Annals of the American Thoracic Society最新文献

{"title":"The Complex Spectrum of Chronic Thromboembolic Pulmonary Disease and the Implications of Hemodynamic Reclassification.","authors":"Michael G Risbano","doi":"10.1513/AnnalsATS.202412-1259ED","DOIUrl":"10.1513/AnnalsATS.202412-1259ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"324-326"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018100","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":"Erratum: Benefit-Harm Analysis of Earlier Initiation of Triple Therapy for Prevention of Acute Exacerbation in Patients with Chronic Obstructive Pulmonary Disease.","authors":"","doi":"10.1513/AnnalsATS.22i3Erratum1","DOIUrl":"10.1513/AnnalsATS.22i3Erratum1","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 3","pages":"471"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525523","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":"2024 Reviewers.","authors":"","doi":"10.1513/AnnalsATS.2024ReviewersList","DOIUrl":"https://doi.org/10.1513/AnnalsATS.2024ReviewersList","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 3","pages":"472-474"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525505","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":"Interprofessional Team Staffing in U.S. Intensive Care Units.","authors":"Allan Garland, Deena Costa, Hannah Wunsch, Amy L Dzierba, Danny Lizano, Hayley Gershengorn","doi":"10.1513/AnnalsATS.202404-441OC","DOIUrl":"10.1513/AnnalsATS.202404-441OC","url":null,"abstract":"<p><p><b>Rationale:</b> There is a paucity of data, and no consensus, about the composition of interdisciplinary teams of healthcare workers (HCWs) who provide care in intensive care units (ICUs). <b>Objectives:</b> To delineate the nature and variation of HCW staff composition in U.S. adult ICUs before the COVID-19 pandemic. <b>Methods:</b> A national survey of 574 adult ICUs inquired about ICU staffing. Two sets of survey items asked about <i>1</i>) \"availability to provide care\" in ICUs for 11 HCW types, collapsed into six groupings; and <i>2</i>) the presence in formal ICU clinical rounds of nine HCW types, collapsed into six groupings. Bedside nurses were assumed to be involved in both categories. Analysis was descriptive, seeking to examine the predominant and full range of staffing patterns. <b>Results:</b> Of surveyed ICUs, 94% were in metropolitan areas, 63% in teaching hospitals, 74% had >250 beds, 66% cared for mixed adult patient types (e.g., medical-surgical), median ICU bed count was 20 (interquartile range, 12-25), and 27% used some form of telemedicine. In addition to bedside nurses, the core staffing group comprised intensivists, respiratory therapists and pharmacists; in 88% of ICUs all were available to provide care. However, there were 28 different combinations of the six groupings (intensivists, respiratory therapists, pharmacists, attending physician support, advanced bedside nurse support, nurse aides), with the most common one, present in 38% of ICUs, including all six. Ninety-six percent of ICUs had interprofessional rounds at least 5 days per week; 78% had them on weekends. Among the ICUs with rounds, 61% of weekday rounding teams included all of intensivists, respiratory therapists, and pharmacists. Nutrition, rehabilitation, and social support practitioners each participated in rounds in 35-80% of ICUs and altogether in 28% of ICUs. Except for intensivists, all HCW types participated much less commonly in weekend than in weekday rounds. <b>Conclusions:</b> ICU care almost always included a core team of bedside nurses, intensivists, respiratory therapists, and pharmacists. Beyond that core, great variability was seen in the presence of many other HCW types. Almost all ICUs had interprofessional rounds, with three-fourths also having them on weekends.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"416-421"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585075","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":"The Epidemiology and Impact of Hypoxemia in Sub-Saharan Africa: Prevalence, Practices, and Outcomes.","authors":"Innocent Sulani, Lauren A Onofrey, Letizia Trevisi, Abi Beane, B Jason Brotherton, Jeanine Condo, Dingase Dula, E Wes Ely, Swati Goel, Stephen B Gordon, Rashan Haniffa, Bethany Hedt-Gauthier, Alexandra Medline, Carolyne Njoki, Peter Oduor, George Otieno, Jamie Rylance, Theogene Twagirumugabe, Nathalie Umutoni, Doris Uwamahoro, Sky Vanderburg, Wangari Waweru-Siika, Elisabeth Riviello","doi":"10.1513/AnnalsATS.202410-1092OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202410-1092OC","url":null,"abstract":"<p><strong>Rationale: </strong>The epidemiology of hypoxemia in Sub-Saharan Africa is largely unknown.</p><p><strong>Objectives: </strong>Determine the prevalence, clinical care, and outcomes for hospitalized hypoxemic adults in Sub-Saharan Africa.