Journal of education & teaching in emergency medicine最新文献

{"title":"Acute Chest Syndrome.","authors":"Patrick Meloy,&nbsp;Daniel R Rutz,&nbsp;Amit Bhambri","doi":"10.21980/J80S8J","DOIUrl":"https://doi.org/10.21980/J80S8J","url":null,"abstract":"<p><strong>Audience: </strong>Emergency medicine residents and medical students on emergency medicine rotations.</p><p><strong>Introduction: </strong>Acute chest syndrome is a life-threatening, potentially catastrophic complication of sickle cell disease.1,2 It occurs in approximately 50% of patients with sickle cell disease, with up to 13% all-cause mortality.1 Most common in children aged 2-4, up to 80% of patients with a prior diagnosis of acute chest syndrome will have recurrence of this syndrome.4 Diagnostic criteria include a new infiltrate on pulmonary imaging combined with any of the following: fever > 38.5°C (101.3°F), cough, wheezing, hypoxemia (PaO2 < 60 mm Hg), tachypnea, or chest pain.4,5 The pathophysiology of acute chest syndrome involves vaso-occlusion in pulmonary vessels resulting in hypoxia, release of inflammatory mediators, acidosis, and infarction of lung tissue. The most common precipitants are infections (viral or bacterial), rib infarction, and fat emboli.1,2,4 Patients commonly present with fever, dyspnea, cough, chills, chest pain, or hemoptysis. Diagnosis is made through physical exam, blood work, and chest imaging.1,2 Chest radiograph is considered the gold standard for imaging modality.3 Management of acute chest syndrome includes hydration with IV crystalloid solutions, antibiotics, judicious analgesia, oxygen, and, in severe cases, transfusion.6 Emergency medicine practitioners should keep acute chest syndrome as a cannot miss, high consequence differential diagnosis for all patients with sickle cell disease presenting to the Emergency Department.</p><p><strong>Educational objectives: </strong>At the end of this oral board session, examinees will: 1) demonstrate the ability to obtain a complete medical history; 2) demonstrate the ability to perform a detailed physical examination in a patient with respiratory distress; 3) identify a patient with respiratory distress and hypoxia and manage appropriately (administer oxygen, place patient on monitor); 4) investigate the broad differential diagnoses which include acute chest syndrome, pneumonia, acute coronary syndrome, acute congestive heart failure, acute aortic dissection and acute pulmonary embolism; 5) list the appropriate laboratory and imaging studies to differentiate acute chest syndrome from other diagnoses (complete blood count, comprehensive metabolic panel, brain natriuretic peptide (BNP), lactic acid, procalcitonin, EKG, troponin level, d-dimer, chest radiograph); 6) identify a patient with acute chest syndrome and manage appropriately (administer intravenous pain medications, administer antibiotics after obtaining blood cultures, emergent consultation with hematology) and 7) provide appropriate disposition to the intensive care unit after consultation with hematology.</p><p><strong>Educational methods: </strong>This case is used as a method to assess learners' ability to rapidly assess a patient in respiratory distress. The learner needs to address a limi","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10194757","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":"Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic.","authors":"Shelley Brukman,&nbsp;Makenzie J Ferguson,&nbsp;Kimberly D Zaky,&nbsp;Chloe Knudsen-Robbins,&nbsp;Theodore W Heyming","doi":"10.21980/J84H1C","DOIUrl":"https://doi.org/10.21980/J84H1C","url":null,"abstract":"<p><strong>Audience: </strong>Emergency medical service (EMS) providers and other health care professionals.</p><p><strong>Introduction: </strong>In 2019 alone, 656,000 children in the United States were victims of child abuse and neglect.1 The medical community has historically struggled with the identification of child maltreatment. In one study, 33% of abused children had a previous visit with a medical provider in which the abuse was found to have been missed.2 Many voices in the healthcare community have advocated for the implementation of routine screening, and studies have demonstrated the implementation of such screening in the emergency department (ED) increases the detection of child maltreatment.3-7 Child maltreatment screening tools are increasingly utilized in primary care and ED settings, but one has yet to be adapted or designed for universal use by emergency medical services (EMS) professionals in the prehospital care context. Because EMS providers are uniquely positioned to assess for maltreatment, they have traditionally been the only provider to interact with families in the home environment. Unfortunately, EMS rates of documentation of maltreatment is quite low. A recent study using the National Emergency Medical Services Information System database to evaluate EMS documentation of child maltreatment in patients ≤3 years of age compared to the national incidence of known maltreatment found an almost 15-fold discrepancy.8 There have been several attempts to elucidate the difficulties of and barriers to reporting by EMS providers. Markenson et al and Tiyyagura et al outlined several areas that potentially contribute