Translational Behavioral Medicine最新文献

{"title":"Multilevel factors influence the use of a cardiovascular disease assessment tool embedded in the electronic health record in oncology care.","authors":"Maura M Kepper, Raúl D Gierbolini-Rivera, Kathryn E Weaver, Randi E Foraker, Emily V Dressler, Chandylen L Nightingale, Aylin A Aguilar, Kimberly D Wiseman, Jenny Hanna, Alyssa D Throckmorton, Simon Craddock Lee","doi":"10.1093/tbm/ibae058","DOIUrl":"10.1093/tbm/ibae058","url":null,"abstract":"<p><p>Digital health tools are positive for delivering evidence-based care. However, few studies have applied rigorous frameworks to understand their use in community settings. This study aimed to identify implementation determinants of the Automated Heart-Health Assessment (AH-HA) tool within outpatient oncology settings as part of a hybrid effectiveness-implementation trial. A mixed-methods approach informed by the Consolidated Framework for Implementation Research (CFIR) examined barriers and facilitators to AH-HA implementation in four NCI Community Oncology Research Program (NCORP) practices participating in the WF-1804CD AH-HA trial. Provider surveys were analyzed using descriptive statistics. Interviews with providers (n = 15) were coded using deductive (CFIR) and inductive codes by trained analysts. The CFIR rating tool was used to rate each quote for (i) valence, defined as a positive (+) or negative (-) influence, and (ii) strength, defined as a neutral (0), weak (1), or strong (2) influence on implementation. All providers considered discussing cardiovascular health with patients as important (61.5%, n = 8/13) or somewhat important (38.5%, n = 5/13). The tool was well-received by providers and was feasible to use in routine care among cancer survivors. Providers felt the tool was acceptable and usable, had a relative advantage over routine care, and had the potential to generate benefits for patients. Common reasons clinicians reported not using AH-HA were (i) insufficient time and (ii) the tool interfering with workflow. Systematically identifying implementation determinants from this study will guide the broader dissemination of the AH-HA tool across clinical settings and inform implementation strategies for future scale-up hybrid trials.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822721","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":"AI for all: bridging data gaps in machine learning and health.","authors":"Monica L Wang, Kimberly A Bertrand","doi":"10.1093/tbm/ibae075","DOIUrl":"https://doi.org/10.1093/tbm/ibae075","url":null,"abstract":"<p><p>Artificial intelligence (AI) and its subset, machine learning, have tremendous potential to transform health care, medicine, and population health through improved diagnoses, treatments, and patient care. However, the effectiveness of these technologies hinges on the quality and diversity of the data used to train them. Many datasets currently used in machine learning are inherently biased and lack diversity, leading to inaccurate predictions that may perpetuate existing health disparities. This commentary highlights the challenges of biased datasets, the impact on marginalized communities, and the critical need for strategies to address these disparities throughout the research continuum. To overcome these challenges, it is essential to adopt more inclusive data collection practices, engage collaboratively with community stakeholders, and leverage innovative approaches like federated learning. These steps can help mitigate bias and enhance the accuracy and fairness of AI-assisted or informed health care solutions. By addressing systemic biases embedded across research phases, we can build a better foundation for AI to enhance diagnostic and treatment capabilities and move society closer to the goal where improved health and health care can be a fundamental right for all, and not just for some.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":"15 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048204","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":"The Selah trial: A preference-based partially randomized waitlist control study of three stress management interventions.","authors":"Rae Jean Proeschold-Bell, David E Eagle, Logan C Tice, Alyssa Platt, Jia Yao, Jessie S Larkins, Eunsoo Timothy Kim, Joshua A Rash","doi":"10.1093/tbm/ibae017","DOIUrl":"10.1093/tbm/ibae017","url":null,"abstract":"<p><p>Chronic stress undermines psychological and physiological health. We tested three remotely delivered stress management interventions among clergy, accounting for intervention preferences. United Methodist clergy in North Carolina enrolled in a partially randomized, preference-based waitlist control trial. The interventions were: mindfulness-based stress reduction (MBSR), Daily Examen prayer practice, and Stress Proofing (stress inoculation plus breathing skills). Co-primary outcomes were symptoms of stress (Calgary Symptoms of Stress Inventory) and 48-hour ambulatory heart rate variability (HRV) at 12 weeks compared to waitlist control. Survey data were collected at 0, 12, and 24 weeks and 48-hour ambulatory HRV at 0 and 12 weeks. The 255 participants were 91% White and 48% female. Forty-nine participants (22%) without a preference were randomly assigned between the three interventions (n = 40) and waitlist control (n = 9). Two hundred six participants (78%) with a