Journal of Emergency Medicine最新文献

{"title":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(25)00086-1","DOIUrl":"10.1016/S0736-4679(25)00086-1","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 170-171"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Down the Wrong Pipe: Tension Pneumoperitoneum from Esophageal Intubation","authors":"Joshua Julian BA ,&nbsp;Joseph Wendt MD ,&nbsp;Tina Chen MD","doi":"10.1016/j.jemermed.2024.09.019","DOIUrl":"10.1016/j.jemermed.2024.09.019","url":null,"abstract":"<div><h3>Background</h3><div>Tension pneumoperitoneum (TPP) is a rare but life-threatening pathology in which significant accumulation of free air in the peritoneum pressurizes the abdominal cavity, creating conditions similar to abdominal compartment syndrome. Due to compression of intra-abdominal vasculature, TPP results in hemodynamic instability. While it most commonly occurs due to viscus perforation in the setting of recent endoscopy, gastric perforation from resuscitative efforts can also lead to TPP.</div></div><div><h3>Case Report</h3><div>We present a case of a 58-year-old female who was intubated out-of-hospital for unresponsiveness, then subsequently developed abdominal distension, mottled lower extremities, and hemodynamic instability. In the emergency department, the patient self-extubated for a brief time before suffering cardiac arrest. During resuscitative efforts, imaging showed significant abdominal free air concerning for tension pneumoperitoneum. The likely etiology was positive pressure ventilation after esophageal intubation, resulting in gastric perforation and rapid accumulation of air in the peritoneal cavity. Despite emergent abdominal needle decompression and prompt exploratory surgery, the patient expired.</div></div><div><h3>Why should an Emergency Physician be aware of this?</h3><div>TPP is a critical pathology that should be on the differential for any patient with recent unverified intubation presenting with hemodynamic instability and abdominal distension. Abdominal needle decompression is a key intervention for the patient with TPP and should be in the emergency physician's skillset. It is also a reminder that intubated patients require confirmation of correct endotracheal tube placement to prevent negative outcomes.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 134-138"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Salicylate Poisoning Due to Teaberry Flavoring Ingestion: A Case Report","authors":"Jarod Berggren MD ,&nbsp;Chase Jones MD ,&nbsp;Kenneth D. Katz MD","doi":"10.1016/j.jemermed.2024.09.022","DOIUrl":"10.1016/j.jemermed.2024.09.022","url":null,"abstract":"<div><h3>Background</h3><div>There are currently many commercial uses for methyl salicylate, including fragrances, flavoring, topical pain relief, and polymer restoration. Most recorded cases of human toxicity due to methyl salicylate are the result of topical or accidental exposures. However, this is a previously unreported case of an adult patient who intentionally ingested teaberry flavoring, causing life-threatening salicylism.</div></div><div><h3>Case Report</h3><div>A 22-year-old man presented to the emergency department with the chief symptoms of nausea, vomiting, and abdominal pain. Triage nursing noted the patient's vomit smelled strongly of wintergreen. Further history indicated the patient had ingested approximately 40 mL of teaberry oil while using it to make ice cream. The initial serum salicylate concentration was 111 mg/dL. The medical toxicology team was consulted, and the patient was given a singular dose of activated charcoal by mouth. He was also administered both an intravenous sodium bicarbonate bolus and sodium bicarbonate infusion. He was admitted to the intensive care unit and the nephrology service was consulted to initiate emergent hemodialysis. After the single hemodialysis treatment with concomitant serum and urine alkalization, the patient had progressive improvement of salicylate concentrations. He was discharged on hospital day 3 in normal condition.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Emergency physicians should be aware of novel etiologies of life-threatening salicylate poisoning.