Canadian journal of diabetes最新文献

{"title":"Guidance for continuous glucose monitor (CGM) use in Canadian hospitals.","authors":"Julie L V Shaw, Davor Brinc, Angela W S Fung, Robyn L Houlden, Annie Garon-Mailer, Lisa Maks, Sarah Moore-Vasram, Leta C Philp, Atoosa Rezvanpour, Cathy J Sun, Vinita Thakur, Allison A Venner, Li Wang","doi":"10.1016/j.jcjd.2026.09.009","DOIUrl":"https://doi.org/10.1016/j.jcjd.2026.09.009","url":null,"abstract":"<p><p>People living with diabetes and healthcare providers are increasingly advocating for the option to continue use of their personal continuous glucose monitoring (CGM) devices during hospital admission to promote continuity of care. Although no CGM devices are currently approved by Health Canada for inpatient use, CGM use in ambulatory settings has been shown to improve glycemic outcomes and patient experience compared with capillary glucose monitoring. Publications in recent years have demonstrated that CGM use in specific populations can be safe and may improve glycemic control while reducing hypoglycemia risk. Accordingly, hospitals must determine how to safely and practically integrate CGM into inpatient clinical practice. This article provides practical guidance for the use of CGM in Canadian hospitals for inpatient glucose monitoring.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198432","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 Causal Role of Adiponectin in Type 2 Diabetes across Ages and Sexes - An Observational and Mendelian Randomization Study.","authors":"Samya Mavrikakis Legault, Isabel Gamache, Wiame Belbellaj, Basile Jumentier, John Eric Hamilton, Alexandre Matboui, Despoina Manousaki","doi":"10.1016/j.jcjd.2026.09.010","DOIUrl":"https://doi.org/10.1016/j.jcjd.2026.09.010","url":null,"abstract":"<p><strong>Aims: </strong>The obesity pandemic has increased the prevalence of Type 2 Diabetes (T2D) across all ages and sexes. Adiponectin, an insulin-sensitizing hormone, shows protective effects against T2D in observational studies. However, it is unclear whether low adiponectin levels cause T2D, as this association might be driven by confounding factors. We aimed to investigate if the association of adiponectin with T2D is causal.</p><p><strong>Materials and methods: </strong>We assessed causality with Two-Sample Mendelian Randomization (MR) using Single Nucleotide Polymorphisms (SNPs) from multi-ancestry genome-wide association studies (GWAS). Multivariable MR (MVMR) and Two-Step network MR evaluated whether the effect of adiponectin on T2D was influenced by adiposity-related phenotypes. Using the Avon Longitudinal Study of Parents and Children (ALSPAC), we examined mediation and longitudinal associations between adiponectin, T2D-related traits, and adiposity in youth.</p><p><strong>Results: </strong>Initial inverse variance-weighted MR estimates suggested protective effects. However, the identified causal association did not persist after removing SNPs linked to adiposity-related traits or adjusting for these traits in MVMR. Two-Step network MR showed that adiponectin could mediate the relationship between visceral fat and T2D in women. ALSPAC results suggest that adiponectin may mediate the relationship between adiposity and fasting glucose levels in youth.</p><p><strong>Conclusions: </strong>Taken together, our MR results did not show a causal association between adiponectin levels and T2D. Instead, adiponectin potentially plays a sex-specific mediating role in the relationship between visceral fat and T2D in women.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186751","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":"Discrimination and material-need insecurities intersect in association with poor mental health among youth and young adults with type 1 diabetes.","authors":"Andrea Danielle Brown, Edward A Frongillo, Kate Flory, Matthew Lohman, Danielle Krobath, Emmanuel F Julceus, Jingkai Wei, Beth A Reboussin, Jason A Mendoza, Anna Bellatorre, Faisal Malik, Angela D Liese","doi":"10.1016/j.jcjd.2026.09.006","DOIUrl":"https://doi.org/10.1016/j.jcjd.2026.09.006","url":null,"abstract":"<p><strong>Objective: </strong>Little is known about how perceived discrimination and material-need insecurities jointly contribute to poor mental health among youth and young adults (YYA) with diabetes. We examined how these factors intersect to influence mental health among YYA with type 1 diabetes.</p><p><strong>Method: </strong>Analyses included 829 YYA with type 1 diabetes from the SEARCH Food Security Cohort study. Classification tree analysis identified patterns among perceived discrimination, material-need insecurities, demographic, and socioeconomic characteristics that distinguish between moderate-to-severe and minimal-to-mild depressive and anxiety symptoms assessed using the Center for Epidemiological Studies-Depression and the 7-item Generalized Anxiety Disorder scales. Material-need insecurities included household food insecurity, housing, and transportation insecurity.