Dysphagia最新文献

{"title":"Evaluating a Regression-Based Approach to Norming the Test of Masticating and Swallowing Solids (ToMaSS): A Comparison with Traditional Stratified Methods.","authors":"Esther Guiu Hernandez, Nicole Lewis, Sarah Perry, Maggie-Lee Huckabee","doi":"10.1007/s00455-026-10949-0","DOIUrl":"https://doi.org/10.1007/s00455-026-10949-0","url":null,"abstract":"<p><p>The Test of Masticating and Swallowing Solids (ToMaSS) is a commonly-used adjunctive assessment to quantify solid bolus ingestion. However, published norms are characterised by relatively small sample sizes and wide age brackets, increasing the risk of skew, influence by outliers, and reduced statistical power. Regression-based approaches to norming may mitigate some of these limitations. To evaluate whether a regression-based approach offered a significant advantage over the traditional stratified approach for the refinement of ToMaSS norms. Prospective-retrospective design, with prospectively collected data combined with historical data from published and unpublished laboratory datasets. All data consisted of healthy adults (aged 20 to 80 + years) recruited from the general public. McFadden's Pseudo R² and Root Mean Squared Error (MSE) were calculated and compared for both statistical approaches. Regression-based norms (GAM Gamma and COM-Poisson models) showed a modest improvement in model fit over traditional stratified norms, with McFadden's Pseudo R² increasing by 6% to 43% across outcomes. MSE values followed a similar trend, with regression-based norms reducing prediction error by up to 12%. Findings support that a regression-based approach offered a significant advantage over a traditional stratified approach to constructing ToMaSS norms. Advantages included smaller sample size requirements and individualised estimates across continuous age ranges. This flexibility allows for a more nuanced understanding of individual ToMaSS performance, which may be of particular relevance to clinical populations where changes in the oral phase of swallowing may vary greatly within a short time frame.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement Techniques and Properties of Single-item Measures for the Evaluation of Oropharyngeal Muscle Function in Adults with Dysphagia: A Systematic Review using the COSMIN Framework.","authors":"Eileen Kelly, Joelle Hako, Anna Creagh Chapman, Brigitta Fazzini, Timothy J Stephens, Renée Speyer, Anna-Liisa Sutt, Zudin Puthucheary","doi":"10.1007/s00455-026-10957-0","DOIUrl":"https://doi.org/10.1007/s00455-026-10957-0","url":null,"abstract":"<p><p>Muscle dysfunction is a critical construct in dysphagia. Despite the availability of diverse techniques to evaluate muscle function, a comprehensive synthesis of measurement items and their properties is lacking. A systematic review of studies examining the measurement techniques used to directly evaluate oropharyngeal muscle function was performed. Studies investigating the use of surface electromyography, tongue dynamometry, ultrasound, high-resolution pharyngeal manometry, magnetic resonance imaging and computed tomography and reporting measurement properties in line with the COnsensus-based Standards for the selection of health Measurement InstrumeNts (COSMIN) were included. Measurement outcomes derived from these techniques were operationalised as single-item measures. Methodological quality was evaluated using the QualSyst tool. From the 6279 records, 125 eligible studies were identified. The breakdown of techniques was surface electromyography (n = 33), tongue dynamometry (n = 34), ultrasound (n = 17), high-resolution pharyngeal manometry (n = 15), magnetic resonance imaging (n = 5), computed tomography (n = 4) and combined techniques (n = 17). Single-item measures were heterogenous, covering a range of domains including muscle activation, coordination, strength, endurance, composition, thickness, and kinematics. Studies focused predominantly on oral rather than pharyngeal musculature. Validity (n = 117) was widely reported, primarily via known-group validity or hypothesis testing. Fewer studies examined reliability (n = 20) and responsiveness (n = 25); however, where reported, results indicated excellent intra- and inter-rater reliability and responsiveness to therapeutic interventions. A diverse range of single-item measures were identified across included measurement techniques. Measurement properties were sparsely reported. Future research should focus on rigorous measurement instrument design and standardisation to comprehensively evaluate the underlying mechanisms of dysphagia.