Air Medical Journal最新文献

{"title":"The Quality Encompassing Stroke Team (QuEST) Project: Defining Stroke Quality Care within the Inter-Hospital Setting for Air Medical Providers","authors":"Mikaela Hagberg MHA, BSN, RN, CEN, CFRN ,&nbsp;Matthew Plourde MS, BSN, RN, CCRN, CFRN ,&nbsp;Kyle Danielson MPH, MN, RN, CFRN, CMTE ,&nbsp;David Gallagher MBA, MHA, BSN, RN, CPHQ ,&nbsp;Michael J. Lauria MD, NRP, FP-C ,&nbsp;Richard Utarnachitt MD","doi":"10.1016/j.amj.2025.06.009","DOIUrl":"10.1016/j.amj.2025.06.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency Medical Services (EMS) first integrated into the stroke notification system in the mid-90s by using 911 telephone triggers to respond to strokes as an acute emergency. EMS systems have different performance metrics compared to hospitals that define success and quality in caring for stroke patients. Examples of these metrics are documentation of a stroke scale, pre-arrival notification, and determining a blood glucose level. Primary Stroke Centers (PSC) were developed in 2004, and Comprehensive Stroke Centers (CSC) developed in 2012. To become a PSC or CSC, the American Heart Association/American Stroke Association and The Joint Commission have defined eligibility requirements and quality metrics to measure success and quality care. Despite established quality metrics for stroke centers, no clear recommendations or guidelines exist for quality metrics and comprehensive quality stroke care within the air medical industry.</div></div><div><h3>Methods</h3><div>A literature review was completed in PubMed with articles from 2012-2022 and included all countries, military, combat, and natural disasters. Retrieved articles surrounding stroke quality metrics focused on ground transport or in-hospital care. There are no published metrics that define quality stroke care in the inter-hospital setting for air medical providers. We completed a retrospective data analysis of stroke patient transfers from January 1, 2019 – June 2, 2023, excluding pediatric patients and ground transports. Metrics from pre-hospital and in-hospital care areas included blood glucose, last known well, FAST, LAMS, and bedside times.</div></div><div><h3>Results</h3><div>A sample size (n=2041) transported patients with hemorrhagic and ischemic strokes were evaluated. The volume of patients was equivocal year over year, and quarter over quarter. Bedside times were consistent; scene calls (10 mins) and interfacility transports (20 mins). Glucose documentation was compliant at 98.24%. FAST documentation was lacking at 45.56%, and LAMS documentation at 38.18%, revealing opportunities for education and quality improvement. Our KPIs address operational, educational, clinical and regulatory requirements allowing us to shift our focus to critical care metrics that promote better patient outcomes.</div></div><div><h3>Conclusion</h3><div>While some of the quality metrics from the pre-hospital and in-hospital areas can be applied to the inter-hospital space, they don’t take account for the unique HEMS environment. More research is required to establish formal recommendations that consider the complexities of the air medical transport. Our analysis reveals that documentation of pre-hospital quality metrics such as FAST and LAMS was less frequent. Until better evidenced based quality metrics are established, air medical programs should consider extrapolating pre-hospital and in-hospital metrics and tracking compliance.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 435"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886007","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":"Post-Pandemic Burnout and Staffing Shortages in Pediatric and Neonatal Transport Teams: A Multicenter Survey","authors":"Paul Dahm MD ,&nbsp;Rudy Kink MD ,&nbsp;Michael Stroud MD ,&nbsp;Archana Dhar MD","doi":"10.1016/j.amj.2025.07.006","DOIUrl":"10.1016/j.amj.2025.07.006","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the post-pandemic staffing status of interfacility pediatric and neonatal transport teams and the impact of resilience promotion strategies.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was distributed to members of the American Academy of Pediatrics Section on Transport Medicine.</div></div><div><h3>Results</h3><div>A total of 34 teams respond (30.9% response rate) to the survey. Most of them (58.8%) reported post-pandemic vacancies. Of the teams with vacancies, 90% cited a lack of qualified applicants as the reason for being unable to fill the vacant slots (<em>P</em> &lt; .01). Increased turnover was reported by 50% of the teams resulting in change in the on-boarding/orientation process for the new hires. Burnout was identified by 26 of the teams (76.4%, <em>P</em> &lt; .01), and 25 respondents (73.5%, <em>P</em> &lt; .01) reported that they had received training to recognize burnout.</div></div><div><h3>Conclusion</h3><div>In our survey, most of the responding pediatric and neonatal transport teams faced post-pandemic staffing vacancies, primarily due to a shortage of qualified applicants. Our data suggest that there were subsequent deviations from ideal team compositions and alteration in the on-boarding process for new hires, secondary to personnel shortages.