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 98-100"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonresponse Bias Against the Underserved in Emergency Department Patient Experience Surveys: A Cross-Sectional Analysis","authors":"Tony Zitek MD ,&nbsp;Luke Weber MD ,&nbsp;Daniel Aloise MD ,&nbsp;Adam Roitman BS ,&nbsp;Claudia Corbea BS ,&nbsp;Dana Sherman DNP, APRN ,&nbsp;Tatiana Nunez MD ,&nbsp;Luis Puron DO ,&nbsp;Michael Shalaby MD ,&nbsp;Frayda Kresch MD ,&nbsp;David A. Farcy MD","doi":"10.1016/j.jemermed.2024.08.017","DOIUrl":"10.1016/j.jemermed.2024.08.017","url":null,"abstract":"<div><h3>Background</h3><div>Patient experience scores are used to assess emergency physicians, but only a small fraction of patients actually respond to patient experience surveys. No prior studies have determined patient characteristics that predict emergency department (ED) patient experience survey response.</div></div><div><h3>Objectives</h3><div>To determine which patient characteristics are associated with ED patient experience survey response.</div></div><div><h3>Methods</h3><div>This was a cross-sectional analysis of a random sample of 2500 patients from our hospital system who were discharged from an ED between January 1 and June 30, 2022. Our hospital system has one hospital-based ED and two freestanding EDs, one of which is in an economically disadvantaged area. For each randomly selected patient, we used chart review to gather the following data points: ED visited, patient age, gender, race, preferred language, primary residence, time of arrival, marital status, health insurance, and emergency severity index for that visit. We used multivariable logistic regression to determine which of those variables were associated with patient experience survey response.</div></div><div><h3>Results</h3><div>Among 2500 patients sent surveys, 207 (8.3%) responded. Those with the lowest response rates were from a freestanding ED in an economically disadvantaged area (5.9%), were uninsured (4.9%), or were homeless (2.1%). On multivariable analysis, adjusted odds ratios for survey response for those characteristics were as follows: 0.54 (95% CI 0.33–0.84), 0.56 (95% CI 0.34–0.90), and 0.30 (95% CI 0.02–1.44), respectively.</div></div><div><h3>Conclusion</h3><div>Multiple markers of lower socioeconomic status were associated with decreased patient experience survey response rates, suggestive of nonresponse bias against these individuals.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 160-167"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Woman with Recurrent Headaches","authors":"Chad Stanley MD, MA ,&nbsp;Richard Newman DO ,&nbsp;Farid Khasiyev MD ,&nbsp;Cindy C. Bitter MD, MPH","doi":"10.1016/j.jemermed.2024.09.014","DOIUrl":"10.1016/j.jemermed.2024.09.014","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 149-150"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperbaric Oxygen Therapy: An Evidence-Based Primer for Emergency Physicians","authors":"Margot Samson MD ,&nbsp;Michael Gottlieb MD ,&nbsp;Christopher Logue MD ,&nbsp;Daniel Popa MD, PhD","doi":"10.1016/j.jemermed.2024.09.009","DOIUrl":"10.1016/j.jemermed.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Hyperbaric medicine is a subspecialty that many emergency physicians may not encounter frequently in their daily practice. As such, we hope to provide a review, where we present an overview of hyperbaric oxygen therapy, complications from the therapy, and a description of how the treatments are administered. We also discuss seven emergency indications that may benefit from transfer to a hyperbaric facility for treatment.</div></div><div><h3>Objective of the Review</h3><div>Our aim is to provide an overview of hyperbaric oxygen therapy as it pertains to an emergency physician. We hope that this review will help emergency physicians identify conditions that may benefit from transfer to a hyperbaric facility.</div></div><div><h3>Discussion</h3><div>We discuss seven emergency conditions that may benefit from transfer to a hyperbaric facility for management—decompression sickness, arterial gas embolism, central retinal artery occlusion, carbon monoxide poisoning, crush injury, necrotizing soft tissue infection, and symptomatic anemia. We also describe special considerations for how to transfer patients needing evaluation by a hyperbaric physician.</div></div><div><h3>Conclusions</h3><div>This review aims to describe hyperbaric oxygen therapy, identify conditions that may benefit from treatment with hyperbaric oxygen, and discuss management of patients with those conditions as it pertains to an emergency physician.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 35-44"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Cohort Study of Tranexamic Acid Administration for the Treatment of Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema in the Emergency Department","authors":"Michael Loewe MD ,&nbsp;Eric Rowley MD ,&nbsp;Joel Mosley MD ,&nbsp;Benjamin Gibson MD ,&nbsp;Michael Cerjance MD ,&nbsp;Elizabeth Pearson MD ,&nbsp;Greggory Davis PhD","doi":"10.1016/j.jemermed.2024.10.001","DOIUrl":"10.1016/j.jemermed.