</p><p><strong>Methods: </strong>We prospectively screened all adults admitted to five hospitals in Kenya, Malawi, and Rwanda over four months, and followed hypoxemic patients to discharge.</p><p><strong>Measurements and main results: </strong>Of the 24,724 adult patients admitted, 1,739 (7%) were hypoxemic on admission. Median imputed PaO₂/FiO₂ was 168. Of all patients screened, 4,546 (18%) had complete oxygenation domains (SpO₂, device, and quantity) documented in their charts on admission. Among hypoxemic patients, 44% of in-hospital days (6,890/15,553) had chart documentation of all three oxygenation domains. Of 1,508 unique hypoxemic patients, 770 (51%) had at least one day with subtherapeutic oxygen (SpO₂<90%). Of patient-days with patients on oxygen therapy, 84% indicated supratherapeutic oxygen therapy (SpO₂>94%). Of all hypoxemic adults, 35% died in-hospital. Sixteen percent of patients were mechanically ventilated during their stay, and in-hospital mortality in this subgroup was 49%.</p><p><strong>Conclusions: </strong>Hypoxemia is common and associated with high mortality in five referral hospitals in three countries in Sub-Saharan Africa. Monitoring and titration practices for oxygen therapy are inconsistent. Subtherapeutic and supratherapeutic oxygen therapy are common. Mortality is high among the few patients who receive mechanical ventilation. These findings suggest the urgent need to study interventions to improve survival for hypoxemic patients in Sub-Saharan Africa. Prioritized investigations include the development and implementation of oxygen monitoring and titration protocols, as well as studies of advanced oxygen therapies other than mechanical ventilation. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517650","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":"Association between Difficulty Affording Medications and Outcomes in Chronic Obstructive Pulmonary Disease.","authors":"Sonal G Mallya, Alka Upadhyay, Kevin J Psoter, Meredith A Case, Michael T Vest, Nirupama Putcha, Nadia N Hansel, Michelle N Eakin","doi":"10.1513/AnnalsATS.202410-1020OC","DOIUrl":"10.1513/AnnalsATS.202410-1020OC","url":null,"abstract":"<p><strong>Rationale: </strong>Medications including inhaled bronchodilators are essential for effective management of chronic obstructive pulmonary disease (COPD) and improve clinical outcomes. However, medications are a major driver of out-of-pocket costs for individuals with COPD. The impact of cost of medications on clinical outcomes in COPD has not been studied.</p><p><strong>Objective: </strong>To examine the association between difficulty affording medications and COPD morbidity, psychological wellbeing, and medication adherence.</p><p><strong>Methods: </strong>Individuals with a physician diagnosis of COPD who were prescribed at least one daily maintenance medication were recruited from centers in the Mid-Atlantic area and followed for 12 months as part of the Medication Adherence Research in COPD (MARC) cohort. Patient-reported COPD outcomes, measures of psychological wellbeing, exacerbation data, and difficulty affording medications were assessed at 6-month intervals. Medication adherence was measured during the 12-month period using electronic monitors. The association between difficulty affording medications at baseline and outcomes at 12 months was evaluated using multivariable regression models. A fixed effects regression model was conducted to evaluate how changes in difficulty affording medications are associated with outcomes over time.</p><p><strong>Results: </strong>Of the 249 participants with completed baseline assessments, a total of 44 (18%) participants reported delaying refilling medications due to cost at baseline. Over the course of the 12-month period, 68 (27%) participants reported delaying refilling medications at any time point due to cost. After adjusting for baseline covariates, no associations between difficulty affording medications at baseline and outcomes at 12 months were observed. In the fixed effects model, changes in difficulty affording medications was associated with worse COPD health status, dyspnea, and health-related quality of life, increased symptoms of anxiety and depression, and lower objectively measured medication adherence but not occurrence of exacerbations.</p><p><strong>Conclusion: </strong>In this multicenter cohort of individuals with physician-diagnosed COPD, we found an association between changes in self-reported difficulty affording medications and increased patient-reported respiratory morbidity, increased anxiety and depression symptoms, and decreased objectively-measured medication adherence over time, but no association with exacerbations. These findings suggest that cost of COPD-specific treatments is an important and potentially modifiable social determinant of health for individuals with COPD.