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 6","pages":"Pages 492-496"},"PeriodicalIF":0.0,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371231","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":"Feasibility of Telementoring for Cricothyroidotomy in Critical Care Transport Team Members","authors":"Mat Goebel MD, MAS ,&nbsp;Meagan Rosenberg MD ,&nbsp;Jacques Townsend DO ,&nbsp;Tovy Haber Kamine MD, MBA","doi":"10.1016/j.amj.2025.07.004","DOIUrl":"10.1016/j.amj.2025.07.004","url":null,"abstract":"<div><h3>Objective</h3><div>Although endotracheal intubation is the cornerstone of advanced airway management, there are cases where surgical airway becomes the only alternative. Since the coronavirus disease 2019 pandemic, there has been increased telemedicine physician consultation, including in trauma and emergency care. The objective of this study is to reveal that telemedicine was a viable means of coaching a prehospital clinician through a simulated cricothyroidotomy.</div></div><div><h3>Methods</h3><div>Paramedic and registered nurse participants from a critical care transport team were observed performing surgical cricothyroidotomy on a task trainer during 2 separate quarterly airway skills assessments. During the control session, participants completed a bougie-assisted cricothyroidotomy with no assistance. During the intervention, session participants used a trauma surgeon through video conferencing as a procedural coach. Skill completion was timed, performance was rated using a global rating scale, and participants completed the National Aeronautics and Space Administration Task Load Index.</div></div><div><h3>Results</h3><div>There were 15 participants with paired observations available for analysis. There was no significant difference in total task time between solo and telementored sessions (effect size −22.47 [−52.82 to 7.89], <em>P</em> = .13). There was no significant difference in overall global rating scale between solo and telementored sessions (difference −0.27 [−1.63 to 1.10], <em>P</em> = .68). There were no differences in overall task load (difference 3.93 [−1.20 to 9.07], <em>P</em> = .12) or in any of the individual task load components between the solo and telementored sessions.</div></div><div><h3>Conclusion</h3><div>Telementorship was not associated with changes in procedural performance, task load, or time to complete a surgical cricothyroidotomy in a critical care transport team.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 6","pages":"Pages 485-487"},"PeriodicalIF":0.0,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371289","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":"Air Transport Medicine: From the Field","authors":"Tim Harris BM, BS, FRCEM, FFICM, FACEM,&nbsp;Neel Bhanderi BM, BS, FACEM, FRCEM,&nbsp;Dan Harris BM, BS, FACEM,&nbsp;Chris Smith BM, BS, FCICM,&nbsp;Ryan Breslin MB, BChir, FANZCA,&nbsp;James Moran BM, BS, FRCEM, FACEM,&nbsp;Le Nguyen MBBS, M Med (Crit Care),&nbsp;James Price MBBS,&nbsp;Ed Barnard PhD","doi":"10.1016/j.amj.2025.07.002","DOIUrl":"10.1016/j.amj.2025.07.002","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 330-332"},"PeriodicalIF":0.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Time to Admission and Mortality in Physician-Led Medical Evacuations in Greenland","authors":"Magnus Nordstrøm Fagerhaug MD ,&nbsp;Oscar Rosenkrantz MD ,&nbsp;Vagn Bach MD ,&nbsp;Jacob Steinmetz MD, PhD","doi":"10.1016/j.amj.2025.06.021","DOIUrl":"10.1016/j.amj.2025.06.021","url":null,"abstract":"<div><h3>Objective</h3><div>Greenland presents unique challenges for medical evacuations due to its vast distances, Arctic weather, and limited infrastructure. The aim of this study was to assess whether the time from booking of an evacuation from any location in Greenland to the patient arrived at Queen Ingrid’s Hospital (QIH) in the capital, Nuuk, was associated with mortality. It was hypothesized that a longer time interval was associated with a higher 30-day mortality.</div></div><div><h3>Methods</h3><div>An observational cohort study was conducted to all medical evacuations attended by physicians from anywhere in Greenland to QIH in Nuuk, Greenland, between January 1, 2020, and July 31, 2024. Data were extracted from travel logs and medical records and included demographic information, evacuation details, and a 30-day outcome period. Logistic regression was used to compute odds ratios (ORs) associating the time interval from booking to admission with 30-day mortality.</div></div><div><h3>Results</h3><div>Of 1303 records of patients identified through the travel logs, 690 patients met the inclusion criteria. The 30-day mortality was 7.5%, with the median time from booking to hospital admission of 7.9 hours (interquartile range 5.1-19.3). The unadjusted OR of 30-day mortality per hour from booking to admission at QIH was 0.99 (95% confidence interval [CI] 0.97-1.01; <em>P</em> = .50) and 1.00 (95% CI 0.96-1.02; <em>P</em> = .73) in the adjusted analysis.