Diabetes Educator最新文献

{"title":"Preparation of the Japanese Version of the Diabetes Caregiver Activity and Support Scale and Verification of Its Reliability and Validity.","authors":"Satoshi Ida,&nbsp;Ryutaro Kaneko,&nbsp;Kanako Imataka,&nbsp;Kaoru Okubo,&nbsp;Yoshitaka Shirakura,&nbsp;Kentaro Azuma,&nbsp;Ryoko Fujiwara,&nbsp;Hiroka Takahashi,&nbsp;Lisa J Scarton,&nbsp;Kazuya Murata","doi":"10.1177/0145721720954065","DOIUrl":"https://doi.org/10.1177/0145721720954065","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to adapt and psychometrically evaluate a Japanese language version of the Diabetes Caregiver Activity and Support Scale (D-CASS-J) to be culturally relevant for people with diabetes living in Japan.</p><p><strong>Methods: </strong>A Japanese translation of the original version of the D-CASS was prepared, corrected, and back-translated. Family caregivers of patients with diabetes mellitus ages ≥65 years who visited the outpatient diabetes clinic of Ise Red Cross Hospital were included. Cronbach's α coefficients were calculated as an assessment of internal consistency. Exploratory factor analyses were performed to verify construct validity. Hierarchical multiple regression analyses were performed using depression as the dependent variable and D-CASS-J and other variables as explanatory variables. Pearson's correlation coefficients between D-CASS-J scores and the support burden scale scores were calculated to verify criterion-related validity.</p><p><strong>Results: </strong>This analysis included 268 subjects. Cronbach's α coefficient was .86. Factor analyses showed the same single-factor structure as the original version of the D-CASS. Hierarchical multiple regression analyses based on the conceptual model demonstrated construct validity. D-CASS-J scores were significantly correlated with support burden scale scores.</p><p><strong>Conclusions: </strong>For family caregivers of elderly patients with diabetes in Japan, D-CASS-J can be used as a tool to evaluate difficulties experienced while providing support to patients.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721720954065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38539918","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":"Working Toward an mHealth Platform for Adolescents with Type 1 Diabetes: Focus Groups With Teens, Parents, and Providers.","authors":"Manuela Sinisterra,&nbsp;Katherine Patterson Kelly,&nbsp;Caitlin Shneider,&nbsp;Ashley El-Zein,&nbsp;Ellen Swartwout,&nbsp;Patricia Deyo,&nbsp;Randi Streisand","doi":"10.1177/0145721720943123","DOIUrl":"https://doi.org/10.1177/0145721720943123","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to explore facilitators and barriers to self-management behaviors in adolescents with type 1 diabetes (T1D) to inform the development of an mHealth platform.</p><p><strong>Methods: </strong>Eight adolescents with T1D, 9 parents, and 13 health care providers participated in separate focus groups that explored teen self-management behaviors.</p><p><strong>Results: </strong>Adolescents and their parents have distinct preferences for handling diabetes management and use of mHealth technologies. Health care providers support the use of new technologies yet acknowledge concern meeting the potential increased volume of communication requests from teens and families.</p><p><strong>Conclusion: </strong>Stakeholders agreed that an ideal mHealth platform would facilitate open communication between teens and their care network and easily integrate with other diabetes technologies. Future directions include incorporating additional feedback from stakeholders to build and modify the mHealth platform. The use of mHealth platforms could be integrated into clinical practice to optimize self-management and support communication between educators, providers, and families in between clinic visits.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721720943123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38217106","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":"Applying a Solution-Focused Approach to Life With Diabetes: Insights Gleaned via Twitter.","authors":"Deborah A Greenwood,&nbsp;Tami A Ross,&nbsp;Elizabeth Reifsnider","doi":"10.1177/0145721720941415","DOIUrl":"https://doi.org/10.1177/0145721720941415","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to explore responses of people with diabetes (PWD) when exposed to a solution-focused brief therapy (SFBT) approach. This approach focuses on solutions rather than the problems and what is desired in life rather than what will not occur.</p><p><strong>Methods: </strong>Ten SFBT questions were presented for discussion during 1 hour of a Twitter chat on November 14, 2018, during a World Diabetes Day multiple-hour chat. Verbatim transcripts of Twitter data were downloaded from Symplur Signals LLC. Thirty-two participants from 4 countries created 358 tweets, 118 retweets, and 1.5 million impressions. A qualitative content analysis was then completed.