Ami Attali, Thomas Vander Woude, Mohamed Fayed, Katherine Nowak
This study aimed to investigate the impact of Gebauer’s Pain Ease® (Gebauer Company, Cleveland, OH) topical refrigerant spray on the disinfection of skin sites, focusing on the volar wrist and lower back. The primary objective was to determine whether the application of Pain Ease would compromise the disinfection of these sites, potentially making it a suitable alternative to injectable lidocaine for invasive medical procedures. This prospective, blinded, controlled study was conducted at Henry Ford Hospital in Detroit, MI. Healthy adult hospital employees were recruited, and written consent was obtained. Swabs were taken from the volar wrist and lower back sites before and after treatment with ChloraPrep™ (BD, Franklin Lakes, NJ) and Pain Ease. Microbial cultures were performed, and microbial growth levels were assessed and categorized. Data analysis included comparisons of microbial growth between untreated samples, ChloraPrep-treated samples, and ChloraPrep + Pain Ease-treated samples. Data were collected from 72 participants, with 6 samples per participant (2 locations, 3 treatments each). For wrist samples, there were no statistically significant differences in microbial growth between ChloraPrep and ChloraPrep + Pain Ease. Similarly, for lower-back samples, microbial growth did not significantly differ between these 2 treatment groups. This study demonstrates that the application of Gebauer’s Pain Ease to ChloraPrep disinfected skin areas does not negatively affect the reduction of the bacterial load, supporting its potential as an alternative to injectable lidocaine and other superficial anesthetics for vascular access or invasive medical procedures. However, further research is warranted to explore the application of Pain Ease in various clinical scenarios and optimize patient comfort during longer and more invasive procedures.
{"title":"Microbial Safety Assessment of Gebauer’s Pain Ease® Spray on Invasive Procedural Sites","authors":"Ami Attali, Thomas Vander Woude, Mohamed Fayed, Katherine Nowak","doi":"10.2309/java-d-23-00023","DOIUrl":"https://doi.org/10.2309/java-d-23-00023","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 This study aimed to investigate the impact of Gebauer’s Pain Ease® (Gebauer Company, Cleveland, OH) topical refrigerant spray on the disinfection of skin sites, focusing on the volar wrist and lower back. The primary objective was to determine whether the application of Pain Ease would compromise the disinfection of these sites, potentially making it a suitable alternative to injectable lidocaine for invasive medical procedures.\u0000 \u0000 \u0000 \u0000 This prospective, blinded, controlled study was conducted at Henry Ford Hospital in Detroit, MI. Healthy adult hospital employees were recruited, and written consent was obtained. Swabs were taken from the volar wrist and lower back sites before and after treatment with ChloraPrep™ (BD, Franklin Lakes, NJ) and Pain Ease. Microbial cultures were performed, and microbial growth levels were assessed and categorized. Data analysis included comparisons of microbial growth between untreated samples, ChloraPrep-treated samples, and ChloraPrep + Pain Ease-treated samples.\u0000 \u0000 \u0000 \u0000 Data were collected from 72 participants, with 6 samples per participant (2 locations, 3 treatments each). For wrist samples, there were no statistically significant differences in microbial growth between ChloraPrep and ChloraPrep + Pain Ease. Similarly, for lower-back samples, microbial growth did not significantly differ between these 2 treatment groups.\u0000 \u0000 \u0000 \u0000 This study demonstrates that the application of Gebauer’s Pain Ease to ChloraPrep disinfected skin areas does not negatively affect the reduction of the bacterial load, supporting its potential as an alternative to injectable lidocaine and other superficial anesthetics for vascular access or invasive medical procedures. However, further research is warranted to explore the application of Pain Ease in various clinical scenarios and optimize patient comfort during longer and more invasive procedures.\u0000 \u0000","PeriodicalId":504313,"journal":{"name":"Journal of the Association for Vascular Access","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140268102","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}
Dayna Holt, Theresa Dodd-Butera, Melissa Stebel, Haylie Lichtenberger, Elizabeth Sharpe
