Mary S. Kim MD , Aleksandra Sarcevic PhD , Genevieve J. Sippel BA , Kathleen H. McCarthy BS , Eleanor A. Wood BSE , Carmen Riley , Aaron H. Mun BS , Karen J. O’Connell MD, MEd , Peter T. LaPuma PhD, CIH, PE , Randall S. Burd MD, PhD
{"title":"Factors associated with correction of personal protective equipment nonadherence in a multidisciplinary emergency department setting: A retrospective video review","authors":"Mary S. Kim MD , Aleksandra Sarcevic PhD , Genevieve J. Sippel BA , Kathleen H. McCarthy BS , Eleanor A. Wood BSE , Carmen Riley , Aaron H. Mun BS , Karen J. O’Connell MD, MEd , Peter T. LaPuma PhD, CIH, PE , Randall S. Burd MD, PhD","doi":"10.1016/j.ajic.2024.08.001","DOIUrl":"10.1016/j.ajic.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Despite local and national recommendations, health care provider adherence to personal protective equipment (PPE) varied during the COVID-19 pandemic. Previous studies have identified factors influencing initial PPE adherence but did not address factors influencing behaviors leading to correction after initial nonadherence.</div></div><div><h3>Methods</h3><div>We conducted a retrospective video review of 18 pediatric resuscitations involving aerosol-generating procedures from March 2020 to December 2022 to identify factors associated with nonadherence correction. We quantified adherent and nonadherent providers, instances of PPE nonadherence, and time to correction. We also analyzed correction behaviors, including provider actions and correction locations.</div></div><div><h3>Results</h3><div>Among 434 providers, 362 (83%) were nonadherent with at least 1 PPE. Only 186 of 1,832 instances of nonadherence were corrected, primarily upon room entry and during patient care. Correction time varied by PPE type and nonadherence level (incomplete vs absent). Most corrections were self-initiated, with few reminders from other providers.</div></div><div><h3>Discussion</h3><div>Potential barriers to correction include a lack of social pressure and external reminders. Solutions include optimizing PPE availability, providing real-time feedback, and educating on double gloving.</div></div><div><h3>Conclusions</h3><div>Most providers were nonadherent to PPE requirements during high-risk infection transmission events. The low correction rate suggests challenges in promoting collective responsibility and maintaining protective behaviors during medical emergencies.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 1","pages":"Pages 30-35"},"PeriodicalIF":3.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isadora Caixeta da Silveira Ferreira , Izabella Clara de Brito Machado , Ralciane de Paula Menezes , Thiago Alves de Jesus , Mallu Santos Mendonça Lopes , Lúcio Borges de Araújo , Daniela Marques de Lima Mota Ferreira , Denise Von Dolinger de Brito Röder
{"title":"Challenges and trends in Gram-negative bacterial infections in critically neonates: A seven-and-a-half-year observational study","authors":"Isadora Caixeta da Silveira Ferreira , Izabella Clara de Brito Machado , Ralciane de Paula Menezes , Thiago Alves de Jesus , Mallu Santos Mendonça Lopes , Lúcio Borges de Araújo , Daniela Marques de Lima Mota Ferreira , Denise Von Dolinger de Brito Röder","doi":"10.1016/j.ajic.2024.08.004","DOIUrl":"10.1016/j.ajic.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Analyze the incidence, risk factors, and fatality rates of bloodstream infections by Gram-negative bacteria (GNB-BSIs) in a Neonatal Intensive Care Unit.</div></div><div><h3>Methods</h3><div>This study employs a retrospective cohort design utilizing records of neonates admitted to the Neonatal Intensive Care Unit between January 2015 and June 2022.</div></div><div><h3>Results</h3><div>Among 1,495 neonates, 5.2% developed GNB-BSIs. The average incidence of infection per 1,000 patient-days was 2.9. Primary risk factors for infection that included preceeding carbapenem use were significant risk factors (odds ratio<!--> <!-->=<!--> <!-->514.4; <em>P</em> < .01) and fourth-generation cephalosporins (odds ratio<!--> <!-->=<!--> <!-->66; <em>P</em> < .01). Among the 85 GNB, 75.3% were fermenters, and 24.7% were non-fermenters. Of the isolates, 14.1% produced extended-spectrum beta-lactamase, and 2.3% carbapenem-resistant. Infection correlated with prolonged hospital stays (10-39<!--> <!-->days) and increased mortality (10%-29.9%).</div></div><div><h3>Conclusions</h3><div>The high incidence of GNB-BSIs was exacerbated by the preceeding use of broad-spectrum antimicrobials, increasing the presence of multidrug-resistant isolates and fatality rates. These findings emphasize the importance of active surveillance.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 1","pages":"Pages 13-21"},"PeriodicalIF":3.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ivan Gilberto Macolla Bazan MD , Barbara Barros Pereira Lobo MD , Angelica Zaninelli Schreiber PhD , Roseli Calil PhD , Sergio Tadeu Martins Marba PhD , Jamil Pedro de Siqueira Caldas PhD
