Spartan medical research journal最新文献

{"title":"Evaluation of a COVID-influenced Curriculum to Address Food Insecurity in a Detroit Family Medicine Residency Clinic","authors":"Amrien Ghouse, W. Gunther, Matthew Sebastian","doi":"10.51894/001c.17649","DOIUrl":"https://doi.org/10.51894/001c.17649","url":null,"abstract":"CONTEXT To date, numerous projects have demonstrated that an ongoing limited access to nutritionally dense food (i.e., “food insecurity”) plays a key role in the overall health and wellbeing of lower income at-risk populations. METHODS For this 2019-2020 pilot project, the resident physician authors first created and administered a simple five-item questionnaire screening process to systematically identify food insecure patients in their metropolitan Detroit residency clinic. A sample of patients who had been identified as food insecure and pre-diabetic were then provided improved access to healthy foods, supplemented by a six-week program of nutritional education classes using a nationally recognized “Cooking Matters’’ six-week long curriculum with a licensed chef and nutrition educator RESULTS After institutional review board approval, the authors enrolled a sample of 10 adults. The authors successfully measured both pre- and post-program Hemoglobin A1c (HbA1C) levels for all participants who completed the required course and subsequent clinic follow up visits. Using a series of initial non-parametric Wilcoxon Signed Rank matched pair tests, post-program follow-up at three months revealed statistically significant reductions in documented HbA1c levels from baseline for six enrolled patients (W=1, Z = - 2.226, p = 0.026) and six-month follow up (i.e., more than four months after completion of the program) (W = 1, Z = - 2.060, p = 0.039). In post-program surveys, each respondent indicated that they found the class content to be generally beneficial to increase their nutritional knowledge. CONCLUSIONS In the authors’ setting, this food insecurity program has subsequently led to a more formal screening process to evaluate and identify food insecure patients. The authors discuss the scheduling difficulties they experienced from the COVID-19 pandemic for their sample patients. However, these pilot results suggest that prolonged benefits may require ongoing “virtual” teaching sessions with pre-diabetic patients to address the complex factors influencing food insecurity levels identified in similar inner-city settings.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44583304","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":"Multi-Specialty Care for Second-Degree Pressure Cooker Explosion Burn Injuries","authors":"Casey P. Schukow, Billy R. Nordyke","doi":"10.51894/001c.17738","DOIUrl":"https://doi.org/10.51894/001c.17738","url":null,"abstract":"CONTEXT Although pressure cookers are very common kitchen utensils used in the United States, only a few cases of serious injuries secondary to pressure cooker explosions have been reported in the medical literature. When second-degree (i.e., “partial-thickness”) burns result from pressure cooker explosions, wounds involving near to or greater than 10% of total body surface area typically require multidisciplinary treatment, with burn center referral for proper wound care, potential fluid resuscitation, and eventual scar management. EXAMPLE CASE The example patient described in this report was an African American female in her early 30s who presented during the summer of 2020 after suffering varying levels of second-degree burns to her bilateral upper torso and left wrist (i.e., approximately 10%, total body surface area). The authors first saw the patient during a primary care office visit a week after her initial injury when she first went to a local urgent care clinic. Upon her arrival to the second author’s family medicine clinic, a multi-specialty wound recovery plan was initiated since her first urgent care visit treatment had been minimal without prophylactic antibiotic therapy or placement of a burn center referral. CONCLUSIONS Partial and full-thickness burn injuries generally warrant immediate clinical (i.e., body surface area burn assessment, fluid resuscitation, empiric antibiotics) as well as ongoing (burn center referral, debridement procedures, active scar management, provision of psychological support) treatment needs. This paper discusses the critical opportunities posed for more extensive burn patients’ physicians to first categorize the extent of burn wounds and initiate subsequent specialty care in other settings.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42215866","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":"Clinicopathological and Perioperative Outcome of Appendiceal Tumors: Case Review of 31 Patients","authors":"Haroutioun H. Boyajian, Vanessa Majeski, A. Flores, D. Sturtz, Fadi Baidoun, Mohammed Dughayli","doi":"10.51894/001c.13487","DOIUrl":"https://doi.org/10.51894/001c.13487","url":null,"abstract":"INTRODUCTION Neoplasms of the appendix are quite rare and found in approximately 1% of appendectomy specimens. These neoplasms have been pathologically categorized into various subgroups depending on cell of origin, and surgical treatment varies according to histological subtype and disease stage. PURPOSE The purpose of this case series review was to evaluate the clinicopathological presentation and survival outcome of a sample of patients with appendiceal tumors. METHODS Before data