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recovery Trajectories and Predictors of Post-Extubation Dysphagia in Intensive Care Unit Patients Following Orotracheal Intubation: A Longitudinal Study.","authors":"Limi Shan, Haifang Wang, Weixia Yu, Jianzheng Cai, Yuyu Wang, Yingying Zhang, Xin Wang","doi":"10.1007/s00455-026-10941-8","DOIUrl":"https://doi.org/10.1007/s00455-026-10941-8","url":null,"abstract":"<p><p>Post-extubation dysphagia (PED) is a prevalent and debilitating complication in intensive care unit (ICU) patients, yet the longitudinal heterogeneity of swallowing recovery remains poorly understood. This study was aimed to characterize distinct recovery trajectories of swallowing function in ICU patients with PED and to identify the clinical predictors associated with each pattern. This longitudinal observational study utilized convenience sampling to enroll ICU patients from a tertiary hospital. Swallowing function was evaluated using the Standard Swallowing Assessment (SSA) at seven time points post-extubation, at 4-6, 24, 48, and 72 h and 7, 14, and 28 days. Latent recovery trajectories were identified using growth mixture modeling (GMM), and independent predictors of group membership were determined by multivariate logistic regression. Of 495 intubated patients, 248 (54.98%) developed PED and were included; 209 completed all follow-up assessments. Three distinct trajectories emerged: Group HS (high level, slow improvement; 10.0%), Group HR (high level, rapid improvement; 22.5%), and Group LE (low level, early recovery; 67.5%). For both Group HR and Group HS, membership was predicted by older age, neurological diagnosis, higher peak inspiratory pressure, longer intubation duration, and early pharyngeal pain. In addition, membership in Group HR was uniquely associated with an APACHE II score of 10-14 and exposure to fiberoptic bronchoscopy. Post-extubation swallowing recovery follows distinct trajectories shaped by physiological, procedural, and disease-related factors. Early trajectory identification allows for personalized, stage-specific interventions to optimize functional outcomes and mitigate long-term morbidity.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of and Experiences with Dysphagia in People with hypermobile Ehlers Danlos Syndrome (hEDS) with or Without Dysautonomia - A Qualitative Study.","authors":"Deanna Britton, Karyssa Stonick, Diana Lopez, Donna Graville","doi":"10.1007/s00455-026-10952-5","DOIUrl":"https://doi.org/10.1007/s00455-026-10952-5","url":null,"abstract":"<p><p>Ehlers Danlos Syndromes (EDS) are hereditary connective tissue disorders. The purpose of this participatory action qualitative research study is to describe experiences of dysphagia in people with hypermobile EDS (hEDS). Ten participants (8 F, 1 M, and 1 nonbinary-assigned F at birth; ages 19-52 years) with hEDS completed the Eating Assessment Tool (EAT-10; Belafsky et al., 2008), Reflux Symptom Index (RSI; Belafsky et al., 2002), and semi-structured interviews. The interviews were audio-recorded, transcribed and verified. Phenomenological qualitative research methods were used to code (Atlas.ti Web) and develop themes. All participants affirmed dysphagia symptoms via the EAT-10 (M = 17.65; SD = 6.93; Range = 4-29) with 6/10 requiring a feeding tube at some point. Most participants also affirmed reflux symptoms on the RSI (M = 20.30; SD = 8.3; Range 7-36). Four preliminary themes related to dysphagia in people with hEDS were identified: (1) Swallowing discomfort is common, requiring cognitive and physical effort; (2) Gastrointestinal symptoms impact deglutition and often lead to a need for supplemental nutrition / hydration; (3) Dyspnea is common, and may intermittently impact respiratory-swallowing coordination; and (4) Dismissal of physiological symptoms as \"anxiety\" by at least one provider prior to acknowledgment of an underlying condition occurs frequently. Dysphagia is commonly reported by people with hEDS and appears to be related to underlying symptoms of hEDS and/or dysautonomia. Further research is needed to elucidate the impact and mechanisms of impairments associated with hEDS and dysautonomia across all phases of swallowing.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Swallowing Related Muscle Loss on Dysphagia: A Cohort Study Based on Ultrasound Monitoring of Postoperative Patients with Intracranial Hemorrhage.","authors":"Jin-Ting Wei, Hai-Ping Wu, Yue Hu, Xin Zhang, Shi-Jing Ma, Tao Feng, Bin Zhong, Zhi-Kun Bai, Ling-Ling Huang, Qiu-Yan Zhang, Jin-Hua Wang","doi":"10.1007/s00455-026-10954-3","DOIUrl":"https://doi.org/10.1007/s00455-026-10954-3","url":null,"abstract":"<p><p>Acquired dysphagia is a common complication after intracranial hemorrhage (ICH) and leads to poor prognosis. The relationship between dysphagia and stroke-related sarcopenia has recently received attention, but the related factors and prediction models are still poorly understood. The purpose of this study was to investigate the risk factors of dysphagia in patients after ICH and the effect of swallowing-related muscle loss on swallowing function during endotracheal intubation (IET) retention, and to establish a simplified dysphagia prediction model. Bedside ultrasound was used to monitor swallowing-related changes during IET in patients after ICH surgery, and swallowing function information was collected when patients