Journal of Hospital Infection最新文献

{"title":"Characterization of the environment of patients colonized with carbapenemase-producing organisms: role of air and surfaces in the dissemination of key resistance genes","authors":"A. Richer-Fortin ,&nbsp;M. Veillette ,&nbsp;F. Rossi ,&nbsp;Y. Longtin ,&nbsp;A. Larrotta ,&nbsp;B. Paquet-Bolduc ,&nbsp;C. Duchaine","doi":"10.1016/j.jhin.2025.07.003","DOIUrl":"10.1016/j.jhin.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Hospital-associated infections caused by carbapenemase-producing organisms (CPOs) pose a significant health concern. Healthcare settings implement measures to control the spread of CPOs and prevent outbreaks, but the role of air in disseminating carbapenemase genes remains unclear. This study assessed three carbapenemase-associated genes (<em>bla</em>_KPC, <em>bla</em>_OXA-48 and <em>bla</em>_NDM) in the environment of CPO-colonized patients.</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted in four hospitals in Quebec, Canada in the rooms of CPO-colonized patients. Air was collected actively inside the rooms of CPO-colonized patients, and floor and no-touch surfaces were sampled using pre-moistened swabs and sponges; the findings were compared with those from control rooms (i.e. rooms hosting non-CPO-colonized patients) located on the same floor. Additional floor samples were collected in adjacent hallways to estimate potential dissemination within the settings. The presence and abundance of carbapenemase-producing genes (<em>bla</em>_KPC, <em>bla</em>_NDM and <em>bla</em>_OXA-48) were evaluated using quantitative polymerase chain reaction.</div></div><div><h3>Results</h3><div>Carbapenemase-encoding genes were detected frequently in CPO-colonized patient environments, notably on floors (97% of detection frequency), door frames (52%), and no-touch surfaces (42%). Conversely, only one air sample tested positive for <em>bla</em>_KPC. These genes were also detected in hallways adjacent to the rooms of CPO-colonized patients (92%), control rooms (100%), and hallways adjacent to the rooms of non-CPO-colonized patients (78%), with abundance decreasing with distance from CPO-colonized rooms.</div></div><div><h3>Conclusion</h3><div>These findings suggest that carbapenem resistance can spread within healthcare settings, and air may play a role in gene dissemination. Additional measures should be considered to limit resistance gene transfer, particularly via floors and air.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"164 ","pages":"Pages 55-63"},"PeriodicalIF":3.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709959","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":"Nurse-led design and evaluation of a retractable safety needle for injection safety","authors":"C.W. Liu ,&nbsp;M. Koo ,&nbsp;Z.C. Lin","doi":"10.1016/j.jhin.2025.07.001","DOIUrl":"10.1016/j.jhin.2025.07.001","url":null,"abstract":"<div><h3>Objective</h3><div>Needlestick injuries remain a significant source of bloodborne pathogen exposure in clinical settings, contributing to healthcare-associated infections among nurses. Existing safety devices rely on user compliance or administrative controls, which are insufficient under real-world pressures. This study evaluates the infection control potential of a nurse-designed retractable safety needle (RSN), developed to structurally reduce exposure risk through substitution-level engineering, as defined by the Hierarchy of Controls framework of the US National Institute for Occupational Safety and Health.</div></div><div><h3>Methods</h3><div>A randomized crossover trial was conducted with 76 nurses at a regional teaching hospital in eastern Taiwan. Participants completed two simulated clinical injection tasks, once with a conventional cap-type safety needle (CSN) and once with an RSN. Safety and usability outcomes were compared using generalized estimating equations, accounting for within-subject and sequencing effects.</div></div><div><h3>Results</h3><div>Compared with the CSN, the RSN significantly reduced near-miss events (mean difference: −0.62 occurrences, <em>P</em> = 0.002), frequency of needle exposure (mean difference: −7.47 occurrences, <em>P</em> &lt; 0.001), and cumulative duration of needle exposure (mean difference: −27.68 s, <em>P</em> &lt; 0.001). While the RSN demonstrated improved safety outcomes, it required significantly longer preparation time (mean difference: 75.6 s, <em>P</em> &lt; 0.001). Usability scores did not differ significantly between the devices (<em>P</em> = 0.156).</div></div><div><h3>Conclusions</h3><div>The RSN offers a practical infection control innovation by structurally eliminating exposure pathways rather than relying on downstream behaviour. This study supports nurse-led device development in advancing engineering-based strategies to reduce occupational exposure and improve injection safety. Findings may inform future implementation of medication preparation systems to mitigate healthcare-associated infections in practice.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"164 ","pages":"Pages 96-104"},"PeriodicalIF":3.