collection, this project design was approved by the authors’ institutional review board. Pathology records at our institution were reviewed for cases of appendiceal tumors from January 2007 to December 2016. A total of 31 patients were identified over this 10-year period. Retrospective data collection included patient demographics, presenting symptoms, tumor size, histologic diagnosis, initial and secondary management, perioperative and postoperative outcome, and survival benefits. RESULTS Thirty one patients with four different appendiceal tumor subtypes were included in the study: Mucinous Cystadenoma, Mucinous Adenocarcinoma, Goblet Cell, and Carcinoid. The sample was comprised of 17 women (54.8%) and 14 men (45.2%) with an overall mean age of 50.1 (SD = 22.3). Subgroups of 13 (42%) patients had Carcinoid tumor, 12 (39%) had Mucinous Cystadenoma, four (13%) had Goblet cell tumor, and two (6%) had Mucinous Adenocarcinoma. The stage at presentation and tumor size also varied by histologic subtype. The most common presenting symptom was abdominal pain (64.5%), followed by a radiological identified mass (12.9%). Overall, 27 (87.1%) patients survived, and four (12.9%) were deceased. CONCLUSIONS The findings from this case series review provides a retrospective analysis of appendiceal tumor characteristics, follow up, and survival. Based on these results, the prognosis and management of patients with these tumors should be based on the histologic subtype and the extent of their disease.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46961588","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":"All's Not Well(ens) that Ends Well: Case Study of Significant Thebesian Veins Mimicking Wellens Syndrome.","authors":"Keith Frank","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Thebeisan veins are microfistulous connections between a coronary arterial branch directly to a ventricular or atrial chamber. Extensive thebesian veins that empty into the left ventricle can cause typical chest pain symptoms, troponin elevation, and ischemic EKG changes from coronary steal leading to acute coronary syndrome in extreme cases. Literature review exposed a consistent pattern of EKG findings among patients with extensive thebesian veins involving all three major coronary arteries. We present a case study as an example of this rare anatomic finding of extensive thebesian veins draining into the left ventricle causing acute coronary syndrome in a symptomatic patient with elevated troponin and ischemic changes on EKG. This same EKG pattern that is present in our patient was discovered to be consistent among available case studies reviewed that had included an EKG tracing in their report. A newly proposed association between the ischemic changes on EKG due to extensive thebeisan veins and those of a severe proximal left anterior descending coronary artery stenotic lesion was discovered. The newly discovered consistency in the EKG pattern with acute coronary syndrome caused by extensive thebesian veins is the same pattern as that seen in Wellens Syndrome.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"12881"},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25430836","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":"Myocardial Ischemia, a Rare Presentation of Meckel's Diverticulum.","authors":"Trevor A Nessel, Connor C Kerndt, Zaid J Shareef, Christopher Doig","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Context: </strong>Meckel's diverticulum is a rare congenital anomaly of the gastrointestinal tract. It is typically asymptomatic and found incidentally in the work-up of another medical complaint. However, it has been known to cause complications in a minority of cases.</p><p><strong>Methods: </strong>This case involves an elderly male in his early 80's who presented to the emergency department with a 2-day history of emesis and hematochezia, in addition to sudden onset syncope and angina-like symptoms. Serial electrocardiograms demonstrated diffuse ST-segment depressions, consistent with myocardial ischemia. The patient underwent laboratory testing, imaging, endoscopy, and a subsequent exploratory laparotomy.</p><p><strong>Results: </strong>Laboratory results revealed lactic acidosis, anemia, and leukocytosis. Upper endoscopy resulted in negative findings. Imaging, including CT-scan and Technetium-99 RBC scan, visualized a gastrointestinal bleed. However, the arterial embolization procedure was unable to stop the bleeding diverticulum. Exploratory laparotomy revealed an infarcted Meckel's diverticulum.</p><p><strong>Conclusions: </strong>This case demonstrates the importance of clinicians generating a wide differential when evaluating a gastrointestinal bleed, and considering Meckel's diverticulum as a potential cause of a bleed with an unknown source. The primary test to diagnose a Meckel's diverticulum is a Technetium-99 RBC scan. However, visualization via exploratory laparotomy is the best test for definitive diagnosis. The decision to intervene surgically earlier can limit mortality with symptomatic Meckel's diverticula.