Annals Of Work Exposures and Health最新文献

{"title":"Effects of the combined exposure to chemicals and unusual working hours.","authors":"Jenny-Anne S Lie, Shan Zienolddiny-Narui, Magne Bråtveit","doi":"10.1093/annweh/wxae033","DOIUrl":"10.1093/annweh/wxae033","url":null,"abstract":"<p><strong>Objective: </strong>Both exposure to occupational chemicals and to unusual working hours have well documented effects on health. Determination of occupational exposure limits is, however, usually based on chemical-only exposure and assumes an 8-h workday, 5 days/week and a 40-h work week. A significant proportion of the workforce is exposed to chemicals while working in other work schedules. This review thus aimed to synthesize and evaluate the scientific support for a combined effect of unusual working hours and chemical exposure and, if possible, give recommendations for OEL adjustments to account for unusual working hours.</p><p><strong>Methods: </strong>The search for articles was made as part of the preparation of a report for the Nordic Expert Group for Criteria Documentation of Health Risks from Chemicals. In this report, unusual working hours were categorized as shift work or extended (>8 h) working hours. Inclusion criteria were observational studies in the English language published up to November 2021 in peer-reviewed journals, with explicit metrics of exposure (chemicals and unusual working hours) and of health outcome, and which explicitly tested the association between exposure and outcome. Search engines of seven databases were used.</p><p><strong>Results: </strong>Of the initially 15 400 identified papers, 9 studies published between 1985 and 2021 met the inclusion criteria, 7 of which showed significant associations. Results from a few of the studies, i.e. regarding effects of dust and endotoxin on lung function, effects of acetone on sleep quality and tiredness, effects of carbon disulphide on coronary artery disease and effects of chemicals on spontaneous abortion, suggested more pronounced effects during night shifts compared to during day shifts.</p><p><strong>Discussion: </strong>The reviewed data is considered insufficient to conclude on recommendations for OEL adjustment for shift work. Suggested areas of future studies are mentioned.</p><p><strong>Conclusion: </strong>Further studies about the effects of the combined exposure to unusual working hours and chemical exposure are essential for risk assessment, and for recommendation of potential OEL adjustments. What is important about this paper? Effects of chemical agents at the workplace may depend not only on exposure level and duration but also on the time of exposure in relation to the circadian rhythm. This study reviewed the scientific support for a combined effect of unusual working hours and chemical exposure and revealed an obvious need for additional studies regarding the complex interplay of the two different exposures with respect to adverse health effects.</p>","PeriodicalId":8362,"journal":{"name":"Annals Of Work Exposures and Health","volume":" ","pages":"647-656"},"PeriodicalIF":1.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11229379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the impact of authorisation process as a regulatory tool in the European REACH regulation: A study on improving occupational safety for applying companies.","authors":"Holger-Lars Deubner, Gudrun Walendzik, Andreas Lüdeke, Urs Schlüter","doi":"10.1093/annweh/wxae032","DOIUrl":"10.1093/annweh/wxae032","url":null,"abstract":"<p><p>This study looks into the effectiveness of the authorisation procedure as a regulatory instrument within the framework of the European REACH regulation. It highlights its impact on enhancing occupational safety and health for both applicants and companies utilising the substances. This procedure encompasses manufacturers, importers, and downstream users of substances, as well as representatives of foreign manufacturers who are also eligible to seek authorisation. When applying for authorisation, the ECHA Risk Assessment Committee (RAC) assesses the risks associated with the intended uses of the substance, including the appropriateness and effectiveness of the Occupational Conditions (OCs) and Risk Management Measures (RMMs) described in the application and the risks posed by potential alternatives. If the RAC determines that the OCs/RMMs are inadequate for managing or controlling the risk, or if the measures to protect workers are deemed insufficient, it may recommend additional measures to enhance occupational safety and health or