PEC innovation最新文献

{"title":"Medical students' perspectives of patient-centered communication skills training during clinical education: A longitudinal mixed-methods survey study","authors":"Anna M. Kerr ,&nbsp;Mackenzie Atwell ,&nbsp;Samantha Galiffo ,&nbsp;Andrew Fernandez ,&nbsp;Charee M. Thompson","doi":"10.1016/j.pecinn.2025.100451","DOIUrl":"10.1016/j.pecinn.2025.100451","url":null,"abstract":"<div><h3>Objective</h3><div>Using repeated measures, we examined third-year medical students' perceptions of communication skills training (CST) during clinical rotations, focusing on dimensions of patient-centered communication most salient in each subspecialty.</div></div><div><h3>Methods</h3><div>273 third-year students at a large Midwestern medical school completed a four-phase longitudinal mixed-methods survey.</div></div><div><h3>Results</h3><div>By the end of their third year, students reported more confidence in their communication skills, particularly question asking and answering. They reported the most direct communication with patients and the most communication training satisfaction during emergency medicine, primary care, and family medicine rotations. These evaluations were lowest during general surgery rotations. <em>Fostering healing relationships</em> and <em>exchanging information</em> were considered the most salient dimensions of patient-centered communication, particularly during primary care rotations. Conversely, during surgical rotations, time management and efficiency were heavily reinforced. Unsuccessful interactions with patients were often attributed to incompatible goals, expectancy violations, unpredictable interactions, and time constraints.</div></div><div><h3>Conclusion</h3><div>Students would benefit from CST related to advanced patient-centered communication skills such as adapting to challenging interactions and remaining patient-centered within clinical time constraints. Future research can use these results to develop communication curricula that is discipline-specific, focuses on multiple dimensions of patient-centered communication, and reinforces the behaviors most salient during students' current or upcoming clinical tasks.</div></div><div><h3>Innovation</h3><div>This study extends previous work by focusing on student-centered and discipline-specific aspects of CST. Centering the behaviors students consider most relevant is a novel approach to medical education that can increase students' attitudes toward the value of communication skills training, make them more confident, and improve care for their future patients.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"8 ","pages":"Article 100451"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metaphors in cancer care: Cultural insights from Spanish and Mexican physician–patient interactions","authors":"Dalia Magaña","doi":"10.1016/j.pecinn.2025.100449","DOIUrl":"10.1016/j.pecinn.2025.100449","url":null,"abstract":"<div><h3>Objectives</h3><div>This qualitative study examines the use of metaphors in Spanish-language oncology consultations, highlighting differences between Mexican Spanish and peninsular Spanish and exploring how metaphor use varies between physicians and patients.</div></div><div><h3>Methods</h3><div>Metaphors are common across languages and offer insight into how people conceptualize illness, treatment, and emotional experience. This study analyzed 50 audio-recorded, real-time oncology consultations—25 from Mexico and 25 from Spain—drawn from a corpus of naturally occurring physician–patient interactions. Using the Metaphor Identification Procedure, we systematically coded cancer-related metaphors, such as referring to treatment as a “path” or medication as something that “fights” the disease.</div></div><div><h3>Results</h3><div>Patients use slightly more metaphorical expressions than their physicians. Journey metaphors were the most frequently used across all groups. Battle metaphors were the second most common, though their use varied: doctors primarily used metaphors to explain treatment and motivate patients, while patients often used them to express emotional and physical vulnerability. Differences between varieties of Spanish also revealed culturally specific metaphorical language.</div></div><div><h3>Conclusions</h3><div>Metaphor use is a plain language strategy in oncology. Recognizing how metaphors are used in different Spanish-speaking contexts can enhance culturally and linguistically responsive care. Greater practitioner awareness of metaphorical language can improve patient understanding, reduce confusion, and foster more empathetic, person-centered communication.</div></div><div><h3>Practical value</h3><div>Incorporating culturally appropriate metaphors—tailored to specific language varieties and patient experiences—can support clearer communication, especially in oncology care. This study provides practical examples that can inform training for healthcare providers working with Spanish-speaking populations in the U.S., particularly those of Mexican origin.</div></div><div><h3>Innovation</h3><div>This study is innovative in highlighting cultural differences between two Spanish-speaking cultures, showing that while battle and journey metaphors are the most common, patients primarily use them to express pain, struggle, and vulnerability rather than resilience or strength.