The anterior choroidal artery (AChA) is the most distal branch of the internal carotid artery (ICA) The ACHA is significant because it supplies important structures in the brain, including the optic tract, anterior portion of cerebral peduncle, lateral geniculate body, uncus, globus pallidus, posterior and superficial areas of the thalamus, and the retrolenticular and posterior portions of the internal capsule on the same side as the artery. Isolated strokes involving the AChA are rare and can result in HHH Syndrome, consisting of contralateral hemiplegia, hemisensory loss, and homonymous hemianopia. Features which distinguish an AChA infarction from larger arterial pathology are lack of headache and lack of depressed level of consciousness in subacute infarction, and usually lack of aphasia acutely. The etiology remains controversial, with proposed mechanisms including cardioembolic, large-vessel atherosclerosis, dissection of the ICA, small-vessel occlusion, and cryptogenic causes. Herein, the authors report a case of an isolated AChA infarction resulting in a right-sided, pure motor hemiparesis with no sensory or vision loss, highly suggestive of cardioembolic origin, with the evaluation of the patient, and eventual treatment strategy.
{"title":"A Drive Interrupted: Stroke of the Anterior Choroidal Artery – A Case Report","authors":"Alex Brown, Thomas Varkey, Savdeep Singh","doi":"10.59236/sc.v1i2.32","DOIUrl":"https://doi.org/10.59236/sc.v1i2.32","url":null,"abstract":"The anterior choroidal artery (AChA) is the most distal branch of the internal carotid artery (ICA) The ACHA is significant because it supplies important structures in the brain, including the optic tract, anterior portion of cerebral peduncle, lateral geniculate body, uncus, globus pallidus, posterior and superficial areas of the thalamus, and the retrolenticular and posterior portions of the internal capsule on the same side as the artery. Isolated strokes involving the AChA are rare and can result in HHH Syndrome, consisting of contralateral hemiplegia, hemisensory loss, and homonymous hemianopia. Features which distinguish an AChA infarction from larger arterial pathology are lack of headache and lack of depressed level of consciousness in subacute infarction, and usually lack of aphasia acutely. The etiology remains controversial, with proposed mechanisms including cardioembolic, large-vessel atherosclerosis, dissection of the ICA, small-vessel occlusion, and cryptogenic causes. Herein, the authors report a case of an isolated AChA infarction resulting in a right-sided, pure motor hemiparesis with no sensory or vision loss, highly suggestive of cardioembolic origin, with the evaluation of the patient, and eventual treatment strategy.","PeriodicalId":517115,"journal":{"name":"Stroke Clinician","volume":" 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140995542","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}
AcT: Intravenous Tenecteplase Compared to Alteplase for Acute Ischaemic Stroke in Canada In this article, we detail the trial’s design and important clinical findings.
{"title":"AcT: Intravenous Tenecteplase Compared to Alteplase for Acute Ischaemic Stroke in Canada","authors":"Stroke Clinician","doi":"10.59236/sc.v1i2.42","DOIUrl":"https://doi.org/10.59236/sc.v1i2.42","url":null,"abstract":"AcT: Intravenous Tenecteplase Compared to Alteplase for Acute Ischaemic Stroke in Canada \u0000In this article, we detail the trial’s design and important clinical findings. \u0000 ","PeriodicalId":517115,"journal":{"name":"Stroke Clinician","volume":" 47","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140995724","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}
Background Blood pressure (BP) is one of the most frequently measured and monitored physiologic vital signs by all stroke clinicians, yet data suggest that only 1 out of 5 clinicians applies evidence-based methods for BP monitoring. Methods An exhaustive review of the literature was conducted and assembled to provide a historical clinical account of BP monitoring modalities and related evidence-based clinical methods. Results Evidence-based clinical methods are described for use of manual sphygmomanometry, noninvasive oscillometric automatic BP (NIBP) monitors, and arterial lines. Implications for practice are discussed in relation to provision of acute and critical care of ischemic and hemorrhagic stroke patients. Conclusion Use of evidence-based BP monitoring methods ensures accurate management of highly vulnerable stroke patients. Knowledge of the history of BP monitoring, along with the benefits and limitations of different measurement methods enables accuracy in BP treatment, benefitting stroke patient outcomes.
