Open Forum Infectious Diseases最新文献

{"title":"Big Data Bayesian Truths: No Vancomycin Trough Concentration Target Is Sufficiently Precise for Safety or Efficacy.","authors":"Justin Shiau, Sharmeen Roy, Paul Sabourenkov, Marc H Scheetz","doi":"10.1093/ofid/ofaf041","DOIUrl":"10.1093/ofid/ofaf041","url":null,"abstract":"<p><strong>Introduction: </strong>Therapeutic drug monitoring is standard of care for vancomycin because of the known efficacy and safety exposure window (ie, area under the concentration-time curve [AUC] of 400-600 mg × 24 hours/L). Despite guideline recommendations, AUCs are infrequently calculated because of the perceived adequacy of trough (Cmin) concentrations. Yet, the percentage of real-world patients with goal measured vancomycin trough concentrations that achieve target vancomycin AUC remains unknown.</p><p><strong>Methods: </strong>A large cohort of internationally represented adult patients treated with vancomycin in 2021 and 2022 and therapeutic drug monitoring performed had data anonymized via an electronic clearinghouse at DoseMe. Unique patients, dosing events, and measured Cmin were identified. Patient-individualized AUC was calculated using a Bayesian method with 4 validated models. For each dosing event, Cmin and AUC pairs were compared and categorized as \"low,\" \"target,\" and \"high\" using the therapeutic ranges for Cmin of 15-20 mg/L and AUC of 400-600 mg × 24 hours/L.</p><p><strong>Results: </strong>In 2022, 17,711 adult patients from the European Union (4.9%), Australia (4.0%), and the United States (91.1%) had 26 769 measured trough levels obtained. Categorical disagreement between Cmin and AUC was 34.3%, with most disagreement (7959 Cmin levels, 30%) occurring with low Cmin but target AUC. Only 23% of paired Cmin and AUC were within range. AUC was variable for all trough categories (ie, low, target, and high).</p><p><strong>Conclusions: </strong>These findings support AUC therapeutic drug monitoring and challenge Cmin as an adequate vancomycin AUC proxy. Because no trough concentration or range was sufficiently precise to ensure AUC targets, we suggest direct calculation of AUC.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf041"},"PeriodicalIF":3.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605806","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":"Reply: \"Continuing the Chat: How Can We Improve the Performance of an Artificial Intelligence Chatbot in Answering Clinical Infectious Diseases Pharmacotherapy Questions?\"","authors":"Wesley D Kufel, Conan MacDougall, Elizabeth W Covington, Jason C Gallagher, Robert W Seabury, Jeffrey M Steele","doi":"10.1093/ofid/ofaf074","DOIUrl":"10.1093/ofid/ofaf074","url":null,"abstract":"","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf074"},"PeriodicalIF":3.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483759","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":"From Chart Biopsy to Liquid Biopsy: Evaluating the Diagnostic Yield and Clinical Impact of Plasma Microbial Cell-Free DNA Next-Generation Sequencing in the Management of Fever of Unknown Origin.","authors":"Nischal Ranganath, Bismarck Bisono Garcia, James Vaillant, Silpita Katragadda, Melissa Kerkelis, Omar Abu Saleh, Madiha Fida","doi":"10.1093/ofid/ofaf038","DOIUrl":"10.1093/ofid/ofaf038","url":null,"abstract":"<p><strong>Background: </strong>The underlying cause of fever of unknown origin (FUO) remains unidentified in up to 51% of cases despite systematic evaluation. Microbial cell-free DNA next-generation sequencing (mcfDNA-NGS) offers an agnostic, noninvasive approach to pathogen identification, but the utility and clinical impact of this assay in FUO remain unknown.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated adult patients referred for FUO evaluation at a tertiary medical center between November 2019 and November 2023. Patients underwent both standard microbiologic testing (ST) and mcfDNA-NGS. Diagnostic impact was assessed in 4 domains: new diagnoses, earlier time to diagnosis, avoidance of invasive procedures, and non-hypothesis-driven diagnoses. Logistic regression was used to identify predictors of positive mcfDNA-NGS testing.