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"8 ","pages":"Article 100449"},"PeriodicalIF":0.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HoloVAD; A feasibility study of a new patient education tool for patients with a left ventricular assist device","authors":"Sofie E. Bresser,&nbsp;Linda M. de Heer,&nbsp;Irene Louwerse-van Kan,&nbsp;Faiz Ramjankhan,&nbsp;Manon G. van der Meer,&nbsp;Saskia W.M. Weldam","doi":"10.1016/j.pecinn.2025.100450","DOIUrl":"10.1016/j.pecinn.2025.100450","url":null,"abstract":"<div><h3>Objective</h3><div>Patient education for patients with a left ventricular assist device (LVAD) and their loved ones is crucial for improving adherence and reducing complications. HoloVAD is an innovative virtual education tool, which offers a preimplantation experience of life with an LVAD (Holomoves ©, The Netherlands). Our objective is <em>to</em> assess the feasibility, defined as acceptability, usability, and tolerability, of HoloVAD.</div></div><div><h3>Method</h3><div>A cross-sectional, quantitative feasibility study was conducted among patients with an LVAD, and their loved ones.</div></div><div><h3>Results</h3><div>In total 45 participants were included. Six out of the seven acceptability domains of the Unified Theory of Acceptance (UTAUT) were scored positively. With an excellent overall SUS-score (82.5) the HoloVAD application is assessed as usable for both groups, and tolerability is scored as positive at every point of the Virtual Reality Sickness Questionnaire (VRSQ), for both groups.</div></div><div><h3>Conclusion</h3><div>HoloVAD is feasible - defined as being acceptable, usable, and tolerable -and represents a promising and helpful new education tool for the study population.</div></div><div><h3>Innovation</h3><div>An LVAD is life-changing with high complication risks. HoloVAD is innovative because it integrates visualization and interaction through mixed reality, enabling a deeper understanding of life with an LVAD. This study highlights the feasibility of HoloVAD as a novel educational tool for patients and their loved ones.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"8 ","pages":"Article 100450"},"PeriodicalIF":0.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘Harnessing storytelling with medical students and community members to build curiosity and trust: A mixed methods evaluation of a pilot intervention’ [PEC Innovation 7 (2025) 100420]","authors":"Rebecca K. Rudel ,&nbsp;Nicole D. Kaufmann ,&nbsp;Shana A.B. Burrowes ,&nbsp;Cheryl Harding ,&nbsp;Cara Solomon ,&nbsp;Benjamin P. Linas ,&nbsp;Mari-Lynn Drainoni ,&nbsp;Katherine Gergen Barnett","doi":"10.1016/j.pecinn.2025.100447","DOIUrl":"10.1016/j.pecinn.2025.100447","url":null,"abstract":"","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"8 ","pages":"Article 100447"},"PeriodicalIF":0.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility evaluation of large language models in anesthesia-specific post-operative care instructions for total knee arthroplasty","authors":"Dhruv Nagesh,&nbsp;Donald P. Keating,&nbsp;Raghu V. Divakaruni,&nbsp;Bryan G. Beutel","doi":"10.1016/j.pecinn.2025.100444","DOIUrl":"10.1016/j.pecinn.2025.100444","url":null,"abstract":"<div><h3>Objective</h3><div>Large language models (LLMs) are increasingly applied in medicine, but their role in peri-operative education is underexplored. This pilot feasibility study compared four LLMs in producing post-operative care instructions for total knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>OpenAI GPT-4o, Claude 3.7 Sonnet, DeepSeek R1, and Gemini 2.0 Flash generated instructions from a standardized prompt. Outputs were scored (0 = does not meet, 1 = partially meets, 2 = fully meets) for accuracy, clarity, relevance, consistency, and readability. Accuracy was benchmarked against ERAS, ASA guidelines, and UpToDate. Readability was assessed using Flesch-Kincaid indices.</div></div><div><h3>Results</h3><div>Within this limited sample, Claude, GPT-4o, and DeepSeek R1 demonstrated higher observed accuracy than Gemini, with Claude and GPT-4o showing full alignment with reference standards. Clarity scores were comparable across models. All achieved high relevance and internal consistency. Readability varied, with Gemini generating less readable text and GPT-4o and DeepSeek R1 producing more accessible content.</div></div><div><h3>Conclusion</h3><div>LLMs can generate accurate, relevant, and consistent instructions, supporting their potential use in anesthesia education. Attention to readability and plain-language prompting may further enhance clinical utility.</div></div><div><h3>Innovation</h3><div>This study provides one of the first anesthesia-specific evaluations of multiple LLMs, showing feasibility and opportunities for AI-driven patient communication.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"8 ","pages":"Article 100444"},"PeriodicalIF":0.0,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First the relationship, then the technology: Healthcare professionals' perceptions on how digital health solutions impact the interaction with patients","authors":"S.J. Oudbier ,&nbsp;T.A. ten Cate ,&nbsp;S.A. Nurmohamed ,&nbsp;J.J. Meij ,&nbsp;E.M.A. Smets","doi":"10.1016/j.pecinn.2025.100448","DOIUrl":"10.1016/j.pecinn.2025.100448","url":null,"abstract":"<div><h3>Objective(s)</h3><div>Previous research has explored barriers and facilitators to digital health solutions (DHS) implementation, yet less is known on how DHS should be implemented to maintain patient interaction, and accommodate shifting responsibilities. This study explores health care professionals' (HCP) perspectives on patient-HCP interactions in DHS including video consultations, remote monitoring, and digital care platforms.