entered the rehabilitation medicine department for rehabilitation. Total of 97 patients with ICH were included for analysis, and the incidence of dysphagia was 70.10%. Masseter muscle thickness (MMT), temporal muscle thickness (TMT), duration of IET, operation time (OT), and Barthel Index were significantly different between the dysphagia group and the non-dysphagia group. Logistic regression analysis showed that the changes in MMT, duration of IET, and OT were risk factors for dysphagia. The cutoff values were MMT reduction of 0.85 mm, duration of ETI were 6.5 days, and OT were 225 min. ROC analysis showed that the nomogram AUC was 0.882 (0.807-0.957). The model based on Ultrasound assessment of swallowing-related muscle loss combined with objective clinical data revealed that the changed of MMT, the ETI duration and OT are risk factors for dysphagia in patients after ICH, and are also effective indicators for predicting dysphagia after ICH.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transitional Foods in Dysphagia and Feeding Management: Perspectives of Speech-Language Therapists in Singapore.","authors":"Seh Ling Kwong, Julia M W Lee, Valerie P C Lim, Benjamin J W Chow, Simeon D Stoyanov, Suk M Goh","doi":"10.1007/s00455-026-10955-2","DOIUrl":"https://doi.org/10.1007/s00455-026-10955-2","url":null,"abstract":"<p><p>Transitional foods (TFs) are foods that change texture with moisture and/or temperature. Despite their potential to aid chewing development and swallowing rehabilitation, TFs remain underutilized in clinical practice. This study explored the perspectives of speech and language therapists (SLTs) in Singapore regarding TFs in dysphagia and feeding management, aiming to inform the development of TF products to expand available food options. A cross-sectional online survey was conducted among actively practicing SLTs. The survey included closed and open-ended questions on understanding of TFs and its usage, and perceived facilitators and barriers to the use of TFs. Fifty-eight registered SLTs who had managed clients with feeding difficulties and/or dysphagia within the last five years participated. Most worked in public health institutions with adult clients. While 93.1% had heard of TFs, only 22.4% accurately described them per the International Dysphagia Diet Standardisation Initiative (IDDSI) definition; 56.9% provided partially correct descriptions lacking key defining features, and 12.1% gave erroneous definitions. Over half (58.6%) had recommended TFs, primarily to expand food options and support therapy, despite infrequent client-driven requests for TFs. Key barriers included concerns about swallowing safety, variability in texture transitions, limited training, and institutional constraints. The findings highlight a gap in SLTs' knowledge and confidence regarding TFs. Despite the perceived benefits of TFs, unclear definitions, lack of safety data, and systemic barriers hinder consistent use. The broad IDDSI definition may limit clinical applicability; refining it through subcategorization based on specific characteristics could improve safety assessment and support wider adoption in dysphagia and feeding management.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to Prophylactic Swallowing Exercises in Patients with Head and Neck Cancer Receiving (Chemo) Radiotherapy Across Two Service Delivery Modes in South India.","authors":"Jasmine Lydia Selvaraj, Lakshmi Venkatesh, Laurelie R Wishart, Satish Srinivas Kondaveeti","doi":"10.1007/s00455-026-10953-4","DOIUrl":"https://doi.org/10.1007/s00455-026-10953-4","url":null,"abstract":"<p><p>This study aimed to investigate adherence to a six-week prophylactic swallowing exercise (PSE) program delivered in two service delivery modes among patients with head and neck cancer (HNC) undergoing (chemo)radiotherapy (C)RT in South India. The study also explored the influence of patient-related and clinical factors on adherence rates. In a prospective study at a quaternary care hospital, 104 HNC patients were randomized to clinician-directed (n = 53) or self-directed (n = 51) PSE programs. The clinician-directed group received weekly in-person supervision by a speech-language pathologist, while the self-directed group practiced independently at home with weekly phone counseling. All received pre-treatment counseling and standardized instructions for a 6-week PSE program involving 10 exercises (mobility & swallowing), performed three times daily, six days a week. Adherence was tracked using weekly logs and calculated as a percentage of completed repetitions (1,800/week; 10,800 total), categorized as high (≥ 76%), moderate (51-75%), or low (< 50%). Overall adherence was higher in the clinician-directed group (87.7%) than in the self-directed group (61.6%, p = .004), and declined over time in both groups. Participants adhered more to mobility exercises than swallowing exercises across all weeks (p < .01), with large effect sizes in weeks 4-6 (r =0.441-0.464). Chi-square analysis showed adherence classification was significantly associated with service delivery mode (p = .006). No significant associations were found with patient-related (age, gender, lifestyle) or clinical factors (tumor site, treatment type). HNC patients demonstrated moderate adherence to PSEs, higher in clinician-directed programs. Declining adherence, particularly in self-directed programs, underscores the need for strategies that promote self-monitoring and motivation to optimize rehabilitation in resource-limited settings.