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

{"title":"Constructive Appraisal of \"Mental Health Symptom Screening Among Adult Emergency Department Patients: A Cross-Sectional Study\".","authors":"Preeti Lamba","doi":"10.1016/j.acepjo.2026.100366","DOIUrl":"10.1016/j.acepjo.2026.100366","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100366"},"PeriodicalIF":1.8,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724795","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":"Impact of a Cellular Host-Response Sepsis Diagnostic on Clinical Decision Making in the Emergency Department: A Vignette-Based Study.","authors":"Roya Sheybani, Hollis R O'Neal, Christopher B Thomas, Robert Scoggins, Christopher Pfaff, Howard Smithline, Donna M Wolk, Eric Melnychuk, Tom P Aufderheide, Thomas Carver, Matthew Chinn, Nathan A Ledeboer, Chadd K Kraus","doi":"10.1016/j.acepjo.2026.100358","DOIUrl":"10.1016/j.acepjo.2026.100358","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis is a complex pathogen-host interaction that traditional laboratories do not easily detect. A test that rapidly assesses immune dysregulation could improve early diagnosis and clinical decision making. This study evaluates ease of application of a new host-response sepsis diagnostic test (IntelliSep; Cytovale, Inc) and its ability to affect decision making, risk stratification, and diagnostic efficacy in the emergency department (ED).</p><p><strong>Methods: </strong>This was a case vignette-based, randomized, multisite decision-impact study. We conducted the study with ED clinicians from 3 health care institutions, selected among the 5 participating institutions from a previous observational study. Participants were ED-attending physician/fellows, residents, and advanced practice clinicians. The study excluded interns. Finally, 13 clinicians at site 1, 28 at site 2, and 11 at site 3 (total, n = 52) were included. The study used retrospectively de-identified data from patient cases to generate 100 case vignettes. Each participant reviewed 10 cases with IntelliSep results and 10 cases without.</p><p><strong>Results: </strong>The study assessed outcomes including impact of the test results on clinical decision making, confidence in decision, and diagnostic accuracy. The test supported or changed/augmented clinician decisions in 86% of cases. The presence of the test significantly increased the proportion of raters with high confidence in their ratings (from 53.1% without, to 63.1% with). Additionally, diagnostic accuracy increased, with a notable increase in sensitivity for critical bands, from 73.1% without the test to 82.8% with it (95% CI, 63.5-81.3 vs 74.6-89.1); this increase was not statistically significant (<i>P</i> = .06).</p><p><strong>Conclusion: </strong>This paper-based study demonstrates that the IntelliSep host-response sepsis test results could impact clinician decisions and may improve the quality of clinical decision making.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100358"},"PeriodicalIF":1.8,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640753","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":"Bedside Intussusception Diagnosis and Reduction: A Comprehensive Emergency Department Process for Bedside Intussusception Diagnosis and Reduction.","authors":"Nitzan Atia, Jordanna H Koppel, Tami Brutman-Barazani, Michalle Soudack, Oren Feldman","doi":"10.1016/j.acepjo.2026.100360","DOIUrl":"10.1016/j.acepjo.2026.100360","url":null,"abstract":"<p><strong>Objectives: </strong>Ileocolic intussusception is a major cause of intestinal obstruction in children under 2 years of age. Diagnosis is typically confirmed using ultrasonography, and treatment often involves an air or hydrostatic enema performed by radiologists or surgeons outside of the pediatric emergency department (PED) without the provision of adequate sedation or analgesia. This study aimed to assess the efficacy and safety of a comprehensive bedside approach for the diagnosis and reduction of ileocolic intussusception within the PED of a tertiary care pediatric hospital.</p><p><strong>Methods: </strong>A retrospective cohort study conducted between January 2021 and July 2024. Key outcome variables included the reduction success rate, time to reduction, and adverse events.</p><p><strong>Results: </strong>During the study period, 28 children diagnosed with ileocolic intussusception via point-of-care ultrasound were treated bedside with ultrasound-guided hydrostatic reduction performed by a pediatric radiologist under sedation provided by pediatric emergency medicine physicians. There were 20 (86%) successful bedside reductions with an average time from admission to reduction of 126 minutes and an average length of stay of 407 minutes, respectively. No adverse events were recorded, although early recurrence of intussusception within 48 hours occurred in 2 patients (7%).</p><p><strong>Conclusion: </strong>This is the first study that detailed a comprehensive bedside approach for the diagnosis and reduction of ileocolic intussusception in the PED. This approach has a high success rate, minimizes the need for interdepartmental transfers, and facilitates the administration of appropriate sedation and analgesia without significant adverse events. Further prospective studies are needed to confirm the safety and efficacy of this bedside approach.