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709934","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":"Costs associated with the treatment of surgical site infection among solid organ transplant recipients: a scoping review","authors":"J.N. da Silva Ferreira ,&nbsp;S.R. Secoli ,&nbsp;J. Tanner ,&nbsp;V. de Brito Poveda ,&nbsp;R.A. Oliveira","doi":"10.1016/j.jhin.2025.06.020","DOIUrl":"10.1016/j.jhin.2025.06.020","url":null,"abstract":"<div><div>There is a notable lack of research addressing the occurrence of surgical site infection (SSI) among solid organ transplant recipients and the related economic burden. The aim was to map the available evidence regarding the direct costs associated with the treatment of SSI among adult solid organ transplant recipients. This was a scoping review conducted in accordance with the guidelines issued by the Joanna Briggs Institute. Searches were carried out in seven databases. Grey literature sources and reference lists of the included studies were consulted in November 2024. Primary scientific studies conducted among solid organ transplant recipients, aged ≥18 years, that reported direct costs related to the occurrence of SSI were included. Cost estimates have been converted to a common currency, the US dollar of 2024. A total of 4145 records were recovered. The final sample consisted of five studies. Three studies included liver transplant recipients and two included kidney transplant recipients. In liver transplantation, the SSI rate ranged from 15.7% to 37.8% and in kidney transplantation from 4.1% to 18.5%. The cost of treating SSI, adjusted for severity, among liver transplant recipients, ranged from US$17,248 to US$246,548 and in kidney transplant recipients it was US$20,183. The most frequently reported cost parameters were hospital stay, medications, laboratory tests, and human resources. The additional direct costs arising from the treatment of SSI in solid organ transplant recipients represent a significant economic burden for society, which may impact the sustainability of health systems.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"164 ","pages":"Pages 125-133"},"PeriodicalIF":3.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709933","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":"Polysorbate additive improves microbiological testing of endoscopes: an exploratory study","authors":"H. Taboga,&nbsp;T. Kaighobadi,&nbsp;N. Babey","doi":"10.1016/j.jhin.2025.07.004","DOIUrl":"10.1016/j.jhin.2025.07.004","url":null,"abstract":"<div><div>Disinfection of endoscopes is inherently difficult due to their flexible structure and inaccessibility for sterilization. We tested a new product based on Polysorbate 80, adding this to the standard reprocessing procedure after an initial non-compliant clean and compared compliance rates during quality assurance between endoscopes cleaned with the standard procedure compared to cleaning with the polysorbate product. Twenty-eight endoscopes received secondary cleaning with the standard procedure, and 29 with the addition of polysorbate. With the addition of polysorbate, compliance reached 100% (95% confidence interval: 88.3–100) compared to 82.1% (64.4–92.1) with standard procedure (<em>P</em> &lt; 0.05). Cleaning technicians were surveyed, rating their satisfaction with the procedure at 9.7/10.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"164 ","pages":"Pages 87-90"},"PeriodicalIF":3.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709935","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":"Applying the theoretical framework of behavioural change to sustainable infection prevention and control based on a binational workshop","authors":"A. Bludau ,&nbsp;P. Weaving ,&nbsp;A. Munro ,&nbsp;N. Reinoso Schiller ,&nbsp;K. Giray ,&nbsp;K. Galuszka ,&nbsp;C. Baier ,&nbsp;J. Zweigner ,&nbsp;A. Kramer ,&nbsp;S. Scheithauer","doi":"10.1016/j.jhin.2025.06.016","DOIUrl":"10.1016/j.jhin.2025.06.016","url":null,"abstract":"<div><h3>Background</h3><div>Infection prevention and control (IPC) is inherently sustainable by reducing avoidable infections and subsequent interventions.</div></div><div><h3>Aim</h3><div>To encompass the perspectives of a binational multi-disciplinary group of experts based on a workshop on the capabilities, opportunities and motivations needed to overcome key barriers to the successful implementation of even more sustainable IPC with regard to ecological sustainability.</div></div><div><h3>Methods</h3><div>The 16 workshop participants were divided into groups to discuss three different issues regarding the most sustainable IPC following the World Café method. Carrying out a content analysis, the results were categorized into common themes – first for each question and then overall – and those categories were mapped into the Capability, Opportunity, Motivation and Behaviour (COM-B) model.</div></div><div><h3>Findings</h3><div>Five intervention functions were identified across two sources of behaviour of the COM-B framework, whereby 10 of the 16 categorized interventions could be initiated directly by the IPC practitioners, whilst others need to be led by the hospital management. A recurring theme was the need for a well-structured, high-quality database that weighs patient safety and sustainability at the source of any intervention.