Journal of geriatric oncology最新文献

{"title":"Evaluation of the Distress Thermometer in older patients with cancer","authors":"Charlotte Zuber ,&nbsp;Kristine Swartz ,&nbsp;Andrew E. Chapman ,&nbsp;Lora Rhodes ,&nbsp;Ting Ting Zhan ,&nbsp;Kuang-Yi Wen","doi":"10.1016/j.jgo.2025.102221","DOIUrl":"10.1016/j.jgo.2025.102221","url":null,"abstract":"<div><h3>Introduction</h3><div>The Geriatric Depression Scale is a useful tool in screening for depression in older adults, a particularly vulnerable population in oncology. The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) has been validated as a fast and effective screening tool for psychological distress in general oncology populations, and it could possibly be used as a surrogate for the longer Geriatric Depression Scale (GDS) test in older adults with cancer.</div></div><div><h3>Materials and Methods</h3><div>In this retrospective cross-sectional study in older adults prior to starting cancer treatment, we evaluated the relationship between the DT and GDS by comparing 242 older adults with cancers' DT scores to their GDS scores, used receiver operating characteristic analysis to determine a DT cutoff score, and used logistic regression to identify variables associated with higher distress.</div></div><div><h3>Results</h3><div>The Spearman correlation coefficient between GDS and DT was 0.41, <em>p</em> &lt; 0.001. A cutoff score of 4 was found to be most sensitive and specific (0.66,0.68) for predicting a positive GDS (c-index = 0.70).</div></div><div><h3>Discussion</h3><div>These results indicate the potential utility of the DT as a mildly to moderately effective screening tool for depression in older adults with cancer starting treatment and support the current NCCN cutoff guidelines to indicate the need for additional distress interventions.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 4","pages":"Article 102221"},"PeriodicalIF":3.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on prehabilitation for older adults with cancer: A report from the International Society of Geriatric Oncology (SIOG) rehabilitation group","authors":"Efthymios Papadopoulos ,&nbsp;Rachelle Brick ,&nbsp;Ailsa Sirois ,&nbsp;Bérengére Beauplet ,&nbsp;Kelley C. Wood ,&nbsp;Hannah Furness ,&nbsp;Caitriona Barrett ,&nbsp;Aida Ward ,&nbsp;Jane Murphy ,&nbsp;Megan Pattwell ,&nbsp;Erna Carmen Navarrete ,&nbsp;Kate Williams ,&nbsp;Kristen Haase","doi":"10.1016/j.jgo.2025.102224","DOIUrl":"10.1016/j.jgo.2025.102224","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102224"},"PeriodicalIF":3.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629326","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":"Unsupervised learning to identify symptom clusters in older adults undergoing chemotherapy","authors":"Erika Ramsdale ,&nbsp;Yilin Zhou ,&nbsp;Lisa Smith ,&nbsp;Huiwen Xu ,&nbsp;Rachael Tylock ,&nbsp;Marie Flannery ,&nbsp;Supriya Mohile ,&nbsp;Ajay Anand","doi":"10.1016/j.jgo.2025.102222","DOIUrl":"10.1016/j.jgo.2025.102222","url":null,"abstract":"<div><h3>Introduction</h3><div>Unsupervised machine learning (ML) approaches such as clustering have not been commonly applied to patient-reported data. This study describes ML methods to explore and describe patient-reported symptom trajectories in older adults receiving chemotherapy.</div></div><div><h3>Materials and Methods</h3><div>This secondary analysis of prospectively collected data from the GAP 70+ Trial (<span><span>NCT02054741</span><svg><path></path></svg></span>; PI: Mohile) collected patient-reported symptoms at baseline (pre-chemotherapy), six weeks, three months, and six months. Complete patient-reported symptom data were available for at least one timepoint for 708/718 patients (98.6 %). Correlation analysis was performed on all symptom items. Multiple clustering algorithms were applied to selected baseline symptoms as an exploratory analysis, using gap statistic and elbow plots to understand optimal cluster numbers for each algorithm. Silhouette scores and t-stochastic neighbor embedding (t-SNE) plots were generated for each algorithm. Hierarchical agglomerative clustering was applied to symptoms at each timepoint, and clusters generated for each timepoint were examined longitudinally utilizing statistical measures, violin plots, and a Sankey diagram.</div></div><div><h3>Results</h3><div>Twenty-six patient-reported items were used for clustering analyses, representing symptom severity and interference. There was significant variability in how different unsupervised learning algorithms clustered the baseline symptom data. Silhouette scores ranged from −0.22 (OPTICS) to 0.16 (BIRCH). Examining agglomerative clustering across timepoints, cluster composition was largely driven by the symptom sum score (i.e., adding the Likert-scale scores). Most patients had “low” symptoms at baseline that remained low, but symptom trajectory was otherwise heterogeneous. A small number of patients had high hand-foot/neuropathy symptoms (but low other symptoms) at six weeks, and another small cluster had high mucosal toxicity at six months. Despite specific symptom patterns in these small clusters, chemotherapy regimens varied.