Journal of the American College of Emergency Physicians open最新文献

{"title":"Development and Validation of Machine Learning Models to Identify Emergency Department Patients at Increased Risk of New or Progressive Acute Kidney Injury.","authors":"Jeremiah S Hinson, Xihan Zhao, Michael R Ehmann, Martin S Copenhaver, Ilya Shpitser, Steven Menez, Chirag Parikh, Alexandra T Strauss, Gabor Kelen, Oluwakemi Badaki-Makun, Scott Levin, Eili Klein","doi":"10.1016/j.acepjo.2026.100397","DOIUrl":"10.1016/j.acepjo.2026.100397","url":null,"abstract":"<p><strong>Objectives: </strong>Acute kidney injury (AKI) is a common and serious condition associated with prolonged hospitalization, chronic kidney disease, and increased mortality. Early prediction of AKI offers an opportunity to mitigate these adverse outcomes, yet existing models often fail to generalize to the emergency department (ED) setting, particularly for patients discharged directly to the community. We sought to develop and validate machine learning models that predict new or progressive AKI within 72 hours of ED departure, addressing challenges related to missing outcome data for discharged patients.</p><p><strong>Methods: </strong>This retrospective, multicenter study of adult patients from 5 EDs within a large health-care system included adult patients with at least 1 serum creatinine measurement during their ED visit. AKI was defined using Kidney Disease Improving Global Outcomes serum creatinine-based criteria, and prediction models relied on demographic, clinical, and laboratory data routinely collected during ED care. Extreme gradient boosting algorithms were trained using 4 approaches to handle missing outcome data: incomplete case exclusion, negative outcome assumption, multiple imputation, and inverse probability weighting. Model performance was evaluated via 10-fold cross-validation and external temporal validation using area under the receiver operating characteristic curve, precision, recall, calibration curve analyses, and measurement of diagnostic performance across a range of risk thresholds.</p><p><strong>Results: </strong>A total of 1,124,017 ED visits between 2017 and 2024 were included in the study; 5.7% (22,093) met AKI progression outcome criteria. The models demonstrated robust predictive performance for any new or progressive AKI (area under the receiver operating characteristics curve, 0.81-0.82) and severe AKI (area under the receiver operating characteristics curve, 0.87-0.88) across validation cohorts. Inverse probability weighting provided a reliable and consistent method for handling missing outcome data, ensuring accurate risk estimates for both hospitalized and discharged patients. Models performed similarly across diverse subgroups and ED sites.</p><p><strong>Conclusion: </strong>Machine learning models trained on routinely collected ED data can provide reliable early predictions of AKI progression, supporting actionable clinical decision making for a broad spectrum of patients. This study advances the real-world usability of such models by expanding their applicability to discharged patients and by enabling estimation of ongoing kidney risk, irrespective of AKI status on arrival.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100397"},"PeriodicalIF":1.8,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791291","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":"Positive eFAST-Not so FAST.","authors":"Barry J Knapp, Mitchell Vallone, Megan Duggins, Matt Jones, Jacob Knapp, Lily Kauffman, Alexander Dornstauder","doi":"10.1016/j.acepjo.2026.100396","DOIUrl":"10.1016/j.acepjo.2026.100396","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100396"},"PeriodicalIF":1.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791414","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":"Organizational and Systems-Based Framework to Guide a Departmental Approach to Academic and Leadership Advancement for Women in Emergency Medicine.","authors":"Kori S Zachrison, Mariam Kapanadze, Dara James, Nour Al Jalbout, Rebecca E Cash, Wee-Jhong Chua, Valerie Dobiesz, Daniel J Egan, Erica L Nelson, Phuong Pham, Elizabeth Temin, Margaret E Samuels-Kalow","doi":"10.1016/j.acepjo.2026.100394","DOIUrl":"10.1016/j.acepjo.2026.100394","url":null,"abstract":"<p><strong>Objectives: </strong>To address gender disparities in career advancement in academic emergency medicine, we sought to identify specific and actionable approaches that an academic department could develop or enhance to create a sustainable pathway for advancement of women in academic and leadership roles.</p><p><strong>Methods: </strong>This project took place in an urban academic department of emergency medicine and included 3 phases: (1) a literature review to assess the current landscape, (2) interviews with key informants, and (3) a consensus process to organize and prioritize strategies.