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100360"},"PeriodicalIF":1.8,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213705","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":"Linking Patients to Residential Substance Use Disorder Treatment Through Peer Coaches and a Clinical Decision Unit.","authors":"Kellie LeVine McKenzie, Tatiana Getz, Joseph Ebersole, Alaina Steck, Alexis Lynch, Kevin Patel, Lakeisha Johnson, Sydney McKee, Matthew Wheatley, Nicholas A Giordano, Umedjon Ibragimov, Joseph Carpenter","doi":"10.1016/j.acepjo.2026.100359","DOIUrl":"10.1016/j.acepjo.2026.100359","url":null,"abstract":"<p><strong>Objectives: </strong>Efforts to improve substance use disorder (SUD) care in the emergency department (ED) include deploying peer recovery coaches (PRCs). PRCs operate through a window of lived experience, providing motivational interviewing and linkage to recovery resources. This may include placement into residential treatment, which can be difficult from the ED given time constraints. We describe a novel clinical decision unit (CDU) pathway wherein PRCs facilitated discharge to residential SUD treatment.</p><p><strong>Methods: </strong>We performed a retrospective analysis of patients presenting to a single hospital between June 2023 and May 2024. The sample was drawn from the consult list of PRCs. Data were obtained through direct export and manual extraction from the medical record. We performed χ² analyses to evaluate the effect of patient factors on pathway success.</p><p><strong>Results: </strong>In total, 75 encounters were included: 49 men (65.3%), 26 women (34.7%); age range, 18 to 69 years (median, 45 years). Forty-nine (65.3%) encounters were identified as Black, 19 (25.3%) as White, and 7 (9.3%) as other; 24 (32%) had a primary ED diagnosis related to substance use, and 38 (50.6%) had a primary psychiatric diagnosis (eg, suicidal ideation). PRCs placed 53 patients (70.6%) in residential treatment. Three patients had a change in clinical status and were admitted to the hospital. Median CDU length of stay was 27 hours (IQR, 21-44 hours). Forty-five (85%) of those placed were insured. Of the 15 uninsured patients, 8 (53%) were placed. No differences in pathway success were observed based on race, insurance status, or primary substance used. The pathway was more successful for men than for women (difference between groups, 34%; 95% CI, 10%-56%). The most common reason for pathway failure was patient-directed discharge (10 [45.5%] pathway failures).</p><p><strong>Conclusion: </strong>In this CDU pathway, PRCs were able to place the majority of patients into residential SUD treatment. Further study is required to examine long-term patient outcomes.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100359"},"PeriodicalIF":1.8,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13015694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521882","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":"Assessment of a County-Wide, Pan-First Responder Take-Home Naloxone Program in Denver, Colorado.","authors":"Joshua Jacoves, Alexandra Mannerings, Donald Stader, Mario Andres Camacho, James Neuenschwander, Ansley Mason, Katelynn Petrasic, Scott G Weiner","doi":"10.1016/j.acepjo.2026.100357","DOIUrl":"10.1016/j.acepjo.2026.100357","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility and geospatial distribution of a county-wide pan-first responder leave-behind naloxone program implemented across emergency medical services (EMS), police, fire, and a community response mobile crisis unit.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of leave-behind naloxone kits distributed in Denver, Colorado, from April 26, 2024, through April 25, 2025. Trained first responders (<i>n</i> ∼2850) recorded each kit distribution via an online form capturing location, agency, recipient category, and transport disposition. Descriptive statistics were used to summarize kit distributions by agency and transport outcomes. A hotspot analysis mapped clusters of distributions and assessed proximity to transit stops and other public facilities.</p><p><strong>Results: </strong>Over the 12-month period, there were 1020 interactions during which responders distributed 2438 naloxone kits. Paramedics accounted for 1407 kits (57.7%), the mobile crisis unit for 642 (26.3%), police for 336 (13.8%), and fire for 53 (2.2%). In many interactions, the kit recipient declined transport, particularly in the mobile crisis unit and EMS cohorts. Geospatial analysis identified 24 hotspots, of which 23 were within feasible walking distance of bus or light-rail stops. These findings suggest that leave-behind naloxone distributions cluster around transportation hubs in Denver.</p><p><strong>Conclusion: </strong>A pan-first-responder leave-behind naloxone program is feasible at the county level, with most kits distributed by paramedics and a mobile crisis unit program. Hotspot analysis highlighted transit-adjacent clusters, informing potential sites for prestationed naloxone. Cross-agency collaboration combined with geospatial targeting may rapidly saturate high-risk settings with naloxone.