The journal of climate change and health最新文献

{"title":"Implementation of a heat alert system for clinical staff in an ambulatory setting: A pilot project","authors":"Paul F Dellaripa ,&nbsp;Candace Feldman ,&nbsp;Lydia Gedmintas ,&nbsp;Susan Ritter ,&nbsp;Caleb Dresser","doi":"10.1016/j.joclim.2025.100478","DOIUrl":"10.1016/j.joclim.2025.100478","url":null,"abstract":"<div><h3>Introduction</h3><div>Climate change leads to an increasing risk of heat exposure and pre-emptive alerting to patients may be an important intervention to limit health risks related to heat. The process of providing counseling and resources related to impending dangerous heat in an ambulatory clinic setting has not been described. In this pilot project utilizing an electronic heat alert system, we describe the implementation of a clinic-level protocol for providing alert-based heat health information and proactively educating rheumatology patients in an ambulatory setting on dangerous heat conditions.</div></div><div><h3>Methods</h3><div>Physicians, nurses and medical assistants received electronic notifications of dangerous heat forecasts via a external heat alert system (Realtime Climate Heat Risk). Participating staff completed surveys at the midpoint and end of the heat season. The primary endpoint was a self-reported estimate of the percentage of patients engaged regarding heat safety on days where heat alerts were issued.</div></div><div><h3>Results</h3><div>There were 4 heat alert days during the study period. Half of participating staff members reported they had engaged 50 % or more of their patients on this topic. Self-reported levels of engagement by medical assistants were significantly higher than those of physicians and nurses, (<em>W</em> = 4.5, p-value = 0.036).</div></div><div><h3>Conclusions</h3><div>Heat and other environmental exposures present risks to patients as the effects of climate change worsen. Heat alerts may help staff address health risks with their patients. This pilot study demonstrates that an external heat alert system can be implemented utilizing providers of different skill levels and at all points of patient interaction in an ambulatory clinic setting.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100478"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144678963","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":"Role of medicines dispensation data in city-based air-health surveillance and health preparedness","authors":"Ritu Parchure ,&nbsp;Santu Ghosh ,&nbsp;Santosh Satam ,&nbsp;Aparna Gokhale ,&nbsp;Balasaheb Pawar ,&nbsp;Vinay Kulkarni","doi":"10.1016/j.joclim.2025.100483","DOIUrl":"10.1016/j.joclim.2025.100483","url":null,"abstract":"<div><h3>Introduction</h3><div>Air pollution in India is a significant public health issue. Air-health surveillance has been recently introduced in heavily polluted Indian cities, to inform relevant mitigation and health preparedness actions. The air-health surveillance tracks emergency room visits (ERV) for acute respiratory illnesses in select sentinel hospitals. Reporting from multiple facilities is necessary to get a representative picture, but expanding coverage poses challenges. In this context, pharmaceutical data can serve as an alternative data source to aid surveillance efforts.</div></div><div><h3>Methods</h3><div>We examined the potential role of data on sales of respules (a combination of corticosteroid and bronchodilator medicines, used in nebulizers) as an indicator in air-health surveillance. The association between daily respules sold at a trust-based hospital in Pune, India, and daily concentration of local ambient particulate matter (PM_2.5) was assessed using a time-stratified case-crossover design.</div></div><div><h3>Results</h3><div>A positive correlation, with a lag effect, was observed. A 10 µg/m³ increase in PM_2.5 level led to an 8 % and 6 % increase in respules sales after a lag of 3 and 4 days, respectively. The number of respules sold correlated well with ERV.</div></div><div><h3>Discussion</h3><div>The findings indicate that respules sold could serve as a reliable proxy for tracking health impacts from air pollution.</div></div><div><h3>Conclusion</h3><div>Our study provides a proof-of-concept analysis showing that pharmaceutical data can be used as a proxy measure to assess the short-term health impacts of air pollution. Further exploration is needed to evaluate its utility for air-health surveillance efforts in India.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100483"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697020","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":"Planetary health education in Indian medical curricula","authors":"Prasoon Pattanaik ,&nbsp;Anandita Pattnaik","doi":"10.1016/j.joclim.2025.100481","DOIUrl":"10.1016/j.joclim.2025.100481","url":null,"abstract":"<div><h3>Introduction</h3><div>This study assesses the state of planetary health education in Indian medical schools and proposes actionable recommendations for enhancement.</div></div><div><h3>Materials and Methods</h3><div>The Planetary Health Report Card (PHRC), an international student-driven metric-based tool, was used to evaluate planetary health content in six report cards from four prominent Indian medical schools. Five key categories were evaluated: planetary health curriculum, interdisciplinary research, community outreach and advocacy, support for student initiatives, and campus sustainability measures.