POCUS journal最新文献

{"title":"Building a Point of Care Ultrasound (POCUS) Curriculum in Undergraduate Medical Education Through Stepwise Development and Assessment.","authors":"Nancy L Hagood, Romik Srivastava, Marc E Heincelman, Meghan K Thomas","doi":"10.24908/pocusj.v10i01.18116","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18116","url":null,"abstract":"<p><strong>Background: </strong>Point of care ultrasound (POCUS) training is increasingly incorporated in undergraduate medical education (UME). However, limited resources and lack of standard guidelines lead to questions regarding the most effective curriculum and assessment method. The authors aimed to develop a longitudinal UME POCUS curriculum through staged intervention. Year 1, which involved simulation alone, led to improved confidence without adequate knowledge. The authors hypothesized that the addition of resident-led workshops alongside faculty-led lectures would improve POCUS knowledge and confidence among third-year medical students.</p><p><strong>Methods: </strong>A prospective cohort study of third-year students on the Internal Medicine (IM) clerkship at a large academic medical center was performed, assessing efficacy of stepwise POCUS curriculum development. Previously implemented year 1 involved comparing the control cohort receiving baseline POCUS education on rounds with the experimental cohort that had access to a high-fidelity POCUS simulator. The year 2 cohort added hands-on resident-led POCUS workshops. The year 3 cohort added faculty-led lectures. All cohorts completed pre- and post-intervention confidence and knowledge-based examinations. The year 1 control cohort served as a control for the current study.</p><p><strong>Results: </strong>A total of 69 and 102 students completed both pre-/post-tests among year 2 and 3 cohorts, respectively. Both cohorts demonstrated statistically significant improvement in POCUS knowledge and confidence, with greater magnitude of improvement in year 3 with overall knowledge improving from 49.9% to 66.7% on pre- to post-intervention examination (p<0.0001).</p><p><strong>Conclusion: </strong>While simulation alone was insufficient to instill knowledge, the addition of resident-led workshops and faculty-led lectures demonstrated benefits in POCUS knowledge and confidence among medical students and represents a sustainable model of training.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"32-37"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of an International Point of Care Ultrasound (POCUS) Training Program for Internal Medicine Physicians.","authors":"Katherine Otto Chebly, Elizabeth Hernández, Mary Cifelli, Michael Janjigian","doi":"10.24908/pocusj.v10i01.18429","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18429","url":null,"abstract":"<p><strong>Background: </strong>Point of care ultrasound (POCUS) training in internal medicine (IM) training remains largely unavailable in lower-resourced health systems globally. Longitudinal inter-institutional collaboration, based in health equity principles, offers a potential mechanism for more accessible and effective IM POCUS education.</p><p><strong>Methods: </strong>In a partnership between two academic medical centers in Caracas, Venezuela (Luis Razetti School of Medicine at the Universidad Central de Venezuela (UCV)) and New York, USA (New York University (NYU) Grossman School of Medicine), we evaluated the impact of an IM POCUS training program on knowledge and skills of IM physicians at UCV. During 2023-2024, 18 UCV IM physicians participated in the program. The program included online tutorials and quizzes, in-person image interpretation review, and supervised practice. Participants completed a pre-course knowledge assessment, post-course knowledge, skills, and self-confidence assessments, and qualitative feedback regarding course acceptability.</p><p><strong>Results: </strong>Pre-to-post knowledge assessments demonstrated mean score improvement. Post-course knowledge scores were not significantly different between UCV and NYU cohorts (77% vs. 78%, respectively; p =0.82). Skill scores measured by a hands-on test were comparable between groups, with few significant differences. Learners self-rated increases in confidence during the course, and rated the course as locally acceptable and sustainable.</p><p><strong>Conclusions: </strong>A standardized, longitudinal, international IM POCUS training program was successfully implemented with faculty learners in a lower-resourced health system, who demonstrated gains in knowledge and skills, and reported high educational value of the partnership. The results support expanding inter-institutional POCUS training programs founded in health equity principles.