Journal of Developmental and Behavioral Pediatrics最新文献

{"title":"All on the Same Team: Simulated Learning to Introduce Pediatric Residents to Interprofessional Collaboration With Individualized Education Program Teams.","authors":"Tara J Minor, Rachel Goode","doi":"10.1097/DBP.0000000000001340","DOIUrl":"10.1097/DBP.0000000000001340","url":null,"abstract":"<p><strong>Objective: </strong>Our study sought to determine if participation in a simulated Individualized Education Program (IEP) meeting improved pediatric medical residents' attitudes toward the IEP team as an interprofessional health care team.</p><p><strong>Methods: </strong>Pediatric medical residents on the Developmental-Behavioral and Advocacy rotations at an urban medical center participated in a simulated IEP eligibility meeting for a case of a fourth grader with a specific learning disability. Standardized actors portrayed the child's parent, principal, school psychologist, and classroom teacher. Residents were instructed to participate as members of the team. After participation, changes in the residents' readiness to participate on the IEP team were measured by the Interprofessional Socialization and Valuing Scale 9A (presimulation) and 9B (postsimulation).</p><p><strong>Results: </strong>Sixty-six pediatric residents participated over 24 months. The mean scores of the aggregate pre- (4.92, SD = 0.83) and postsurveys (5.75, SD = 0.74) illustrated residents' improvement in 3 areas of interprofessional practice: understanding their role as a member of an IEP team; appreciation of an IEP team as an interprofessional health care team; and comfort and confidence in working as a member of an IEP team (Z = -6.37; p < 0.001; r = 0.78). Comparison of disaggregated data illustrated improvement for post-graduate year 1 (Z = -4.95; p < 0.001; r = 0.85) and categorical pediatric residents (Z = -5.86; p < 0.001; r = 0.83).</p><p><strong>Conclusion: </strong>Simulated IEP meetings help pediatric residents reconceptualize their role in the school health of children with disabilities to include participation in and understanding of the IEP process.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":"e197-e202"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015398","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":"Effects of the COVID-19 Pandemic on Early Child Development: A Systematic Review & Meta-Analysis.","authors":"Hannah O'Connor, Maura DiSalvo, Maia Gersten, Sean Boyden, Mai Uchida","doi":"10.1097/DBP.0000000000001352","DOIUrl":"10.1097/DBP.0000000000001352","url":null,"abstract":"<p><strong>Objective: </strong>To explore the effects of the COVID-19 pandemic on early childhood development and identify areas of interest surrounding development.</p><p><strong>Methods: </strong>A systematic literature review was performed to identify articles examining how the COVID-19 pandemic has affected early childhood development, and a meta-analysis was conducted from the results of those articles to examine the degree of the impact of the pandemic on the areas of childhood development.</p><p><strong>Results: </strong>Ten articles from 6 countries were identified that met all inclusion and exclusion criteria. The multivariate meta-analysis showed no significant difference in overall development (pooled Cohen's d = 0.28, 95% CI, -0.33 to 0.88; p = 0.18) or odds for developmental delay (pooled odds ratio (OR) = 1.44, 95% CI, 0.77 to 2.67; p = 0.20) between pre-COVID-19 development and COVID-19 development. However, there was significantly more impairment ( d = 0.46, p = 0.003) and greater odds (72%; OR = 1.72, p = 0.01) for developmental delay in the language and communication domain for COVID-19 children versus pre-COVID-19 children.</p><p><strong>Conclusion: </strong>While exposure to the COVID-19 pandemic was not associated with global developmental delays, it had a significant impact on child development regarding language and communication. Further research monitoring effects of the COVID-19 pandemic is necessary, and parents and communities should focus on increasing early intervention and enriched curriculum to offset these delays.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":"e227-e239"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812811","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":"Attention-Deficit/Hyperactivity Disorder and Teen Self-Report on Health Behaviors and Social-Emotional Wellbeing: United States, July 2021-December 2022.","authors":"Samuel M Katz, Angelika H Claussen, Lindsey I Black, Rebecca T Leeb, Kimberly Newsome, Melissa L Danielson, Benjamin Zablotsky","doi":"10.1097/DBP.0000000000001350","DOIUrl":"10.1097/DBP.0000000000001350","url":null,"abstract":"<p><strong>Objective: </strong>Promoting health during adolescence can support long-term well-being, especially for teens diagnosed with attention-deficit/hyperactivity disorder (ADHD), who face increased risks due to the disorder's impact on development and health behaviors. ADHD is often associated with difficulties in social interactions, a higher likelihood of bullying involvement, and co-occurring mental health conditions. These factors may also be influenced by health factors such as physical activity, sleep quality, and screen time usage. Nationally representative teen self-reports provide a novel perspective on ADHD-related health outcomes compared with relying on parent reports.