Urogynecology (Hagerstown, Md.)最新文献

{"title":"G2211 Coding Guidance in Urogynecology: Developed by the AUGS Coding Committee.","authors":"Mamta M Mamik, Jameca R Price","doi":"10.1097/SPV.0000000000001689","DOIUrl":"10.1097/SPV.0000000000001689","url":null,"abstract":"","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"557-558"},"PeriodicalIF":0.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782138","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":"Smoking's Impact on 30-Day Complications in Mesh and Nonmesh Prolapse Surgery.","authors":"Tara D Marczak, Mallika Anand, Yi Hsieh, Ayodele Ajayi, Michele R Hacker, William D Winkelman","doi":"10.1097/SPV.0000000000001658","DOIUrl":"10.1097/SPV.0000000000001658","url":null,"abstract":"<p><strong>Importance: </strong>Tobacco smoking is linked to poor surgical outcomes, leading many physicians to avoid synthetic implants like mesh in smokers due to concerns about impaired healing. While long-term outcomes for smokers have been studied, the effect of smoking on 30-day postoperative complications, especially related to surgical mesh, is less understood.</p><p><strong>Objectives: </strong>This study aimed to quantify the association between tobacco smoking and risk of postoperative infection, readmission, and reoperation within 30 days of minimally invasive apical prolapse repair. We also examined whether these associations differed based on whether mesh was used.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database for patients who underwent minimally invasive apical pelvic organ prolapse repair from 2012 to 2022. Smoking in the last year was the exposure. Outcomes included postoperative infection, unplanned readmission, and reoperation within 30 days. We calculated adjusted risk ratios for complications and stratified results based on mesh use.</p><p><strong>Results: </strong>Of 67,235 cases, 5,518 (8.2%) patients smoked in the past year. Smokers had a significantly higher likelihood of infection and unplanned readmission. Smoking did not increase the risk of unplanned reoperation. The association between smoking and 30-day complications did not differ based on mesh use (all P for interaction ≥0.24).</p><p><strong>Conclusions: </strong>Tobacco use was associated with an increase in postoperative complications within 30 days, though the absolute risk was low. There was no evidence of effect modification by mesh use; suggesting that mesh-augmented repairs could be considered in smokers who receive appropriate counseling.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"597-603"},"PeriodicalIF":0.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061722","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":"Adverse Events Associated With Female External Urinary Collection Devices.","authors":"Mahgol Golshani, Aaron Tverye, Taylor Bate, Jennifer T Anger, Colby P Souders","doi":"10.1097/SPV.0000000000001656","DOIUrl":"10.1097/SPV.0000000000001656","url":null,"abstract":"<p><strong>Importance: </strong>Female external urinary collection devices were designed with the goal of decreasing the risk of catheter-associated urinary tract infections, which can have significant clinical complications. The BD PureWick urinary collection system, C. R. Bard, Inc., a wholly owned subsidiary of BD, Franklin Lakes, NJ, was the first device to enter the market and has had a widespread distribution. There is a lack of clinical data evaluating the safety of the PureWick device.</p><p><strong>Objectives: </strong>This study aimed to evaluate adverse events associated with the PureWick device using reports from the U.S. Food and Drug Administration Manufacturer and User Device Experience database.</p><p><strong>Study design: </strong>A retrospective case series was conducted of adverse events from the database, which includes the adverse events and patient demographics from mandatory and voluntary reporters. Grounded theory was applied, utilizing inductive reasoning to identify salient keywords in the analysis of adverse events.</p><p><strong>Results: </strong>A total of 1,406 reports were submitted to the database from January 2016 to October 2023, with each report having at least 1 adverse event complaint. Report complaints were classified by patient injury (n = 1412, 67.6%), device malfunction (n = 459, 22.1%), user error (n = 125, 6.0%), device instructions (n = 83, 4.0%) and death (n = 6, 0.29%). Salient keywords include urinary tract infection, skin irritation, and device leakage.</p><p><strong>Conclusions: </strong>There are adverse events associated with the PureWick external urinary collection device in reports from the U.S. Food and Drug Administration database. These findings warrant additional studies to assess the safety of the PureWick for patients using the device in the hospital and at home.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"590-596"},"PeriodicalIF":0.