Transfusion最新文献

{"title":"Donating blood in a team: Investigating social factors as predictors and outcomes of a positive team experience.","authors":"Kristen S Baker, Kathleen Chell, Barbara M Masser, Marijke Welvaert","doi":"10.1111/trf.18271","DOIUrl":"10.1111/trf.18271","url":null,"abstract":"<p><strong>Background: </strong>Social connections are crucial in blood donation, with positive social influences providing valuable information and serving as motivation to donate. Australian Red Cross Lifeblood's group donation program, Lifeblood Teams, leverages social connections by enabling donors to donate together and/or contribute to their team's donation tally. One-third of annual donations are from Team donors, yet predictors and outcomes of a positive team experience remain unexplored. This study investigated how connectedness and perceived benefits to being in a team influence team satisfaction, team identity, and advocacy for others to join a team and whether these relationships differ for novice and experienced donors.</p><p><strong>Study design and methods: </strong>Team registrants (n = 646) completed a survey on their team donation experiences linked to donor records. The survey investigated themes of motivations, rewards, and social factors to understand why donors join and continue donating with teams.</p><p><strong>Results: </strong>Feeling connected to team members and perceiving a greater number of benefits were positively related to higher team satisfaction, in turn leading to a stronger team identity and increased advocacy for others to join a team. The relationship between satisfaction with their team and advocating for others to join a team was stronger for novice than for experienced donors.</p><p><strong>Discussion: </strong>Blood collection agencies should promote team benefits and facilitate strengthening social ties within donation teams to ensure satisfying group donation experiences that lead to stronger team identities and increased advocacy for joining donation teams.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"1092-1100"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the incidence of transfusion-associated circulatory overload using active surveillance: A systematic review and meta-analysis.","authors":"Sandra K White, Brandon S Walker, Scott Potter, David Anderson, Ryan A Metcalf","doi":"10.1111/trf.18258","DOIUrl":"10.1111/trf.18258","url":null,"abstract":"<p><strong>Background: </strong>Transfusion-associated circulatory overload (TACO) is an adverse event that is the leading cause of transfusion-related death. It is underrecognized, and the aim of this study was to synthesize the available evidence from active surveillance studies to estimate its incidence.</p><p><strong>Study design and methods: </strong>This study is a systematic review and meta-analysis of publications reporting TACO incidence using active surveillance. A research librarian searched Medline and Embase, identifying publications between January 1991 and June 2024. Studies reporting TACO either by patient, blood component (red blood cells [RBCs], platelets, or plasma) or transfusion episode were identified, and all patient settings were eligible. A random effects model estimated TACO incidence, and potential sources of heterogeneity were evaluated using meta-regression.</p><p><strong>Results: </strong>Twenty-two studies met eligibility criteria and were included for analysis. The rate per patient was 22.2/1000 (95% CI: 16.2-29.2) based on 21 studies. The rate estimate of TACO among total blood components (RBCs, plasma, and platelets combined) reported in 10 studies was 2.2/1000 units transfused (95% CI: 1.2-3.5/1000). There was substantial between-study variation in rates and more recent studies tended to report higher rates. Although the platelet point estimate was higher than the point estimates for RBCs and plasma, the confidence intervals overlapped. Only two studies reported TACO rates per transfusion episode and the pooled estimate was 6.3/1000 (95% CI: 1-16.3/1000), about three times greater than the overall per unit estimate.</p><p><strong>Discussion: </strong>Clinicians should consider quantitative risks of important transfusion-related harms, such as TACO, when making the decision to transfuse.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"1061-1071"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet sequestration patterns and clearance rates in healthy individuals.","authors":"Vivianne S Nelson, Marina Kartachova, Sufia N Amini, Masja de Haas, Martin R Schipperus, Rick Kapur, Tanja Netelenbos","doi":"10.1111/trf.18267","DOIUrl":"10.1111/trf.18267","url":null,"abstract":"<p><strong>Background: </strong>Indium-111 platelet scintigraphy evaluates the rate of platelet clearance and the site of platelet sequestration. While the indium-111 scan is commonly used as a predictor for the success of splenectomy in immune thrombocytopenia (ITP), studies evaluating platelet sequestration in healthy adults are lacking and are warranted for a comparative standard.