</div></div><div><h3>Discussion</h3><div>Unsupervised machine learning techniques may be helpful to understand longitudinal patient-reported data such as symptoms. They permit data-driven exploration, which may uncover patterns to inform hypotheses or further analysis (e.g., outcome prediction). Results of clustering analyses should be validated through further hypothesis-driven analysis. In this analysis, it was challenging to uncover consistent symptom patterns, though it suggests symptom composite (sum) scores may warrant further investigation. Clinicians should understand the philosophy, strengths, and limitations of an unsupervised machine learning approach applied to patient data.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102222"},"PeriodicalIF":3.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term mortality in older (≥70 years) patients with early breast cancer treated with neo‐/adjuvant chemotherapy: A Swedish nationwide retrospective population-based study","authors":"Christine Lundgren ,&nbsp;Kristina Engvall ,&nbsp;Irma Fredriksson ,&nbsp;Antonios Valachis","doi":"10.1016/j.jgo.2025.102220","DOIUrl":"10.1016/j.jgo.2025.102220","url":null,"abstract":"<div><h3>Introduction</h3><div>There are substantial differences in the utilization of chemotherapy between younger and older patients, mainly due to the higher risk for adverse events among older patients. Short-term mortality after chemotherapy could reveal fatal side effects of treatment. The aim of this study was to explore the impact of treatment setting (neoadjuvant vs. adjuvant) and different chemotherapeutic agents on short-term mortality among older patients with early breast cancer.</div></div><div><h3>Material and Methods</h3><div>The population-based, national, research database BCBaSe 3.0 was used as a data source to identify older (≥70 years old) patients with stage I–III breast cancer, diagnosed between 2008 and 2019, who received neoadjuvant or adjuvant chemotherapy. Primary outcome was short-term mortality defined as death due to any cause within one year after breast cancer diagnosis. Multivariable logistic regression analysis was applied to investigate the impact of treatment setting and different chemotherapeutic agents (anthracycline-based vs. taxane-based vs. sequential anthracyclines and taxanes) on outcome, adjusted for potential confounders.</div></div><div><h3>Results</h3><div>In total, 4,072 older patients were treated with neoadjuvant or adjuvant chemotherapy and median age was 73 years (quartile [Q]1–Q3; 71–75). The one-year mortality rate was 1.5 % (95 % confidence interval [CI]: 1.2–1.9 % [63 of 4072 patients]). Risk factors independently associated with one-year mortality were older age, larger tumor size, positive nodal status, presence of triple negative breast cancer, and use of neoadjuvant as compared to adjuvant chemotherapy (odds ratio [OR]: 2.00, 95 % CI: 1.04–3.84). No association was found between type of chemotherapeutic regimen and one-year mortality. Median time to death was 7 months (interquartile range: 5–9). The reason for death was mainly classified as breast cancer-related (neoadjuvant: 78 %, <em>n</em> = 14; adjuvant: 49 %, <em>n</em> = 22), followed by potential treatment-related deaths (neoadjuvant: 11 %, n = 2; adjuvant: 27 %, <em>n</em> = 12).</div></div><div><h3>Discussion</h3><div>The short-term mortality rate at first year after diagnosis among older (≥70 years) patients with breast cancer was relatively low. The higher risk among patients treated with neoadjuvant chemotherapy could be attributed to residual confounding and deserves further evaluation. The low risk of potential treatment-associated death suggests that chemotherapy in this respect is safe, and older patients should not be disqualified for this treatment.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102220"},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty predicts treatment-related toxicity and discontinuation in older adults with chronic lymphocytic leukemia treated with BTK and BCL-2 inhibitors: Findings from a prospective single-center cohort study","authors":"Enrica Antonia Martino ,&nbsp;Ernesto Vigna ,&nbsp;Paola De Luca ,&nbsp;Antonella Bruzzese ,&nbsp;Caterina Labanca ,&nbsp;Francesco Mendicino ,&nbsp;Eugenio Lucia ,&nbsp;Virginia Olivito ,&nbsp;Valentina Fragliasso ,&nbsp;Antonino Neri ,&nbsp;Fortunato Morabito ,&nbsp;Andrea Corsonello ,&nbsp;Massimo Gentile","doi":"10.1016/j.jgo.2025.102219","DOIUrl":"10.1016/j.jgo.2025.102219","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic lymphocytic leukemia (CLL) particularly impacts older adults with multiple comorbidities. The advent of targeted therapies has improved outcomes, but challenges related to treatment adherence and drug interactions persist. Assessment of frailty is recommended to tailor treatment, though its application in clinical settings is often limited due to its complexity. This study aimed to investigate the predictive value of frailty regarding treatment toxicity and discontinuation in older patients with CLL treated with targeted therapies.