Dementia (London, England)最新文献

{"title":"'Memories we treasure': Evaluating the impact on co-designers and audiences of a photographic exhibition by participants with memory problems.","authors":"Sinéad McIntyre, Claudia Cooper, Natalia Chemas, Sukey Parnell Johnson, Paul Higgs, Wendy Martin, Sarah Morgan-Trimmer, Alexandra Burton, Michaela Poppe, Ellie Whitfield","doi":"10.1177/14713012251338551","DOIUrl":"https://doi.org/10.1177/14713012251338551","url":null,"abstract":"<p><p>Visual research, including photovoice methods are increasingly used to elicit the experiences of people living with memory loss, though few such studies have investigated the impact of produced images on audiences. Drawing on Freire's empowerment pedagogy, we aimed to explore how a photography exhibition, created by individuals with memory concerns participating in the APPLE-Tree (Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce) dementia prevention programme contributed to an understanding on life with memory loss, and whether it reduced any stigma, among its co-producers and audience. Approximately 200 people attended the exhibition launch, of whom 97 completed a survey. We interviewed two co-producers with lived experience of memory problems and seven academic co-producers. In our thematic analysis of survey responses and interview transcripts, we developed three themes: (1) Increasing understanding by giving voice to participants: seeing unique individuals behind the work; (2) The power of visual methods to communicate research findings: interviewees described how the quality of the works and exhibition created an atmosphere that honoured participants as artists, valuing and respecting their messages; (3) Evoking emotions: fear and hope: The audience described the exhibition's power to evoke strong emotions of fear at the risk of losing \"treasured memories\" and hope of living successfully with memory loss. Some attendees and study team members felt motivated to try to reduce their future dementia risk. We consider the value of public engagement using arts-based co-production, and the impact of the exhibition in this field. We explore how our findings reflect notions of empowerment in two juxtaposing ways: empowerment to express how living with memory loss feels as a means of activism to reduce associated stigma, and empowerment to change future dementia risk through lifestyle changes.</p>","PeriodicalId":72778,"journal":{"name":"Dementia (London, England)","volume":" ","pages":"14713012251338551"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029765","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":"Comparing two caregiver-delivered music listening interventions for community-dwelling people with dementia: A randomised controlled crossover pilot trial.","authors":"Lena M Hofbauer, Pd Francisca S Rodriguez","doi":"10.1177/14713012251334185","DOIUrl":"https://doi.org/10.1177/14713012251334185","url":null,"abstract":"<p><p><b>Objectives:</b> To facilitate access to music-based interventions (MBIs) for people with dementia in the community, it is necessary to develop MBIs that can be used by people with dementia and their informal caregivers at home. In this pilot trial, we aimed to establish whether using slow and fast music of positive valence in a caregiver-delivered MBI results in differential effects. <b>Methods:</b> 17 person-with-dementia-and-caregiver dyads were randomised. Dyads underwent 6-week periods of two music listening interventions, 'MBI A' (consisting of fast, positively valenced music) and 'MBI B' (slow, positively valenced music). The order of these was crossed-over. Half of the dyads also completed a control intervention (6-week care-as-usual). People with dementia listened on tablets or CDs provided. Quantitative assessments included person with dementia outcomes (cognition, well-being, quality of life) and caregiver-reported outcomes (behavioural and psychiatric symptom severity and related distress). Dyads' descriptions of experiences were also recorded. <b>Results:</b> MBI A was associated with superior delayed recall compared to MBI B (MBI A- B: 1.04 [95% CI: 0.16, 1.92], <i>p = .028, Hedge's g</i>_<i>av</i> <i>= 0.70</i>). Dyads' descriptions highlight 'in-the-moment' effects of the MBIs. Positive effects of MBI A included heightened mood and movement (e.g. clapping), MBI B was associated with relaxation. <b>Conclusions:</b> The positive effect of MBI A on delayed recall performance suggests that fast, positively valenced music may be explored further to support cognition in people with dementia. Dyads' reports underline the value of music listening to the momentary well-being of people with dementia.