European Heart Journal - Quality of Care and Clinical Outcomes最新文献

{"title":"The controversy between atrial fibrillation subtypes and worsening heart failure.","authors":"Amir Razaghizad, Thao Huynh, Abhinav Sharma","doi":"10.1093/ehjqcco/qcae018","DOIUrl":"10.1093/ehjqcco/qcae018","url":null,"abstract":"","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140048988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of cumulative health status with subsequent mortality in patients with acute heart failure.","authors":"Yue Peng, Guangda He, Wei Wang, Lubi Lei, Jingkuo Li, Boxuan Pu, Xiqian Huo, Yanwu Yu, Lihua Zhang, Jing Li","doi":"10.1093/ehjqcco/qcae017","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcae017","url":null,"abstract":"<p><strong>Objective: </strong>We aim to examine the association between long-term cumulative health status and subsequent mortality among patients with acute heart failure (HF).</p><p><strong>Methods: </strong>Based on a national prospective cohort study of patients hospitalized for HF, we measured health status by Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 at 4 time points, i.e. admission, 1-,6- and 12-month after discharge. Cumulative health status was interpreted by cumulative KCCQ-12 score and cumulative times of good health status. Outcomes included subsequent all-cause and cardiovascular mortality. Multivariable Cox proportional hazard models were performed to examine the association between cumulative health status and subsequent mortality.</p><p><strong>Results: </strong>Totally, 2328 patients (36.7% women and median age 66 [IQR: 56-75] years) were included, the median follow-up was 4.34 (IQR: 3.93-4.96) years. Compared with Quartile 4, the lowest Quartile 1 had the highest HR for all-cause mortality (2.96; 95% CI: 2.26-3.87), followed by Quartile 2 (1.79; 95% CI: 1.37-2.34) and Quartile 3 (1.62; 95% CI: 1.23-2.12). Patients with 0-time of good health status had the highest risk of all-cause mortality (HR: 2.41, 95% CI: 1.69-3.46) compared with patients with 4-times of good health status. Similar associations persisted for cardiovascular mortality.</p><p><strong>Conclusions: </strong>A greater burden of cumulative health status indicated worse survival among patients hospitalized for HF. Repeated KCCQ measurements could be helpful to monitor long-term health status and identify patients vulnerable to death. Clinical Trial Registration: www.clinicaltrials.gov (NCT02878811).</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140048987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trend analysis of rheumatic heart disease burden in high-income countries between 1990 and 2019.","authors":"Utkarsh Ojha, Dominic C Marshall, Justin D Salciccioli, Becker M Al-Khayatt, Matthew Hammond-Haley, Richard Goodall, Kim L Borsky, Conor P Crowley, Joseph Shalhoub, Adam Hartley","doi":"10.1093/ehjqcco/qcac083","DOIUrl":"10.1093/ehjqcco/qcac083","url":null,"abstract":"<p><strong>Aims: </strong>To assesses trends in rheumatic heart disease (RHD) burden in high-income, European Union 15+ (EU15+) countries between 1990 and 2019.</p><p><strong>Methods and results: </strong>Cross-sectional analysis of the incidence and mortality of RHD was conducted using data from the Global Burden of Disease (GBD) Study database. Age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) were extracted for EU15+ countries per sex for each of the years from 1990 to 2019, inclusive, and mortality-to-incidence indices (MII) were computed. Joinpoint regression analysis was used for the description of trends. Over 29 years, an overall declining trend in RHD incidence and mortality across EU 15+ nations were observed. There was significant variability in RHD incidence and mortality rates across high-income countries. However, both RHD incidence and mortality were higher among females compared with males across EU15+ countries over the observed period. The most recent incidence trend, starting predominantly after 2014, demonstrated a rise in RHD incidence in most countries for both sexes. The timing of this RHD resurgence corresponds temporally with an influx of migrants and refugees into Europe. The recent increasing RHD incidence rates ranged from +0.4% to +24.7% for males, and +0.6% to +11.4% for females.</p><p><strong>Conclusion: </strong>More than half of EU15+ nations display a recent increase in RHD incidence rate across both sexes. Possible factors associated with this rise are discussed and include increase in global migration from nations with higher RHD prevalence, host nation factors such as migrants' housing conditions, healthcare access, and migrant health status on arrival.