</div></div><div><h3>Results</h3><div>Disparities were found in integrating planetary health into medical education among surveyed schools. While some topics like \"the effect of extreme heat and pollution on health\" were commonly integrated, critical topics such as \"the carbon footprint of healthcare systems\" were often overlooked. Limited interdisciplinary research and community engagement were noted, with insufficient support for student initiatives. However, all schools showed progress in campus sustainability. The National Medical Commission’s curriculum includes only limited content on planetary health. The absence of dedicated coursework and inconsistent implementation has resulted in uneven integration across the country, with much of it depending on individual faculty initiatives.</div></div><div><h3>Conclusion</h3><div>Recommendations include developing dedicated coursework with clear learning outcomes, promoting planetary health research, organizing outreach activities, making educational materials accessible, supporting student initiatives, and enhancing campus sustainability. These recommendations aim to equip future healthcare professionals with the knowledge and skills to address the relationship between human health and planetary well-being, fostering a sustainable healthcare system in India.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100481"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556615","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":"Heat stress risk assessment of farmers working in a hot environment: What about in Zambia?","authors":"Anayawa Nyambe ,&nbsp;Edwell S Mwaanga ,&nbsp;Allan Mayaba Mwiinde ,&nbsp;Charles Michelo","doi":"10.1016/j.joclim.2025.100457","DOIUrl":"10.1016/j.joclim.2025.100457","url":null,"abstract":"<div><h3>Introduction</h3><div>Farmers are vulnerable to heat stress due to the nature of their work and the environment. This cross-sectional study aimed to assess the heat stress risk among rural farmers in the Monze and Sioma districts of Zambia.</div></div><div><h3>Method</h3><div>Wet Bulb Globe Temperature (WBGT) readings were taken by trained farmers to assess environmental heat stress risk. Additionally, structured questionnaires on heat stress risk at the workplace were used to assess the personal experience of 200 farmers from September to November 2021.</div></div><div><h3>Results</h3><div>Male (<em>n</em> = 92) and female (<em>n</em> = 108) respondents had a mean age of 45.4 years (<em>SD</em> = 13.75) with 97.5 % of respondents being crop farmers. WBGT readings of greater than 28 °C, which is considered an upper heat stress risk threshold for a heavy workload, were recorded. Results revealed 62.5 % of the farmers were at risk of developing heat stress, with multiple factors emerging as potential contributors to the risk.</div></div><div><h3>Conclusions</h3><div>There is a growing heat stress risk among farmers in Monze and Sioma, along with a need to investigate heat stress effects on productivity and specific drivers of heat stress that consider differential geographical and population demographic variations. Climate adaptive and mitigative measures, including Indigenous knowledge-based approaches used by communities in rural area's should be assessed.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100457"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The spread of infectious diseases in migration routes between caravans and resident communities: Modelling yellow fever in Central America","authors":"Sabrina Soares Simon ,&nbsp;Marcos Amaku ,&nbsp;Eduardo Massad","doi":"10.1016/j.joclim.2025.100473","DOIUrl":"10.1016/j.joclim.2025.100473","url":null,"abstract":"<div><h3>Introduction</h3><div>Climate-sensitive diseases are significantly affected by weather patterns and the social consequences of a changing climate. In this context, epidemics and human mobility can interact, leading to unpredictable impacts on both human and planetary health.</div></div><div><h3>Methods</h3><div>To investigate the impact of yellow fever (YF) vaccination in the context of an outbreak and its association with migration, we use a SEIRV-SEI compartmental deterministic model for humans and vectors and numerical simulations applied to three coupled populations - caravans, endemic and disease-free communities. Two scenarios are evaluated with different vaccination coverage levels at endemic communities and in caravans.</div></div><div><h3>Results</h3><div>When communities endemic to YF are the source of migration, herd immunity is critical, but vaccinating caravans is by far the most significant intervention to protect migrants and disease-free communities upwards from the risk of YF introduction.</div></div><div><h3>Conclusion</h3><div>Preventing outbreaks of climate-sensitive infectious diseases in the context of migration must be a joint effort of common interest. Maintaining vaccination coverage at recommended levels combined with the continued effort to vaccinate people on the move is the only intervention that can prevent a health crisis. Therefore, vaccination against climate-sensitive diseases should be considered climate adaptation.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100473"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587746","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":"“Beyond the flood: Exploring the psychosocial consequences and resilience challenges in the aftermath of “El Niño” in Tumbes, Peru”","authors":"Elaine C. Flores ,&nbsp;Daniela C. Fuhr ,&nbsp;Victoria Simms ,&nbsp;Andres G. Lescano ,&nbsp;Nicki Thorogood","doi":"10.1016/j.joclim.2025.100477","DOIUrl":"10.1016/j.joclim.2025.100477","url":null,"abstract":"<div><h3>Background</h3><div>El Niño's impacts on health are widespread, but evidence of its psychosocial effects on historically affected communities is limited. We aimed to describe perceived mental health impacts, local barriers to psychological well-being, and challenges in accessing support post-El Niño in Tumbes, Peru.