</p><p><strong>Results: </strong>Among 176 patients, mcfDNA-NGS was positive in 44.3%, with 49% of these cases considered clinically significant. Infectious cause of FUO was identified in 39% of patients, noninfectious in 35%, and unknown in 26%. mcfDNA-NGS contributed to a positive diagnostic impact in 30% of cases, mainly by earlier diagnosis (16%) and potential for avoidance of invasive procedures (10%). Positive mcfDNA-NGS was significantly associated with higher Charlson comorbidity index score (odds ratio [OR], 1.22; <i>P</i> < .001) and white blood cell (WBC) count ≤4.5 × 10⁹ cells/L (OR, 8.61; <i>P</i> < .001). Conversely, FUO without localization was associated with a decreased likelihood of positive mcfNDA testing (OR, 0.18; <i>P</i> < .001).</p><p><strong>Conclusions: </strong>mcfDNA-NGS effectively complements ST in diagnosing FUO, providing earlier detection and minimizing invasive testing. Clinical predictors such as high comorbidity and low WBC count may guide the optimal use of mcfDNA-NGS in FUO. Prospective evaluation of optimal timing and use of mcfDNA-NGS and cost-benefit analysis in FUO is needed.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf038"},"PeriodicalIF":3.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365430","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":"Immunogenicity and Safety of the Higher-Valent Pneumococcal Conjugate Vaccine vs the 13-Valent Pneumococcal Conjugate Vaccine in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Thundon Ngamprasertchai, Narisa Ruenroengbun, Rattagan Kajeekul","doi":"10.1093/ofid/ofaf069","DOIUrl":"10.1093/ofid/ofaf069","url":null,"abstract":"<p><strong>Background: </strong>The immunogenicity of the 15-valent pneumococcal conjugate vaccine (PCV15) and PCV20 in older adults was approved on the basis of comparative data with PCV13, although their relative immunogenicity and safety in this population remain undetermined. A systematic review and meta-analysis were conducted to provide insights, addressing the lack of large-scale efficacy studies.</p><p><strong>Methods: </strong>This analysis included phase 2 and 3 randomized controlled trials evaluating the immunogenicity of a single dose of PCV15 or PCV20 in older adults by opsonophagocytic assay geometric mean titer (GMT) response at 1 month postvaccination as compared with PCV13.</p><p><strong>Results: </strong>In total, 8 trials were eligible. PCV15 demonstrated superior immunogenicity vs PCV13 among older adults (GMT ratio, 1.11; 95% CI, 1.02-1.20). In immunogenicity vs PCV13, PCV20 demonstrated noninferiority, exceeding 0.5 at 1 month postvaccination (GMT ratio, 0.84; 95% CI, .81-.87). The incidence of local and systemic reactions was higher in the PCV15 group as compared with the PCV13 group, with risk ratios of 1.23 (95% CI, 1.14-1.32) and 1.15 (95% CI, 1.02-1.29), respectively. PCV20 is well tolerated and exhibits a comparable rate of local and systemic reactions to PCV13.</p><p><strong>Conclusions: </strong>These findings support the immunogenicity and safety of PCV15 and PCV20 for pneumococcal vaccination in older adults. Given its superior immune response, PCV15 may address the gaps left by PCV13. Despite higher antibody levels, the clinical effectiveness of these vaccines remains uncertain. Ongoing surveillances are essential to evaluate the impact of both vaccines on remaining vaccine-type pneumococcal disease.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf069"},"PeriodicalIF":3.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468688","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":"Diminished <i>Mycobacterium tuberculosis</i>-specific T-cell Responses During Pregnancy in Women With HIV and Receiving Isoniazid Preventive Therapy.","authors":"Aparajita Saha, Jaclyn N Escudero, Troy Layouni, Jerphason Mecha, Elizabeth Maleche-Obimbo, Daniel Matemo, John Kinuthia, Grace John-Stewart, Barbra A Richardson, Sylvia M LaCourse, Javeed A Shah","doi":"10.1093/ofid/ofaf067","DOIUrl":"10.1093/ofid/ofaf067","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy increases <i>Mycobacterium tuberculosis</i> (Mtb) reactivation risk and alters immune responses. We assessed Mtb-specific CD4+ T-cell responses in pregnant women with HIV (WLHIV) and without, including those receiving isoniazid preventive therapy (IPT).</p><p><strong>Methods: </strong>We measured adaptive immune responses from 33 participants (HIV+ 21, HIV- 12) with positive interferon-gamma release assay during pregnancy (20-34 weeks' gestation), 6 weeks, and 12 months postpartum by intracellular cytokine staining. We measured overall responses using COMPASS and made comparisons by nonparametric analysis of variance.