American journal of disaster medicine最新文献

{"title":"Prehospital emergency department care activations during the initial COVID-19 pandemic surge.","authors":"Rebecca Leff,&nbsp;Alex Fleming-Nouri,&nbsp;Arjun K Venkatesh,&nbsp;Vivek Parwani,&nbsp;Craig Rothenberg,&nbsp;Rohit B Sangal,&nbsp;Colin T Flood,&nbsp;Matthew Goldenberg,&nbsp;Charles Wira","doi":"10.5055/ajdm.2022.0417","DOIUrl":"https://doi.org/10.5055/ajdm.2022.0417","url":null,"abstract":"<p><strong>Objective: </strong>To describe trends in prehospital presentations of critical medical and trauma conditions during the COVID-19 pandemic using prehospital and emergency department (ED) care activations.</p><p><strong>Methods: </strong>Observational analysis of ED care activations in a tertiary, urban ED between March 10, 2020 and September 1, 2020 was compared to the same time periods in 2018 and 2019. ED care activations for critical medical conditions were classified based on clinical indication: undifferentiated medical, trauma, or stroke.</p><p><strong>Main outcome: </strong>The primary outcomes were the number of patients presenting from the prehospital setting with specified ED activation criteria, total ED volume, ambulance arrival volume, and volume of COVID-19 hospital admissions. Locally weighted scatterplot smoothing curves were used to visually display our results.</p><p><strong>Results: </strong>There were 1,461 undifferentiated medical activations, 905 stroke activations, and 1,478 trauma activations recorded, representing absolute decreases of 11.3, 28.1, and 20.3 percent, respectively, relative to the same period in 2019, coinciding with the declaration of a public health emergency in Connecticut. For all three types of presentation, post-peak spikes in activations were observed in early May, approximately two weeks after our health system in Connecticut reached its peak number of COVID-19 hospitalizations-eg, undifferentiated medical activations: increase in 280 percent, n = 140 from 2019, p < 0.0001-and declined thereafter, reaching a nadir in early June 2020.</p><p><strong>Conclusions: </strong>After the announcement of public health measures to mitigate COVID-19, ED care activations declined in a large Northeast academic ED, followed by post-peak surges in activations as COVID- 19 cases decreased.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40661299","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":"Chemical, biological, radiological, nuclear, and explosives (CBRNEs) preparedness for sporting event mass gatherings: A systematic review of the literature.","authors":"Sonny S Patel,&nbsp;Julian H Neylan,&nbsp;Katerina Bavaro,&nbsp;Peter R Chai,&nbsp;Eric Goralnick,&nbsp;Timothy B Erickson","doi":"10.5055/ajdm.2022.0420","DOIUrl":"https://doi.org/10.5055/ajdm.2022.0420","url":null,"abstract":"<p><strong>Objective: </strong>Sporting events often constitute mass gatherings (MGs) featuring large crowds of spectators and participants. Our objective is to understand the current state of emergency preparedness for sporting events by examining past MG sporting events to evaluate mitigation, preparedness, response, and recovery against chemical, biological, radiological, nuclear, and explosive (CBRNE) events.</p><p><strong>Methods: </strong>In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was carried out among 10 literature databases. The quality and risk of bias in each reviewed publication was assessed using the Mixed Methods Appraisal Tool.</p><p><strong>Results: </strong>A total of 5,597 publications were identified. Of these, 81 papers were selected for full text reads and 25 publications were accepted. The included articles documented sporting events worldwide, ranging from incidents occurring from 1972 to 2020. Cross-cutting themes found in best practices and recommendations were strategic communication, surveillance, planning and preparedness, and training and response.</p><p><strong>Conclusion: </strong>More evidence-based guidelines are needed to ensure best practices in response and recovery for CBRNE incidents at sporting events. Public health risks as well as implementation barriers and opportunities to prepare for potential CBRNE threats at sporting event MGs require further investigation.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9360913/pdf/nihms-1828127.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40662700","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":"Evaluation of the implementation of personal protective equipment for French military firefighters in a CBRN context.","authors":"Bastien Van Overbeck,&nbsp;Hélène Deshayes,&nbsp;Fabian Thien-Bourgery,&nbsp;Nicolas Pailhes,&nbsp;Sébastien Beaume,&nbsp;Aurélien Renard,&nbsp;Cédric Boutillier du Retail,&nbsp;Nicolas Cazes","doi":"10.5055/ajdm.2022.0419","DOIUrl":"https://doi.org/10.5055/ajdm.2022.0419","url":null,"abstract":"<p><strong>Introduction: </strong>Military firefighters are the first responders in the event of a chemical, biological, radiation, and nuclear (CBRN) event in the Marseille area. They receive initial training to intervene safely in a CBRN context. We wanted to evaluate the use of CBRN personal protective equipment (PPE) at a distance from this training.