</p><p><strong>Study design and methods: </strong>We designed a prospective cohort study to determine platelet clearance and sequestration in 10 healthy adults at 2 time points (S1 and S2). Moreover, we compared the results with a retrospective ITP cohort (n = 84).</p><p><strong>Results: </strong>Half of the healthy individuals (5/10) at S1 and 37.5% (3/8) at S2 had a splenic sequestration pattern. The spleen: liver (S:L) ratios determined at 48 h were comparable for S1 and S2 (median S1: 1.39 and S2: 1.20, p = .29); thus, they remained stable in time. No significant difference in S:L ratios was observed between healthy adults and the ITP cohort (median: 1.30, p = .54 and p = .80). Most patients with ITP (81.0%) showed a higher clearance rate than our healthy adult cohort.</p><p><strong>Discussion: </strong>Overall, this exploratory study in healthy subjects showed that there is an individual pattern of platelet clearance and sequestration, which was reproducible over time. This study sets the stage for studies into platelet clearance mechanisms in a healthy senescent or pathological setting and applications of the indium-111 scan beyond predicting splenectomy responses in ITP.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"1146-1154"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfusion quantities associated with 24-h mortality in trauma patients.","authors":"Mary L Wallace, Ryan A Kingrey, Julie A Rizzo, Michael D April, Andrew D Fisher, Maxwell A Braverman, Mark H Yazer, Steven G Schauer","doi":"10.1111/trf.18172","DOIUrl":"10.1111/trf.18172","url":null,"abstract":"<p><strong>Introduction: </strong>Data on the correlation between transfusion volumes and trauma mortality are limited. The association between the total number of red blood cell (RBC) and low titer group O whole blood (LTOWB) units, as well as the total volume of all transfused products that were administered up to 4-h after admission and 24-h mortality was determined.</p><p><strong>Methods: </strong>The Trauma Quality Improvement Program (TQIP) datasets from 2020 to 2022 were reviewed to identify patients aged ≥15 who received any volume of blood products. Receiver operating characteristic (ROC) were constructed along with the calculated area under the ROC curve (AUROC) to determine the association between the quantity of transfusion and 24-h mortality.</p><p><strong>Results: </strong>There were 144,379 encounters that met inclusion, with 22,467 patients who died within the first 24 h. There was a 90% probability of 24-h mortality following the transfusion of 56 RBC/LTOWB units (AUROC 0.673), with the 90% specificity, Youden's index, and 90% sensitivity surrounding this probability occurring after the transfusion of 8, 4, and 2 units, respectively. In terms of the volume of transfusion, there was a 90% probability of 24-h mortality following the transfusion of 36,000 mL of all blood products combined (AUROC 0.662), with the 90% specificity, Youden's index, and 90% sensitivity surrounding this probability occurring after the transfusion of 4400, 2000, and 500 mL, respectively.</p><p><strong>Conclusions: </strong>Both the total number of RBC and LTOWB units transfused and the total volume of all blood products transfused demonstrated poor predictive association with the risk of 24-h mortality in the civilian trauma population.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S40-S47"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of an anti-D-alloimmunization kinetics model to correct the interval censored D-alloimmunization rate following red blood cell transfusions.","authors":"Emil Ainsworth Jochumsen, Kathleen Selleng, Jay S Raval, Carolina Bonet Bub, Jose M Kutner, Ulrik Sprogøe, Mark H Yazer","doi":"10.1111/trf.18138","DOIUrl":"10.1111/trf.18138","url":null,"abstract":"<p><strong>Introduction: </strong>The rate of D-alloimmunization amongst RhD-negative recipients of RhD-positive red blood cell (RBC) transfusions is not certain. Recipients with a short duration between the index RhD-positive transfusion and the last antibody detection test that did not show anti-D might become D-alloimmunized in the future. A regression model was developed to predict how often such patients might develop D-alloimmunization in the future to help account for the immunohematological uncertainty that accompanies having short serological follow up periods.</p><p><strong>Methods: </strong>Using the published literature on recipients who were intentionally transfused with RhD-positive RBCs and serially followed with antibody screens, as well as unpublished datasets, a regression model was constructed to demonstrate the timing of D-alloimmunization for recipients who became D-alloimmunized within 6 months following the index transfusion. The model was then applied to a series of RhD-negative hospitalized recipients of at least one unit of RhD-positive RBCs who did not become D-alloimmunized but who had fewer than 6 months of serological follow up to weight their contribution to the D-alloimmunization rate.