Hypertension (HTN) is the most common chronic disease in both developed and developing countries and is a major public health concern affecting adults. It is the leading cause of mortality and disability-adjusted life year all over the world, causes more cardiovascular deaths than any other modifiable cardiovascular risk factors, and is the second only to smoking as a preventable cause of mortality.[1-2] In the United States, National Health and Nutrition Examination Survey of more than 23,000 subjects, more than 50% of deaths from chronic heart disease and stroke occurred among patients with elevated blood pressure (BP). Approximately 1 billion people were estimated to be hypertensive in 2000, and most of these identified to be hypertensive live in lower and middle-income countries.[3-4] There have been several measures done to control elevations in BP, and while in developed countries, the prevalence of HTN appears to be stabilizing, the rates in the Southeast Asian region continues to rise. Southeast Asia is a subregion in Asia consisting of Thailand, Malaysia, Indonesia, the Philippines, Singapore, Vietnam, Laos, Cambodia, Myanmar, and East Timor. About a third of adults in the region have HTN and nearly 1.5 million deaths are attributed to HTN annually.[5] It represents an important public health issue, as this is partly due in part to absent or poor disease management, with rates of uncontrolled HTN as high as 70%.[6] This paper looks at the different status of HTN prevalence, awareness, and control strategy available in six countries in SEA.
高血压(HTN)是发达国家和发展中国家最常见的慢性疾病，是影响成年人的主要公共卫生问题。它是全世界死亡和残疾调整生命年的主要原因，造成的心血管死亡人数超过任何其他可改变的心血管风险因素，并且是仅次于吸烟的第二大可预防的死亡原因。[1-2]美国国家健康与营养检查调查(National Health and Nutrition Examination Survey)对23000多名受试者进行了调查，发现50%以上的慢性心脏病和中风死亡发生在血压升高的患者中。据估计，2000年约有10亿人患有高血压，其中大多数被确定为高血压的人生活在低收入和中等收入国家。[3-4]已经采取了一些措施来控制血压升高，虽然在发达国家，HTN的患病率似乎趋于稳定，但东南亚地区的发病率继续上升。东南亚是亚洲的一个次区域，由泰国、马来西亚、印度尼西亚、菲律宾、新加坡、越南、老挝、柬埔寨、缅甸和东帝汶组成。该地区约有三分之一的成年人患有HTN，每年有近150万人死于HTN。[5]它代表了一个重要的公共卫生问题，因为这部分是由于缺乏或不良的疾病管理，不受控制的HTN率高达70%。[6]本文着眼于东南亚6个国家HTN流行、认识和控制策略的不同状况。
{"title":"A Review on the Status of Hypertension in Six Southeast Asian Countries","authors":"R. Oliva","doi":"10.15713/ins.johtn.0151","DOIUrl":"https://doi.org/10.15713/ins.johtn.0151","url":null,"abstract":"Hypertension (HTN) is the most common chronic disease in both developed and developing countries and is a major public health concern affecting adults. It is the leading cause of mortality and disability-adjusted life year all over the world, causes more cardiovascular deaths than any other modifiable cardiovascular risk factors, and is the second only to smoking as a preventable cause of mortality.[1-2] In the United States, National Health and Nutrition Examination Survey of more than 23,000 subjects, more than 50% of deaths from chronic heart disease and stroke occurred among patients with elevated blood pressure (BP). Approximately 1 billion people were estimated to be hypertensive in 2000, and most of these identified to be hypertensive live in lower and middle-income countries.[3-4] There have been several measures done to control elevations in BP, and while in developed countries, the prevalence of HTN appears to be stabilizing, the rates in the Southeast Asian region continues to rise. Southeast Asia is a subregion in Asia consisting of Thailand, Malaysia, Indonesia, the Philippines, Singapore, Vietnam, Laos, Cambodia, Myanmar, and East Timor. About a third of adults in the region have HTN and nearly 1.5 million deaths are attributed to HTN annually.[5] It represents an important public health issue, as this is partly due in part to absent or poor disease management, with rates of uncontrolled HTN as high as 70%.[6] This paper looks at the different status of HTN prevalence, awareness, and control strategy available in six countries in SEA.","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89621530","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}
The detection, awareness, treatment, and control rates of hypertension are poor in Indian subcontinent; the huge 1.3 billion population posing a substantial challenge to health providers. The new data analysis in JAMA estimates that a systolic blood pressure (SBP) between 110 and 115 mmHg accounts for 212 million disability-adjusted life year worldwide; of which, 39 million (around 20%) are from India.[1] The scenario of hypertension detection management in India is challenging; as per the National Capital Region cross-sectional database, there is a progressive increase in prevalence – from 23% in urban areas and 11% rural areas in 1991–1994 period to 42.2% urban and 29.9% rural in 2012–2014. More concerning is the fact that these crosssectional data show that there has been no substantial change in terms of awareness, treatment, and control rates of hypertension in the tested population between the two time periods.[2] The data from Jaipur (Jaipur Heart watch), in contrast, show progressive rise in awareness (13–56%), treatment (95–36%), and control (2–21%) from 1991 to 1994 compared to 2012–2014 period, despite the point that the numbers fell short of the WHO global monitoring framework and UN sustainable development goal.[3]