</p><p><strong>Method: </strong>A prospective observational bicentric descriptive study on 20 operational firefighters operating on rescue and emergency vehicles. Two PPE dressing sessions, separated by 3 months, were evaluated and timed. A reminder of the correct procedure was given by the investigator after the first dressing.</p><p><strong>Results: </strong>On average, 60.5 percent of the steps were correctly performed during the first dressing and 83 percent during the second dressing. Between the two dressings, there was a significant improvement (p < 0.01) in the team verification of the dressing and the chronological order of the dressing as well as the actions to be taken before dressing (remembering to make oneself comfortable, to urinate, to drink). The second dressing is on average 21 seconds faster than the first. Professional training and exercise experience of the firefighters in CBRN improve the success and speed of dressing in the absence of a prior reminder.</p><p><strong>Conclusion: </strong>Shorter and more frequent training and exercises, which simulate real-life situations for firefighters, lead to safer, more competent and faster donning of PPE.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40662699","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":"Emergency medical services operations during civil unrest: Best practices from lessons learned.","authors":"Gregory Jasani,&nbsp;Bryan McNeilly,&nbsp;Kelly Poe,&nbsp;Stephen Liang","doi":"10.5055/ajdm.2022.0445","DOIUrl":"https://doi.org/10.5055/ajdm.2022.0445","url":null,"abstract":"<p><p>During periods of civil unrest, emergency medical services (EMSs) clinicians will be called upon to provide care to those impacted, including those who are actively instigating violence. Working during periods of civil unrest poses significant operational and security challenges to EMS leadership and clinicians. This review provides best practices for EMS operating during periods of civil unrest through analysis of after action reports from Baltimore, Maryland; Charlottesville, North Carolina; Minneapolis, Minnesota; and Washington, DC.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9951679","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":"Management of emergency department diversion during the COVID-19 pandemic and disaster periods.","authors":"Michael Steflovich","doi":"10.5055/ajdm.2022.0448","DOIUrl":"https://doi.org/10.5055/ajdm.2022.0448","url":null,"abstract":"<p><strong>Background: </strong>Recent news has shown the strain on hospital emergency departments (EDs) and emergency medical services agencies due to the surge of COVID-19; however, compared to all emergency medical service transports, is it true that the United States is seeing an increase in the frequency of diversions? In this quantitative research report, data were collected and analyzed from a national prehospital emergency medical services information system, which allowed for a comparison of the frequency of diverted ambulances, transport times, and final patient acuity of patients arriving by diverted ambulances before and during the COVID-19 pandemic. Statistical analysis was performed on data obtained from the National Emergency Medical Services Information System to compare the frequency of ambulance diversion prior to the COVID-19 disaster and during COVID-19.</p><p><strong>Findings: </strong>Analysis of data obtained from the National Emergency Medical Services Information System found that there was not a significant increase in the percentage of ambulance transports that were diverted during the COVID-19 pandemic compared to before the pandemic. However, there were significant increases in the volume of all transports and diverted transports during the COVID-19 pandemic (p < 0.01 for both measures).</p><p><strong>Conclusion: </strong>The significant increases seen in the demand for services, combined with an overall downward trend in the number of healthcare facilities, have resulted in an increase in the volume of diversions, despite the overall demand increasing as well. The COVID-19 pandemic serves as a disaster/public health crisis that is subject to the same phases compared to other types of disasters. The significant findings of this report should provide the emergency services field a big picture, understanding that the problem at hand is multifaceted, with these findings shining light on the effects of current issues between emergency services and hospital EDs.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9945804","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":"Disaster and public health emergency health data collection and management: A scoping review.","authors":"Alissa J Mitchell,&nbsp;Tatsuhiko Kubo,&nbsp;Alexander H Chang,&nbsp;Odgerel Chimed Ochir,&nbsp;Anthony Salerno,&nbsp;Yui Yumiya,&nbsp;Daniel J Barnett,&nbsp;Katsumi Nakase,&nbsp;Edbert B Hsu","doi":"10.5055/ajdm.2022.0443","DOIUrl":"https://doi.org/10.5055/ajdm.2022.0443","url":null,"abstract":"<p><strong>Objective: </strong>The World Health Organization (WHO) developed the Emergency Medical Team (EMT) Minimum Data Set (MDS) to provide a structured, data-based approach to health data collection and management during disasters and public health emergencies. Given recent creation of the EMT MDS, we conducted a scoping review to gauge current practices surrounding health data collection and sharing in emergent settings.</p><p><strong>Design: </strong>An English-based scoping review of PubMed and Embase databases of publications before June 28, 2021.