SSM - Health Systems最新文献

{"title":"Global capacity for implementing the eight practical steps to achieve universal access to water, sanitation, and hygiene in healthcare facilities: A qualitative study using implementation science","authors":"Darcy M. Anderson,&nbsp;Caralee Sadler,&nbsp;Lucy K. Tantum,&nbsp;Ryan Cronk","doi":"10.1016/j.ssmhs.2026.100182","DOIUrl":"10.1016/j.ssmhs.2026.100182","url":null,"abstract":"<div><h3>Background</h3><div>Targets to achieve universal access to environmental health services include healthcare facilities. To support improvement efforts, the World Health Organization and UNICEF published the “Eight Practical Steps,” a roadmap for countries to achieve universal access. This document provides clear directions, but many steps are ambitious, and countries' readiness to complete them is unclear.</div></div><div><h3>Methods</h3><div>We conducted a qualitative study in 2023 to evaluate stakeholder readiness to implement the Eight Practical Steps and documented capacity development needs, using interviews with 43 participants. We applied an implementation science theory—organizational readiness for change—to structure our interviews around factors influencing readiness.</div></div><div><h3>Results</h3><div>Readiness was highest for conducting baseline situation assessments (Step 1), establishing standards (Step 3), improving infrastructure (Step 4), and strengthening the health workforce (Step 6). Readiness was enhanced by stakeholder cooperation, positive attitudes for change, and availability of tools for monitoring, risk assessment, and healthcare worker training. Capacity development was needed to tailor situation assessment tools, training materials, and standards for different contexts. Readiness for change was lower for developing costed roadmaps (Step 2), monitoring progress (Step 5), engaging communities (Step 7), and conducting operational research (Step 8). Stakeholders prioritized earlier steps and had not yet dedicated substantial effort or resources to later ones. Barriers included a lack of tools and guidance.</div></div><div><h3>Conclusions</h3><div>Our results indicate enthusiasm and cooperation to improve environmental health services, but rapid action sometimes came at the expense of strategic planning and learning opportunities. We recommend strengthening funding, personnel, and technical support for planning, monitoring, evaluation, and operational research.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100182"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188903","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":"Rethinking cross-border health systems for contexts of mobility and forced displacement","authors":"Fouad Fouad ,&nbsp;Kyu Kyu Than ,&nbsp;Maria Paola Bertone ,&nbsp;Sophie Witter ,&nbsp;Nyi Nyi Kyaw ,&nbsp;Ibrahim R. Bou-Orm","doi":"10.1016/j.ssmhs.2026.100172","DOIUrl":"10.1016/j.ssmhs.2026.100172","url":null,"abstract":"<div><div>Health systems today are deeply affected by conflicts, forced displacement, and other stressors such as climate change. Traditional health system frameworks, while influential, often assume stable, territorially bounded national systems and do not fully capture the realities of mobility, contested authority, and health care seeking and delivery across borders. This paper explores how health systems operate in contexts where both internationally recognized borders and internal power lines shape the dynamics of health provision for displaced and mobile populations. Drawing on illustrative cases from Northwest Syria and Myanmar, we examine how health systems adapt across and beyond borders in the absence of formal national response. In Syria, humanitarian cross-border mechanisms, local governance bodies, and mobile referral networks have sustained care despite fragmented authority. In Myanmar, ethnic health organizations, diaspora networks, and transnational supply chains have long supported communities in border areas, with populations frequently moving across borders into Thailand, China, and Bangladesh to access essential care. We propose a new approach to cross-border health systems that includes recognizing the roles of non-state and humanitarian actors, enabling flexible financing and workforce recognition across jurisdictions, and developing interoperable data systems sensitive to mobility. By incorporating these dimensions, health systems can be better understood and supported in ways that reflect the realities of forced displacement and mobility in complex conflict-affected settings.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926907","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":"Community health workers’ perspectives on challenges faced by diverse, low-income suburban residents in Long Island, New York, United States","authors":"Tatiana Ramirez,&nbsp;Meshack Achore,&nbsp;Martine Hackett","doi":"10.1016/j.ssmhs.2025.100162","DOIUrl":"10.1016/j.ssmhs.2025.100162","url":null,"abstract":"<div><h3>Background</h3><div>Serving as a bridge between community members and the healthcare system, community health workers (CHWs) play a vital role in addressing health inequities within their communities. Research on CHWs, particularly in suburban contexts, remains limited. This study aims to identify the challenges faced by diverse, low-income suburban residents in Long Island, New York, United States, through the perspectives of the CHWs who serve these communities.</div></div><div><h3>Methods</h3><div>Data were collected through demographic surveys and semi-structured interviews with 10 CHWs working in Long Island, New York, from April 2024 to September 2024. Interview transcripts were coded and analyzed for themes and sub-themes using Atlas.ti software.