</div></div><div><h3>Methods</h3><div>Between May-June 2017, we conducted 27 semi-structured interviews and three focus groups in Spanish with 24 adult residents, including local authorities and residents from heavily and minimally El Niño affected areas. Data were analyzed thematically.</div></div><div><h3>Results</h3><div>Initially, participants minimized El Niño's mental health impact, claiming to be \"accustomed\" to it. However, most described specific cases of suffering, including socioeconomic struggles, feelings of lack of support, unfairness, and helplessness. Local authorities acknowledged inadequate support availability. Psychosocial distress was exacerbated by poverty, scarce work opportunities, and disproportionate effects on vulnerable groups. Contextual factors like corruption, underfunding of prevention, and lack of reconstruction led to despair and distrust of authorities. Participants identified responsibility gaps at different levels but rarely acknowledged their responsibility or suggested alternatives. Psychosocial problems, therapy availability, or community support programs were seldom mentioned, though mutual collaboration was highlighted as useful but non-existent.</div></div><div><h3>Conclusions</h3><div>We found multiple interrelated issues in under-resourced post-disaster communities, highlighting the psychological burden of living \"between disasters\" and how socioeconomic distress and lack of support contribute to suffering. Beyond emergency aid, these communities require integrated care considering contextual and community-level distress, improving access to prevention and reconstruction activities, and addressing ongoing anxiety about future disasters to foster long-term resilience.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100477"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335812","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":"Preemptive hospital evacuation during the 2021 European floods: A qualitative study on factors influencing decision-making","authors":"Willemijn vd Wal ,&nbsp;Dennis G. Barten ,&nbsp;Linsay Ketelings ,&nbsp;Frits H.M. van Osch ,&nbsp;Madhura Rao ,&nbsp;Luc Mortelmans ,&nbsp;Joost Bierens","doi":"10.1016/j.joclim.2025.100460","DOIUrl":"10.1016/j.joclim.2025.100460","url":null,"abstract":"<div><h3>Introduction</h3><div>In July 2021, several European countries were affected by severe floods, with water levels of the river Meuse reaching a record high. It was decided to completely evacuate VieCuri Medical Center (Venlo, The Netherlands), a hospital located directly adjacent to this river. The aim of this study was to explore the decision-making process of this emergency hospital evacuation.</div></div><div><h3>Methods</h3><div>This descriptive qualitative study assessed factors influencing the decision-making process of this hospital evacuation. Data were collected through semi-structured interviews with 11 key stakeholders. Data were analyzed by reflexive thematic analysis.</div></div><div><h3>Results</h3><div>Three themes were constructed from the interviews: risk-assessment and estimation; prior experience; and prerequisites for evacuation. The decision to evacuate was made when there was uncertainty regarding maximum water level forecasts. Therefore, the risks of a hospital evacuation were balanced against the risk of the loss of essential services in case of a dike breach. Prior experiences with crises played a major role, and the use of a national patient coordination center (NPCC), which was established during the COVID-19 pandemic, enabled rapid assessment of the capacity of destination hospitals and facilitated patient transfers. It was determined that prerequisites for evacuation include clear evacuation guidelines, concise communication and collaboration.</div></div><div><h3>Conclusion</h3><div>The decision to evacuate was made when there was uncertainty regarding maximum expected water levels, while administrators balanced the risk of hospital evacuation against the risk of essential services failure in case of a dike breach. Prior experience with crises and the availability of a NPCC were decisive factors in this evacuation procedure. The NPCC allowed for swift identification of available capacity in appropriate destination hospitals.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100460"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329771","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":"Practical tools to align planetary health objectives within the current Liaison Committee on Medical Education accreditation Process","authors":"Elizabeth Gillespie ,&nbsp;Cecilia Sorensen ,&nbsp;Sheetal Rao ,&nbsp;Arnab K. Ghosh ,&nbsp;Holly Rosencranz ,&nbsp;Joanne Bernstein ,&nbsp;Barbara Erny ,&nbsp;Rebecca Philipsborn","doi":"10.1016/j.joclim.2025.100468","DOIUrl":"10.1016/j.joclim.2025.100468","url":null,"abstract":"<div><div>The preparedness of health professionals to address the climate crisis is increasingly important for the health and well-being of society at large. As society grapples with mounting health consequences of a changing climate, the crisis also presents an opportunity to emphasize planetary health principles in medicine and care delivery. The preparedness of physicians to address climate change and apply principles of planetary health will shape strategies to optimize individual and population health, healthcare delivery, and the health sector. The Liaison Committee on Medical Education (LCME) accreditation standards do not currently reference climate change nor planetary health