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Treatment options for angiotensin-converting enzyme inhibitor-induced angioedema (ACEi-AE) are primarily limited to airway monitoring and protection with intubation. The efficacy of tranexamic acid (TXA) in this context remains poorly understood.</div></div><div><h3>Objective</h3><div>Examine outcomes among patients treated with and without TXA for ACEi-AE.</div></div><div><h3>Methods</h3><div>A retrospective cohort study conducted in two hospitals examined emergency department patients with suspected ACEi-AE from 2017 to 2021. Primary outcomes included intensive care unit (ICU) admission, intubation, days intubated, time to administration of TXA, surgical airway required, and death in patients that received TXA compared with those that did not.</div></div><div><h3>Results</h3><div>Of 336 eligible patients, 37 received TXA and 299 did not. ICU admission rate was significantly higher in the TXA group (57%) vs. the no-TXA group (15%), odds ratio (OR) 7.61 (95% confidence interval [CI] 3.69–15.70). There were significantly more intubations in the TXA group (20%) vs. the no-TXA group (5.7%), OR 3.87 (95% CI 1.49–10.08). The median time to TXA administration was 51 min (interquartile range 34–131). The number of days intubated, surgical airway, and 30-day mortality were not significantly different in the TXA group compared with the no-TXA group.</div></div><div><h3>Conclusion</h3><div>TXA use did not improve many of the clinical outcomes involved in the treatment of ACEi-AE. One interpretation of these results may be that TXA use was associated with patients who presented with more severe disease, as TXA use was up to the discretion of the treating physician. Randomized controlled trials are needed to clarify the efficacy of TXA use in ACEi-AE.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 101-109"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Point-of-Care Ultrasound to Assess Gastrostomy Balloon Placement","authors":"Nithin S. Ravi MD, MPH ,&nbsp;Rakesh D. Mistry MD, MS ,&nbsp;Jonathan Orsborn MD ,&nbsp;Mairead Dillon MB ,&nbsp;Jeffrey Tutman MD ,&nbsp;Kari Hayes MD ,&nbsp;Carmelle Wallace MD, MPH, DTMH ,&nbsp;Jeremiah T. Lowe MD, MSC ,&nbsp;Tien Vu MD","doi":"10.1016/j.jemermed.2024.09.017","DOIUrl":"10.1016/j.jemermed.2024.09.017","url":null,"abstract":"<div><h3>Background</h3><div>Fluoroscopy is the gold standard for evaluation of gastrostomy tube (GT) placement, though it is costly and resource-intensive. Point-of-care ultrasound (POCUS) has potential as a low-risk alternative to confirm GT placement.</div></div><div><h3>Objective</h3><div>To determine the diagnostic accuracy of POCUS for identification of correct gastrostomy balloon placement as compared to fluoroscopy.</div></div><div><h3>Methods</h3><div>This was a prospective convenience sample of children presenting to interventional radiology for routine GT or gastrojejunal (GJ) tube exchange. Prior to exchange, POCUS operators scanned and interpreted ultrasound images for GT placement, followed by fluoroscopy. A blinded radiologist interpreted fluoroscopic studies. Diagnostic test characteristics, concordance with 95% confidence intervals, and interrater agreement (Cohen's Kappa) between POCUS and fluoroscopy were calculated.</div></div><div><h3>Results</h3><div>Four (3%) of 118 evaluated GT balloons were displaced. Compared to fluoroscopy, novice POCUS assessment of GT/GJ balloon placement had a sensitivity of 87% (79%–92%), specificity of 25% (1%–81%), PPV of 97% (92%–99%), NPV of 6% (1%–30%), proportion agreement of 85%, (77%-91%) kappa 0.04. Expert POCUS interpretation exhibited sensitivity of 91% (84%, 96%), proportion agreement of 89% (82%-94%), kappa 0.09. pH testing had the highest sensitivity of 93% (85%, 97%), proportion of agreement 92% (84%-97%) and kappa 0.19.</div></div><div><h3>Conclusion</h3><div>POCUS demonstrated a high sensitivity and concordance for GT/GJ balloon placement, with low interrater agreement with fluoroscopy. POCUS may not add additional clinical benefit in routine evaluation of GTs over current standards of care. However, POCUS may serve as a useful screening test in settings where fluoroscopy is unavailable or pH is unobtainable.