PEC innovation最新文献

{"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}

{"title":"User evaluation of a virtual reality simulation for anaesthesiologists-intensivists for non-technical skills","authors":"Krista Hoek ,&nbsp;Monique van Velzen ,&nbsp;Elise Sarton ,&nbsp;Christina Jaschinski","doi":"10.1016/j.pecinn.2025.100441","DOIUrl":"10.1016/j.pecinn.2025.100441","url":null,"abstract":"<div><h3>Objective</h3><div>Simulation training in medical settings is a cornerstone in medical education to practice technical and non-technical skills. The objective of this study was to evaluate user experiences and initial reactions to a multiplayer virtual reality (VR) simulation designed for anaesthesiologists.</div></div><div><h3>Methods</h3><div>A user-centred design approach guided the development of a VR-scenario training simulating a case of massive blood loss. Seven anaesthesiology residents and trainers from a Dutch academic hospital participated in qualitative and quantitative evaluations. Quantitative measures included questionnaires on presence, agency, physical dyscomfort, and perceived training value. Qualitative data were collected through structured observations and interviews.</div></div><div><h3>Results</h3><div>Participants reported a high sense of physical presence and moderate agency, with lower levels of self-presence. The VR environment was perceived as realistic and engaging. Challenges included unfamiliarity with VR controls, abstract avatars, and limited haptic feedback. Despite these barriers, participants recognized the potential of VR for team-based learning of non-technical skills, especially with prior onboarding or practice sessions.</div></div><div><h3>Innovation</h3><div>This study introduces a novel application of multiplayer VR simulation in anaesthesiology training, focusing on non-technical skills. The integration of user-centred design with qualitative and quantitative evaluation provides insights into the feasibility and acceptability of VR as an educational tool in this context.</div></div><div><h3>Conclusions</h3><div>VR simulation shows promise for training non-technical skills in anaesthesiology. While participants appreciated the realism and collaborative aspects, enhancements in usability and interaction design are necessary for broader implementation and impact.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"7 ","pages":"Article 100441"},"PeriodicalIF":0.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415068","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 ‘The Pediatric Ethics & Professionalism Assessment Tool (Pedi-EPAT): Development and implementation of a novel, competency-based assessment’ [PEC Innovation 7 (2025) 100433]","authors":"Omri-David Soffer ,&nbsp;Lori R. Newman ,&nbsp;Mary Brennan ,&nbsp;David N. Williams ,&nbsp;Christy L. Cummings","doi":"10.1016/j.pecinn.2025.100440","DOIUrl":"10.1016/j.pecinn.2025.100440","url":null,"abstract":"","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"7 ","pages":"Article 100440"},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320072","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":"Barriers and facilitators to diabetes prevention support for women in Malaysia with gestational diabetes mellitus: A qualitative study","authors":"Irmi Zarina Ismail ,&nbsp;Madeleine Benton ,&nbsp;Hafizah Mahamad Sobri ,&nbsp;Anisah Baharom ,&nbsp;Nicola Guess ,&nbsp;Kimberley Goldsmith ,&nbsp;Iklil Iman ,&nbsp;Siew Mooi Ching ,&nbsp;Barakatun-Nisak Mohd Yusof ,&nbsp;Nurul Iftida Basri ,&nbsp;Mazatulfazura Sf Binti Salim ,&nbsp;Faezah Hassan ,&nbsp;Helen Murphy ,&nbsp;Angus Forbes ,&nbsp;Khalida Ismail ,&nbsp;Boon How Chew ,&nbsp;Iliatha Papachristou Nadal","doi":"10.1016/j.pecinn.2025.100438","DOIUrl":"10.1016/j.pecinn.2025.100438","url":null,"abstract":"<div><h3>Objectives</h3><div>To explore the barriers and facilitators to diabetes prevention support among pregnant women in Malaysia.</div></div><div><h3>Design</h3><div>A qualitative study using individual in-depth interviews, analysed using reflexive thematic analysis.</div></div><div><h3>Setting</h3><div>Public health clinics and one central government hospital in Selangor, Malaysia.</div></div><div><h3>Participants</h3><div>Women diagnosed with gestational diabetes mellitus.</div></div><div><h3>Results</h3><div>Sixteen women aged 26 to 41 years, from three different ethnic groups (Malay, Chinese, and Indian) participated in the study. Key barriers to diabetes prevention support included limited access to relevant and usable information; competing health needs during pregnancy; social and cultural priorities overriding self-care; and structural constraints. Facilitators included intrinsic motivation and self-awareness; awareness of future diabetes risk; social and family support; access to trusted and culturally relevant information. All participants reported challenges in maintaining healthy lifestyle practices, particularly related to physical activity and diet during pregnancy. Information on diabetes prevention support was obtained from various sources, including healthcare providers, online platforms, and family members.