 (95% CI: 131-145) in 2000 to 106 per 100,000 (95% CI: 102-114) in 2019 (AAPC: −1.79, 95% CI: −1.93 to −1.66). Similarly, ASMR declined from 104 per 100,000 (95% CI: 99-108) to 65.5 (95% CI: 62-69) in 2019 per 100,000 (AAPC: −2.16, 95% CI: −2.13 to −2.20). Regionally, CMRs decreased in Oceania, Europe, and North America, while they rose in Asia, Africa, and Central and South America. ASMRs declined worldwide except in Africa (AAPC: 1.33, 95% CI: 1.30-1.36). Males showed higher mortality than females, but both sexes demonstrated decreasing trends, with males having a steeper decline. In age groups across all regions, Africa showed an upward trend, while other regions demonstrated declines.</div></div><div><h3>Conclusions</h3><div>While global IHD mortality has declined from 2000 to 2019, disparities by geographic region and sex persist. Implementing targeted health awareness programs and collaborative global health efforts are crucial for addressing these inequalities.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101904"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321221","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":"The Evidence Surrounding Type B Dissection in Marfan Syndrome","authors":"Nupoor Narula MD, MSc ,&nbsp;Jonathan W. Weinsaft MD ,&nbsp;Richard B. Devereux MD ,&nbsp;Leonard N. Girardi MD ,&nbsp;Mary J. Roman MD","doi":"10.1016/j.jacadv.2025.101921","DOIUrl":"10.1016/j.jacadv.2025.101921","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101921"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307947","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":"Type 2 Diabetes Mellitus–Related Mortality in the United States, 1999 to 2023","authors":"Mushood Ahmed MBBS ,&nbsp;Eeshal Zulfiqar MBBS ,&nbsp;Aimen Shafiq MD ,&nbsp;Maryam Shahzad MBBS ,&nbsp;Tallal Mushtaq Hashmi MBBS ,&nbsp;Raheel Ahmed MRCP ,&nbsp;Jamal S. Rana MD PhD ,&nbsp;Stephen Sidney MD ,&nbsp;Stephen J. Greene MD ,&nbsp;Robert J. Mentz MD ,&nbsp;Marat Fudim MD MHS ,&nbsp;Gregg C. Fonarow MD","doi":"10.1016/j.jacadv.2025.101882","DOIUrl":"10.1016/j.jacadv.2025.101882","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of type 2 diabetes mellitus (T2DM) has increased in the United States, contributing significantly to morbidity and mortality.</div></div><div><h3>Objectives</h3><div>This study analyzes trends in T2DM-related mortality focusing on demographic and regional disparities.</div></div><div><h3>Methods</h3><div>The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was utilized to extract death certificate data for adults aged 25 and older from 1999 to 2023. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated. Temporal trends were assessed by calculating the annual percent change using Joinpoint regression analysis.</div></div><div><h3>Results</h3><div>From 1999 to 2023, a total of 2,031,626 deaths were attributed to T2DM in the United States. The AAMR more than doubled from 21.54 per 100,000 in 1999 to 53.95 per 100,000 in 2023 with a pronounced increase between 2018 and 2021 (AAMR: 62.7 in 2021, annual percent change: 16.06%; 95% CI: 11.84-19.66). Males had considerably higher AAMR than females (68.82 vs 42.48 in 2023). Among racial and ethnic groups, Hispanic or Latino populations had the highest AAMR in 2023 (69.69), followed by non-Hispanic Black or African American (65.45), non-Hispanic other populations (53.7), and non-Hispanic White group (49.98). The Western region of the United States showed the highest AAMR (78.29), and rural areas consistently had higher mortality rates compared to urban areas (69.88 vs 55.32 in 2020). From 1999 to 2023, cardiovascular disease accounted for 626,706 deaths among adults with T2DM.</div></div><div><h3>Conclusions</h3><div>T2DM-related mortality has increased substantially over the time in the United States, with a peak observed between 2018 and 2021, emphasizing the need for targeted interventions.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101882"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307946","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":"Bifid-E Wave","authors":"K. Carlos El-Tallawi MD,&nbsp;Fatima Qamar MD,&nbsp;William A. Zoghbi MD,&nbsp;Dipan J. Shah MD","doi":"10.1016/j.jacadv.2025.101881","DOIUrl":"10.1016/j.jacadv.2025.101881","url":null,"abstract":"<div><h3>Background</h3><div>Mitral valve prolapse (MVP) is a relatively common valvular disease initially assessed using transthoracic echocardiography. We identified a novel mitral inflow Doppler signal—bifid-E wave—in patients with MVP.