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 110-116"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Prospective, System-Wide Intervention to Influence Opioid Prescribing Practices Among Patients with Back Pain","authors":"Virgenal Owens,&nbsp;Meghan K. Wally,&nbsp;Ziqing Yu,&nbsp;Daniel Leas,&nbsp;Rebecca Henson,&nbsp;Rachel B. Seymour,&nbsp;Joseph R. Hsu,&nbsp;Susan Odum,&nbsp;PRIMUM Group","doi":"10.1016/j.jemermed.2024.08.013","DOIUrl":"10.1016/j.jemermed.2024.08.013","url":null,"abstract":"<div><h3>Background</h3><div>In response to the opioid epidemic, our multidisciplinary team designed and integrated an alert-based, clinical-decision support intervention which identifies patients at risk of opioid misuse based on five evidence-based risk factors (early refill of opioids/benzodiazepines; &gt;2 ED/Urgent Care visits with onsite opioids; &gt;3 prescriptions of opioids/benzodiazepines; prior overdose; and positive toxicology screen).</div></div><div><h3>Objective</h3><div>To evaluate the impact of the intervention on prescribing decisions for back pain by measuring the percent of opioid prescriptions modified in response to the alert.</div></div><div><h3>Methods</h3><div>A total of 93,192 adult patients presenting to the emergency department with complaints of back pain from 2017–2021 were included in this prospective, observational study. We calculated rates of “decision influenced” (modifying or canceling prescriptions) in response to the PRIMUM intervention and characterized patients, encounters, and prescriptions in this population.</div></div><div><h3>Results</h3><div>The 30.2% of back pain patients received an opioid prescription. Among patients prescribed opioids, 18.6% had a risk factor. An alert fired in 6,501 (19.8%) encounters, and positive toxicology was the most common risk factor (52.1%). The prescriber decision was influenced in 430 of these encounters overall (6.6%) and was highest for three or more prescriptions in the past month (11.8%) and early refill (9.1%). Chronic patients were more likely to receive opioids.</div></div><div><h3>Conclusions</h3><div>Roughly 1 in 3 patients presenting to the emergency department for back pain received an opioid. A clinical decision support intervention to identify patients at risk of opioid use disorder had a minimal influence on opioid prescribing decisions in this population.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 1-9"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Acute Kidney Injury After Exposure to Intravenous Contrast in Emergency Department Patients Presenting for Stroke","authors":"Imran Faruqi MD ,&nbsp;Terrell Caffery MD ,&nbsp;Maddie Colter MD ,&nbsp;Cameron Williams MD ,&nbsp;Ashley Trent MD ,&nbsp;Douglas Cushner MD ,&nbsp;Jacob Nelson BS ,&nbsp;Greggory Davis PhD","doi":"10.1016/j.jemermed.2024.09.012","DOIUrl":"10.1016/j.jemermed.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) is to be considered an independent risk factor for developing post-computed tomography (CT) acute kidney injury (AKI); however, current data are limited.</div></div><div><h3>Objectives</h3><div>Examine the incidence of AKI after intravenous contrast exposure among patients with and without CKD.</div></div><div><h3>Methods</h3><div>A single-center retrospective study examined patients that presented to the Emergency Department and activated the stroke protocol, which involved an immediate CT angiogram. Patients were subdivided into “normal to mild” (glomerular filtration rate [GFR] &gt; 60 mL/min/1.73 m²), CKD III (GFR 30–60 mL/min/1.73 m²), and CKD IV (GFR &lt; 30 mL/min/1.73 m²) groups. The primary outcome was the development of AKI. Patients already on dialysis were excluded.</div></div><div><h3>Results</h3><div>Among the 794 patients identified, 452 (56.9%) were classified as “normal to mild,” 280 (35.3%) were classified as CKD III, and 62 (7.8%) were classified as CKD IV. Patients with normal GFR had a 2.4% incidence of developing AKI, those with CKD III had a 1.4% incidence, and patients with CKD IV had an 8.1% incidence of developing AKI. Overall, 2.5% of patients developed AKI. For CKD III vs. “normal” groups, odds ratio (OR) = 0.58 (95% confidence interval [CI] 0.16–1.72). For CKD IV vs. “normal,” OR = 3.52 (95% CI 1.07–10.05). Of those patients with CKD IV who had AKI, all saw improvement in their creatinine prior to discharge and none required renal replacement therapy.</div></div><div><h3>Conclusion</h3><div>This study builds on the evidence demonstrating that patients with CKD III are likely at the same risk of developing post-CT AKI as those with normal renal function. Furthermore, the risk of developing post-CT AKI in CKD IV patients may be far lower than previously thought, was transient, and did not result in renal replacement therapy.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"70 ","pages":"Pages 10-18"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}