{"title":"Blood Pressure: The History and Development of Monitoring Modalities","authors":"Desiree M. Cihelka","doi":"10.59236/sc.v1i2.39","DOIUrl":"https://doi.org/10.59236/sc.v1i2.39","url":null,"abstract":"Background \u0000Blood pressure (BP) is one of the most frequently measured and monitored physiologic vital signs by all stroke clinicians, yet data suggest that only 1 out of 5 clinicians applies evidence-based methods for BP monitoring. \u0000Methods \u0000An exhaustive review of the literature was conducted and assembled to provide a historical clinical account of BP monitoring modalities and related evidence-based clinical methods. \u0000Results \u0000Evidence-based clinical methods are described for use of manual sphygmomanometry, noninvasive oscillometric automatic BP (NIBP) monitors, and arterial lines. Implications for practice are discussed in relation to provision of acute and critical care of ischemic and hemorrhagic stroke patients. \u0000Conclusion \u0000Use of evidence-based BP monitoring methods ensures accurate management of highly vulnerable stroke patients. Knowledge of the history of BP monitoring, along with the benefits and limitations of different measurement methods enables accuracy in BP treatment, benefitting stroke patient outcomes. ","PeriodicalId":517115,"journal":{"name":"Stroke Clinician","volume":" 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140997475","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}
Kelly Matmati, Nabil Matmati, Susan Madison, Brian Bixler, Kelsey Vogler, Mary Dombovy, Chris Burke
Background One in four strokes occur in stroke victims, with hospital readmissions contributing to high-cost care. Transition of care programs have been successful in reducing hospital readmissions in other diseases, but the data on such programs for stroke are mixed. A transition of care program was implemented with the goal of reducing recurrent strokes and hospital readmissions. Methods We implemented a transition of care program using nurse navigators and early outpatient follow-up with a vascular neurologist. Data were obtained on: Rate of recurrent stroke admissions within one-year, all-cause readmission within one-year, all-cause readmission within 30 days, initial follow-up scheduled within 7-10 days, compliance with follow up, and compliance rates with provision of two-day post-hospital discharge phone calls. Results An improvement was seen in process measures reflecting adherence to the intervention across all 3 years. The rate of readmission for stroke at 12 months was 8.5%, 9.0%, 6.6%, and 4.2% for year 0, 1, 2, and 3, respectively, representing a 50% reduction from baseline year 0. All-cause readmission remained unchanged, at 38.9%, 42.6%, 36.6%, and 37.4% for year 0, 1, 2, and 3 respectively. Conclusions Our nurse navigator led stroke transition intervention was associated with significant reduction in readmissions for stroke but did not impact all cause readmission at one year or 30 days. Our focus on Centers for Medicare/Medicaid intervention compliance has produced a sustainable program capable of now expanding to support other important patient needs.