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10904725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9272332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic assessment of the characteristics of randomized controlled trials cited by acute coronary syndrome clinical practice guidelines.","authors":"Maribel Gonzalez-Del-Hoyo, Caterina Mas-Llado, Joan Siquier-Padilla, Laura Blaya-Peña, J J Coughlan, Vicente Peral, Xavier Rossello","doi":"10.1093/ehjqcco/qcad034","DOIUrl":"10.1093/ehjqcco/qcad034","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to describe the methodological features of the randomized controlled trials (RCTs) cited in American and European clinical practice guidelines (CPGs) for ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTE-ACS).</p><p><strong>Methods and results: </strong>Out of 2128 non-duplicated references cited in the 2013 and 2014 American College of Cardiology/American Heart Association and 2017 and 2020 European Society of Cardiology CPGs for STEMI and NSTE-ACS, we extracted data for 407 RCTs (19.1% of total references). The majority were multicenter studies (81.8%), evaluated pharmacological interventions (63.1%), had a 2-arm (82.6%), and superiority (90.4%) design. Most RCTs (60.2%) had an active comparator, and 46.2% were funded by industry. The median observed sample size was 1001 patients (84.2% of RCTs achieved ≥80% of the intended sample size). Most RCTs had a single primary outcome (90.9%), which was a composite in just over half (51.9%). Among the RCTs testing for superiority, 44.0% reported a P-value of ≥0.05 for the primary outcome and 61.9% observed a risk reduction of >15%. The observed treatment effect was lower-than-expected in 67.6% of RCTs, with 34.4% having at least a 20% lower-than-expected treatment effect. The calculated post hoc statistical power was ≥80% for 33.9% of cited RCTs.</p><p><strong>Conclusions: </strong>This analysis demonstrates that RCTs cited by CPGs can still have significant methodological issues and limitations, highlighting that a better understanding of the methodological aspects of RCTs is crucial in order to formulate recommendations relevant to clinical practice.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9601327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital admissions in the last year of life of patients with heart failure.","authors":"Alexandra A I Abel, Nathan A Samuel, Joseph J Cuthbert, Oliver I Brown, Pierpaolo Pellicori, Syed Kazmi, John G F Cleland, Miriam J Johnson, Andrew L Clark","doi":"10.1093/ehjqcco/qcad047","DOIUrl":"10.1093/ehjqcco/qcad047","url":null,"abstract":"<p><strong>Aim: </strong>To explore the frequency, causes, and pattern of hospitalisation for patients with chronic heart failure (HF) in the 12 months preceding death. We also investigated cause of death.</p><p><strong>Methods: </strong>Patients referred to a secondary care HF clinic were routinely consented for follow-up between 2001 and 2020 and classified into three phenotypes: (i) HF with reduced ejection fraction (HFrEF), (ii) HF with preserved ejection fraction (HFpEF) with plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) 125-399 ng L-1, and (iii) HFpEF with NT-proBNP ≥400 ng L-1. Hospital admissions in the last year of life were classified as: HF, other cardiovascular (CV), or non-cardiovascular (non-CV). The cause of death was systematically adjudicated.</p><p><strong>Results: </strong>A total of 4925 patients (38% women; median age at death 81 [75-87] years) had 9127 hospitalisations in the last year of life. The median number of hospitalisations was 2 (1-3) and total days spent in hospital was 12 (2-25). Out of the total, 83% of patients had ≥1 hospitalisation but only 20% had ≥1 HF hospitalisation; 24% had ≥1 CV hospitalisation; 70% had ≥1 non-CV hospitalisation. Heart failure hospitalisations were most common in patients with HFrEF, but in all groups, at least two thirds of admissions were for non-CV causes. There were 788 (16%) deaths due to progressive HF, of which 74% occurred in hospital.</p><p><strong>Conclusion: </strong>For patients with chronic HF in the last year of life, most hospitalisations were for non-CV causes regardless of HF phenotype. Most patients had no HF hospitalisations in their last year of life. Most deaths were from causes other than progressive HF.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9959882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burden of cardiovascular disease attributable to high body mass index-an observational study.","authors":"Xin-Jiang Dong, Xiao-Qi Zhang, Bei-Bei Wang, Fei-Fei Hou, Yang Jiao, Jian-Gang Wang","doi":"10.1093/ehjqcco/qcad044","DOIUrl":"10.1093/ehjqcco/qcad044","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to provide a timely and comprehensive estimate of the current burden and temporal trend of cardiovascular disease (CVD) attributable to high body mass index (HBMI).