</div></div><div><h3>Results</h3><div>Three main themes emerged from the interview analysis: structural barriers and access, psychosocial and emotional well-being, and navigating systems. CHWs identified several challenges faced by diverse, low-income residents, including transportation, housing, food insecurity, emotional support, mental health resource navigation, immigration, and cultural barriers. CHWs addressed these challenges in various ways, primarily by connecting clients to resources, building relationships with them, and participating in the development of necessary programs and services.</div></div><div><h3>Conclusion</h3><div>Diverse, low-income suburban residents face numerous challenges that put them at risk for poor health outcomes and reduced quality of life. Community Health Workers (CHWs) have played a crucial role in assisting residents in navigating these challenges, although they have also faced difficulties in the process. Organizations serving these residents should develop improved CHWs resources to effectively meet community needs.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791983","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":"Co-designing family planning interventions: Insights from religious leaders in urban eastern Uganda","authors":"Jacquellyn Nambi Ssanyu ,&nbsp;Catherine Birabwa ,&nbsp;Kharim Mwebaza Muluya ,&nbsp;Felix Kizito ,&nbsp;Sarah Namutamba ,&nbsp;Moses Kyangwa ,&nbsp;Othman Kakaire ,&nbsp;Peter Waiswa ,&nbsp;Rornald Muhumuza Kananura","doi":"10.1016/j.ssmhs.2026.100176","DOIUrl":"10.1016/j.ssmhs.2026.100176","url":null,"abstract":"<div><h3>Background</h3><div>In Uganda, religion strongly influences family planning (FP) practices, yet religious leaders are often excluded from FP program design and delivery. Engaging them meaningfully could help address misconceptions and improve voluntary FP uptake.</div></div><div><h3>Methods</h3><div>We applied Community-Based Participatory Action Research and Human-Centered Design to engage 16 religious leaders from Muslim, Catholic, Anglican, and Pentecostal faiths in Jinja City and Iganga Municipality, eastern Uganda. Faith-specific discussions were conducted using a structured agenda and co-moderated by participants. Data from audio recordings and notes were transcribed, translated, and analyzed thematically.</div></div><div><h3>Results</h3><div>All religious leaders expressed openness to FP but differed in their definitions and preferred methods. Christian leaders associated FP with responsible parenthood and manageable family sizes, while Muslim leaders emphasized parental responsibility without limiting fertility, stressing faith in divine provision. Natural methods were widely accepted, while hormonal methods were met with caution due to health concerns. There was unanimous opposition to providing FP to unmarried adolescents, with abstinence endorsed as the only acceptable option. Leaders welcomed the opportunity to share FP messages through their platforms, provided materials were accurate, respectful of religious values, and comprehensive in scope.</div></div><div><h3>Conclusions</h3><div>Religious leaders can play a pivotal role in advancing FP awareness and acceptance when engaged as partners in design and messaging. Programs should prioritize culturally sensitive communication, clarify misconceptions, and co-create strategies that align with faith-based perspectives. These approaches can enhance trust, shift social norms, and improve access to FP services, especially in communities where religious influence is strong.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100176"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037833","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":"Integrating family planning into Nigeria’s public health insurance: Challenges, opportunities, and feasibility for enhanced primary health care","authors":"Emmanuel Nwala ,&nbsp;Ayan Jha ,&nbsp;Sa’id Gaya ,&nbsp;Jay Gribble ,&nbsp;Frances Ilika","doi":"10.1016/j.ssmhs.2026.100169","DOIUrl":"10.1016/j.ssmhs.2026.100169","url":null,"abstract":"<div><div>In Nigeria, integrating family planning (FP) into the essential benefits package under public health insurance is pivotal to improving reproductive health and combating poverty. The government’s commitment to achieve 90 % health insurance coverage by 2030 presents a timely opportunity to expand FP access and affordability. Through policy analysis, stakeholder interviews across 11 states, and a multi-stakeholder roundtable, we identified key barriers including inadequate and inefficient public financing, donor over-reliance, weak procurement, and workforce shortages. While some states have integrated FP, coverage remains fragmented with variations in services offerings. Key stakeholders advocated for comprehensive integration of FP services into primary healthcare and public health insurance, ensuring access to education, counseling, and a full range of contraceptives. Services were proposed to be tiered as primary (for all facilities) and secondary (for advanced facilities). Sustainable integration shall require a phased approach with necessary insurance premium adjustments. A blended payment model combining capitation and fee-for-service was recommended for provider compensation. Addressing the shortage of skilled FP providers, particularly for long-acting reversible contraceptives, requires training programs like the Community-Based Health Research Innovative Training and Services Program to equip frontline health workers. These actions can support integration, ensure equitable contraceptive access, and advance Nigeria’s health sector reforms.