The Canadian Journal of Psychiatry最新文献

{"title":"Psychotherapy: Evidence First","authors":"D. Gratzer, D. Gratzer, D. Goldbloom, D. Goldbloom","doi":"10.1177/0706743716689050","DOIUrl":"https://doi.org/10.1177/0706743716689050","url":null,"abstract":"","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113977179","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":"Detecting and Managing Neuropsychiatric Symptoms in Dementia","authors":"A. Iaboni, M. Rapoport","doi":"10.1177/0706743716672409","DOIUrl":"https://doi.org/10.1177/0706743716672409","url":null,"abstract":"This issue of the Canadian Journal of Psychiatry contains two review articles on the issue of neuropsychiatric symptoms of dementia. We welcome attention to this topic for two reasons. First, it is a reflection of the growing importance of seniors’ mental health and geriatric psychiatry as our population ages. Second, it provides general psychiatrists with concise and helpful information about recent developments and controversies in recognizing and treating neuropsychiatric symptoms in dementia. The disciplines of geriatric psychiatry and dementia care have been advancing quickly in the past five years. Subspecialty training in geriatric psychiatry was recognized in Canada in 2012, and since that time, 11 universities have opened formal geriatric psychiatry training programs in Canada. More than 180 psychiatrists—many of whom have been in practice for decades—have qualified with the new geriatric psychiatry subspecialty designation. Even so, we are currently at less than half of the benchmarks set by the guidelines for comprehensive services for elderly persons in Canada. In most of the country, geriatric psychiatrists remain a scarce resource. Therefore, there is still tremendous need for general psychiatrists across the country to provide expert assessment and management of patients with dementia, particularly as the population ages and the prevalence of dementia climbs. The first article in this issue reflects on the early presence of neuropsychiatric symptoms prior to the diagnosis of dementia and provides suggestions for using the symptoms as an opportunity for early diagnosis and intervention. The second article focuses on the problem of widespread antipsychotic use in patients with dementia, a topic of significant interest to any psychiatrist working with older people. Both of these topics are of importance to all psychiatrists. Gallagher, Fischer, and Iaboni argue that neuropsychiatric or behavioural symptoms, even in individuals with no or little change in cognitive functioning, can herald a neurocognitive disorder. This ‘‘precognitive’’ stage, with mood and sleep changes, anxiety, agitation, and apathy symptoms, is understood to have biological as well as psychological underpinnings. Pathological changes in the brain precede the onset of clinical dementia by decade or two. Neurodegenerative or vascular damage disrupts frontal-subcortical circuits in the brain, affecting drive, affect regulation, salience, perception, and impulse control. The regulation of emotion and behaviour is thus subtly altered as cognitive performance begins to slip. There is clearly value in considering whether late-onset psychiatric symptoms indicate the presence of a neurocognitive disorder. The prevalence of mild cognitive impairment (MCI) is about 18% to 35% in those older than 65 years. While the overall rate of conversion of MCI to dementia is around 5% per year, in those who are exhibiting neuropsychiatric symptoms, 25% will convert to dementia per year. ","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116207489","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":"Neuropsychiatric Symptoms in Mild Cognitive Impairment","authors":"Damien Gallagher, Corinne E. Fischer, Andrea Iaboni","doi":"10.1177/0706743716648296","DOIUrl":"https://doi.org/10.1177/0706743716648296","url":null,"abstract":"Objective: Neuropsychiatric symptoms (NPS) may be the first manifestation of an underlying neurocognitive disorder. We undertook a review to provide an update on the epidemiology and etiological mechanisms of NPS that occur in mild cognitive impairment (MCI) and just before the onset of MCI. We discuss common clinical presentations and the implications for diagnosis and care. Method: The authors conducted a selective review of the literature regarding the emergence of NPS in late life, before and after the onset of MCI. We discuss recent publications that explore the epidemiology and etiological mechanisms of NPS in the earliest clinical stages of these disorders. Results: NPS have been reported in 35% to 85% of adults with MCI and also occur in advance of cognitive decline. The occurrence of NPS for the first time in later life should increase suspicion for an underlying neurocognitive disorder. The presenting symptom may provide a clue regarding the etiology of the underlying disorder, and the co-occurrence of NPS may herald a more accelerated cognitive decline. Conclusions: NPS are prevalent in the early clinical stages of neurocognitive disorders and can serve as both useful diagnostic and prognostic indicators. Recognition of NPS as early manifestations of neurocognitive disorders will become increasingly important as we move towards preventative strategies and disease-modifying treatments that may be most effective when deployed in the earliest stages of disease.