Journal of the American Geriatrics Society最新文献

{"title":"Agreement Between Fingerstick Blood Glucose and Continuous Glucose Monitor Measures Among Long-Term Care Facility Residents.","authors":"Marzan A Khan, Medha N Munshi, Christine Slyne, Nina R Joyce, Andrew R Zullo","doi":"10.1111/jgs.70024","DOIUrl":"https://doi.org/10.1111/jgs.70024","url":null,"abstract":"<p><strong>Background: </strong>Long-term care facility (LTCF) residents with diabetes are at high risk of hypoglycemia. Continuous glucose monitoring (CGM), which measures interstitial glucose at 5-min intervals over 10-14 days, and fingerstick blood glucose (FBG) which analyzes glucose from a drop of blood, are both used to monitor glucose levels. Observational studies using electronic health record (EHR) data containing FBG measures could help to identify ways to reduce hypoglycemia risk. We first need to understand the validity of such data. Our objective was to compare EHR-based FBG measures against reference-standard CGM measures of hypoglycemia.</p><p><strong>Methods: </strong>We studied two cohorts of residents with diabetes in parallel. In Cohort 1, we analyzed linked CGM and Long-Term Care Data Cooperative EHR-based FBG data collected in 2023. In Cohort 2, we analyzed linked CGM and EHR-based FBG data obtained directly from LTCFs between 2022 and 2023. We defined hypoglycemia as glucose < 70 mg/dL and assessed the sensitivity and specificity of FBG versus CGM measures to detect hypoglycemia. The unit of analysis was each pair of contemporaneous FBG-CGM measures.</p><p><strong>Results: </strong>In Cohort 1, two White female residents with a mean (standard deviation [SD]) age of 81 [12.7] years generated 25 daily hypoglycemia measurements. The sensitivity and specificity were 14% and 100%, respectively, for FBG-measured hypoglycemia. Cohort 2 included 40 residents (mean [SD] age 68 [11] years, 45% females, 60% White race) who generated 425 daily measurements of hypoglycemia. The sensitivity and specificity were 13% and 99%, respectively.</p><p><strong>Conclusion: </strong>EHR FBG measures of hypoglycemia had high specificity but failed to identify four out of every five hypoglycemic events among LTCF residents. Researchers and healthcare providers should assume hypoglycemia is measured with substantial errors in EHRs and account for this in their research and clinical practice.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765908","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":"Development and Pilot Testing of an Artificial Intelligence and Care Coach Intervention for Cognitively Impaired Older Adults.","authors":"Cameron J Gettel, Chitra Dorai, James Galske, Tonya Chera, Edith Stern, Kate Keefe, Erica DeFrancesco, Sreeranjini Seetharam, Sandeep Nagaraj, Vaishnavi Raveendranathan, Heidi Gil","doi":"10.1111/jgs.70028","DOIUrl":"https://doi.org/10.1111/jgs.70028","url":null,"abstract":"<p><strong>Background: </strong>Care transitions from the emergency department (ED) to community settings are particularly challenging for persons living with cognitive impairment (PLWCI) and their caregivers. The chaotic ED environment and limited post-discharge support contribute to poor outcomes and high caregiver burden. This study aimed to develop and pilot test an intervention integrating artificial intelligence (AI) technology and care coaching to enhance post-ED support among PLWCI and their caregivers.</p><p><strong>Methods: </strong>We conducted a three-phase study using a user-centered approach. Phase 1 involved focus groups with key informants to explore care transition experiences. Phase 2 included a design thinking workshop with PLWCI, caregivers, clinicians, and technology experts to co-create the intervention. The final intervention combined a 5-part AI technology application (termed NeuViCare)-planner, task support, resource advisor, care advisor, and community hub-with access to a care coach trained in occupational therapy or nursing. In Phase 3, we pilot tested the intervention in four EDs, measuring caregiver self-efficacy (Fortinsky Caregiver Self-Efficacy scale) and burden (4-item Zarit Caregiver Burden scale).</p><p><strong>Results: </strong>Focus groups including 15 participants highlighted major ED and transition challenges, emphasizing the need for better communication and support. Workshop participants (n = 23) identified key intervention components. In the pilot, 40 participants enrolled, with 34 completing the 7-day follow-up and 29 completing the 30-day follow-up. Engagement with NeuViCare was high, with caregiver self-efficacy improving from 52.0 at Day 0 to 65.8 at Day 30, and caregiver burden decreasing from 9.2 to 8.2.</p><p><strong>Conclusion: </strong>Integrating AI-driven support with human care coaching shows promise in improving ED care transitions for PLWCI and their caregivers. The intervention enhanced caregiver self-efficacy and modestly reduced burden, suggesting potential for broader implementation.