Western Journal of Nursing Research最新文献

{"title":"Differential Levels of Caregiver Burden Among Parents of Adults With Autism.","authors":"Christina N Marsack-Topolewski, Kathryn Hughesdon, Preethy S Samuel","doi":"10.1177/01939459251338421","DOIUrl":"10.1177/01939459251338421","url":null,"abstract":"<p><strong>Background: </strong>Parents of a child with autism spectrum disorder (ASD) often continue providing care for their children across the lifespan until they are no longer able, which can cause caregiver burden and affect their quality of life (QOL). To date, most of the research focuses on parents of young children with ASD, with only a small body of research on older parents of adults with ASD.</p><p><strong>Objective: </strong>The purpose of this study was to determine whether perceived caregiver health, QOL, availability of informal support, and number of formal supports differed by 3 levels of caregiver burden.</p><p><strong>Methods: </strong>A total of 320 older parents (age ≥50 years) of adults with ASD participated in this cross-sectional survey research study that used multiple analysis of variance (MANOVA) to understand the challenges of caregivers when compared by the perceived levels of caregiver burden.</p><p><strong>Results: </strong>MANOVA indicated that better health, positive QOL, more availability of informal support, and use of fewer formal supports were associated with lower levels of caregiver burden (<i>F</i>_8,614 = 18.48, <i>P</i> < .001, <math><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> = 0.19).</p><p><strong>Conclusion: </strong>Given that high caregiver burden was associated with lower caregiver health, QOL, decreased availability of informal support, and greater use of formal supports, nurses and other health professionals should be cognizant that older parents need specialized attention.</p>","PeriodicalId":49365,"journal":{"name":"Western Journal of Nursing Research","volume":" ","pages":"720-731"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Core Antenatal Depressive Symptoms: A Network Analysis.","authors":"Wanqin Hu, Shiben Zhu, Zhanbiao Li, Janet Yuen-Ha Wong","doi":"10.1177/01939459251339046","DOIUrl":"10.1177/01939459251339046","url":null,"abstract":"<p><strong>Background: </strong>The limited identification of core symptoms of antenatal depression is currently impeding the development of targeted interventions, with scant research utilizing network analysis to identify these core symptoms.</p><p><strong>Objective: </strong>We aimed to construct a network of depressive symptoms using data from a sample of pregnant women in the United States, identifying the core symptoms using centrality indices within the network.</p><p><strong>Methods: </strong>We conducted a secondary analysis of data from the National Health and Nutrition Examination Survey (2003-2020). Depressive symptoms were measured with the Patient Health Questionnaire-9. Pregnancy status was evaluated via self-report, urine, and serum testing. Centrality analysis was then used to examine the centralities in depressive symptoms and their relationships with each other. A case-dropping bootstrap procedure and a bootstrapped difference test were used to assess the accuracy and stability of the network.</p><p><strong>Results: </strong>The final analysis included 669 pregnant women. A sad mood (<i>r</i>_s = 6.444, <i>r</i>_c = 0.091, <i>r</i>_b = 12), guilt (<i>r</i>_s = 6.260, <i>r</i>_c = 0.088, <i>r</i>_b = 10), and anhedonia (<i>r</i>_s = 5.141, <i>r</i>_c = 0.088, <i>r</i>_b = 12) had the largest values in terms of strength, closeness, and betweenness. Sad mood-guilt had the highest edge weight. Although fatigue was the most severe depressive symptom among pregnant women, the centrality of fatigue was lower than the other depressive symptoms.</p><p><strong>Conclusions: </strong>Sadness, guilt, and anhedonia can be identified as core antenatal depressive symptoms. Targeting these core symptoms could improve the precision and effectiveness of interventions aimed at pregnant women with depression.</p>","PeriodicalId":49365,"journal":{"name":"Western Journal of Nursing Research","volume":" ","pages":"732-741"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 Blood Pressure in School-Age Children With Obstructive Sleep Apnea.","authors":"Shameka Rodgers Phillips, Laura Gray, Ann Hammack Johnson, Sara Davis, Heather Soistmann, Peng Li, Elizabeth Coleman, Thuy Lynch, Marti Rice","doi":"10.1177/01939459251340492","DOIUrl":"10.1177/01939459251340492","url":null,"abstract":"<p><strong>Background: </strong>Children with obstructive sleep apnea (OSA) have an increased risk for high blood pressure (BP). Evidence suggests that arousals, total sleep time (TST), sleep efficiency, oxygen saturation, end-tidal carbon dioxide (ETCO₂) levels, inflammation, and body mass index (BMI) are associated with changes in BP. Yet, less is known about these relationships in school-aged children with OSA.</p><p><strong>Objective: </strong>This study aimed to determine factors associated with BP in school-aged children with OSA.</p><p><strong>Methods: </strong>A cross-sectional, secondary data analysis of 163 school-aged children (mean age of 7.15 ± 1.16, 62% black, 54.6% female) who participated in the Childhood Adenotonsillectomy Trial.