Journal of Infection Prevention最新文献

{"title":"Preventive health behaviour differences across racial groups during the early stages of COVID-19","authors":"Jordan Mitchell, Xiao Li, Phillip Decker, Jae Man Park","doi":"10.1177/17571774241238659","DOIUrl":"https://doi.org/10.1177/17571774241238659","url":null,"abstract":"Throughout the COVID-19 pandemic, the practice of preventative health behaviours had been used disparately across different racial groups. This study seeks to identify any differences in preventative health behaviours across racial groups, controlling for other socio-demographic factors. A US national survey study was electronically conducted from July through November 2020, to measure racial/ethnic differences in health preventive behaviours about COVID-19. We performed 2-part regression models to assess whether preventive health behaviours differed by race and ethnicity. Specifically, we employed generalized logistic regressions for investigating the predictors of the use of complementary or alternative medicine (CAM), or stay-at-home strategy, then performed ordinal logistic regression to examine the predictors of social distancing, face mask wearing, and hand hygiene strategy practice. The results show that non-White respondents were more likely to practice social distancing, mask wearing, and hand hygiene strategy to prevent COVID-19, compared to their White counterparts. Additionally, the findings indicate that individuals who experienced COVID-19-related racial abuse or depression had a higher likelihood of practicing preventive health behaviours. We found ethnicity can be a predictor of health preventive behaviours, in accordance with previous research. The causes of these disparities will require further investigation in order to be addressed.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140242095","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":"Examining the impact and response to an outbreak of carbapenemase-producing Enterobacterales in a neonatal unit in the United Kingdom: An outbreak report","authors":"Megha Anil, Jacki Dopran, A. Claxton, Paul Fleming, Narendra Aladangady","doi":"10.1177/17571774241239222","DOIUrl":"https://doi.org/10.1177/17571774241239222","url":null,"abstract":"Carbapenemase-producing Enterobacterales (CPE) are a group of Gram-negative bacteria causing global concern due to their resistance to carbapenems. In this report, we detail the learning points from a CPE outbreak in a tertiary neonatal unit (NU) in the UK. Routine surveillance screening (rectal swabs) of babies on the NU identified a potential cluster of CPE carriage. Samples were sent to a reference laboratory for confirmatory testing. Environmental screening and cot mapping were undertaken to determine movements of babies within the unit. Regular audits of cleaning standards, hand hygiene, and maternal hygiene when expressing breast milk were carried out. The outbreak lasted 19 weeks. During the outbreak, there were 360 admissions, with 11 babies being colonised with the outbreak strain. Once the outbreak was declared, there were enhanced Infection Prevention and Control (IPC) precautions (including increased environmental and equipment cleaning frequency). CPE screening frequency was increased and cot capacity was reduced. Hand hygiene compliance improved from 92% at the start of the outbreak to 100% by its close. Cleaning standards remained compliant. Maternal hygiene standards varied from 78% to 100%, but no cross-infection links were identified. Environmental screening was negative. No route of cross-infection was identified. Notably, no babies developed invasive CPE infection. This is the first report of a CPE outbreak in a UK NU. Although no specific mode of cross-transmission was identified and the outbreak’s end cannot be attributed to any single intervention, the bundle of interventions proved successful after a 5-month period.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140244741","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":"An exploration of sharps injuries within healthcare students at a UK university","authors":"K. Hambridge, W. Burt, G. Bettache, M. Keshishian, T. Walvin, E. Cozma","doi":"10.1177/17571774241238661","DOIUrl":"https://doi.org/10.1177/17571774241238661","url":null,"abstract":"There is evidence available worldwide that nursing, medical and dental students sustain sharps injuries during their programmes of study. However, there is lack of evidence and research relating to the many students of other healthcare professions who may encounter sharps instruments. The aim of the study was to identify the extent, type and impact of sharps injuries sustained by pre-registration healthcare students. An online survey was administered to 3372 healthcare students at a University in the United Kingdom. Some healthcare students other than nursing, medical and dentistry had sustained a sharps injury. The most common device involved were glass ampoules. The common causes were equipment and carelessness. Some healthcare students sustained psychological impacts following the sharps injury. Sharps injuries are common amongst some healthcare students and there is scope for more education for these groups of students relating to the risks, safe handling, reporting and prevention of sharps injuries.