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765923","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":"Penalties in 2024 in Medicare's Skilled Nursing Facility Value-Based Purchasing Program.","authors":"Sydney P Wheeler, Sunny C Lin, Gmerice Hammond, Khavya Avula, R J Waken, David C Grabowski, Michael L Barnett, Karen E Joynt Maddox","doi":"10.1111/jgs.70025","DOIUrl":"https://doi.org/10.1111/jgs.70025","url":null,"abstract":"<p><strong>Background: </strong>The Medicare Skilled Nursing Facility (SNF) Value-Based Purchasing Program (VBP) provides incentive or penalty payments to SNFs based on their 30-day readmission rates. Our objective was to identify facility-level characteristics associated with penalties in the 2024 program.</p><p><strong>Methods: </strong>This retrospective, cross-sectional analysis of 10,278 SNFs used publicly available CMS data for the 2024 SNF VBP program. Using logistic regression, we analyzed the relationship between patient makeup (proportion of Black or Hispanic patients), structural characteristics (facility size, profit status, Medicare or Medicaid certification, hospital affiliation, SNF operating margin, and total nursing staff hours per resident per day), and community characteristics (ZIP SDI, rural versus urban location, region, and state average home health quality rating) on receipt of maximum penalty.</p><p><strong>Results: </strong>Most SNFs participating in the 2024 SNF VBP were penalized (71.7%), with 33.1% of facilities receiving the maximum penalty of -1.98%. In multivariate regression models, facilities with a high proportion of Black residents (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.02-1.28) or Hispanic residents (aOR 1.42, 95% CI 1.26-1.60) and for-profit SNFs (aOR 1.42, 95% CI 1.26-1.61; vs. non-profit) were more likely to receive maximum penalties than their counterparts, as were those located in socioeconomically deprived ZIP codes (aOR 1.20, 95% CI 1.04-1.39), urban location (aOR 1.56, CI 1.35-1.81) or the South (aOR 2.32, 95% CI 1.98-2.71). Other measured characteristics were not associated with increased likelihood of maximum penalty.</p><p><strong>Conclusion: </strong>Penalties under the Medicare Skilled Nursing Facility Value-Based Purchasing Program vary by key facility characteristics, including patient mix, ownership, and geography. This information may help inform policymakers on how to improve outcomes in new iterations of the SNF VBP program and identify areas where technical modifications or additional investments in facility support for quality improvement could be prioritized.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765924","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":"Identifying a Set of Quality Indicators for Older Adults Hospitalized After Injury: An Expert Consensus Study.","authors":"Marianne Giroux, Marie-Josée Sirois, Marcel Émond, Mélanie Bérubé, Michèle Morin, Lynne Moore","doi":"10.1111/jgs.70015","DOIUrl":"https://doi.org/10.1111/jgs.70015","url":null,"abstract":"<p><strong>Background: </strong>Older people account for over 50% of trauma admissions and are at increased risk of adverse outcomes. Several authors have proposed quality indicators for geriatric trauma care. However, there is still no consensus on those that should be used to assess the quality of care in this population. This study aims to reach a consensus on a set of indicators for assessing the quality of care of older patients hospitalized for injury.</p><p><strong>Methods: </strong>We conducted a consensus study using the RAND-UCLA Appropriateness method, using an individual online questionnaire (round 1) and a virtual group meeting (round 2). Forty indicators identified in the literature were submitted to a panel of experts in trauma and geriatrics and three patient partners from the inclusive trauma system of the province of Quebec (Canada). Indicators were evaluated using four criteria: importance, evidence, actionability, and measurability. Consensus was defined using RAND-UCLA criteria.</p><p><strong>Results: </strong>30/41 (73%) invited participants completed the two rounds. In the first round, 12 indicators were retained and 14 were rejected. In the second round, three additional indicators were retained. The final set consisted of 15 indicators, including early mobilization and rehabilitation, delirium screening, documentation of the level of care < 48 h, favorable discharge destination, optimal pain management using appropriate modalities for older people, and surgical delay.</p><p><strong>Conclusion: </strong>We propose a set of 15 quality indicators based on evidence, expert consensus, and patient partners' priorities that could be implemented in trauma systems and contribute to improving the quality of hospital care for older patients.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762883","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":"Drivers of Frequent Emergency Department Use in Socioeconomically Disadvantaged Older Adults: A Qualitative Study.","authors":"Anita Chary, Annika Bhananker, Michelle Suh, David Leavitt, Elise Brickhouse, Shreya Tamma, Jose Ramirez, Mariana Rios, Aanand D Naik, Margaret Samuels-Kalow, Naomi George","doi":"10.1111/jgs.19616","DOIUrl":"https://doi.org/10.1111/jgs.19616","url":null,"abstract":"<p><strong>Background: </strong>The emergency department (ED) is the safety net for and a common point of healthcare access for socioeconomically disadvantaged older adults. Little is known about socioeconomically disadvantaged older ED patients' perspectives on their health, healthcare access, and ED use. Such insights could guide tailored interventions to address unmet clinical and health-related social needs (HRSN).