CHEST critical care最新文献

{"title":"Vasopressors Administration Through Midline Catheters","authors":"","doi":"10.1016/j.chstcc.2024.100086","DOIUrl":"10.1016/j.chstcc.2024.100086","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100086"},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000406/pdfft?md5=7c12ab6643f5aa1ad261c765deba483a&pid=1-s2.0-S2949788424000406-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141398065","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":"Effects of Intrapulmonary Percussive Ventilation in Nonventilated Patients Who Are Critically Ill on Length of Stay, Oxygenation, and Pulmonary Complications","authors":"Anwar Hassan MHSc ,&nbsp;Stephen Huang PhD ,&nbsp;Fiona Fitzsimons BASc ,&nbsp;Deepa Shetty MBBS ,&nbsp;Richard Evans MBBS ,&nbsp;Jennifer A Alison PhD ,&nbsp;Maree A Milross PhD","doi":"10.1016/j.chstcc.2024.100068","DOIUrl":"10.1016/j.chstcc.2024.100068","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary complications such as chest infection and pulmonary atelectasis may lead to respiratory failure, prolonged ICU stay, and poor outcomes. Routine application of respiratory physiotherapy interventions is not supported by the current body of evidence. Intrapulmonary percussive ventilation (IPV) is used to treat various clinical conditions; however, the evidence to support its effectiveness in the ICU remains weak. This study aimed to evaluate the effectiveness of IPV in improving outcomes in patients admitted to intensive care.</p></div><div><h3>Research Question</h3><p>What is the effect of IPV on ICU length of stay, oxygenation, and pulmonary complications in nonventilated patients who are critically ill compared with commonly applied chest physiotherapy (CPT)?</p></div><div><h3>Methods</h3><p>This was a randomized controlled trial. Of 201 patients screened, 106 were recruited. Participants with a respiratory impairment were randomly allocated to either the IPV or the CPT group. Both groups received two treatment sessions daily. Data were analyzed for 100 participants for ICU length of stay, changes in oxygenation, respiratory rate, and radiologic findings.</p></div><div><h3>Results</h3><p>The median length of stay in the IPV group was 3.5 days (1.9, 5.9); in the CPT group, the length of stay was 5.2 days (3.4, 9.9). The mean difference in length of stay was 1.56 days (95% CI, 1.2-2.1; <em>P</em> = .002). The between-group difference (IPV minus CPT) for preintervention to postintervention peripheral oxygen saturation was 0.94% (95% CI, 0.43-1.45; <em>P</em> &lt; .001). The between-group difference (IPV minus CPT) in respiratory rate was 2.1 breaths/minute (95% CI, 0.9-3.2; <em>P</em> &lt; 0.001). No significant difference in radiologic atelectasis score was observed (<em>P</em> = .65).</p></div><div><h3>Interpretation</h3><p>This study showed that the IPV intervention reduced ICU length of stay and respiratory rate, with a small improvement in oxygenation compared with CPT interventions in nonventilated patients. The use of IPV intervention may improve outcomes in patients who are critically ill with impaired respiratory function.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100068"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000224/pdfft?md5=2999a6d219939625b8190a2dd3362a1a&pid=1-s2.0-S2949788424000224-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140791210","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":"Evolution of Tracheobronchial Colonization Following Tracheal Intubation in Patients With Neurologic Injury Who Are Ventilated","authors":"Estelle Danche MD ,&nbsp;Sylvain Meyer PharmD ,&nbsp;Elie Guichard MSc ,&nbsp;Ana Catalina Hernandez Padilla MD, PhD ,&nbsp;Anne-Laure Fedou MD ,&nbsp;Philippe Vignon MD, PhD ,&nbsp;Olivier Barraud PharmD, PhD ,&nbsp;Bruno François MD","doi":"10.1016/j.chstcc.2024.100075","DOIUrl":"https://doi.org/10.1016/j.chstcc.2024.100075","url":null,"abstract":"<div><h3>Background</h3><p>The characteristics and course of endotracheal secretions have scarcely been studied in patients under mechanical ventilation (MV) at risk of developing ventilator-associated pneumonia (VAP).</p></div><div><h3>Research Question</h3><p>Can endotracheal secretions be exhaustively described and what is their predictive value for the diagnosis of VAP during MV?</p></div><div><h3>Study Design and Methods</h3><p>This single-center prospective study included neuro-injured patients with neurologic injury requiring MV for at least 7 days. Patients with pulmonary and infectious diseases were ineligible. All endotracheal aspirates (ETAs) collected between tracheal intubation and day 7 were analyzed. Macroscopic characteristics and microbiology were assessed. Clinical Pulmonary Infection Score was calculated daily. An anonymized adjudication committee validated all VAP events.