</p><p><strong>Results: </strong>Overall, 35.6% of participants reported moderate-to-severe depressive symptoms and 27.6% reported moderate-to-severe anxiety symptoms. Discrimination intersected with food insecurity among YYA with type 1 diabetes such that 86% of those experiencing greater discrimination and food insecurity reported moderate-to-severe depressive symptoms compared to 47% among the food secure group. In those reporting less discrimination, 56% of those with food insecurity reported moderate to severe depressive symptoms compared to 17% among the food secure group. For anxiety, 56% of those with food insecurity reported moderate-to-severe symptoms among those who were food secure, 40.4% of those with greater discrimination and 16.8% of those with less discrimination reported moderate-to-severe anxiety symptoms. Adding discrimination to models which included food insecurity and demographic measures improved prediction accuracy (AUC=0.71 versus AUC=0.64 for depressive and AUC=0.68 versus AUC=0.64 for anxiety symptoms).</p><p><strong>Conclusions: </strong>Addressing household food insecurity and discrimination may help to decrease mental health problems among YYA with type 1 diabetes.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119723","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 Diabetes Management Behaviors with FreeStyle Libre 2: Insights from Adults with Type 2 Diabetes in Quebec.","authors":"Jean-François Yale, Sylvie Bouchard, Abraham Lee, Yeesha Poon","doi":"10.1016/j.jcjd.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.jcjd.2026.09.008","url":null,"abstract":"<p><strong>Objectives: </strong>To understand the long-term behavior changes associated with use of the FreeStyle Libre 2 sensor-based glucose monitor by people living with type 2 diabetes (T2D).</p><p><strong>Methods: </strong>This was a qualitative study of adults with T2D living in Quebec and using FreeStyle Libre 2. Discussions were moderated by an experienced facilitator using a semi-directed discussion guide. Discussions were transcribed and analyzed thematically.</p><p><strong>Results: </strong>16 people living with T2D who had been using FreeStyle Libre 2 for > 6 months participated in two focus groups (non-insulin treatments, six women and three men; basal insulin, two women and five men). There were no material differences in responses or anecdotes between the two groups. Use of FreeStyle Libre 2 was associated with four main themes: 1) Personalized knowledge, including participants' sense of autonomy and control and their ability to see the effect of their actions on glucose levels and to make informed choices, such as modifying their diet; 2) Improved communication with healthcare providers (HCPs), who can access patients' glucose data in real-time if shared via the smartphone app; 3) Reductions in hypoglycemia, particularly due to warnings of low glucose levels; and 4) Long-term benefits, including reductions in stress and improved HRQoL.</p><p><strong>Conclusion: </strong>Long-term users found that FreeStyle Libre 2 improved their diabetes self-management, communication with healthcare providers, HRQoL, and stress levels, and facilitated lifestyle changes. Individuals with T2D described the device empowering ongoing healthy behavior change. This research serves as a person-centered qualitative finding to consider in access decisions.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119934","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":"Factors Associated with HbA1c-Lowering in a Randomized Trial of Continuous Glucose Monitoring in Adults with Non-Insulin-Treated Diabetes: An Observational Analysis.","authors":"Jiawei Ryan Zhang, Pratima Singh, Roseanne O Yeung, Donna P Manca, Tawnya Perry, Inga Olu-Jordan, Gulelala Rahim, Evan M Hagen, Darren Lau","doi":"10.1016/j.jcjd.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.jcjd.2026.09.007","url":null,"abstract":"<p><strong>Background: </strong>A prior randomized trial showed that CGM lowers HbA1c in adults with type 2 diabetes and elevated glycated hemoglobin (HbA1c > 7.0%) not on insulin.</p><p><strong>Objectives: </strong>We examined the effect modifiers of CGM effectiveness, and factors associated with HbA1c-lowering.</p><p><strong>Methods: </strong>Secondary analysis of data from a randomized trial. The primary outcome was change in HbA1c from baseline to 12 weeks. Explanatory variables included sociodemographics, diabetes and treatment parameters, and neighbourhood environment characteristics. Variables were assessed for interaction with CGM using linear regression, which was also used to estimate associations between each variable and HbA1c change, and to develop a final multi-variable adjusted-model.</p><p><strong>Results: </strong>We included 86 individuals. No formal interactions were identified with CGM effectiveness, though noticeable numeric differences in the effect of CGM were seen with sex, recent diagnosis, and neighbourhood walkability. Aside from CGM treatment allocation (β=-0.65, p=0.003 95% CI [-1.07 to -0.22]), multi-variable predictors of HbA1c-lowering were higher baseline HbA1c (β =-0.71, p<0.001 [-0.