</p><p><strong>Method: </strong>We used nationally representative data from the National Health Interview Survey (NHIS) and NHIS-Teen from July 2021 to December 2022, to examine teen-reported health and well-being factors, stratified by parent-reported ADHD diagnoses among teens aged 12 to 17 years. Weighted prevalence estimates and adjusted prevalence ratios (aPR) adjusting for teen age, sex, and family income, all with 95% confidence intervals (CIs), were calculated.</p><p><strong>Results: </strong>Just over 10% of teens had ADHD and they reported higher prevalence of bullying victimization (aPR = 1.64, CI = 1.27-2.11), difficulties making friends (aPR = 1.83, CI = 1.15-2.90), difficulty getting out of bed (aPR = 1.29, CI = 1.02-1.64), irregular wake times (aPR = 2.17, CI = 1.45-3.25), and >4 hours daily screen time (aPR = 1.26, CI = 1.05-1.52) than teens without ADHD; teens with ADHD reported a lower prevalence of lacking peer support (aPR = 0.70, CI = 0.51-0.96).</p><p><strong>Conclusion: </strong>Teens with ADHD face distinct challenges related to social-emotional well-being and health behaviors that support overall wellness. Findings may inform opportunities for health promotion among teens with ADHD.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":"46 2","pages":"e155-e161"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12011209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059689","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":"Improving Resident Physician History and Physical in Challenging Situations.","authors":"Nicholas Rockwell, Nancy M Tofil, Chrystal Rutledge, Stacy L Gaither, Carrie Norwood, J Lynn Zinkan, Inmaculada Aban, James Willig, Michele Kong","doi":"10.1097/DBP.0000000000001341","DOIUrl":"10.1097/DBP.0000000000001341","url":null,"abstract":"<p><strong>Objective: </strong>To educate physician trainees using simulation on best management of children with autism spectrum disorder who have neurocognitive and behavioral challenges when experiencing acute illness.</p><p><strong>Method: </strong>A simulation-based curriculum including baseline assessment, communication techniques, and use of calming resources was developed to educate residents in assessing children with sensory barriers. Traditional simulation and deliberate practice were used to teach this curriculum to second- and third-year pediatric and internal medicine-pediatric residents. Using alternating assignment, residents were placed into 3 groups: deliberate practice, traditional simulation-based debriefing, and control (no simulation training). The residents were assessed on the initial visit, 2 weeks and 4 to 6 months follow-up periods with a sensory assessment tool. Assessment scores were analyzed using a general linear mixed model with random intercept based on Poisson regression to approximate distribution of the total score.</p><p><strong>Results: </strong>Forty-three residents participated: 46.5% men, 53.5% women. There were 15, 16, and 12 residents in the control, deliberate practice and traditional simulation groups, respectively. Both teaching styles showed improved performance at 2 weeks follow-up. In addition, these groups demonstrated higher performance when compared with the control group. We were able to show that resident physicians were able to learn important principles and retain them during 4 to 6 months follow-up. However, there was not a difference between 2 teaching styles both in improvement and retention.</p><p><strong>Conclusion: </strong>Simulation education, both deliberate and traditional, can be used to enhance teaching of key components in assessing children with sensory and communication barriers, including those with autism spectrum disorder when presenting with acute illness.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":"e190-e196"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014265","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":"Eco-anxiety and Climate Anxiety: Bellwethers of the Climate Crisis's Mental Health Impact on Children and Adolescents.","authors":"Robert Cook, Xinyue Nam, Michael Weitzman","doi":"10.1097/DBP.0000000000001357","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001357","url":null,"abstract":"<p><strong>Objective: </strong>To highlight the need for more research about climate change's effects on child and adolescent mental health.</p><p><strong>Method: </strong>Articles and reports were searched for in 12 pediatric journals and 10 international societies using the mesh terms \"climate change and mental health,\" \"climate change and children's mental health,\" and \"eco-anxiety.\" Articles were scanned for relevancy using the terms \"climate change,\" \"climate crisis,\" \"mental health,\" \"child,\" \"anxiety,\" and \"mental anxiety.\" Relevant literature was compiled and analyzed.</p><p><strong>Results: </strong>Although the climate crisis has been highlighted as a critical threat to the physical health of adolescents worldwide, its mental health impacts are far less recognized. Existing research on climate change and mental health is limited, primarily focusing on the acute response of adults directly affected by extreme weather events rather than climate change's emerging indirect mental health effects. Far more limited is the literature focusing on the mental health effects of climate change on adolescents and children, who are hypothesized to bear the brunt of the mental health detriment of climate change. In addition, nonstandardized scales and definitions and lack of nationally representative data, among many other things, hinder current understanding, attention, and evidence-based action to prevent and treat these effects.