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978385","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":"Developing more responsive mental health services in Lesotho: Using a socioecological framework to explore the system’s building blocks","authors":"Ann Scheunemann ,&nbsp;Moleboheng Mohlalisi ,&nbsp;Sebaka Malope ,&nbsp;Brian W. Jack ,&nbsp;David C. Henderson","doi":"10.1016/j.ssmhs.2026.100173","DOIUrl":"10.1016/j.ssmhs.2026.100173","url":null,"abstract":"<div><div>Despite increased focus on mental health as a sustainable development goal and human right, treatment gaps between service need and access remain high globally. Treatment gaps are impacted by the availability and desirability of the services being provided with mental health systems and can be assessed through the health systems building blocks framework, which identifies six factors for providing mental health services that are responsive to the needs of the individuals and communities served. This study explored service user and provider experiences of treatment gaps within Lesotho’s mental health system, across socioecological levels of care and the building blocks framework, as well as recommendations for improvement. Qualitative data were collected with 218 participants across 25 five groups and four interviews, including health workers, mental health workers, and community members. Participants and data collection sites were selected for diversity, ensuring that all districts, ecological regions, and geographic areas were represented. Two themes and seven sub-themes were identified. Participants felt that communication across governmental and nongovernmental sectors and between levels of care was limited and suggested developing policies to better guide service delivery. Service delivery could also be improved by diversifying care options and providers. Participants identified shortages in the mental health workforce and recommended better support for employees, training more providers, and better capacitating specialists and generals to provide care. Access could be enhanced through infrastructure development. These findings provide direction for strengthening mental health services in resource-constrained settings, through collaboration to improve service availability and responsiveness to improve desirability.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100173"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978448","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":"Innovating mental healthcare with blockchain technology: Expert perspectives from Tanzania","authors":"Augustino Mwogosi","doi":"10.1016/j.ssmhs.2026.100187","DOIUrl":"10.1016/j.ssmhs.2026.100187","url":null,"abstract":"<div><div>This study examines expert perceptions of the potential role of blockchain technology in mental healthcare in Tanzania, focusing on perceived applications, implementation barriers, ethical and regulatory considerations, and anticipated impacts on patient empowerment, research, and professional–patient relationships. A three-round Delphi method was employed, involving 45 experts with backgrounds in mental health, blockchain, health informatics, and public sector governance. Data were collected using structured questionnaires and analysed using descriptive statistics, Kendall’s coefficient of concordance, Wilcoxon signed-rank tests to assess stability across rounds, and thematic analysis of open-ended responses. Experts perceived secure electronic health record management, patient identity verification, and clinical trial data integrity as the most promising application areas. However, a strong consensus also emerged around significant barriers, particularly high implementation costs, limited technical capacity, regulatory uncertainty, and infrastructural constraints. Ethical concerns were not limited to privacy and data ownership but also reflected tensions between immutable data storage and fluctuating decisional capacity in mental health contexts. Patient empowerment was primarily associated with greater control over data access and improved transparency, though some experts questioned whether vulnerable populations could effectively assume these responsibilities without institutional support. The findings reflect informed expectations rather than empirical evidence of technical or economic feasibility. While experts anticipate that blockchain could strengthen data governance and trust in mental health systems, successful adoption in low-resource settings is likely to depend on foundational investments in digital infrastructure, workforce capacity, regulatory clarity, and participatory governance. The study provides context-specific insights to inform policy dialogue and future empirical evaluations of digital health innovations in mental healthcare.