</p><p><strong>Result: </strong>We observed diminished Mtb-specific CD4+ T-cell responses in WLHIV during pregnancy versus 12 months postpartum (COMPASS median functional score [FS] .009 vs 0.12, <i>P</i> = .03). WLHIV who received IPT (n = 8) during concurrent pregnancy had attenuated Mtb-specific CD4+ T-cell responses during pregnancy versus 12 months postpartum (median FS 8.3 × 10^-7 vs 0.13, <i>P</i> = .02), but WLHIV who did not receive IPT during pregnancy had similar responses in pregnancy and postpartum. Mtb-specific CD8+ FS was increased postpartum in all groups. We found preexisting Mtb-specific CD4+ T-cell responses in participants who converted interferon-gamma release assay tests postpartum (n = 10).</p><p><strong>Conclusions: </strong>Pregnant WLHIV, especially those on IPT, showed reduced Mtb-specific CD4+ T-cell responses. Understanding the impact of pregnancy on Mtb-specific T-cell responses may improve diagnostic approaches.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf067"},"PeriodicalIF":3.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468684","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":"Telemedicine Offers Solutions for the Rural Disparities in Infectious Disease (ID) Care Delivery.","authors":"Christian Perez","doi":"10.1093/ofid/ofaf052","DOIUrl":"10.1093/ofid/ofaf052","url":null,"abstract":"<p><p>In the United States, there is a growing shortage of infectious diseases (ID) physicians that highlights disparity between rural versus urban ID expertise resulting in a healthcare gap with significant consequences for patients unable to have ID directed care available to them. Telemedicine is a crucial modality of healthcare that can be used to bridge that gap by providing quality care consistent with outcomes for inpatient ID service models, while also serving as a tool for much greater geographic coverage by a single ID physician. As a specialty, we must embrace telemedicine for the good of our patients, whose local communities may not have access to ID care, and to create the incentive of broader community impact for potential entrants into the ID field.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf052"},"PeriodicalIF":3.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441622","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":"Enhancing Hepatitis C Virus Testing, Linkage to Care, and Treatment Commencement in Hospitals: A Systematic Review and Meta-analysis.","authors":"Rebecca Mathews, Claudia Shen, Michael W Traeger, Helen M O'Brien, Christine Roder, Margaret E Hellard, Joseph S Doyle","doi":"10.1093/ofid/ofaf056","DOIUrl":"10.1093/ofid/ofaf056","url":null,"abstract":"<p><strong>Background: </strong>The hospital-led interventions yielding the best hepatitis C virus (HCV) testing and treatment uptake are poorly understood.</p><p><strong>Methods: </strong>We searched Medline, Embase, and Cochrane databases for studies assessing outcomes of hospital-led interventions for HCV antibody or RNA testing uptake, linkage to care, or direct-acting antiviral commencement compared with usual care, a historical comparator, or control group. We systematically reviewed hospital-led interventions delivered in inpatient units, outpatient clinics, or emergency departments. Random-effects meta-analysis estimated pooled odds ratios [pORs] measuring associations between interventions and outcomes. Subgroup analyses explored outcomes by intervention type.</p><p><strong>Results: </strong>A total of 7872 abstracts were screened with 23 studies included. Twelve studies (222 868 participants) reported antibody testing uptake, 5 (n = 4987) reported RNA testing uptake, 7 (n = 3185) reported linkage to care, and 4 (n = 1344) reported treatment commencement. Hospital-led interventions were associated with increased antibody testing uptake (pOR, 5.83 [95% confidence interval {CI}, 2.49-13.61]; <i>I</i> ² = 99.9%), RNA testing uptake (pOR, 10.65 [95% CI, 1.70-66.50]; <i>I</i> ² = 97.9%), and linkage to care (pOR, 1.75 [95% CI, 1.10-2.79]; <i>I</i> ² = 79.9%) when data were pooled and assessed against comparators. Automated opt-out testing (5 studies: pOR, 16.13 [95% CI, 3.35-77.66]), reflex RNA testing (4 studies: pOR, 25.04 [95% CI, 3.63-172.7]), and care coordination and financial incentives (4 studies: pOR, 2.73 [95% CI, 1.85-4.03]) showed the greatest increases in antibody and RNA testing uptake and linkage to care, respectively. No intervention increased uptake at all care cascade steps.</p><p><strong>Conclusions: </strong>Automated antibody and reflex RNA testing increase HCV testing uptake in hospitals but have limited impact on linkage to treatment. Other interventions promoting linkage must be explored.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf056"},"PeriodicalIF":3.