preference were randomly assigned to waitlist control (n = 62) or their preferred intervention (n = 144). Compared to waitlist control, MBSR [mean difference (MD) = -0.30, 95% CI: -0.41, -0.20; P < .001] and Stress Proofing (MD = -0.27, 95% CI: -0.40, -0.14; P < .001) participants had lower stress symptoms at 12 weeks; Daily Examen participants did not until 24 weeks (MD = -0.24, 95% CI: -0.41, -0.08). MBSR participants demonstrated improvement in HRV at 12 weeks (MD = +3.32 ms; 95% CI: 0.21, 6.44; P = .036). MBSR demonstrated robust improvement in self-reported and objective physical correlates of stress; Stress Proofing and Daily Examen resulted in improvements in self-reported correlates of stress. These brief practices were sustainable and beneficial for United Methodist clergy during the heightened stressors of the COVID pandemic. ClinicalTrials.gov identifier: NCT04625777.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892534","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":"A community-engaged implementation mapping approach to increase SNAP participation in a diverse Latine community.","authors":"Elena Byhoff, Rebecca K Rudel, Rachel Burgun, Sandra Silva, Jonathan Lichkus, Mari-Lynn Drainoni","doi":"10.1093/tbm/ibaf004","DOIUrl":"https://doi.org/10.1093/tbm/ibaf004","url":null,"abstract":"<p><strong>Background: </strong>The Supplemental Nutrition Assistance Program (SNAP) is an underutilized program. SNAP uptake is limited in Latine households in particular due to concerns about immigration eligibility, even when there are SNAP-eligible household members. Implementation strategies are urgently needed to increase SNAP participation rates among those who are eligible.</p><p><strong>Purpose: </strong>We used collaborative planning and implementation mapping to design implementation strategies to increase SNAP participation.</p><p><strong>Methods: </strong>Collaborative planning and implementation mapping included: (i) identify a shared priority; (ii) review relevant data to identify determinants of SNAP participation; (iii) design strategies to accomplish the priority goal; (iv) reach consensus and pilot-chosen strategies and workflows; and (v) evaluate implementation success based on chosen outcomes. Using the Practical Robust Implementation and Sustainability Model, we identified two implementation strategies, a community and a policy strategy, to pilot from January to December 2023.</p><p><strong>Results: </strong>The community strategy leveraged an existing food program to identify participants who were not already enrolled in SNAP. This resulted in 69 referrals and 4 new SNAP enrollees. The policy strategy leveraged the existing policy context to link SNAP enrollment with Medicaid insurance reenrollment at the end of the COVID-19 public health emergency protections. This resulted in an unknown number of referrals due to data workflow barriers.</p><p><strong>Conclusions: </strong>Despite considering context in the design and piloting of two implementation strategies, success was limited. Future success will require including the perspectives of those with lived experience to inform processes to identify eligible individuals without creating additional stigma or furthering distrust among those who may be ineligible.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":"15 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597918","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":"Supporting community translation of lung cancer screening: A web-based decision aid to support informed decision making.","authors":"Jamie L Studts, Richard S Thurer, Christina R Studts, Margaret M Byrne","doi":"10.1093/tbm/ibae073","DOIUrl":"10.1093/tbm/ibae073","url":null,"abstract":"<p><strong>Background: </strong>Results of the National Lung Screening Trial create the potential to reduce lung cancer mortality, but community translation of lung cancer screening (LCS) has been challenging. Subsequent policies have endorsed informed and shared decision-making and using decision support tools to support person-centered choices about screening to facilitate implementation. This study evaluated the feasibility and acceptability of LuCaS CHOICES, a web-based decision aid to support delivery of accurate information, facilitate communication skill development, and clarify personal preferences regarding LCS-a key component of high-quality LCS implementation.</p><p><strong>Methods: </strong>Using a parallel groups randomized trial, the study investigated the feasibility and acceptability of LuCaS CHOICES decision aid in comparison to the National Cancer Institute's Lung Cancer Screening website. Three waves of self-report data were collected: baseline (PRE), 2 weeks post-baseline (POST), and 4 months post-baseline (FOL). Participant accrual and intervention access data were also collected to evaluate methodological feasibility for conducting a larger subsequent trial.</p><p><strong>Results: </strong>Participants assigned to LuCaS CHOICES (n = 25) and the NCI website (n = 25) interventions reported similar, favorable levels of intervention feasibility and acceptability that exceeded a priori criteria. Methodological feasibility was partially supported for the proposed accrual and retention goals, but accrual was slower than hypothesized, and documented exposure to the digital interventions was suboptimal per a priori standards.