</p><p><strong>Results: </strong>Five themes emerged regarding the desired future state: more living life, laughter and humor, self-compassion, resilience, and support. There was an overwhelming sense of burden associated with diabetes yet a global feeling of hope, acceptance, and being \"capable\" to manage diabetes.</p><p><strong>Conclusion: </strong>Employing SFBT, asking future-directed questions with a focus on solutions and the desired state, generated impactful insights around life with diabetes. Diabetes care and education specialists can incorporate SFBT as a tool to focus diabetes care, education, and support in partnership with PWD. Use of SFBT in diabetes demonstrates potential to strengthen resilience and confidence needed to manage this challenging condition.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721720941415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38161751","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":"Reliability and Validity of the Spoken Knowledge in Low Literacy in Diabetes in Measuring Diabetes Knowledge Among Hispanics With Type 2 Diabetes.","authors":"Jie Hu,&nbsp;Karen A Amirehsani,&nbsp;Thomas P McCoy,&nbsp;Debra C Wallace,&nbsp;Sheryl L Coley,&nbsp;Fei Zhan","doi":"10.1177/0145721720941409","DOIUrl":"https://doi.org/10.1177/0145721720941409","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to examine the reliability and validity of the Spoken Knowledge in Low Literacy in Diabetes (SKILLD) scale in measuring diabetes knowledge among Hispanics with type 2 diabetes (T2DM).</p><p><strong>Methods: </strong>A total of 111 Hispanic participants with T2DM were recruited from clinics and churches in the Southeastern US. The Spanish version of the SKILLD was used. Internal consistency reliability and exploratory factor analysis (EFA) were examined for the Spanish SKILLD. Spearman rank correlations of SKILLD scores with the Summary of Diabetes Self-Care Activities (SDSCA) scores were inspected for evidence of convergent validity along with A1C level and duration of diabetes.</p><p><strong>Results: </strong>The average SKILLD score was 35.1% (SD = 23.4%). The correct response for each SKILLD item ranged from 4.5% to 56.8%. The estimated reliability via internal consistency was adequate (Kuder-Richardson 20 = 0.706). EFA of the SKILLD items modestly indicated 1 factor could be retained. Spearman rank correlations of SKILLD scores with diabetes self-care activities were significant and positive for foot self-care. Higher SKILLD scores were significantly correlated with duration of diabetes, using insulin, having a high education level, ever attending a diabetes class, or having a parent with diabetes.</p><p><strong>Conclusion: </strong>The Spanish SKILLD showed acceptable reliability and adequate validity in this sample of Hispanics with T2DM. SKILLD scores indicated low diabetes knowledge in this sample. Patient-centered diabetes education tailored to low literacy needs of Hispanics is needed.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721720941409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38160314","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":"Challenges Experienced by Parents of Emerging Young Adults With Type 1 Diabetes Mellitus During the Transition to College.","authors":"Michelle M Ness,&nbsp;Jennifer L Saylor,&nbsp;Xiaopeng Ji,&nbsp;Ann Bell,&nbsp;Barbara Habermann","doi":"10.1177/0145721720943120","DOIUrl":"https://doi.org/10.1177/0145721720943120","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to gain a deeper understanding of the challenges experienced by parents of emerging young adults (EYAs) with type 1 diabetes mellitus (T1DM) who completed their freshman or sophomore year of college.</p><p><strong>Methods: </strong>Using a descriptive, qualitative design, 16 parents participated in semistructured interviews that explored factors impacting the college transition for parents of college freshmen and sophomores with T1DM. Participants were recruited from local endocrinology clinics as well as the College Diabetes Network (CDN) Parent Facebook page, the CDN Facebook page, the CDN Twitter feed, and the Delaware Chapter of the JDRF (formerly Juvenile Diabetes Research Foundation). Researchers used a thematic analysis to analyze the data and develop categories. Interviews were conducted and recorded via video conferencing from July 2019 to September 2019.</p><p><strong>Results: </strong>Results represent data from 16 interviews comprising 15 (94%) mothers and 1 father. Thematic analysis resulted in the emergence of 3 themes: managing parental concerns, changes in the parental role, and identifying sources of parental support. Parents identified several challenges including the EYAs' ability to manage T1DM at college, communication with the EYA, and the availability of support for parents.