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with twenty-six HCPs. Interviews were transcribed verbatim and thematically analysed by two researchers.</div></div><div><h3>Results</h3><div>Analysis revealed three overarching themes (the impact of DHS on the relationship, responsibility and anxiety), and ten subthemes. HCPs noted that DHS changed patient-HCP interactions, hindering relationship building. In regard to video consultations, interactional etiquette shifted, with the patient-HCP interaction transitioning towards more informal contact. Remote monitoring and digital care platforms increase patient responsibility, which can hinder communication, particularly when patients access medical results prior to consultations. Most HCPs emphasized that a trusting relationship should be established before introducing DHS to ensure responsible and effective use.</div></div><div><h3>Conclusion and innovation</h3><div>This study shifts the focus from how DHS can be implemented to how they should be implemented to sustain meaningful patient-HCP interactions. The findings challenge the assumption that DHS can readily replace or supplement traditional care, emphasizing that face-to-face encounters remain essential for patient engagement, relational continuity, and professional fulfilment of HCPs. DHS implementation should therefore follow the establishment of trust and be guided by a tailored, human-centered approach that accounts for individual differences in patients' health status and digital literacy.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"8 ","pages":"Article 100448"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human interaction with a virtual assistant in preparation for in-hospital orthopedic consultation. A feasibility and acceptability study in older adults with osteoarthritis","authors":"Walter van der Weegen ,&nbsp;Thomas Timmers ,&nbsp;Maud Jacobs ,&nbsp;Katja Saris ,&nbsp;Sebastiaan A.W. van de Groes","doi":"10.1016/j.pecinn.2025.100446","DOIUrl":"10.1016/j.pecinn.2025.100446","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the feasibility and acceptability of an avatar-based history taking tool for patients referred for knee or hip osteoarthritis.</div></div><div><h3>Methods</h3><div>In a single Centre study patients referred for knee or hip osteoarthritis were asked to use an avatar-based history taking tool. The technical basis of this tool was formed by speech recognition (Google Dialogflow), a “rule-based” model and ChatGPT 3.5. To assess feasibility and acceptability patients filled in a modified version of the Artificial-Social-Agent Questionnaire afterwards, with supplemental open questions.</div></div><div><h3>Results</h3><div>Of the 40 participating patients (median age 67 years, min: 47.3, max 87.5, 26 women), 36 (87.5 %) scored the digital conversation as natural, 33 (82.5 %) found the avatar easy to use, 31 (77.5 %) were open to using the avatar more often in the future, and 26 (65 %) found the conversation captivating.</div></div><div><h3>Conclusion</h3><div>Avatar-based history taking is feasible and accepted by older patients seeking orthopedic care for knee or hip osteoarthritis.</div><div>Innovation:</div><div>Avatar-based history taking applications could be offered to patients who are referred for knee or hip osteoarthritis, before they have their face-to-face consultation with an orthopedic surgeon.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"8 ","pages":"Article 100446"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of teach-back and plain language acceptability during patient interactions","authors":"Andressa A. Sleiman ,&nbsp;Erin M. Richard ,&nbsp;Daniel Gonzales-Portillo ,&nbsp;Sarah Tallman ,&nbsp;Nicole E. Gravina","doi":"10.1016/j.pecinn.2025.100445","DOIUrl":"10.1016/j.pecinn.2025.100445","url":null,"abstract":"<div><h3>Objective</h3><div>This research investigated participants' acceptability of clinicians' use of teach-back and plain language.</div></div><div><h3>Methods</h3><div>A 30-min survey was administered to 162 undergraduates who watched and rated two doctor-patient interactions explaining multiple sclerosis and diabetes.</div><div>Interactions included jargon only, jargon+teach-back, plain language only, and plain language+teach-back.</div></div><div><h3>Results</h3><div>The results indicated a significant preference for plain language over jargon in both multiple sclerosis [F(1, 157) = 57.73, <em>p</em> &lt; . 001, hp2 = 0.27] and diabetes [F(1, 157) = 63.42, <em>p</em> &lt; .001, hp2 = 0.29]. Teach-back was favored over no teach-back for multiple sclerosis [F(1, 157) = 8.99, <em>p</em> &lt; .01, hp2 = 0.05] but not for diabetes [F(1, 157) = 1.05, n.s.]. Participants reported being more familiar with the diabetes diagnosis.</div></div><div><h3>Conclusion</h3><div>Clinicians should avoid excessive jargon and actively engage patients by employing teach-back questions, especially when discussing unfamiliar information.