Substance Abuse and Rehabilitation最新文献

{"title":"Patterns of health care utilization and cost before and after opioid overdose: findings from 10-year longitudinal health plan claims data.","authors":"Daniel D Maeng,&nbsp;John J Han,&nbsp;Michael H Fitzpatrick,&nbsp;Joseph A Boscarino","doi":"10.2147/SAR.S135884","DOIUrl":"https://doi.org/10.2147/SAR.S135884","url":null,"abstract":"<p><strong>Objective: </strong>To describe the longitudinal pattern of health care utilization and cost of care before and after opioid overdose (OD) over a 10-year period using health plan claims data.</p><p><strong>Methods: </strong>Patients who had experienced opioid ODs between April 2005 and March 2015 were identified from Geisinger Health System's electronic health records. Among these patients, a subgroup of patients who were Geisinger Health Plan (GHP) members at any point between January 2006 and December 2015 were also identified. From the corresponding GHP claims data, their all-cause health care utilization (inpatient admissions, emergency department [ED] visits, and physician office visits) and total medical costs, excluding prescription medication cost, were obtained. Per-member-per-month estimates for each month before and after the index date of opioid OD were calculated, adjusting for age, gender, plan type, year, and comorbidity via multivariate regression models.</p><p><strong>Results: </strong>A total of 942 opioid OD patients with an average GHP enrollment period of 41.4 months were identified. ED visit rates rose rapidly starting around 19-24 months prior to the opioid OD date. Acute inpatient admission rates and total medical cost also rose rapidly starting around 12 months prior. After the OD date, the utilization rates and cost declined but tended to remain above those of the pre-OD period.</p><p><strong>Conclusion: </strong>Opioid OD is preceded by sharp increases in utilization of acute care and cost well before the actual OD. These findings therefore suggest that early signals of OD may be detected from patterns of acute care utilization, particularly the ED visits.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2017-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S135884","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35463470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The opioid overdose epidemic: opportunities for pharmacists.","authors":"Li-Tzy Wu,&nbsp;Udi E Ghitza,&nbsp;Anne L Burns,&nbsp;Paolo Mannelli","doi":"10.2147/SAR.S144268","DOIUrl":"https://doi.org/10.2147/SAR.S144268","url":null,"abstract":"php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Substance Abuse and Rehabilitation 2017:8 53–55 Substance Abuse and Rehabilitation Dovepress","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2017-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S144268","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35329150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptance and commitment therapy for clients institutionalized for severe substance-use disorder: a pilot study.","authors":"Gabriella Svanberg,&nbsp;Ingrid Munck,&nbsp;Maria Levander","doi":"10.2147/SAR.S132255","DOIUrl":"https://doi.org/10.2147/SAR.S132255","url":null,"abstract":"<p><strong>Background: </strong>Individuals with substance-use disorder (SUD) often have co-occurring mental health disorders and decreased executive function, both of which are barriers to sustained rehabilitation. Clients with severe SUD can be institutionalized in The Swedish National Board of Institutional Care but are difficult to engage and dropout rates remain high. Recent studies suggest that acceptance and commitment therapy (ACT) is an effective treatment for mental health and SUD.</p><p><strong>Objectives: </strong>The overall aims of the present pilot study were to explore a manual-based ACT intervention for clients institutionalized for severe SUD and to describe the effects on mental health, psychological flexibility, and executive function. This pilot study is the first to use a manual-based ACT intervention within an inpatient context.</p><p><strong>Methods: </strong>Eighteen participants received a seven-session ACT intervention tailored for SUD. Statistical analyses were performed for the complete data (n=18) and on an individual level of follow-up data for each participant. In order to follow and describe changes, the strategy was to assess the change in 13 clinical scales from pre-intervention to post-intervention.</p><p><strong>Results: </strong>Results suggested that there was no change in mental health and a trend implying positive changes for psychological flexibility and for 9 of 10 executive functions (e.g., inhibitory control, task monitoring, and emotional control).</p><p><strong>Conclusion: </strong>The pilot study suggests clinical gains in psychological flexibility and executive functions both at the Institution regulated by the Care of Alcoholics and Drugabuser Act (also known as LVM home) and at the individual level. Since the sample size does not provide adequate statistical power to generalize and to draw firm conclusions concerning intervention effects, findings are descriptive and preliminary in nature. Further development and implementation of ACT on a larger scale study, including the maintenance phase and a follow-up, is needed.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2017-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S132255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35400425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the Assessment of Recovery Capital scale reflect a single or multiple domains?","authors":"Stephan Arndt,&nbsp;Ethan Sahker,&nbsp;Suzy Hedden","doi":"10.2147/SAR.S138148","DOIUrl":"https://doi.org/10.2147/SAR.S138148","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this study was to determine whether the 50-item Assessment of Recovery Capital scale represents a single general measure or whether multiple domains might be psychometrically useful for research or clinical applications.</p><p><strong>Methods: </strong>Data are from a cross-sectional de-identified existing program evaluation information data set with 1,138 clients entering substance use disorder treatment. Principal components and iterated factor analysis were used on the domain scores. Multiple group factor analysis provided a quasi-confirmatory factor analysis.