</p><p><strong>Results: </strong>Our literature review identified 55 manuscripts and key themes of mentorship, training, grant success, data and benchmarks, recognition, and institutional policies. Across 20 interviews with internal and external faculty members, themes that emerged were programs and training, barriers, facilitators, mentorship, and individual and system components. During our consensus review, potential strategies were organized by relative feasibility and importance. Ultimately, strategies for building standardized systems were prioritized for their achievability based on available resources and alignment with department priorities and policy.</p><p><strong>Conclusion: </strong>There are several strategic options that academic departments may pursue to address gender equity challenges. This includes building standardized systems to support equitable advancement of all faculty members across domains, including salary, support, and opportunities. Standardized approaches ensure that departments not only promote gender equity but also facilitate the professional growth and promotion of all faculty members.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100394"},"PeriodicalIF":1.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791440","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":"Association Between Nasal Packing and 72-Hour Emergency Department Revisits in Adult Epistaxis: A Single-Center Retrospective Cohort Study.","authors":"Kaichi Kawai, Kazuhiro Shirakawa, Hiroaki Watanabe, Koichi Ariyoshi","doi":"10.1016/j.acepjo.2026.100364","DOIUrl":"10.1016/j.acepjo.2026.100364","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether nasal packing reduces 72-hour emergency department (ED) revisit rates in adult patients with epistaxis.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of patients aged 18 years or older who visited the ED for epistaxis between April 1, 2019, and March 31, 2024. Patients who were admitted were excluded. The primary outcome was an ED revisit for epistaxis within 72 hours of discharge. To adjust for confounders, we used inverse probability of treatment weighting (IPTW) based on propensity scores, and performed sensitivity analysis using propensity score matching (PSM).</p><p><strong>Results: </strong>Among 948 patients analyzed, the unadjusted ED revisit rates were 5.1% in the nasal packing group and 6.1% in the no nasal packing group. In the IPTW-adjusted sample, the revisit rate remained lower in the nasal packing group (5.1% vs. 7.9%; OR, 0.63 [95% CI, 0.39 to 1.00]), though this difference did not reach statistical significance. Subgroup analyses showed a trend toward fewer revisits among patients with posterior bleeding (9.0% vs. 24.3%; OR, 0.31 [95% CI, 0.11 to 0.85]) and among those with ongoing bleeding at presentation (4.4% vs. 11.8%; OR, 0.35 [95% CI, 0.21 to 0.58]). A sensitivity analysis using PSM yielded similar results.</p><p><strong>Conclusion: </strong>Nasal packing may help reduce short-term ED revisits due to rebleeding in patients with epistaxis, especially in patients with posterior or active bleeding.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100364"},"PeriodicalIF":1.8,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13091343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724851","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":"Man With Dyspnea.","authors":"Anupa D Ghimire, Katherine B Griesmer, Logan L Beach, Micah R Whitson, David C Pigott","doi":"10.1016/j.acepjo.2026.100368","DOIUrl":"10.1016/j.acepjo.2026.100368","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100368"},"PeriodicalIF":1.8,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13091333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724778","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":"Initiating Care for Low Back Pain in the Emergency Department of the Veterans Health Administration, Impact on the Location of Subsequent Visits.","authors":"Charles W Penza, Brian C Coleman, Erica A Abel, Cynthia A Brandt, Anthony J Lisi, Tessa Runels, Andrew K Flack, Alcia Williams, Joseph L Goulet","doi":"10.1016/j.acepjo.2026.100367","DOIUrl":"10.1016/j.acepjo.2026.100367","url":null,"abstract":"<p><strong>Objectives: </strong>Our study objective was to evaluate the location and timing of subsequent Veterans Health Administration care for low back pain (LBP) based on the initial clinic. Veterans can initiate care for LBP through different entry points such as primary care, emergency department (ED), urgent care, or other service line clinics. We examined how different starting points impacted the location and timing of the next LBP encounter.</p><p><strong>Methods: </strong>Veteran Affairs (VA) electronic health records were used to identify veterans with an initial visit for LBP, defined as a visit with an International Classification of Diseases, 10th Revision (ICD-10) LBP-related code after a 365-day period without such a visit, between October 1, 2015, and September 30, 2016. Primary and secondary clinic stop codes were used to identify the initial entry point and stratify the clinics into 3 groups: ED/urgent care, primary care, and all other service lines grouped into \"other.