Adolescent Psychiatry最新文献

{"title":"Are adolescents engaged in violent radicalization suicidal?","authors":"Valerie Dao, A. Oppetit, Hugues Pellerin, E. Chamboredon, Aveline Aouidad, G. Bronsard, Nicolas Campelo, David Cohen","doi":"10.2174/2210676613666230801153633","DOIUrl":"https://doi.org/10.2174/2210676613666230801153633","url":null,"abstract":"\u0000\u0000Radicalization among adolescents is a rising phenomenon that has become a public health concern in Europe. According to some authors, violent radicalization by resorting to self-violence could be a form of suicidal behavior. However, evidence-based studies to support this assertion are lacking.\u0000\u0000\u0000\u0000The aim of this study was to investigate the issue of suicidality among adolescents engaged in violent radicalization.\u0000\u0000\u0000\u0000We compared a group of radicalized adolescents convicted of criminal association to commit terrorism (AMT) in France (N=15) with hospitalized adolescents who have attempted to end their lives (N=320). This comparative study is based on two samples from two studies that used the same instruments to assess psychiatric diagnoses, suicide risk, reasons for living, and coping.\u0000\u0000\u0000\u0000AMT adolescents were significantly less suicidal and less depressive/hopeless than adolescents with suicide attempts (SAs). AMT adolescents showed fewer instances of depressive and borderline personality disorders but more manic and psychotic episodes than SA adolescents. They also had much more efficient coping strategies than SA adolescents, especially for the following strategies: seeking professional help, relational support and spiritual support. All the subscores of the reasons for the living scale were significantly higher for AMT adolescents than for SA individuals, apart from the subscore on peer acceptance and support.\u0000\u0000\u0000\u0000Adolescents engaged in violent radicalization cannot be considered suicidal adolescents who have found an opportunity to end their lives through the process of radicalization. Understanding this phenomenon within a social, political and cultural context is necessary.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44459694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of COVID-19 on Psychotropic Medication Prescriptions in Adolescents: Analysis of a Federated Research Network","authors":"Joshua White, T. Kohn, M. Rivero, A. Muthigi, Jamie Thomas, A. Ghomeshi, Francis Petrella, David Miller, M. Rueda-Lara, Ranjith Ramasamy","doi":"10.2174/2210676613666230619142223","DOIUrl":"https://doi.org/10.2174/2210676613666230619142223","url":null,"abstract":"\u0000\u0000COVID-19 pandemic restrictions resulted in psychosocial stress and increased potential for psychiatric disorders in the adolescent population. Adolescent psychiatric disorders are increasingly managed with psychotropic medications. We aimed to evaluate the first-time prescription rates of psychotropic medications—antidepressants, antipsychotics, hypnotics, sedatives, mood stabilizers, and psychostimulants—in adolescent patients during the COVID-19 pandemic compared to the years immediately prior.\u0000\u0000\u0000\u0000We utilized electronic health records, claims data, and pharmaceutical data generated from 68 healthcare organizations stored within the TriNetX Research Network to conduct a retrospective matched cohort study. Adolescent patients aged 10-19 years presenting for outpatient evaluation were placed into two cohorts: 1) outpatient evaluation before (2017-2019) and 2) during (2020-2022) the COVID-19 pandemic. Patients with prior history of psychiatric disorders and/or prior use of psychotropic medications were excluded. The main outcome was first-time psychotropic medication prescription within 90 days of outpatient evaluation. We used propensity score matching with logistic regression to build cohorts of equal size based on covariates of interest.\u0000\u0000\u0000\u0000A total of 1,612,283 adolescents presenting before the COVID-19 pandemic and 1,008,161 adolescents presenting during the COVID-19 pandemic were identified. After matching on age, race/ethnicity, smoking status, and obesity status, a total of 1,005,408 adolescents were included in each cohort, each with an average age of 14.7 ± 2.84 years and 52% female and 48% male. The standardized differences between propensity scores were less than 0.1, suggesting a minimal difference between the two groups. Prescription rates for antipsychotics and benzodiazepines were increased for adolescents presenting during the pandemic (Risk Ratio (RR): 1.58, 95% confidence intervals (CI) 1.48-1.69). However, this group had decreased prescription rates for antidepressants (RR: 0.6, 95% CI 0.57-0.63), anxiolytics (RR: 0.78, 95% CI 0.75-0.81), psychostimulants (RR: 0.26, 95% CI 0.25-0.27), and mood stabilizers (RR: 0.44, 95% CI 0.39-0.49).\u0000\u0000\u0000\u0000Adolescents presenting for outpatient evaluation during the COVID-19 pandemic were prescribed antipsychotics and benzodiazepines at an increased rate relative to the years immediately prior, suggesting an increased need for sedation in this patient population. Given reduced access to care during the COVID-19 pandemic, the decreased prescription rate observed for other psychotropic medication classes does not necessarily reflect a decreased incidence of the associated psychiatric disorders.