</p><p><strong>Conclusion: </strong>Gathering information regarding the climate crisis and children's mental health is paramount. Consequently, the development of a research workforce, a funding stream, and standardized methodology is necessary to properly investigate and aid adolescents and children facing the climate crisis's mental health effects.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":"46 2","pages":"e223-e226"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057285","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":"Challenging Case: 2 Year Old With \"Autistic Behaviors\".","authors":"Brian A Harris, Katherine A Trier, DePorres Cormier, Marie Reilly, Marilyn Augustyn","doi":"10.1097/DBP.0000000000001353","DOIUrl":"10.1097/DBP.0000000000001353","url":null,"abstract":"<p><strong>Case: </strong>\"George\" is a 2-year, 9-month-old boy who presented for Developmental Behavioral Pediatric evaluation with the concern of global developmental delay and autistic behaviors. He had been receiving early intervention support since he turned 2 years, receiving a parent coaching model with a developmental specialist.During the clinical interview, parents endorsed limited expressive language skills and felt that his receptive language outpaced his expressive language skills. They reported consistent response to name when called and integration of eye contact and other nonverbal gestures (e.g., point, smile, and nod). Regarding social interaction skills, parents reported that when around other children, he tends to copy the play of the other child or engage in parallel play. George frequently shares items of interest with his caregivers and attempts to initiate play with his younger sibling. Parents state that he always carries around an item such as a cable wire and repetitively twirls it.Owing to lack of other \"B\" criteria symptoms outside of the perseverative interest in cable wires, a diagnosis of global developmental delay was established, and he did not meet criteria for a diagnosis of autism spectrum disorder. Speech and language, occupational, and physical therapy were recommended as well as guidance on how to initiate special education services with the local school district when he turned 3 years old. Genetic testing was offered-Fragile X analysis returned negative and chromosomal microarray revealed a variant of unknown significance in an autosomal recessive gene, which was noncontributory to explain his developmental delays.Over time, George continued to present with slow, yet steady progress in all areas of his development as he transitioned to receiving special education services through an individualized education plan and continued to receive intensive outpatient therapy. Parents continued to contend with multiple providers and teachers raising concerns about autism and recommending applied behavioral analysis therapy.Almost 3 years later, the family re-connected with Genetics to pursue interval testing as technology has improved. Whole-exome sequencing (WES) was able to confirm a rare, autosomal dominant mutation that presents as a multisystem disorder characterized by significant neurodevelopmental compromise with limited to absent speech, behavioral issues, and craniofacial anomalies. Behavioral issues may include autistic features, hyperactivity, and aggressiveness. What supports will help the family move on in this next phase of his care?</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":"e240-e242"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765678","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":"Effect of Childhood Adversity on the Relationship Between Family Resilience and Behavioral or Conduct Problems in Children With Special Healthcare Needs.","authors":"Suman Kanti Chowdhury, Rihana Aaliyah Aydin, Harsha Puri, Suruthi Sundaramurugan, Nagashree Ravi Rao, Haille Skinner, Rachel Sauls, Dowensly Jean Brice, Steven Tsang, Chighaf Bakour, Russell S Kirby","doi":"10.1097/DBP.0000000000001343","DOIUrl":"10.1097/DBP.0000000000001343","url":null,"abstract":"<p><strong>Objective: </strong>Behavioral or conduct problems (BCPs) are common co-occurring conditions in children with special health care needs (CSHCNs), affecting their developmental and functional milestones. The role of family resilience in mitigating BCPs among these children and how adverse childhood experiences (ACEs) affect this dynamic remain largely unclear. The aim of the study was to disentangle the complex interplay between family resilience, ACEs, and BCPs by examining how ACEs moderate the relationship between family resilience and BCPs.</p><p><strong>Methods: </strong>The study included 19,922 CSHCNs aged 3 to 17 years from the 2020-2021 National Survey of Children's Health. Weighted analysis was conducted using the Rao-Scott χ 2 test and multivariable logistic regression to account for the complex survey design.