</p></div><div><h3>Results</h3><p>Forty-eight patients and 1,544 ETAs were analyzed. Overall, 81% of the ETAs were purulent, and 50% were thick. Culture results showed high interindividual and intraindividual variability. Ten patients (21%) developed early-onset VAP. Eight patients (80%) with VAP and 14 (37%) without VAP had a Clinical Pulmonary Infection Score &gt; 6. The day prior to VAP diagnosis, a 20 mL increase in ETA volume detected VAP with a sensitivity of 67% and a specificity of 93%.</p></div><div><h3>Interpretation</h3><p>This study provides new information regarding the course of respiratory colonization in patients who are mechanically ventilated and suggests that ETA color/aspects and pathogen kinetics cannot predict VAP. Traditional VAP criteria (Clinical Pulmonary Infection Score and bacterial load) also had a low diagnostic specificity. Conversely, an increase in secretion volume should alert for VAP development.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000297/pdfft?md5=f8a9d2a3710d2e4c53d03e8fb17494de&pid=1-s2.0-S2949788424000297-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141239649","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 Management of Cardiogenic Shock From Diagnosis to Devices","authors":"Fatimah A. Alkhunaizi MD ,&nbsp;Nikolhaus Smith ,&nbsp;Samuel B. Brusca ,&nbsp;David Furfaro MD","doi":"10.1016/j.chstcc.2024.100071","DOIUrl":"10.1016/j.chstcc.2024.100071","url":null,"abstract":"<div><p>Cardiogenic shock (CS) is a heterogenous syndrome broadly characterized by inadequate cardiac output leading to tissue hypoperfusion and multisystem organ dysfunction that carries an ongoing high mortality burden. The management of CS has advanced rapidly, especially with the incorporation of temporary mechanical circulatory support (tMCS) devices. A thorough understanding of how to approach a patient with CS and to select appropriate monitoring and treatment paradigms is essential in modern ICUs. Timely characterization of CS severity and hemodynamics is necessary to optimize outcomes, and this may be performed best by multidisciplinary shock-focused teams. In this article, we provide a review of CS aimed to inform both the cardiology-trained and non-cardiology-trained intensivist provider. We briefly describe the causes, pathophysiologic features, diagnosis, and severity staging of CS, focusing on gathering key information that is necessary for making management decisions. We go on to provide a more detailed review of CS management principles and practical applications, with a focus on tMCS. Medical management focuses on appropriate medication therapy to optimize perfusion—by enhancing contractility and minimizing afterload—and to facilitate decongestion. For more severe CS, or for patients with decompensating hemodynamic status despite medical therapy, initiation of the appropriate tMCS increasingly is common. We discuss the most common devices currently used for patients with CS—phenotyping patients as having left ventricular failure, right ventricular failure, or biventricular failure—and highlight key available data and particular points of consideration that inform tMCS device selection. Finally, we highlight core components of sedation and respiratory failure management for patients with CS.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294978842400025X/pdfft?md5=5ebc35e08c2fce0c16244ef1ac2a43de&pid=1-s2.0-S294978842400025X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765072","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":"Outcome Measures to Evaluate Functional Recovery in Survivors of Respiratory Failure","authors":"Kaitlyn Parrotte DPT ,&nbsp;Luz Mercado MPH ,&nbsp;Hope Lappen MLIS, MS ,&nbsp;Theodore J. Iwashyna MD, PhD ,&nbsp;Catherine L. Hough MD ,&nbsp;Thomas S. Valley MD ,&nbsp;Mari Armstrong-Hough MPH, PhD","doi":"10.1016/j.chstcc.2024.100084","DOIUrl":"10.1016/j.chstcc.2024.100084","url":null,"abstract":"<div><h3>Background</h3><p>Respiratory failure is a life-threatening condition affecting millions of individuals in the United States annually. Survivors experience persistent functional impairments, decreased quality of life, and cognitive impairments. However, no established standard exists for measuring functional recovery among survivors of respiratory failure.</p></div><div><h3>Research Question</h3><p>What outcomes are being used to measure and characterize functional recovery among survivors of respiratory failure?