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44946354","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":"Baseline and Outcome Comparison of Adolescents in Treatment for Opioid and Non-opioid Use Disorder","authors":"M. LaCasse, Ryan M. Loh, C. Thurstone","doi":"10.2174/2210676613666230503094501","DOIUrl":"https://doi.org/10.2174/2210676613666230503094501","url":null,"abstract":"\u0000\u0000In the current opioid epidemic, little is known about\u0000differences in treatment structure for youth with opioid use disorder (OUD) and\u0000youth with other substance use disorders.\u0000\u0000\u0000\u0000This study analyzed baseline characteristics and outcome data\u0000comparing youth who suffer from OUD vs. those with other substance use disorders\u0000in an urban Denver, Colorado clinic.\u0000\u0000\u0000\u0000A retrospective cohort review was conducted, analyzing clinical data\u0000between February 2017 and March 2021. Two groups were created and compared:\u0000those with OUD (n = 59) and those with other substance use disorders (n = 417).\u0000The primary outcome variable was achieving a negative urine drug screen within 16\u0000weeks of baseline assessment. We hypothesized that there would be no difference\u0000between the groups in the primary outcome variable.\u0000\u0000\u0000\u0000Youth with OUD were slightly older and had more co-morbid stimulant\u0000use disorder. No difference between the groups was observed in achieving a\u0000negative urine drug screen within 16 weeks.\u0000\u0000\u0000\u0000A multimodal, generalized treatment approach yielded similar\u0000outcomes for those suffering from OUD compared to those with other substance\u0000use disorders. There might not need to be significant variances in treatment\u0000approach depending on the specific substance use disorder.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42749499","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":"Sleep Disturbances in Children and Adolescents with Autism Spectrum Disorder:\u0000An Overview for Clinicians","authors":"Mayank Gupta, Nihit Gupta, Yuli Fradkin, T. Petti","doi":"10.2174/2210676613666230126115646","DOIUrl":"https://doi.org/10.2174/2210676613666230126115646","url":null,"abstract":"\u0000\u0000Sleep disorders in autism spectrum disorders (ASD/SD) are distinct, broad, and highly variable clinical entities that ubiquitously affect core symptomatology, development of comorbid disorders, and overall quality of life for affected children and families. High genetic predisposition and the presence of co-occurring disorders present significant challenges in assessment and appropriate interventions.\u0000\u0000\u0000\u0000The study aimed to review the best available evidence and address the clinical gaps in the knowledge about sleep disorders in children and adolescents with autism spectrum disorders.\u0000\u0000\u0000\u0000The review provides a comprehensive literature search of 1622 articles and summarizes 110 selected for empirical evidence to methodically consider critical aspects of sleep disorders in ASD for informing clinicians of useful information.\u0000\u0000\u0000\u0000Clinicians have insufficient guidance and support to effectively manage sleep disruptions in ASD youth in practice. Prevalence of sleep disruption in ASD, close to 80%, is characterized by unique subtypes, including but not limited to obstructive sleep apnea, circadian rhythm disorders, and sleep-related movement disorders. Greater awareness of sleep disruption, its neurodevelopmental basis, scope, and impact allows for improved treatment and prevention efforts of these conditions, and is critical for clinical practice and future research. The bidirectional nature of disruptive sleep and ASD is considered a major area requiring further clarification.\u0000\u0000\u0000\u0000Clinician-friendly screening tools are needed for everyday office practice to identify ASD/SD conditions and interventions, and mitigate harmful effects. Psychoeducational and cognitive-behavioral approaches for improving and supporting healthy sleep hygiene, considered the first line of treatment, are detailed. The weak database for the use of psychopharmacologic agents is summarized, and the strength of prescribing prolonged-release melatonin for optimal results is described. The promise of other medications is discussed.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41593218","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":"Post-Traumatic Mental And Physical Consequences Of Frontline Reporting In Mena Region","authors":"Lakhdar Chadli, Farooq Haq, A. Okasha, Rafik Attou","doi":"10.2174/18749445-v15-e221209-2022-233","DOIUrl":"https://doi.org/10.2174/18749445-v15-e221209-2022-233","url":null,"abstract":"\u0000 \u0000 A current need in journalistic frontline work is to understand the potential psychological and physical traumatic consequences that may result from on-duty appointments. Journalists are active in frontline zones to report on conflicts, crisis, and natural disasters. In the Middle East and North Africa [MENA] region, reporters are not equipped or trained mentally or emotionally to handle stressful events. Most journalists suffer from certain degrees of post-traumatic mental and physical disorders associated with their frontline duties.