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412064","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":"Black and Hispanic Women's Views on LUTS Treatment and a Home-Based Intervention.","authors":"Oluwateniola Brown, Eloisa Serrano, Julia Geynisman-Tan, Melissa Simon, James W Griffith, Kimberly Kenton","doi":"10.1097/SPV.0000000000001699","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001699","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to examine facilitators and barriers to treatment for lower urinary tract symptoms among care-seeking Black and Hispanic women and to explore perspectives on \"SUPPORT,\" a self-directed, 8-week, home-based intervention combining education, bladder retraining, pelvic floor muscle training, and cognitive behavior therapy.</p><p><strong>Study design: </strong>This was a qualitative observational study. We recruited a convenience sample of care-seeking women with lower urinary tract symptoms who self-identified as Black race or Hispanic ethnicity and were English or Spanish speaking. We conducted focus groups in the participants' primary language. Two authors analyzed the focus group transcripts using modified grounded theory techniques.</p><p><strong>Results: </strong>We enrolled 27 participants and conducted 7 focus groups. There were 13 non-Hispanic Black and 14 Hispanic participants. The mean ± SD age of the cohort was 49 ± 14 years. Barriers reported by both Black and Hispanic participants included (1) unfamiliarity with treatment options and negative perceptions of procedural treatments, (2) unsatisfactory interactions with the health care team, (3) travel distance for treatment, and (4) resources. Barriers distinct to Spanish-speaking and Black participants were inadequate interpreter services and feeling blocked from accessing care by clinic staff, respectively. Facilitators of treatment included (1) patient-centered clinical environments, (2) streamlined financial assistance services, and (3) shared treatment decision making. Most participants found the SUPPORT intervention concept promising for reducing psychosocial stress related to lower urinary tract symptoms and potentially overcoming various barriers to treatment.</p><p><strong>Conclusion: </strong>Participants reported multilevel barriers to lower urinary tract treatments. The concept of the SUPPORT intervention was acceptable to participants and may overcome barriers to treatment.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201037","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":"Evaluation of Incontinence Program Implemented Virtually Versus In-Person.","authors":"Madeline K Moureau, Zoe A Rozema, Heidi W Brown","doi":"10.1097/SPV.0000000000001698","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001698","url":null,"abstract":"<p><strong>Importance: </strong>Mind Over Matter: Healthy Bowels, Healthy Bladder (Mind Over Matter) is a small-group behavioral management program with proven effectiveness to improve continence in women 50 years and older when implemented in person. To preserve access to the program during the COVID-19 pandemic, community organizations shifted to virtual implementation without evidence to support its effectiveness in that format.</p><p><strong>Objectives: </strong>This study aimed to characterize participants reached by virtual versus in-person implementation of Mind Over Matter and to compare their symptom improvement and program satisfaction.</p><p><strong>Study design: </strong>We performed a retrospective analysis of pretest and posttest evaluation surveys completed by program participants between April 2019 and December 2021.</p><p><strong>Results: </strong>Data were available for 708 participants (481 in-person, 227 virtual), most of whom identified as non-Hispanic White, with a mean age of 74 ± 9 years. Virtual participants were younger (73 vs 75 years, P = 0.031) and were more likely to live alone (66% vs 54%, P = 0.011), have a bachelor's or graduate degree (53% vs 44%, P = 0.006), and have help around the house (93% vs 85%, P = 0.007). Urinary incontinence improved in both virtual and in-person participants; virtual participants also had a significant improvement in fecal incontinence. Overall program satisfaction was high, but virtual participants were less likely (55% vs 63%, P = 0.031) to feel completely satisfied.</p><p><strong>Conclusions: </strong>Virtual implementation of Mind Over Matter achieved similar symptom improvement and program satisfaction to in-person implementation. However, those without some college and those who do not identify as non-Hispanic White were unlikely to be reached by either format.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121649","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":"Initiation and Utilization of Psychotherapy in Women With Overactive Bladder.","authors":"Sarah E S Jeney, Cassie B Ford, Jennifer M Wu, David Sheyn, W Thomas Gregory","doi":"10.1097/SPV.0000000000001696","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001696","url":null,"abstract":"<p><strong>Importance: </strong>The incidence of and factors associated with psychotherapy use in women with overactive bladder are unknown.</p><p><strong>Objectives: </strong>The primary objectives of this study were to determine the incidence of psychotherapy initiation after overactive bladder diagnosis in female Medicare beneficiaries and to analyze clinical and sociodemographic factors associated with initiation of psychotherapy within 3 years from overactive bladder (OAB) diagnosis.