\" The location of the first subsequent visit within 365 days with an ICD-10 code for LBP, if any, was similarly identified. Logistic regression was used to assess the impact of entry point on the location of the first subsequent LBP visit and identify demographic and clinical characteristics of veterans whose first subsequent LBP visit was in the ED/urgent care clinic.</p><p><strong>Results: </strong>We identified 55,612 veterans, 88% of whom were male, 61% of whom identified as White, 54% of whom were married, and 9% of whom had co-occurring neck pain, who presented to VA care settings for an initial visit for LBP. Of those, 44,956 (80.8%) were initially seen in primary care, 4652 (8.4%) in the ED/urgent care, and 6004 (10.8%) in other clinics. First subsequent LBP visits occurred in primary care clinics (39%), other clinics (37%), no subsequent LBP visit within 365 days (21%), or ED/urgent care clinics (3%). The odds of the first subsequent LBP visit occurring in the ED/urgent care clinics were lower for veterans initially seen in the primary care clinic (odds ratio [OR], 0.12; 95% CI, 0.11-0.14) or other clinics (OR, 0.12; 95% CI, 0.09-0.15) compared with veterans initially seen in the ED/urgent care settings. Pain, a history of a serious LBP diagnosis, and prescription of opioids were associated with the first subsequent LBP care in the ED settings.</p><p><strong>Conclusion: </strong>In the VA care setting, 1 in 10 initial LBP visits occur in the ED/urgent care setting. This initial site of care is associated with an 8-fold increase in the odds that the next medical visit for LBP will also occur in the ED/urgent care setting. Future research is needed to explore patient and system factors contributing to the first subsequent LBP care occurring in the ED/urgent care setting after their initial LBP visit.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100367"},"PeriodicalIF":1.8,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13091326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724786","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":"Estimating the Need for Naloxone Distribution from United States Emergency Departments.","authors":"Alexandra O K Mannerings, Donald E Stader, R Gentry Wilkerson, James Neuenschwander, Scott G Weiner","doi":"10.1016/j.acepjo.2026.100365","DOIUrl":"10.1016/j.acepjo.2026.100365","url":null,"abstract":"<p><strong>Objectives: </strong>Naloxone is a key intervention for opioid overdose, and emergency departments (EDs) are an important setting for its distribution. Existing estimates rely only on overdose diagnoses, likely missing many patients with an increased risk of opioid overdose (referred to as \"at-risk\" visits or patients \"at risk\" throughout this paper), before that point. We sought to create an evidence-based, expanded definition and estimation of at-risk ED visits to better quantify opportunities and volume for naloxone distribution.</p><p><strong>Methods: </strong>We produced an expert-reviewed set of diagnosis codes that identified claims for patients with evidence-based risk factors for opioid overdose, beyond the opioid overdose codes currently in use. Using the 2021 Healthcare Cost and Utilization Project (HCUP) National Emergency Department Sample, we applied linearized survey analysis with stratified weights to quantify the frequency of claims with any matching primary or secondary diagnosis codes and provide a national estimate of qualifying visits. We cross-referenced this estimate with Centers for Disease Control and Prevention (CDC) overdose surveillance data for validation.</p><p><strong>Results: </strong>We estimate that United States EDs saw at least 3.87 million visits by at-risk patients, compared with 226,000 for treatment of opioid overdose alone. Of these, approximately 3.64 million visits were not classified as overdose cases. Over 900,000 visits involved nonopioid drug use, and more than 40% of visits were covered by Medicaid. At-risk visits represented over 3% of all ED visits nationally.</p><p><strong>Conclusion: </strong>Our estimate represents a significant increase over previous approaches. We believe this expansion more accurately represents need, can contribute to expanded distribution of naloxone, and will better serve agencies quantifying naloxone in EDs.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100365"},"PeriodicalIF":1.8,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730797","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":"Syndecan-1 Levels in Trauma and Burn Patients Remain Elevated During Resuscitation and Correlate With Coagulopathy.","authors":"Grace Bonson, Peter Callas, Maria-Cristina Bravo, Thomas Orfeo, Adrian Sackheim, Olivia Fauver, Abigail B Wager Ray, Roz King, Rachael A Callcut, Anthony E Pusateri, Jeffrey W Shupp, Mitchell J Cohen, Kalev Freeman","doi":"10.1016/j.acepjo.2026.100350","DOIUrl":"10.1016/j.acepjo.2026.100350","url":null,"abstract":"<p><strong>Objectives: </strong>Shedding of the proteoglycan syndecan-1 (SDC-1) from the vascular endothelial surface into the circulation in severe trauma predicts mortality in trauma patients. However, the timing and duration of SDC-1 elevation in trauma patients have not been defined. The primary aim of this study was to describe the longitudinal pattern of SDC-1 elevation in trauma patients with either mechanical and/or burn injury during the first 120 hours of resuscitation and initial stabilization. Our secondary objective was to determine the association of endotheliopathy, as defined by elevated SDC-1 levels, with trauma-induced coagulopathy (international normalized ratio [INR] ≥ 1.4).