International Journal of Eating Disorders最新文献

{"title":"Rethinking Screening, and Considering Cross-Cultural Similarities and Differences in the Clinical Presentation of Avoidant/Restrictive Food Intake Disorder (ARFID): A Commentary Building Upon Presseller et al. (2024).","authors":"Sandra Mulkens","doi":"10.1002/eat.24428","DOIUrl":"https://doi.org/10.1002/eat.24428","url":null,"abstract":"<p><p>Avoidant/restrictive food intake disorder (ARFID) is increasingly recognized globally, yet its clinical presentation may vary across cultures. This commentary highlights the importance of considering cultural context in the assessment of ARFID. We begin by reflecting on a study by Presseller et al. which examines the utility of the nine-item ARFID screen (NIAS) in a large Swedish sample, finding that the NIAS alone may not adequately differentiate ARFID from eating disorders driven by shape/weight concerns. Building upon this, we broaden the discussion to include the potential comorbidity of ARFID and other eating disorders driven by weight/shape concern, which also requires additional assessment. Furthermore, we explore potential cross-cultural similarities and differences in ARFID presentation, drawing on clinical experience in the Netherlands, Europe, and globally. Factors such as cultural norms surrounding eating, the acceptability of expressing feeding difficulties, and food availability itself may all influence how ARFID manifests. A deeper understanding of these cultural nuances is essential for accurate diagnosis, culturally sensitive treatment approaches, and ultimately, improved outcomes for individuals with ARFID worldwide. The nuanced interplay of cultural factors and diagnostic tools underscores the imperative for tailored approaches in addressing ARFID across diverse populations.</p>","PeriodicalId":51067,"journal":{"name":"International Journal of Eating Disorders","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Barriers and Facilitators of Use of Artificial Intelligence in Eating Disorder Care: A Commentary on Linardon et al. (2025).","authors":"Gemma Sharp","doi":"10.1002/eat.24426","DOIUrl":"https://doi.org/10.1002/eat.24426","url":null,"abstract":"<p><p>Artificial intelligence (AI) has the potential to revolutionize mental health care, including for eating disorders, but there are still a number of concerns focused on ethics, governance, and regulation. As the authors found in their preliminary survey study involving mental health clinicians and people experiencing eating disorder symptoms, there was support and recognition of the benefits of AI tools in eating disorder care. However, participants also had concerns surrounding issues like data privacy, governance, information accuracy, and therapeutic rapport. From our own research involving the development of multiple AI tools, particularly chatbots, to assist people experiencing eating disorders and their loved ones, we suggest that these perceived barriers can be overcome with thoughtful and comprehensive codesign with multidisciplinary teams following ethical frameworks for AI and digital technologies. In this way, we can optimally mitigate the risk of using AI tools while still offering the most advanced technologies to treat eating disorders.</p>","PeriodicalId":51067,"journal":{"name":"International Journal of Eating Disorders","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Serum Neurofilament Light Chain Concentration Associated With Microglial Morphology Changes in Chronically-Starved Mice.","authors":"Annelie Zimmermann, Hanna Rupprecht, Stephan Lang, Rickmer Wienecke, Hanna-Sophia Henschke, Kaja Dickert, Katharina Schuster, Anna Staffeld, Christoph Berger, Alexander Dück, Michael Kölch, Antje Vogelgesang, Matthias Grothe, Leo Heinig, Lukas Wenzel, Markus Kipp, Linda Frintrop","doi":"10.1002/eat.24423","DOIUrl":"https://doi.org/10.1002/eat.24423","url":null,"abstract":"<p><strong>Objective: </strong>Anorexia nervosa (AN) is associated with hyperactivity, amenorrhea, and brain atrophy. Weight rehabilitation reversed these symptoms, although the underlying pathophysiological mechanisms are mostly unknown. Serum neurofilament light chain (NfL) levels are widely used as a biomarker of neurodegeneration. Based on neuroimaging studies and increased serum NfL levels, we assume that neurodegeneration is a core neuropathological feature in AN patients.</p><p><strong>Method: </strong>Female mice were given a limited amount of food once a day and had unlimited access to a running wheel until they reached a 25% weight reduction, which was maintained for 2 weeks to mimic chronic starvation. This was followed by 3 weeks of refeeding. Running activity was measured by wheel sensors, while amenorrhea was determined by analyzing vaginal smears. Brain sections were used to investigate brain volumes. NfL levels were determined using a NF-light assay. Behavioral tests such as forced swim and elevated plus maze assessed behavioral changes. Immunohistochemistry was used to quantify the density of microglia, while their morphological analysis was performed using Neurolucida 360.