</p><p><strong>Study design: </strong>This was a retrospective cohort study of women diagnosed with OAB between the years 2011 and 2021 using the Medicare 5% Limited Data Set. International Classification of Diseases codes were used to identify women with OAB, and from that cohort, Current Procedural Terminology codes were used to identify incident use of psychotherapy within 5 years from OAB diagnosis. Cox proportional hazards models were used to evaluate clinical and sociodemographic factors associated with the use of psychotherapy. Logistic regression was used to evaluate clinical and sociodemographic factors associated with high (≥10 sessions) versus low (<10 sessions) utilization of psychotherapy.</p><p><strong>Results: </strong>There were 374,918 women who met the inclusion criteria for OAB diagnosis; of these, 28,571 (8.7%) attended at least 1 psychotherapy session within 5 years. Factors associated with the increased use of psychotherapy included dual Medicaid/Medicare status (adjusted odds ratio [aOR] 1.26 [1.21, 1.31]), living in the Northeast (vs South) (aOR 1.26 [1.21, 1.31]), being diagnosed with anxiety or depression (aOR 5.14 [5.01, 5.26]), alcohol or drug abuse (aOR 1.66 [1.57, 1.75]), and increasing Charlson comorbidity score (aOR 1.03 [1.03, 1.04]).</p><p><strong>Conclusions: </strong>Psychotherapy use in older women with OAB is not rare. Demographic factors and psychiatric comorbidities affect the likelihood of psychotherapy use in this population.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045799","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":"Reducing Waste During Midurethral Slings: A Quality Improvement Initiative.","authors":"Sarah Ashmore, C Emi Bretschneider, Oluwateniola Brown, Kimberly Kenton, Margaret Mueller, Julia Geynisman-Tan","doi":"10.1097/SPV.0000000000001695","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001695","url":null,"abstract":"<p><strong>Importance: </strong>The health care industry accounts for 8.5% of U.S. greenhouse gas emissions, with operating rooms being key contributors.</p><p><strong>Objective: </strong>The objective of this study was to decrease surgical waste during synthetic midurethral sling (MUS) surgical procedures.</p><p><strong>Study design: </strong>A quality improvement initiative was implemented to decrease the amount of MUS surgical waste. Waste audits were performed during 20 isolated MUS surgical procedures. Used and unused disposable items and nondisposable instruments were documented from the original packs/trays. All disposable waste was weighed after the completion of each procedure. The utilization rate of each instrument and item were determined. The MUS surgical tray was then updated, and a custom MUS surgical pack was created to include items with a utilization rate >20%. The primary and secondary outcome was the amount of waste generated and health care savings, respectively.</p><p><strong>Results: </strong>A total of 10 of 21 nondisposable instruments on the surgical tray and 7 of 26 disposable items from the surgical pack had a utilization rate <20% during the initial waste audits. There were 12 of 15 added disposable items that had a utilization rate >20%. Preaudit, median weight of waste per case was 5.6 kg. After updating the MUS surgical trays and packs, median weight of waste per case decreased to 4.9 kg (P = 0.04). On average, $348.93 was saved per case after creation of custom surgical packs that included disposable items specific to MUS surgical procedures.</p><p><strong>Conclusion: </strong>A waste audit with pack updates and health care team education significantly reduced the amount of waste and cost generated during MUS surgery.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of a Novel Device for Stress Incontinence.","authors":"Christina Escobar, Eric R Sokol, Nirit Rosenblum, Douglas Milikien, Karolynn Echols","doi":"10.1097/SPV.0000000000001676","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001676","url":null,"abstract":"<p><strong>Importance: </strong>There is a need for safe and efficacious nonsurgical options for women with stress urinary incontinence (SUI).</p><p><strong>Objective: </strong>This study compared the safety and efficacy of Yōni.Fit, a novel intravaginal insert, with a sham device in treating women's SUI.</p><p><strong>Study design: </strong>In a multicenter, single-blind, randomized, sham-controlled trial, women with SUI for ≥3 months with a positive cough stress test result were enrolled. Participants, using either Yōni.Fit or a sham device, self-fitted from 6 sizes wore the insert daily for 12 hours. The primary outcome was responder rate defined as a ≥ 50% reduction in pad weights. Secondary endpoints were change in pad weight, frequency of SUI episodes, Patient Global Impression of Change, Incontinence-Quality of Life Assessment, proportion of pad dry days, and Usefulness, Satisfaction, and Ease of Use Questionnaire.