American journal of infection control最新文献

{"title":"Improving hand hygiene in hospitals: A comparative study using body-worn cameras and direct observation","authors":"D. Belman MB BS ,&nbsp;E. Ben-Chetrit MD ,&nbsp;C. Belman RN ,&nbsp;P.D. Levin MB Bchir","doi":"10.1016/j.ajic.2025.06.025","DOIUrl":"10.1016/j.ajic.2025.06.025","url":null,"abstract":"<div><h3>Background</h3><div>Hand hygiene (HH) prevents infections, but traditional monitoring is limited by office hours and the Hawthorne effect. We used body-worn cameras in ICU to compare video with direct observation.</div></div><div><h3>Methods</h3><div>After ethics approval, staff wore a GoPro™ on the upper abdomen during patient care. A trained observer simultaneously documented opportunities and performance. A blinded researcher analyzed the video. Both methods were compared on opportunities, compliance, performance, and duration.</div></div><div><h3>Results</h3><div>Seventeen paired video and observer data sets captured 166 HH opportunities and 147 events. Of these, 118/147 (80%) were in response to a HH opportunity and 29/147 not (20%). Including HH performance-related to events, overall HH compliance was 71%. Both methods identified 80% of opportunities. Video detected 11.5% of missed opportunities, while the observer identified 8.5% missed by video. Mean duration was comparable (11.3±9.2 sec vs. 12.0±9.8 sec, p=0.55).</div></div><div><h3>Discussion</h3><div>Body-worn cameras effectively identified HH opportunities, performance, and duration, capturing events missed by observers ~20% of the time. However, video analysis had flaws, revealing missed events upon review. Observer data, long considered the gold-standard, showed only 80% accuracy.</div></div><div><h3>Conclusions</h3><div>Body-worn cameras are a feasible tool for HH monitoring, but are labor-intensive. Automating video analysis could enhance feasibility for routine use.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 10","pages":"Pages 1055-1057"},"PeriodicalIF":2.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144566991","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":"Hero Program: A data-driven reward system to improve hand hygiene","authors":"Ali Barzegar Khanghah MASc ,&nbsp;Shaghayegh Chavoshian BS ,&nbsp;Majid Janidarmian PhD ,&nbsp;Simon Rustin MASc ,&nbsp;Geoff Fernie PhD ,&nbsp;Atena Roshan Fekr PhD","doi":"10.1016/j.ajic.2025.06.026","DOIUrl":"10.1016/j.ajic.2025.06.026","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare-associated infections compromise patient outcomes and pose a burden on healthcare systems worldwide. Despite widespread awareness of the critical role of Hand Hygiene (HH) in preventing healthcare-associated infections, compliance among healthcare workers remains suboptimal. This study evaluates a reward program called the <em>Hero Program</em> which is designed to incentivize and sustain HH practices through positive reinforcement.</div></div><div><h3>Methods</h3><div>The program used data from an electronic HH prompting system that has been installed in an inpatient unit in Toronto Rehabilitation Institute - University Health Network for 3<!--> <!-->years. A scoring algorithm was implemented to weigh individual HH compliance rates, considering workload and rewarding consistency. Daily winners were selected based on their scores and received gift card rewards.</div></div><div><h3>Results</h3><div>The analysis of data from 61 caregivers and more than 566,000 records for approximately 2.5<!--> <!-->years indicates that the Hero Program led to an 11.45% increase in HH compliance after 120<!--> <!-->days of implementation. This is a promising finding, suggesting that the program was effective in promoting behavior change early on. Compliance rates continued to improve over time, reaching 94% 1<!--> <!-->year later.</div></div><div><h3>Conclusions</h3><div>This sustained improvement suggests that the program had a long-lasting positive impact on HH practices in the unit.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 10","pages":"Pages 1064-1069"},"PeriodicalIF":2.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564249","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":"Vaccination coverage outcomes and health care organization program implementers’ experiences after introduction of a health care worker influenza vaccination mandate in Victoria, Australia, 2022-2023","authors":"Lyn-Li Lim MBBS, MPH, Grad Dip Clin Epi ,&nbsp;Stephanie K. Tanamas BBiomedSc(Hons), PhD ,&nbsp;Leon J. Worth MBBS, Grad Dip Clin Epi, PhD ,&nbsp;Ann Bull BSC(Hons), M.App.Epid, PhD ,&nbsp;Nadia Deborah Friedman MBBS, MD, MPH ,&nbsp;Sanne Peters MEd, PostGradDipT, PhD ,&nbsp;Sarah Bird BA, M.Int Politics ,&nbsp;Nick Wilson B.Pharm ,&nbsp;Noleen Bennett RN, Grad Dip Infec Cont, MPH, PhD","doi":"10.1016/j.ajic.2025.06.021","DOIUrl":"10.1016/j.ajic.2025.06.021","url":null,"abstract":"<div><h3>Background</h3><div>In 2022, the Victorian government, Australia, introduced a seasonal influenza vaccination mandate for specified health care workers (HCW). We describe implementation of the mandate’s requirements in health care organizations by<ul><li><span>(1)</span><span><div>Reporting 2022 and 2023 HCW vaccination coverage rates</div></span></li><li><span>(2)</span><span><div>Describing the experiences of vaccination program implementers.