\u0000 \u0000 \u0000 \u0000 The objective of this exploratory study is to provide comprehensive insights into challenges faced by journalists reporting in conflict zones in the MENA region.\u0000 \u0000 \u0000 \u0000 This research study is based on a qualitative research approach where data was collected by directly interviewing eight journalists who have covered frontline conflicts and disasters in the MENA region. The collected qualitative data was analysed by conducting the thematic analysis to appreciate emerging categories. The ontology of critical realism was adopted to recognise the realistic feelings and experiences of the responding journalists.\u0000 \u0000 \u0000 \u0000 This original study presents six themes emerging from the data and researcher triangulation. The health and social issues in MENA are found to be most critical for high-risk reporting.\u0000 \u0000 \u0000 \u0000 Amidst the psychological and physical problems, all journalists did not give up their jobs or ask for privileges. Media houses could consider a more robust training plan based on health and safety to prepare these journalists.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43968121","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":"Editorial","authors":"I. Dancyger, V. Fornari","doi":"10.2174/221067661203221103155221","DOIUrl":"https://doi.org/10.2174/221067661203221103155221","url":null,"abstract":"<jats:sec>\u0000<jats:title />\u0000<jats:p />\u0000</jats:sec>","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44776420","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":"Caring for Transgender Youth with Eating Disorders in a Day Treatment Program","authors":"Lauren Salvatore Farkas, I. Dancyger, Shervin Shadianloo, V. Fornari","doi":"10.2174/2210676613666221027124554","DOIUrl":"https://doi.org/10.2174/2210676613666221027124554","url":null,"abstract":"\u0000\u0000The treatment of transgender youth with an eating disorder presents particular considerations due to the unique combination of body dissatisfaction, drive for thinness, malnutrition coupled with the evolving gender identity in the midst of biological and physical changes. At this time, public awareness, societal acknowledgment and legislative initiatives have led to wider acceptance of Lesbian, Gay, Bi-sexual and Transgender rights. However, at the same time, transgender youth are at increased risk for mental health problems, including eating disorders.\u0000\u0000\u0000\u0000To describe two cases of trans adolescents with anorexia nervosa treated in a day treatment program.\u0000\u0000\u0000\u0000In this paper, the two clinical vignettes of transgender adolescent with anorexia nervosa will be discussed. The focused care included specific attention to the initial disclosure of gender identity in a safe space, name and pronoun preferences as well as wardrobe and hair style changes. In addition, treatment focused on the reduction of social anxiety around meal consumption with special attention given to the impact of weight on the development of secondary sex characteristics. Themes of identity, rejection and secrecy were explored.\u0000\u0000\u0000\u0000In summary, the treatment of transgender youth with anorexia nervosa is more complex than treatment of cis gender youth. Additional issues, such as hormonal treatments, the development of secondary sexual characteristics as well as social and cultural factors can exacerbate eating disorder symptoms. Treatment should focus on understanding the etiology and the trajectory of the disorder within this lens.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42863214","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":"Systematically identifying communication deficits in youth under psychiatric care through a self-report scale","authors":"Nagy Lr, U. A, Petti Ta","doi":"10.2174/2210676613666221021113633","DOIUrl":"https://doi.org/10.2174/2210676613666221021113633","url":null,"abstract":"\u0000\u0000Communication disorders are associated with psychopathology and social distress in adolescents, yet moderate or less severe deficits often go undiagnosed. Data from a quality improvement initiative was analyzed from the Communication Perception Estimate Scale (CoPES), a self-report scale for receptive-expressive and pragmatic language deficits in youth receiving mental health services.\u0000\u0000\u0000\u0000To identify the frequency of communication deficits (CDs) among youth in psychiatric care and identify patterns of self-reported symptoms. The scale may be used as a clinical screening tool for Language disorder and Social (Pragmatic) communication disorder.\u0000\u0000\u0000\u0000CoPES is a 31-item scale administered to 318 adolescents 11-18 years old, asking questions about receptive-expressive and pragmatic CDs. In the first 12 items, subjects identified frequency of communication disorder symptoms using a forced-choice scale; in the following items frustration with CDs and then yes or no for earlier intervention and current interest in getting help for CDs. Respondents are from five representative clinical services.\u0000\u0000\u0000\u0000Patients were divided into self-identified groups: 14.5% significant Receptive-Expressive deficits only (R-ED); 6.6% significant Pragmatic deficits only (PD); 29.9% Both significant Receptive-Expressive and Pragmatic deficits (BCD); and 49.1% with limited or no deficits (NCD). The R-ED group expressed high rates of frustration and requests for help with Receptive-Expressive deficits. The PD group reported elevated rates of frustration in both areas. The BCD group indicated significantly more frustration and requests for help with both language areas compared to the NCD group.