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140243270","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":"Preparedness for infection prevention and control practice among undergraduate health sciences students: A systematic review protocol","authors":"D. Mukona, Rebecca George, Joemol James, Smitha Joseph, Jean Mukasa, Charity Timberlake, Beatrice Monaco, Salimbabu Abdulla, Atika G Adbulla, Emma Burnett","doi":"10.1177/17571774241236247","DOIUrl":"https://doi.org/10.1177/17571774241236247","url":null,"abstract":"The World Health Organization (WHO) advocates for the strengthening of education and training in infection prevention and control (IPC) in higher educational institutions (HEIs). This is fundamental to ensure health science students are confident and competent in clinical practice. Explore the preparedness of undergraduate health science students for IPC practice. The PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, ProQuest, Scopus, Web of Science, ClinicalKey, and Google Scholar databases and grey literature will be searched for relevant articles. Quantitative, and mixed methods studies on teaching and learning, technological methods, strengths and limitations, and challenges of IPC practice in HEI undergraduate curricula. Undergraduate health science students including medical, nursing, pharmacy, dental, physiotherapy, radiology, medical imaging, and paramedicine. Studies published anywhere in the world, in English, and from 2010 to 2023. Preparedness, health science students, infection prevention and control, technology, higher education institutions. The data extracted will be recorded on a data extraction form. This will be conducted according to the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. No ethical approval was required for this protocol. Interim findings will be presented at relevant local and international conferences and a manuscript will be published in a peer reviewed journal. This systematic review will provide a baseline for recommendations for developing innovative ways to improve IPC teaching and learning in HEI.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140419510","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":"Outbreak of Pseudomonas aeruginosa on a neonatal intensive care unit: Lessons from a Qatari setting","authors":"H. Petkar, Imelda Caseres-Chiuco, Afaf Al-Shaddad, Mahmoud Mohamed, Irshad Ahmed, Rosemary Rao, Roderic Perdon, Moneir Elhaj, Lajish Latheef, Bonnie George, Eman Mustafa, Jameela Al-Ajmi, Huda Saleh","doi":"10.1177/17571774241236248","DOIUrl":"https://doi.org/10.1177/17571774241236248","url":null,"abstract":"Pseudomonas aeruginosa is a major cause of morbidity and mortality in neonatal intensive care units (NICUs). Robust infection prevention and control is key to reducing risk. We describe lessons learnt from an NICU outbreak of P.aeruginosa in the main maternity hospital in the country. Cases were identified from clinical samples and active screening. Clinical information was collected from the electronic patient record. Infection prevention and control (IPC) practice observations were made using organisational checklists and unit observations. Microbiological testing was by conventional microbiological methods. Statistical analyses were performed using R program. Associations were assessed using the Mann–Whitney U or Fisher exact test. Isolates were typed by pulsed field gel electrophoresis; gel was analysed in Bionumerics software from Applied Maths, Belgium. Five cases were identified – one was excluded as maternal acquisition. Typing showed a polyclonal outbreak. Widespread contamination of tap outlets of handwashing sinks in clinical areas was found. Main contributing factors were extensive misuse of hand wash sinks for waste disposal, improper sink cleaning, poor hand hygiene compliance and inadequate environmental cleaning. Successful management required a multi-disciplinary approach. All potential water sources and moist environments within and outside the unit were investigated. Interventions successfully addressed the main contributing factors, supported by good communication and robust auditing. With a diverse workforce, the challenge was to ensure housekeeping staff understood handwash sink cleaning procedures; existing training programmes were delivered in multiple languages tailored to the workforce.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140426332","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":"Determining barriers to submitting antimicrobial-resistant isolates among hospitals in Texas Public Health Region 8","authors":"Bailie Moorhead, Niva Shrestha, Alvin Boyd Newman-Caro, Sydney L. Vangeli, Victoria N. Lussier, Mark I. Grijalva, Margaret E. Giro, Danielle Natividad Jackson, Tianna M. Mack, Zackary L. Herrle, Marcheta Hill, Gretchen Rodriguez, Rachael Singer, Cynthia Williams, A. Nwanguma, Enyinnaya Merengwa, Rachel Pittman, Rebecca L. Sanchez","doi":"10.1177/17571774241235101","DOIUrl":"https://doi.org/10.1177/17571774241235101","url":null,"abstract":"The Antimicrobial Resistance Laboratory Network (AR Lab Network) was developed by the CDC to detect emerging antimicrobial-resistant (AR) threats and prevent outbreaks. However, low submission rates of AR isolates limit the potential of the AR Lab Network to address antimicrobial resistance (AMR). The aim of this study was to investigate barriers to submission of AR isolates in acute care hospitals (ACHs) and critical access hospitals (CAHs) within Texas Public Health Region 8 (PHR8) counties. A survey was designed and emailed to laboratory professionals to identify barriers to AR isolate submission. Responses