</div></span></li></ul></div></div><div><h3>Methods</h3><div>An analysis was undertaken of annual organizational surveillance data routinely reported by health care organizations to the coordinating center from 2018 to 2023. Focus group interviews with program implementers were conducted.</div></div><div><h3>Results</h3><div>Annual vaccination coverage increased from a median of 85.4% (2018-2021) to 93.6% (2022-2023). Those with “unknown status” and declinations decreased from a median of 8.2%-5.1% and 5.0%-1.1%, respectively. Implementers described increased leadership support and accountability for program delivery, and a focus on educating HCWs on the mandate and how to provide evidence of vaccination. New challenges included interpreting the mandate and applying pragmatic consequences. Implementers described increased administrative burden and seeking technological solutions.</div></div><div><h3>Conclusions</h3><div>Introduction of the mandate coincided with an increase in HCW influenza vaccination coverage and changes to program delivery. Investment in technological solutions can support surveillance by reducing the administrative burden and potentially increasing reporting accuracy of number of HCWs with “unknown status.”</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 10","pages":"Pages 1091-1099"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526081","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":"Observing is influencing: How hand disinfection compliance observations affect hand disinfection rates; specifics derived from an electronic monitoring system","authors":"Robin Otchwemah Dr med. ,&nbsp;Dominik Sons MSc ,&nbsp;Christoph Senges Dr rer. nat. ,&nbsp;Heide Niesalla Dr rer. nat. ,&nbsp;Marieke Stolte MSc ,&nbsp;Swetlana Herbrandt Dr rer. nat. ,&nbsp;Frauke Mattner Dr med.","doi":"10.1016/j.ajic.2025.06.020","DOIUrl":"10.1016/j.ajic.2025.06.020","url":null,"abstract":"<div><h3>Background</h3><div>Monitoring hand disinfection (HD) with direct observation is considered the gold standard but is flawed by the Hawthorne effect (HE). In our project in a German university hospital, we quantified the HE and evaluated possible room-specific differences.</div></div><div><h3>Methods</h3><div>Data were collected on an intensive care unit (ICU), an intermediate care unit, and a normal ward (NW) each categorized into “patient,” “utility/waste,” and “other” rooms. While dispensers were monitored by sensors of a full-time active electronic monitoring system, the infection prevention and control staff performed step-by-step observations according to the World Health Organization “5 moments.” Periods with and without direct observations were compared regarding the number of HDs performed per patient day (HD/PD) using descriptive evaluation and a linear mixed model.</div></div><div><h3>Results</h3><div>The HE was detected in “patient” rooms on the NW and ICU (+ 31.4%, + 27.4% HD/PD; both <em>P</em> &lt; .01) during observation periods. Opposite effects, expressed by significant decreases in HD/PD during observations, occurred in “utility/waste” rooms on the NW (−57.7%), intermediate care unit (−99.4%), and ICU (−32.9%).</div></div><div><h3>Conclusions</h3><div>In our setting, the HE varied considerably between wards and room types. As HE occurred in patient rooms, the usual HD compliance during patient care may be lower than directly observed.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 10","pages":"Pages 1058-1063"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526079","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":"Opioid use and risk of Clostridioides difficile infection in hospitalized patients: A systematic review and meta-analysis","authors":"Pooja Gokhale PharmD,&nbsp;Lorenzo Villa Zapata PhD","doi":"10.1016/j.ajic.2025.06.019","DOIUrl":"10.1016/j.ajic.2025.06.019","url":null,"abstract":"<div><h3>Background</h3><div><em>Clostridioides difficile</em> infection (CDI) is a leading cause of nosocomial infections, particularly in immunocompromised individuals. Evidence suggests that opioid use may increase the risk of CDI in hospitalized patients. This systematic review and meta-analysis aims to assess the association between opioid use and CDI among hospitalized patients.