International journal of MS care最新文献

{"title":"Validated, Quantitative, Machine Learning-Generated Neurologic Assessment of Multiple Sclerosis Using a Mobile Application","authors":"Sharon Stoll, Charisse Litchman, Noah Rubin, Larry Rubin, Timothy Vartanian","doi":"10.7224/1537-2073.2023-009","DOIUrl":"https://doi.org/10.7224/1537-2073.2023-009","url":null,"abstract":"Abstract Background: The BeCare MS Link mobile app collects data as users complete different in-app assessments. It was specifically developed to evaluate the symptomatology and neurologic function of patients with multiple sclerosis (MS) and to become a digital equivalent of the Expanded Disability Status Scale (EDSS) and other standard clinical metrics of MS progression. Methods: Our research compared EDSS scores derived from the BeCare MS link app to EDSS scores derived from neurologist assessment for the same cohort of 35 patients diagnosed with MS. App-derived data was supplied to 4 different machine learning algorithms (MLAs) with an independent EDSS score prediction generated from each. These scores were compared to the clinically-derived EDSS score to assess the similarity of the scores and to determine an accuracy estimate for each MLA. The trial is registered on ClinicalTrials.gov as NCT04281160. Results: Out of the 4 MLAs employed, the most accurate MLA produced 19 EDSS score predictions that exactly matched the clinically-derived scores, 21 score predictions within 0.5 EDSS points, and 32 score predictions within 1 EDSS point. The remaining MLAs also provided a relatively high level of accuracy in predicting EDSS scores when compared to clinically-derived EDSS, with over 80% of scores predicted within 1 point and a mean squared error with a range of 1.05 to 1.37. Conclusions: The BeCare MS Link app can replicate the clinically-derived EDSS assessment of a patient with MS. The app may also offer a more complete evaluation of disability in patients with MS.","PeriodicalId":14150,"journal":{"name":"International journal of MS care","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135877989","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":"Effect of Foot Reflexology on Patients With Multiple Sclerosis: A Systematic Review of Current Evidence","authors":"Boopalan Deenadayalan, Vijayakumar Venugopal, Ravi Poornima, Vanamoorthy Mahesh Kannan, Anandhan Akila, Chidambaram Yogapriya, Kuppusamy Maheshkumar","doi":"10.7224/1537-2073.2022-093","DOIUrl":"https://doi.org/10.7224/1537-2073.2022-093","url":null,"abstract":"Abstract Background: Individuals with multiple sclerosis (MS) commonly experience fatigue, discomfort, sleep problems, anxiety, and reduced quality of life. Studies have shown that foot reflexology can help relieve these symptoms. The objective of this current study is to systematically review the effects of foot reflexology on patients with MS. Methods: We conducted a systematic review of published literature in many databases, including PubMed, EMBASE, and Cochrane Library, from January 1, 2000, to January 27, 2022. With language restrictions, we included randomized controlled trials of foot reflexology interventions for MS that had any clinical or psychological symptom measurements as outcomes. The Cochrane risk-of-bias tool was used to assess evidence quality. Two authors independently screened titles and abstracts. Potential eligible articles were retrieved for full-text review. A third author checked for excluded records. All discrepancies were resolved through a discussion among the 4 reviewing authors. Results: A total of 154 studies were identified; 9 studies with 545 MS patients were included in this review. The most frequently reported findings of foot reflexology intervention in individuals with MS were reductions in fatigue, pain, muscle spasms, stiffness, and psychological symptoms and improvement in bowel and bladder functions and quality of life Conclusions: The findings suggest that foot reflexology could be a safe and effective modality to reduce the physical, and psychological symptoms and also improve the quality of life for individuals with MS; however, well-designed, large-scale trials are required to confirm the effect.","PeriodicalId":14150,"journal":{"name":"International journal of MS care","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135877987","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":"Assessment of Multiple Aspects of Upper Extremity Function Independent From Ambulation in Patients With Multiple Sclerosis.","authors":"Caspar E P van Munster,&nbsp;Burggraaff Jessica,&nbsp;Saskia Steinheimer,&nbsp;Christian P Kamm,&nbsp;Marcus D'Souza,&nbsp;Manuela Diederich,&nbsp;Jonas Dorn,&nbsp;Lorcan Walsh,&nbsp;Frank Dahlke,&nbsp;Ludwig Kappos,&nbsp;Bernard M J Uitdehaag","doi":"10.7224/1537-2073.2021-069","DOIUrl":"10.7224/1537-2073.2021-069","url":null,"abstract":"<p><strong>Background: </strong>Upper extremity function (UEF) is often compromised in multiple sclerosis (MS), although its importance is regularly underrecognized relative to ambulation. We explored the concurrent presence of impairment in UEF and ambulation by examining various aspects of UEF across different levels of ambulation.