{"title":"Common but Underrated – Are we Neglecting these Hypertensive Subsets in India?","authors":"T. Nair","doi":"10.15713/ins.johtn.0145","DOIUrl":"https://doi.org/10.15713/ins.johtn.0145","url":null,"abstract":"The detection, awareness, treatment, and control rates of hypertension are poor in Indian subcontinent; the huge 1.3 billion population posing a substantial challenge to health providers. The new data analysis in JAMA estimates that a systolic blood pressure (SBP) between 110 and 115 mmHg accounts for 212 million disability-adjusted life year worldwide; of which, 39 million (around 20%) are from India.[1] The scenario of hypertension detection management in India is challenging; as per the National Capital Region cross-sectional database, there is a progressive increase in prevalence – from 23% in urban areas and 11% rural areas in 1991–1994 period to 42.2% urban and 29.9% rural in 2012–2014. More concerning is the fact that these crosssectional data show that there has been no substantial change in terms of awareness, treatment, and control rates of hypertension in the tested population between the two time periods.[2] The data from Jaipur (Jaipur Heart watch), in contrast, show progressive rise in awareness (13–56%), treatment (95–36%), and control (2–21%) from 1991 to 1994 compared to 2012–2014 period, despite the point that the numbers fell short of the WHO global monitoring framework and UN sustainable development goal.[3]","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85373138","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}
“Old age is like a plane flying through a storm. Once you’re aboard, there’s nothing you can do.” -Golda Meir Hypertension (HTN) is a leading risk factor in the aged for cardio/cerebrovascular events, the prevalence of which increases with age. Pathophysiologically, it differs from HTN of the young (altered structure and function of conduit arteries vis-a-vis resistance vessels of the young). Older hypertensives have altered or downregulated biological functions, have multiple comorbidities warranting polypharmacy with attendant drug interactions� Elevated blood pressure (BP) is the most common cause of mortality over the globe, being responsible for about 13% of all deaths every year, accounting for about 57 million disability-adjusted life years�[1] The prevalence of elevated BP worldwide in 2008 was about 40%, being highest in the WHO African region (46%) and lowest in the Americas (35% in both sexes). The prevalence of uncontrolled HTN has increased by approximately 600 million compared to that in 1980�[2] The burden of HTN is rising globally due to the growth of the obese and aged population and is projected to affect around 70% of the global population by 2025�[3] Abstract
{"title":"Hypertension in Elderly – Pathogenesis and Treatment","authors":"T. Padmanabhan, M. Azam","doi":"10.15713/ins.johtn.0164","DOIUrl":"https://doi.org/10.15713/ins.johtn.0164","url":null,"abstract":"“Old age is like a plane flying through a storm. Once you’re aboard, there’s nothing you can do.” -Golda Meir Hypertension (HTN) is a leading risk factor in the aged for cardio/cerebrovascular events, the prevalence of which increases with age. Pathophysiologically, it differs from HTN of the young (altered structure and function of conduit arteries vis-a-vis resistance vessels of the young). Older hypertensives have altered or downregulated biological functions, have multiple comorbidities warranting polypharmacy with attendant drug interactions� Elevated blood pressure (BP) is the most common cause of mortality over the globe, being responsible for about 13% of all deaths every year, accounting for about 57 million disability-adjusted life years�[1] The prevalence of elevated BP worldwide in 2008 was about 40%, being highest in the WHO African region (46%) and lowest in the Americas (35% in both sexes). The prevalence of uncontrolled HTN has increased by approximately 600 million compared to that in 1980�[2] The burden of HTN is rising globally due to the growth of the obese and aged population and is projected to affect around 70% of the global population by 2025�[3] Abstract","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74797938","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}