environmental protection. The 398 processed Applications for Authorisation (AfA) that have been submitted to date were examined to determine these recommended measures, categorised as Conditions for use, Monitoring arrangements, and Recommendations for Review Reports. Overall, a significant improvement concerning occupational safety and health seems necessary, as indicated by the large number of measures recommended by the ECHA Committee for Risk Assessment (RAC) and ECHA Committee for Socio-economic Analysis (SEAC) or supplemented by the European Commission. In addition to the proposed measures, a short assessment provided by the committees as to whether the operational conditions and risk management measures are adequate in controlling the risks is also included in the study.</p>","PeriodicalId":8362,"journal":{"name":"Annals Of Work Exposures and Health","volume":" ","pages":"617-625"},"PeriodicalIF":1.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11229307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outdoor workers' perceptions of skin cancer prevention: a qualitative study.","authors":"Jeanne Ward, Frances Hardin-Fanning, Andrew Scott LaJoie, Lesley Harris, Anna Simpson","doi":"10.1093/annweh/wxae039","DOIUrl":"10.1093/annweh/wxae039","url":null,"abstract":"<p><strong>Objectives: </strong>Outdoor workers are at increased risk for skin cancer and melanoma. This qualitative study aimed to explore outdoor workers' perspectives and experiences of primary (i.e. sun protection) and secondary prevention, i.e. skin self-examination (SSE) of skin cancer.</p><p><strong>Methods: </strong>Purposive, snowball, and theoretical sampling was used to recruit outdoor workers in Kentucky and Indiana. Semi-structured interviews via telephone or videoconference of approximately 45 min were conducted with interviewer probes and questions about perceptions of cancer risk, prevention, and screening techniques conducted, perceived barriers and facilitators, and preferences for health dissemination venues. The recordings were transcribed verbatim and de-identified. Analysis involved constructivist grounded theory coding strategies. Using peer debriefing and consensus building around themes, the researcher established a codebook for all interviews to utilize within Dedoose software for systematizing and organizing data.</p><p><strong>Results: </strong>Eighteen interviews were conducted. Interviewees (N = 18) ranged in age from 35 to 78 yr, with 3 females. Outdoor industries included agriculture, maintenance, and grounds maintenance. Themes derived from the data showed the underlying factors and perceptions that influence outdoor workers to conduct primary and secondary cancer prevention activities. The level of alarm attributed to disease and the level of trust in information contribute to intentions to conduct activities. The intentions and trust toward healthcare institutions and providers drive the primary or secondary prevention behaviors. Cultural and contextual factors included masculinity and self-sufficiency, familial and occupational priorities, and community ties.</p><p><strong>Conclusions: </strong>These data provide a basis for developing future communications and interventions to decrease skin cancer incidence in outdoor workers. They indicate that secondary prevention and building self-efficacy in conducting SSE should be emphasized in tandem or over primary skin cancer prevention methods in this population. Trusted local healthcare providers should primarily provide prevention information, and materials should utilize testimonials from the local community to best influence this population. Communications and training interventions are needed in this population to induce a proactive level of alarm about cancer and result in the performance of SSE.</p>","PeriodicalId":8362,"journal":{"name":"Annals Of Work Exposures and Health","volume":" ","pages":"636-646"},"PeriodicalIF":1.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140920928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sources of noise exposure across Australian workplaces: cross-sectional analysis and modelling the impact of a targeted noise-source reduction initiative.","authors":"Kate Lewkowski, Jane S Heyworth, Kahlia McCausland, Warwick Williams, Lin Fritschi","doi":"10.1093/annweh/wxae029","DOIUrl":"10.1093/annweh/wxae029","url":null,"abstract":"<p><strong>Context: </strong>Workplace noise regulations and guidance follow the hierarchy of control model that prioritizes eliminating or reducing noise at its source.