to a lack of reporting: minimal continuing medical education (CME) on child maltreatment, knowledge of physical and historical details suspicious for abuse, knowledge of child development, limited clinical evaluation time in a fast-paced work environment, understanding of how to appropriately interact with families, and fear of being wrong.9,10 This class/escape room activity was developed to directly address several of these areas. Emergency medical service providers participate in traditional didactics (in the form of a short lecture), followed by an escape room activity in which they further explore and reinforce learning in a fun and memorable environment. This activity also promotes teamwork, an especially important skill in potentially complex and difficult situations such as those surrounding suspected child maltreatment.</p><p><strong>Educational objectives: </strong>By the end of the escape room, the learner should be able to: 1) understand the national and local prevalence of child maltreatment; 2) understand the different types of child maltreatment and common associated presentations; 3) know the local EMS agency reporting requirements; 4) understand when to make base hospital contact with respect to concern for maltreatment; 5) collaborate effectively as a team.</p><p><strong>Educational methods: </stron","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9837118","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":"Imaging Findings of Small Bowel Diverticulitis: A Case Report.","authors":"Albert Zhou,&nbsp;Sarah Bella,&nbsp;Amy Patwa","doi":"10.21980/J8F078","DOIUrl":"https://doi.org/10.21980/J8F078","url":null,"abstract":"<p><p>Small bowel diverticulitis is an uncommon subset of acute diverticulitis and can mimic many other intra-abdominal processes. As a result, imaging modalities such as ultrasound and computed tomography (CT) scan are especially important for timely recognition of diverticulitis and can expedite diagnosis and treatment and reduce complications. In the case described in this report, an 81-year-old male with history of esophageal cancer and recurrent diverticulitis with history of multiple bowel resections presented to the emergency department (ED) with right lower quadrant abdominal pain and constipation. Findings on ultrasound were suggestive of diverticulitis, and findings on CT of the abdomen and pelvis showed ileitis with phlegmon and micro-abscess suspicious for small bowel diverticulitis. ED providers should familiarize themselves with ultrasound findings of diverticulitis and be aware that diverticulitis can also present in the small bowel. Treatment of small bowel diverticulitis is similar to colonic diverticulitis.</p><p><strong>Topics: </strong>Ileitis, small bowel diverticulitis, abdominal ultrasound.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9891621","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":"Electrocardiogram Abnormalities Following Diphenhydramine Ingestion: A Case Report.","authors":"Patrick Bruss,&nbsp;Christine Bowman,&nbsp;Teagan Carroll","doi":"10.21980/J85H1P","DOIUrl":"https://doi.org/10.21980/J85H1P","url":null,"abstract":"<p><p>In the United States, tricyclic antidepressants (TCA) are commonly prescribed to treat psychiatric illnesses and neuropathic pain. This class of antidepressants has been found to cause pathognomonic electrocardiogram (ECG) changes in cases of overdose.1 Specifically, TCA's cause a dominant terminal R wave in aVR and widening of the QRS complex due to their sodium channel blocking effect. Diphenhydramine, better known as Benadryl, is known to disrupt sodium channels in the same manner. In this case report, a 13-year-old female was brought into the emergency department (ED) after attempted suicide by diphenhydramine overdose. The patient presented with palpitations, nausea and confusion. She was agitated, tachycardic and exhibited opsoclonus. An ECG was performed upon the patient's arrival which showed large terminal R waves in aVR along with large S waves in lead I indicating right axis deviation. Given the patient's age and reported ingestion, it was highly suspicious that her symptoms and ECG changes were the result of a sodium channel blockade. Sodium bicarbonate was given, which resulted in notable ECG changes as well as symptomatic improvement. TCA's, and similarly diphenhydramine, have sodium channel blocking properties which can be revealed by performing an ECG. Administration of sodium bicarbonate in the ED has been shown to be a successful treatment by reversing this sodium channel blockade.</p><p><strong>Topics: </strong>Tricyclic antidepressants, diphenhydramine, overdose, sodium channel blockage, sodium bicarbonate administration.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10194748","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":"Aortic Dissection Case Report.","authors":"Chelsea Bunce,&nbsp;Christopher Bryczkowski,&nbsp;Mary Rometti","doi":"10.21980/J8964Z","DOIUrl":"https://doi.org/10.21980/J8964Z","url":null,"abstract":"<p><p>Although uncommon, acute aortic dissections are a life-threatening, cannot miss diagnosis for the emergency medicine clinician. Point of care ultrasound can play an integral role in the initial work up of the undifferentiated patient. While not initially utilized to make the diagnosis of aortic dissection, the ultrasound images obtained in this case describe key findings on ultrasound vital for an emergency clinician to recognize. It is essential for emergency medicine clinicians to differentiate an aortic dissection from other causes of chest pain and abdominal pain because the quick mobilization of resources plays a key role in the management and outcome of such patients.