{"title":"Stroke Transition of Care Intervention with Stroke Nurse Navigators and Early Stroke Clinic Follow-up Reduces Readmissions for Stroke at 12 Months","authors":"Kelly Matmati, Nabil Matmati, Susan Madison, Brian Bixler, Kelsey Vogler, Mary Dombovy, Chris Burke","doi":"10.59236/sc.v1i2.30","DOIUrl":"https://doi.org/10.59236/sc.v1i2.30","url":null,"abstract":"Background\u0000One in four strokes occur in stroke victims, with hospital readmissions contributing to high-cost care. Transition of care programs have been successful in reducing hospital readmissions in other diseases, but the data on such programs for stroke are mixed. A transition of care program was implemented with the goal of reducing recurrent strokes and hospital readmissions.\u0000Methods\u0000We implemented a transition of care program using nurse navigators and early outpatient follow-up with a vascular neurologist. Data were obtained on: Rate of recurrent stroke admissions within one-year, all-cause readmission within one-year, all-cause readmission within 30 days, initial follow-up scheduled within 7-10 days, compliance with follow up, and compliance rates with provision of two-day post-hospital discharge phone calls. \u0000Results\u0000An improvement was seen in process measures reflecting adherence to the intervention across all 3 years. The rate of readmission for stroke at 12 months was 8.5%, 9.0%, 6.6%, and 4.2% for year 0, 1, 2, and 3, respectively, representing a 50% reduction from baseline year 0. All-cause readmission remained unchanged, at 38.9%, 42.6%, 36.6%, and 37.4% for year 0, 1, 2, and 3 respectively. \u0000Conclusions\u0000Our nurse navigator led stroke transition intervention was associated with significant reduction in readmissions for stroke but did not impact all cause readmission at one year or 30 days. Our focus on Centers for Medicare/Medicaid intervention compliance has produced a sustainable program capable of now expanding to support other important patient needs. ","PeriodicalId":517115,"journal":{"name":"Stroke Clinician","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140997075","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}
Lauren Sheehan, Tailar Johnson, Kirsten Carroll, T. Jovin
Background Principal Illness Navigation (PIN) services may play an important role in helping patients through important transitions in care following acute hospitalization. We evaluated a novel PIN telemedicine approach to understand the feasibility of providing these services to diverse patient cohorts. Methods A single-arm, retrospective observational study of Kandu Health’s post-acute PIN service was conducted in patients experiencing ischemic or hemorrhagic stroke in California and New Jersey. The technology-enabled program offered remote healthcare support led by occupational therapists and licensed clinical social workers that was tailored to individual patient needs to facilitate transition to community settings post-discharge. Barriers to recovery were addressed through patient education, one-on-one guidance, and specialized referrals. Patient outcomes were assessed through in-app assessments and clinician-assessed modified Rankin Scores conducted via video consultation. Readmissions were monitored through both patient reporting and admission/discharge/transfer feeds from health information exchanges. Results A total of 111 patients were enrolled between June 22, 2022 and January 11, 2024. Patients were onboarded an average of 29 ± 40 days (median 18, IQR 8-32) after acute care hospital discharge and spent an average of 81 ± 21 days (median 90, IQR 75-90) in the program. During that time, the average enrollee spent 333 ± 156 minutes (median 350, IQR 205-435) of 1:1 time interacting with their dedicated navigator, and navigators spent an additional 113 ± 87 minutes (median 95, IQR 61-140) per patient on care coordination and curriculum curation. Patients with 5 or more social determinants of health (SDOH) needs required over 50% more navigator time than those without any SDOH needs. Within 6 weeks of hospital discharge, 8.5% experienced an inpatient hospital all-cause readmission that was not associated with race, ethnicity, or SDOH. Conclusions High rates of enrollment and extensive patient engagement in both navigator-facilitated and self-directed program elements can be achieved using the Kandu program. Our findings indicate that telemedicine facilitated, app-supported PIN is feasible to deliver following acute stroke discharge across diverse ages, races, ethnicities, functional status (mRS), and social needs.
{"title":"Feasibility of a Telemedicine-Based Principal Illness Navigation (PIN) Service for Complex Populations Following Hospital Discharge After Acute Stroke","authors":"Lauren Sheehan, Tailar Johnson, Kirsten Carroll, T. Jovin","doi":"10.59236/sc.v1i2.38","DOIUrl":"https://doi.org/10.59236/sc.v1i2.38","url":null,"abstract":"Background \u0000Principal Illness Navigation (PIN) services may play an important role in helping patients through important transitions in care following acute hospitalization. We evaluated a novel PIN telemedicine approach to understand the feasibility of providing these services to diverse patient cohorts. \u0000Methods \u0000A single-arm, retrospective observational study of Kandu Health’s post-acute PIN service was conducted in patients experiencing ischemic or hemorrhagic stroke in California and New Jersey. The technology-enabled program offered remote healthcare support led by occupational therapists and licensed clinical social workers that was tailored to individual patient needs to facilitate transition to community settings post-discharge. Barriers to recovery were addressed through patient education, one-on-one guidance, and specialized referrals. Patient outcomes were assessed through in-app assessments and clinician-assessed modified Rankin Scores conducted via video consultation. Readmissions were monitored through both patient reporting and admission/discharge/transfer feeds from health information exchanges. \u0000Results \u0000A total of 111 patients were enrolled between June 22, 2022 and January 11, 2024. Patients were onboarded an average of 29 ± 40 days (median 18, IQR 8-32) after acute care hospital discharge and spent an average of 81 ± 21 days (median 90, IQR 75-90) in the program. During