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"19-26"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the Role of Point of Care Ultrasound for Suspected Pulled Elbow in Children? A Narrative Literature Review.","authors":"Salmah Lashhab, David J McCreary","doi":"10.24908/pocusj.v10i01.17853","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.17853","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to evaluate and appraise the existing evidence on the use of point of care ultrasound (POCUS) for pulled elbow, including its positive findings and their reliability.</p><p><strong>Methods: </strong>We searched PubMed, Medline, EMBASE, CINAHL and Google Scholar for prospective and retrospective studies evaluating POCUS use for suspected pulled elbow. We identified positive sonographic findings along with their sensitivity and specificity relating to this diagnosis.</p><p><strong>Results: </strong>We included 13 studies that reviewed ultrasonographic findings in suspected pulled elbow. These studies discussed a range of sonographic findings between them, including radio- capitellar distance, 'J-sign'/'Hook sign', fat pad sign and partial eclipse sign. The studies were of mixed quality and were susceptible to bias.</p><p><strong>Conclusions: </strong>Children presenting with suspected pulled elbow who have evidence of hook sign (or J-sign) and an absence of elbow effusion on POCUS can be diagnosed with pulled elbow and safely undergo reduction. POCUS can be used following reduction to demonstrate resolution of these signs and confirm its success. Elbow injuries with effusion are likely to have bony injury, meaning that X-ray is required. Additional prospective study of children presenting with elbow injury would be required to accurately determine the effectiveness of POCUS in the diagnosis of pulled elbow.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"175-187"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demonstrating Feasibility of Point of Care Ultrasound (POCUS)-Guided Inpatient Transthoracic Echo Triage Decision Pathway.","authors":"Stephanie M Conner, Mustafa Husaini, Maya Fiore, Mohamed Ramadan, Benjamin Hoemann, Nicholas Arnold, Farhan Katchi, Crystal Atwood, Carol Faulk, Karl Wallenkampf, Jing Li","doi":"10.24908/pocusj.v10i01.17776","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.17776","url":null,"abstract":"<p><strong>Background: </strong>Prolonged inpatient length of stay (LOS) is associated with worse clinical outcomes and increased healthcare costs. Transthoracic echocardiography (TTE) is commonly utilized in cardiac evaluation of hospital inpatients but is associated with prolonged LOS and may not always be necessary. Point of care ultrasound (POCUS) may help reduce the need for inpatient TTEs.</p><p><strong>Objective: </strong>We aimed to demonstrate the feasibility of a POCUS-guided TTE triage protocol and estimate its impact on inpatient TTE utilization.</p><p><strong>Methods: </strong>From September to December 2023, inpatient clinicians and participating patients at a large academic institution were surveyed about their perspectives and experiences with POCUS. Cardiac POCUS exams were performed and interpreted for pre-specified clinical indications by POCUS-trained hospitalists, then reviewed independently by at least two board-certified cardiologists. Interpretations were compared using pairwise agreement analysis (kappa (κ) statistic). Finally, hospitalists and cardiologists independently offered their TTE triage recommendation, categorized as either inpatient, outpatient, or cancellation. Triage agreement between the two groups was reported as a percentage of overall cases.</p><p><strong>Results: </strong>Clinicians and patients were receptive to integrating POCUS exams into clinical care. Ninety POCUS exams were completed during the intervention period, on average 22 hours before TTE. Hospitalist and cardiologist agreement was moderate to very good (0.57-0.99) for specific cardiac findings. The hospitalist and at least one cardiologist agreed that 59 (66%) of 90 exams performed within the triage pathway could result in deferral or cancellation of inpatient TTE.</p><p><strong>Conclusions: </strong>A POCUS-guided TTE triage protocol can reduce low-value inpatient TTE use, potentially expediting necessary TTEs and reducing TTE backlog.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"45-52"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health System Impact of Emergency Department-Based Vascular Access Program in Patients with Difficult Intravenous Access.","authors":"Nathan P Roll, Shilpa Raju, Micah Ownbey, Jamal Jones, Christy Hopkins, Jennifer Cotton","doi":"10.24908/pocusj.v10i01.18274","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18274","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound guided (USG) peripheral intravenous (PIV) access is a vital use of point of care ultrasound (POCUS) that decreases time to access, reduces need for more invasive access, preserves vasculature, and improves patient experience.