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124059353","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 Hotel Study—Clinical and Health Service Effectiveness in a Cohort of Homeless or Marginally Housed Persons","authors":"W. Honer, Alejandro Cervantes-Larios, Andrea A. Jones, F. Vila-Rodriguez, J. Montaner, H. Tran, Jimmy Nham, W. Panenka, D. Lang, A. Thornton, T. Vertinsky, A. Barr, R. Procyshyn, Geoffrey N. Smith, T. Buchanan, M. Krajden, M. Krausz, G. Macewan, K. Gicas, O. Leonova, Verena Langheimer, Alexander Rauscher, K. Schultz","doi":"10.1177/0706743717693781","DOIUrl":"https://doi.org/10.1177/0706743717693781","url":null,"abstract":"Objective: The Hotel Study was initiated in Vancouver’s Downtown East Side (DTES) neighborhood to investigate multimorbidity in homeless or marginally housed people. We evaluated the clinical effectiveness of existing, illness-specific treatment strategies and assessed the effectiveness of health care delivery for multimorbid illnesses. Method: For context, we mapped the housing locations of patients presenting for 552,062 visits to the catchment hospital emergency department (2005-2013). Aggregate data on 22,519 apprehensions of mentally ill people were provided by the Vancouver Police Department (2009-2015). The primary strategy was a longitudinal cohort study of 375 people living in the DTES (2008-2015). We analysed mortality and evaluated the clinical and health service delivery effectiveness for infection with human immunodeficiency virus or hepatitis C virus, opioid dependence, and psychosis. Results: Mapping confirmed the association between poverty and greater number of emergency visits related to substance use and mental illness. The annual change in police apprehensions did not differ between the DTES and other policing districts. During 1581 person-years of cohort observation, the standardized mortality ratio was 8.43 (95% confidence interval, 6.19 to 11.50). Physician visits were common (84.3% of participants over 6 months). Clinical treatment effectiveness was highest for HIV/AIDS, intermediate for opioid dependence, and lowest for psychosis. Health service delivery mechanisms provided examples of poor access, poor treatment adherence, and little effect on multimorbid illnesses. Conclusions: Clinical effectiveness was variable, and illness-specific service delivery appeared to have little effect on multimorbidity. New models of care may need to be implemented.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128094568","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":"Genetic Determinants of Clozapine-Induced Metabolic Side Effects","authors":"K. Vasudev, Yun-Hee Choi, R. Norman, R. Kim, U. Schwarz","doi":"10.1177/0706743716670128","DOIUrl":"https://doi.org/10.1177/0706743716670128","url":null,"abstract":"Objective: Atypical antipychotics are linked to a higher incidence of metabolic side effects, including weight gain, dyslipidemia, and diabetes. In this study, we examined the prevalence and potential genetic predictors of metabolic side effects in 60 adult patients on clozapine. Method: Genetic variants of relevance to clozapine metabolism, clearance, and response were assessed through targeted genotyping of cytochrome P450 enzymes CYP1A2 and CYP2C19, the efflux transporter ABCB1, the serotonin receptor (HTR2C), leptin (LEP), and leptin receptor (LEPR). Clozapine levels and other potential confounders, including concurrent medications, were also included in the analysis. Results: More than half of the patients were obese (51%), had metabolic syndrome (52.5%), and 30.5% were overweight. There was a high prevalence of antipsychotic polypharmacy (61.9%). With multivariable linear regression analysis, LEP –2548G>A, LEPR c.668A>G, and HTR2C c.551-3008 C>G were identified as genetic predictors of body mass index (BMI) after considering effects of clozapine dose, blood level, and concurrent medications (adjusted R2 = 0.305). Metabolic syndrome was found to be significantly associated with clozapine level and CYP2C19*2 and LEPR c.668 G alleles. Clozapine levels in patients with metabolic syndrome were significantly higher compared to those without metabolic syndrome (1886 ± 895 vs. 1283 ± 985 ng/mL, P < 0.01) and were associated with the CYP2C19*2 genotype. No association was found between the genetic variants studied and lipid or glucose levels. Conclusion: This study confirms a high prevalence of metabolic side effects with clozapine and suggests higher clozapine level and pharmacogenetic markers in CYP2C19, LEP, LEPR, and HTR2C receptors as important predictors of BMI and metabolic syndrome.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116562834","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":"Involuntary Outpatient Commitment and the Elusive Pursuit of Violence Prevention","authors":"M. Swartz, Sayanti Bhattacharya, Allison G. Robertson, J. Swanson","doi":"10.1177/0706743716675857","DOIUrl":"https://doi.org/10.1177/0706743716675857","url":null,"abstract":"Objective: Involuntary outpatient commitment (OPC)—also referred to as ‘assisted outpatient treatment’ or ‘community treatment orders’—are civil court orders whereby persons with serious mental illness and repeated hospitalisations are ordered to adhere to community-based treatment. Increasingly, in the United States, OPC is promoted to policy makers as a means to prevent violence committed by persons with mental illness. This article reviews the background and context for promotion of OPC for violence prevention and the empirical evidence for the use of OPC for this goal. Method: Relevant publications were identified for review in PubMed, Ovid Medline, PsycINFO, personal communications, and relevant Internet searches of advocacy and policy-related publications. Results: Most research on OPC has focussed on outcomes such as community functioning and hospital recidivism and not on interpersonal violence. As a result, research on violence towards others has been limited but suggests that low-level acts of interpersonal violence such as minor, noninjurious altercations without weapon use and arrests can be reduced by OPC, but there is no evidence that OPC can reduce major acts of violence resulting in injury or weapon use. The impact of OPC on major violence, including mass shootings, is difficult to assess because of their low base rates. Conclusions: Effective implementation of OPC, when combined with intensive community services and applied for an adequate duration to take effect, can improve treatment adherence and related outcomes, but its promise as an effective means to reduce serious acts of violence is unknown.