</p><p><strong>Topics: </strong>Aortic dissection, vascular, dissection flap, back pain, point of care ultrasound, POCUS.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10213094","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":"Epilepsy Caused by Neurocysticercosis: A Case Report","authors":"Mary McGoldrick, D. Polvino, Grant Wei","doi":"10.5070/m58160085","DOIUrl":"https://doi.org/10.5070/m58160085","url":null,"abstract":"Neurocysticercosis is one of the most common causes of acquired epilepsy worldwide. This diagnosis is rarely considered in patients presenting to the emergency department (ED) with recurrent seizures in the United States (U.S.). This is the case of a young adult male presenting with post-ictal confusion and recurrent seizures requiring intubation for agitation and airway protection. It illustrates the need to maintain a broad differential when considering etiology of seizures in a globalized patient population. Topics Seizure, neurocysticercosis, epilepsy, parasitic infection.","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75619080","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":"Electrocardiogram Abnormalities Following Diphenhydramine Ingestion: A Case Report","authors":"Patrick Bruss, Christine Bowman, Teagan Carroll","doi":"10.5070/m58160084","DOIUrl":"https://doi.org/10.5070/m58160084","url":null,"abstract":"In the United States, tricyclic antidepressants (TCA) are commonly prescribed to treat psychiatric illnesses and neuropathic pain. This class of antidepressants has been found to cause pathognomonic electrocardiogram (ECG) changes in cases of overdose.1 Specifically, TCA’s cause a dominant terminal R wave in aVR and widening of the QRS complex due to their sodium channel blocking effect. Diphenhydramine, better known as Benadryl, is known to disrupt sodium channels in the same manner. In this case report, a 13-year-old female was brought into the emergency department (ED) after attempted suicide by diphenhydramine overdose. The patient presented with palpitations, nausea and confusion. She was agitated, tachycardic and exhibited opsoclonus. An ECG was performed upon the patient’s arrival which showed large terminal R waves in aVR along with large S waves in lead I indicating right axis deviation. Given the patient’s age and reported ingestion, it was highly suspicious that her symptoms and ECG changes were the result of a sodium channel blockade. Sodium bicarbonate was given, which resulted in notable ECG changes as well as symptomatic improvement. TCA’s, and similarly diphenhydramine, have sodium channel blocking properties which can be revealed by performing an ECG. Administration of sodium bicarbonate in the ED has been shown to be a successful treatment by reversing this sodium channel blockade. Topics Tricyclic antidepressants, diphenhydramine, overdose, sodium channel blockage, sodium bicarbonate administration.","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87183126","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":"Mushroom for improvement: The Importance of Involving Mycologists","authors":"Gary Bhagat, M. Tweet, S. Aks","doi":"10.5070/m57459209","DOIUrl":"https://doi.org/10.5070/m57459209","url":null,"abstract":"","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47234986","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":"A Novel Module Based Method of Teaching Electrocardiogram Interpretation for Emergency Medicine Residents.","authors":"Alexandra S Koutsoubis,&nbsp;Emily Fishbein,&nbsp;Megan Stobart-Gallagher,&nbsp;Behzad B Pavri,&nbsp;Jennifer White","doi":"10.21980/J8Z06J","DOIUrl":"https://doi.org/10.21980/J8Z06J","url":null,"abstract":"<p><strong>Audience: </strong>This online learning module is designed for PGY 1-3 emergency medicine (EM) residents.</p><p><strong>Introduction: </strong>Interpretation of the 12-lead electrocardiogram (ECG) is an essential skill for EM residents. The traditional approach to ECG interpretation in medical school is primarily didactic, teaching: \"rate, rhythm, axis,\" etc. Throughout residency, EM residents continue to receive lectures and practical ECG teaching to independently interpret ECGs with accuracy and efficiency. In addition to basic rhythm interpretation, physicians must be able to identify cardiac ischemia, abnormal rhythms, and subtle ECG findings that could herald sudden death.1 Life-threatening diagnoses such as digitalis toxicity or hyperkalemia can be made promptly through ECG evaluation and catastrophic if missed. If correctly diagnosed through ECG, many channelopathies can be treated and cardiac events can be prevented.2,3 Lecture-based learning is a necessary part of medical education, but there is a need to supplement the traditional teaching approach with online learning modules. Online learning modules provide learners with an accessible and efficient tool that allows them to improve their ECG skills on their own time.