Pub Date : 2022-12-02DOI: 10.5005/jp-journals-11010-06102
Vamsidhar Chamala
The average blood pressure recorded in the superior vena cava near right atrium represents ‘central venous pressure’ (CVP). Traditionally CVP has been used as an indicator for predicting cardiac preload as well as volume responsiveness in critically ill patients. CVP is chiefly dependent on two factors: venous blood volume (venous return) and venous compliance. CVP is not an independent variable in determining cardiac output. Its relationship with cardiac output varies largely with the dynamic changes in the compliance of vascular compartment. The total blood volume in a venous system exists in two forms: Stressed volume (Vs) and Unstressed volume (Vu). The unstressed volume is equivalent to a basal blood volume that occupies the venous system. The stressed volume is the proportion that is dynamic in nature and affects the venous return and cardiac output. In this article, the basic physiology and applications of CVP as well as its limitations when compared to other dynamic parameters in assessing cardiovascular function are discussed.
{"title":"Rise and fall of CVP","authors":"Vamsidhar Chamala","doi":"10.5005/jp-journals-11010-06102","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-06102","url":null,"abstract":"The average blood pressure recorded in the superior vena cava near right atrium represents ‘central venous pressure’ (CVP). Traditionally CVP has been used as an indicator for predicting cardiac preload as well as volume responsiveness in critically ill patients. CVP is chiefly dependent on two factors: venous blood volume (venous return) and venous compliance. CVP is not an independent variable in determining cardiac output. Its relationship with cardiac output varies largely with the dynamic changes in the compliance of vascular compartment. The total blood volume in a venous system exists in two forms: Stressed volume (Vs) and Unstressed volume (Vu). The unstressed volume is equivalent to a basal blood volume that occupies the venous system. The stressed volume is the proportion that is dynamic in nature and affects the venous return and cardiac output. In this article, the basic physiology and applications of CVP as well as its limitations when compared to other dynamic parameters in assessing cardiovascular function are discussed.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47315610","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 : 2022-12-02DOI: 10.5005/jp-journals-11010-04203
P. Nanjangud
Airway management in critically ill patients is often difficult and is associated with complications. Knowledge of airway anatomy, its change during laryngoscopy and physiology of oxygen transport is essential for predicting difficult airway and in planning the management. Optimal assessment of the airway anatomy to predict difficulty, formulating a plan of action, and an alternate plan, assembling the required equipment and personnel, keeping the difficult airway trolley ready, preparation of the patient by preoxygenation and proper positioning are some of the measures to decrease complications. Adequate training to develop cognitive and procedural skill for managing difficult airway is very important. All physicians involved in airway management should update their skills by involving in simulation excercises and workshops
{"title":"Difficult airway in intensive care unit","authors":"P. Nanjangud","doi":"10.5005/jp-journals-11010-04203","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-04203","url":null,"abstract":"Airway management in critically ill patients is often difficult and is associated with complications. Knowledge of airway anatomy, its change during laryngoscopy and physiology of oxygen transport is essential for predicting difficult airway and in planning the management. Optimal assessment of the airway anatomy to predict difficulty, formulating a plan of action, and an alternate plan, assembling the required equipment and personnel, keeping the difficult airway trolley ready, preparation of the patient by preoxygenation and proper positioning are some of the measures to decrease complications. Adequate training to develop cognitive and procedural skill for managing difficult airway is very important. All physicians involved in airway management should update their skills by involving in simulation excercises and workshops","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47932106","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 : 2022-12-02DOI: 10.5005/jp-journals-11010-04109
Rajendram R, Parker R, J. A
Ventilatory failure may result from dysfunction of any part of the respiratory pathway. Muscle weakness preexisting or acquired should be considered in all patients. Case Report: A 52-year-old smoker presented in extremis with type II respiratory failure. She was treated with bronchodilators, steroids and antibiotics. Weaning ventilatory support was difficult and so a tracheostomy was performed.. Two weeks later, she was transferred to a respiratory ward where she was decannulated before discharge home. After discharge, her breathlessness and weakness progressed until she was readmitted in extremis 1 week later. On readmission, she deteriorated despite treatment for COPD. Mandatory ventilation was initiated after recannulation of the tracheostomy. The patient gradually improved over the next few days and was transferred to a respiratory ward where she was weaned onto nocturnal NIV and the tracheostomy was decannulated. Flow volume loops excluded air flow obstruction but spirometry confirmed severe inspiratory muscle weakness. The patient reported progressive weakness over several years. On examination all muscle groups were weak and deep tendon reflexes were absent but there was no fatigability or fasciculation. Sensation was intact. The diagnosis of acid maltase deficiency (AMD) was confirmed by analysis of peripheral blood lymphocytes, muscle biopsy and enzyme assay.