</p><p><strong>Objectives: </strong>To determine the main sources of workplace noise exposure in the Australian working population and estimate the reduction of workers exposed over the noise limit (LAeq,8h > 85 dB) if noise levels of specific tools or equipment were reduced by 10 dB.</p><p><strong>Methods: </strong>Information on the tools used and tasks performed during each participant's last working shift was collected from 4,977 workers via telephone survey. Using a predetermined database of task-based noise levels, partial noise exposures (Pa2h) were determined for each noisy activity performed by the workers and their daily noise exposure level (LAeq,8h) was estimated. Partial exposures were categorized into 15 tool/task groups and the tally, average, and sum (Pa2h) for each group were calculated. The impacts of 5 different scenarios that simulated a reduction of 10 dB in noise emissions for specific tool groups were modelled.</p><p><strong>Results: </strong>Powered tools and equipment were responsible for 59.3% of all noise exposure (Pa2h); vehicles for 10.6%; mining, refineries, and plant equipment for 5.1%; and manufacturing and food processing for 4.2%. Modelling demonstrated that a 10 dBA noise-level reduction of all powered tools and equipment would lead to a 26.4% (95% confidence interval: 22.7% to 30.3%) reduction of workers with an LAeq,8h > 85 dB. This could represent over 350,000 Australian workers no longer exposed above the workplace limit daily.</p><p><strong>Conclusions: </strong>A universal reduction of 10 dB to power tools and equipment would substantially reduce the future burden of hearing loss, tinnitus, workplace injuries, and other health effects. Initiatives to reduce the noise emissions of specific powered tool groups are warranted.</p>","PeriodicalId":8362,"journal":{"name":"Annals Of Work Exposures and Health","volume":" ","pages":"626-635"},"PeriodicalIF":1.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141096902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"128 Assessing potential health risks from multi-exposure to chemicals in U.S. workplaces: findings from the OSHA database","authors":"Philippe Sarazin, Jean-François Sauvé, France Labrèche, Vikki Ho, Maude Pomerleau, Delphine Bosson-Rieutort, Jérôme Lavoué","doi":"10.1093/annweh/wxae035.060","DOIUrl":"https://doi.org/10.1093/annweh/wxae035.060","url":null,"abstract":"Introduction The combined effects of occupational exposure to multiple chemicals on health can be substantial. However, the most prevalent multi-exposure situations and their toxic effects remain understudied. We assessed the health risks from multi-exposure to chemicals in U.S. workplaces using the Occupational Safety and Health Administration’s (OSHA) measurement database. Methods We analysed personal air measurements for the period 1971-2021 summarized by workplace situation (WS), corresponding to measurements taken for the same job title, within a company, within a year. We calculated hazard quotients (HQ) by dividing the agents’ concentrations by their ACGIH® threshold limit value. We calculated the mixtures’ hazard indices (HI) by summing the HQs of agents by combination of WS and toxicological class (n=24) using the MiXie tool, which identifies classes of toxic effects for &amp;gt;700 chemicals. Results We extracted 609,233 measurements of 206 chemicals from 162,473 WSs. Workers in 58,252 WSs were exposed to ≥2 agents, of which 21,563 had an HI&amp;gt;1, indicating overexposure for at least one toxicological class. Toxicological classes with the highest HIs among multi-exposed WSs were lower airway damage (median 0.41; interquartile interval 0.05-1.9; percentage of overexposed WSs 35%), ototoxicity (0.28; 0.04-1.1; 26%) and central nervous system (CNS) damage (0.26; 0.02-1.2; 28%). For these three classes respectively, the most frequent multi-exposures leading to high values of HI were manganese-iron oxides, toluene-xylene and manganese-lead. Conclusions Although the OSHA database does not necessarily represent a random sample of U.S. workplaces, our approach provides insights into the health risks of occupational exposures to prevalent chemical mixtures.","PeriodicalId":8362,"journal":{"name":"Annals Of Work Exposures and Health","volume":"38 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"311 Lessons learned from R&D and industrial metal additive manufacturing","authors":"Maria Assenhöj, Stefan Ljunggren, Helen Karlsson","doi":"10.1093/annweh/wxae035.123","DOIUrl":"https://doi.org/10.1093/annweh/wxae035.123","url":null,"abstract":"Metal additive manufacturing (AM), commonly