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126422401","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":"Book Review: Changing Behavior in DBT: Problem Solving in Action","authors":"G. Myhr","doi":"10.1177/0706743716676753","DOIUrl":"https://doi.org/10.1177/0706743716676753","url":null,"abstract":"Psychotherapists deal with the usually tacit processes of learning theory on a daily basis. Feelings and behaviours arise in response to stimuli (classical conditioning) and are reinforced or punished by consequences (operant conditioning). The patient who consistently cries throughout psychotherapy sessions may be avoiding the anxiety that might ensue if focusing on therapy tasks, crying that may be inadvertently reinforced when it leads to greater concern on the part of therapist and longer sessions. The therapist who changes topics in response to angry outbursts from her patient should not be surprised if angry outbursts in future sessions increase rather than decrease as both therapist and patient successfully avoid something painful (negative reinforcement). The skills trainer might find that a patient who has mastered self-assertion skills in office role-plays might quickly abandon them at home, in response to punishing consequences. Behavioural learning theories underlie the process of changing behaviour in dialectic behavior therapy (DBT), a structured, multicomponent psychotherapy developed by Marsha Linehan to treat people with borderline personality disorder (BPD). The approach is ‘‘dialectic’’ in that it balances the tension of the change processes of learning theory and problem solving with those of validation and acceptance-based strategies such as mindfulness. Changing Behavior in DBT: Problem Solving in Action, by Drs Heard and Swales, is the first book to focus exclusively on the problem-solving component of DBT. The book is a practical one, beginning with the selection of behavioural targets and their conceptualisation using behavioral chain analyses and solution analyses. It goes on to discuss choice and implementation of therapeutic interventions: skills training, stimulus control and exposure, cognitive modification, and contingency management. The authors are experienced DBT trainers, sensitive to the often missed but powerful effects of conditioning on the part of both patient and therapist in shaping therapeutic outcomes. They know the common ways problem solving in DBT can fail. One pitfall, for example, is the failure to be specific in the setting of problems to target. Defining a behavioural target as aggression, for example, does not give enough behavioural specificity to guide treatment. Therapists should have ‘‘a sufficient description for someone to imagine the client’s specific actions, which could range from yelling to throwing furniture’’ (p. 48). Another poor target would be fear of abandonment, which is not, in itself, a behavioural target at all. As Heard and Swales put it, ‘‘Fearing abandonment did not directly destabilize anyone’s life, require intervention or lead to a low functioning’’ (p. 51). Better target behaviours in a client could be calling her husband repeatedly at work or crying intensely any time he wanted to do activities without her. Only in clarifying the exact behaviour target could one know ","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131933793","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 Use of Scientific Evidence about Schizophrenia and Violence in Clinical Services","authors":"R. Müller-Isberner","doi":"10.1177/0706743716646362","DOIUrl":"https://doi.org/10.1177/0706743716646362","url":null,"abstract":"This special section of the Canadian Journal of Psychiatry focuses on violent behaviour by persons with schizophrenia. Three brief but informative articles critically review clinically relevant, up-to-date evidence. Hodgins and Klein draw attention to new evidence about the aetiology of violence among people with schizophrenia, potent predictors of violence, and the need to restructure psychiatric services such that individuals developing schizophrenia are assessed for past and current violent behaviour and to provide them with a host of treatments targeting both their violent behaviours and the schizophrenia. Quinn and Kolla review the evidence on effective treatments, concluding that randomized clinical trials (RCTs) are urgently needed to bolster the evidence base. Swartz, Bhattacharya, Robertson, and Swanson review the evidence about outpatient commitment, most of which comes from the United States. However, as noted by Hodgins and Klein, some people with schizophrenia have a long history of antisocial behaviour, ways of thinking, and attitudes that lead to noncompliance with psychiatric care. The review by Swartz et al. shows that outpatient commitment