{"title":"Do all breathless smokers have a COLD?","authors":"Rajendram R, Parker R, J. A","doi":"10.5005/jp-journals-11010-04109","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-04109","url":null,"abstract":"Ventilatory failure may result from dysfunction of any part of the respiratory pathway. Muscle weakness preexisting or acquired should be considered in all patients. Case Report: A 52-year-old smoker presented in extremis with type II respiratory failure. She was treated with bronchodilators, steroids and antibiotics. Weaning ventilatory support was difficult and so a tracheostomy was performed.. Two weeks later, she was transferred to a respiratory ward where she was decannulated before discharge home. After discharge, her breathlessness and weakness progressed until she was readmitted in extremis 1 week later. On readmission, she deteriorated despite treatment for COPD. Mandatory ventilation was initiated after recannulation of the tracheostomy. The patient gradually improved over the next few days and was transferred to a respiratory ward where she was weaned onto nocturnal NIV and the tracheostomy was decannulated. Flow volume loops excluded air flow obstruction but spirometry confirmed severe inspiratory muscle weakness. The patient reported progressive weakness over several years. On examination all muscle groups were weak and deep tendon reflexes were absent but there was no fatigability or fasciculation. Sensation was intact. The diagnosis of acid maltase deficiency (AMD) was confirmed by analysis of peripheral blood lymphocytes, muscle biopsy and enzyme assay.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48507948","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 : 2022-12-02DOI: 10.5005/jp-journals-11010-04102
R. Restrepo, A. Tate, Donna D. Gardner, Leonard D. Wittnebel, R. Wettstein, Felix Khusid
Despite the decline in overall asthma mortality, acute severe asthma continues to be a significant challenge to clinicians. Patients with acute severe asthma present unique clinical features that require early recognition and aggressive treatment. The aim of this review is to describe the most current evidence that supports diagnostic and therapeutic approaches in the management of patients with acute severe asthma in the clinical setting.
{"title":"Current approaches to the assessment and treatment of acute severe asthma","authors":"R. Restrepo, A. Tate, Donna D. Gardner, Leonard D. Wittnebel, R. Wettstein, Felix Khusid","doi":"10.5005/jp-journals-11010-04102","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-04102","url":null,"abstract":"Despite the decline in overall asthma mortality, acute severe asthma continues to be a significant challenge to clinicians. Patients with acute severe asthma present unique clinical features that require early recognition and aggressive treatment. The aim of this review is to describe the most current evidence that supports diagnostic and therapeutic approaches in the management of patients with acute severe asthma in the clinical setting.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45934206","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 : 2022-12-02DOI: 10.5005/jp-journals-11010-06101
A. Shenoy
{"title":"Patient safety in the ICU","authors":"A. Shenoy","doi":"10.5005/jp-journals-11010-06101","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-06101","url":null,"abstract":"","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43954720","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 : 2022-12-02DOI: 10.5005/jp-journals-11010-06105
Saumy Johnshon
Neuromuscular disorders (NMD) are a group of disorders characterised by weakness of muscles and may have a slow and progressing alveolar hypoventilation leading to the ventilatory failure. It may necessitate initiation of mechanical ventilation. Noninvasive ventilation is the method of choice. Invasive mechanical ventilation is indicated when noninvasive mechanical ventilation fails. Tracheostomy is the airway of choice for invasive mechanical ventilation. Endotracheal intubation is used only as an emergency airway or when reversible causes of acute respiratory failure are being considered. This article details ventilation in patients with neuromuscular disorders.