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100357"},"PeriodicalIF":1.8,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12990331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476470","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":"State of the Art: Observation Units in the Emergency Department, an Interim Practice Update and Policy Review.","authors":"Christopher Caspers, Mallika Singh, Christopher W Baugh, Lauren T Southerland, Jason J Bischof, Andrew Weinberger, Hardeep Singh, George B Hughes, Matthew Wheatley, Michael A Ross","doi":"10.1016/j.acepjo.2026.100354","DOIUrl":"10.1016/j.acepjo.2026.100354","url":null,"abstract":"<p><p>Emergency department observation units (EDOUs) provide an essential model of care to address emergency department crowding, preventable hospital admissions, and rising health-care costs through protocol-driven, short-term management of patients requiring further evaluation or treatment. This interim update to the 2013 American College of Emergency Physicians Policy Resource and Education Paper reviews the current state of observation medicine, highlighting structural and staffing principles, professional billing models, and evolving applications across diverse clinical conditions, including geriatrics, toxicology, psychiatry, oncology, and chest pain. Recent developments in telehealth integration, pandemic surge response, and novel clinical pathways underscore the adaptability and high-value role of observation units within modern emergency care. By consolidating evidence-based practices and policy considerations, this paper emphasizes the continued importance of EDOUs in improving efficiency, outcomes, and cost-effectiveness while outlining key directions for future research and implementation.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100354"},"PeriodicalIF":1.8,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12990362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476522","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":"The Future of Artificial Intelligence in Emergency Medical Services by 2030: An International Consensus Report.","authors":"Talal AlShammari","doi":"10.1016/j.acepjo.2026.100355","DOIUrl":"10.1016/j.acepjo.2026.100355","url":null,"abstract":"<p><strong>Objectives: </strong>Artificial intelligence (AI) is an application of digital technology with considerable potential to improve quality, safety, and access; however, research on the future of AI in the health-care system and specifically emergency medical services (EMS) remains limited. The aim of this research is to anticipate the possible effects of using this technology on EMS.</p><p><strong>Methods: </strong>A Delphi panel was recruited based on proven international expertise in EMS to contribute to an iterative consensus-based Delphi study design. Data collection was initiated in September 2024 and ended in March 2025.</p><p><strong>Results: </strong>The 3-round study involved 27 expert participants and a 3-member steering group and was concluded at round 3, with 7 items not reaching consensus. The final result included 81 items with expert consensus divided into 6 EMS domains, namely communication, clinical, education, management, operations, and ethics.</p><p><strong>Conclusion: </strong>The forecasted items, although with a limited number of experts, provide an insightful model for an in-depth understanding of the future of AI in EMS and other health care, educational, and associated industries.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100355"},"PeriodicalIF":1.8,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12996645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488938","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":"Comparison of Emergency Medicine Resident and Attending Physician Approval Rates in Online Medical Control: A 10-year Retrospective Analysis.","authors":"Russell A Baker, Alexander Toppo","doi":"10.1016/j.acepjo.2026.100356","DOIUrl":"10.1016/j.acepjo.2026.100356","url":null,"abstract":"<p><strong>Objectives: </strong>We assessed whether emergency medicine residents, after completing a structured 4-hour training program and supervised proctoring, demonstrate decision making in online medical control comparable with that of board-certified attending physicians.</p><p><strong>Methods: </strong>This was a retrospective cross-sectional study of online medical direction calls to the University Medical Centre of El Paso, the emergency medical services (EMS) base station for the El Paso Fire Department. First-year residents completed a 4-hour curriculum covering EMS systems, protocols, ethics, communication, and simulation, followed by 5 supervised calls. We analyzed all online medical control encounters between August 2016 and August 2025. Calls lacking a binary approval outcome were excluded. Approval/disapproval rates were compared between residents and attendings using Fisher's exact test for small samples, chi-square tests for overall comparisons, and 2-proportion z-tests for large categories. Odds ratios (ORs) with 95% CIs were calculated. Equivalence testing applied a prespecified margin of ± 3%.</p><p><strong>Results: </strong>Of 10,492 calls, 8405 were eligible. Residents (n = 6589) approved 93.4% of requests versus 93.1% for attendings (n = 1816) (χ² = 0.11, <i>P</i> = .74; OR, 1.04; 95% CI, 0.84-1.29). Category-level comparisons revealed no statistically significant differences, with Fisher's exact <i>P</i> > 0.05 for all subgroups. Patient refusals (99.5% vs 100%) and termination of resuscitation (98.0% vs 99.4%) were uniformly high across both groups. The 2 one-sided test procedure confirmed equivalence, with a 90% CI for the difference (-0.85% to 1.35%) falling entirely within the ±3% margin.