does improve compliance. However, most of this evidence is not being used by psychiatric services. First-episode clinics do not generally assess for past and current antisocial and aggressive behaviour, nor do they have the resources to treat these behaviours, including substance misuse, along with the schizophrenia. A subgroup of their patients will be prosecuted for a violent crime. If it is proven and they are judged not responsible due to a mental disorder, in most countries, they are sent to a forensic hospital. Patients are initially discharged on a court order under the jurisdiction of a provincial review board and, in other countries on similar court orders, with powers to quickly return the patients to the forensic hospital if the conditions of their discharge are not respected or their mental status deteriorates. Thus, orders for outpatient treatment begin within forensic services. I have been the director of a large forensic psychiatric service with a geographic catchment area of 6,000,000 inhabitants for 30 years. Most patients are men with schizophrenia. They remain in hospital, on average, 5 years, with gradual access to the community long before final discharge. Throughout these years, I have done my utmost to try and base our clinical services on scientific evidence. Powerful challenges, however, have and continue to block progress towards this goal. First, who among the clinical staff has the responsibility and the time to keep up with the literature and identify new effective treatments and assessment tools? Second, once a treatment program has been shown to be effective or an assessment tool has been shown to be valid, how are funders of a clinical service to be convinced to pay for staff training and implementation of the new program or instrument? How are competent trainer","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130565902","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":"A Multimodal Intervention for Children with ADHD Reduces Inequity in Health and Education Outcomes","authors":"J. Enns, Jason R. Randall, Mark Smith, D. Chateau, Carole R Taylor, M. Brownell, J. Bolton, E. Burland, A. Katz, L. Katz, Nathan C. Nickel","doi":"10.1177/0706743717692301","DOIUrl":"https://doi.org/10.1177/0706743717692301","url":null,"abstract":"Objective: To evaluate whether a multimodal intervention for children with attention-deficit hyperactivity disorder (ADHD) resulted in better long-term health and education outcomes and reduced inequity across the socioeconomic gradient. Method: We analyzed administrative data held in the Manitoba Population Research Data Repository describing recipients of a combined pharmacological/behavioural intervention for ADHD. The study cohort included children aged 5 to 17 years who visited the Manitoba Adolescent Treatment Centre’s ADHD intervention service at least 3 times (2007-2012). Controls were matched on age, sex, year of ADHD diagnosis, and income quintile. We compared rates of hospital and emergency department visits, medication use and adherence, contact with child welfare services, and whether children were in their age-appropriate grade. We used concentration curves to estimate differences in outcomes between children from high- and low-income families. Results: Children who received the intervention (n = 485) had higher rates of medication use (rate ratio [RR], 1.21; 95% CI, 1.08 to 1.36) and adherence (RR, 1.42; 95% CI, 1.03 to 1.96) and were more likely to be in their age-appropriate grade (RR, 1.33; 95% CI, 1.09 to 1.63) compared with controls (n = 1884). The intervention was also associated with reduced inequity in these outcomes across income deciles. There was no difference in the rates of hospital or emergency department visits or contacts with child welfare services. Conclusions: A multimodal ADHD intervention was associated with increased medication use and adherence and higher academic achievement. It was also related to lower inequity across the socioeconomic gradient. These results suggest that multimodal approaches may provide more equitable health and education outcomes for children with ADHD.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128028555","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":"Is Psychoanalysis Still Relevant to Psychiatry?","authors":"J. Paris","doi":"10.1177/0706743717692306","DOIUrl":"https://doi.org/10.1177/0706743717692306","url":null,"abstract":"Psychoanalysis is a theory of psychopathology and a treatment for mental disorders. Fifty years ago, this paradigm had great influence on the teaching and practice of psychiatry. Today, psychoanalysis has been marginalized and is struggling to survive in a hostile academic and clinical environment. This raises the question as to whether the paradigm is still relevant in psychiatric science and practice. In a difficult climate for the theory and practice of psychoanalysis, several responses have emerged, either by attempting to bridge the gap with science or by redefining the field as lying outside of science. Thus, some analysts have supported revised paradigms, such as attachment theory, that are better supported by evidence. Others have taken the view that Freud’s ideas concerning the unconscious mind are compatible with modern neuroscience. Still others have moved in the opposite direction, arguing that it is sufficient to offer a coherent interpretation of psychological phenomena. This review will briefly examine all these attempts to revive psychoanalysis.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121682926","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}