known as 3D-printing, is an emerging state-of-the art technology with significant economic and practical advantages. Due to its relative short history, especially in industrial serial production, the knowledge regarding exposure and health risks is severely limited. To alleviate this, we have monitored the occupational exposure and potential health effects at both smaller R&amp;D-sites and at large-scale AM/powder production facilities. Exposure was monitored through stationary and personal sampling of total and inhalable dust followed by metal analysis. Particle counting instruments were used to identify dusty works tasks and to evaluate preventive measures. AM operators and controls underwent health examinations, including questionnaires, spirometry, and blood and urine sampling to measure exposure and clinical health markers. Exposure during printing were generally low but other aspects of the production chain were of greater concern regarding exposure risks: production of metal powder feedstock, handling of metal powder before/after print, and post-printing processes. During three research projects, we have seen a shift from a dusty work environment to a more safe-by-design approach throughout the AM process. Despite the AM operator’s relatively low exposure to dust and metals, we identified changes in a urinary marker for kidney function. However, this finding needs to be further evaluated. In summary, our studies into the relative new field of metal AM exposure and health effects provides a basis to help companies and operators handling these techniques to move toward safe working conditions.","PeriodicalId":8362,"journal":{"name":"Annals Of Work Exposures and Health","volume":"23 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"346 Planning for growth: occupational hygiene capability","authors":"Roger Alesbury","doi":"10.1093/annweh/wxae035.002","DOIUrl":"https://doi.org/10.1093/annweh/wxae035.002","url":null,"abstract":"ILO estimates that each year a total of 160 million new cases of work-related illness occur globally (35 million due to exposure to chemicals) and 2 million lives are lost to occupational disease (3% of all deaths). How do we as a community grow the occupational hygiene skill base to manage this risk? In 2006, concerned at the slow growth in occupational hygiene capability, a group of senior occupational hygienists with global reach met to consider options. Their report was circulated widely and presented at International Conferences and IOHA and National Association meetings. With input and contributions from across the world, a series of modular training packages were developed. In 2009, the Occupational Hygiene Training Association (OHTA) was formed to run this program under the IOHA umbrella. This talk will cover how OHTA evolved, what it offers and how it complements and supports other programmes to develop and grow occupational hygiene capability. For the last 15 years, its resources have been used by occupational hygienists across the world for the training and development of the next generation of occupational hygienists. As OHTA enters the next phase of its evolution, hear latest developments and how you can become part of this program “Uniting Occupational Hygiene Professionals at a Global level to protect worker health”","PeriodicalId":8362,"journal":{"name":"Annals Of Work Exposures and Health","volume":"136 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"222b - Relevant information and challenges for human biomonitoring","authors":"Sonja Wrobel","doi":"10.1093/annweh/wxae035.159","DOIUrl":"https://doi.org/10.1093/annweh/wxae035.159","url":null,"abstract":"Human biomonitoring (HBM) has proven to be a useful tool to perform risk assessment of chemicals. Nevertheless, certain criteria for a reliable HBM should be taken into account. Knowledge regarding the suitability of the chosen biological matrix, as well as the specificity and sensitivity of biomarkers is essential. For a specific HBM, the biomarker must not be formed from other substances with expected exposures. The sensitivity of the biomarker depends on the aim of the study with higher sensitivities needed for the investigation of background exposures in the general population, compared to verifying the adherence to health-based guidance values (e.g., in an occupational context). Furthermore, aspects of analytical ruggedness of the biomarkers need to be considered, such as susceptibility to pre-analytical contamination. To obtain valid HBM results, analytical methods for these biomarkers need to be sufficiently