</p><p><strong>Main outcome measures: </strong>The review aimed to identify facilitators and barriers to the implementation of the WHO-standardized health data collection systems in the context of disasters and public health emergencies; characterize best practices regarding implementation of an MDS to improve health data collection capacity in differing settings; and highlight internationally accepted, standardized tools or methods for setting up essential public health data for disaster response.</p><p><strong>Results: </strong>A total of 8,038 citations from PubMed and Embase were imported into Covidence with 46 duplicates removed. Among these, 7,992 citations underwent title screening and abstract review, with 161 articles proceeding to full-text article review where an additional 109 articles were excluded. Fifty-two citations were included in final data abstraction.</p><p><strong>Conclusions: </strong>Findings revealed a range of critical operational, structural, and functional insights of relevance to implementation of the EMT MDS. The literature identified facilitators and barriers to collecting and storing disaster-based datasets, gaps in standardization of data collection resulting in poor data quality during the transition from the acute to post-acute phase, and best practices in the collection of EMT MDS.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9951675","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":"Disasters on campus: A cross-sectional survey of college EMS systems' preparedness to respond to mass casualty incidents.","authors":"Matthew A Tovar, Catherine H Zwemer, Christopher M Wend, Andrew C Meltzer, Babak Sarani, James P Phillips","doi":"10.5055/ajdm.2021.0411","DOIUrl":"10.5055/ajdm.2021.0411","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to assess the training and readiness levels of Collegiate Emergency Medical Service (EMS) providers to respond to mass casualty incidents (MCIs).</p><p><strong>Methods: </strong>An anonymous cross-sectional survey of Collegiate EMS providers was performed.</p><p><strong>Participants: </strong>Participants were US-based EMS providers affiliated with the National Collegiate Emergency Medical Services Foundation.</p><p><strong>Outcome measures: </strong>The main outcome measures were levels of EMS experience and MCI training, subjective readiness levels for responding to various MCI scenarios, and analyzing the effect of the COVID-19 pandemic on MCI response capabilities.</p><p><strong>Results: </strong>Respondents had a median age of 21 years (interquartile range IQR 20, 22), with 86 percent (n = 96/112) being trained to the Emergency Medical Technician-Basic level. Providers reported participating in an average of 1.6 MCI trainings over the last four years (IQR, 1.0, 2.2). Subjective MCI response readiness levels were highest with active assailant attacks followed by large event evacuations, natural disasters, hazardous material (HAZMAT) incidents, targeted automobile ramming attacks, explosions, and finally bioweapons release. Disparate to this, only 18 percent of participants reported training in the fundamentals of tactical and disaster medicine. With respect to the effect of the COVID-19 pandemic on MCI readiness, 27 percent of respondents reported being less prepared, and there was a statistically significant decrease in subjective readiness to respond to HAZMAT incidents.</p><p><strong>Conclusion: </strong>Given low rates of MCI training but high rates of self-assessed MCI preparedness, respondents may overestimate their readiness to adequately respond to the complexity of a real-world MCI. More objective assessment measures are needed to evaluate provider preparedness.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40320895","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 review of interventions for noncommunicable diseases in humanitarian emergencies in low- and middle-income countries.","authors":"Rebecca Leff, Anand Selvam, Robyn Bernstein, Lydia Wallace, Alison Hayward, Pooja Agrawal, Denise Hersey, Christine Ngaruiya","doi":"10.5055/ajdm.2021.0412","DOIUrl":"10.5055/ajdm.2021.0412","url":null,"abstract":"<p><strong>Objective: </strong>Noncommunicable diseases (NCDs) are of increasing prevalence in low- and middle-income countries (LMICs), affected by disasters. Humanitarian actors are increasingly confronted with how to effectively manage NCDs, yet primary focus on this topic is lacking. We conducted a systematic review on the effects of disasters on NCDs in LMICs. Key interventions were identified, and their effects on populations in disaster settings were reviewed.</p><p><strong>Design: </strong>We electronically searched Medline, PubMed, Global Health, and Social Science Citation Index. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. Eligible articles incorporated core intervention components as defined by the United States Department of Health and Human Services. Key intervention components including target population, phase of crisis, and measured outcomes were extracted and synthesized using a thematic analysis approach. The full systematic review is registered at PROSPERO (CRD42018088769).