</p><p><strong>Conclusion: </strong>Parents experience several challenges during their EYA's transition to college with T1DM. Supporting the needs of parents and EYAs during this time may serve to reduce diabetes-related complications for EYAs and increase overall quality of life for both members of the dyad.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721720943120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38221674","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":"Preventing Type 2 Diabetes Among Midlife Women: A Feasibility Study Comparing a Combined Sleep and Lifestyle Intervention With a Standard Lifestyle Intervention.","authors":"Catherine A Chesla,&nbsp;Caryl Gay,&nbsp;Laurie Bauer,&nbsp;Melinda Sarmiento Bender,&nbsp;Kathryn Lee","doi":"10.1177/0145721720943128","DOIUrl":"https://doi.org/10.1177/0145721720943128","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this pilot study was to evaluate the feasibility, acceptability, and initial efficacy of adding a sleep extension intervention to a well-established diabetes prevention intervention among midlife women with short sleep duration at risk for type 2 diabetes.</p><p><strong>Methods: </strong>For this 2-group comparative design, 26 women with prediabetes or metabolic syndrome and sleep duration <7 hours were recruited from the community to participate in an 8-session diet and physical activity lifestyle intervention alone (L-alone) or L-alone plus a behavioral sleep intervention (L+Sleep). Body mass index (BMI), waist circumference, and other outcomes were compared at baseline and 3 and 6 months using analysis of covariance.</p><p><strong>Results: </strong>Incorporating a sleep intervention into lifestyle changes proved feasible and acceptable to midlife women at risk for type 2 diabetes. Significant decreases in BMI and waist circumference over time were observed in both groups, but comparative efficacy of L+Sleep versus L-alone yielded few group differences. Exploratory analysis indicated that women who increased their sleep to ≥7 h/night, regardless of group assignment, lost more weight than women who continued to report sleeping <7 h/night.</p><p><strong>Conclusion: </strong>Adding sleep extension to a lifestyle change intervention proved feasible and satisfactory to participants, but initial efficacy did not differentiate the 2 intervention groups.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721720943128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38242045","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":"Pilot Mobile Phone Intervention in Promoting Type 2 Diabetes Management in an Urban Area in Ghana: A Randomized Controlled Trial.","authors":"Ernest Asante,&nbsp;Victoria Bam,&nbsp;Abigail Kusi-Amponsah Diji,&nbsp;Alberta Yemotsoo Lomotey,&nbsp;Agnes Owusu Boateng,&nbsp;Osei Sarfo-Kantanka,&nbsp;Eunice Oparebea Ansah,&nbsp;Dennis Adjei","doi":"10.1177/0145721720954070","DOIUrl":"https://doi.org/10.1177/0145721720954070","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to evaluate the feasibility and effectiveness of a nurse-led mobile phone call intervention on glycemic management and adherence to self-management practices among patients with type 2 diabetes mellitus (T2DM) in Ghana.</p><p><strong>Methods: </strong>This was a pilot randomized controlled trial to compare diabetes care as usual to a mobile phone call intervention delivered by nurses in addition to care as usual over a 12-week period in a tertiary referral hospital in Ghana. Sixty patients with T2DM were randomized to either the intervention or the control arm. The intervention group received up to 16 mobile phone calls (mean duration = 12 minutes) from a diabetes specialist nurse in addition to their care as usual. The control group received only care as usual. The primary outcome was the change in A1C over the 12-week period. The secondary outcomes were changes in self-reported adherence to medication and diabetes self-management measures over the 12-week period.</p><p><strong>Results: </strong>Mean baseline A1C was comparable between the intervention and control groups (9.54%, SD = 2.00% vs 9.07%, SD = 1.72%, <i>P</i> = .334). After 12 weeks, A1C was significantly lower in the intervention group compared to the control group. The difference in mean A1C in the control group rose by +0.26 ± 1.30% (<i>P</i> = .282; 95% CI, -0.23 to 0.75), whereas that of the intervention group reduced by -1.51 ± 2.67% (<i>P</i> = .004; 95% CI, -2.51 to -0.51). No improvements in self-management were recorded in the control group. In the intervention group, however, the only significant improvement was recorded in the area of foot care practices. Participant recruitment and retention were 100% without any attrition. About 87% (n = 26) of the intervention group completed at least 70% (≥11) of the calls. At the end of the trial, participants who received the intervention rated their satisfaction as 89.3% on average.