</p><p><strong>Methods: </strong>We performed a qualitative study with older adults in a single public safety net hospital ED. We interviewed patients age 60+ who had ≥ 4 ED 4 visits in the past year. Semi-structured interviews explored perceived health needs and motivations underlying ED visits. We screened for HRSN using validated measures. We performed content analysis to evaluate key drivers of ED use based on Andersen's Behavioral Model of Health Services Use and used principles of narrative analysis to identify distinct profiles of older patients with frequent ED use.</p><p><strong>Results: </strong>Among 68 interview participants, 40% identified as Black and 43% as Hispanic. Sixty percent had health insurance. Most participants (63%) reported HRSN, but rarely described these as primary drivers of ED use. Instead, poor access to outpatient care and medical complexity related to condition-specific needs were the most salient factors. Six distinct profiles emerged of patients who: (1) lacked insurance and primary care; (2) faced an acute condition; (3) held acute concerns related to serious underlying diseases; (4) had chronic disease whose management bordered between outpatient and inpatient settings; (5) had a sentinel event (e.g., fall, surgery) with cascading sequelae; (6) faced recurrent challenges managing indwelling catheters, tubes, and long-term vascular access.</p><p><strong>Conclusions: </strong>Among socioeconomically disadvantaged older adults in our sample, medical complexity was a more salient driver of frequent ED use than unmet social needs. Innovations to strengthen outpatient care and offer alternatives to ED and hospital admission are needed for this population.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746660","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":"AI and Technology in Geriatrics: A New Chapter in JAGS.","authors":"Peter M Abadir, T E Schlesinger","doi":"10.1111/jgs.70007","DOIUrl":"https://doi.org/10.1111/jgs.70007","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746658","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":"Announcing a New Section in JAGS on Artificial Intelligence and Technology.","authors":"Joseph G Ouslander, Debra Saliba, Alexander Smith","doi":"10.1111/jgs.70008","DOIUrl":"https://doi.org/10.1111/jgs.70008","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746659","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":"Shedding Light on an Invisible Population in Geriatric Medicine: A Scoping Review of Older Adults Who Are Homebound.","authors":"Caoimhe McManus, Benjamin H Oseroff, Robert M Zimbroff, Tiffany J Riser, Katherine A Ornstein, Orla C Sheehan","doi":"10.1111/jgs.19620","DOIUrl":"https://doi.org/10.1111/jgs.19620","url":null,"abstract":"<p><strong>Background: </strong>Older adults who are homebound, defined as individuals who rarely or never leave their homes without assistance, represent a vulnerable and growing population with complex social and medical needs. Despite their significant healthcare utilization and unmet care needs, research on this group is fragmented and has not been comprehensively synthesized. This scoping review aimed to summarize the determinants, characteristics, and outcomes of being homebound to identify care gaps and propose directions for future research.</p><p><strong>Methods: </strong>This review followed the PRISMA-ScR framework, conducting systematic searches in PubMed, Embase, Web of Science, and CINAHL using terms such as \"homebound,\" \"housebound,\" and \"home-limited.\" Eligible studies were peer-reviewed, community-based, and written in English. Data extracted included demographics, health outcomes, care gaps, and interventions. Results were categorized into three themes: Risk Factors, Problems and Needs, and Implications of Being Homebound.</p><p><strong>Results: </strong>The prevalence of homebound sample populations ranged from 4.2% to 65%, stratified by factors such as age, gender, socioeconomic status, and the presence of chronic conditions. Studies highlighted a need to address dental care, nutrition, and fall prevention among individuals who are homebound. Cognitive impairment (31.7%-48%) and mental health conditions, particularly depression (present among up to 43.9%), were highly prevalent, yet access to neuropsychology services remained limited. Frailty and functional dependence were pervasive, contributing to undesired healthcare utilization, including emergency department visits and hospitalizations. Care gaps in advance care planning, social support, and rehabilitation were identified as critical barriers to improving quality of life.</p><p><strong>Conclusion: </strong>Older adults who are homebound face multifaceted challenges that require integrated, multidisciplinary, home-based care approaches. Expanding home-based primary and palliative care, addressing unmet care needs, and providing caregiver support are critical priorities among countries with aging populations. Future research should focus on home-based healthcare delivery models and targeted interventions to address gaps in mental health services, cognitive assessment and management, and physical rehabilitation for older adults who are homebound.