were analyzed using 2-sided Fisher’s exact tests to identify associations between responses and respondent characteristics. Of the 33 hospitals within PHR8 invited to participate in the survey, responses were received from 21, a response rate of 63.6%. Lack of awareness of the AR Lab Network was the most frequently cited barrier to submission (65.4% of respondents). Other reported barriers to submission included lack of laboratory staff time (57.7%), lack of training with the submission process (34.6%), lack of personnel certified to ship infectious substances (23.1%), and lack of laboratory/shipping supplies (23.1%). Regardless of the respondent’s role, time in that role, or type of hospital in which they worked, the most common barrier to isolate submission was lack of awareness of the AR Lab Network. In the future, we will address the identified barriers by implementing educational outreach programs about AMR and the AR Lab Network for hospitals and other healthcare facilities within PHR8.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140426553","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":"A large multicenter Ralstonia pickettii outbreak in critically ill patients during the COVID-19 pandemic: Epidemiological and clinical characteristics of 66 cases","authors":"E. Viana-Cárdenas, Abel Triana, Jorge Cardenas-Alvarez, Edwin Carvajal-Diaz, Humberto Mendoza, D. Viasus","doi":"10.1177/17571774241236250","DOIUrl":"https://doi.org/10.1177/17571774241236250","url":null,"abstract":"To describe a multicenter outbreak of R. pickettii that occurred in a large number of critically ill patients in a city in Colombia, during the COVID-19 pandemic. In April 2021, the National Institute for Food and Drug Surveillance (INVIMA) reported an outbreak of R. pickettii infection associated with contaminated intravenous medications. The Municipal Health Department began collecting data for all cases identified by the hospitals and the results of microbiological studies. Medical records and death certificates of included cases were reviewed. Between March and May 2021, 66 cases of R. pickettii bloodstream infections from nine hospitals were documented. The median age of the patients was 60 years (IQR 51–72), and most of them had comorbidities (78.8%), mainly arterial hypertension and diabetes mellitus. At the time of the R. pickettii bloodstream infection, 89.4% had COVID-19, 86.4% were on mechanical ventilation, and 98.5% were receiving corticosteroids. The overall mortality was 81.8%. Nearly 60% of the deaths were related to R. pickettii bloodstream infections. R. pickettii was identified in the cultures from intravenous medications. This large multicenter outbreak caused by intravenous medications contaminated with R. pickettii mainly affected critically ill COVID-19 patients. Mortality was high and largely related to R. pickettii bloodstream infection.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140436839","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":"Identifying research priorities for infection prevention and control. A mixed methods study with a convergent design","authors":"MP Smiddy, E. Burton, L. Kingston, T. T. Poovelikunnel, M. Moyo, A. Flores","doi":"10.1177/17571774241230676","DOIUrl":"https://doi.org/10.1177/17571774241230676","url":null,"abstract":"Meaningful research creates evidence for Infection Prevention and Control (IPC) practice. To establish Infection Prevention Society (IPS) members’ research priorities to support future research projects. A mixed methods convergent parallel design incorporating a cross-sectional survey of IPS members (2022–2023), and focus group findings from the IPS Consultative Committee, (October 2022). Quantitative data were analysed using descriptive statistics. Qualitative data were transcribed verbatim, entered into NVivo 12, and analysed using a thematic analysis approach. 132 IPS members responded to the survey, including 120 (90.9%) nurses. The three most prevalent priorities were: Quality Improvement and Patient Safety ( n = 84, 16.1%); IPC Training and Education ( n = 77, 14.8%); and IPC Evidence-based Guidelines ( n = 76, 14.6%). Analysis of the focus group transcripts identified six emergent themes ‘Patient Centred Care’, ‘Training and Education’, ‘IPC Role and Identity’, ‘IPC Leadership’, ‘IPC is Everyone’s Responsibility’, and ‘Research Activity’. Triangulation of findings demonstrated concordance between quantitative and qualitative findings with Quality Improvement and Patient Safety (QIPS) and Training and Education identified as priority research areas. This study highlights the necessity of developing support systems and incorporating research priorities in QIPS, as well as Training and Education. The findings of this study align with the recommended core competencies and components for effective infection prevention and control programs, making them relevant to QIPS initiatives. The outcomes of the study will serve as a valuable resource to guide the IPS Research and Development Committee in delivering practical support to IPS members.