</p><p><strong>Methods: </strong>The cohort consisted of 247 patients with clinically definite MS or clinically isolated syndrome according to the revised 2010 McDonald criteria. The Nine-Hole Peg Test and the Expanded Disability Status Scale were used to stratify patients into clinically different subgroups. For UEF, cerebellar function (finger-to-nose test), pyramidal function (pronator drift test), and the ability to perform a task of activities of daily living (drinking-from-cup test) were examined. Patient-reported limitations of UEF in daily life were assessed using the Arm Function in Multiple Sclerosis Questionnaire.</p><p><strong>Results: </strong>Patients in more severely impaired ambulation groups displayed poorer performance on all UEF measures. Although most patients had normal to mild (n = 147) or moderate (n = 46) ambulatory impairment, 87.7% exhibited some level of UEF impairment as defined using the Nine-Hole Peg Test. Most patients had mild UEF impairment (n = 174), accounting for the largest proportion in all ambulation groups (51.9%-77.8%).</p><p><strong>Conclusions: </strong>A distinct pattern of impairment was found for ambulation and multiple aspects of UEF. Independent assessment of multiple aspects of disability may be helpful in treatment decision-making and could support the development of rehabilitation strategies that specifically target UEF impairment.</p>","PeriodicalId":14150,"journal":{"name":"International journal of MS care","volume":"25 5","pages":"226-232"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503816/pdf/i1537-2073-25-5-226.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LETTER FROM THE EDITOR","authors":"Francois Bethoux","doi":"10.7224/1537-2073-25.5.iv","DOIUrl":"https://doi.org/10.7224/1537-2073-25.5.iv","url":null,"abstract":"FRANCOIS BETHOUX, MDEDITOR IN CHIEFCleveland ClinicCleveland, Ohio, USAA few months ago, I took up rock climbing. Those who know me well will find the thought amusing. I am not that young (although vanity prevents me from disclosing my age here), not that fit, laden with anxiety and self-doubt, and the idea of going to the gym generates a mild gastric discomfort in me (please keep this between us, as I ask all my patients to overcome their reluctance to exercise). Above all, I’m afraid of heights; I gave up cleaning my gutters, and standing on the observation platform of the Empire State Building inevitably results in panic symptoms even though I know perfectly well that there is no danger. Yet, aside from walking, climbing is now my preferred form of exercise. I can’t help but draw a parallel with the daily experiences of the individuals with multiple sclerosis (MS) who entrust their care to us (keeping in mind that I do not speak from personal experience dealing with this unrelenting disease). Some of my patients’ feelings when facing a regular workday seem akin to my first perception of climbing a 40-ft wall, but after a realistic evaluation of one’s abilities and of the risks involved, it is often a matter of mindset, strategy, and teamwork. I was enticed by my daughter to take on this activity, and we have made it a family experience, cheering for each other. I learned to trust the safety equipment and the belayer. I also learned to focus on the task at hand (forgetting my fears for a moment) and to believe at least a little in myself, even if my performance isn’t always up to my expectations. I will not belabor my point here, but I consider this experience an opportunity to gain more respect and admiration for the resourcefulness of my patients in facing the consequences of MS.Disease-modifying therapies (DMTs) continue to be the mainstay of MS management. Although the advent of infusion therapies has allowed a closer monitoring of treatment adherence, many DMTs continue to be self-managed. In this issue of the International Journal of MS Care, the scoping review by Ben-Zacharia and colleagues summarizes evidence on factors related to treatment adherence, whereas Neter and Miller propose a personalized program to improve adherence. Medication adverse effects are consistently identified as impacting DMT adherence: Bou Rjeily and colleagues report on 2 cases of serum sickness–like reaction after infusion of ocrelizumab.In their analysis of 30-day all-cause hospital readmissions in individuals with neuromyelitis optica spectrum disorder, Padarti and colleagues highlight comorbid conditions as predictors of readmission. Although not identified as a factor in this particular study, sleep disorders are a very common comorbidity in individuals with MS and other central neuroimmune disorders. Behavioral interventions have emerged as potentially effective in some sleep-related symptoms. The systematic review by Siengsukon and colleagues summarizes t","PeriodicalId":14150,"journal":{"name":"International journal of MS care","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135348392","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":"Letter From the Editor.","authors":"Francois Bethoux","doi":"10.7224/1537-2073-25.5.vi","DOIUrl":"10.7224/1537-2073-25.5.vi","url":null,"abstract":"","PeriodicalId":14150,"journal":{"name":"International journal of MS care","volume":"25 5","pages":"vi"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503819/pdf/i1537-2073-25-5-vi.