</p><p><strong>Results: </strong>Systolic BP (<i>r</i> = 0.21, <i>p</i> < .01) and diastolic BP (DBP; <i>r</i> = 0.22, <i>p</i> < .01) had a positive relationship with BMI percentiles. The relationship between BMI percentiles and DBP remained when accounting for race and OSA severity (β = 0.19, <i>p</i> = .02). DBP also had a positive relationship with the log percentage of TST with ETCO₂ ≥50 mmHg (<i>r</i> = 0.23, <i>p</i> < .01) that persisted when accounting for BMI percentiles, OSA severity, and race (β = 0.23, <i>p</i> = .004). No other significant relationships were found.</p><p><strong>Conclusions: </strong>Findings suggest that BMI is a main driver of BP in school-aged children with OSA. Also, the percentage of TST with ETCO₂ ≥50 mmHg impacted BP in this sample and further research is needed to explore mechanisms behind these relationships. Clinicians and researchers should advocate for the assessment of all polysomnographic findings when assessing the risk for elevated BP and other comorbidities in children with OSA.</p>","PeriodicalId":49365,"journal":{"name":"Western Journal of Nursing Research","volume":" ","pages":"680-686"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Physical Activity on Health Among Informal Caregivers of People With Cognitive Decline: A Systematic Review and Meta-Analysis.","authors":"Sangwoo Ahn, Sandra J Cobb, Rochelle Butler, Saeed M Abdullah, Marie P Boltz, Misook L Chung, Patricia N E Roberson, Jung-Ah Lee, Xiaopeng Zhao, Joel G Anderson","doi":"10.1177/01939459251341197","DOIUrl":"10.1177/01939459251341197","url":null,"abstract":"<p><strong>Background: </strong>Caregiving for people living with cognitive decline, including Alzheimer's disease and related dementias, can negatively affect informal caregivers' health.</p><p><strong>Objective: </strong>Our review aimed to systematically evaluate the effects of physical activity on physical and psychological health and well-being among informal caregivers of people with cognitive decline because no comprehensive evidence has been drawn so far.</p><p><strong>Methods: </strong>A literature search of 9 databases was conducted to identify appropriate randomized controlled trials. Meta-analysis was performed using STATA (version 18.0) with the standardized mean difference (Hedge's <i>g</i>) used to calculate the effect size of interventions.</p><p><strong>Results: </strong>Twelve studies were included (n = 1163 total participants, all of whom were informal caregivers of people with Alzheimer's disease and related dementias; mean age = 64 years), 2 of which were rated as strong in methodological quality, 1 as weak, and the remaining 9 showing moderate quality. Physical activity, consisting of walking, Tai Chi, or multicomponent activities (aerobic, strengthening, stretching, and/or balance activities), exerted beneficial effects on static balance as an element of physical health and psychological well-being as an element of well-being with moderate effect sizes.</p><p><strong>Conclusions: </strong>Nurses may suggest that informal caregivers engage in physical activity to improve physical and mental well-being, potentially decreasing onerous aspects of caregiving. Given the limited number of studies in our review, future research is warranted to identify the optimal type and dose of physical activity to improve informal caregivers' health.</p>","PeriodicalId":49365,"journal":{"name":"Western Journal of Nursing Research","volume":" ","pages":"770-785"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12238670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing an Attention Control Condition for a Randomized Controlled Trial Using TED Talks.","authors":"Karen A Nelson, Sahereh Mirzaei, Judith M Schlaeger, Hongjin Li, Larisa Burke, Peter Cabezas, Monya Meinel, Lauren Rountree, Sofie Su, Holli A DeVon","doi":"10.1177/01939459251342753","DOIUrl":"10.1177/01939459251342753","url":null,"abstract":"<p><strong>Background: </strong>Attention control is an important part of clinical trials, allowing the influence of attention to be parsed from the effects of the intervention. Poor control group design can lead to unintended outcomes, overestimate the effectiveness of an intervention, or threaten a potentially beneficial treatment. The aims of this paper were to describe the development of a novel attention control using TED Talks and provide recommendations for the design of an attention control condition.</p><p><strong>Methods: </strong>Twenty-four TED Talks were selected for inclusion in the control condition. The talks ranged from 6.0 to 19.1 minutes for a total length of 4 hours and 12 minutes (mean = 10 minutes, 30 seconds). Topics included education, technology, health, space, human behavior, sanitation, parenting, cliff climbing, public speaking, happiness, obituaries, procrastination, and age diversity. We then developed 3 to 4 simple questions reflecting the content of the Talk. Responses ranged from true/false to 4 multiple-choice answers. Four to five videos were selected for each attention control session and bundled to create an approximately 90-minute attention control condition to match the intervention (acupuncture) session (45 minutes × 10 sessions).