</p>","PeriodicalId":72778,"journal":{"name":"Dementia (London, England)","volume":" ","pages":"14713012251334185"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998985","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":"Meaning making during bereavement as part of caregiver speaks, a narrative photo-elicitation intervention for Caregivers of persons living with dementia.","authors":"Annabelle R Yang, Karla T Washington, Jacquelyn J Benson, Taryn L Bogdewiecz, Abigail J Rolbiecki","doi":"10.1177/14713012251333484","DOIUrl":"https://doi.org/10.1177/14713012251333484","url":null,"abstract":"<p><p>A majority of persons living with dementia rely on informal family and friend caregivers. These caregivers shoulder immense responsibility while the person living with dementia is alive, and during bereavement are at risk for complicated grief or other psychobiological complications. Meaning making, the process of accommodating worldviews and beliefs to make meaning of a death, can mitigate the risk for complications of grief during bereavement. This meaning making can be facilitated by storytelling photo-elicitation interventions, which invite caregivers to narrate their experiences and emotions using images. Caregiver Speaks is one such photo-elicitation intervention. In this study, we sought to understand how caregivers of persons living with dementia who participated in Caregiver Speaks made meaning of their experiences. Researchers conducted a secondary qualitative analysis of text and image social media posts made by bereaved caregivers, employing a hybrid deductive-inductive approach. Six themes were identified: grieving, remembering, benefit finding, reconstructing identity, religious and spiritual coping, and connecting. These themes demonstrate that meaning making in caregivers of persons living with dementia was supported by Caregiver Speaks and expand on understanding of bereavement specific to caregivers of persons living with dementia. Our themes emphasize the significance of complete remembrance-of positive memories, but also of complex familial relationships and difficulties in caregiving and end of life. Additionally, we identified overwhelmingly positive religious coping, speaking to the role of faith in this population. Our theme of connecting also identified the novel ways in which caregivers might communicate through use of images, metaphors, and emojis to convey their emotions. Our findings support the use of storytelling, photo-elicitation interventions like Caregiver Speaks to prevent or mitigate grief complications in bereaved caregivers of persons living with dementia. They also suggest possible complementary interventions in bereavement support, such as facilitating remembrance or faith-based community outreach.</p>","PeriodicalId":72778,"journal":{"name":"Dementia (London, England)","volume":" ","pages":"14713012251333484"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008709","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":"UTI risk factors in older people living with dementia: A conceptual framework and a scoping review.","authors":"Kuan-Ching Wu, Basia Belza, Donna Berry, Frances Lewis, Oleg Zaslavsky, Andrea Hartzler","doi":"10.1177/14713012251326129","DOIUrl":"https://doi.org/10.1177/14713012251326129","url":null,"abstract":"<p><p><b>Background and Aims</b>: UTIs greatly impact hospitalization rates for people living with dementia. This study aims to craft a framework through a scoping review, assessing UTI symptoms, risk factors, and non-pharmacological prevention strategies in older people living with dementia. <b>Research Design and Methods</b>: Our scoping review followed PRISMA-ScR guidelines, exploring databases (PubMed, CINAHL, Embase, Web of Science) for topics like geriatric care, urinary tract issues published from January 1977 to April 2023. Two reviewers assessed data, organizing it using the Social-Ecological Model to construct the UTI Prevention (UTIP) framework. <b>Results</b>: The literature review scrutinized 1394 articles, selecting 14 through rigorous evaluation. It detailed demographic characteristics, synthesized UTI symptoms, 14 risk factors, and seven outcomes for older people living with dementia. Moreover, it outlined ten preventive domains and proposed a comprehensive UTI Prevention (UTIP) framework spanning individual, relational, community, and societal levels. This framework aims to prevent UTIs among older people living with dementia, integrating risk factors and outcomes to bolster effective prevention strategies for this population. <b>Discussion and Implications</b>: The review introduced a UTIP framework, and non-pharmacological preventive measures tailored for elderly people living with dementia. However, some factors in the framework require further validation to strengthen their associations with outcomes. Preventive measures from studies had limitations like small sample sizes, bias risks, and inconsistent findings. Future research should prioritize robust randomized trials with strong statistical power, strict criteria, and consistent individual-level interventions to boost outcome reliability and validity. Such efforts will enhance the credibility of findings and contribute significantly to refining preventive strategies for this vulnerable population.