</p><p><strong>Results: </strong>Fifty-six women completed the treatment phase. The responder rate based on pad weights was higher for Yōni.Fit (53.0% vs 23.3%, P = 0.013). Among Yōni.Fit participants, a greater proportion achieved SUI responder status compared to sham (96.3% vs 27.2%, P < 0.001). Participants using Yōni.Fit rated it higher in usefulness than sham (5.95 vs 4.13, P = 0.008). Although the adverse event rate was 54.8% in Yōni.Fit and 29.6% in sham, most adverse events were mild, with vaginal discomfort reported as most common.</p><p><strong>Conclusions: </strong>Yōni.Fit significantly reduced pad weights and SUI events and was evaluated as more useful when compared to sham. Although adverse events were higher with Yōni.Fit, they were generally mild. Further research is necessary to evaluate long-term safety and efficacy.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060763","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":"Clinical Tools to Diagnose Frailty in Women With Geriatric Urinary Incontinence.","authors":"Mary Namugosa, Christina Mezes, Anita Rong, Timothy Craven, Jesseca Crawford, Candace Parker-Autry","doi":"10.1097/SPV.0000000000001692","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001692","url":null,"abstract":"<p><strong>Importance: </strong>Establishing an efficient and accurate frailty measure in older women with bothersome urinary incontinence (UI) is necessary because frailty increases the risk of UI treatment failure and postoperative morbidity.</p><p><strong>Objective: </strong>This study aimed to primarily observe associations between the clinical frailty measure of gait speed and the electronic frailty index (eFI) to determine if the eFI may be a proxy in determining presence of frailty in older women with moderate-to-severe UI symptoms.</p><p><strong>Study design: </strong>This was a secondary data analysis of a prospective cohort study of women, older than 70 years, seeking treatment for UI between 2016 and 2023. Participants underwent functional geriatric assessment to determine 4-m gait speed, chair stand pace, and UI symptom assessment. Participants with ≥2 UI episodes per day defined severe UI symptoms present with geriatric UI. Those with <2 UI episodes per day defined controls. Univariate analyses compared clinical and functional characteristics based on UI severity. Spearman rank correlated the association between the eFI, UI severity, and functional geriatric impairments. Logistic regression analyses determined the odds of having severe UI based on eFI frailty risk, adjusted for age and body mass index (BMI).</p><p><strong>Results: </strong>Eighty-one participants were included. The eFI was negatively correlated with gait speed ([r] = -0.29, P = 0.02) and did not correlate with chair stand pace. The eFI did not correlate with UI severity ([r] = 0.05, P = 0.74). The odds of having severe UI and at least mild frailty risk based on the eFI was OR of 1.15 (95% CI, 0.71-1.88]).</p><p><strong>Conclusion: </strong>The eFI may have limited clinical utility in frailty risk assessment in women with geriatric UI.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial for Dual-Agent Local Analgesic in Sling Surgery.","authors":"Mildrede N Bonglack, Marlana M Ray, Meredith H Carrel-Lammert, Kelsey E Lewis, Jennifer Yeung, Jonathan M Hoehn, Rachel N Pauls, Catrina C Crisp","doi":"10.1097/SPV.0000000000001691","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001691","url":null,"abstract":"<p><strong>Importance: </strong>Narcotic use after retropubic suburethral sling surgery is not unusual. Surgeons may consider using topical analgesics to minimize narcotic use.</p><p><strong>Objectives: </strong>The aim of the study was to determine if using bupivacaine-meloxicam (Zynrelef) reduces narcotic use in the first 3 days after surgery, measured as morphine milligram equivalents (MME). Secondary aims were to compare, postoperatively, average and worst pain, satisfaction with pain control and quality of recovery between groups.</p><p><strong>Study design: </strong>This was a single-center prospective single-blinded randomized controlled trial for women undergoing retropubic sling surgery. The intervention arm received Zynrelef at the suprapubic incisions, no placebo was used in controls. Participants tracked pain levels, medication use, satisfaction with pain control and Quality of Recovery surveys in the first 3 postoperative days. Appropriate statistical analyses were applied.</p><p><strong>Results: </strong>A total of 119 women were randomized. For primary outcome, totalmedian MME from postoperative days 0-3, the control group used 37.5 MME compared to 30 MME in the Zynrelef group (interquartile range [IQR] 5.63-71.25; P = 0.61). Pain scores were low in both groups, participants were satisfied or very satisfied with pain control. Quality of recovery scores were similar between groups, with improvement by postoperative day 3 to near baseline scores. Patients with anxiety/depression used more oxycodone; 10 mg (IQR 0-30) vs 0 mg (IQR 0-15), P = 0.0027.</p><p><strong>Conclusions: </strong>Use of Zynrelef during retropubic sling surgery does not reduce narcotic use in the first 3 days postoperatively. Patients can be reassured that pain and narcotic use after surgery are low and recovery is quick.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812970","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}