{"title":"Mechanical ventilation in neuromuscular disorders- A review","authors":"Saumy Johnshon","doi":"10.5005/jp-journals-11010-06105","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-06105","url":null,"abstract":"Neuromuscular disorders (NMD) are a group of disorders characterised by weakness of muscles and may have a slow and progressing alveolar hypoventilation leading to the ventilatory failure. It may necessitate initiation of mechanical ventilation. Noninvasive ventilation is the method of choice. Invasive mechanical ventilation is indicated when noninvasive mechanical ventilation fails. Tracheostomy is the airway of choice for invasive mechanical ventilation. Endotracheal intubation is used only as an emergency airway or when reversible causes of acute respiratory failure are being considered. This article details ventilation in patients with neuromuscular disorders.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49033387","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 : 2022-12-02DOI: 10.5005/jp-journals-11010-04107
Dixy Domini, Sr. Mary Mannarathu, M. Anas, Rennis Davis
Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Aim: The present study was undertaken to assess the effectiveness of breathing exercises in the reduction of dyspnoea among the COPD patients. Methods: A quantitative research approach, quasi experimental pre-test and post-test control group design was used in the study. The study was theoretically supported by the frame work based on goal attainment theory of Imogen King. The study was conducted in pulmonology wards of a teaching institute in South India. A total of 60 subjects were selected. The samples were selected by using convenient sampling technique. BODE index was used to grade dyspnoea. The data collected were analysed using descriptive and inferential statistics. Results: 63% of patients were having BODE index score between 4 and 7. In the experimental group the mean pre-test value was 6.13 and the mean post-test value was 2.96 and significant at p value 0.001 level. The post interventional level of dyspnoea of both groups was analysed by using Mann Whitney test, and showed a p value of 0.001. There is significant reduction in the level of dyspnoea after practising breathing exercises compared with control group. Conclusion: There is significant reduction in the level of dyspnoea among COPD patients with breathing exercises.
{"title":"Effectiveness of breathing exercises in patients with chronic obstructive pulmonary disease","authors":"Dixy Domini, Sr. Mary Mannarathu, M. Anas, Rennis Davis","doi":"10.5005/jp-journals-11010-04107","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-04107","url":null,"abstract":"Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Aim: The present study was undertaken to assess the effectiveness of breathing exercises in the reduction of dyspnoea among the COPD patients. Methods: A quantitative research approach, quasi experimental pre-test and post-test control group design was used in the study. The study was theoretically supported by the frame work based on goal attainment theory of Imogen King. The study was conducted in pulmonology wards of a teaching institute in South India. A total of 60 subjects were selected. The samples were selected by using convenient sampling technique. BODE index was used to grade dyspnoea. The data collected were analysed using descriptive and inferential statistics. Results: 63% of patients were having BODE index score between 4 and 7. In the experimental group the mean pre-test value was 6.13 and the mean post-test value was 2.96 and significant at p value 0.001 level. The post interventional level of dyspnoea of both groups was analysed by using Mann Whitney test, and showed a p value of 0.001. There is significant reduction in the level of dyspnoea after practising breathing exercises compared with control group. Conclusion: There is significant reduction in the level of dyspnoea among COPD patients with breathing exercises.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42404355","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 : 2022-12-02DOI: 10.5005/jp-journals-11010-04206
Lakshmikanthcharan S, M. Sivakumar
ARDS is a clinical syndrome characterised by severe refractory hypoxaemia associated with significant mortality and morbidity. Low tidal volume ventilation and restricting plateau pressure has got maximum survival benefit. Various others measures to tackle refractory hypoxaemia in patients with ARDS have been studied. Prone ventilation is one such rescue therapy which has shown promising results. This article is intended to discuss the benefits of prone ventilation and to clarify some of the common queries one has in practising prone ventilation.
{"title":"Prone Ventilation in ARDS","authors":"Lakshmikanthcharan S, M. Sivakumar","doi":"10.5005/jp-journals-11010-04206","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-04206","url":null,"abstract":"ARDS is a clinical syndrome characterised by severe refractory hypoxaemia associated with significant mortality and morbidity. Low tidal volume ventilation and restricting plateau pressure has got maximum survival benefit. Various others measures to tackle refractory hypoxaemia in patients with ARDS have been studied. Prone ventilation is one such rescue therapy which has shown promising results. This article is intended to discuss the benefits of prone ventilation and to clarify some of the common queries one has in practising prone ventilation.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49254434","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 : 2022-12-02DOI: 10.5005/jp-journals-11010-04114
S. Johnson, Nybin Jose, Sébin, A. Vaidya
Introduction: Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia that develops within 48 hours or more of mechanical ventilation. It is also associated with significant morbidity including increased ventilatory days, intensive care unit (ICU) stay and higher medical cost that leads to high mortality rate in ICU. Aim: To evaluate the clinical outcome of the patients diagnosed with VAP and also to identify the risk factors for VAP. Methodology: This retrospective study included 27 patients admitted in Medical and casualty ICU's from August 2013 to April 2014 who were diagnosed with various diseases and later developed VAP. The patient's demographic data and diagnosis based on Centres for Disease Control and prevention (CDC) criteria were collected. Results: Among 27 patients, 20 were male patients and 7 were female patients. The order of organism according to the frequency in the current study was found to be Acinectobacter, Klebsiella, Pseudomonas aeruginosa, methicillin resistant Staphylococcus aureus, Streptococcus pneumonia, Hemophilus influenza, Enterobacter sp. Twenty two patients had late onset VAP and five patients had early onset VAP. Overall the survival was 52%. Conclusion: The incidence and the mortality of VAP are high in the current ICU setup. The mortality rate in the current study was 48% and the patients who survived had a longer ICU stay due to ventilator dependence.