</p><p><strong>Results: </strong>Chronic starvation led to AN-related symptoms of hyperactivity and amenorrhea. The decreased cerebral cortex, hippocampal, and corpus callosum volumes were paralleled by increased NfL levels after chronic starvation. A behavioral association was reduced anxiety-like behavior after chronic starvation. Starvation induced decreased microglial density, increased soma area, and prolonged microglial processes.</p><p><strong>Discussion: </strong>Chronic starvation led to an increase in NfL levels and changed microglial morphology in a mouse model of AN, suggesting that neuronal pathophysiology may contribute to the disease.</p>","PeriodicalId":51067,"journal":{"name":"International Journal of Eating Disorders","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing the Science of Avoidant/Restrictive Food Intake Disorder (ARFID): Six Key Questions.","authors":"P Evelyna Kambanis, Jennifer J Thomas","doi":"10.1002/eat.24418","DOIUrl":"https://doi.org/10.1002/eat.24418","url":null,"abstract":"<p><p>Avoidant/restrictive food intake disorder (ARFID) has rapidly emerged as a substantial focus of research and clinical attention since its introduction in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5). This special issue brings together over 30 articles that answer six of the field's most compelling current research questions about ARFID. Specifically, key contributions explore: (1) whether the diagnostic criteria for ARFID should be revised; (2) how well our current self-report measures assess ARFID symptoms; (3) candidate psychological mechanisms that may maintain ARFID symptoms; (4) whether common medical comorbidities may provide clues to etiology; (5) how close we are to identifying evidence-based treatments; and (6) how cultural context may shape ARFID phenotypic presentation. A critical gap remains in understanding ARFID across diverse cultural contexts, with most research still centered in North America and Europe. Expanding global research and refining transdiagnostic and personalized treatment approaches-including combining existing interventions into a comprehensive model of stepped or adaptive care-will be essential next steps in the field. In sum, this issue reflects the rapid evolution of ARFID research and lays the groundwork for future advancements in diagnosis, treatment, and intervention.</p>","PeriodicalId":51067,"journal":{"name":"International Journal of Eating Disorders","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus-Based Recommendations for Yoga as Adjunct Therapy in Eating Disorder Treatment: A Delphi Study.","authors":"Eleanor Trethewey, Subhadra Evans, Shane McIver, Michael de Manincor, Janani Janakiraman, Arvind V Iyer, Melissa O'Shea","doi":"10.1002/eat.24420","DOIUrl":"https://doi.org/10.1002/eat.24420","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop consensus-based statements, combining the expertise of eating disorder (ED) clinicians and yoga instructors, on key considerations for applying yoga for individuals with anorexia nervosa, bulimia nervosa, and binge-eating disorder.</p><p><strong>Method: </strong>A two-round modified Delphi technique was conducted via an online survey platform. Participants rated the importance of various yoga components to ensure the safety and therapeutic usefulness of yoga for the EDs. Survey items covered key aspects of yoga, including style, frequency, duration, environmental factors, safety precautions (e.g., medical monitoring), language and expression, instructor qualifications, postures, breathwork, and meditation practices. A total of 12 ED clinicians and 16 yoga instructors participated in the first round, with 10 clinicians and 13 instructors completing the second round.</p><p><strong>Results: </strong>General recommendations were developed for both the transdiagnostic and disorder-specific application of yoga. These were organized into six core areas: yoga style, environmental factors, dosage, language and expression, the instructor's role, and the integration of yoga into ED treatment. Additionally, the yoga panel provided technique-specific recommendations addressing postures, breathwork, and meditation practices for both transdiagnostic and disorder-specific application across the ED spectrum.</p><p><strong>Discussion: </strong>This study offers preliminary recommendations for integrating yoga into ED treatment through developing consensus-based statements. The findings emphasize both transdiagnostic and disorder-specific considerations for EDs, while highlighting the importance of trauma-informed, individualized approaches. Further research is needed to develop comprehensive guidelines for the therapeutic use of yoga in eating disorder treatment.</p>","PeriodicalId":51067,"journal":{"name":"International Journal of Eating Disorders","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoidant/Restrictive Food Intake Disorder Plus Eating Disorder Comorbidity: Are Two Diagnoses Better Than One?","authors":"Kamryn T Eddy, Sonakshi Negi","doi":"10.1002/eat.24417","DOIUrl":"https://doi.org/10.1002/eat.24417","url":null,"abstract":"<p><p>Zickgraf and colleagues propose an elegant revised framework for avoidant/restrictive food intake disorder that would recognize it as a diagnosis based on the presence of specific eating behaviors, and, importantly, allow for it to be diagnosed alongside other medical and psychiatric conditions, including other eating disorders. While likely to have good ecological validity, this radical proposal challenges the general conceptualization of ARFID as the eating disorder in which weight- and shape-concerns are not present. Here, we consider whether two diagnoses are indeed better than one, raising challenges we have observed in clinical and research practice. We offer an alternative hybrid categorical-dimensional framework for considering ARFID and co-occurring eating disorder symptoms and encourage a set of next steps for research in this nosological arena.