Our project implementing a VAST produced these improved outcomes. There were 31% fewer IV devices. There were 22% fewer needle sticks. There were 49% reduction in delays. Vascular access is essential in the care of hospitalized pediatric patients. Planning and device selection are important for optimal patient outcomes. Vessel preservation is critical for pediatric patients. To determine and evaluate the impact of a vascular access team on pediatric patient care. A vascular access specialist team (VAST) was implemented on one medical unit at a tertiary children’s hospital, 16 hours a day for 4 weeks. Descriptive statistics were used, including (a) first-stick success rates, (b) number of needle sticks and vascular access devices per hospital stay, (c) delays in therapy, and (d) frequency of topical analgesic use. Preintervention data were compared with postintervention data. Qualitatively, nursing and medical staff were surveyed to evaluate their perception of project experiences. Compared with preintervention data, 56% fewer peripheral intravenous lines were initiated, and 31% fewer total vascular access devices were used during the hospital stay. There were 22% fewer needle sticks per peripheral intravenous line attempt. The first-stick success rate of the VAST was 71% compared with the bedside nurse rate of 52%. There was a 78% reduction in time between devices/1000 patient-days/week, representing reduced interruptions in therapy. The use of topical anesthetics for intravenous device placement increased 333%. This project provided clarity regarding the value of the VAST for pediatric hospitalized patients. The VAST model is evidence based, follows best-practice guidelines, is fiscally sound, and optimizes nursing practice and quality patient care.
{"title":"Impact of a Vascular Access Specialty Service on Hospitalized Pediatric Patients: A Pilot Feasibility Study","authors":"Dayna Holt, Theresa Dodd-Butera, Melissa Stebel, Haylie Lichtenberger, Elizabeth Sharpe","doi":"10.2309/java-d-23-00028","DOIUrl":"https://doi.org/10.2309/java-d-23-00028","url":null,"abstract":"\u0000 \u0000 Our project implementing a VAST produced these improved outcomes. There were 31% fewer IV devices. There were 22% fewer needle sticks. There were 49% reduction in delays.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 Vascular access is essential in the care of hospitalized pediatric patients. Planning and device selection are important for optimal patient outcomes. Vessel preservation is critical for pediatric patients.\u0000 \u0000 \u0000 \u0000 To determine and evaluate the impact of a vascular access team on pediatric patient care.\u0000 \u0000 \u0000 \u0000 A vascular access specialist team (VAST) was implemented on one medical unit at a tertiary children’s hospital, 16 hours a day for 4 weeks.\u0000 \u0000 \u0000 \u0000 Descriptive statistics were used, including (a) first-stick success rates, (b) number of needle sticks and vascular access devices per hospital stay, (c) delays in therapy, and (d) frequency of topical analgesic use. Preintervention data were compared with postintervention data. Qualitatively, nursing and medical staff were surveyed to evaluate their perception of project experiences.\u0000 \u0000 \u0000 \u0000 Compared with preintervention data, 56% fewer peripheral intravenous lines were initiated, and 31% fewer total vascular access devices were used during the hospital stay. There were 22% fewer needle sticks per peripheral intravenous line attempt. The first-stick success rate of the VAST was 71% compared with the bedside nurse rate of 52%. There was a 78% reduction in time between devices/1000 patient-days/week, representing reduced interruptions in therapy. The use of topical anesthetics for intravenous device placement increased 333%.\u0000 \u0000 \u0000 \u0000 This project provided clarity regarding the value of the VAST for pediatric hospitalized patients. The VAST model is evidence based, follows best-practice guidelines, is fiscally sound, and optimizes nursing practice and quality patient care.\u0000 \u0000","PeriodicalId":504313,"journal":{"name":"Journal of the Association for Vascular Access","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269768","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}
Pub Date : 2024-03-01DOI: 10.2309/jvad-29-1-guested
Josie Stone
{"title":"Decreasing Pain and Anxiety in Pediatric Vascular Access Procedures: Guest Editorial","authors":"Josie Stone","doi":"10.2309/jvad-29-1-guested","DOIUrl":"https://doi.org/10.2309/jvad-29-1-guested","url":null,"abstract":"","PeriodicalId":504313,"journal":{"name":"Journal of the Association for Vascular Access","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278563","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}
Jamie Lorenc, Nicholas Flaucher, Emily Evans, Jennifer V. Schurman
Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (i.e., peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24,134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.