</p><p><strong>Conclusion: </strong>Emergency medicine residents trained with a focused 4-hour curriculum and limited supervised experience performed online medical control duties at a level statistically and clinically equivalent to attending physicians across a decade of real-world EMS consultations. This model provided a practical and efficient way to include residents in EMS medical direction roles, supporting both system capacity and residency education.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100356"},"PeriodicalIF":1.8,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12990345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476508","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":"The Implications of Private Equity Investment in Emergency Medicine.","authors":"Monisha Dilip, Arthur R Derse, James H Paxton, Daniel R Martin","doi":"10.1016/j.acepjo.2026.100348","DOIUrl":"10.1016/j.acepjo.2026.100348","url":null,"abstract":"<p><p>Private equity (PE) investment in emergency medicine (EM) has expanded rapidly, with PE firms acquiring physician staffing groups and hospital-based services. This concept and policy review summarizes current evidence on PE involvement in EM, outlines ethical and operational implications, and identifies key gaps requiring further empirical study. The profit-driven model raises substantial ethical concerns for patient care and physician autonomy. Although these concerns are common to many for-profit models, we think that an examination of PE practices offers valuable insights into the ways in which the profit motive common to US modern health care and exacerbated by PE can conflict with the provision of high-quality patient care. PE-backed emergency departments (EDs) often implement cost-cutting measures, which may compromise care quality, increase costs, and heighten clinician moral distress. At the same time, proponents argue that PE investment can bring new capital, management expertise, and support growth strategies. The duty of PE firms to maximize investor returns inherently conflicts with the ethical obligations of emergency physicians to prioritize beneficence and nonmaleficence. The rise of PE investment in EM underscores fundamental tensions between profit motives and the ethical practice of EM. Safeguarding patient welfare will require enhanced regulatory oversight, physician advocacy, and professional organization support for physician-led practice models. Nonetheless, PE ownership may also provide opportunities for innovation, improved efficiency, and financial stability when aligned with patient-centered goals. Given limited EM-specific empirical data, we propose focused avenues for future research.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 2","pages":"100348"},"PeriodicalIF":1.8,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482785","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":"Human Trafficking: Emergency Department Screening and Referral.","authors":"Christa Pulvino, Robert S Braun, Kelli L Jarrell, Elysia M Smith, Carolyn R Smith, Priyanka Vemuru, Alexis Kimmel, Caroline E Freiermuth","doi":"10.1016/j.acepjo.2026.100353","DOIUrl":"10.1016/j.acepjo.2026.100353","url":null,"abstract":"<p><strong>Objectives: </strong>Our objective was to initiate screening for human trafficking in the University of Cincinnati Medical Center Emergency Department (UCMC ED) and then estimate the number of patients who were at risk of human trafficking and the proportion who were referred for further services.</p><p><strong>Methods: </strong>A retrospective study was conducted at the UCMC ED, a large urban academic center emergency department, to describe the number of patients who screened positive for human trafficking risk and received relevant resources over a 12-month period between December 2022 and November 2023. Any patient who was approached by an early intervention program (EIP) counselor and completed a risk assessment was included. A person was considered to have a positive screen if they answered affirmatively to at least 1 of the 4 screening questions included in the previously validated Rapid Appraisal for Trafficking tool. Acceptance of referrals was also recorded by the EIP team and is reported here.</p><p><strong>Results: </strong>Out of 557 patients assessed, 69 (12.4%) screened positive for risk of human trafficking. Of those, 39 (56.5%) patients accepted referrals to resources specific to trafficked persons, and 60 (87%) accepted referrals to any resources, including assistance with housing, substance use disorders, and food insecurity.</p><p><strong>Conclusion: </strong>Human trafficking is a problem affecting ED patients. The proportion of individuals who screened positive for trafficking risk and accepted resources indicates that many patients are willing to accept assistance. EDs should institute a mechanism to screen for human trafficking and offer services to address trafficking and other social determinants of health.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 2","pages":"100353"},"PeriodicalIF":1.8,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482721","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}