</p><p><strong>Conclusions: </strong>Overall, both interventions demonstrated intervention feasibility and acceptability. In addition, the proposed methods achieved desired levels of retention and overall data collection. Modifications to enhance intervention engagement should be explored prior to further testing. Subsequent steps involve conducting a randomized clinical trial to evaluate the effect of LuCaS CHOICES on informed decision making and preference-concordant screening behavior, supporting LCS translation into community settings.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":"15 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014603","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":"Scale-up influences and definitions of scale-up 'success': evidence from globally scaled interventions.","authors":"Harriet Koorts, Jiani Ma, Samuel Cassar, Adrian Bauman, Mark Lawrence, Harry Rutter, Jo Salmon","doi":"10.1093/tbm/ibae063","DOIUrl":"10.1093/tbm/ibae063","url":null,"abstract":"<p><p>The World Health Organization ExpandNet framework for scaling up contains key recommendations to support the scaling of health interventions globally. Despite being widely used, it is not known how the framework informs intervention scale-up nor how 'successful' scale-up is defined. Using data from the Scaling Up InTErventions' study, this paper assessed adoption of framework components using an international sample of scaled-up physical activity and nutrition interventions, and explored individuals' definitions of scale-up 'success'. An online survey with academic, community, and government representatives involved in scaling physical activity and nutrition interventions globally. Survey questions (n = 27) corresponded to 32 components of the ExpandNet framework, reflecting four core areas: (i) intervention; (ii) user organization; (iii) resource team; and (iv) scale-up strategy. Data were analysed descriptively and qualitative free-text survey responses coded thematically. In total, 62 survey responses were obtained [academia (n = 32), community (n = 20), and government (n = 10)], corresponding to 35 scaled-up interventions. Only 8% of participants reported all 32 framework components during scale-up. Four core elements (containing eight themes) underpinned successful scale-up: (i) scaling inputs (e.g., sustained partner buy-in); (ii) scaling outputs (e.g., sustained, quality implementation); (iii) scaling outcomes (e.g., increased and equitable reach, improved organization and system capacity) and; (iv) scaling context (e.g., partner mental models, and a context-specific construct). There is no universal definition of successful scale-up. We propose core elements of 'successful scale-up' that could be used as criteria for scale-up planning and evaluation, and are applicable to other areas of public health.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":"15 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392243","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":"Pass the Expanding Access To (EAT) Local Foods Act to promote farm viability and nutrition security.","authors":"Roger Figueroa, Elizabeth Perry, Gwyneth Frederick, Mildred Alvarado, Elizabeth Adams, Melanie K Bean","doi":"10.1093/tbm/ibaf003","DOIUrl":"https://doi.org/10.1093/tbm/ibaf003","url":null,"abstract":"<p><p>The Society of Behavioral Medicine (SBM) supports passing the Expanding Access To Local Foods Act-a bill to promote economic opportunities for farmers and ranchers to strengthen local food supply chains, and to increase access to nutritious foods among households experiencing food insecurity and chronic disease risk.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":"15 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392195","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":"Co-designing prediction data visualizations for a digital binge eating intervention.","authors":"Adrian Ortega, Isabel R Rooper, Thomas Massion, Chidibiere Azubuike, Lindsay D Lipman, Tanvi Lakhtakia, Macarena Kruger Camino, Leah M Parsons, Emily Tack, Nabil Alshurafa, Matthew Kay, Andrea K Graham","doi":"10.1093/tbm/ibaf009","DOIUrl":"10.1093/tbm/ibaf009","url":null,"abstract":"<p><strong>Background: </strong>Digital interventions can leverage user data to predict their health behavior, which can improve users' ability to make behavioral changes. Presenting predictions (e.g. how much a user might improve on an outcome) can be nuanced considering their uncertainty. Incorporating predictions raises design-related questions, such as how to present prediction data in a concise and actionable manner.</p><p><strong>Purpose: </strong>We conducted co-design sessions with end-users of a digital binge-eating intervention to learn how users would engage with prediction data and inform how to present these data visually. We additionally sought to understand how prediction intervals would help users understand uncertainty in these predictions and how users would perceive their actual progress relative to their prediction.</p><p><strong>Methods: </strong>We conducted interviews with 22 adults with recurrent binge eating and obesity. We showed prototypes of hypothetical prediction displays for 5 evidence-based behavior change strategies, with the predicted success of each strategy for reducing binge eating in the week ahead (e.g. selecting to work on self-image this week might lead to 4 fewer binges while mood might lead to 1 fewer). We used thematic analysis to analyze data and generate themes.