{"title":"Long-lasting effects of control measures on trends in incidence in neonatal late-onset sepsis due to multiresistant bacteria in a Brazilian neonatal unit","authors":"Ivan Gilberto Macolla Bazan MD , Barbara Barros Pereira Lobo MD , Angelica Zaninelli Schreiber PhD , Roseli Calil PhD , Sergio Tadeu Martins Marba PhD , Jamil Pedro de Siqueira Caldas PhD","doi":"10.1016/j.ajic.2024.08.007","DOIUrl":"10.1016/j.ajic.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><div>In response to a 1995 outbreak of sepsis caused by multidrug-resistant (MR) Gram-negative bacteria (GNB), a Brazilian level III neonatal unit established a series of control and prevention measures. This study evaluated the long-term effects of these measures on late-onset neonatal sepsis (LONS) caused by MR bacteria from 2000 to 2020 and examined their impact on in-hospital mortality.</div></div><div><h3>Methods</h3><div>Newborns with LONS and positive cultures for <em>Staphylococcus aureus</em>, GNB, and <em>Enterococcus sp</em> were selected, adhering to Center for Desease Control and Prevention and local criteria. Joinpoint regression analysis was used to assess annual trends.</div></div><div><h3>Results</h3><div>Over the 21-year period, the overall LONS rate was 4.6%, showing a significant decline from 2000 to 2016 (<em>P</em> < .0001, slope -0.36). However, from 2016 to 2020, there was a non-significant increase in sepsis rates (slope +0.92, <em>P</em> = .08). MR sepsis were in 15.8% of sepsis cases and displayed a non-significant upward trend (slope +0.50, <em>P</em> = .08) with no major shifts. In-hospital mortality rates for MR and non-MR LONS showed no significant differences (<em>P</em> = .413).</div></div><div><h3>Discussion</h3><div>The study indicates a low prevalence of MR sepsis due to effective antimicrobial use and educational interventions.</div></div><div><h3>Conclusions</h3><div>MR sepsis prevalence remained low and stable, not increasing in-hospital mortality.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 1","pages":"Pages 22-29"},"PeriodicalIF":3.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effectiveness of sensing gloves–applied virtual reality education system on hand hygiene practice: A randomized controlled trial","authors":"Mahiro Izumi , Hideharu Hagiya MD, PhD , Yuki Otsuka MD, PhD , Yoshiaki Soejima MD, PhD , Shinnosuke Fukushima MD, PhD , Mitsunobu Shibata , Satoshi Hirota , Toshihiro Koyama PhD , Fumio Otsuka MD, PhD , Akio Gofuku PhD","doi":"10.1016/j.ajic.2024.08.003","DOIUrl":"10.1016/j.ajic.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>We developed a virtual reality (VR) education system and evaluated its clinical utility for promoting hand hygiene practices.</div></div><div><h3>Methods</h3><div>This prospective, 2-week, randomized controlled study conducted at Okayama University Hospital, Japan, from November 2023 to January 2024, involved 22 participants (18 medical students and 4 residents). A fully immersive 360° VR system (VIVE Pro Eye) using a head-mounted display and sensing gloves was used to develop 3 health care tasks in a virtual patient room—Environmental Cleaning, Gauze Exchange, and Urine Collection. After monitoring all participants' baseline usage data of portable hand-rubbing alcohol in the first week, we randomly assigned them into 1:1 groups (VR training and video lecture groups). The primary outcome was differences in hand-rubbed alcohol use before and after intervention.</div></div><div><h3>Results</h3><div>Before the intervention, alcohol use did not significantly differ between both groups. After the intervention, a significant increase in alcohol use was observed in the VR training group (median: 8.2 g vs 16.2 g; <em>P</em> = .019) but not in the video lecture group.</div></div><div><h3>Conclusions</h3><div>Our immersive 360° VR education system enhanced hand hygiene practices. Infection prevention and control practitioners and digital technology experts must collaborate to advance the development of superior educational devices and content.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 1","pages":"Pages 65-69"},"PeriodicalIF":3.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karen K. Hoffmann MS, BSN, RN , Connie Steed MSN, RN , David Kremelberg PhD, MA , Richard Wenzel MD, MSc