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399632","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":"Infectious Causes of Death: An Autopsy-Based Study of 546 Cases.","authors":"Soudabeh Eshaghi, Fereshte Sheybani, Aria Hedjazi, HamidReza Naderi, Matin Shirazinia, Negar Morovatdar","doi":"10.1093/ofid/ofaf065","DOIUrl":"10.1093/ofid/ofaf065","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic accuracy in cases of infectious diseases is crucial for appropriate patient management and public health interventions. This retrospective study aimed to evaluate the most common causes of death caused by infectious diseases and the rate of agreement between clinical diagnoses and autopsy findings in individuals diagnosed with infectious diseases in Mashhad, Iran.</p><p><strong>Methods: </strong>Autopsy reports from March 2009 to February 2018 were analyzed for patients diagnosed with infectious diseases. Demographic data, clinical diagnoses, and autopsy results were collected and compared. Discrepancies between clinical and autopsy diagnoses were assessed, and potential predictors of diagnostic discrepancy were examined.</p><p><strong>Results: </strong>Among 28 451 autopsied cases, 546 (1.9%) were diagnosed with infectious diseases. Pleuropulmonary infections were the most common cause of death (69.8%) as determined by autopsy, followed by bloodstream infections (14.1%) and intra-abdominal infections (10.0%). Discrepancies between clinical and autopsy diagnoses were identified in 22.4% of cases. Pleuropulmonary infections had the highest frequency of diagnostic discrepancies (29.1%), followed by central nervous system (CNS) infections (15.8%).</p><p><strong>Conclusions: </strong>This study underscores the importance of autopsy in identifying diagnostic discrepancies and improving clinical practice in cases of infectious diseases. They also highlight the need for ongoing efforts to enhance diagnostic capabilities, particularly in challenging cases such as pleuropulmonary and CNS infections, to reduce the burden of misdiagnosis and improve patient outcomes.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf065"},"PeriodicalIF":3.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441586","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":"The Stealth and Potentially Fatal Nature of <i>Kingella kingae</i> Outbreaks in Daycare Facilities.","authors":"Pablo Yagupsky","doi":"10.1093/ofid/ofaf066","DOIUrl":"10.1093/ofid/ofaf066","url":null,"abstract":"<p><p>Although <i>Kingella kingae</i> infections are usually sporadic, outbreaks of <i>K. kingae</i> disease have been reported. Outbreaks of invasive <i>K. kingae</i> infections in daycare centers were searched through the Pubmed database. Twenty-seven outbreaks have been detected in North America, Western Europe, and Israel. The median age of the 72 affected attendees was 14 months, and the attack rate was 18%. Osteoarthritis was diagnosed in 66 (92%) attendees, and endocarditis in 3 (4%), 2 of whom died. A high prevalence of the invasive strains was found among asymptomatic classmates. Genomic analysis of the available strains identified the highly invasive sequence-type complexes 23/25, 14, or 6 in 12 of 13 (92%) outbreaks. <i>Kingella kingae</i> strains causing daycare outbreaks exhibit enhanced colonization, transmissibility, and virulence. Increased awareness of this emerging public health problem and the use of molecular diagnostic methods are recommended for early identification of outbreaks and prevention of fatal outcomes.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf066"},"PeriodicalIF":3.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449737","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":"Association Between Inpatient Medication Treatment for Opioid Use Disorder and Reduced One-Year All-Cause Mortality in Patients With Invasive Bacterial Infections.","authors":"Nicholas J Blair, Adam Kopp, Christine Kubin, Jesse Cotton, Michael T Yin, Matthew Scherer","doi":"10.1093/ofid/ofaf061","DOIUrl":"10.1093/ofid/ofaf061","url":null,"abstract":"<p><p>Invasive bacterial infections are frequent causes of hospitalization among people who use opioids. We evaluated the association between inpatient administration of medication for opioid use disorder with one-year all-cause mortality in patients hospitalized with invasive bacterial infections.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf061"},"PeriodicalIF":3.8,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586570","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}