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Dysphagia in Patients with Tracheostomy: Clinical Position Statement of the UEP Swallowing Committee.","authors":"Sally M Adel, D Farneti, Ahmed Abdelhamid Abdelgoad, Mariam S Shadi, Rania M Abdou, Virginie Woisard, Tamer Abou-Elsaad, Ana Danic Hadzibegovic, Zofia Korim, Miro Tedla, Mohamed Farahat","doi":"10.1007/s00455-026-10951-6","DOIUrl":"https://doi.org/10.1007/s00455-026-10951-6","url":null,"abstract":"<p><p>The tracheostomy procedure in adults is an invasive intervention usually performed for complicated respiratory problems that cannot be managed conservatively. The proximity of the trachea and esophagus, along with shared pathways, can increase the likelihood of swallowing challenges in individuals with a tracheostomy. A post-tracheostomy care bundle provided by a multidisciplinary service significantly improves decannulation rates and oral diet tolerance. Eleven experts within the Union of European Phoniatricians (UEP) Swallowing Committee were selected based on their experience and practice in the field. Each working group conducted a bibliographic search on the assigned topics using Medline (PubMed), covering articles from the last 10 years or earlier if deemed of interest. Based on bibliographic research, each working group formulated a text supporting the position statements. The reference texts were revised through a series of periodic meetings, held at least quarterly, over a year (from June 2023 to June 2024), until a unanimous agreement was reached for all. A review group reviewed the material produced, providing final suggestions that were incorporated by the panel until the final document was reached, which was then proposed to a group of reviewers from the UEP Board. Dysphagia is a common complication in patients with tracheostomy tubes, with significant implications for patient safety and quality of life. They are susceptible to aspiration, and if it does occur, it is likely to be silent and difficult to detect during a clinical evaluation. It is necessary to prioritize the assessment and management of dysphagia alongside respiratory and ventilator considerations. Addressing swallowing difficulties early in the weaning process can help minimize complications and improve patient outcomes.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment Tools for Intensive Care Unit-Acquired Dysphagia: A Network Meta-Analysis of Diagnostic Accuracy Studies.","authors":"Lijun Ge, Yi Hu, Beiyao Gao, Siyuan Wang, Yan Hou, Haoran Yang, Peijian Wang, Shan Jiang","doi":"10.1007/s00455-026-10928-5","DOIUrl":"https://doi.org/10.1007/s00455-026-10928-5","url":null,"abstract":"<p><p>This study aims to determine the diagnostic accuracy for assessment tools as compared to reference standard in Intensive Care Unit-Acquired Dysphagia (ICUAD) using network meta-analysis. Comprehensive searches of PubMed, Embase, and Web of Science were conducted from database inception before May 2025 to identify studies on ICUAD assessment tools. Two reviewers independently performed study screening, data extraction, and quality assessment. All analyses were implemented in R version 4.3.2. True positives (TP), False positives (FP), True negatives (TN), False negatives (FN), Sensitivity, Specificity, Positive predictive value (PPV), and Negative predictive value (NPV) were calculated and used to rank the index tests. Nineteen studies involving 1,167 patients and 11 tools were analyzed. The gold standards, Video Fluoroscopic Swallow Study (VFSS) and Flexible Endoscopic Examination of Swallowing (FEES), showed the highest accuracy. Among bedside tools, the Gugging Swallowing Screen (GUSS) (32.55%) and Standardized Swallowing Assessment (SSA) (42.26%) achieved the best balance of sensitivity and specificity, followed by the modified Volume-Viscosity Swallow Test (mV-VST) (30.07%). GUSS and SSA are practical and reliable bedside tools for ICUAD screening, but cannot replace VFSS or FEES. Further large-scale high-quality prospective studies are needed to confirm their diagnostic performance.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Characteristics of Pill Dysphagia in Adults with Swallowing Disorders: A FEES Based Retrospective Study.","authors":"Yael Shapira-Galitz, Alaa Awisat, Nadine Hendi, Raviv Allon","doi":"10.1007/s00455-026-10936-5","DOIUrl":"https://doi.org/10.1007/s00455-026-10936-5","url":null,"abstract":"","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}