</div></div><div><h3>Objectives</h3><div>The authors postulated that the bifid-E wave is predominantly present in bileaflet prolapse (BLP), representing the displaced prolapse volume in early diastole. We investigated this further to identify its determinants and associated parameters using cardiac magnetic resonance imaging.</div></div><div><h3>Methods</h3><div>This is a cross-sectional study where we analyzed 134 patients divided equally between BLP and single leaflet prolapse (SLP). Cardiac magnetic resonance was used to assess chamber volumes, mitral regurgitation (MR), and prolapse volume. Transthoracic echocardiography was used to determine single vs bifid-E wave morphology. Multivariable analysis was performed to identify the parameters associated with the bifid-E wave.</div></div><div><h3>Results</h3><div>Patients with BLP had a larger prolapse volume, total MR volume, and left ventricular (LV) volume compared to SLP. Bifid-E wave was more prevalent in BLP vs SLP (33% vs 6%). Additionally, bifid-E wave patients were more likely to have BLP. When compared to single-E wave, patients with bifid-E had a larger prolapse volume but similar total MR and LV volumes; however, disproportionate LV enlargement (enlarged LV with mild MR) was more prevalent in bifid-E wave patients. On multivariable analysis, parameters associated with the bifid-E were LV replacement fibrosis, prolapse volume, and disproportionate LV enlargement. Finally, the bifid-E wave was the sole parameter associated with MVP-related fibrosis.</div></div><div><h3>Conclusions</h3><div>We identified a novel mitral Doppler sign that could represent an echocardiographic marker of advanced MVP with a large regurgitant volume and more myocardial fibrosis.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101881"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314130","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":"Low-Dose Combinations With 3 or 4 Blood Pressure–Lowering Medications for the Treatment of Hypertension","authors":"Nelson Wang PhD ,&nbsp;Phidias Rueter MD ,&nbsp;Abdul Salam PhD ,&nbsp;Mark D. Huffman MD ,&nbsp;Emily Atkins PhD ,&nbsp;Dike Ojji PhD ,&nbsp;Asita De Silva PhD ,&nbsp;Ruth Webster PhD ,&nbsp;Clara Chow PhD ,&nbsp;Paul K. Whelton MD ,&nbsp;Aletta E. Schutte PhD ,&nbsp;Anthony Rodgers PhD","doi":"10.1016/j.jacadv.2025.101883","DOIUrl":"10.1016/j.jacadv.2025.101883","url":null,"abstract":"<div><h3>Background</h3><div>Low-dose combinations (LDCs) of 3 or 4 blood pressure (BP)–lowering drugs as a single pill show promise for initial treatment of hypertension.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to assess the efficacy and safety of single pill LDC therapies compared to placebo, monotherapy, or usual care.</div></div><div><h3>Methods</h3><div>A systematic search for randomized trials comparing LDC consisting of 3 or 4 BP-lowering drugs all at ≤0.5 standard dose, compared to placebo, monotherapy, or usual care. Mean BP reductions, proportions achieving BP &lt;140/90 mm Hg, and risk of adverse events were summarized using random effects meta-analyses.</div></div><div><h3>Results</h3><div>Twelve trials (N = 2,581) were included which contributed to 12 comparisons of LDCs vs placebo, 6 for LDCs vs monotherapy, and 4 for LDCs vs usual care. LDC reduced BP by 14/6 mm Hg vs placebo at 4 to 12 weeks, with larger systolic BP reductions at higher pretreatment systolic BP. Compared to monotherapy, LDC reduced BP by 7/6 mm Hg and increased the proportion achieving BP &lt;140/90 mm Hg at first follow-up (67% vs 46%). Compared to usual care, LDC-based care was superior for BP reduction (7/4 mm Hg) and BP control (80% vs 65%) over an average 29 weeks; and results were similar whether patients were initially untreated or on monotherapy. LDC was not associated with significant increase in withdrawals due to adverse events compared to placebo (3% vs 2%), monotherapy (1% vs 0%), or usual care (3% vs 4%).</div></div><div><h3>Conclusions</h3><div>Single pill LDCs are effective and safe as an initial treatment option for hypertension. The degree of BP reduction depends strongly on pretreatment BP level.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101883"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314128","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}