</div></div><div><h3>Innovation</h3><div>This study advances clinician-patient communication by examining the acceptability of teach-back rather than its effectiveness, addressing a key gap in understanding when such strategies are likely to be adopted in practice. Findings challenge assumptions that teach-back inherently ensures comprehension, emphasizing the necessity of plain-language delivery and offering a replicable framework for evaluating patient acceptability in real-world contexts.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"8 ","pages":"Article 100445"},"PeriodicalIF":0.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of physiotherapists' explanation of therapeutic virtual reality on treatment expectations in healthy people and people with chronic musculoskeletal pain: Two online RCTs","authors":"Syl Slatman ,&nbsp;Wim van Lankveld ,&nbsp;J. Bart Staal ,&nbsp;Harry van Goor ,&nbsp;Raymond Ostelo ,&nbsp;Janine Westendorp ,&nbsp;Jesper Knoop","doi":"10.1016/j.pecinn.2025.100443","DOIUrl":"10.1016/j.pecinn.2025.100443","url":null,"abstract":"<div><h3>Objectives</h3><div>Chronic musculoskeletal pain (CMP) is a disabling condition, for which physiotherapy is a common treatment. Therapeutic virtual reality (VR) is an emerging treatment modality in physiotherapy care for patients with CMP. Treatment expectations of patients regarding therapeutic VR influence its effectiveness and could possibly be enhanced by the therapist by using positive language about therapeutic VR. The aim of the current studies was to explore the effect of physiotherapists explaining VR using positive versus neutral language, on treatment expectations of healthy participants (study 1) and patients with CMP (study 2).</div></div><div><h3>Methods</h3><div>Two web-based, double-blinded RCTs were conducted with two groups (healthy participants and patients with CMP), that were randomly allocated to a video explaining therapeutic VR using positive language or neutral language. The primary outcome measures were treatment credibility and expectancy, assessed at baseline and post-intervention. Between-group differences and within-group changes were respectively analyzed using simple linear regression analyses and repeated measures ANOVAs. All analyses were performed separately for healthy participants and patients with CMP.</div></div><div><h3>Results</h3><div>In total, 127 healthy participants (study 1) and 115 patients with CMP (study 2) were included and randomized. We found no between-group difference in treatment expectations between positive versus neutral language videos, neither in healthy participants nor patients with CMP. We found significant within-group changes for treatment expectations in both conditions (positive and neutral language) in healthy participants, and in the positive language condition only in the CMP group.</div></div><div><h3>Conclusions</h3><div>The studies show that any explanation of therapeutic VR (both using positive or neutral language) seems to improve treatment expectations. Unexpectedly, using positive language was not superior to using neutral language. Future research should examine strategies for healthcare providers to set optimal treatment expectations on therapeutic VR in patients with CMP.</div></div><div><h3>Practice implications</h3><div>A brief verbal explanation about therapeutic VR improves treatment expectations in both healthy participants and patients with CMP.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"8 ","pages":"Article 100443"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An innovative immersive learning program for healthcare communication training","authors":"Jennifer Foucart ,&nbsp;Maxime Etenaille ,&nbsp;Noelle Junod-Perron","doi":"10.1016/j.pecinn.2025.100442","DOIUrl":"10.1016/j.pecinn.2025.100442","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to develop and evaluate an Immersive Learning (IL) to enhance healthcare communication skills training.</div></div><div><h3>Methods</h3><div>The IL consisted of a digital tool using a branching scenario model for six clinical themes with feedback provided to students at each critical point. A pre-post-trial design was conducted comparing the IL program against traditional role-playing exercises at Brussels University. Third year physiotherapy students were randomly assigned to an experimental IL group or a control group. Outcomes measures included students' self-perceived communication skills, satisfaction with the IL as well as its usability. Statistical analyses included Wilcoxon tests for skill progression.</div></div><div><h3>Results</h3><div>The IL group showed significantly improved self-perceived communication skills compared to the control group (<em>p</em> ≤0.001). Students considered IL program to be highly usable (satisfaction = 82) and strongly recommended its use (NP score = 63.83).</div></div><div><h3>Conclusion</h3><div>The IL program enhanced students' self-perceived communication skills, offering a supportive, engaging, and safe learning environment. IL is a valuable complement to traditional methods in healthcare education.</div></div><div><h3>Innovation</h3><div>This study introduces an innovative IL tool that provides personalized, interactive, and scenario-based learning, fostering autonomy and skill development in a low-pressure environment.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"7 ","pages":"Article 100442"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465464","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}