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted from inception to January 2024 across PubMed/MEDLINE, Web of Science, and the Cochrane Library. The search was supplemented by hand-searching reference lists of included articles. Observational studies comparing adult opioid users with nonusers in a hospital setting were included. The meta-analysis employed a restricted maximum likelihood random-effects model using R Statistical Software, version 4.3.2.</div></div><div><h3>Results</h3><div>From 1,521 articles initially retrieved, 4 met the inclusion criteria, comprising 119,145 patients. Of these, 42,794 were opioid users, and 76,351 were nonusers. There were 13,399 cases of CDI among opioid users, compared with 13,184 among nonusers. The meta-analysis revealed an odds ratio of 1.98 (95% confidence interval: 1.54-2.56), indicating a significantly higher risk of CDI in opioid users.</div></div><div><h3>Conclusions</h3><div>The findings underscore the need for further research to explore the impact of opioid use on the severity of CDI.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 10","pages":"Pages 1105-1112"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526080","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":"Characterization of patients with Candida (Candidozyma) auris before and during the COVID-19 pandemic in New York, 2017-2022","authors":"Haillie C. Meek DVM, MPH ,&nbsp;Stacey Konkle PhD, MPH ,&nbsp;Belinda Ostrowsky MD ,&nbsp;Eli S. Rosenberg PhD ,&nbsp;Karen Southwick MD, MSc ,&nbsp;Sarah Kogut MPH, CIC ,&nbsp;Monica Quinn MS, RN, CIC ,&nbsp;Ernest J. Clement MSN ,&nbsp;Emily Lutterloh MD, MPH","doi":"10.1016/j.ajic.2025.06.016","DOIUrl":"10.1016/j.ajic.2025.06.016","url":null,"abstract":"<div><h3>Background</h3><div><em>Candida auris</em> causes severe, invasive infections. We characterized <em>C. auris</em> epidemiology in New York before and during the coronavirus disease 2019 (COVID-19) pandemic.</div></div><div><h3>Methods</h3><div>Multiple statewide databases were linked to assess demographic and clinical characteristics and outcomes among <em>C. auris</em> screening cases (patients tested for colonization screening) and clinical cases (patients tested to diagnose disease). Cases diagnosed during 2017–2022 were divided into four phases (pre-COVID-19, first wave, ongoing mitigation, and vaccine era ) and compared. Joinpoint analysis was used to assess monthly percentage change (MPC) and temporal trends among clinical cases.</div></div><div><h3>Results</h3><div>During the first wave, higher proportions of <em>C. auris</em> cases were among Black and Hispanic patients (clinical and screening), patients from high social vulnerability index neighborhoods (clinical), and patients aged &lt; 60 years (screening), compared with pre-COVID-19. Increased proportions of Hispanic patients and those aged &lt; 60 years among screening cases persisted through ongoing mitigation and vaccine era. MPC of clinical cases was stable throughout the analysis period (1.97%), and there were no significant joinpoints.</div></div><div><h3>Conclusions</h3><div>COVID-19 hospitalizations might have driven shifts in characteristics of clinical and screening <em>C. auris</em> cases<em>.</em> Clinical <em>C. auris</em> incidence increased during 2017–2022, but the incidence slope did not increase.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 10","pages":"Pages 1034-1042"},"PeriodicalIF":2.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511428","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":"First report of Lodderomyces elongisporus identification in intensive care unit patients in Colombia","authors":"María Carolina Gutiérrez Galvis MSc ,&nbsp;Edimerk Mauricio Gil Güiza MSc ,&nbsp;Maicol Andrés Avellaneda Arciniegas BSc ,&nbsp;Olga Marcela Medina Pérez MSc ,&nbsp;Angélica Yurley Ramírez Vásquez BSc ,&nbsp;Laura Juliana Ortiz García BSc ,&nbsp;Claudia Ivonne García González MSc ,&nbsp;Sindy Fernanda Macías Duarte BSN ,&nbsp;Luz Helena Sánchez Rodríguez MSc ,&nbsp;Marisela Márquez Herrera MSN ,&nbsp;Agustín Vega Vera MD ,&nbsp;Yeny Zulay Castellanos-Dominguez MSc ,&nbsp;Laura Viviana Herrera Sandoval MSc ,&nbsp;Clara Inés Sánchez Suárez PhD","doi":"10.1016/j.ajic.2025.06.018","DOIUrl":"10.1016/j.ajic.2025.06.018","url":null,"abstract":"<div><div><em>Lodderomyces elongisporus</em><span>, a yeast commonly associated with environmental sources, is emerging as a human fungal pathogen. This report presents the first documented case of </span><em>L.elongisporus</em><span> colonization in 2 intensive care unit patients in Colombia. Our findings emphasize the need for accurate identification and enhanced surveillance to evaluate its clinical impact in hospital infections.</span></div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 9","pages":"Pages 1011-1016"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504502","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":"Digital feedback to improve adherence to hand hygiene: A longitudinal study on the effects of an electronic monitoring system","authors":"Karin Granqvist RN, CNOR, PhD ,&nbsp;Linda Ahlstrom RN, PhD ,&nbsp;Jon Karlsson MD, PhD ,&nbsp;Birgitta Lytsy MD, PhD ,&nbsp;Annette Erichsen RN, CNOR, PhD","doi":"10.1016/j.ajic.2025.06.017","DOIUrl":"10.1016/j.ajic.