that time, the average enrollee spent 333 ± 156 minutes (median 350, IQR 205-435) of 1:1 time interacting with their dedicated navigator, and navigators spent an additional 113 ± 87 minutes (median 95, IQR 61-140) per patient on care coordination and curriculum curation. Patients with 5 or more social determinants of health (SDOH) needs required over 50% more navigator time than those without any SDOH needs. Within 6 weeks of hospital discharge, 8.5% experienced an inpatient hospital all-cause readmission that was not associated with race, ethnicity, or SDOH. \u0000Conclusions \u0000High rates of enrollment and extensive patient engagement in both navigator-facilitated and self-directed program elements can be achieved using the Kandu program. Our findings indicate that telemedicine facilitated, app-supported PIN is feasible to deliver following acute stroke discharge across diverse ages, races, ethnicities, functional status (mRS), and social needs.","PeriodicalId":517115,"journal":{"name":"Stroke Clinician","volume":"128 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140994617","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}
L. Pope, Nicole Dellostretto, Kelly Buchinsky, P. Noah, Chris T Hackett, Russell Cerejo, A. Tayal
Background Transitions in stroke care across the healthcare system are complex, requiring significant patient and family support. Navigation has been used in other disease states including oncology but has not been described well in the stroke population. Methods Our stroke program leadership performed a gap analysis to identify opportunities to streamline the care transition process. The emerging stroke nurse navigator role was implemented to meet patient/family needs and ensure implementation of evidence-based stroke services throughout transitions across the stroke system of care. Results The stroke navigator role was formally implemented in April 2018, along with adaptive patient selection criteria that have evolved as expertise in navigation has grown. Clarity in role function between the stroke coordinator and stroke navigator positions was established demonstrating the synergistic relationships between these two roles. Similarly, interventions and services performed routinely by stroke navigators developed over time as navigators became well versed in the needs of patients and families in the post-acute phase of care. We provide a detailed history of our 6-year experience with stroke navigation and make recommendations for role adoption and enactment. Conclusion Stroke navigator roles are likely to continue to grow to support the complex needs of stroke survivors and family members. Flexibility in role development and reflective role evolution are encouraged to support growth of the stroke navigator position and measures of role effectiveness.
{"title":"Development and Implementation of a Stroke Nurse Navigator Position to Improve Program and Patient Outcomes","authors":"L. Pope, Nicole Dellostretto, Kelly Buchinsky, P. Noah, Chris T Hackett, Russell Cerejo, A. Tayal","doi":"10.59236/sc.v1i2.37","DOIUrl":"https://doi.org/10.59236/sc.v1i2.37","url":null,"abstract":"Background \u0000Transitions in stroke care across the healthcare system are complex, requiring significant patient and family support. Navigation has been used in other disease states including oncology but has not been described well in the stroke population. \u0000Methods \u0000Our stroke program leadership performed a gap analysis to identify opportunities to streamline the care transition process. The emerging stroke nurse navigator role was implemented to meet patient/family needs and ensure implementation of evidence-based stroke services throughout transitions across the stroke system of care. \u0000Results \u0000The stroke navigator role was formally implemented in April 2018, along with adaptive patient selection criteria that have evolved as expertise in navigation has grown. Clarity in role function between the stroke coordinator and stroke navigator positions was established demonstrating the synergistic relationships between these two roles. Similarly, interventions and services performed routinely by stroke navigators developed over time as navigators became well versed in the needs of patients and families in the post-acute phase of care. We provide a detailed history of our 6-year experience with stroke navigation and make recommendations for role adoption and enactment. \u0000Conclusion \u0000Stroke navigator roles are likely to continue to grow to support the complex needs of stroke survivors and family members. Flexibility in role development and reflective role evolution are encouraged to support growth of the stroke navigator position and measures of role effectiveness.","PeriodicalId":517115,"journal":{"name":"Stroke Clinician","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140995362","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}
Disease Navigation: From Oncology to Chronic and Complex Illness
疾病导航：从肿瘤到慢性病和复杂疾病
{"title":"Disease Navigation: From Oncology to Chronic and Complex Illness","authors":"Jennifer Edwards","doi":"10.59236/sc.v1i2.36","DOIUrl":"https://doi.org/10.59236/sc.v1i2.36","url":null,"abstract":"Disease Navigation: From Oncology to Chronic and Complex Illness","PeriodicalId":517115,"journal":{"name":"Stroke Clinician","volume":" 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140996071","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}
After discharge, stroke survivors are at high risk for secondary stroke as well as readmission to a hospital. While stroke center certification standards emphasize preparing patients and caregivers for discharge, patients discharged to home may experience delays in seeing a community provider and report inadequate preparation for discharge. Several models suggest inpatient stroke programs are assuming additional roles and responsibilities in the management of patients after discharge. Models such as a stroke nurse navigator, post-stroke clinics and other interdisciplinary supported discharge programs may address gaps in care after discharge. Even with this evidence, stroke leaders should evaluate their own patient outcomes to understand their needs and plan services accordingly. Strategies to evaluate discharge outcomes and advocate for services are discussed.