</p>","PeriodicalId":51067,"journal":{"name":"International Journal of Eating Disorders","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Associations of Appearance-Related Teasing With Eating Disorder Psychopathology, Eating-Related Psychosocial Impairment, and Psychological Distress in Chinese Adults: Both Teasing Victimization and Perpetration Matter.","authors":"Jinbo He, Xi Chen, Wesley R Barnhart, Yuru Fu, Shuqi Cui, Zexuan Jiang, Shijia Wu, Jason M Nagata, Chun Chen","doi":"10.1002/eat.24419","DOIUrl":"https://doi.org/10.1002/eat.24419","url":null,"abstract":"<p><strong>Objective: </strong>This study examined prospective associations of weight and muscularity teasing, including both victimization and perpetration, with thinness- and muscularity-oriented eating disorder (ED) psychopathology, eating-related psychosocial impairment, and psychological distress.</p><p><strong>Method: </strong>An online sample of 799 Chinese adults (400 men and 399 women) participated in this longitudinal study with two waves of data collection at baseline (T1) and 6 months later (T2). Analyses were conducted separately by gender. Univariable and multivariable longitudinal analyses based on linear regressions were used to examine the prospective links between weight and muscularity teasing experiences at T1 and outcome variables at T2, adjusting for covariates and outcome variables at T1.</p><p><strong>Results: </strong>Univariable analyses revealed that, for both men and women, all teasing experiences at T1 (except for muscularity teasing perpetration in men) were prospectively associated with one or more outcome variables at T2. Multivariable analyses revealed that for men, weight and muscularity teasing victimization at T1 were independently linked to greater eating-related psychosocial impairment and/or psychological distress at T2. For women, weight teasing perpetration at T1 was independently linked to higher thinness-oriented ED psychopathology and greater psychological distress at T2.</p><p><strong>Discussion: </strong>Findings suggest that both victimization and perpetration of weight and muscularity teasing were prospectively associated with one or more outcome variables, including ED psychopathology, eating-related psychosocial impairment, and psychological distress. Future research and interventions should address both victimization and perpetration in appearance-related teasing to enhance our understanding and mitigate its adverse effects on eating behaviors and mental health.</p>","PeriodicalId":51067,"journal":{"name":"International Journal of Eating Disorders","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family-Based Treatment for Primary Care: An Observational Study of a Community Sample of Youth With Restrictive Eating Disorders.","authors":"Jocelyn Lebow, Angela Mattke, Paige Partain, Marcie Billings, Jennifer Geske, Janna R Gewirtz O'Brien, Cassandra Narr, Renee Breland, Tammy Schmit, Daniel Le Grange, Katharine Loeb, Robert M Jacobson, Leslie Sim","doi":"10.1002/eat.24416","DOIUrl":"https://doi.org/10.1002/eat.24416","url":null,"abstract":"<p><strong>Objective: </strong>To examine the outcomes of a clinical sample of young patients with restrictive eating disorders who received Family-Based Treatment for Primary Care (FBT-PC).</p><p><strong>Methods: </strong>Participants were 134 youth (mean age = 15.7 years) and their caregiver(s). Participants and caregivers completed measures of eating disorder symptomatology, quality of life, and caregiver self-efficacy.</p><p><strong>Results: </strong>Of the 134 patients who received at least one session of FBT-PC, 55.9% completed treatment, 20.1% were followed until they began a higher level of care, and 23.8% were non-completers. Weekly measures for the full sample were evaluated using intention-to-treat analyses. Patient-reported scores on the ED-15 improved by -0.1 (SE = 0.02, F_(1,133)=26.4, p < 0.0001) per week, and caregivers' ratings of patient symptoms also improved by 0.85 (SE = 0.2, F_(1,133)=13.1, p = 0.0003) per week. Patient's BMI percentile increased by 1.25 points per week (SE = 0.14, F_(1,133) = 83.9, p < 0.0001). For patients who completed FBT-PC, eating disorder symptoms, per patient- (M = -1.43, p < 0.0001) and caregiver-report (M = -1.33 p < 0.0001) decreased significantly from baseline to end of treatment. Patient's quality of life increased significantly from baseline to end of treatment (M = 21.6, p < 0.0001) and caregivers showed significant increases in self-efficacy (M = 3.41, p < 0.0001, d = 0.856). At the end of treatment, 62.5% of patients with complete data met criteria for full research remission, and 44.6% met criteria for full clinical remission.