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div>This study investigated the impact of digital feedback from an electronic monitoring system (EMS) to health care workers (HCWs) at both the group and individual levels on the adherence to hand hygiene (HH).</div></div><div><h3>Methods</h3><div>An EMS was installed in a surgical ward at a tertiary hospital and adherence rates among HCWs (n = 15) were measured from October 2018 to December 2019. After an initial baseline period, digital feedback was given to the HCWs first at the group level (2 months), and then at both the group and individual levels (2 months). Adherence rates were then measured over an additional follow-up period of 9 months.</div></div><div><h3>Results</h3><div>Digital feedback for 9 months at both the individual and group levels significantly increased adherence to HH compared with the baseline (37.9% vs 52.5%). The mean increase in adherence rates was 14.5%. Feedback over a shorter period (2 months) had the same effect at neither the group level nor the individual level.</div></div><div><h3>Conclusions</h3><div>Follow-up long-term studies are crucial to evaluate the effect of digital feedback. As research on innovations monitoring HH adherence is still in its infancy, this study contributes with valuable findings into the impact of digital feedback.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 10","pages":"Pages 1049-1054"},"PeriodicalIF":2.4,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482799","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":"Impact of empowerment of onco-hematological patients on the incidence of catheter-related bloodstream infections","authors":"Rodrigo Reghini MSc ,&nbsp;Ivan Leonardo Avelino França e Silva MD, PhD ,&nbsp;Silvia Figueiredo Costa MD, PhD ,&nbsp;Thaís Guimarães MD, PhD","doi":"10.1016/j.ajic.2025.06.015","DOIUrl":"10.1016/j.ajic.2025.06.015","url":null,"abstract":"<div><h3>Background</h3><div><span>Patients with hematologic malignancies and </span>hematopoietic stem cell transplant recipients (HSCT) are at high risk of central venous catheter-related bloodstream infections (CLABSI). Global actions have encouraged patient empowerment as a strategy to reduce these infections. We aim to evaluate the impact of patient empowerment in reducing the incidence density (ID) of CLABSI.</div></div><div><h3>Methods</h3><div>Prospective, pre- and post-intervention, quantitative study of development, validation and application of an instrument to assess good practices in CVC handling, consisting of 6 questions and answers by hospitalized patients who had a CVC in 2 oncological units.</div></div><div><h3>Results</h3><div>Fifty-three patients were enrolled, totaling 1,290 evaluations. In the postintervention period, a significant increase (<em>P</em><span> &lt; .001) was observed in 3 practices: hand hygiene after handling the CVC (92.1% vs 98.8%), salinization with pulsatile movements after administering medications and collecting laboratory tests (86.8% vs 96.7%) and daily CVC assessment (97.4% vs 99.8%). The ID of CLABSI decreased in the HSCT unit (4.4 vs 0 CLABSI/1,000 CVC-days), though without statistical significance (</span><em>P</em> = .066).</div></div><div><h3>Discussion</h3><div>Increased adherence to good practices highlights the potential of patient involvement as a complementary strategy for CLABSI prevention.</div></div><div><h3>Conclusions</h3><div>Actions aimed at patient participation can contribute to improving processes and reducing the ID of CLABSI.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 9","pages":"Pages 957-961"},"PeriodicalIF":2.4,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482800","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":"Infection prevention prelicensure nursing education: Exploring graduating student and preceptor experiences","authors":"Mary Lou Manning PhD, CRNP, CIC, AL-CIP, FAPIC, FSHEA, FAAN ,&nbsp;Julia Kay BFA, PMP ,&nbsp;Susan Egger PhD, MSN, RN ,&nbsp;Mariann Kerr PhD, MSN, RN, PCCN-K, CNE ,&nbsp;John Renzi DNP, MBA, RN, CCCTM, NE-BC","doi":"10.1016/j.ajic.2025.06.014","DOIUrl":"10.1016/j.ajic.2025.06.014","url":null,"abstract":"<div><div>This study explores infection prevention and control (IPC) perceptions and experiences of final-semester pre-licensure nursing students and their clinical preceptors, highlighting the need for strong IPC education and collaboration between infection preventionists and nursing faculty.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 9","pages":"Pages 1017-1020"},"PeriodicalIF":2.4,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482801","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}