</p><p><strong>Methods: </strong>This prospective observational study enrolled adults meeting trauma activation criteria at 1 of 3 trauma centers. The blood was collected at presentation in the emergency department (time 0) and again at 2, 4, 6, 12, 24, 72, 96, and 120 hours. SDC-1 was quantified by ELISA, and elevated levels were defined as ≥40 ng/mL. The primary outcome of coagulopathy was defined as a clinical laboratory report of INR ≥ 1.4 during this timeframe. We determined the association between elevated SDC-1 and coagulopathy using logistic regression and adjusted for age, sex, burn status, and injury severity.</p><p><strong>Results: </strong>We studied 301 severely injured individuals, including those with mechanical and burn injuries. Among these individuals, 96 (31.9%) had coagulopathy, 122 (40.5%) required transfusions, and 42 (14%) died. SDC-1 plasma levels were significantly greater in subjects with coagulopathy relative to noncoagulopathic patients. Plasma levels of SDC-1 ≥ 40 ng/mL conferred significantly increased odds of presenting with INR ≥ 1.4, with an adjusted odds ratio of 17.88 (95% CI, 5.14-62.24), <i>P</i> < .05. High SDC-1 levels (≥40 ng/mL) were most often evident at the initial blood draw and tended to remain elevated.</p><p><strong>Conclusion: </strong>Plasma SDC-1 peaks early and remains elevated across time in most individuals with mechanical and/or burn injury. Individuals with elevated SDC-1 levels have an increased risk of coagulopathy independent of injury severity.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100350"},"PeriodicalIF":1.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724816","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":"A Cross-Sectional Study on the Impact of Emergency Department Boarding and Crowding on Emergency Department Observation Unit Patient Populations.","authors":"Kian D Samadian, Charlotte W Croteau, Melissa A Meeker, Joshua J Baugh","doi":"10.1016/j.acepjo.2026.100363","DOIUrl":"10.1016/j.acepjo.2026.100363","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency Department (ED) boarding affects patient flow and clinical decision making, but its impact on ED observation unit (EDOU) utilization remains unclear. In this study, we examine whether ED boarding census levels are associated with changes in the characteristics, care processes, and outcomes of patients placed in the EDOU.</p><p><strong>Methods: </strong>We performed a cross-sectional study of all adult EDOU encounters from July 1, 2023 to June 30, 2024 in a single academic ED (∼120,000 annual visits) with a 31-bed EDOU staffed by ED clinicians. Encounters were stratified into quartiles of ED boarding census (number of admitted patients boarding ≥2 hours). Patient demographics, encounter characteristics, resource utilization, and outcomes were compared using χ² and Kruskal-Wallis tests.</p><p><strong>Results: </strong>Among 8,469 encounters, patient characteristics remained largely consistent across boarding quartiles. Most diagnostic testing and imaging did not vary significantly. Higher boarding levels were associated with longer ED-to-EDOU times and modest increases in specialty consultations, ultrasounds, and echocardiograms. Admission rates were slightly higher in the highest boarding quartile compared with the lowest. EDOU length of stay increased incrementally with higher boarding levels.</p><p><strong>Conclusions: </strong>ED boarding levels were not strongly associated with changes in EDOU patient characteristics, management, or outcomes. Structured eligibility criteria and dedicated review processes likely insulated EDOU use from short-term operational pressures. Modest increases in consultations, diagnostics, and admissions suggest that slightly more complex patients may be placed in the EDOU during periods of high boarding. Overall, EDOU function remained relatively stable, supporting its role as a consistent throughput mechanism even during ED crowding.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100363"},"PeriodicalIF":1.8,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724668","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":"Male with chest pain after blunt trauma.","authors":"Kahra Nix, Nicholas DiMeo, Garrett Stults, Luther Daniel, Jeffery Baker","doi":"10.1016/j.acepjo.2026.100362","DOIUrl":"10.1016/j.acepjo.2026.100362","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100362"},"PeriodicalIF":1.8,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724838","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}