-90 to -0.53]), diabetes diagnosis < 1 year (β=-1.06, p=0.004 [-1.77 to -0.35]), male sex (β=-0.51, p=0.017 [-0.93 to -0.09]), and not using sodium-glucose co-transporter-2 inhibitor medication at baseline (β=0.62, p=0.006 [0.18 to 1.05]). Neighbourhood walkability was associated with HbA1c-lowering on crude (β=-0.26, p=0.041 [-0.51 to -0.01]), but not adjusted, analysis.</p><p><strong>Conclusions: </strong>Further studies are needed to determine the factors influencing the effectiveness of CGM. Individuals with type 2 diabetes, not on insulin, who voluntarily seek CGM, may experience a reduction in HbA1c proportional to their baseline HbA1c, regardless of treatment allocation.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120102","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":"Comparing physical activity and sedentary time in children and adolescents with type 1 diabetes using different accelerometer data processing protocols.","authors":"Eden Sedarous, Elyse Letts, Madelyn M Byra, Elizabeth Ball, Karen McAssey, Brian W Timmons, Joyce Obeid","doi":"10.1016/j.jcjd.2026.09.005","DOIUrl":"https://doi.org/10.1016/j.jcjd.2026.09.005","url":null,"abstract":"<p><strong>Background: </strong>Regular physical activity (PA) is crucial for managing type 1 diabetes (T1D), yet many children fail to achieve the recommended 60 minutes of daily moderate-to-vigorous physical activity (MVPA). Device-based (accelerometry) measurement of PA and sedentary time (SED) may be influenced by analytical decisions (e.g., cut-points), but less is known about these methodological effects in children with T1D.</p><p><strong>Objectives: </strong>To (1) compare the effects of different accelerometer data processing protocols on PA and SED estimates and (2) examine how these variations influence the proportion of children with T1D meeting PA guidelines.</p><p><strong>Methods: </strong>Participants aged 7-17 years with T1D (n=43; 49% female; 13.7±2.3 years) wore an ActiGraph accelerometer on their right hip for 7 days. ActiLife software processed data according to eight published protocols to classify SED, light PA (LPA), and MVPA. Linear mixed-effects models compared activity time estimates across protocols, and Cochran's Q test assessed differences in the proportion meeting PA guidelines.</p><p><strong>Results: </strong>SED, LPA, and MVPA estimates differed significantly across protocols (p < 0.001), with mean daily SED ranging from 438-700 minutes, LPA from 82-329 minutes, and MVPA from 16-193 minutes. Protocol choice also influenced the proportion of participants meeting the MVPA guidelines (Q(7) =172.0, n=31, p<0.001), with some methods consistently classifying more participants as meeting recommendations than others.</p><p><strong>Conclusion: </strong>This study addresses gaps in accelerometer-based research by identifying protocol-specific variability in activity measurement in children with T1D. Without criterion reference measures, it remains unclear which protocols provide the most accurate estimates. Future research should incorporate validation methods to strengthen methodological decision-making.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120136","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 do they say manage?\" A Mixed Method Exploration of Lifestyle-Driven Remission in Type 2 Diabetes.","authors":"Tahmina Rahman, Alexis Marcotte-Chénard, Margherita Cameranesi, Barbara Olivera, Rebecca Mollard, Jonathan Little, Dylan MacKay","doi":"10.1016/j.jcjd.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.jcjd.2026.09.001","url":null,"abstract":"<p><strong>Objective: </strong>Type 2 diabetes (T2D) remission might be achievable through sustained lifestyle modifications, yet lived experience of remission is understudied. This study explored the barriers and facilitators to lifestyle-based remission in Canadians.</p><p><strong>Methods: </strong>In this two-phase mixed methods study, quantitative data from 21 adults (57±8 years) who had achieved T2D remission were collected through questionnaires, HbA1c, and continuous glucose monitoring (CGM). A purposive sub-sample of 7 participants also completed semi-structured interviews. Qualitative data underwent inductive thematic analysis and were integrated using meta-inference with joint display approach.</p><p><strong>Results: </strong>Quantitative results showed strong glycemic regulation (24hr median CGM glucose: 5.0 [4.8-5.6] mmol/L; 92.2 [85-97] % time in range), consistent physical activity, and good perceived health. Qualitative analysis identified seven themes: i) sustainable lifestyle strategies; ii) self-reliance: iii) commitment to Remission; iv) individualized and supportive Care; v) healthcare, not medical care; vi) barriers inside and out; and vii) I'd rather be healthy.