</div></div><div><h3>Materials and Methods</h3><div>This prospective cohort study involved 82 older adults with CLL (≥65 years) treated with Bruton's tyrosine kinase inhibitors (BTKi) or BCL-2 inhibitors (BCL-2i) from November 2018 to February 2024. Patients were assessed by the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) within a week before starting treatment. Demographics, CLL characteristics, comorbidities, and treatment-related adverse events were collected. Statistical analyses included receiver operating characteristic (ROC) curve analysis to determine the optimal cut-off for predicting treatment discontinuation due to toxicity.</div></div><div><h3>Results</h3><div>The median age of patients was 75 years. Most patients (90.2 %) were at Binet stage B/C, with 14.6 % having 17p deletion and 17.1 % <em>TP53</em> mutations. Overall, 46 patients experienced treatment-related toxicity. The ROC curve analysis showed that the best cut-off for predicting treatment-related toxicity was a CSHA CFS &gt;3. The accuracy was fair, with an area under the curve (AUC) of 0.695 (95 % CI 0.55–0.84; <em>P</em> = 0.02), sensitivity = 85 % and specificity = 53 %. Patients with a score &gt; 3 experienced higher rates of treatment discontinuation (28.6 %) compared to those with a score ≤ 3 (12.5 %; <em>P</em> &lt; 0.05). Other factors such as polypharmacy, cumulative illness rating, and comorbidity indices did not significantly affect treatment discontinuation rates.</div></div><div><h3>Discussion</h3><div>The CSHA CFS is a feasible tool for identifying older adults with CLL at higher risk of treatment toxicity and discontinuation. Patients with a CFS &gt;3 had a significantly higher likelihood of treatment interruption due to adverse effects. Therefore, CSHA CFS can aid in stratifying patients and optimizing therapeutic strategies. Further validation in multicenter studies is warranted to confirm these results and explore the potential for adjusting treatment dosages based on frailty assessments in the era of targeted therapies.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102219"},"PeriodicalIF":3.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578383","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":"Feasibility of home step-tracking using wearable devices for older adults undergoing thoracic surgery: A brief report","authors":"Anupama Singh ,&nbsp;Mary E. Cooley ,&nbsp;Emanuele Mazzola ,&nbsp;Ashley L. Deeb ,&nbsp;Miles McAllister ,&nbsp;Fatemehsadat Pezeshkian ,&nbsp;Clark DuMontier ,&nbsp;Laura N. Frain ,&nbsp;Paula Ugalde Figueroa ,&nbsp;Desiree Steimer ,&nbsp;Michael T. Jaklitsch","doi":"10.1016/j.jgo.2025.102218","DOIUrl":"10.1016/j.jgo.2025.102218","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 3","pages":"Article 102218"},"PeriodicalIF":3.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534306","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":"Disparities in electronic health record patient portal activation and use among people with hematological malignancies","authors":"Angela M. Trammel ,&nbsp;Bryan A. Sisk ,&nbsp;Mark A. Fiala","doi":"10.1016/j.jgo.2024.102135","DOIUrl":"10.1016/j.jgo.2024.102135","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102135"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review of nutrition interventions in older patients with cancer: A synthesis of evidence and a future research priority","authors":"Brenton J. Baguley ,&nbsp;Hannah Arnold ,&nbsp;Ashlee Bence ,&nbsp;Emma Bryant ,&nbsp;Eliza Martino ,&nbsp;Kiara Stojanoski ,&nbsp;Samantha Ackerly ,&nbsp;Erin Laing ,&nbsp;Jessica Jong ,&nbsp;Nicole Kiss ,&nbsp;Jenelle Loeliger","doi":"10.1016/j.jgo.2024.102181","DOIUrl":"10.1016/j.jgo.2024.102181","url":null,"abstract":"<div><h3>Introduction</h3><div>Older patients with cancer (65 years and older) are a growing population with unique nutrition-and treatment-related issues that accelerate aging. Nutrition interventions attenuate nutritional decline, muscle loss, and risk of malnutrition and sarcopenia in patients with cancer, however the evidence for older patients with cancer is limited. The aim of this systematic review was to evaluate the efficacy of nutrition interventions on nutritional status, body weight/composition and clinical outcomes in older patients with cancer and to identify future research priority areas.