explicitly. LCME has a vested interest in improving physician workforce preparedness to meet the needs of patients and society, and consideration of climate change and planetary health in these standards is an important future step for LCME. In the meantime, the current accreditation standards offer some opportunity for students and faculty to align curricular efforts or initiatives on climate change and planetary health at their institution. The authors present practical tools highlighting multiple avenues for integrating planetary health concepts into medical education such as sustainability, resilience, and curriculum. Using existing LCME standards and data collection instruments, the authors showcase how medical students, instructors, and other leaders can incorporate planetary health concepts into the accreditation process. This approach aims to leverage accreditation to advocate for planetary health efforts and build momentum for grassroots policy change within physician training programs.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100468"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322241","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":"Climate cafés as a space for navigating climate emotions: A scoping review","authors":"Anna De Jong ,&nbsp;Susan Harris ,&nbsp;Christy Costanian ,&nbsp;Harvey Skinner","doi":"10.1016/j.joclim.2025.100466","DOIUrl":"10.1016/j.joclim.2025.100466","url":null,"abstract":"<div><h3>Introduction</h3><div>Climate change poses significant physical health risks, while its mental and emotional impacts are increasingly being recognized and researched. Although Climate Cafés have emerged as community-led interventions offering spaces to discuss climate-related thoughts and feelings, there is a paucity of literature describing their utility and impact. This scoping review maps the existing landscape of Climate Cafés and assesses their role in addressing climate-induced distress, and motivating action.</div></div><div><h3>Methods</h3><div>A literature review was conducted using academic literature published between 2015 and 2024 from the MEDLINE, PsychINFO, Public Health Database, and Web of Science databases. A grey literature search was also undertaken to capture information not published in the academic literature.</div></div><div><h3>Results</h3><div>No academic literature met inclusion criteria while the grey literature yielded 41 records. The grey literature depicted Climate Cafés as flexible, community-driven spaces for individuals to express and process emotions related to climate change. Programs varied: some were action-free spaces focused on emotional support while others promoted climate action. Participant feedback indicated reduced isolation, decreased anxiety, and increased hopefulness after attending sessions. Challenges identified include issues with inclusivity for marginalized communities, cultural barriers, logistical difficulties, and a lack of standardized evaluation methods.</div></div><div><h3>Conclusions</h3><div>Climate Cafés represent a promising yet under-researched approach to addressing the emotional impacts of climate change. Further research is needed to evaluate the effectiveness of Climate Cafés, which could inform their integration into strategies to support both individual well-being and community resilience.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"24 ","pages":"Article 100466"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322240","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":"Developing a climate change health literacy scale: A methodological study in Turkish adults","authors":"Tufan Nayir ,&nbsp;Ersin Uskun ,&nbsp;Huseyin Ilter ,&nbsp;Secil Ozkan ,&nbsp;Emine Didem Evci Kiraz","doi":"10.1016/j.joclim.2025.100451","DOIUrl":"10.1016/j.joclim.2025.100451","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to develop a valid and reliable measurement tool assessing attitudes and behaviors of individuals aged 18 and above regarding the health impacts of climate change, supporting existing literature, field studies, and climate change mitigation efforts.</div></div><div><h3>Methods</h3><div>In this methodological study, the \"Climate Change Health Literacy Scale (CCHLS)\" item pool was created, followed by content validity testing and validity and reliability analyses of the 31-item scale based on expert opinions. The scale was administered to 318 adults, revealing a four-factor structure with 24 items and explaining 67.03 % of the total variance through exploratory and confirmatory factor analyses.</div></div><div><h3>Results</h3><div>Confirmatory factor analysis indicated acceptable goodness-of-fit values (χ²/sd=2.31, RMSEA=0.06, CFI=0.94, SRMR=0.04). The Cronbach's alpha coefficient was 0.94 for the entire scale, and sub-dimensions ranged from 0.75 to 0.93, indicating high reliability. Differentiation assessment between groups with the highest and lowest 27 % scores confirmed the discriminative and valid nature of all scale items, with no observed floor or ceiling effects.</div></div><div><h3>Conclusions</h3><div>CCHLS, which was developed in Turkish and analyzed in Turkiye to assess adults' attitudes and behaviors towards climate change, is a valid and reliable tool, and its translation into other languages and dissemination will support individuals in society in assessing their knowledge and increasing their awareness about the effects of climate change on health.</div></div>","PeriodicalId":75054,"journal":{"name":"The journal of climate change and health","volume":"23 ","pages":"Article 100451"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168026","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}