\u0000\u0000\u0000\u0000This data supports the need for greater awareness and consideration of communication disorders in youth presenting for psychiatric care.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48190493","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":"Lesbian Gay Bisexual Transgender Questioning/Queer Two-Spirit Adolescents and Suicidality","authors":"Valerie Tobin, N. Sheth, Hale M. Thompson, N. Karnik","doi":"10.2174/2210676612666220826142153","DOIUrl":"https://doi.org/10.2174/2210676612666220826142153","url":null,"abstract":"\u0000\u0000At a time when suicides are increasing throughout the United States, lesbian, gay, bisexual, transgender, and two spirit (LGBTQ2S) adolescents are at especially high risk for suicidal ideation, attempts, and completed suicide.\u0000\u0000\u0000\u0000To 1) provide an overview and clinical perspective on LGBTQ2S suicidal ideation, attempts, and completed suicide; 2) discuss how the literature maps on to theories of suicide, and also points the way to clinical recommendations; and 3) give recommendations for clinical care based on this evidence.\u0000\u0000\u0000\u0000This article uses a narrative review style to discuss the current concerns around LGBTQ2S adolescent suicide. The Social Ecological Model, the Interpersonal Psychological Theory of Suicide, and Minority Stress Theory are used describe the manner in which risks are acquired.\u0000\u0000\u0000\u0000Emerging research demonstrates risks and protective factors in the lives of LGBTQ2S adolescents. The social context of LGBTQ2S adolescents puts them at risk for internalizing the experiences of discrimination evident in our society, In addition, there are other risk factors frequently associated with their LGBTQ2S status, such as substance misuse, homelessness, and lack of social support . Adolescents of color are especially vulnerable as they experience multiple marginalizations, often living in under resourced communities with poor access to health care. Support to families can be provided in the form of psychoeducation based on research findings. Social support is crucial and can be effectively provided in schools. Access to mental health care needs to be increased and barriers reduced.\u0000\u0000\u0000\u0000There is a need for more research, especially prospective study designs and research that centers adolescents of color and homeless adolescents. While there may be barriers to addressing the current rate of suicidality in this population, clinicians who work with adolescents can use a range of therapies to support their LGBTQ2S adolescent patients and their families, decreasing risk of suicidality.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46230585","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 Systematic Review of Systematic Reviews Exploring the Factors Related to Child and Adolescent Self-Harm.","authors":"Danielle Varley, Clare Fenton, Georgina Gargan, Olivia Taylor, A. Taylor, N. Kirby, Michel Morton, J. Barrow, Christopher Hatton, B. Wright","doi":"10.2174/2210676612666220721101210","DOIUrl":"https://doi.org/10.2174/2210676612666220721101210","url":null,"abstract":"\u0000\u0000In recent years the rates of young people presenting with self-harming have increased dramatically, with self-harm being a predictor of suicide. Despite evidence suggesting that self-harm is common in young people and that hospital admissions are increasing, research exploring the reasons behind young people’s motivations is not easily accessed. Systematic reviews have explored this from a range of perspectives, but none have drawn all this literature together.\u0000\u0000\u0000\u0000A systematic review of systematic reviews was conducted in accordance with PRISMA guidelines. Seven databases were searched using a peer reviewed search strategy, with a focus on the factors of child and adolescent self-harming. All English language articles, published between 2008 and 2021, were considered, and screened against inclusion criteria. References of included articles were also searched for eligible articles.\u0000\u0000\u0000\u0000Twenty-two systematic reviews were included after screening against eligibility criteria. Narrative synthesis identified eight themes for motivation or reasons for self-harming: identity and subcultures, peer influences, educational stressors, mental ill health, cognitive and neuropsychological factors, trauma and attachment, internet influences and social media.\u0000\u0000\u0000\u0000Reasons for self-harming in adolescents are complex and multifactorial. Many studies focus on single causes or associations with self-harm rather than open-mindedly exploring a range of factors or the interactions between them. This leaves gaps in the research where hypothetical reasons for self-harm have not been systematically explored. The themes identified here could help in the clinical assessment process and guide future research in this area including the development of potential differentiated prevention and treatment approaches.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46835158","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}