</div></div><div><h3>Conclusions</h3><div>In this study of all medical evacuations attended by physicians in Greenland in a 4.5-year period, there was no association between the time interval from booking to hospital admission at QIH in Nuuk and 30-day mortality.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 6","pages":"Pages 465-472"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371372","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":"Clinical Profile and Outcome of Air Medical Evacuation Cases Involving Anesthesiologists of a Military Tertiary Care Hospital of Nepal: A Retrospective Study","authors":"Bishwo Ram Amatya MD ,&nbsp;Sagun Dawadi MBBS ,&nbsp;Mallika Rayamajhi MD ,&nbsp;Puja Thapa MD ,&nbsp;Aashish Shah MD ,&nbsp;Pradip KC MD ,&nbsp;Bishan Limbu MD","doi":"10.1016/j.amj.2025.06.023","DOIUrl":"10.1016/j.amj.2025.06.023","url":null,"abstract":"<div><h3>Objective</h3><div>Air medical evacuation (AE) plays a vital role in emergency medical services by facilitating swift transfer of critically ill or injured patients to advance health care facilities. Despite its increasing importance, standardized protocols and comprehensive research on AE outcomes remain scarce, particularly in Nepal. This study evaluates clinical characteristics, interventions, and prognostic determinants of AE cases managed by anesthesiologists at a military tertiary care hospital.</div></div><div><h3>Methods</h3><div>This retrospective observational study analyzed AE cases handled by anesthesiologists in an 11-year period (July 2013-July 2024). Data were retrieved from hospital records, encompassing patient demographics, clinical characteristics, air medical factors, and outcomes. The primary outcomes assessed were in-hospital mortality and recovery. Chi-square tests and logistic regression analyses were used to evaluate associations between key clinical variables and patient outcomes.</div></div><div><h3>Results</h3><div>The study included 83 patients, with a median age of 30 years (interquartile range: 23-36) and a male-to-female ratio of 16:1. Road traffic accidents were leading cause of AE (39.8%), followed by high-altitude illness and heat-related conditions (9.6% each). Mortality was significantly associated with hemodynamic instability (odds ratio: 96.67, 95% confidence interval: 11.34-823.77, <em>P</em> &lt; .001) and intubation status (odds ratio: 12.75, 95% confidence interval: 3.236-50.191, <em>P</em> &lt; .001), whereas no significant correlation was observed between the reason for AE and mortality.</div></div><div><h3>Conclusions</h3><div>Our study represents first in-depth analysis of AEs involving anesthesiologists in Nepal, identifying illness severity, hemodynamic instability, and intubation status as significant predictors of mortality. The findings underscore urgent need for improved AE infrastructure, implementation of standardized protocols, and specialized training to enhance patient outcomes.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 6","pages":"Pages 478-484"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between On-Scene Time and Number of Physicians in Helicopter Emergency Medical Services in Japan: A Retrospective Study","authors":"Hidekazu Hishinuma MSN ,&nbsp;Takafumi Noguchi PhD ,&nbsp;Kentaro Hayashi MD, PhD ,&nbsp;Jin Kikuchi MD ,&nbsp;Arata Honda MD ,&nbsp;Noboru Iwata PhD ,&nbsp;Gen Kobashi MD, PhD ,&nbsp;Koji Wake MD, PhD","doi":"10.1016/j.amj.2025.06.022","DOIUrl":"10.1016/j.amj.2025.06.022","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to determine the impact of having 2 physicians versus 1 physician in a helicopter emergency medical team on OST.</div></div><div><h3>Methods</h3><div>This retrospective observational study analyzed 828 patients who underwent helicopter emergency medical services in 2 years (2020-2021). We used chi-square and <em>t</em> tests to analyze the difference in OST between patients attended by 1 versus 2 physicians. We then used general linear model analysis to evaluate the impact of the number of physicians on OST.</div></div><div><h3>Results</h3><div>Of the 828 patients, we observed 1 physician group (<em>n</em> = 356) and 2 physician groups (<em>n</em> = 472). Analysis revealed significant main effects of diagnosis type (F = 10.78, <em>P</em> &lt; .001) and the number of physicians (F = 18.60, <em>P</em> &lt; .001) on OST, whereas the interaction was not significant (F = 0.30, <em>P</em> = .911). In another analysis, the interaction between the transport facility and the number of physicians was significant (F = 7.00, <em>P</em> = .008), including their main effects.</div></div><div><h3>Conclusions</h3><div>Having 2 physicians on board the helicopter emergency medical services seems to reduce OST compared with having 1, particularly in trauma and neurology cases.