</div></div><div><h3>Conclusion</h3><div>While a top-down approach is essential in parts, various interventions can also be initiated and led directly by IPC practitioners. In addition, to ensure sustainable and lasting changes in practice, there needs to be structured and comprehensive data collection. These results add valuable information for healthcare facilities and IPC practitioners who want to become more environmentally-friendly.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"165 ","pages":"Pages 64-72"},"PeriodicalIF":3.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Omicron variant significantly increases viral load emissions in healthcare settings: implication for healthcare workers","authors":"F. Rossi ,&nbsp;K-P. Pelletier ,&nbsp;M. Veillette ,&nbsp;B. Paquet-Bolduc ,&nbsp;C. Duchaine","doi":"10.1016/j.jhin.2025.07.002","DOIUrl":"10.1016/j.jhin.2025.07.002","url":null,"abstract":"<div><h3>Background</h3><div>The SARS-CoV-2 Omicron variant is transmitted via contaminated droplets and aerosols, raising concerns in healthcare settings where poor ventilation and high patient density can increase airborne viral load.</div></div><div><h3>Aim</h3><div>This study aimed to assess real-world exposure of healthcare workers to COVID-19-positive patients isolated in designated hospital areas, using continuous 24-h air sampling.</div></div><div><h3>Methods</h3><div>Air sampling was conducted inside 10 hospital rooms hosting a succession of 38 patients who tested positive for SARS-CoV-2. Sampling was performed using 37-mm cassettes placed near the patients' heads. The Omicron variant in the air was detected by RT-qPCR, with results expressed as emission rates based on air changes per hour for each room and correlated with the onset of patients' symptoms.</div></div><div><h3>Findings</h3><div>The SARS-CoV-2 was detected and quantified in the air of 89% of patients, indicating that 76.7% of the rooms hosting positive patients had detectable levels of airborne virus. This corresponded to an average viral emission rate of 1.45 × 10⁵ ± 2.16 × 10⁵ genomes/h per patient. Expectoration was the sole symptom significantly affecting emission rates, with patient suffering from it exhibiting values three times higher than patients without. Additionally, the room accounted for half of the variance in emission rates, suggesting that the number of patients and the room's prior usage are key determinants of viral particle exposure.</div></div><div><h3>Conclusion</h3><div>Our findings indicate that healthcare workers face significant exposure when providing care in rooms with positive patients, even when mechanically ventilated. Greater attention should be given to treating and managing these spaces to reduce the potential for viral transmission toward healthcare workers.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"163 ","pages":"Pages 88-97"},"PeriodicalIF":3.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709936","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":"Chicken or egg? The role of dysbiosis in intestinal carriage of carbapenemase-producing Enterobacterales","authors":"M.J.S. Knudsen ,&nbsp;F.H. Jensen ,&nbsp;I.M.C. Rubin ,&nbsp;A.M. Petersen","doi":"10.1016/j.jhin.2025.06.018","DOIUrl":"10.1016/j.jhin.2025.06.018","url":null,"abstract":"<div><h3>Background</h3><div>Carbapenemase-producing Enterobacterales (CPE) have a well-established capability of spreading in healthcare environments and cause outbreaks in hospital wards.</div></div><div><h3>Aim</h3><div>To determine whether intestinal dysbiosis is associated with intestinal carriage of CPE; also to investigate treatment with antibiotics, and hospitalization prior to study inclusion.</div></div><div><h3>Methods</h3><div>A systematic search of the PubMed, Embase, and Cochrane databases was conducted in September 2024, and studies were included where the authors compared microbiome analysis of CPE carriers with microbiome analysis of non-carriers.</div></div><div><h3>Findings</h3><div>The search resulted in 1812 records. After removing duplicates, and non-eligible records based on title and abstract screening, 67 records were retrieved for full-text screening. Of these, four studies were included in the systematic review including 140 CPE carriers and 141 controls. In three studies the authors found dysbiosis in the group of CPE carriers, and in the fourth study they found a decrease in diversity in CPE carriers compared with healthy adults; however, there was no decrease in diversity compared with hospitalized non-carriers.</div></div><div><h3>Conclusion</h3><div>This systematic review has revealed an association between intestinal dysbiosis and intestinal carriage of CPE. Nonetheless, the potential influence of antibiotic treatment on this result cannot be dismissed.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"164 ","pages":"Pages 64-71"},"PeriodicalIF":3.