{"title":"Establishing a Plan to Improve Pediatric Patient Comfort during PIV Insertions and Blood Specimen Collection: A Quality Improvement Effort","authors":"Jamie Lorenc, Nicholas Flaucher, Emily Evans, Jennifer V. Schurman","doi":"10.2309/java-d-23-00026","DOIUrl":"https://doi.org/10.2309/java-d-23-00026","url":null,"abstract":"\u0000 \u0000 Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (i.e., peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically.\u0000 \u0000 \u0000 \u0000 The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24,134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change.\u0000 \u0000 \u0000 \u0000 The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2.\u0000 \u0000 \u0000 \u0000 From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions.\u0000 \u0000 \u0000 \u0000 While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.\u0000 \u0000","PeriodicalId":504313,"journal":{"name":"Journal of the Association for Vascular Access","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140088347","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}
Pub Date : 2023-12-01DOI: 10.2309/java-2023-28-04-editorial
Michelle L Hawes
{"title":"Ineffective: Sutures as an Ineffective Securement Device: Editor’s Message","authors":"Michelle L Hawes","doi":"10.2309/java-2023-28-04-editorial","DOIUrl":"https://doi.org/10.2309/java-2023-28-04-editorial","url":null,"abstract":"","PeriodicalId":504313,"journal":{"name":"Journal of the Association for Vascular Access","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139189270","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 rate of IDU among those who received a VAD placement was 3%. The VAD + IDU patients had 1.8 times longer mean LOS than VAD-only cohorts. The VAD + IDU cohort had 1.9 times higher mean inpatient cost than VAD-only cohorts. PPCRI increased in VAD + IDU cohort during pandemic.
在接受 VAD 安置的患者中，IDU 的比例为 3%。VAD + IDU 患者的平均住院时间是纯 VAD 患者的 1.8 倍。VAD + IDU 组群的平均住院费用是纯 VAD 组群的 1.9 倍。大流行期间，VAD + IDU 组群的 PPCRI 增加。
{"title":"Length of Stay, Hospitalization Cost, and Infection Rate for Inpatients With Vascular Access Devices With and Without History of Injection Drug Use","authors":"Laura Soloway, Tarja Kärpänen","doi":"10.2309/java-d-23-00015","DOIUrl":"https://doi.org/10.2309/java-d-23-00015","url":null,"abstract":"The rate of IDU among those who received a VAD placement was 3%. The VAD + IDU patients had 1.8 times longer mean LOS than VAD-only cohorts. The VAD + IDU cohort had 1.9 times higher mean inpatient cost than VAD-only cohorts. PPCRI increased in VAD + IDU cohort during pandemic.","PeriodicalId":504313,"journal":{"name":"Journal of the Association for Vascular Access","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139195466","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}
Pub Date : 2023-12-01DOI: 10.2309/java-2023-28-04-foundational
Sarah A. Norris, Andrew Todd
{"title":"Foundational Support","authors":"Sarah A. Norris, Andrew Todd","doi":"10.2309/java-2023-28-04-foundational","DOIUrl":"https://doi.org/10.2309/java-2023-28-04-foundational","url":null,"abstract":"","PeriodicalId":504313,"journal":{"name":"Journal of the Association for Vascular Access","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139190301","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}
Pub Date : 2023-12-01DOI: 10.2309/1557-1289-28.4.31
{"title":"2023 Association for Vascular Access Scientific Meeting: Poster Abstracts","authors":"","doi":"10.2309/1557-1289-28.4.31","DOIUrl":"https://doi.org/10.2309/1557-1289-28.4.31","url":null,"abstract":"","PeriodicalId":504313,"journal":{"name":"Journal of the Association for Vascular Access","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139193843","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}
Samantha W. Neumeister, Megan E Gabel, Jeffrey M. Meyers, Brenda Tesini, Julie Albright Gottfried, Acadia Fairchild, Jan Schriefer