{"title":"Ventilator-associated pneumonia: Study of clinical outcome","authors":"S. Johnson, Nybin Jose, Sébin, A. Vaidya","doi":"10.5005/jp-journals-11010-04114","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-04114","url":null,"abstract":"Introduction: Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia that develops within 48 hours or more of mechanical ventilation. It is also associated with significant morbidity including increased ventilatory days, intensive care unit (ICU) stay and higher medical cost that leads to high mortality rate in ICU. Aim: To evaluate the clinical outcome of the patients diagnosed with VAP and also to identify the risk factors for VAP. Methodology: This retrospective study included 27 patients admitted in Medical and casualty ICU's from August 2013 to April 2014 who were diagnosed with various diseases and later developed VAP. The patient's demographic data and diagnosis based on Centres for Disease Control and prevention (CDC) criteria were collected. Results: Among 27 patients, 20 were male patients and 7 were female patients. The order of organism according to the frequency in the current study was found to be Acinectobacter, Klebsiella, Pseudomonas aeruginosa, methicillin resistant Staphylococcus aureus, Streptococcus pneumonia, Hemophilus influenza, Enterobacter sp. Twenty two patients had late onset VAP and five patients had early onset VAP. Overall the survival was 52%. Conclusion: The incidence and the mortality of VAP are high in the current ICU setup. The mortality rate in the current study was 48% and the patients who survived had a longer ICU stay due to ventilator dependence.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49663857","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 : 2022-12-02DOI: 10.5005/jp-journals-11010-04111
Rajendram R, J. A
A 31 year old man with spina bifida and a ventriculo-atrial (VA) cerebrospinal fluid (CSF) shunt in situ presented with sudden onset dyspnoea and pleuritic chest pain. He reported a nine month history of increasing breathlessness. Clinical signs of right heart strain were present. Echocardiography estimated the pulmonary artery pressure to be 86 mm Hg. Computed tomography pulmonary angiogram confirmed acute pulmonary embolism (PE) and chronic pulmonary thromboembolic disease. He was anticoagulated but unfortunately had a cardiac arrest and succumbed. VA CSF shunts were used for the treatment of hydrocephalus between the 1950s and 1980s. Although most VA shunts sited for hydrocephalus in childhood have been removed, some may remain in situ in adults. These patients are at risk of PE and development of chronic thromboembolic pulmonary hypertension (CTEPH). Removal of the VA shunt should be considered when patients are shown to be shunt independent. We advise the regular screening of patients with VA CSF shunts for pulmonary hypertension with pulse oximetry, electrocardiography, chest radiography and echocardiography as it is preventable, detectable and treatable.
{"title":"Chronic thromboembolic pulmonary hypertension in an adult with spina bifida and a ventriculo-atrial cerebrospinal fluid shunt in situ","authors":"Rajendram R, J. A","doi":"10.5005/jp-journals-11010-04111","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-04111","url":null,"abstract":"A 31 year old man with spina bifida and a ventriculo-atrial (VA) cerebrospinal fluid (CSF) shunt in situ presented with sudden onset dyspnoea and pleuritic chest pain. He reported a nine month history of increasing breathlessness. Clinical signs of right heart strain were present. Echocardiography estimated the pulmonary artery pressure to be 86 mm Hg. Computed tomography pulmonary angiogram confirmed acute pulmonary embolism (PE) and chronic pulmonary thromboembolic disease. He was anticoagulated but unfortunately had a cardiac arrest and succumbed. VA CSF shunts were used for the treatment of hydrocephalus between the 1950s and 1980s. Although most VA shunts sited for hydrocephalus in childhood have been removed, some may remain in situ in adults. These patients are at risk of PE and development of chronic thromboembolic pulmonary hypertension (CTEPH). Removal of the VA shunt should be considered when patients are shown to be shunt independent. We advise the regular screening of patients with VA CSF shunts for pulmonary hypertension with pulse oximetry, electrocardiography, chest radiography and echocardiography as it is preventable, detectable and treatable.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47969213","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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