</p><p><strong>Conclusion: </strong>A mobile phone follow-up call by nurses emphasizing adherence to self-management practices is feasible and can improve short- to medium-term glycemic management among patients with T2DM.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721720954070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38539919","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 Framework for Optimizing Technology-Enabled Diabetes and Cardiometabolic Care and Education: The Role of the Diabetes Care and Education Specialist.","authors":"Deborah A Greenwood,&nbsp;Fran Howell,&nbsp;LaurieAnn Scher,&nbsp;Gretchen Yousef,&nbsp;Joanne Rinker,&nbsp;Kirsten Yehl,&nbsp;Diana Isaacs,&nbsp;Malinda M Peeples","doi":"10.1177/0145721720935125","DOIUrl":"https://doi.org/10.1177/0145721720935125","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this article is to present a framework for optimizing technology-enabled diabetes and cardiometabolic care and education using a standardized approach. This approach leverages the expertise of the diabetes care and education specialist, the multiplicity of technologies, and integration with the care team. Technology can offer increased opportunity to improve health outcomes while also offering conveniences for people with diabetes and cardiometabolic conditions. The adoption and acceptance of technology is crucial to recognize the full potential for improving care. Understanding and incorporating the perceptions and behaviors associated with technology use can prevent a fragmented health care experience.</p><p><strong>Conclusion: </strong>Diabetes care and education specialists (DCES) have a history of utilizing technology and data to deliver care and education when managing chronic conditions. With this unique skill set, DCES are strategically positioned to provide leadership to develop and deliver technology-enabled diabetes and cardiometabolic health services in the rapidly changing healthcare environment.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721720935125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38252360","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":"Technology Integration: The Role of the Diabetes Care and Education Specialist in Practice.","authors":"Diana Isaacs,&nbsp;Carla Cox,&nbsp;Kathy Schwab,&nbsp;Tamara K Oser,&nbsp;Joanne Rinker,&nbsp;Mary Jo Mason,&nbsp;Deborah A Greenwood,&nbsp;Anastasia Albanese-O'Neill","doi":"10.1177/0145721720935123","DOIUrl":"https://doi.org/10.1177/0145721720935123","url":null,"abstract":"<p><strong>Purpose: </strong>Technology is rapidly evolving and has become an integral component of diabetes care. People with diabetes and clinicians are harnessing a variety of technologies, including connected blood glucose meters, continuous glucose monitors, insulin pumps, automated insulin delivery systems, data-sharing platforms, telehealth, remote monitoring, and smartphone mobile applications to improve clinical outcomes and quality of life. Although diabetes technology use is associated with improved outcomes, this is enhanced when the person using it is knowledgeable and actively engaged; simply wearing the device or downloading an app may not automatically translate into health benefits. The diabetes care and education specialist (DCES) has a central role in defining and establishing a technology-enabled practice setting that is efficient and sustainable. The purpose of this article is to describe the role of the DCES in technology implementation and to demonstrate the value of diabetes technology in both the care of the individual and as a tool to support population-level health improvements.</p><p><strong>Conclusion: </strong>By following the recommendations in this article, DCESs can serve as technology champions in their respective practices and work to reduce therapeutic inertia while improving health outcomes and providing patient-centered care for the populations they serve.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721720935123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38252361","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":"Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association.","authors":"Margaret A Powers,&nbsp;Joan K Bardsley,&nbsp;Marjorie Cypress,&nbsp;Martha M Funnell,&nbsp;Dixie Harms,&nbsp;Amy Hess-Fischl,&nbsp;Beulette Hooks,&nbsp;Diana Isaacs,&nbsp;Ellen D Mandel,&nbsp;Melinda D Maryniuk,&nbsp;Anna Norton,&nbsp;Joanne Rinker,&nbsp;Linda M Siminerio,&nbsp;Sacha Uelmen","doi":"10.1177/0145721720930959","DOIUrl":"https://doi.org/10.1177/0145721720930959","url":null,"abstract":"","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721720930959","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38022478","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}