Central line-associated bloodstream infections (CLABSIs) result in significant morbidity but are largely preventable. Methods to reduce hospital-acquired CLABSIs are well described, but few recommendations exist for how these practices might translate to patients with central lines in the ambulatory setting. This team sought to reduce the mean monthly community-acquired CLABSI rate by 25% from 11.7 to 8.8 per 1000 community line-days in children with intestinal failure who require home parenteral nutrition within 12 months. First, an interprofessional quality improvement team was formed. After baseline data collection, plan-do-study-act cycles began. Tests of change consisted of a central venous catheter (CVC) maintenance bundle. This bundle included a CVC care tote with additional supplies, improved educational materials, and ethanol lock prophylaxis. A control chart was used to display the monthly community-acquired CLABSI rate and observe for special cause variation. At baseline, the average monthly community-acquired CLABSI rate was 11.7 per 1000 community catheter-days. The home CVC maintenance bundle was implemented, after which there were 5 consecutive months with no infections. After enhancements to the care bundle and tote, special cause variation was noted, and the average monthly community-acquired CLABSI rate declined by 66% to 4 per 1000 community catheter-days. Special cause variation was noted at 2 other time points without an identifiable cause. A lower community-acquired CLABSI rate has been sustained for 24 months and reflects approximately 12 fewer infections per year in this at-risk population.
{"title":"An Interprofessional Quality Improvement Project to Reduce Community-Acquired Central Line-Associated Bloodstream Infections in the Pediatric Intestinal Failure Population","authors":"Samantha W. Neumeister, Megan E Gabel, Jeffrey M. Meyers, Brenda Tesini, Julie Albright Gottfried, Acadia Fairchild, Jan Schriefer","doi":"10.2309/java-d-23-00010","DOIUrl":"https://doi.org/10.2309/java-d-23-00010","url":null,"abstract":"Central line-associated bloodstream infections (CLABSIs) result in significant morbidity but are largely preventable. Methods to reduce hospital-acquired CLABSIs are well described, but few recommendations exist for how these practices might translate to patients with central lines in the ambulatory setting. This team sought to reduce the mean monthly community-acquired CLABSI rate by 25% from 11.7 to 8.8 per 1000 community line-days in children with intestinal failure who require home parenteral nutrition within 12 months. First, an interprofessional quality improvement team was formed. After baseline data collection, plan-do-study-act cycles began. Tests of change consisted of a central venous catheter (CVC) maintenance bundle. This bundle included a CVC care tote with additional supplies, improved educational materials, and ethanol lock prophylaxis. A control chart was used to display the monthly community-acquired CLABSI rate and observe for special cause variation. At baseline, the average monthly community-acquired CLABSI rate was 11.7 per 1000 community catheter-days. The home CVC maintenance bundle was implemented, after which there were 5 consecutive months with no infections. After enhancements to the care bundle and tote, special cause variation was noted, and the average monthly community-acquired CLABSI rate declined by 66% to 4 per 1000 community catheter-days. Special cause variation was noted at 2 other time points without an identifiable cause. A lower community-acquired CLABSI rate has been sustained for 24 months and reflects approximately 12 fewer infections per year in this at-risk population.","PeriodicalId":504313,"journal":{"name":"Journal of the Association for Vascular Access","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139194709","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}
Pub Date : 2023-09-01DOI: 10.2309/java-2023-28-03-erratum
Claire B. Joseph,, Gregory E. Gilbert,
{"title":"Erratum to ‘How to Perform a Successful Literature Search’ [J Assoc Vasc Access 28 (2023) 19–22]","authors":"Claire B. Joseph,, Gregory E. Gilbert,","doi":"10.2309/java-2023-28-03-erratum","DOIUrl":"https://doi.org/10.2309/java-2023-28-03-erratum","url":null,"abstract":"","PeriodicalId":504313,"journal":{"name":"Journal of the Association for Vascular Access","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346090","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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