Primary hyperaldosteronism (PA) or Conn’s syndrome and pheochromocytoma (Pheo) are functioning tumors from the adrenal glands that can cause secondary hypertension.[1,2] Conn’s syndrome is the excess production of the hormone aldosterone from the zona glomerulosa of the adrenal glands. The prevalence of PA has been reported to range from 4.6 to 9.5% among hypertensive individuals.[3,4] The high circulating aldosterone results in hypokalemia which leads to weakness, tingling, muscle spasms, and periods of temporary paralysis.[4,5] Bilateral adrenal hyperplasia and aldosterone-producing adrenal tumor are the most common causes of PA.[6] Pheochromocytoma (Pheo) is a rare adrenomedullary tumor with an incidence of 0.1–0.6%.[1,7] About 0.05–0.1% of Pheo cases are undiagnosed in autopsy studies.[8] These tumors can synthesize, metabolize, store, and secrete catecholamines and their metabolites.[9] Pheos originate from adrenomedullary chromaffin cells that commonly produce epinephrine, norepinephrine, and dopamine. Chromaffin cells evolve into 80–85% Pheos and 15–20% are paragangliomas.[10] A high index of clinical suspicion remains the pivotal point to initiate biochemical studies, particularly in those patients with a certain pattern of spells, blood pressure elevation (paroxysmal or alternating with hypotension), drug-resistant hypertension, Abstract
{"title":"Clinical Presentation, Diagnosis, and Management of Primary Aldosteronism and Pheochromocytoma","authors":"L. Mercado-Asis, R. Castillo","doi":"10.15713/ins.johtn.0160","DOIUrl":"https://doi.org/10.15713/ins.johtn.0160","url":null,"abstract":"Primary hyperaldosteronism (PA) or Conn’s syndrome and pheochromocytoma (Pheo) are functioning tumors from the adrenal glands that can cause secondary hypertension.[1,2] Conn’s syndrome is the excess production of the hormone aldosterone from the zona glomerulosa of the adrenal glands. The prevalence of PA has been reported to range from 4.6 to 9.5% among hypertensive individuals.[3,4] The high circulating aldosterone results in hypokalemia which leads to weakness, tingling, muscle spasms, and periods of temporary paralysis.[4,5] Bilateral adrenal hyperplasia and aldosterone-producing adrenal tumor are the most common causes of PA.[6] Pheochromocytoma (Pheo) is a rare adrenomedullary tumor with an incidence of 0.1–0.6%.[1,7] About 0.05–0.1% of Pheo cases are undiagnosed in autopsy studies.[8] These tumors can synthesize, metabolize, store, and secrete catecholamines and their metabolites.[9] Pheos originate from adrenomedullary chromaffin cells that commonly produce epinephrine, norepinephrine, and dopamine. Chromaffin cells evolve into 80–85% Pheos and 15–20% are paragangliomas.[10] A high index of clinical suspicion remains the pivotal point to initiate biochemical studies, particularly in those patients with a certain pattern of spells, blood pressure elevation (paroxysmal or alternating with hypotension), drug-resistant hypertension, Abstract","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81400790","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}
Aaron Y. Kluger, K. Tecson, S. Sudhakaran, Jun Zhang, P. McCullough
{"title":"Statin Update: Intolerance, Benefit, and Beyond","authors":"Aaron Y. Kluger, K. Tecson, S. Sudhakaran, Jun Zhang, P. McCullough","doi":"10.15713/INS.JOHTN.0141","DOIUrl":"https://doi.org/10.15713/INS.JOHTN.0141","url":null,"abstract":"","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74597302","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}
Sarla F. Duller, Dan Louie Renz P. Tating, Lourdes Marie S. Tejero
Background: The same problems of access to health care due to inadequate and inequitable distribution of human resources for health continue to be present in countries worldwide, including the Philippines. However, these conditions have not stimulated the development of the role on advanced practice nursing (APN) in the country, despite hypertension (HTN) being a prevalent public health problem that can be addressed at the primary care level. Nurses, being the most numerous health professionals, can be trained to fulfill this deficiency. Objective: This study aimed to determine the validity and effectiveness of the investigatordesigned HTN training program for advanced practice nurses. Methods and Design: This was one group, pre-test-post-test design, involving nursing clinics for wellness in a government-subsidized university, located in Manila, the Philippines. Out of the 28 masters-prepared nurses who consented, 24 participants completed the training program and