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100187"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188794","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":"Healthcare infrastructure and cervical cancer screening in low-resource settings: A systematic review focused on Sub-Saharan Africa","authors":"Magnus Michael Sichalwe ,&nbsp;Abdul Basit ,&nbsp;Attiq Ur Rehman ,&nbsp;Grace Tavengana ,&nbsp;Manas Ranjan Behera ,&nbsp;Muskan Fatima ,&nbsp;Phephile Patience Sifundza","doi":"10.1016/j.ssmhs.2026.100186","DOIUrl":"10.1016/j.ssmhs.2026.100186","url":null,"abstract":"<div><div>Cervical cancer remains a major public health problem, causing over 340,000 deaths in 2020, with nearly 90 % occurring in low- and middle-income countries. Sub-Saharan Africa (SSA) carries the highest burden due to weak health systems, limited HPV vaccination, and very low screening coverage. This review, conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, synthesized evidence from thirty recent studies and found that screening uptake in SSA remains extremely low (10–19 %, pooled 12.9 %), constrained by limited access to facilities, personnel shortages, inadequate equipment, socioeconomic inequities, weak supply chains, low provider guideline awareness, cultural stigma, and high loss to follow-up. Promising strategies to address these barriers include task-shifting to nurses and community health workers, structured training and supervision, mobile clinics, community outreach, and emerging technologies such as AI-powered diagnostics. With targeted investment, political commitment, and adaptation of proven global strategies, SSA can strengthen screening, improve equity, and move closer to eliminating cervical cancer as a public health threat.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188901","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 Ocean View Community Care Centre (CCC): Lessons for everyday health systems resilience from a community-led response to the Covid-19 pandemic in South Africa","authors":"Leanne Brady ,&nbsp;Shaheem De Vries ,&nbsp;Deon Terry ,&nbsp;Ricochet Van Rensburg ,&nbsp;Asha George ,&nbsp;Lucy Gilson","doi":"10.1016/j.ssmhs.2026.100185","DOIUrl":"10.1016/j.ssmhs.2026.100185","url":null,"abstract":"<div><div>Community engagement is widely acknowledged as critical to Everyday Health Systems Resilience (EHSR), but there are few empirical case studies that examine ‘how’ and ‘why’ initiatives at the community-health system interface unfold over time. In this paper, we present the experience of the Ocean View Community Care Centre (CCC), a community-led response to the Covid-19 pandemic in the Western Cape, South Africa. Using a five-year long embedded research approach, we drew on traditions of participatory action research and organisational ethnography. Data collection included documenting observations and reflections in a research diary during implementation, in-depth interviews, focus group discussions (using photo-elucidation methods) and a WhatsApp archive. In addition, a series of sensemaking discussions with academic research team members were done. Our analysis draws on and extends the EHSR framework which characterises resilience as an emergent phenomena of health systems. We consider the CCC as a potentially transformative resilience strategy as it nurtured system capacities (networks and relationships) that could support future responses to shocks. Our findings demonstrate how relationships and networks can generate resources (hardware and software) and nurture system capacities for EHSR, but also highlights that relationships and networks on their own are not enough. The CCC experience offers the notion of boundary spanning (not yet explored in the EHSR literature) to shed light on how the energy of these networks needs to be harnessed by individuals who have a ‘passport of legitimacy’ to work across networks, suggesting that boundary spanners are themselves important in nurturing system capacities for resilience.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100185"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188789","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":"Utilization of healthcare services by informal workers: Evidence from Assam","authors":"Kanchan Devi ,&nbsp;Vandana Upadhyay","doi":"10.1016/j.ssmhs.2025.100163","DOIUrl":"10.1016/j.ssmhs.2025.100163","url":null,"abstract":"<div><div>The informal sector is a crucial part of the economy, yet its workers face significant healthcare access barriers, including financial constraints, long working hours, and limited social security. While research on healthcare utilization in India exists, studies focusing on informal workers, especially at the state level, remain limited. Assam, with its high dependence on the informal economy, presents unique healthcare challenges for this workforce. This study examines inpatient and outpatient healthcare utilization among informal workers in Assam, analysing barriers and sources of care. Using both primary, a cross-sectional household survey was conducted across three districts, Dhubri, Sonitpur, and Dhemaji. Healthcare utilization patterns were analysed using probit and logistic regression models, with model selection based on comparative pseudo values. Key socioeconomic, demographic, and health-related factors were examined to assess their influence on healthcare utilization. The findings reveal significant district-wise disparities, with outpatient care rates higher than inpatient care. Urban residents, insured individuals, and non-migrants utilized both services more frequently. Gender disparities persist, with males accessing more inpatient care except in Dhemaji. SC/ST groups and lower-income populations faced greater barriers, while non-communicable diseases primarily drove inpatient care demand. Key barriers included poor service quality and long distances to healthcare facilities. To improve healthcare utilization among informal workers, policies should focus on strengthening public healthcare infrastructure, expanding financial assistance programs, and improving service quality. Awareness campaigns, socioeconomic equity measures, and effective implementation of universal health coverage initiatives are essential for ensuring equitable healthcare access in Assam.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841086","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}