</p><p><strong>Results: </strong>Overall, the rate of D-alloimmunization was 21/105 (20.0%). There were 39 patients whose last documented antibody screen was performed between 14 days and 6 months after the index RhD-positive transfusion, and these patients were entered into the weighted model. After applying the model, the D-alloimmunization rate rose to 26.3%.</p><p><strong>Conclusion: </strong>Using a weighted model can help reduce the immunohematological uncertainty that accompanies the inclusion of patients with relatively short serological follow up in studies of RBC alloimmunization.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S304-S312"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An in silico simulation of the frequency of administering HLA-incompatible low titer group O whole blood units when the donor pool includes unscreened female donors.","authors":"Mark H Yazer, Samantha Ngamsuntikul, Manish Gandhi, Torunn Apelseth, Audra Taylor, Jansen N Seheult","doi":"10.1111/trf.18141","DOIUrl":"10.1111/trf.18141","url":null,"abstract":"<p><strong>Background: </strong>As low titer group O whole blood (LTOWB) increases in popularity, blood centers are finding innovative ways of maintaining the supply. One potential way is collecting LTOWB from parous female donors without testing for HLA antibodies. This in silico simulation predicted the risk of an LTOWB unit containing an HLA antibody and the subsequent risk for an HLA-incompatible transfusion.</p><p><strong>Methods: </strong>An LTOWB blood bank with 1 million units was simulated consisting of male, nulliparous, and parous female donors. The proportion of each donor type was modeled after the sex distribution at US blood centers. The parity of female donors was calculated based on the average number of live births per female depending on her age. HLA-alloimmunization risk was determined by her parity status. The HLA haplotypes of the simulated recipients were derived from the 100 most common HLA haplotypes in the US National Marrow Registry Program database. The proportion of different race/ethnic groups in the US was used to simulate 100,000 LTOWB recipients to whom between 1 and 10 units were administered.</p><p><strong>Results: </strong>Overall, the risk of an LTOWB unit containing at least one HLA antibody was 12.2% and the rate of receiving an HLA-incompatible unit was 21.3%. The risk of receiving an HLA-incompatible unit rose from 4.8% after receipt of one unit to 36.5% after 10 units.</p><p><strong>Conclusion: </strong>Blood collectors and hospitals should evaluate the potential TRALI risk against the benefit of a potentially expanded inventory of LTOWB before collecting plasma-containing products from non-HLA-tested parous female donors.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S227-S236"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Storage of whole blood in the plasma bag of an ordinary blood component collection set as an emergency preparedness measure.","authors":"Svein Sondre Valvik Lindgaard, Hanne Braathen, Joar Sivertsen, Torunn Oveland Apelseth","doi":"10.1111/trf.18182","DOIUrl":"https://doi.org/10.1111/trf.18182","url":null,"abstract":"<p><strong>Background: </strong>Demand for whole blood (WB) transfusions can increase dramatically during a disaster, but it is difficult to predict the need for blood products in the early phase of an event. Generally, blood services have large stocks of blood component collection sets but lack bags for the collection of WB for transfusion. While the collection bag in conventional blood component sets often lacks transfusion ports and cannot be used for WB transfusion, the plasma bags in these same sets have transfusion ports and are without filters or additives. This study aimed to evaluate the feasibility of transfer to and storage of WB in plasma bags from blood component collection sets.</p><p><strong>Study design and methods: </strong>Blood was collected in 10 Reveos (REV) and 10 Macopharma (MP) blood bag systems. Samples were taken from the units on days 1, 14, 21, 28, and 35 after donation. At each sample point, hematological, metabolic, and coagulation parameters were analyzed.</p><p><strong>Results: </strong>All results from both groups were in accordance with European regulatory requirements until Day 28, where three and one bags from the REV and MP groups, respectively, exhibited hemolysis at or above the 0.8% threshold. By day 35, this rose to seven and three bags, respectively. Platelet count, coagulation function, and factor VIII levels decreased but remained detectable throughout storage.</p><p><strong>Discussion: </strong>We conclude that storage of WB in the plasma bag of an ordinary blood component collection set as an emergency preparedness measure can maintain quality for a minimum of 21 days.