</p></div><div><h3>Study Design and Methods</h3><p>In this scoping review, we developed a review protocol following International Prospective Register of Systematic Reviews (PROSPERO) guidelines. Two independent reviewers assessed titles and abstracts, followed by full-text review. Articles were included if study participants were aged 18 years or older, survived a hospitalization for acute respiratory failure, and received invasive mechanical ventilation as an intervention; identified function or functional recovery after respiratory failure as a study outcome; were peer-reviewed; and used any type of quantitative study design.</p></div><div><h3>Results</h3><p>We reviewed 5,873 abstracts and identified 56 eligible articles. Among these articles, 28 distinct measures were used to assess functional recovery among survivors, including both performance-based measures (n = 8) and self-reported and proxy-reported measures (n = 20). Before 2019, 12 of the 28 distinct outcome measures (43%) were used, whereas 25 distinct measures (89%) were used from 2019 through 2024. The 6-min walk test appeared most frequently (46%) across the studies, and only 34 of 56 studies measured outcomes ≥ 6 months after discharge or study enrollment.</p></div><div><h3>Interpretation</h3><p>Heterogeneity exists in how functional recovery is measured among survivors of respiratory failure, which highlights a need to establish a gold standard to ensure effective and consistent measurement.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000388/pdfft?md5=8f9a571fa0ebf9074ed5464448c9fa9b&pid=1-s2.0-S2949788424000388-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087525","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":"Improving Spontaneous Breathing Trials With a Respiratory Therapist-Driven Protocol","authors":"Christopher A. Linke RN, MHI, CSSBB ,&nbsp;Jenna L. Potter DNP, ACNP ,&nbsp;Alissa Pool DNP ,&nbsp;Lindsay Berger RRT ,&nbsp;Frew Mekuria RRT ,&nbsp;Melissa Olson RRT-ACCS, MHA ,&nbsp;Tyan Thomas RRT ,&nbsp;Kathryn M. Pendleton MD","doi":"10.1016/j.chstcc.2024.100085","DOIUrl":"10.1016/j.chstcc.2024.100085","url":null,"abstract":"<div><h3>Background</h3><p>Respiratory therapist (RT)-driven spontaneous breathing trial (SBT) protocols have been shown to improve patient outcomes.</p></div><div><h3>Research Question</h3><p>Can an RT-driven SBT protocol be implemented and sustained to improve outcomes?</p></div><div><h3>Study Design and Methods</h3><p>This quality improvement (QI) project aimed to standardize and re-establish RT-driven protocol for screening patients for SBT readiness and administering SBTs to appropriate patients. Endotracheally intubated and mechanically ventilated adult patients admitted to an academic medical center ICU were screened daily by RTs for SBT readiness. Eligible patients received an SBT with extubation decisions made by the physician team. Patient demographics, indications for intubation, SBT eligibility and exclusionary indications, SBT ventilator settings, start times, duration, and outcomes were collected from the electronic health record. QI interventions included staff re-education, documentation tips, creation of process maps, and interdisciplinary open forum discussions.</p></div><div><h3>Results</h3><p>One hundred twenty-eight patients representing 759 safety screen weaning assessment opportunities were included over a baseline sample and three plan-do-study-act (PDSA) cycles. Documentation of SBT eligibility increased from 25% at baseline to 86% in PDSA cycle 3 (<em>P</em> ≤ .001). Patients assessed to be eligible for and who received an SBT constituted 42% at baseline, 35% at PDSA cycle 1, 36% at PDSA cycle 2, and 51% at PDSA cycle 3 (<em>P</em> = .092). Use of the protocolized SBT ventilator settings improved significantly from 18% to 83% (<em>P</em> ≤ .001). Patients who started an SBT before 9 <span>am</span> increased from 41% to 67% (<em>P</em> = .097), and the median duration of SBT decreased from 211 to 64 min (<em>P</em> = .008).</p></div><div><h3>Interpretation</h3><p>This study shows that standardization of an RT-driven SBT protocol is feasible despite multiple obstacles, including staffing and communication challenges and poor shared understanding of terminology.