</div></div><div><h3>Conclusion</h3><div>The findings from this study have significant implications for enhancing diabetes prevention support and informing the potential development of tailored diabetes prevention interventions for women in Malaysia.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"7 ","pages":"Article 100438"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320071","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 protective role of HCWs communication for the distress of newly diagnosed people with leukemia and lymphoma","authors":"Fabio Guolo ,&nbsp;Francesca Riccardi ,&nbsp;Paola Del Sette ,&nbsp;Cecilia Perrone ,&nbsp;Paola Minetto ,&nbsp;Andrea Todiere ,&nbsp;Filippo Ballerini ,&nbsp;Carola Riva ,&nbsp;Michele Cea ,&nbsp;Roberto Massimo Lemoli ,&nbsp;Gabriella Biffa ,&nbsp;Elena Sarcletti","doi":"10.1016/j.pecinn.2025.100439","DOIUrl":"10.1016/j.pecinn.2025.100439","url":null,"abstract":"<div><h3>Objectives</h3><div>Patients with hematologic malignancies face a unique illness trajectory that contributes to high distress. Physician-patient communication can enhance well-being, therapeutic alliance, and adherence; however, its impact in hematology remains underexplored. We investigate the satisfaction of people with leukemia and lymphoma regarding the communication of healthcare providers and their perceived support, and their effects on distress.</div></div><div><h3>Methods</h3><div>In this cross-sectional, observational study, 54 individuals with leukemia and lymphoma completed a questionnaire assessing their perceived support, communication, and distress. We conducted correlation and regression analyses to assess how healthcare worker–patient communication and perceived support relate to distress.</div></div><div><h3>Results</h3><div>We found moderate to high distress in more than 60 % of patients. Main results revealed that distress was related to the perception of having received adequate information from healthcare providers, <em>β</em> = −0.20, <em>p</em> = .046, along with emotional, <em>β</em> = 0.66, <em>p</em> &lt; .001, and practical problems, <em>β</em> = 0.28, <em>p</em> = .006.</div></div><div><h3>Conclusions</h3><div>Findings highlight healthcare providers' role in reducing distress by addressing patients' informational needs, underscoring the necessity of targeted communication training.</div></div><div><h3>Innovation</h3><div>This study pioneers evidence in hematology, demonstrating how patient-centered communication and tailored strategies effectively support patients' well-being in unpredictable trajectories.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"7 ","pages":"Article 100439"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265878","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":"Improving medication information systems utilizing a universal design framework","authors":"Kate Li ,&nbsp;Grayson Holt ,&nbsp;Jeffrey Zabinski ,&nbsp;Martin Calabrese","doi":"10.1016/j.pecinn.2025.100437","DOIUrl":"10.1016/j.pecinn.2025.100437","url":null,"abstract":"<div><h3>Objective</h3><div>Almost a quarter of U.S. adults cannot determine what time they should take medication based on instructions printed on prescription medication labels. Taking medication at an incorrect dosage or alongside incompatible foods can lead to severe health complications.</div></div><div><h3>Methods</h3><div>The principles of Universal Design (UD) can guide the design of tools and materials that more effectively communicate medication information to all patients. UD aims to create designs that can be accessed and understood by people of all abilities, ages, and backgrounds. The framework has shown success in several fields, including the built environment, product design, and education. This demonstrated effectiveness suggests UD has the potential to improve the communication of medication information.</div></div><div><h3>Results</h3><div>Applying the evaluative framework identified strengths in perceptible information and flexibility of use across audio aids and digital platforms. However, these tools fail to uphold simple and intuitive use for individuals with low digital health literacy. Applying UD to prescriber-modifiable language can improve simple and intuitive use and tolerance for error, but it encounters limitations in the principles of size and space and low physical effort. These examples highlight the effectiveness of a UD framework in identifying gaps in information access and guiding the creation of more inclusive design approaches.</div></div><div><h3>Conclusion</h3><div>Applying UD principles can address healthcare inequity and create a safer, more reliable medication information system for patients.</div></div><div><h3>Innovation</h3><div>The recent FDA proposal for new Patient Medication Information sheet highlights the need for better communication of medication information. To our knowledge, Universal Design (UD) has not yet been applied to medication information systems. Thus, we propose utilizing Universal Design (UD) as a framework to evaluate and improve medication information systems.</div></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"7 ","pages":"Article 100437"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219252","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}