</p>","PeriodicalId":72778,"journal":{"name":"Dementia (London, England)","volume":" ","pages":"14713012251326129"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061311","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":"Post-diagnostic care pathways in dementia: Experiences and needs of family carers and considerations for interventions.","authors":"Grace Wei, Skye McDonald, Michelle Kelly, Kirrie J Ballard, Fiona Kumfor","doi":"10.1177/14713012251337230","DOIUrl":"https://doi.org/10.1177/14713012251337230","url":null,"abstract":"<p><p>ObjectivesSocial and behavioural symptoms, prevalent across dementia syndromes, contribute to increased carer challenges and stress. However, post-diagnostic support for these symptoms remains limited. The Carers Way Ahead, initially developed for brain injury, is an online carer program addressing behavioural management of apathy, irritability, aggression, disinhibition, social difficulties, and self-care. This study aimed to explore the experiences and needs of family carers and co-design the adaptation of the Carers Way Ahead program for dementia.MethodTen family carers of people with dementia (4 frontotemporal dementia, 3 Alzheimer's disease, 3 Lewy body dementia, 1 Vascular dementia) in Australia participated in focus groups and interviews. Carers completed the Carers Way Ahead modules and provided insights into their experiences and feedback on the program. Transcripts were analysed using reflexive thematic analysis.FindingsThree themes were generated: (1) <i>Adapting to life transitions</i> highlighted challenges and relationship changes in the dementia journey, (2) <i>Navigating dementia care pathways</i> underscored complexities in accessing and navigating institutional and practical support, and (3) <i>Finding solutions that address carers' needs</i> emphasised the importance of considering varying needs across disease stages and pragmatic intervention considerations.ConclusionDisparities in the accessibility, consistency, and quality of post-diagnostic support for carers were revealed. Substantial unmet needs exist in the current post-diagnostic experience for people with dementia and carers in Australia. This study suggests opportunities for improvement and provides valuable insight for the development and adaptation of psychosocial interventions like the Carers Way Ahead program.</p>","PeriodicalId":72778,"journal":{"name":"Dementia (London, England)","volume":" ","pages":"14713012251337230"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051584","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":"\"We will tell everyone!\" Capturing the impact of public and patient involvement in music therapy and dementia research through songwriting.","authors":"Lisa Kelly, Carl Corcoran, Gerry Paley, Nuala Paley, Kevin Quaid, Helena Quaid, Helen Rochford-Brennan, Carmel Geoghegan, Ita Richardson, Hilary Moss","doi":"10.1177/14713012251333839","DOIUrl":"https://doi.org/10.1177/14713012251333839","url":null,"abstract":"<p><p>This paper describes and presents findings from a doctoral research project where songwriting was used as an approach to capture the impact of Patient and Public Involvement (PPI) in research. This paper is situated in the context of a larger research project which explored how telehealth music therapy can support people with dementia and their family caregivers living in the community. The research was guided by three PPI contributors with dementia with support from their family care partners to ensure the relevance of research outputs for people with dementia living in the community. To capture their experiences of being involved in this research, they collaboratively wrote a song entitled 'We Will Tell Everyone', about living well with dementia and the impact of being involved in dementia research. This paper presents the process of writing the song, the lyrics of the original song, alongside the PPI contributors experiences. Qualitative research using Interpretative Phenomenological Analysis was undertaken to analyse the process. Three themes emerged: (a) An empowering experience, (b) the importance of collaboration, respect and listening, and (c) a message of hope. This paper demonstrates how arts-based research methods such as songwriting can make research findings more impactful and offers a creative and accessible approach to capture the voices and lived experiences of people with dementia in research.