</p><p><strong>Objectives: </strong>We describe the impact of an Emergency Department (ED) based vascular access program with a specialized team of paramedics and emergency medical technicians (EMTs). This team is trained in USG PIV access to assist with patients that have difficult intravenous access (DIVA) both in the ED and throughout the academic medical center.</p><p><strong>Methods: </strong>This descriptive report details the implementation, development, and evolution of a highly skilled vascular access team trained in USG PIV placement at a single academic center. Under the guidance of ultrasound fellowship trained, board-certified Emergency Medicine (EM) ultrasound faculty, ED paramedics and EMTs are provided comprehensive training and oversight of USG PIV placement. Program description, patient selection, and billing capture are described. This report met Institutional Review Board exemption criteria as a descriptive quality improvement project.</p><p><strong>Conclusions: </strong>This report details the formation and maintenance of a highly skilled vascular access team. The team is comprised of paramedics and EMTs who have been trained in USG PIV placement allowing them to care for patients with DIVA. The evolution of this team has allowed the development of a tiered approach to vascular access and vascular preservation throughout the organization, benefitting both patients and hospital staff.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"78-82"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Troubleshooting Transvenous Pacemakers with Point of Care Ultrasound (POCUS).","authors":"Emily Gohde, Seth Lotterman, Ikram Irfanullah, David Hansen, Felix Pacheco, Adam Wise, Matthew Tichauer, Trent She","doi":"10.24908/pocusj.v10i01.18073","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18073","url":null,"abstract":"<p><p>Emergent transvenous pacing can be performed for patients with an unstable bradyarrhythmia in the emergency department. While emergent transvenous pacemaker (TVP) placement is performed relatively rarely, its importance in the management of these patients requires emergency physicians to be familiar with the procedure. Point of care ultrasound (POCUS) is traditionally used for the initial vascular access associated with TVP placement but can also be indispensable in the subsequent placement and advancement of the TVP wire itself. This article discusses two cases and then outlines a general protocol that incorporates POCUS into a standard emergent TVP procedure. Further, we outline some common POCUS troubleshooting tactics to improve success and ways in which POCUS can rapidly identify complications.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"53-60"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforation of the Interventricular Septum by a Temporary Transvenous Pacing Lead Detected by Cardiac Point of Care Ultrasound (POCUS).","authors":"Pablo Blanco, Liliana Figueroa","doi":"10.24908/pocusj.v10i01.18271","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18271","url":null,"abstract":"<p><p>Several complications can arise during or shortly after the placement of a temporary transvenous pacemaker (TTP), some of which can be potentially devastating. A TTP was successfully placed under the guidance of point of care ultrasound (POCUS) and intracavitary electrocardiogram (ECG) in a middle-aged woman with symptomatic complete atrioventricular block. Three days post-insertion, pacemaker malfunction was observed along with the migration of the pacing lead to the left ventricular apex on cardiac POCUS. The lead was promptly repositioned, and no complications were noted on subsequent cardiac POCUS examinations. To prevent complications and aid early detection of complications associated with TTPs, cardiac POCUS should be strongly considered.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"64-67"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Point of Care Ultrasound (POCUS) Artifact Mimicking an Aortic Dissection: A Case Series.","authors":"Olivia Klee, Julia Buechler, Molly Fears, Caroline Gosser, Kahra Nix","doi":"10.24908/pocusj.v10i01.18498","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18498","url":null,"abstract":"<p><strong>Introduction: </strong>This case series describes a point of care ultrasound (POCUS) artifact involving the abdominal aorta of four standardized patients. The purpose of this case series is to highlight this artifact and maneuvers to discern pathology from normal.</p><p><strong>Methods: </strong>Permission was obtained for each case described in this series. POCUS images of the abdominal aorta in both sagittal and transverse were obtained in these four cases. The findings were reviewed and compared.</p><p><strong>Discussion: </strong>All four standardized patients were otherwise healthy, thin and female. The artifact was consistently a linear, hyperechoic structure within the lumen of the abdominal aorta in the sagittal plane.