{"title":"Emerging Post-Hospital Models of Care: A Primer for Stroke Center Leaders","authors":"Sarah Livesay, Debbie Hill","doi":"10.59236/sc.v1i2.41","DOIUrl":"https://doi.org/10.59236/sc.v1i2.41","url":null,"abstract":"After discharge, stroke survivors are at high risk for secondary stroke as well as readmission to a hospital. While stroke center certification standards emphasize preparing patients and caregivers for discharge, patients discharged to home may experience delays in seeing a community provider and report inadequate preparation for discharge. Several models suggest inpatient stroke programs are assuming additional roles and responsibilities in the management of patients after discharge. Models such as a stroke nurse navigator, post-stroke clinics and other interdisciplinary supported discharge programs may address gaps in care after discharge. Even with this evidence, stroke leaders should evaluate their own patient outcomes to understand their needs and plan services accordingly. Strategies to evaluate discharge outcomes and advocate for services are discussed.","PeriodicalId":517115,"journal":{"name":"Stroke Clinician","volume":" 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140997525","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}
Stroke clinicians incorporate essential stroke care measures into their professional practice within certified stroke centers on a regular basis. Supported by evidence-based guidelines, these time-sensitive care requirements target the unique needs of stroke patients making them essential for optimal translation to bedside clinical practice. Varied interprofessional staff learning styles call for educational instruction to be engaging and innovative to yield intended results. This article introduces a new learning tool called BRAVEST (B: Blood pressure; R: Rehabilitation; A: Antithrombotics; V: Venous thromboembolism prophylaxis; E: Education; S: Statin therapy; T: Thrombolysis/Thrombectomy), a custom-made visual aid that presents evidence-based, certification-required acute stroke care as a creative mnemonic infographic to enhance interprofessional stroke clinicians’ learning and retention.
{"title":"BRAVEST: A Visual Teaching Aid for Stroke Clinicians","authors":"Linda Sugrue","doi":"10.59236/sc.v1i2.40","DOIUrl":"https://doi.org/10.59236/sc.v1i2.40","url":null,"abstract":"Stroke clinicians incorporate essential stroke care measures into their professional practice within certified stroke centers on a regular basis. Supported by evidence-based guidelines, these time-sensitive care requirements target the unique needs of stroke patients making them essential for optimal translation to bedside clinical practice. Varied interprofessional staff learning styles call for educational instruction to be engaging and innovative to yield intended results. This article introduces a new learning tool called BRAVEST (B: Blood pressure; R: Rehabilitation; A: Antithrombotics; V: Venous thromboembolism prophylaxis; E: Education; S: Statin therapy; T: Thrombolysis/Thrombectomy), a custom-made visual aid that presents evidence-based, certification-required acute stroke care as a creative mnemonic infographic to enhance interprofessional stroke clinicians’ learning and retention.","PeriodicalId":517115,"journal":{"name":"Stroke Clinician","volume":" 44","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140995680","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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