</p>","PeriodicalId":72778,"journal":{"name":"Dementia (London, England)","volume":" ","pages":"14713012251333839"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036787","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":"Dementia in the minds of characters and readers - A transdisciplinary study of fictional language.","authors":"Paula Devine, Jane Lugea, Gemma M Carney, Carolina Fernandez-Quintanilla, Jan Carson","doi":"10.1177/14713012251335067","DOIUrl":"https://doi.org/10.1177/14713012251335067","url":null,"abstract":"<p><p>The concept of personhood in dementia has maintained its status as the definitive approach to dementia care. Personhood works at both practical and philosophical levels to maintain the humanity of people with dementia. The project described in this article used the concept of personhood to design community-engaged research which harnessed the power of literary language to access the internal life of a person with dementia. Here we outline the design and methods in detail, homing in on our main conclusion that literary language is a powerful tool in helping diverse stakeholder groups access the person in dementia. The research comprised three inter-linked strands. In Strand One we built a corpus of dementia fiction from which we identified twelve extracts from contemporary novels offering the internal perspective of a person with dementia. Strand Two involved six weekly meetings of separate reading groups with four distinct stakeholder groups - student social workers, members of the public, family carers, and people with dementia. The four groups engaged in separate, facilitated discussions of the extracts. This aspect of the project is unique as to the best of our knowledge no previous research has analysed readers' responses to extracts of fictional characters' narration of living with dementia. Strand Three was led by a well-known writer and comprised a series of public events and outputs which engaged readers and authors of dementia fiction with the genre. A dementia fiction festival and writer workshops resulted in publication of an anthology of short stories which included stories addressing a deficiency of racial and ethnically diverse characters noted in our corpus. The article concludes by discussing how working across disciplines and sectors to engage with dementia as a cultural as well as a clinical challenge has the potential to facilitate the understanding and emphasis of personhood in dementia studies.</p>","PeriodicalId":72778,"journal":{"name":"Dementia (London, England)","volume":" ","pages":"14713012251335067"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051583","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":"Navigating memory problems and mild cognitive impairment in later life: A qualitative secondary data analysis.","authors":"Christine Carter, Penny Rapaport, Claudia Cooper, Henry Llewellyn, Michaela Poppe, Marina Palomo, Hassan Mansour, Paul Higgs","doi":"10.1177/14713012251335380","DOIUrl":"https://doi.org/10.1177/14713012251335380","url":null,"abstract":"<p><p>Many people experience memory concerns as they get older, which can produce uncertainty and confusion. Some seek help for memory concerns and receive diagnoses of Mild Cognitive Impairment or Subjective Cognitive Decline, while most do not. We aimed to explore the subjective experiences of people with cognitive concerns, and how memory impairment is understood in the context of ageing. We undertook a secondary data analysis of 18 in-depth semi-structured interviews with people aged 60+ living with memory concerns, 9 of whom had sought professional help. We thematically analysed the data, identifying three themes. 1. <i>Situating Memory Concerns</i>: people are required to situate their experiences within contradictory discourses: medicalised, diagnostic categories, and reassurances that symptoms are normal, part of ageing and distinct from dementia. 2. <i>Affirming self in the face of memory loss:</i> individuals refer to social roles in families, work, and associated activities to reaffirm identity. For some, activities were a vital anchor of identity, resulting in negative self-comparison to their past self if abilities declined. 3<i>. Maintaining</i> identity <i>and Relationships;</i> labelling memory concerns helped relatives seeking external validation of symptoms, but not the person experiencing them, for whom it brought no additional support. Consequently, some participants concealed memory concerns. We concluded that the subjective experiences of people with memory concerns were characterised by confusion, and diagnostic labels compounded this rather than offering reassurance, bringing tension to some relationships. Activities were often perceived as an outward sign of continuing identity, leading to distress when ability to continue them declined. We discuss these issues in relation to broader societal issues around age and ageing.