</p><p><strong>Conclusion: </strong>Integration highlighted informed decision-making, alongside psychosocial and educational factors as central to sustaining T2D remission in naturalistic settings.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027155","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":"Time to Finding a Regular Primary Care Provider for Unattached Patients at the Primary Care Diabetes Support Program in London, Ontario, Canada.","authors":"Rhiannon Lyons, Lindsay Hedden, Stewart Harris, Yun-Hee Choi, Bridget L Ryan, Sonja Reichert, Leslie Meredith, Maria Mathews","doi":"10.1016/j.jcjd.2026.09.004","DOIUrl":"10.1016/j.jcjd.2026.09.004","url":null,"abstract":"<p><strong>Objective: </strong>The Primary Care Diabetes Support Program (PCDSP) at St. Joseph's Health Care in London, Ontario, focuses on managing diabetes in high-risk adults (e.g. those who are socially and medically complex) and works to attach patients to a regular primary care provider. We describe the characteristics of the unattached patient population enrolled in the PCDSP and identify the time to and predictors of attachment (i.e. finding a regular provider).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using electronic medical record data of patients enrolled in the PCDSP between April 1, 2011, and March 31, 2018 and followed patients for 5 years. We used descriptive statistics to assess characteristics of patients and time-to-event analyses to assess time to attachment.</p><p><strong>Results: </strong>Among a final cohort of 726 patients with 5-year follow-up data, 401 individuals (55.2%) became attached. The estimated median time to attachment was 998 days (95% confidence interval [CI]: 748-1,248). Individuals who were both socially and medically complex (hazard ratio=1.44; 95% CI: 1.01-2.06) and joined the PCDSP in fiscal 2012 (hazard ratio=1.40; 95% CI: 1.01-1.95) were more likely to be attached compared with those who were non-complex and joined the program in fiscal 2011, respectively.</p><p><strong>Conclusions: </strong>The PCDSP prioritises high-risk patients, particularly those who are both medically and socially complex, to attach them to a regular primary care provider. Our findings may relate to the social support workers in the program who play a crucial role in documenting social risk indicators, prioritising high-risk patients, and advocating for their attachment to primary care.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019072","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 Evolution of Carbohydrate Management in Type 1 Diabetes.","authors":"Aastha Relan, Robyn Houlden","doi":"10.1016/j.jcjd.2026.09.003","DOIUrl":"10.1016/j.jcjd.2026.09.003","url":null,"abstract":"","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003160","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 Virtual Care Experiences for Gestational Diabetes in Adults: A Qualitative Descriptive Study.","authors":"Sharon Brudnyi, Stacy Kozak, Alan Santinele Martino, Erin A Brennand, Simren Trehin, Doreen M Rabi, Jamie L Benham","doi":"10.1016/j.jcjd.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.jcjd.2026.09.002","url":null,"abstract":"<p><strong>Background: </strong>Gestational diabetes mellitus (GDM) care is increasingly provided virtually, yet a gap exists in evaluating virtual GDM care from a patient perspective. This study's objective is to explore the experience of receiving virtual care for GDM management to inform care optimization.</p><p><strong>Methods: </strong>We conducted a pragmatic qualitative descriptive study guided by Oben's patient experience framework and feedback from a person with lived experience. Eligible participants (≥18 years) had GDM within the past 2 years and received virtual GDM care in Alberta, Canada. We collected data from April to August 2025 through virtual semi-structured interviews and moderated focus group discussions that were coded inductively in NVivo using Reflexive Thematic Analysis.</p><p><strong>Results: </strong>Of the 35 participants (20 metropolitan, 15 rural), the median age was 34 years, 16 (46%) identified as part of a racialized group, 17 (49%) experienced their first pregnancy, and 9 (26%) experienced GDM in previous pregnancies. Four themes were developed to describe patient experiences of virtual GDM care: 1) tension between convenience and drawbacks of virtual care; 2) aligning virtual care to the evolving needs of patients; 3) supporting a virtual therapeutic relationship; and 4) improving access with virtual care.</p><p><strong>Interpretation: </strong>Generally, participants appreciated virtual care for its ability to help them fit GDM care into their everyday lives, especially when faced with competing demands during pregnancy. Virtual care can be optimized to better address patient needs, including by improving access to GDM care rurally.</p>","PeriodicalId":93918,"journal":{"name":"Canadian journal of diabetes","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003179","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}