</p><p><strong>Results: </strong>The solution accounted for 75.24% of the total variance, suggesting that 10 factors provide a reasonably good fit. However, Tucker's congruence coefficients between the factor structure and defining weights (0.41-0.52) suggested a poor fit to the hypothesized 10-domain structure. Principal components of the 10-domain scores yielded one factor whose eigenvalue was greater than one (5.93), accounting for 75.8% of the common variance. A few domains had perceptible but small unique variance components suggesting that a few of the domains may warrant enrichment.</p><p><strong>Conclusion: </strong>Our findings suggest that there is one general factor, with a caveat. Using the 10 measures inflates the chance for Type I errors. Using one general measure avoids this issue, is simple to interpret, and could reduce the number of items. However, those seeking to maximally predict later recovery success may need to use the full instrument and all 10 domains.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2017-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S138148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35303868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cannabis withdrawal syndrome: current insights.","authors":"Udo Bonnet, Ulrich W Preuss","doi":"10.2147/SAR.S109576","DOIUrl":"10.2147/SAR.S109576","url":null,"abstract":"<p><p>The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (<i>Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition</i>) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to psychopharmacological or behavioral approaches, such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS symptoms, the specification of CWS intensity and duration as well as gender effects.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2017-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/22/sar-8-009.PMC5414724.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34983618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stability of the alcohol use disorders identification test in practical service settings.","authors":"Ethan Sahker,&nbsp;Donna A Lancianese,&nbsp;Stephan Arndt","doi":"10.2147/SAR.S126664","DOIUrl":"https://doi.org/10.2147/SAR.S126664","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of the present study is to explore the stability of the Alcohol Use Disorders Identification Test (AUDIT) in a clinical setting by comparing prescreening heavy drinking questions and AUDIT scores over time. Because instrument stability is equal to test-retest reliability at worst, investigating the stability of the AUDIT would help better understand patient behavior change in context and the appropriateness of the AUDIT in a clinical setting.</p><p><strong>Methods: </strong>This was a retrospective exploratory analysis of Visit 1 to Visit 2 AUDIT stability (n=1,099; male [75.4%], female [24.6%]) from all patients with first-time and second-time records in the Iowa Screening, Brief Intervention, and Referral to Treatment project, October 2012 to July 7, 2015 (N=17,699; male [40.6%], female [59.4%]).</p><p><strong>Results: </strong>The AUDIT demonstrated moderate stability (intraclass correlation=0.56, 95% confidence interval: 0.52-0.60). In a multiple regression predicting the (absolute) difference between the two AUDIT scores, the participants' age was highly significant, <i>t</i>(1,092)=6.23, <i>p</i><0.001. Younger participants clearly showed less stability than their older counterparts. Results are limited/biased by the observational nature of the study design and the use of clinical service data.</p><p><strong>Conclusion: </strong>The present findings contribute to the literature by demonstrating that the AUDIT changes are moderately dependable from Visit 1 to Visit 2 while taking into account patient drinking behavior variability. It is important to know the stability of the AUDIT for continued use in Screening, Brief Intervention, and Referral to Treatment programming.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2017-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S126664","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34899288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The National Acupuncture Detoxification Association protocol, auricular acupuncture to support patients with substance abuse and behavioral health disorders: current perspectives.","authors":"Elizabeth B Stuyt, Claudia A Voyles","doi":"10.2147/SAR.S99161","DOIUrl":"https://doi.org/10.2147/SAR.S99161","url":null,"abstract":"<p><p>The National Acupuncture Detoxification Association (NADA)-standardized 3- to 5-point ear acupuncture protocol, born of a community-minded response to turbulent times not unlike today, has evolved into the most widely implemented acupuncture-assisted protocol, not only for substance abuse, but also for broad behavioral health applications. This evolution happened despite inconsistent research support. This review highlights the history of the protocol and the research that followed its development. Promising, early randomized-controlled trials were followed by a mixed field of positive and negative studies that may serve as a whole to prove that NADA, despite its apparent simplicity, is neither a reductive nor an independent treatment, and the need to refine the research approaches. Particularly focusing on the last decade and its array of trials that elucidate aspects of NADA application and effects, the authors recommend that, going forward, research continues to explore the comparison of the NADA protocol added to accepted treatments to those treatments alone, recognizing that it is not a stand-alone procedure but a psychosocial intervention that affects the whole person and can augment outcomes from other treatment modalities.