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":"65 Suppl 1 ","pages":"S212-S218"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women receive less LTOWB than men. Why? Does it matter?","authors":"Lucy Z Kornblith, Andrew P Cap","doi":"10.1111/trf.18251","DOIUrl":"https://doi.org/10.1111/trf.18251","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":"65 Suppl 1 ","pages":"S4-S5"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide trends in prehospital blood product use after injury 2020-2023.","authors":"Christine Carico, Chandler Annesi, N Clay Mann, Matthew J Levy, Pawan Acharya, Timothy Hurson, Daniel Lammers, Jan O Jansen, Jeffrey D Kerby, John B Holcomb, Zain G Hashmi","doi":"10.1111/trf.18221","DOIUrl":"10.1111/trf.18221","url":null,"abstract":"<p><strong>Introduction: </strong>Prehospital blood transfusion improves survival after injury. Understanding potential demand for and usage of prehospital blood transfusion is important to help improve supply and utilization of this prehospital intervention. The primary objective of this study is to describe potential current demand for prehospital blood product in adults after blunt and penetrating injury from 2020 to 2023. We also estimate the extent to which this potential demand is being met.</p><p><strong>Methods: </strong>Patients ≥16 years with blunt/penetrating injuries included in the National Emergency Medical Services Information System (NEMSIS) from 2020 to 2023 were identified. Patients were classified into Cohort 1 (systolic blood pressure (SBP) <90 and heart rate (HR) >108 or SBP <70) and Cohort 2 (shock index ≥1), and total numbers in each cohort were reported. Additionally, the number and percentage of patients who were potentially eligible for and who received prehospital blood transfusion were calculated and trended over time.</p><p><strong>Results: </strong>After exclusions, 20.4 million trauma patients were included. A total of 262,761 Cohort 1 patients and 1,227,556 Cohort 2 patients were potentially eligible for transfusion. Estimated demand for blood transfusion increased from 2020 to 2023 (p < 0.001) in both cohorts. Cohort 1 had the highest estimated proportion of patients (0.9%, n = 2,289) who received transfusion, demonstrating that few potentially eligible adult trauma patients received blood product.</p><p><strong>Conclusions: </strong>Altogether, 1.2 million hemodynamically unstable trauma patients were potentially eligible for prehospital blood transfusion after injury during 2020-2023, yet less than 1% received this intervention. These data underscore the need to evaluate and resolve barriers to wider use of prehospital blood transfusions.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S30-S39"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The simplest solution may be good, but is it good enough? Evaluating the effect of a nudge to administer calcium during blood product resuscitation for traumatic injuries.","authors":"Daniela Schmulevich, Sarah M Joergensen, Alea I Zone, Kathleen E Bishop, Andrea P Morlok, Theresa A Colyar, Alyson D Hinkle, Rinad S Beidas, M Kit Delgado, Jeremy W Cannon","doi":"10.1111/trf.18180","DOIUrl":"10.1111/trf.18180","url":null,"abstract":"<p><strong>Background: </strong>Hypocalcemia following severe injury is common. Current institution-specific guidelines recommend calcium (Ca⁺⁺) supplementation during blood product resuscitation. We hypothesize that a nudge intervention would improve clinician adherence to Ca⁺⁺-specific guidelines.</p><p><strong>Methods: </strong>This study at an urban Level I trauma center evaluated compliance with Ca⁺⁺-specific guidelines during trauma resuscitations. A baseline assessment of guideline awareness preceded four-month pre-intervention and four-month post-intervention periods from July 2021 to February 2022. Nudge signs prompting clinicians to administer Ca⁺⁺ were placed throughout all phases of care. Administration of ≥1 dose of Ca⁺⁺ after four blood products was the primary endpoint. Aggregate ionized calcium (iCa⁺⁺) levels and percent time within a normal iCa⁺⁺ range were secondary outcomes.</p><p><strong>Results: </strong>Baseline assessment of n = 41 trauma team members indicated 83% were uncertain or unaware of current Ca⁺⁺ recommendations. Of 86 screened patients, 25 met inclusion criteria. These were median ([IQR] 34 [25-43]) years old with an Injury Severity Score of 18 [14-26] and 84% penetrating injuries with n = 11 pre-intervention and n = 14 post-intervention. The absolute difference (95% CI) in Ca⁺⁺ guideline adherence post-intervention compared to pre-intervention was 6.5% (-11.9% to 24.9%, p = 0.755). In aggregate, iCa⁺⁺ levels were no different between groups, although the distribution of levels post-intervention trended toward the normal range with less extreme hypocalcemia.</p><p><strong>Conclusions: </strong>Signs prompting clinicians to give Ca⁺⁺ were associated with a modest, non-statistically significant increase in adherence to institution-specific guidelines and a slight shift in the distribution of iCa⁺⁺ values toward normal. Future work to optimize resuscitation should evaluate larger cohorts of acutely injured patients and more potent nudges.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S113-S122"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}