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709960","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":"Infection prevention and control in burns services: guidance from the Healthcare Infection Society.","authors":"P A Jumaa, L Teare, P N Hoffman, A E Young, S Smailes, V Edwards-Jones, C Thomas, L S P Moore, S Booth, M A Mugglestone, N S Moiemen","doi":"10.1016/j.jhin.2025.06.008","DOIUrl":"10.1016/j.jhin.2025.06.008","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610321","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":"Postoperative serum amyloid A as a primary marker in a predictive model for ventilator-associated pneumonia in elderly patients with acute ischaemic stroke undergoing endovascular therapy with general anaesthesia.","authors":"Xuerong Zhang, Xueying Yang, Qiong Zhao","doi":"10.1016/j.jhin.2025.06.015","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.06.015","url":null,"abstract":"<p><strong>Background: </strong>The risk factors associated with ventilator-associated pneumonia (VAP) in acute ischaemic stroke (AIS) patients who have undergone endovascular therapy have been primarily reported as clinical-related parameters.</p><p><strong>Aim: </strong>This study aims to combine clinical parameters with inflammatory biomarkers to identify VAP-related risk factors and develop a predictive model.</p><p><strong>Methods: </strong>A total of 564 AIS patients were recruited and divided into the training set (n = 395) and the validation set (n = 169). The least absolute shrinkage and selection operator (LASSO), univariate and multivariate logistic regression analyses were utilized to examine the independent risk factors or biomarkers associated with VAP.</p><p><strong>Findings: </strong>We identified four VAP-associated risk factors or biomarker in AIS patients, consisting of thrombolysis in cerebral infarction (TICI) score (0-IIa) (OR = 4.528; 95% CI: 2.249-9.119; P < 0.001), admission national Institute of Health stroke scale (NIHSS) (OR=1.330; 95% CI: 1.217-1.453; P<0.001), neutrophil lymphocyte ratio (NLR) (OR=2.179; 95% CI: 1.312-3.618; P=0.003), and postoperative serum amyloid A (SAA) (OR=1.194; 95% CI: 1.146-1.244; P<0.001). This predictive model demonstrated robust performance and stability, with an AUC of 0.926 (95% CI: 0.899-0.953) in the training set and 0.937 (95% CI: 0.897-0.977) in the validation set. Notably, using the machine learning algorithm Random Forest for feature importance ranking, postoperative SAA emerged as the most critical predictor of VAP.</p><p><strong>Conclusion: </strong>The predictive model has good predictive value for VAP. Postoperative SAA may serve as a rapid diagnostic biomarker for predicting VAP.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610322","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":"Developing infection prevention and control guidelines for healthcare professionals in the Netherlands: an evaluation of the process","authors":"A.E. Sussenbach ,&nbsp;H. Graveland ,&nbsp;A. Voss ,&nbsp;B. Versteeg","doi":"10.1016/j.jhin.2025.06.012","DOIUrl":"10.1016/j.jhin.2025.06.012","url":null,"abstract":"<div><h3>Background</h3><div>Nosocomial infections in healthcare pose potentially life-threatening risks to patients and can drive up healthcare costs. To address this, the Dutch Collaborative Partnership for Infection Prevention Guidelines (SRI) creates evidence-based guidelines to reduce infections in hospitals, long-term care facilities, and public health settings.</div></div><div><h3>Aim</h3><div>To evaluate professionals' experiences with the evidence-based guideline development process in order to gain insights into the feasibility of the current process.</div></div><div><h3>Methods</h3><div>Guideline development group (GDG) members from 2021 to 2022 were surveyed. Data on expectations prior to participation; experienced workload; satisfaction with the composition of the GDG, the guideline development process, and generic or domain-specific guidelines; and implementation factors, were collected and analysed.</div></div><div><h3>Findings</h3><div>Eighty out of 168 (48%) members of 17 GDGs responded. Expectations were clear to 46 (57%) respondents prior to participating. Twenty-seven (34%) respondents found time investment higher than expected, especially literature screening. Seventy (88%) respondents agreed that their association was represented sufficiently, and 69 (86%) reported that there was sufficient knowledge on infection prevention. However, 25 (31%) respondents expressed that Grading of Recommendations Assessment, Development and Evaluation (GRADE) is unsuitable to assess available evidence, although not offering alternatives. Thirty-two (40%) respondents wished for the adaptation of generic guidelines into domain-specific guidelines.</div></div><div><h3>Conclusion</h3><div>Respondents emphasized the need for adaptation of generic guidelines into domain-specific guidelines, implying the necessity to develop guidelines that closely align with the needs of the field. Addressing areas for improvement – such as workload management, methodological concerns, and implementation strategies – are crucial to optimize the development process and ensure the guidelines' impact on infection prevention.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"164 ","pages":"Pages 1-7"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568079","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}