</div></div><div><h3>Materials and Methods</h3><div>Three databases were systematically searched from inception until January 2024. Eligible studies were randomised controlled trials (RCT) evaluating a nutrition intervention in older patients with cancer that reported nutrition-related and clinical outcomes. Studies including older patients were determined by the mean age ≥ 65 years with the error to the mean &gt; 60 years. Between-group differences in nutritional and clinical outcomes were extracted.</div></div><div><h3>Results</h3><div>Eleven studies describing nine RCTs were included in this review. Three trials specifically included patients 65 years and older. Most interventions intended to reduce malnutrition risk across a mix of cancer types and treatments, and one trial was designed to reduce comorbidities after treatment. Changes in dietary intake (<em>n</em> = 4), nutrition status (<em>n</em> = 1), weight (<em>n</em> = 5), and muscle mass (<em>n</em> = 3) were inconsistently reported, but preliminary evidence showed dietary counselling with oral nutrition supplements (ONS) resulted in improved weight maintenance in patients with pancreatic cancer. There was limited evidence of a benefit from nutrition interventions on treatment tolerance or quality of life. The heterogeneous findings in methodological design, including dietary prescription and frequency of consultations and reporting of outcomes, inhibits evidence-based recommendations for older adults with cancer.</div></div><div><h3>Discussion</h3><div>Nutrition interventions designed specifically to address nutrition-related issues unique to older patients with cancer is a clear research priority. Research specifically targeting older patients post treatment, a period during which treatment-related side effects still occur, is limited. To support the growing population of older patients with cancer, future research must consistently report the dietary prescription, adherence to nutritional requirements, and clearly-defined nutrition-related parameters and clinical outcomes that are specific to older patients.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102181"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving beyond studying mere association: A methodological perspective","authors":"Sophie Pilleron","doi":"10.1016/j.jgo.2024.102178","DOIUrl":"10.1016/j.jgo.2024.102178","url":null,"abstract":"","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102178"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828714","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":"Examining unmet needs in older adults with lung cancer: A systematic review and narrative synthesis","authors":"Nicole Knox ,&nbsp;Meera R. Agar ,&nbsp;Shalini Vinod ,&nbsp;Louise Hickman","doi":"10.1016/j.jgo.2024.102161","DOIUrl":"10.1016/j.jgo.2024.102161","url":null,"abstract":"<div><h3>Introduction</h3><div>Unmet needs in the older population with cancer are complex due to aging-related health conditions. A review of unmet needs in older people with cancer showed that needs varied among different cancer types. In lung cancer, a higher incidence of geriatric syndromes and comorbidities exist compared to other cancer cohorts, impacting treatment tolerance and completion. Consequently, it is crucial to identify and understand unmet needs to address supportive care needs beyond cancer diagnosis and treatment. This systematic review aims to synthesise the available literature to analyse the number and nature of unmet needs experienced by older patients with lung cancer.</div></div><div><h3>Materials and Methods</h3><div>We performed a systematic search following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, which was registered in PROSPERO(CRD42022311105). We searched CINAHL, Medline, Embase, and Scopus electronic databases for published literature (January 2002 to November 2023) on unmet needs of patients ≥65 years diagnosed with lung cancer. We used a narrative synthesis approach to summarise the results and identify themes.</div></div><div><h3>Results</h3><div>The search yielded 1356 articles, of which 35 met the inclusion criteria. A significant portion of older patients with lung cancer reported experiencing unmet needs, ranging from 78 % to100 %. Compared to other cancer streams, older patients with lung cancer experienced a higher burden of unmet needs, with a mean of seven unmet needs per person. Most studies identified psychological and physical/daily living domains as having the greatest prevalence and highest burden of unmet need.</div></div><div><h3>Discussion</h3><div>Increased psychological distress and poorer quality of life correlated with increased unmet needs. Identifying and addressing unmet needs is critical for patient wellbeing and should be prioritised when developing models of care and tailored interventions for older people with lung cancer.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"16 2","pages":"Article 102161"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}