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140449276","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":"The use of procedural kits may reduce unscheduled central line dressing changes: A matched pre–post intervention study","authors":"Amit Bahl, N. Mielke, S. M. Gibson, Julie George","doi":"10.1177/17571774241232063","DOIUrl":"https://doi.org/10.1177/17571774241232063","url":null,"abstract":"Unscheduled dressing changes for central venous lines (CVLs) have been shown to increase the risk of bloodstream infections. The objective of this study is to determine if the use of an innovative dressing change kit reduces the rate of unscheduled dressing changes. This pre–post interventional study took place at a large, academic, tertiary care center in metro Detroit, Michigan, the United States. We assessed the impact of the interventional dressing change procedure kit on the rate of unscheduled dressing changes for adult patients who underwent placement of a CVL inclusive of a central catheter, peripherally inserted central catheter, or hemodialysis catheter. Data was collected for the pre-intervention cohort through electronic health records (EHRs), while data for the post-intervention cohort were collected by direct observation by trained research staff in combination with EHR data. The primary outcome was the rate of unscheduled dressing changes. Secondary outcomes included rate of unscheduled dressing changes based on admission floor type, etiology of unscheduled dressing changes, and central line-associated bloodstream infections (CLABSIs). The study included a convenience sample of 1548 CVLs placed between May 2018 and June 2022 with a matched analysis including 488 catheters in each of the pre- and post-intervention groups. The results showed that the unadjusted rate of unscheduled dressing evaluations was significantly reduced from the pre-intervention group (0.21 per day) to the post-intervention group (0.13 per day) ( p < .001). The adjusted rate ratio demonstrated the same trend at 1.00 pre- and 0.60 post-intervention ( p < .001). Stratifying the analysis based on the highest level of care showed that the intervention was effective in reducing the unadjusted rate of unscheduled dressing evaluations for both the advanced and regular medical floor subgroups pre- to post-intervention; the advanced subgroup had an reduction from 0.22 to 0.15 per day ( p = .001), while the regular medical floor subgroup had a reduction from 0.21 to 0.09 per day ( p < .001). CLABSIs were similar in both groups (0.6% vs 0.8%; p = 1.00) in pre- and post-intervention groups, respectively. Procedural kits for central line dressing changes are effective in reducing unscheduled dressing changes and may have a role in reducing CLABSI. Further studies assessing the impact of dressing change kits on cost, procedural compliance, and the precise impact on CLABSI are needed.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139854030","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":"The use of procedural kits may reduce unscheduled central line dressing changes: A matched pre–post intervention study","authors":"Amit Bahl, N. Mielke, S. M. Gibson, Julie George","doi":"10.1177/17571774241232063","DOIUrl":"https://doi.org/10.1177/17571774241232063","url":null,"abstract":"Unscheduled dressing changes for central venous lines (CVLs) have been shown to increase the risk of bloodstream infections. The objective of this study is to determine if the use of an innovative dressing change kit reduces the rate of unscheduled dressing changes. This pre–post interventional study took place at a large, academic, tertiary care center in metro Detroit, Michigan, the United States. We assessed the impact of the interventional dressing change procedure kit on the rate of unscheduled dressing changes for adult patients who underwent placement of a CVL inclusive of a central catheter, peripherally inserted central catheter, or hemodialysis catheter. Data was collected for the pre-intervention cohort through electronic health records (EHRs), while data for the post-intervention cohort were collected by direct observation by trained research staff in combination with EHR data. The primary outcome was the rate of unscheduled dressing changes. Secondary outcomes included rate of unscheduled dressing changes based on admission floor type, etiology of unscheduled dressing changes, and central line-associated bloodstream infections (CLABSIs). The study included a convenience sample of 1548 CVLs placed between May 2018 and June 2022 with a matched analysis including 488 catheters in each of the pre- and post-intervention groups. The results showed that the unadjusted rate of unscheduled dressing evaluations was significantly reduced from the pre-intervention group (0.21 per day) to the post-intervention group (0.13 per day) ( p < .001). The adjusted rate ratio demonstrated the same trend at 1.00 pre- and 0.60 post-intervention ( p < .001). Stratifying the analysis based on the highest level of care showed that the intervention was effective in reducing the unadjusted rate of unscheduled dressing evaluations for both the advanced and regular medical floor subgroups pre- to post-intervention; the advanced subgroup had an reduction from 0.22 to 0.15 per day ( p = .001), while the regular medical floor subgroup had a reduction from 0.21 to 0.09 per day ( p < .001). CLABSIs were similar in both groups (0.6% vs 0.8%; p = 1.00) in pre- and post-intervention groups, respectively. Procedural kits for central line dressing changes are effective in reducing unscheduled dressing changes and may have a role in reducing CLABSI. Further studies assessing the impact of dressing change kits on cost, procedural compliance, and the precise impact on CLABSI are needed.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139794257","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}