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Risk of Adverse Cardiac Events Following Pneumonia in Patients with Coronary Artery Disease.","authors":"Benjamin Bartlett, Frank M Sanfilippo, Silvia Lee, Herbert Ludewick, Grant Waterer, Adil Rajwani, Chrianna Bharat, Abdul Rahman Ihdayhid, Vicente Corrales-Medina, Girish Dwivedi","doi":"10.1513/AnnalsATS.202407-714OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202407-714OC","url":null,"abstract":"<p><strong>Rationale: </strong>Pneumonia triggers an inflammatory response that can persist beyond resolution of infection. This may increase the risk of major adverse cardiac events (MACE) in people with known coronary artery disease (CAD).</p><p><strong>Objectives: </strong>To assess the impact of pneumonia on MACE in individuals with pre-existing CAD.</p><p><strong>Methods: </strong>We identified patients who had coronary artery revascularisation procedures in 7 major hospitals in Western Australia between 2000-2005. Multivariable Cox regression models assessed the association between time-dependent pneumonia and MACE [composite of all-cause death + myocardial infarction (MI) + unstable angina + ischemic stroke + heart failure (HF)] and component outcomes separately, over 30 days, 1 year, and full follow-up.</p><p><strong>Measurements: </strong>There were 14,425 patients in the study cohort (mean age 64.4, 23.6% female). Over a maximum of 13-years follow-up, 988 patients experienced ≥1 pneumonia hospitalisation.</p><p><strong>Main results: </strong>The risk of MACE increased over time, with adjusted hazard ratios (aHR) of 4.91 (95% CI 1.21-20.00) and 4.91 (CI 2.62-9.19) over 30-day and 1-year intervals, respectively, and an aHR of 11.41 (CI 9.22-14.11) over the entire follow-up. MI risk was highest during the first 30 days (aHR 11.34) and reduced over the 1-year interval and remainder of follow-up (aHR 2.27 and 2.63, respectively). Risk of HF and cardiovascular death were also high over the entire follow-up period (aHR 10.39 and 12.25, respectively).</p><p><strong>Conclusions: </strong>Pneumonia hospitalisation significantly increases short- and long-term risk of MACE in CAD patients. Underlying mechanisms should be better understood to develop targeted interventions to reduce MACE in this already high-risk population.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460906","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":"Exploring the Dose-Response Relationship Between Mandibular Protrusion and Respiratory Effort Burden in Oral Appliance Therapy for OSA.","authors":"Jean-Louis Pépin, Jean-Benoît Martinot, Nhat Nam Le Dong, Sophie Leroy, Didier Clause, Atul Malhotra, Gilles Lavigne, Peter A Cistulli","doi":"10.1513/AnnalsATS.202408-889OC","DOIUrl":"10.1513/AnnalsATS.202408-889OC","url":null,"abstract":"<p><strong>Rationale: </strong>Increased respiratory effort (RE) is a critical feature of obstructive sleep apnea (OSA). While prior studies have established the efficacy of mandibular advancement device (MAD) therapy in reducing the apnea-hypopnea index (AHI), the impact of MAD therapy on RE burden remains unexplored.</p><p><strong>Objective: </strong>In this study, we used a validated mandibular jaw movement (MJM) monitoring technology to determine the dose-response relationship between MAD protrusion levels and RE burden measured as the percentage of total sleep time (TST) spent in elevated respiratory effort (REMOV) during MAD titration.</p><p><strong>Methods: </strong>Ninety-three OSA patients eligible for MAD treatment were included in this prospective cohort study. A subjective titration process involved iterative adjustments based on the persistence or worsening of OSA symptoms. Optimal AHI and REMOV responses were defined as an AHI reduction of greater than 50% and a residual REMOV lower than 14% TST, respectively. MJM-based home sleep tests were conducted at initial, intermediate, and final protrusion levels. The treatment effect on REMOV was estimated by regression analysis.</p><p><strong>Results: </strong>AHI and REMOV reductions increased progressively with higher MAD protrusion levels, with AHI decreasing by -10.3, -12.7, and -13.0 events/h and REMOV by 14.5%, 16.8%, and 18.6% of TST across the three titration steps. However, a consistent discrepancy was observed between REMOV and AHI responses: at the end of titration, 68.8% of patients achieved optimal responses for both indices, while 15.1% had optimal REMOV response without AHI normalization, and 5.4% showed the reverse. Regression analysis showed a significant dose-response relationship for REMOV, with a 10% TST reduction within the 0-6.5 mm protrusion range and diminishing benefits beyond 6.5 mm. Of note, each millimeter advancement would yield a 2.6% TST (95%CI: -3.0; -2.1) improvement in REMOV.</p><p><strong>Conclusion: </strong>Our findings demonstrate a dose-response relationship between the MAD protrusion level and the improvement in RE burden. Optimal responses in both AHI and REMOV signify greater efficacy of MAD therapy in reducing obstructive respiratory events and RE burden. This underscores the benefit of using at-home MJM analysis to monitor these two critical metrics in the management of MAD therapy to achieve better clinical outcomes and enhance MAD titration efficacy.