</p><p><strong>Results: </strong>Users welcomed using prediction data, but wanted to maintain their autonomy and minimize negative feelings if they do not achieve their predictions. Although preferences varied, users generally preferred designs that were simple and helped them quickly compare prediction data across strategies.</p><p><strong>Conclusions: </strong>Predictions should be presented in efficient, organized layouts and with encouragement. Future studies should empirically validate findings in practice.</p><p><strong>Clinical trial information: </strong>The Clinical Trials Registration #: NCT06349460.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":"15 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755308","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":"Food retailer actions toward the National Strategy on Hunger, Nutrition, and Health to promote nutrition security: Applicability of the Business Impact Assessment-Obesity as a monitoring tool.","authors":"Maria DeNunzio, Bailey Houghtaling, Vivica Kraak, Maaz Gardezi, Elena Serrano, Sarah Misyak","doi":"10.1093/tbm/ibae057","DOIUrl":"10.1093/tbm/ibae057","url":null,"abstract":"<p><p>The White House National Strategy on Hunger, Nutrition, and Health (National Strategy) encourages actions across government and society to promote nutrition security. Nutrition security includes adequate food, diet quality, and equity, and food retail settings can promote these major concepts. Of all National Strategy whole-of-society calls to action, food retailers can contribute to 15 calls as key actors. However, there is currently no standardized monitoring tool to track food retailers' commitments and actions toward the National Strategy to promote nutrition security. The Business Impact Assessment-Obesity and population-level nutrition (BIA-Obesity), a tool originally developed for corporate accountability monitoring, can be tailored for the National Strategy and nutrition security, given its standardized indicators and process to assess food company policies and commitments across six domains. We discuss the fit of the BIA-Obesity indicators for tracking food retailers' commitments and actions across four pillars of the National Strategy. Existing indicators are appropriate to monitor components of Pillar 1: Improve Food Access and Affordability; Pillar 2: Integrate Nutrition and Health; Pillar 3: Empower All Consumers to Make and Have Access to Healthy Choices; and Pillar 5: Enhance Nutrition and Food Security Research. We suggest expanding current indicators to include equity, local foods, the digital food environment, and food waste reduction to improve alignment of the BIA-Obesity with the National Strategy. Application of the BIA-Obesity as an existing tool can facilitate data cohesion and more rapid assessment of the food retailer landscape to mutually meet nutrition security goals by 2030.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"703-712"},"PeriodicalIF":3.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478119","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":"Factors associated with successful FLOW implementation to improve mental health access: a mixed-methods study.","authors":"Natalie E Hundt, Bo Kim, Maribel Plasencia, Amber B Amspoker, Annette Walder, Zenab Yusuf, Herbert Nagamoto, Christie Ga-Jing Tsao, Tracey L Smith","doi":"10.1093/tbm/ibae050","DOIUrl":"10.1093/tbm/ibae050","url":null,"abstract":"<p><p>The FLOW program assists mental health providers in transitioning recovered and stabilized specialty mental health (SMH) patients to primary care to increase access to SMH care. In a recent cluster-randomized stepped-wedge trial, nine VA sites implemented the FLOW program with wide variation in implementation success. The goal of this study is to identify site-level factors associated with successful implementation of the FLOW program, guided by the Consolidated Framework for Implementation Research (CFIR). We used the Matrixed Multiple Case Study method, a mixed-methods approach, to compare key metrics hypothesized to impact implementation that were aligned with CFIR. Based upon the number of veterans transitioned at each site, we categorized two sites as higher implementation success, three as medium, and four as lower implementation success. Themes associated with more successful implementation included perceptions of the intervention itself (CFIR domain Innovation), having a culture of recovery-oriented care and prioritizing implementation over competing demands (CFIR domain Inner Setting), had lower mental health provider turnover, and had an internal facilitator who was well-positioned for FLOW implementation, such as having a leadership role or connections across several clinics (CFIR domain Characteristics of Individuals). Other variables, including staffing levels, leadership support, and organizational readiness to change did not have a consistent relationship to implementation success. These data may assist in identifying sites that are likely to need additional implementation support to succeed at implementing FLOW.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"693-702"},"PeriodicalIF":3.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356420","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}