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10635159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using an Intervention Mapping Approach to Improve Adherence to Disease-Modifying Treatment in Multiple Sclerosis.","authors":"Efrat Neter,&nbsp;Ariel Miller","doi":"10.7224/1537-2073.2022-018","DOIUrl":"10.7224/1537-2073.2022-018","url":null,"abstract":"<p><strong>Background: </strong>Up to 50% of individuals with multiple sclerosis (MS) who are prescribed disease-modifying treatments (DMTs) do not take them as advised. Although many studies report on DMT adherence rate, few studies report on interventions involving individuals with MS. The current paper describes the development of an intervention aimed at improving adherence to DMTs among identified nonadherent individuals with MS.</p><p><strong>Methods: </strong>An intervention was developed using an Intervention Mapping approach, recommendations from reviews on medication adherence, and input from individuals with MS. Its content was determined by theories of health behavior (specifically, a perceptions and practicalities approach), empirical evidence collected among the specific target population (an observational \"needs assessment\" stage [n = 186]), and other studies.</p><p><strong>Results: </strong>A personalized intervention was tailored to the reasons for nonadherence, uncovered during the observational needs assessment stage, to be delivered sequentially by a neurologist and a psychologist. After the intervention objectives were identified, components of the intervention were set: psychoeducation and ways of coping with adverse effects; modification of unhelpful treatment beliefs (such modifications were found predictive of adherence in the observational phase of the study); improving confidence and self-efficacy; and developing strategies for remembering to take DMTs. These components were embedded within motivational interviewing.</p><p><strong>Conclusions: </strong>Intervention Mapping was useful in developing an intervention grounded both in the theoretical approach of perceptions and practicalities and in empirical evidence from the literature and the target sample; concurrently, identifying determinants that the intervention did not address. The effectiveness of the intervention-which could potentially improve adherence among individuals with MS-needs to be examined.</p>","PeriodicalId":14150,"journal":{"name":"International journal of MS care","volume":"25 5","pages":"206-213"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503812/pdf/i1537-2073-25-5-206.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Sickness/Serum Sickness-like Reactions Following Ocrelizumab Infusion in 2 Patients With Multiple Sclerosis.","authors":"Nicole Bou Rjeily,&nbsp;Bardia Nourbakhsh,&nbsp;Ellen M Mowry","doi":"10.7224/1537-2073.2022-080","DOIUrl":"10.7224/1537-2073.2022-080","url":null,"abstract":"<p><p>Serum sickness (SS) is a rare hypersensitivity reaction that can occur with monoclonal antibodies, and only 1 case of SS has been reported with ocrelizumab. We describe 2 patients with multiple sclerosis (MS) who developed SS/SS-like reactions (SSLRs) following ocrelizumab infusions. A man, aged 45 years, and a woman, aged 59 years, both with primary progressive MS, developed generalized weakness and arthralgias following their ocrelizumab infusions. Brain and spinal cord MRIs revealed no new or enhancing demyelinating lesions in both cases. They both had elevated inflammatory markers and negative infectious workups. They were subsequently treated for presumed SS with a steroid taper (and with potent anti-inflammatories in the second case), and symptoms improved dramatically after a few days. These cases suggest that SS/SSLRs should be suspected in a patient with new-onset arthralgia following ocrelizumab infusion who has an otherwise negative workup and rapid response to steroids.</p>","PeriodicalId":14150,"journal":{"name":"International journal of MS care","volume":"25 5","pages":"196-198"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503817/pdf/i1537-2073-25-5-196.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Disease-Modifying Therapy Adherence and Persistence in Multiple Sclerosis: A Scoping Literature Review.","authors":"Aliza Bitton Ben-Zacharia, Bryan Walker, Amy Perrin Ross, Carlo Tornatore, Natalie C Edwards, Yvette Lipman, Amy L Phillips","doi":"10.7224/1537-2073.2021-139","DOIUrl":"10.7224/1537-2073.2021-139","url":null,"abstract":"<p><strong>Background: </strong>Patients with multiple sclerosis (MS) receiving disease-modifying therapies (DMT) show published adherence rates of 27.0% to 93.8% and published persistence rates of 49.7% to 96.5%. Improvements in DMT adherence and persistence are key to optimizing MS care, and enhanced understanding could improve MS disease management and identify research gaps. This scoping literature review aims to examine the nature and findings of the literature evaluating factors associated with DMT adherence and persistence in patients with MS.</p><p><strong>Methods: </strong>Eligible articles included in the literature review were quantitative clinical studies written in English, included adherence or persistence as primary outcomes, and accounted for covariates/confounders. The articles were assessed to identify factors associated with adherence/persistence and analyzed according to DMT type (self-injectable, oral, infusion).