</p><p><strong>Methods: </strong>We systematically assessed the current burden and temporal trend of CVD attributable to HBMI by calendar year, age, sex, region, nation, socioeconomic status, and specific CVD based on the most recent Global Burden of Disease Study (GBD) 2019.</p><p><strong>Results: </strong>Globally, the numbers of CVD-related disability-adjusted life years (DALYs) and deaths attributable to HBMI has more than doubled from 1990 to 2019. Conversely, the age-standardized rates (ASRs) of CVD-related DALYs and deaths attributable to HBMI showed a slight downward trend, with estimated annual percentage change (EAPC) of -0.18 and -0.43, respectively. The ASRs of CVD-related DALYs and deaths attributable to HBMI were lower in low and high Socio-demographic Index (SDI) regions in 2019, but higher in middle and high-middle SDI regions. The ASRs of CVD-related DALYs and deaths attributable to HBMI showed a downward trend in the high SDI regions from 1990 to 2019, but showed an upward trend in the low and low-middle SDI regions. The leading causes of CVD burden attributable to HBMI were ischemic heart disease, stroke, hypertensive heart disease, and atrial fibrillation/flutter in 2019.</p><p><strong>Conclusion: </strong>The CVD burden attributable to HBMI remains a challenging global health concern. Policymakers in high and increasing burden regions can learn from some valuable experiences of low and decreasing burden regions and develop more targeted and specific strategies to prevent and reduce CVD burden attributable to HBMI.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9843536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of machine learning vs. traditional modeling approaches for predicting in-hospital mortality after cardiac surgery: temporal and spatial external validation based on a nationwide cardiac surgery registry.","authors":"Juntong Zeng, Danwei Zhang, Shen Lin, Xiaoting Su, Peng Wang, Yan Zhao, Zhe Zheng","doi":"10.1093/ehjqcco/qcad028","DOIUrl":"10.1093/ehjqcco/qcad028","url":null,"abstract":"<p><strong>Aims: </strong>Preoperative risk assessment is crucial for cardiac surgery. Although previous studies suggested machine learning (ML) may improve in-hospital mortality predictions after cardiac surgery compared to traditional modeling approaches, the validity is doubted due to lacking external validation, limited sample sizes, and inadequate modeling considerations. We aimed to assess predictive performance between ML and traditional modelling approaches, while addressing these major limitations.</p><p><strong>Methods and results: </strong>Adult cardiac surgery cases (n = 168 565) between 2013 and 2018 in the Chinese Cardiac Surgery Registry were used to develop, validate, and compare various ML vs. logistic regression (LR) models. The dataset was split for temporal (2013-2017 for training, 2018 for testing) and spatial (geographically-stratified random selection of 83 centers for training, 22 for testing) experiments, respectively. Model performances were evaluated in testing sets for discrimination and calibration. The overall in-hospital mortality was 1.9%. In the temporal testing set (n = 32 184), the best-performing ML model demonstrated a similar area under the receiver operating characteristic curve (AUC) of 0.797 (95% CI 0.779-0.815) to the LR model (AUC 0.791 [95% CI 0.775-0.808]; P = 0.12). In the spatial experiment (n = 28 323), the best ML model showed a statistically better but modest performance improvement (AUC 0.732 [95% CI 0.710-0.754]) than LR (AUC 0.713 [95% CI 0.691-0.737]; P = 0.002). Varying feature selection methods had relatively smaller effects on ML models. Most ML and LR models were significantly miscalibrated.</p><p><strong>Conclusion: </strong>ML provided only marginal improvements over traditional modelling approaches in predicting cardiac surgery mortality with routine preoperative variables, which calls for more judicious use of ML in practice.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9498536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to: Cohort profile: Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) longitudinal cohort.","authors":"","doi":"10.1093/ehjqcco/qcad066","DOIUrl":"10.1093/ehjqcco/qcad066","url":null,"abstract":"","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10904718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of cardiovascular disease among elderly: based on the Global Burden of Disease Study 2019.","authors":"Chunrun Qu, Sheng Liao, Jingdan Zhang, Hui Cao, Hao Zhang, Nan Zhang, Luzhe Yan, Gaoyuan Cui, Peng Luo, Qingwei Zhang, Quan Cheng","doi":"10.1093/ehjqcco/qcad033","DOIUrl":"10.1093/ehjqcco/qcad033","url":null,"abstract":"<p><strong>Background: </strong>The burden of elderly cardiovascular disease (CVD) has received increasing attention with population ageing worldwide.