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"5 1","pages":"12844"},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41184451","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 Face of <i>Clostriodes Difficile</i> Infections in the Outpatient Setting.","authors":"Michael S Wang, Samad Faheem, Joanna Mangio, Kevin Pham, Daniel Lloyd, Brianna Hatch-Vallier, Ewanah Johnson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>It has long been well-established that Clostridiodes difficile infections (CDI) can cause severe morbidity and mortality. However, most of the literature to date has focused on hospital-diagnosed infections with less emphasis on clinic-based CDI cases. Guidelines from the 2010 IDSA/SHEA for CDI advocate for metronidazole as first-line therapy for mild to moderate CDI cases. However, the 2017 guidelines recommend oral vancomycin or fidaxomicin as first-line therapy due to their superior efficacy. Objective: The purpose of this study was to compare Clostriodes difficile infections in convenience samples of clinic vs. hospital patients.</p><p><strong>Methods: </strong>In 2019, a retrospective, case-controlled study was performed by the first six authors between 2015-2017 (i.e., prior to the 2017 IDSA/SHEA CDI guidelines) to compare ambulatory and hospital CDI treatment prescriptions. Analytic data included frequency of White blood cells (WBC) and creatinine collection, frequency of severe CDI cases, compliance with the 2010 guidelines, CDI recurrence, and mortality.</p><p><strong>Results: </strong>An eligible subgroup of N = 92 hospital patients at Spectrum Health Lakeland were more likely to have WBC (98.4% vs 32.6%, p<0.001) and creatinine (97.8 vs. 39.4, P < 0.001) drawn than 184 patients receiving clinic-based care. Hospital sampled patients were more likely to have severe CDI (46.7% vs 6.7%, p < 0.001). Mortality was less common in hospital patients (1.1% vs. 7.6%, p = 0.017) and the recurrence rates were similar. (21.2% inpatient vs. 28.3% outpatient, (p = 0.224).</p><p><strong>Conclusions: </strong>Based on these results, assessment of CDI severity remains limited in the ambulatory population due to the lack of severity markers. It is unclear if this is due to lack of available laboratory resources or difference in clinical presentation. Of those sample patients who have available markers of severity, patients receiving clinic-based diagnoses were less likely assessed to have severe CDI. Keywords: Cloistriodes difficile infection, ambulatory, severity markers.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"5 1","pages":"12883"},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41184452","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":"All’s Not Well(ens) that Ends Well: Case Study of Significant Thebesian Veins Mimicking Wellens Syndrome","authors":"Keith Frank","doi":"10.51894/001c.12881","DOIUrl":"https://doi.org/10.51894/001c.12881","url":null,"abstract":"Thebeisan veins are microfistulous connections between a coronary arterial branch directly to a ventricular or atrial chamber. Extensive thebesian veins that empty into the left ventricle can cause typical chest pain symptoms, troponin elevation, and ischemic EKG changes from coronary steal leading to acute coronary syndrome in extreme cases. Literature review exposed a consistent pattern of EKG findings among patients with extensive thebesian veins involving all three major coronary arteries. We present a case study as an example of this rare anatomic finding of extensive thebesian veins draining into the left ventricle causing acute coronary syndrome in a symptomatic patient with elevated troponin and ischemic changes on EKG. This same EKG pattern that is present in our patient was discovered to be consistent among available case studies reviewed that had included an EKG tracing in their report. A newly proposed association between the ischemic changes on EKG due to extensive thebeisan veins and those of a severe proximal left anterior descending coronary artery stenotic lesion was discovered. The newly discovered consistency in the EKG pattern with acute coronary syndrome caused by extensive thebesian veins is the same pattern as that seen in Wellens Syndrome.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47875836","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":"Incidence of Heterotopic Ossification in Direct Anterior Approach to Total Hip Arthroplasty with use of Aspirin as Thromboembolic Prophylaxis.","authors":"Paul Knapp, Ross Doehrmann, Sanar Yokhana, Syed Rizvi, Judith Boura, David Knesek","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Context: </strong>Heterotopic ossification (H.O.) is a common occurrence after total hip arthroplasty (THA) with significant potential clinical ramifications. Controversy still exists regarding the exact etiology of the disorder, including possible risk factors. Surgical technique, surgical approach, postoperative medication protocols and even thromboembolic prophylaxis have been implicated in the formation of H.O. Our study looked at one institution with a single surgeon performing direct anterior THA (DAA THA) in patients who received aspirin (ASA) as monotherapy for thromboembolic prophylaxis.</p><p><strong>Methods: </strong>Patients at a single institution who underwent DAA THA between 2015 and 2019 were identified by CPT code. 45 patients ultimately met inclusion criteria. Postoperative radiographs were analyzed retrospectively for H.O. according to the Brooker classification. Several patient characteristics and comorbidities were statistically analyzed using Chi-square tests, Fisher Exact tests, Wilcox rank sum tests, and Pearson correlation.</p><p><strong>Results: </strong>12 patients (26.7%) were found to have heterotopic ossification (67% Class 1, 8% Class 2, 25% Class 3, and 0% Class 4); with a median follow up of 35 weeks (range: 12-96). 