</p><p><strong>Results: </strong>Fifty-eight studies (103,450 patients) were included. Study distribution by DMT type was self-injectable only (n = 41), oral only (n = 2), infusion only (n = 1), and more than 1 type (n = 14). Older age and previous DMT use were associated with increased adherence and/or persistence. Increased alcohol consumption, DMT adverse events, higher education, and higher body mass index were negatively associated with adherence and/or persistence. Greater number and severity of relapses was associated with increased adherence but decreased persistence.</p><p><strong>Conclusions: </strong>Most studies examined factors associated with adherence and persistence to self-injectable DMTs. These factors should be evaluated further for oral and infusion DMTs. Insights into the modifiable factors associated with adherence and persistence could guide treatment decisions and help improve adherence and clinical outcomes.</p>","PeriodicalId":14150,"journal":{"name":"International journal of MS care","volume":"25 5","pages":"188-195"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503813/pdf/i1537-2073-25-5-188.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diversity, Equity, and Inclusion in the Multiple Sclerosis Community: A Call to Action.","authors":"Carrie M Hersh,&nbsp;Sarah A Morrow,&nbsp;Mitzi Joi Williams,&nbsp;Lilyana Amezcua,&nbsp;June Halper,&nbsp;Katherine Wandersee","doi":"10.7224/1537-2073.2023-039","DOIUrl":"10.7224/1537-2073.2023-039","url":null,"abstract":"<p><p>Many medical organizations have begun to confront the longstanding problem of inequalities in health care delivery and the undeniable effect of disparities on health outcomes. The Consortium of Multiple Sclerosis Centers (CMSC) recognizes that disparities affect the lives of many people with multiple sclerosis (MS) and acknowledges the need to address this as an organization. The CMSC recently (1) appointed a task force, (2) conducted a survey of its membership, (3) commissioned this review article and call to action, and (4) formulated a mission statement on diversity, equity, and inclusion (DEI), which was adopted by the CMSC's Board of Governors in March 2023. This paper summarizes recent literature on health care disparities in MS, particularly those relating to race/ethnicity, sexual orientation, and gender identity. It presents findings from CMSC's survey of members' awareness of DEI issues, the need for education and resources for MS care providers, and existing institutional policies on DEI in the members' practice settings. It also presents the task force's recommendations for next steps, which includes the goal of greater diversity in the MS workforce of the future. The CMSC will continue to revisit DEI policies and practices over time with the goal of motivating greater awareness, momentum, and positive changes within the MS community.</p>","PeriodicalId":14150,"journal":{"name":"International journal of MS care","volume":"25 5","pages":"199-205"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503818/pdf/i1537-2073-25-5-199.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Readmission Rates in Patients With Neuromyelitis Optica Spectrum Disorder.","authors":"Akhil Padarti,&nbsp;Amod Amritphale,&nbsp;William Kilgo","doi":"10.7224/1537-2073.2022-049","DOIUrl":"10.7224/1537-2073.2022-049","url":null,"abstract":"<p><strong>Background: </strong>Neuromyelitis optica spectrum disorder (NMOSD) is an aggressive central nervous system astrocytopathy often resulting in rapid neurologic decline. Patients have recurrent flares that require immunomodulatory therapy for relapse prevention. These patients are usually hospitalized and may need rehospitalization after decline. Hospital readmission rates are important indicators that can be used to gauge health care quality and have direct implications on hospital compensation. This study aims to identify high-risk characteristics of patients with NMOSD that can be used to predict hospital readmissions.</p><p><strong>Methods: </strong>The 2017 Nationwide Readmissions Database was searched for hospital admissions for NMOSD in the United States. All patients with hospital readmission within 30 days of discharge from the index hospitalization were included.</p><p><strong>Results: </strong>The 30-day all-cause readmission rate for NMOSD was 11.9% (95% CI, 10.6%-13.3%). Patients aged 65 to 74 years had higher odds of readmission; those with private insurance had decreased odds. Sex did not affect readmission. Several comorbidities, such as respiratory failure, peripheral vascular disease, neurocognitive disorders, and neurologic blindness, were predictive of readmissions. Plasma exchange increased the odds of readmission, whereas intravenous immunoglobulin and immunomodulatory infusions, such as chemotherapies and monoclonal antibodies, did not affect readmission.</p><p><strong>Conclusions: </strong>The most common etiologies for 30-day read-mission were neurologic, infectious, and respiratory. Treatment targeted toward these etiologies may result in reduced overall readmission, thereby decreasing overall disease burden.</p>","PeriodicalId":14150,"journal":{"name":"International journal of MS care","volume":"25 5","pages":"221-225"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503814/pdf/i1537-2073-25-5-221.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}