answered the post-training instruments; the majority were females, with a mean age of 32.42 years (standard deviations [SD] = 8.397) and mean the clinical experience of 5.84 years (SD = 3.503). A panel of six experts reviewed and validated the seven modules for the HTN training program. It consisted of lectures, demonstration sessions, small group discussions, oral examination, skill performance evaluation, and clinic visit with a demonstration, totaling 32 h of in-person training. Participants took the written examinations before and after the training program. Results: The expert panel determined that the module content covered the learning objectives adequately. After the training program, the total knowledge score of the participants increased from 33.00 points (SD = 5.25) to 43.08 points (SD = 43.08), which was statistically significant (t = −11.245, P < 0.001). Furthermore, self-efficacy scores increased significantly (t = −6.187, P < 0.001), from 8.08 points (SD = 1.16) to 9.06 (SD = 0.69). Conclusions: The validated HTN training program module effectively equipped the masters-prepared nurses with the required knowledge, skills, and attitudes in providing entry-level APN care for patients with primary HTN, addressing the competencies outlined by the National Organization of Nurse Practitioner Faculty in the United States. Since the positive outcomes on the nurse participants translated to the patient outcomes seen in the advanced practice nurse-led HTN Clinic done after this study, the competencies included in the training program modules should be integrated into the country’s master’s degree curriculum in Adult Health Nursing to provide adequate preparation for entry-level APN care.
{"title":"The Effectiveness of a Training Program for Advanced Practice Nurses in the Philippines on the Care of Patients with Primary Hypertension","authors":"Sarla F. Duller, Dan Louie Renz P. Tating, Lourdes Marie S. Tejero","doi":"10.15713/ins.johtn.0156","DOIUrl":"https://doi.org/10.15713/ins.johtn.0156","url":null,"abstract":"Background: The same problems of access to health care due to inadequate and inequitable distribution of human resources for health continue to be present in countries worldwide, including the Philippines. However, these conditions have not stimulated the development of the role on advanced practice nursing (APN) in the country, despite hypertension (HTN) being a prevalent public health problem that can be addressed at the primary care level. Nurses, being the most numerous health professionals, can be trained to fulfill this deficiency. Objective: This study aimed to determine the validity and effectiveness of the investigatordesigned HTN training program for advanced practice nurses. Methods and Design: This was one group, pre-test-post-test design, involving nursing clinics for wellness in a government-subsidized university, located in Manila, the Philippines. Out of the 28 masters-prepared nurses who consented, 24 participants completed the training program and answered the post-training instruments; the majority were females, with a mean age of 32.42 years (standard deviations [SD] = 8.397) and mean the clinical experience of 5.84 years (SD = 3.503). A panel of six experts reviewed and validated the seven modules for the HTN training program. It consisted of lectures, demonstration sessions, small group discussions, oral examination, skill performance evaluation, and clinic visit with a demonstration, totaling 32 h of in-person training. Participants took the written examinations before and after the training program. Results: The expert panel determined that the module content covered the learning objectives adequately. After the training program, the total knowledge score of the participants increased from 33.00 points (SD = 5.25) to 43.08 points (SD = 43.08), which was statistically significant (t = −11.245, P < 0.001). Furthermore, self-efficacy scores increased significantly (t = −6.187, P < 0.001), from 8.08 points (SD = 1.16) to 9.06 (SD = 0.69). Conclusions: The validated HTN training program module effectively equipped the masters-prepared nurses with the required knowledge, skills, and attitudes in providing entry-level APN care for patients with primary HTN, addressing the competencies outlined by the National Organization of Nurse Practitioner Faculty in the United States. Since the positive outcomes on the nurse participants translated to the patient outcomes seen in the advanced practice nurse-led HTN Clinic done after this study, the competencies included in the training program modules should be integrated into the country’s master’s degree curriculum in Adult Health Nursing to provide adequate preparation for entry-level APN care.","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84511058","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}