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2016-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140327186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"E-cigarettes for the management of nicotine addiction.","authors":"Oliver Knight-West,&nbsp;Christopher Bullen","doi":"10.2147/SAR.S94264","DOIUrl":"https://doi.org/10.2147/SAR.S94264","url":null,"abstract":"<p><p>In this review, we discuss current evidence on electronic cigarettes (ECs), a rapidly evolving class of nicotine delivery system, and their role in managing nicotine addiction, specifically in helping smokers to quit smoking and/or reduce the amount of tobacco they smoke. The current evidence base is limited to three randomized trials (only one compares ECs with nicotine replacement therapy) and a growing number of EC user surveys (n=6), case reports (n=4), and cohort studies (n=8). Collectively, these studies suggest modest cessation efficacy and a few adverse effects, at least with the short-term use. On this basis, we provide advice for health care providers on providing balanced information for patients who enquire about ECs. More research, specifically well-conducted large efficacy trials comparing ECs with standard smoking cessation management (eg, nicotine replacement therapy plus behavioral support) and long-term prospective studies for adverse events, are urgently needed to fill critical knowledge gaps on these products. </p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2016-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S94264","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34347356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary care for opioid use disorder.","authors":"Paolo Mannelli,&nbsp;Li-Tzy Wu","doi":"10.2147/SAR.S69715","DOIUrl":"https://doi.org/10.2147/SAR.S69715","url":null,"abstract":"Recent reports on prescription opioid misuse and abuse have described unprecedented peaks of a national crisis and the only answer is to expand prevention and treatment, including different levels of care.1 Nonetheless, concerns remain about the ability of busy primary care settings to manage problem opioid users along with other patients. In particular, proposed extensions of buprenorphine treatment, a critically effective intervention for opioid use disorder (OUD), are cautiously considered due to the potential risk of misuse or abuse.2 General practitioners are already facing this burden daily in the treatment of chronic pain, and expert supervision and treatment model adjustment are needed to help improve outcomes. Approximately 20% of patients in primary care have noncancer pain symptoms, with most of them receiving opioid prescriptions by their physicians, and their number is increasing.3 Pain diagnoses are comparable in severity to those of tertiary centers and are complicated by significant psychiatric comorbidity, with a measurable lifetime risk of developing OUD.4,5 Some primary care physicians report frustration about opioid abuse and diversion by their patients; support from pain specialists would improve their competence, the quality of their performance, and the ability to identify patients at risk of opioid misuse.6 Thus, buprenorphine treatment should not be adding to a complex clinical scenario. To this end, the promising models of care emphasize the integration of medical with psychological and pharmacological expertise for the management of OUD. \u0000 \u0000Primary care is an important entry point for all patients suffering from chronic conditions, including substance use disorders. Even in the absence of chronic opioid therapy for pain as a predictor of problem opioid use, the wealth of medical and behavioral information available for a diagnosis is potentially unmatched by what the tertiary level physician (or specialist) would be able to gather. Despite limited time and the self-reported low level of preparedness, primary care is arguably the ideal place where substance use treatment can be successfully integrated into medical care, if adequate support is guaranteed. In addition to psychosocial, educational, and integrated treatments for substance use disorders, office-based buprenorphine therapy has demonstrated adaptability to a primary care setting.7 Also, buprenorphine primary care prescribers have gradually been closing the number gap with psychiatrists, though a reduced presence in rural areas and a low prescribing rate continue to leave part of the demand unanswered,8,9 indicating the work to be done even before buprenorphine treatment expansion occurs. In some areas of the US, there are less than three prescribers per 100,000 persons, the average number of patients for certified prescribers is only one-quarter of the current limit of 100, and one-quarter of physicians with a waiver have never prescribed the medication.2 \u0000 \u0000Of","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2016-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S69715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34347355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method.","authors":"Robert Hämmig,&nbsp;Antje Kemter,&nbsp;Johannes Strasser,&nbsp;Ulrich von Bardeleben,&nbsp;Barbara Gugger,&nbsp;Marc Walter,&nbsp;Kenneth M Dürsteler,&nbsp;Marc Vogel","doi":"10.2147/SAR.S109919","DOIUrl":"https://doi.org/10.2147/SAR.S109919","url":null,"abstract":"<p><strong>Background: </strong>Buprenorphine is a partial µ-opioid receptor agonist used for maintenance treatment of opioid dependence. Because of the partial agonism and high receptor affinity, it may precipitate withdrawal symptoms during induction in persons on full µ-opioid receptor agonists. Therefore, current guidelines and drug labels recommend leaving a sufficient time period since the last full agonist use, waiting for clear and objective withdrawal symptoms, and reducing pre-existing full agonist therapies before administering buprenorphine. However, even with these precautions, for many patients the induction of buprenorphine is a difficult experience, due to withdrawal symptoms. Furthermore, tapering of the full agonist bears the risk of relapse to illicit opioid use.</p><p><strong>Cases: </strong>We present two cases of successful initiation of buprenorphine treatment with the Bernese method, ie, gradual induction overlapping with full agonist use. The first patient began buprenorphine with overlapping street heroin use after repeatedly experiencing relapse, withdrawal, and trauma reactivation symptoms during conventional induction. The second patient was maintained on high doses of diacetylmorphine (ie, pharmaceutical heroin) and methadone during induction. Both patients tolerated the induction procedure well and reported only mild withdrawal symptoms.</p><p><strong>Discussion: </strong>Overlapping induction of buprenorphine maintenance treatment with full µ-opioid receptor agonist use is feasible and may be associated with better tolerability and acceptability in some patients compared to the conventional method of induction.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2016-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S109919","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34738780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}