</p><p><strong>Discussion: </strong>We developed an attention control condition that met crucial requirements of (1) equivalent attention to that of the experimental group, (2) a design that can hold the participant's interest, (3) standardization to avoid potentially confounding outcomes, and (4) the evaluation of expectancy.</p><p><strong>Conclusion: </strong>Investigators can develop a rigorous attention control condition using TED Talks guided by our protocol.</p>","PeriodicalId":49365,"journal":{"name":"Western Journal of Nursing Research","volume":" ","pages":"764-769"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education Programs for Patients With Parkinson's Disease Receiving Deep Brain Stimulation: A Scoping Review.","authors":"Monica Petralito, Chiara Tedesco, Gianluca Pucciarelli, Francesco Fanari, Arianna Magon, Stefano Terzoni, Maura Lusignani, Rosario Caruso","doi":"10.1177/01939459251341814","DOIUrl":"10.1177/01939459251341814","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease (PD), the second most prevalent neurodegenerative disorder, presents a significant challenge in terms of both motor and non-motor symptom management. Deep brain stimulation (DBS) emerges as an advanced therapeutic option, showing efficacy in alleviating PD symptoms. However, the literature on educational programs tailored for patients with PD undergoing DBS remains scattered and underexplored.</p><p><strong>Objective: </strong>This study sought to map the existing evidence on educational programs designed for patients with PD receiving DBS, highlighting the scope and nature of such interventions.</p><p><strong>Methods: </strong>Following Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 extension, a scoping review was conducted. Relevant documents were identified through PubMed, Scopus, CINAHL, EMBASE, Web of Science, and Google Scholar systematic searches up to November 2024. The review examined content, delivery of educational programs, and outcomes, as well as program characteristics, materials used, and involved health care providers. A narrative synthesis was performed to integrate the findings without specific statistical tests due to the scoping nature of the review.</p><p><strong>Results: </strong>Seven studies were included. Educational interventions demonstrated a positive impact on social adaptation, physical performance, and patient satisfaction. Notably, innovative tools such as the DBS-Edmonton app were identified as beneficial in enhancing patient autonomy and decision-making.</p><p><strong>Conclusions: </strong>The review underscores the critical role of multidisciplinary, tailored educational interventions in supporting patients with PD undergoing DBS. Despite the promising benefits observed, the field requires further standardization and research to optimize educational strategies and to improve patient outcomes.</p>","PeriodicalId":49365,"journal":{"name":"Western Journal of Nursing Research","volume":" ","pages":"786-796"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12238669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-Time Fatigue and Physical Activity of Older Adults in Assisted Living: Feasibility of Ecological Momentary Assessment.","authors":"Katelyn E Webster-Dekker, Yvonne Lu, Eileen Hacker","doi":"10.1177/01939459251340218","DOIUrl":"10.1177/01939459251340218","url":null,"abstract":"<p><strong>Background: </strong>Fatigue is associated with decreased physical activity (PA) among older adults in assisted living (AL), but the direction of the relationship is unclear and may differ with mobility status.</p><p><strong>Objective: </strong>This study (1) assessed the feasibility and acceptability of measuring real-time fatigue and PA using ecological momentary assessment (EMA) and (2) described the temporal relationship between real-time fatigue and PA in AL residents with differing mobility levels.</p><p><strong>Methods: </strong>Older adults in AL (<i>N</i> = 34; mean age 75.6) wore an activity monitor for 7 days and recorded fatigue scores 5 times/day. We reported recruitment, completion, and satisfaction metrics. We used generalized estimating equations to examine the temporal relationships between real-time fatigue and each of 6 PA time intervals (PA counts per minute averaged over 30-, 60-, and 120-minute intervals before and after fatigue scores). We examined 2 subgroups who (1) primarily ambulated or (2) primarily used a wheelchair or scooter.</p><p><strong>Results: </strong>Eighty percent of those screened were eligible and enrolled. Participants wore the PA monitor for a mean of 7.5 (SD: 1.7) days and completed 76% of fatigue ratings. Most participants said the monitor was comfortable and had no difficulty entering fatigue scores. In the non-ambulatory subgroup, there were significant positive associations between PA (all time intervals) and subsequent fatigue (<i>P</i> = .002-.049).</p><p><strong>Conclusions: </strong>This study supports the feasibility and acceptability of using EMA methods with older adults in AL and provides preliminary evidence regarding the temporal relationship between PA and fatigue in this population.