sensitive, selective, and rugged and need to be applied under quality-assured conditions. In this presentation, the choice of a reliable biomarker will be discussed using practical examples.","PeriodicalId":8362,"journal":{"name":"Annals Of Work Exposures and Health","volume":"17 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"153 Performance testing of cordless handheld vacuum cleaners","authors":"Hui-Jing Li, Jason Lin, Sheng-Hsiu Huang, Chih-Wei Lin, Chih-Chieh Chen","doi":"10.1093/annweh/wxae035.220","DOIUrl":"https://doi.org/10.1093/annweh/wxae035.220","url":null,"abstract":"The cordless handheld vacuum cleaners market is expanding rapidly and is expected to reach $10 billion by 2027, raising concerns about indoor air quality. Despite growing demand, there is limited research into the aerosol emissions from these devices and their impact on respiratory health, which is a current concern for everyone. Our study aimed to investigate particulate matter (PM) emissions from these vacuum cleaners and identify the key factors contributing to such emissions. Two custom-built devices were designed to quantify upstream and downstream PM concentrations and suction pressure with and without filter cartridge and motor exhaust. We tested six popular cordless vacuum cleaner models under different conditions and found that filter cartridge sealing, motor design, and dust load can affect PM emissions. In contrast to previous research, brushless motors (manufacturer claims) do not necessarily emit fewer particles than brushed motors. We also found that some filter cartridges are not airtight and will cause PM concentration to rise significantly, especially under heavy load conditions. While leaking cartridges result in higher suction and clean air delivery rates, we still recommend regulating airtight filter cartridges due to elevated PM emissions. Our findings also suggest the need for regulations controlling motor assembly and design standards, not just motor type. For immediate mitigation, users should ventilate areas and use respiratory protection. Our work is a foundation for understanding the health risks of vacuum cleaner aerosol emissions and informs consumer choices and potential regulatory measures.","PeriodicalId":8362,"journal":{"name":"Annals Of Work Exposures and Health","volume":"240 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"129 Sampling protocol to assess occupational exposure to microbial contamination in wood working environments","authors":"Marta Dias, Pedro Pena, Bianca Gomes, Renata Cervante, Sara Gonçalves, Susana Viegas, Carla Viegas","doi":"10.1093/annweh/wxae035.061","DOIUrl":"https://doi.org/10.1093/annweh/wxae035.061","url":null,"abstract":"The sawmill market is driven by rising construction demand, with building and furniture gaining prominence. Workers in the sawmill industry may be exposed to wood derivatives, microorganisms, and their products, which can cause health effects such as decreased lung function, bronchial hyperresponsiveness, and various respiratory disorders. Exposure to wood dust infected with microorganisms, particularly fungi, can lead to allergic alveolitis and asthma in woodworkers. It is well known that there is a knowledge gap in the field of microbial occupational exposure assessment in sawmills, nevertheless, the importance of an accurate assessment and risk management should be emphasized. The sampling approach applied in this study comprehends several sampling methods that are used as a complement to overcome the advantages and disadvantages of each. Those methods are active sampling methods, such as Andersen six-stage, MAS-100 and Button Samplers, and passive sampling methods namely surface swabs, electrostatic dust cloths (EDC), EDC in t-shirts, settled dust, gloves and masks and filters from the vacuumed settled dust. This sampling approach was developed to be applied in wood working environment and it was meticulously developed using previously conducted bibliographic research and applied in sampling campaigns developed in “Do It Yourself” (DIY) stores with a wood cutting section, and in sawmills. With the application of this comprehensive protocol, it was possible to conclude that the use of all these sampling methods in parallel is crucial to overcome the constraints of each to allow a proper characterization of the risks to which these workers are exposed. Similar considerations should be taken to select the best lab approach.","PeriodicalId":8362,"journal":{"name":"Annals Of Work Exposures and Health","volume":"75 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}