{"title":"Response to the letter to the editor regarding “The efficacy of an alcohol-based nasal antiseptic versus mupirocin or an iodophor for preventing SSIs using a meta-analysis”","authors":"Karen K. Hoffmann MS, BSN, RN , Connie Steed MSN, RN , David Kremelberg PhD, MA , Richard Wenzel MD, MSc","doi":"10.1016/j.ajic.2024.09.018","DOIUrl":"10.1016/j.ajic.2024.09.018","url":null,"abstract":"","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 1","pages":"Pages 172-173"},"PeriodicalIF":3.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Information for Authors","authors":"","doi":"10.1016/S0196-6553(24)00867-8","DOIUrl":"10.1016/S0196-6553(24)00867-8","url":null,"abstract":"","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 1","pages":"Pages A9-A10"},"PeriodicalIF":3.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seyed M. Karimi PhD , Md Yasin Ali Parh MS , Shaminul H. Shakib PhD , Hamid Zarei MS , Venetia Aranha MPH , Angela Graham MPH , Trey Allen PhD , Sirajum Munira Khan MS , Mana Moghadami MD , Demetra Antimisiaris PharmD , William Paul McKinney PhD , Bert Little PhD , YuTing Chen MPH, MS , Taylor Ingram MPH
{"title":"COVID-19 vaccine uptake inequality among older adults: A multidimensional demographic analysis","authors":"Seyed M. Karimi PhD , Md Yasin Ali Parh MS , Shaminul H. Shakib PhD , Hamid Zarei MS , Venetia Aranha MPH , Angela Graham MPH , Trey Allen PhD , Sirajum Munira Khan MS , Mana Moghadami MD , Demetra Antimisiaris PharmD , William Paul McKinney PhD , Bert Little PhD , YuTing Chen MPH, MS , Taylor Ingram MPH","doi":"10.1016/j.ajic.2024.09.007","DOIUrl":"10.1016/j.ajic.2024.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Age, race, ethnicity, and sex are important determinants of coronavirus disease of 2019 (COVID-19) outcomes. Older adults (65 years and older) are at the highest risk of COVID-19 morbidity and mortality. Analyzing their vaccine uptake by subclassifying demographics is rare and can assist vaccination policies. This study investigates COVID-19 dose 1 and 2 vaccine uptakes among them by race, ethnicity, and sex.</div></div><div><h3>Methods</h3><div>Immunization registry data were used to calculate temporal changes in older adults’ COVID-19 vaccine uptake by race, ethnicity, race-sex, and ethnicity-sex in Kentucky’s most populous county, Jefferson County, during the first 6 quarters of the COVID-19 vaccination program.</div></div><div><h3>Results</h3><div>By May 2022, the county’s Asian residents had the highest dose 1 and 2 vaccination rates (97.0% and 80.4%), then White residents (90.0% and 80.2%). Black residents had one of the lowest COVID-19 vaccination rates (87.3% and 77.3%). The rate among Hispanic residents (82.0% and 66.4%) was considerably lower than non-Hispanic residents (90.2% and 80.1%). The rates were consistently lower in males.</div></div><div><h3>Conclusions</h3><div>Racial, ethnic, and sex-based COVID-19 vaccine inequalities were largely maintained during the study period. Vaccine rollout practices and promotional programs should aim to boost the uptake of the COVID-19 vaccination among racial minority and male older adults.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 1","pages":"Pages 115-125"},"PeriodicalIF":3.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer Falgione MPH , Graham M. Snyder MD, SM , Catherine Cannon MSN, BSN , Janina-Marie Huss MBA, CIC, LTC-CIP
{"title":"Assessing COVID-19 transmission risk: Roommate and unit mate exposures at an inpatient behavioral health facility","authors":"Jennifer Falgione MPH , Graham M. Snyder MD, SM , Catherine Cannon MSN, BSN , Janina-Marie Huss MBA, CIC, LTC-CIP","doi":"10.1016/j.ajic.2024.09.003","DOIUrl":"10.1016/j.ajic.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Inpatient psychiatric facilities have an increased risk of infection transmission. This study evaluated the impact of roommate and unit mate exposures on coronavirus disease-2019 (COVID-19) transmission to inform isolation practices.</div></div><div><h3>Methods</h3><div>A single-center retrospective study was conducted among patients hospitalized in an inpatient behavioral health hospital from July 2020 through August 2023. We compared the risk of COVID-19 acquisition after exposure among patients with a contagious roommate versus those exposed to a contagious unit mate.