S. Santhosh, Prabhu Ethiraj, J. Solomon, R. Rajasekar
A 42-year-old male who is a known smoker and alcoholic presented to the vascular surgery department with complaints of gripping pain in both lower limbs over the past 6 months. He is undergoing treatment for refractory hypertension (BP 200/130 mmHg) despite optimum medication comprising calcium channel blocker, beta-blocker, and diuretics over 6 years. His serum creatinine was 1.6 mg/dl while the blood sugar, electrolytes, cholesterol, and liver function tests were within normal limits. He is also being treated for chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] = 27 ml/min/1.73m2 at diagnosis) and possible bilateral renal artery stenosis (RAS) was considered. Contrast-enhanced computed tomography showed complete occlusion of the right renal artery with contracted right kidney and 70–80% occlusion at the origin of the left renal artery [Figure 1a and b]. Pan angiogram showed a significant peripheral vascular disease of both iliac arteries while the subclavian, carotid, and upper limb vessels were normal. He was treated for one episode of flash pulmonary edema 9 months ago. At that time, his echocardiography showed concentric LVH and global LVEF of 58%. There was no regional wall motion abnormality. ECG showed ST depression in II, III, and aVF, and therefore, he was started on statins also, along with aspirin. At the time of referral to our institution, his global LVEF was 43%. We received him in our department to study the functional significance of RAS with 99mTechnetium-DTPA renogram with angiotensin-converting enzyme inhibitors (ACEIs). The patient was prepared as per the Society of Nuclear Medicine and Molecular Imaging guidelines for baseline and ACEI renogram (2 days protocol).[1] He was allowed to continue his medication during the study period. On day 1, baseline renogram was performed by giving intravenous injection of 100 MBq of 99mTc-DTPA in 1.0 ml saline through an intravenous cannula. Sequential dynamic and periodic static images of the abdomen Abstract
{"title":"Angiotensin-converting Enzyme Inhibitor Radionuclide Renogram – A Non-invasive Tool to Suspect Renovascular Hypertension","authors":"S. Santhosh, Prabhu Ethiraj, J. Solomon, R. Rajasekar","doi":"10.15713/INS.JOHTN.0144","DOIUrl":"https://doi.org/10.15713/INS.JOHTN.0144","url":null,"abstract":"A 42-year-old male who is a known smoker and alcoholic presented to the vascular surgery department with complaints of gripping pain in both lower limbs over the past 6 months. He is undergoing treatment for refractory hypertension (BP 200/130 mmHg) despite optimum medication comprising calcium channel blocker, beta-blocker, and diuretics over 6 years. His serum creatinine was 1.6 mg/dl while the blood sugar, electrolytes, cholesterol, and liver function tests were within normal limits. He is also being treated for chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] = 27 ml/min/1.73m2 at diagnosis) and possible bilateral renal artery stenosis (RAS) was considered. Contrast-enhanced computed tomography showed complete occlusion of the right renal artery with contracted right kidney and 70–80% occlusion at the origin of the left renal artery [Figure 1a and b]. Pan angiogram showed a significant peripheral vascular disease of both iliac arteries while the subclavian, carotid, and upper limb vessels were normal. He was treated for one episode of flash pulmonary edema 9 months ago. At that time, his echocardiography showed concentric LVH and global LVEF of 58%. There was no regional wall motion abnormality. ECG showed ST depression in II, III, and aVF, and therefore, he was started on statins also, along with aspirin. At the time of referral to our institution, his global LVEF was 43%. We received him in our department to study the functional significance of RAS with 99mTechnetium-DTPA renogram with angiotensin-converting enzyme inhibitors (ACEIs). The patient was prepared as per the Society of Nuclear Medicine and Molecular Imaging guidelines for baseline and ACEI renogram (2 days protocol).[1] He was allowed to continue his medication during the study period. On day 1, baseline renogram was performed by giving intravenous injection of 100 MBq of 99mTc-DTPA in 1.0 ml saline through an intravenous cannula. Sequential dynamic and periodic static images of the abdomen Abstract","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82939979","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}
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