</p><p><strong>Results: </strong>Children from families with no and low resilience as compared with high-resilient families had 1.78 times (odds ratio [OR]: 1.78, 95% confidence interval [CI], 1.31-2.43) and 1.44 times (OR: 1.44, 95% CI, 1.18-1.76) higher odds of BCPs, respectively. While the odds of BCPs decreased in nonresilient families as ACEs increased from none to 1 ACE, 2 or more ACEs versus no ACE increased the odds of BCPs in low-resilient families from 1.42 times (OR: 1.42, 95% CI, 1.03-1.94) to 1.51 times (OR: 1.51, 95% CI, 1.13-2.02).</p><p><strong>Conclusion: </strong>The findings suggest that family resilience is associated with a lower likelihood of BCPs in CSHCNs. ACEs have varying effects on the relationship between family resilience and BCPs across different levels of family resilience. These results highlight the importance of strengthening family resilience and addressing ACEs in interventions to reduce behavioral issues in CSHCNs.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":"e169-e174"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015401","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":"Case Report: A Comprehensive Early Childhood Mental Health Evaluation for Children in the Foster Care System.","authors":"Cara M Lucke, Katie J Stone, Kimara Gustafson, Maria G Kroupina","doi":"10.1097/DBP.0000000000001336","DOIUrl":"10.1097/DBP.0000000000001336","url":null,"abstract":"<p><strong>Background: </strong>Children in the foster care system often have a host of prenatal and postnatal risk factors that can compromise development including disruptions in important attachment relationships. We argue that to effectively address this complex history and inform specific recommendations for intervention, it is important for an Early Childhood Mental Health (ECMH) evaluation to include both an assessment of the caregiver-child relationship status and neurodevelopment.</p><p><strong>Case presentation: </strong>We describe an ECMH evaluation for a 21-month-old girl who was referred to a multidisciplinary birth to three specialty clinic for difficulties separating from her preadoptive mother, indiscriminate friendliness, and emotional and behavioral dysregulation. She had a history of prenatal substance exposure and several disruptions in important attachment relationships. We gained insight into the caregiver-child relationship through behavioral observations and used standardized testing to assess neurodevelopment. This combination of assessment techniques revealed inconsistencies in secure base attachment patterns between the parent and child. She also performed lower than what would be expected for her age across several domains of development.</p><p><strong>Conclusion: </strong>This case highlights a comprehensive approach to an ECMH evaluation. Recommendations for intervention prioritized the parent-child relationship given the importance of attunement between caregiver and child to first optimize stress regulation and thus set the foundation for higher-order cognitive processes to develop.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":"e203-e207"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787520","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":"Journal Article Reviews.","authors":"Audrey Christiansen, Beth Bloom Emrick, Ashley Dawn Greathouse, Carol Weitzman","doi":"10.1097/DBP.0000000000001364","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001364","url":null,"abstract":"","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":"46 2","pages":"e243-e247"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057203","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":"Embedding Universal Language Promotion in Pediatric Primary Care to Optimize Early Child Development and Reduce Long-Term Health Disparities.","authors":"Brenda Salley, Heather von Bevern, Nicolette Grasley-Boy, Kandace Fleming, Kirsten Weltmer, Judith Carta","doi":"10.1097/DBP.0000000000001344","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001344","url":null,"abstract":"<p><strong>Objective: </strong>To report on the feasibility and outcomes of universal language promotion intervention (Talk With Me Baby [TWMB]) embedded within routine well-child care for children from birth to 3-years old.</p><p><strong>Methods: </strong>Across 2 primary care clinics, 29 health care team members participated in a 12-month trial to deliver TWMB within well-child care visits. Feasibility was based on clinician feedback during the trial, clinician knowledge assessments, and clinic data. Sixty-three parents and their infant/toddlers were enrolled to provide feedback on TWMB and to assess parent language promotion behaviors, specifically, parents' self-reported use of their language-building interactions during daily activities with their child.</p><p><strong>Results: </strong>Clinician feedback and clinic data support TWMB as an acceptable and feasible intervention that can be used successfully within standard of care well-child visits by health care teams. Initial outcome data show positive changes for increasing parent-child language promoting interactions during daily activities.</p><p><strong>Conclusion: </strong>Results support the promise of leveraging primary care as a low-cost, scalable way to deliver universal language promotion intervention to optimize the developmental potential of all young children.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":"46 2","pages":"e183-e189"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058849","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}