</p><p><strong>Discussion: </strong>Findings provide preliminary support for FBT-PC as an effective treatment for youth with restrictive eating disorders. Additional research is needed to replicate these findings in other primary care settings and to understand the durability of treatment effects.</p>","PeriodicalId":51067,"journal":{"name":"International Journal of Eating Disorders","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Momentary Mediational Associations Among Affect, Emotion Dysregulation, and Different Types of Loss of Control Eating Among Adults With Binge Eating Disorder.","authors":"Kelly A Romano, Carol B Peterson, Glen Forester, Joseph A Wonderlich, Stephen A Wonderlich, Scott E Engel, Ross D Crosby","doi":"10.1002/eat.24415","DOIUrl":"https://doi.org/10.1002/eat.24415","url":null,"abstract":"<p><strong>Objective: </strong>Few studies have directly assessed the mechanistic role of transdiagnostic self-regulatory factors that are theorized to promote core disinhibited disordered eating behaviors that characterize binge eating disorder (BED) in the natural environment, such as emotion dysregulation. The present study used ecological momentary assessment (EMA) to address this research gap by examining whether: (1) emotion dysregulation mediated associations between negative and positive affect and loss of control (LOC) eating at the within-person level; (2) these associations varied across distinct LOC eating dimensions.</p><p><strong>Method: </strong>Adults with BED (N = 107; M_age = 39.87, SD = 13.35) responded to six surveys per day for a 7-day EMA period. Multilevel structural equation models examined whether momentary emotion dysregulation mediated momentary associations between negative and positive affect, and different LOC eating outcomes (\"general\" [subjective experience of] LOC while eating; difficulties resisting eating; difficulties stopping eating after starting; feeling driven/compelled to eat; not paying attention to one's eating; feeling disconnected while eating [e.g., numb, zoned out]).</p><p><strong>Results: </strong>Experiencing a sequential worsening of negative affect and, in turn, emotion dysregulation over a day mapped onto higher levels of certain LOC eating outcomes (\"general\" LOC eating, difficulties resisting eating, driven/compelled to eat, disconnected while eating) but not others (difficulties stopping eating, not paying attention to one's eating). All momentary mediational pathways involving positive affect as a predictor were not significant.</p><p><strong>Discussion: </strong>These findings support emotion dysregulation as a mechanistic process that can precipitate certain types of LOC eating in daily life and may be leveraged to improve BED theory, research, and real-time interventions.</p>","PeriodicalId":51067,"journal":{"name":"International Journal of Eating Disorders","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, Phenotype, and Correlates of Avoidant/Restrictive Food Intake Disorder Symptoms in the Gulf Cooperation Council: An Underserved Region.","authors":"Bernou Melisse, Hassan Fakhri, Lynne Kennedy, Maria J Figueiras, Munirah Alshebali, Hala Abu Taha, Carine El Khazen, Dalal Alkazemi, Sandra Mulkens","doi":"10.1002/eat.24400","DOIUrl":"https://doi.org/10.1002/eat.24400","url":null,"abstract":"<p><strong>Introduction: </strong>Prevalence estimates and correlates of ARFID in non-Western samples are lacking. This study aims to estimate the prevalence of ARFID symptoms, identify its phenotypes, and explore its correlates in a community sample from the Gulf Cooperation Council (GCC).</p><p><strong>Method: </strong>Participants were parents of children aged 4-13 years (n = 87) and individuals of ≥ 14 years old (n = 433). They completed the Pica, ARFID, and Rumination Disorder Interview-ARFID-Questionnaire (PARDI-AR-Q), the Nine Item ARFID Screen (NIAS) and the Eating Disorder Examination-Questionnaire (EDE-Q). Multiple regression analyses were performed with body mass index or its standard deviation score, comorbid psychopathology, EDE-Q global score, sex, and age as independent variables; the dependent variable was ARFID psychopathology.</p><p><strong>Results: </strong>Among individuals not reporting eating disorder symptoms driven by overvaluation of shape and weight, the PARDI-AR-Q diagnostic prediction suggested that approximately 23.4% of those aged ≥ 14 exhibited ARFID symptoms. Based on the NIAS, sensory-based food avoidance was the most reported phenotype expression, with approximately 29.4% of children (4-13 years) and 12.8% of adolescents/adults (≥ 14-years) reporting ARFID symptoms. In adolescents and adults, ARFID psychopathology was positively associated with eating disorder pathology driven by overvaluation of shape and weight, with female sex and negatively associated with age.</p><p><strong>Discussion: </strong>This study is the first to identify a subset of individuals in GCC countries with ARFID symptoms across sexes and a broad age range, with sensory sensitivity as the most common symptom.</p>","PeriodicalId":51067,"journal":{"name":"International Journal of Eating Disorders","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}