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294978842400039X/pdfft?md5=1faa96b3f6fcd86090bf43c87789509b&pid=1-s2.0-S294978842400039X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728756","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":"Answers to the Search for Heterogeneity in COVID-19 Depend on the Question","authors":"","doi":"10.1016/j.chstcc.2024.100083","DOIUrl":"10.1016/j.chstcc.2024.100083","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100083"},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000376/pdfft?md5=f5732e2dc0a9258886d3ec15796dfa0d&pid=1-s2.0-S2949788424000376-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141143525","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":"Elevated Hemoglobin A1c and the Risk of Developing ARDS in Two Cohort Studies","authors":"","doi":"10.1016/j.chstcc.2024.100082","DOIUrl":"10.1016/j.chstcc.2024.100082","url":null,"abstract":"<div><h3>Background</h3><p>Only a subset of patients at risk for ARDS go on to develop it, and the contribution of preexisting comorbidities (eg, diabetes) to ARDS risk is not well understood. Prior studies of the association between diabetes and ARDS have yielded conflicting results.</p></div><div><h3>Research Question</h3><p>Does assessing ARDS risk based on hemoglobin A1c (HbA1c) as a marker of long-term blood glucose levels, rather than a charted diagnosis of diabetes, clarify the relationship between diabetes and ARDS?</p></div><div><h3>Study Design and Methods</h3><p>Using data from two prospective observational cohorts of critically ill adults (Validating Acute Lung Injury Biomarkers for Diagnosis [VALID] and Early Assessment of Renal and Lung Injury [EARLI]), we analyzed the association between clinical HbA1c category and development of ARDS in patients with a risk factor for ARDS and at least one clinical HbA1c measurement within the 180 days prior through 14 days after enrollment.</p></div><div><h3>Results</h3><p>A total of 599 patients in VALID and 276 in EARLI met inclusion criteria, of whom 164 and 58 developed ARDS, respectively. Patients with a charted diagnosis of diabetes were not shown to be more likely to develop ARDS (VALID: 24.6% ARDS in those categorized as nondiabetic vs 30.0% in those categorized as diabetic, <em>P</em> = .14; EARLI: 19.6% vs 22.8%, respectively; <em>P</em> = .55). However, in VALID, patients categorized as diabetic with inadequate glycemic control based on their HbA1c had an increased risk of developing ARDS compared with those with nondiabetic HbA1c (20.9% vs 34.0%, respectively; <em>P</em> = .0073), a finding that persisted in multivariable analysis (OR for those categorized as diabetic with inadequate glycemic control vs those categorized as nondiabetic range HbA1c, 1.25; 95% CI, 1.01-1.57). These findings were not reproduced in the smaller EARLI cohort, but were appreciated when the cohorts were combined for analysis.</p></div><div><h3>Interpretation</h3><p>Elevated HbA1c may be associated with risk of developing ARDS, independent of clinical diagnosis of diabetes, but prospective validation is needed. If confirmed, these findings suggest that inadequate glycemic control could be an unrecognized risk factor for ARDS.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000364/pdfft?md5=5bbe0c5796bf31738e810f7557810907&pid=1-s2.0-S2949788424000364-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141057536","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":"Potential Value of the Radiographic Assessment of Lung Edema Score to Assess Resolution of Pulmonary Edema in a Clinical Trial in ARDS","authors":"Matthieu Jabaudon MD, PhD ,&nbsp;Melissa A. Warren MD ,&nbsp;Tatsuki Koyama PhD ,&nbsp;Philip Lavin PhD, FASA, FRAPS ,&nbsp;Jonathan C. Javitt MD, MPH ,&nbsp;Melvin L. Morganroth MD ,&nbsp;Marc Korczykowski MSc ,&nbsp;John W. Hollingsworth MD ,&nbsp;Richard A. Lee MD ,&nbsp;Jihad G. Youssef MD ,&nbsp;Lorraine B. Ware MD","doi":"10.1016/j.chstcc.2024.100081","DOIUrl":"10.1016/j.chstcc.2024.100081","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000352/pdfft?md5=e84ccb995b76e97e34d56cda15ee1e4a&pid=1-s2.0-S2949788424000352-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141038967","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":"Cancellation and Resumption of Elective Surgeries Over Time Across a National Sample of US Hospitals During the COVID-19 Pandemic","authors":"Kelly C. Vranas MD, MCR ,&nbsp;Deena Kelly Costa PhD, RN ,&nbsp;Billie S. Davis PhD ,&nbsp;Andrew J. Admon MD, MPH ,&nbsp;Bo Zhao PhD ,&nbsp;Jeremy M. Kahn MD ,&nbsp;Meeta Prasad Kerlin MD, MSCE","doi":"10.1016/j.chstcc.2024.100080","DOIUrl":"10.1016/j.chstcc.2024.100080","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000340/pdfft?md5=e47b1ef03c869bddea88c72279f99b38&pid=1-s2.0-S2949788424000340-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141033775","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}