</p><p><strong>Conclusion: </strong>In each of these cases, the artifact disappeared on rotation of the probe from the sagittal plane to the transverse plane. Knowledge of this POCUS artifact and maneuvers to avoid it are important in both clinical and educational settings.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"88-91"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Train-the-Trainer Point of Care Ultrasound (POCUS) Program for Pediatric Pneumonia in a Low-Resource Setting.","authors":"Michelle S Lee, Fatima Mir, Amerta Ladhani, Huba Atiq, Shaun K Morris, Mark O Tessaro","doi":"10.24908/pocusj.v10i01.18285","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18285","url":null,"abstract":"<p><strong>Background: </strong>Lung point of care ultrasound (POCUS) has the potential to transform pediatric pneumonia care in low resource settings. Prior studies of novice POCUS users in such settings showed high agreement with remote POCUS experts for diagnosing pediatric pneumonia, but use of remote experts may falsely inflate this agreement.</p><p><strong>Objectives: </strong>This study aimed to 1. Deliver a train-the-trainer program in Pakistan on lung POCUS for diagnosing pediatric pneumonia; 2. Determine inter-rater reliability between i) study-trained community health workers (CHWs) and a remote expert, with both interpreting POCUS examinations acquired by the CHWs, and ii) study-trained CHWs and local champions, with both interpreting examinations that they had acquired.</p><p><strong>Methods: </strong>Phase 1: Canadian pediatric POCUS experts developed and delivered a lung POCUS training program for two user groups in Pakistan. These groups included local champions (who had POCUS experience) and CHWs (who were POCUS novices). Phase 2: Children with suspected pneumonia underwent two lung POCUS examinations, one by a CHW and one by a local champion. Examinations were recorded and later reviewed by a remote expert for interpretation and quality assurance. Inter-rater reliability was determined.</p><p><strong>Results: </strong>Two local champions and three CHWs were successfully trained. An analysis of 231 recruited patients showed strong inter-rater reliability between study-trained CHWs and remote expert interpretations (κ = 0.83). In contrast, inter-rater reliability was moderate (κ = 0.66) between interpretations by novices and local champions when these users interpreted the examinations that they themselves had acquired.</p><p><strong>Conclusion: </strong>Our study showed that train-the-trainer programs are feasible and can be effective, while highlighting the importance of hands-on training and having local champions provide longitudinal support to novices.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"157-163"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interrater Agreement of Physicians Identifying Lung Sliding Artifact on B-Mode And M-Mode Point of Care Ultrasound (POCUS).","authors":"Ross Prager, Hans Clausdorff Fiedler, Delaney Smith, Derek Wu, Robert Arntfield","doi":"10.24908/pocusj.v10i01.17807","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.17807","url":null,"abstract":"<p><strong>Background: </strong>Chest point of care ultrasound (POCUS) is a first-line diagnostic test to identify lung sliding, an important artifact to diagnose or rule out pneumothorax. Despite enthusiastic adoption of this modality, the interrater reliability for physicians to identify lung sliding is unknown. Additionally, the relative diagnostic performance of physicians interpreting B-mode and M-mode ultrasound is unclear. We sought to determine the interrater reliability of physicians to detect lung sliding on B-mode and M-mode POCUS.</p><p><strong>Methods: </strong>We performed a cross-sectional interrater agreement study surveying acute care physicians on their interpretation of 20 B-mode and M-mode POCUS clips. Two experienced clinicians determined the reference standard diagnosis. Respondents reported their interpretation of each POCUS B-mode clip or M-mode image. The primary outcome was the interrater agreement, determined by an intra-class correlation coefficient (ICC).</p><p><strong>Results: </strong>From September to November 2023, there were 20 survey respondents. Fourteen (70%) respondents were resident physicians. Respondents were confident or very confident in their skill performing chest POCUS in 14 (70%) cases, with 19 (90%) performing chest POCUS every week or more frequently. The ICC on B-mode was 0.44 and for M-mode was 0.43, indicating moderate agreement. There were no significant differences in interrater reliability between subgroups of confidence or experience.</p><p><strong>Conclusion: </strong>There is only moderate interrater reliability between clinicians to diagnose lung sliding. Clinicians have superior accuracy on B-mode compared to M-mode clips.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"92-98"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}