</p><p><strong>Educational objectives: </strong>After completion of the module learners should be able to: 1) correctly recognize and identify ECG abnormalities including but not limited to abnormal or absent P waves, widened QRS intervals, ST elevations, abnormal QT intervals, and dysrhythmias that can lead to sudden cardiac death; and 2) synthesize findings into a succinct but accurate interpretation of the ECG findings.</p><p><strong>Educational methods: </strong>An online module was developed using Articulate 360 and was implemented with EM residents. The module covers common ECG findings seen in the emergency department including ischemia, atrioventricular blocks, and bundle branch blocks. The module uniquely emphasizes ECG findings of arrythmias that could lead to sudden cardiac death and highlights that diagnosing sudden cardiac death syndromes relies on both clinical presentation and specific ECG findings. Online modules have proven to be as effective as lecture-based learning at improving ECG interpretation among healthcare professionals and are convenient and easily accessible to the busy EM resident.4,5 Additionally, the module is self-paced, can be completed at any time, and includes elements of active learning by incorporating knowledge checks throughout. This allows learners in real time to see where individualized improvement is needed. The ease of embedment of self-paced questions into the module is one of the salient reasons why module-based learning can be superior to lecture-based learning. This allows for real time retrieval practice, feedback, and repetition, all of which can be powerful and effective tools for learning.6.</p><p><strong>Research methods: </strong>This module was offered at a ","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9827263","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":"Use of An Ophthalmology Tutorial to Improve Resident Comfort with the Emergency Eye Exam","authors":"J. Pelletier, J. Facciani, F. Gines, D. Kuehl","doi":"10.5070/m57459215","DOIUrl":"https://doi.org/10.5070/m57459215","url":null,"abstract":"Audience This tutorial should be utilized for emergency medicine (EM) interns and junior residents. Introduction Ophthalmology is characteristically a weak area in both medical school and resident education. Medical students are rarely given formal didactic education on the use of the slit lamp or a systematic approach to examining the eye. For EM residents, this leads to inefficient and uncomfortable encounters with patients with eye complaints. We sought to develop a comprehensive emergency ophthalmology tutorial utilizing asynchronous learning followed by a hands-on skill session that would address this need. Educational Objectives By the end of this small group didactic, learners will be able to: 1) demonstrate ability to focus on the various components of the slit lamp exam 2) demonstrate understanding of a systematic approach to the eye exam 3) demonstrate appropriate use of the Diaton, iCare, and Tonopen tonometers. Educational Methods This two-hour small group didactic combines hands-on learning sessions to learn the slit lamp exam and tonometry measurement, with a systematic review of the eye exam to help learners better organize their exams and understand the use of necessary tools. Research Methods The emergency ophthalmology tutorial was initially designed as an education project in which we collected pre- and post-participation surveys regarding resident comfort with various components of the emergency eye exam. After the course residents received a post-course survey to complete. Given the positive feedback we received from our residents regarding the tutorial, we applied for Institutional Review Board (IRB) approval to publish our retrospective survey data. Our IRB waived the need for participant consent. Results Twelve emergency medicine residents including 11 interns and one post-graduate year (PGY) 2 resident participated in the emergency ophthalmology tutorial as part of our intern boot camp in July of 2021. Twelve PGY-1 residents initially signed up for the course and filled out the pre-participation survey but one of them was not able to attend their scheduled class, so a PGY-2 resident requested to attend. Prior to the course, we used a Likert scale from 1–7, finding that 61.5% (8/13) of participants felt very uncomfortable with performing slit lamp exams, 84.6% (11/13) felt very uncomfortable with using the Diaton tonometer, 76.9% (10/13) felt very uncomfortable with using the iCare tonometer, and 69.3% (9/13) felt uncomfortable or very uncomfortable with using a systematic approach to examining the eye. After the course, 75% (9/12) of participants felt that the course exceeded expectations in ensuring their ability to perform the subcomponents of the slit lamp exam, 75% (9/12) and 83.3% (10/12) of participants felt that the course exceeded expectations in ensuring their ability to use the Diaton and iCare tonometers, respectively, and 91.7% (11/12) felt that the course exceeded expectations in ensuring their ability to per","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80282591","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}