</p>","PeriodicalId":49365,"journal":{"name":"Western Journal of Nursing Research","volume":" ","pages":"742-750"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The <i>e-PainSupport</i> Digital Application for Assessing Pain and Pain Management in Home Hospice: A Randomized Controlled Trial.","authors":"Masako Mayahara, JoEllen Wilbur, Louis Fogg, Mary Clare Houlihan, Debra Parker Oliver, Jacquelyn J Benson, Arlene M Miller","doi":"10.1177/01939459251338392","DOIUrl":"10.1177/01939459251338392","url":null,"abstract":"<p><strong>Background: </strong>Poor patient pain management in home hospice is associated with low family caregiver adherence to analgesic regimens. Health care technology can improve caregiver access to education and communication to hospice nurses.</p><p><strong>Objective: </strong>The study purpose was to (1) compare the effects of the e-PainSupport intervention for family caregivers on change in patient pain intensity from baseline to 14 days to the effects of a usual care control condition and (2) examine mediating effects of pain management knowledge, self-efficacy, and adherence to analgesic regimens on change in pain intensity, controlling for study condition and patient gender.</p><p><strong>Methods: </strong>Utilizing a 2-group, 2-week randomized controlled trial with dyads (N = 44) of patients (52% female, mean age 74.1 years) and their caregivers (75% female, mean age 55.2 years), dyads were randomly assigned to either the e-PainSupport intervention or usual care control condition. The e-PainSupport intervention included caregiver pain education, a pain assessment and management tracker, and communication to nurses. Participants were recruited from 4 hospice agencies in a large metropolitan area. Outcome measures included caregiver knowledge, self-efficacy, medication adherence, and patient-reported pain intensity.</p><p><strong>Results: </strong>The e-PainSupport intervention produced a small positive effect on reducing pain intensity (<i>d</i> = 0.27) and statistically significant increase in adherence (<i>P</i> = .003), compared with usual care. Hierarchical regression models showed a significant mediating effect of increased caregiver knowledge on reduced pain intensity (<i>P</i> < .01), regardless of condition.</p><p><strong>Conclusions: </strong>Caregiver use of the e-PainSupport app is feasible and may contribute to decreasing hospice patient pain.</p><p><strong>Clinical trial registration: </strong>The study was registered at ClinicalTrials.gov on May 3, 2021, NCT04869085. The first participant was enrolled on April 21, 2021.</p>","PeriodicalId":49365,"journal":{"name":"Western Journal of Nursing Research","volume":" ","pages":"708-719"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Flexibility and Diabetes Self-Management: The Mediating Roles of Depressive Symptoms and Self-Efficacy.","authors":"Chang Wang, Yalin Zheng, Xiaonian Wang, Muzi Wang, Xue Yang","doi":"10.1177/01939459251336042","DOIUrl":"10.1177/01939459251336042","url":null,"abstract":"<p><strong>Background: </strong>Psychological flexibility is the concept and focus of Acceptance and Commitment Therapy. It has been demonstrated to benefit self-efficacy and depressive symptoms. However, its role in diabetes self-management (DSM) and the potential mechanisms remain unknown.</p><p><strong>Purpose: </strong>This study aimed to investigate the association between psychological flexibility and self-management and to explore the mediating effect of depressive symptoms and self-efficacy among people with diabetes in China.</p><p><strong>Methods: </strong>Using a cross-sectional study design, 249 people with type 2 diabetes in China were recruited from February 1, 2024, to April 30, 2024, and completed a structured online questionnaire.</p><p><strong>Results: </strong>Psychological flexibility and DSM showed a moderate correlation (<i>r</i> = 0.45, <i>P</i> < .001). Path analysis showed significant associations between the 3 subscales of psychological flexibility and depressive symptoms and self-efficacy. In addition, depressive symptoms partially mediated the relationship between the valued action subscale of psychological flexibility and DSM, while the mediation role of self-efficacy was not significant.</p><p><strong>Conclusions: </strong>The findings highlight the potential mechanisms of how higher levels of psychological flexibility may affect depressive symptoms reduction and self-management promotion. Acceptance and Commitment Therapy that particularly aims to enhance valued action may be effective for alleviating depressive symptoms and enhancing self-management.</p>","PeriodicalId":49365,"journal":{"name":"Western Journal of Nursing Research","volume":" ","pages":"698-707"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Impressions: Writing Effective Abstracts.","authors":"Todd Ruppar","doi":"10.1177/01939459251352615","DOIUrl":"https://doi.org/10.1177/01939459251352615","url":null,"abstract":"","PeriodicalId":49365,"journal":{"name":"Western Journal of Nursing Research","volume":"47 8","pages":"679"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}