</p><p><strong>Results: </strong>Of the 4,430 identified citations, we identified seven eligible studies. Studies reported on the response (n = 4) and recovery (n = 3) phases of disaster, with no studies reporting on the mitigation or preparedness phases. Successful interventions conducted predeployment risk assessments, performed training and capacity building for healthcare workers, worked in close cooperation with local health services, evaluated individual needs of subpopulations, promoted task shifting between humanitarian and development actors, and adopted flexibility in guideline -implementation.</p><p><strong>Conclusions: </strong>This review highlights the limited quantity and quality of evidence on interventions designed to address NCDs in humanitarian emergencies, with a particular paucity of studies addressing the mitigation and preparedness phases of disaster. While several challenges to NCD management such as insecurity and fluid movement of refugees create inherent challenges to NCD management in disasters, the lack of knowledge and training in NCD management among healthcare providers and the absence of basic medications and supplies for NCD management highlighted in this review are amenable to further intervention.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40320896","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":"Earthquake response in Chile: A case study in health emergency and disaster risk management.","authors":"Alexander Hart, Álvaro Mardones Rodríguez, José Retamal Carvajal, Gregory R Ciottone","doi":"10.5055/ajdm.2021.0413","DOIUrl":"10.5055/ajdm.2021.0413","url":null,"abstract":"<p><p>Chile is one of the most seismically active nations in the world. Due to the frequency of earthquakes, the Chilean government has invested heavily in several earthquake mitigation strategies and is able to boast impressively low numbers of deaths after relatively strong earthquakes. These include earthquake-centered building codes, which help prevent collapses, early detection technologies, early warning systems, public awareness campaigns, and unified command of responding agencies. Disaster risk management is a field in need of more evidence-based recommendations, and taking cues from successful programs such as these is vital to decrease global deaths. There is still room for improvement. Individual frontline responders have sought out further training specific to earthquakes, and the frequency of earthquakes in the country has led to impressive institutional knowledge. However, there needs to be more universal, standardized response training. Additionally, although all responders are brought under one umbrella during a disaster, there is a lack of coordinated training, with most responder training occurring in silos. Further investment in preparedness, and a strong focus on mitigation and prevention of disasters is vital across a number of disasters. Fast onset disasters like earthquakes are especially amenable to mitigation strategies such as those in place in Chile.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40319330","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":"Ophthalmology emergency room admission after Hurricane Harvey.","authors":"Cina Karimaghaei, Kevin Merkley, Hossein Nazari","doi":"10.5055/ajdm.2021.0409","DOIUrl":"10.5055/ajdm.2021.0409","url":null,"abstract":"<p><strong>Objective: </strong>To study the pattern of ophthalmic emergencies after Hurricane Harvey (HH).</p><p><strong>Design: </strong>A retrospective chart review.</p><p><strong>Setting: </strong>University of Texas Medical Branch (UTMB) in Galveston, Texas.</p><p><strong>Participants: </strong>Patients who presented to UTMB emergency room (ER) during the month before (47 patients) and the month after (39 patients) HH landfall and were seen by the ophthalmology service.</p><p><strong>Main outcome measures: </strong>Ocular injuries before and after hurricane landfall were classified by duration of symptoms (acute, subacute, and chronic), type of injury (hurricane related, traumatic, and infectious), region of injury (corneal/anterior segment, glaucoma, vitreoretinal, orbital-oculoplastic, and neuro-ophthalmologic), and level of involvement of injury (limited to eye, a manifestation of systemic disease, and associated with other bodily injuries).</p><p><strong>Results: </strong>Patient demographics were similar before and after the storm. Three direct hurricane-related injuries from rescue and cleanup activities were identified. Only patients with acute/subacute ophthalmic injuries presented after HH. A trend for more traumatic injuries (from 28 to 41 percent of patients), corneal/anterior segment injuries (from 38 to 46 percent of patients), and vitreoretinal injuries (from 17 to 23 percent of patients) was observed after HH. A greater proportion of patients presented with localized injuries limited to the eye (from 49 to 56 percent of patients). Fewer patients had ocular manifestations of systemic disease (from 38 to 31 percent of patients) after HH. None of the changing trends reached statistical significance.</p><p><strong>Conclusions: </strong>The low incidence of hurricane-related injuries was likely due to victims' evacuation to surrounding nonimpacted areas and limited access to ER facilities within the affected area. ERs and eye care professionals should be prepared for future environmental disasters.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40320893","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}