</p>","PeriodicalId":72778,"journal":{"name":"Dementia (London, England)","volume":" ","pages":"14713012251335380"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999049","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":"\"We have a behaviour support plan, let's have a mental health support plan\": Perspectives of staff, residents and family carers on understanding, responding to and promoting the mental health of residents within long-term care.","authors":"Deborah Brooks, Deepa Sriram, Claire V Burley, Rachel Brimelow, Nadeeka N Dissanayaka","doi":"10.1177/14713012251334170","DOIUrl":"https://doi.org/10.1177/14713012251334170","url":null,"abstract":"<p><p>Up to two thirds of people living in long-term care homes experience mental health conditions such as anxiety and depression. In addition, over half of residents have cognitive impairment or dementia. However, the quality of mental health care provided in residential care homes is often poor, and the use of mental health quality indictors is lacking. As the first step in a larger project to develop mental health quality indicators for long-term care (MHICare project), this study aimed to explore factors considered important for understanding and responding to mental health conditions and promoting mental well-being of residents. Individual interviews and small group discussions were conducted with twelve residents (both with and without dementia), eight family carers of residents with dementia, and six care home staff members, from across Australia. Qualitative data were analysed using an inductive thematic analysis approach to generate themes and a deductive approach to generate factors and map these to a Balanced Score Card quality indicator framework. Four main factors with several inter-related themes were identified: (1) Resident-related (Transitional impacts, Social connections and active engagement, and Pre-existing and co-morbid conditions); (2) Care and Communication Practices (Assessment and care strategies, Person-centred mental health care, Cultural and generational communication differences, and Staff handover and knowledge sharing); (3) Staff-related (Staff mental health awareness, Staff knowledge, practical skills and training needs, and Staff values and attitudes); and (4) Organisational (Internal staffing levels, Access to external mental health professionals, and Provision of volunteer programs). Findings will inform the key areas and initial content for mental health indicators for use in residential care homes. Once developed, these have the potential to highlight both strengths and gaps in current mental health care practices, and drive quality improvement initiatives.</p>","PeriodicalId":72778,"journal":{"name":"Dementia (London, England)","volume":" ","pages":"14713012251334170"},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043875","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":"Impact of adult day service on long-term care placement: A scoping review.","authors":"Kingsley C Udeh, Heather L Menne","doi":"10.1177/14713012251334676","DOIUrl":"https://doi.org/10.1177/14713012251334676","url":null,"abstract":"<p><p>Cognitive decline and dementia account for the highest number of cognitive disabilities, functional limitations, chronic healthcare conditions, and long-term care needs among older adults aged 65 and older in the US. The optimization of public health policies and advances made from gerontological research have resulted in a steady increase in the number of older adults 65 and above, which makes the risk of cognitive decline and dementia higher. The use of interventions like adult day services (ADS) may delay placement into long-term care homes among older adults living with dementia and other cognitive impairment-related disabilities. The purpose of this scoping review study was to address the research question: What impact do adult day services have on long-term care home placement for people living with dementia? Electronic searches were performed using six databases for sources published between 1998 and May 2024. A total of 150 citations were found. After screening titles and abstracts, full-text reviews were completed for eight articles. Of these eight articles, only two articles addressed the research question directly and reported increased risk for placement. With very few recent studies on the impact of ADS on long-term care placement, more research is needed to draw firm scientific conclusions on the benefit of ADS, and these future studies should include the perspectives of people living with dementia, family caregivers, and ADS providers.</p>","PeriodicalId":72778,"journal":{"name":"Dementia (London, England)","volume":" ","pages":"14713012251334676"},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047651","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}