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451258","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":"Association Between Nurse Care Continuity and Mortality in the Intensive Care Unit.","authors":"Kathryn A Connell, Billie S Davis, Jeremy M Kahn","doi":"10.1513/AnnalsATS.202406-603OC","DOIUrl":"10.1513/AnnalsATS.202406-603OC","url":null,"abstract":"<p><strong>Rationale: </strong>Continuity of nursing care is highly valued in the intensive care unit (ICU), but its impact on patient outcomes remains unclear.</p><p><strong>Objectives: </strong>To investigate the relationship between nurse continuity and mortality among ICU patients.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using electronic health records from 38 ICUs across eighteen hospitals between 2018 and 2020. Cumulative nurse continuity was defined at the shift level as the proportion of 12-hour shifts in which the patient received care from a nurse that had previously provided care to them, up to and including the present shift. Employing a landmark analysis framework, we used logistic regression to assess the relationship between in-hospital mortality and cumulative nurse continuity at each shift, adjusting for potential confounders.</p><p><strong>Measurements and main results: </strong>The study included 47,564 ICU patients. In-hospital mortality was 10.4%. Average cumulative nurse continuity increased from 10.2% at shift three to 34.2% at shift 14. In the regression models, increasing cumulative nurse continuity was associated with a modest but statistically significant increase in mortality in some but not all shifts. The results were robust to sensitivity analyses including limiting the cohort to patients receiving mechanical ventilation, excluding patients admitted during the COVID-19 pandemic, using different measures of continuity, and treating continuity as a time-varying covariate using proportional hazards regression.</p><p><strong>Conclusions: </strong>Nurse continuity was not associated with lower mortality and may lead to increased mortality in some settings. Further research is needed to understand the mechanisms underlying the association between nurse continuity and ICU outcomes.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451228","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":"Why Women Appear To Have Better Outcomes When Undergoing Screening For Lung Cancer.","authors":"Gerard A Silvestri, Ralph C Ward, Raewyn J Scott, Hormuzd Katki, Rebecca Landy, Robert P Young","doi":"10.1513/AnnalsATS.202408-863OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202408-863OC","url":null,"abstract":"<p><strong>Rationale: </strong>Randomized controlled trials (RCT) of lung cancer screening (LCS) using computed tomography (CT) documented lung cancer mortality reductions between 7.2%-29.2% compared to chest radiograph (CXR). Women appear to have a greater reduction than men.</p><p><strong>Objective: </strong>To determine why women appear to have better outcomes from LCS compared to Men.</p><p><strong>Methods: </strong>Secondary analysis of the National Lung Screening Trial (NLST), a RCT comparing CXR with CT among screen eligible individuals aged 55-74 years. Descriptive statistics and a competing risk proportional hazards model that included an interaction between sex and screening arm were used to examine differences in screening outcomes by sex.</p><p><strong>Results: </strong>Of 31,530 men and 21,922 women, 648 (2. 1%) and 373 (1.7%) died of lung cancer during the study, respectively. Overall mortality was higher in men: 2771 (8.8%) vs 1198 (5.5%). In an adjusted competing cause of death analysis, the LC mortality subdistribution hazard ratio (sHR) favoring CT was significant in women (sHR=0.74, 95% CI: 0.6, 0.9, p=0.003) but not men (sHR=0.91, 95% CI: 0.78, 1.06, p=0.24). The interaction between screening arm and sex was not significant (p=0.1). COPD and heart disease, more prevalent in men, were independently associated with LC death. LC deaths were consistently greater in the CT arm (vs CXR), for pre-existing COPD and DM in men but not women. Of those with lung cancer, women in the CT arm had 53.7% prevalence of adenocarcinoma (AD) histology, while women in the CXR arm and men in both arms had approximately 36-41% AD prevalence. However, there was no overall difference between sexes in the screening difference for AD lethality.</p><p><strong>Conclusion: </strong>Women in the NLST had a greater reduction in LC mortality, that while not statistically significant, could be the result of more prevalent comorbid disease in men which contributed to greater all-cause and LC mortality.  .</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451282","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}