</div></div><div><h3>Results</h3><div>During the study period, the conversion rate was 10.05% overall, 24.4% for roommates, and 9.3% for unit mates; patients exposed to a roommate were at 3.14 times higher odds (95% confidence interval, 1.42-6.92) of acquiring COVID-19 after exposure. On unit-stratified analysis, patients exposed to a roommate on the geropsychiatric unit had the highest risk of postexposure conversion compared with unit mate exposed patients (odds ratio 6.38, 95% confidence interval 1.75-23.22). Logistic regression analysis identified a nonsignificant risk associated with increased time in group therapy.</div></div><div><h3>Conclusions</h3><div>Exposure to a COVID-19-contagious roommate significantly increases the risk of COVID-19 acquisition among exposed patients receiving inpatient psychiatric care. Cohorting contagious and exposed individuals and avoiding multibedded rooms may mitigate COVID-19 transmission risk during psychiatric care.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 1","pages":"Pages 110-114"},"PeriodicalIF":3.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Elimination of an outbreak of carbapenem-resistant Acinetobacter baumannii in a burn unit","authors":"Nancy L. Havill MT(ASCP), MHA, CIC , Monique Samuels BSN, RN, CIC , Anjali Poudyal RN, MPH, CIC , Vineetha Sujanan RN, MSN, CIC , Christina Murdzek M(ASCP), MHS, CIC , Michael J. Aniskiewicz M(ASCP), CIC , Meghan Maloney MPH, CIC , Jacqueline Laird BSN, RN, CNM , Alisa Savetamal MD, FACS","doi":"10.1016/j.ajic.2024.10.002","DOIUrl":"10.1016/j.ajic.2024.10.002","url":null,"abstract":"<div><div>Carbapenem-resistant <em>Acinetobacter baumannii</em> is an opportunistic pathogen which has caused numerous health care-associated outbreaks particularly in intensive care and burn units. We describe an outbreak in a burn unit where 3 patients were identified as being colonized or infected with carbapenem-resistant <em>Acinetobacter baumannii</em>. A multifaceted approach and rapid implementation of infection prevention measures were effective in identification and removal of potential environmental reservoirs resulting in the prevention of further transmission.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 1","pages":"Pages 160-162"},"PeriodicalIF":3.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel Grupel MD , Abraham Borer MD , Riki Yosipovich RN , Ronit Nativ RN, MPH , Orli Sagi PhD , Lisa Saidel-Odes MD
{"title":"A multilayered infection control intervention on carbapenem-resistant Acinetobacter baumannii acquisition: An interrupted time series","authors":"Daniel Grupel MD , Abraham Borer MD , Riki Yosipovich RN , Ronit Nativ RN, MPH , Orli Sagi PhD , Lisa Saidel-Odes MD","doi":"10.1016/j.ajic.2024.08.018","DOIUrl":"10.1016/j.ajic.2024.08.018","url":null,"abstract":"<div><h3>Background</h3><div>Carbapenem-resistant <em>Acinetobacter baumannii</em> (CRAB) causes life-threating hospital-acquired. Due to a limited number of Intensive-Care-Unit (ICU) beds, these patients are often treated in high-dependency (HD) non-ICUs within internal-medicine wards (IMW) in Israel. We aimed to assess the effectiveness of a multilayered infection-control intervention on CRAB infection rate in IMWs, especially in its HD non-ICUs with ongoing CRAB transmission.</div></div><div><h3>Methods</h3><div>A quasi-experimental, before-and-after, interrupted time-series study with control outcomes. We conducted a multilayered intervention over 3.5<!--> <!-->years, which included 4 phases: (1) Pre intervention; (2) Intervention introduction: introduced enhanced environment cleaning; (3) Intervention phase 1: introduced active surveillance; (4) Intervention phase 2: introduced CRAB-positive patient cohorting, in addition to previous ongoing measures taken.</div></div><div><h3>Results</h3><div>CRAB was isolated from 204 patients aged 69.8y/o ± 15.86y, 59.8% male, 34.3% had CRAB-positive clinical samples. Mean hospital length-of-stay was 30.5<!--> <!-->days, with a 30-day postdischarge mortality rate of 55.9%. Mean CRAB clinical cases decreased from 0.89 in preintervention to 0.11 at the end of phase 2, with a change in slope and level after the intervention of <em>P</em> = .02 (CI: −<!--> <!-->0.204 to −<!--> <!-->0.040) and <em>P</em> = .004 (CI: −<!--> <!-->0.013 to −<!--> <!-->0.003), respectively.</div></div><div><h3>Conclusions</h3><div>This intervention, including enhanced environment cleaning, active surveillance, and patient cohorting, successfully reduced CRAB acquisition in IMWs and their HD non-ICUs.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 1","pages":"Pages 98-104"},"PeriodicalIF":3.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}