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746661","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":"Pattern and Associated Factors of Benzodiazepine Discontinuation Among Older Adults Following Hospitalization.","authors":"Chun-Ting Yang, James M Wilkins, Kevin T Pritchard, Qiaoxi Chen, Yichi Zhang, Dae Hyun Kim, Kueiyu Joshua Lin","doi":"10.1111/jgs.70018","DOIUrl":"https://doi.org/10.1111/jgs.70018","url":null,"abstract":"<p><strong>Background: </strong>Prolonged benzodiazepine (BZD) use following hospital discharge may heighten the risk of BZD dependence and serious adverse drug events in older adults. However, there is limited understanding of BZD discontinuation pattern and associated factors in this population.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted using Optum CDM from January 2004 to February 2025. We included patients aged ≥ 65 years who newly initiated a BZD prescription within 30 days of hospitalization. We excluded patients with anxiety, mental illnesses, alcohol abuse, seizure disorder, and those receiving hospice care. BZD discontinuation was defined as a gap exceeding 15 days following the end of a BZD prescription. Discontinuation rates were estimated by the Kaplan-Meier method, and the association between patient characteristics and BZD discontinuation was analyzed using Cox proportional hazards models in the primary analysis. Inverse probability of censoring weight was applied to adjust for the competing risk of death.</p><p><strong>Results: </strong>A total of 33,449 patients were included (mean age [SD]: 73.1 [5.8] years; 51.7% men). The IPW-weighted BZD discontinuation rate by 30, 60, and 90 days was 53.3% (95% CI: 52.7%-53.8%), 86.7% (86.3%-87.1%), and 92.6% (92.3%-93.0%), respectively. The 30-day discontinuation rate increased from 31.7% (29.5%-33.9%) in 2004 to 71.1% (68.7%-73.5%) in 2024. During the study period, an annual 4% increase in the discontinuation rate was observed. Risk factors associated with lower BZD discontinuation were insomnia (hazard ratio [HR]: 0.66 [0.63-0.69]), moderate-to-severe frailty (HR: 0.82 [0.75-0.90]), and new uses of antidepressants (HR: 0.80 [0.76-0.85]) and atypical antipsychotics (HR: 0.90 [0.82-0.99]) following hospitalization and before the first BZD prescription.</p><p><strong>Conclusions: </strong>Discontinuation rates of BZDs following hospitalization in older adults without a psychiatry history have increased over time. However, challenges remain in discontinuing BZDs, particularly among individuals with insomnia and moderate-to-severe frailty, which may be target populations for developing effective deprescribing strategies in the future.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736434","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":"Mitochondrial Fitness Science Communication: A Qualitative Study.","authors":"Jeffrey T Boon, Brandon Grubbs, Maulik R Patel, John Dunavan, Kelly J Knickerbocker, Cathy A Maxwell","doi":"10.1111/jgs.70019","DOIUrl":"https://doi.org/10.1111/jgs.70019","url":null,"abstract":"<p><strong>Background: </strong>Geroscience explores aging at the cellular level. We developed a lay-friendly science communication intervention (MitoFit) that addresses healthy aging through mitochondrial fitness. The intervention aims to promote physical activity by educating aging adults about optimizing mitochondrial function to promote healthy aging and prevention of chronic disease. We conducted focus groups to gauge older adults' responses to the video component of the intervention and the effect on their uptake of the intervention.</p><p><strong>Participants and setting: </strong>Adults ages 50 and older (N = 101; mean age 67.8 years, 75.0% female, 71.7% White, 27.3% Black or African American) participated in one of 16 focus group sessions in community sites in the Nashville, TN, USA area.</p><p><strong>Methods: </strong>Participants viewed the six MitoFit videos two at a time, pausing after each set of two for focus group discussions of their responses to those videos. Facilitators used a semi-structured interview guide, and the focus groups were audio recorded. After all focus groups, three study team members analyzed the transcripts using open and axial coding processes. After the discussion of emergent themes from the data, a conceptual model was developed depicting how the science communication approach operated in the sample.</p><p><strong>Results: </strong>The participants reported overall positive responses to the video quality and content, including recognizing that they were able to understand scientific content about mitochondrial function and its relationship to aging. Participants expressed a sense of having to take action toward physical activity and a sense of hope as a result of the science communication. Our conceptual model suggests that the science communication approach fosters cognitive restructuring, which in turn enhances motivation to engage in physical activity.</p><p><strong>Conclusions: </strong>The MitoFit scientific communication was well received and should be considered in behavior change strategies that promote physical activity in community-dwelling older adults.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700781","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}