</p><p><strong>Aims: </strong>We reported on the global CVD burden in elderly individuals over 70, 1990-2019.</p><p><strong>Methods and results: </strong>Based on the Global Burden of Disease Study 2019, elderly CVD burden data were analysed. Temporal burden trends were analysed with the joinpoint model. The slope index and concentration index were used to evaluate health inequality. From 1990 to 2019, the global elderly CVD incidence, prevalence, death, and disability-adjusted life year rates generally decreased. However, the current burden remains high. The rapid growth in burden in parts of sub-Saharan Africa and Asia is a cause for concern. Countries with a higher socio-demographic index (SDI) have generally seen a greater decrease in burden, while countries with a lower SDI have generally experienced increases or smaller declines in burden. Health inequality analysis confirmed that the burden was gradually concentrating towards countries with a low SDI. Among the different CVDs, ischaemic heart disease causes the greatest burden in elderly individuals. Most CVD burdens increase with age, but stroke and peripheral vascular disease show markedly different distributional characteristics. In addition, the burden of hypertensive heart disease shows an unusual shift towards high-SDI countries. High systolic blood pressure was consistently the leading risk factor for CVD among elderly individuals.</p><p><strong>Conclusion: </strong>The burden of CVD in older people remains severe and generally tends to shift to lower-SDI countries. Policymakers need to take targeted measures to reduce its harm.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10904724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9973789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-based differences in risk factors for incident myocardial infarction and stroke in the UK Biobank.","authors":"Elizabeth Remfry, Maddalena Ardissino, Celeste McCracken, Liliana Szabo, Stefan Neubauer, Nicholas C Harvey, Mamas A Mamas, John Robson, Steffen E Petersen, Zahra Raisi-Estabragh","doi":"10.1093/ehjqcco/qcad029","DOIUrl":"10.1093/ehjqcco/qcad029","url":null,"abstract":"<p><strong>Aim: </strong>This study examined sex-based differences in associations of vascular risk factors with incident cardiovascular events in the UK Biobank.</p><p><strong>Methods: </strong>Baseline participant demographic, clinical, laboratory, anthropometric, and imaging characteristics were collected. Multivariable Cox regression was used to estimate independent associations of vascular risk factors with incident myocardial infarction (MI) and ischaemic stroke for men and women. Women-to-men ratios of hazard ratios (RHRs), and related 95% confidence intervals, represent the relative effect-size magnitude by sex.</p><p><strong>Results: </strong>Among the 363 313 participants (53.5% women), 8470 experienced MI (29.9% women) and 7705 experienced stroke (40.1% women) over 12.66 [11.93, 13.38] years of prospective follow-up. Men had greater risk factor burden and higher arterial stiffness index at baseline. Women had greater age-related decline in aortic distensibility. Older age [RHR: 1.02 (1.01-1.03)], greater deprivation [RHR: 1.02 (1.00-1.03)], hypertension [RHR: 1.14 (1.02-1.27)], and current smoking [RHR: 1.45 (1.27-1.66)] were associated with a greater excess risk of MI in women than men. Low-density lipoprotein cholesterol was associated with excess MI risk in men [RHR: 0.90 (0.84-0.95)] and apolipoprotein A (ApoA) was less protective for MI in women [RHR: 1.65 (1.01-2.71)]. Older age was associated with excess risk of stroke [RHR: 1.01 (1.00-1.02)] and ApoA was less protective for stroke in women [RHR: 2.55 (1.58-4.14)].</p><p><strong>Conclusion: </strong>Older age, hypertension, and smoking appeared stronger drivers of cardiovascular disease in women, whereas lipid metrics appeared stronger risk determinants for men. These findings highlight the importance of sex-specific preventive strategies and suggest priority targets for intervention in men and women.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10904726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10000953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}