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 6","pages":"Pages 473-477"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371373","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":"September/October 2025 Forum","authors":"","doi":"10.1016/j.amj.2025.07.001","DOIUrl":"10.1016/j.amj.2025.07.001","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 336-337"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885124","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":"Clinical Outcomes of Patients Experiencing Seizures Treated With Antiemetic Drugs During Transport by Physician-Staffed Helicopters in Japan","authors":"Youichi Yanagawa MD, PhD,&nbsp;Chihiro Maekawa MD,&nbsp;Noriko Tanaka MD,&nbsp;Namiko Suda MD,&nbsp;Yukinori Hirooka MD,&nbsp;Kenji Kawai MD,&nbsp;Michika Hamada MD,&nbsp;Hiroaki Taniguchi MD","doi":"10.1016/j.amj.2025.06.014","DOIUrl":"10.1016/j.amj.2025.06.014","url":null,"abstract":"<div><h3>Objective</h3><div>We conducted a retrospective study to evaluate the clinical significance of antiemetic drug use in patients with seizures who were transported by physician-staffed helicopters (Doctor Helicopters [DHs]) in Japan.</div></div><div><h3>Methods</h3><div>Data retrieved included patient age, sex, presence or absence of cardiac arrest on DH staff contact, vital signs at the time of contact, details of medical interventions, duration of hospitalization, and final outcome. Patients who experienced cardiac arrest at the time of DH contact and those with missing final outcome data were excluded. Given the established prognostic significance of age and level of consciousness in patients with seizures, individuals younger than 46 years and those with a Glasgow Coma Scale score of &lt;9 were excluded to minimize baseline variability between the 2 groups, based on the results of a preliminary analysis. Subjects were divided into the following 2 groups: the Control group (no antiemetic administered prehospital) and the Antiemetic group.</div></div><div><h3>Results</h3><div>The Control group included 532 patients, whereas the Antiemetic group comprised 149 patients. No significant differences were observed between the 2 groups in terms of sex, age, respiratory rate, systolic blood pressure, Glasgow Coma Scale score, mortality rate, or hospitalization rate. However, the Antiemetic group demonstrated a significantly lower rate of endotracheal intubation and a significantly better cerebral performance category score compared with the Control group.</div></div><div><h3>Conclusion</h3><div>This is the first study to evaluate the prognostic role of antiemetic use in older adults with seizures during helicopter transport in Japan. Future prospective, randomized, double-blind studies are warranted to determine whether the use of antiemetic agents serves as a prognostic factor in patients with seizures.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 390-393"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886001","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":"Ambulance Emergency Medical Services Professionals’ Perspectives on Collaboration With Helicopter Emergency Medical Services Physicians","authors":"Elina Panula MD ,&nbsp;Sami Länkimäki MD, PhD ,&nbsp;Heini Huhtala MSc ,&nbsp;Piritta Setälä MD, PhD ,&nbsp;Sanna Hoppu MD, PhD","doi":"10.1016/j.amj.2025.06.018","DOIUrl":"10.1016/j.amj.2025.06.018","url":null,"abstract":"<div><h3>Objective</h3><div>Collaboration between ambulance emergency medical service (EMS) professionals and helicopter EMS (HEMS) physicians has not been extensively highlighted in the literature. This study aims to address this gap by exploring the perspectives of ambulance EMS professionals on their collaboration with the physician-staffed HEMS unit in Finland.</div></div><div><h3>Methods</h3><div>This survey study was conducted in Finland’s first rural physician-staffed HEMS unit’s, FinnHEMS40 (FH40), operating area in the autumn of 2023 and repeated after a year. A digital survey link was sent through e-mail to all EMS professionals working in ambulance units. The surveys consisted of 5-point Likert-scale questions, multiple-choice questions, and open-ended questions. Likert-scale answers were analyzed with contingency tables and the chi-square test and Fisher’s exact test.</div></div><div><h3>Results</h3><div>Response rates were 210 of 522 (40%) for the first survey and 200 of 518 (39%) for the second survey. Most of all respondents (90%) felt that collaboration with FH40 has been good or excellent. The opinions on the importance of a HEMS physician’s attendance on EMS missions depended on their educational background and previous work experience in EMS. Results indicated that EMS professionals with 2 to 5 years of work experience seemed to feel more confident in managing various EMS missions independently without assistance from a HEMS physician.</div></div><div><h3>Conclusion</h3><div>Collaboration between HEMS physicians and ambulance units is appreciated and deemed important among EMS professionals working in ambulances. Educational background and work experience influence opinions on the necessity of HEMS physicians’ attendance in EMS missions.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 409-415"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886045","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}