25% of these patients received ASA 325mg BID while 75% received ASA 81 BID. No statistical differences in development of H.O. were detected among age, gender, BMI, sex, race, diabetes, or NSAID use in the post-operative interval. There were significantly more smokers in the H.O. group (50% vs. 9%, p<0.006).</p><p><strong>Conclusions: </strong>Our analysis aimed to quantify the incidence of H.O. with consistency in surgical approach and post-operative protocol. There have been few studies on this topic, and we believe it is very relevant with the increasing use of aspirin in the post-operative protocol for thromboembolic prophylaxis. Our retrospective analysis identified H.O. at rates similar to previous studies in DAA.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"5 1","pages":"12263"},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10501341","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":"Approach to Formalized Ultrasound Credentialing in a Community Hospital Health System with both Academic and Non-Academic Clinical Settings","authors":"Jeremy E. Long, S. Meyering, Timothy Scheel","doi":"10.51894/001c.12748","DOIUrl":"https://doi.org/10.51894/001c.12748","url":null,"abstract":"INTRODUCTION In the US, ultrasound in Emergency Medicine (EM) is widely considered the standard of care in clinical practice amongst most Emergency Department providers. At the authors’ institution and affiliates, there were a variety of health care providers utilizing ultrasound for clinical practice, and their skill levels varied, dependent on training and exposure. As an attempt to standardize credentialing practice and determine need for additional training thresholds, the authors endeavored to perform a skills assessment utilizing both written and clinical based practical assessments. METHODS A 7 point questionnaire was administered to a convenience sample of providers requesting formal training information, number of ultrasounds performed, and self-assessed competency. A 10 point written assessment with ultrasound knowledge and clinical application questions was also administered. A subsequent clinical assessment on live humans and models was then performed with multiple stations assessing 15 different instrumentation skills and technique, as well as image interpretation and evaluation. RESULTS A total of 23 attending EM board-certified physicians, and four advanced practice providers (PA and NP) took the credentialing assessments scoring an average of 7.3 out of 10 (SD 0.83) for the written assessment. Twenty (71%) of the 28 tested passed the clinical evaluation on their initial attempt. Five (17%) passed on a first remediation. Three (10%) required more than one initial revision attempt. All those who did remediate were able to complete the revision with a passing score. CONCLUSIONS Overall, the testing was considered a successful process. This program appears to have offered a level of standardization that was appealing to the credentialing body at our institution. We were able to assess to a level of competence considered standard of care by national credentialing bodies.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46154289","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":"Removal of Ioban May Pull Bacteria to the Surface of the Skin: Lessons Learned","authors":"J. Lytle, Jordan McCoy, K. Smeltzer, R. Nelson","doi":"10.51894/001c.12463","DOIUrl":"https://doi.org/10.51894/001c.12463","url":null,"abstract":"CONTEXT Cutibacterium acnes (C. Acnes, formerly known as Propionibacterium acnes) are slow growing, gram positive, anaerobic bacilli. C. acnes are found in many locations, both as part of normal skin flora, as well as a contaminant of environmental surfaces. These bacteria have been associated with prosthetic joint infections of the shoulder, and it has been challenging to prevent such infections for a variety of reasons. The purpose of this quality improvement project was to investigate whether the surgical adhesive dressing Ioban could pull subcutaneous C. acnes bacteria from the surgical field. METHODS During this quality improvement project, a convenience sample of 16 adult volunteers were gathered from other residency departments and from medical students at our hospital. The volunteers were used to take samples from two sites on each shoulder. The shoulder sites were prepped and covered with iodine-impregnated dressings. RESULTS There were 26 of 64 (40.6%) samples in the no Ioban group that grew C. acnes. The Ioban group had 37 of 64 (57.8%) samples found to be positive for C. acnes growth. During this project, we identified several key points that could be useful to future researchers working in community hospitals. We describe these lessons concerning ongoing communication with lab and research departments, offering volunteers compensation to participate, interacting with departments unaccustomed to research, and development of a clear methodology. CONCLUSIONS This was the first time our department had conduct a project utilizing the laboratory as well as volunteers. This came with unforeseen challenges which caused significant time delays. We believe that by highlighting these lessons for future researchers, they might avoid such problems during project activities.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44937951","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}