2025 is here and medicine has continued to move away from the utopian vision of our admission essays for medical school. We are spending countless hours on electronic health records scrolling through layers of data to find the information we need, receiving vital information through fax machines, and listening to on-hold music as we try to help patients progress through labyrinthine treatment pathways so that they can get the care that they need. The administrative burden of modern medicine has become overwhelming. Healthcare providers face relentless obstacles in their workflows and inefficient technologies that impede patient care and contribute to suboptimal patient outcomes and physician burnout.1 Clearly, the labour of clinical practice is ripe for disruption and transformation. In response, the purveyors of artificial intelligence (AI) have promised solutions to overcome these seemingly intractable obstacles and inefficiencies. Given past experiences with the introduction of technology, such ambitious promises may understandably elicit doubt. A new paper …
{"title":"AI in medicine: preparing for the future while preserving what matters","authors":"Raj Mehta, Michael E Johansen","doi":"10.1136/bmj.r27","DOIUrl":"https://doi.org/10.1136/bmj.r27","url":null,"abstract":"2025 is here and medicine has continued to move away from the utopian vision of our admission essays for medical school. We are spending countless hours on electronic health records scrolling through layers of data to find the information we need, receiving vital information through fax machines, and listening to on-hold music as we try to help patients progress through labyrinthine treatment pathways so that they can get the care that they need. The administrative burden of modern medicine has become overwhelming. Healthcare providers face relentless obstacles in their workflows and inefficient technologies that impede patient care and contribute to suboptimal patient outcomes and physician burnout.1 Clearly, the labour of clinical practice is ripe for disruption and transformation. In response, the purveyors of artificial intelligence (AI) have promised solutions to overcome these seemingly intractable obstacles and inefficiencies. Given past experiences with the introduction of technology, such ambitious promises may understandably elicit doubt. A new paper …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"203 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935189","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}
As medical statisticians, we welcome revisions to the Declaration of Helsinki emphasising the importance of appropriate methods to reduce research waste.1 The declaration now states that rigorous study design and execution are essential to avoid research waste (principle 21). Thirty years ago, Doug Altman urged the medical community to conduct “less research, better research, and research done for the right reasons.” …
{"title":"Appropriate statistical methods are necessary for ethical medical research","authors":"Nicole M White, Adrian Barnett","doi":"10.1136/bmj.r3","DOIUrl":"https://doi.org/10.1136/bmj.r3","url":null,"abstract":"As medical statisticians, we welcome revisions to the Declaration of Helsinki emphasising the importance of appropriate methods to reduce research waste.1 The declaration now states that rigorous study design and execution are essential to avoid research waste (principle 21). Thirty years ago, Doug Altman urged the medical community to conduct “less research, better research, and research done for the right reasons.” …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935140","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}
It was a familiar scene in the lead-up to Christmas: husbands looking lost in highly perfumed, dazzlingly lit shops. An expensive lipstick or cashmere scarf, seldom actually wanted, was bought as a surrogate object to represent “I love you.” Parents strained to understand the latest craze in overpriced plastic toys that promised more quality time with their children, away from digital distractions, but which often led to less. I too stood in those shops and bought those scarves and toys for my wife and children. But I’d already bought the perfect present for my friends—a gift that no one wants. For Christmas last year I bought my friends a funeral. This may seem a strange gift, and in many ways it is. Over the past 20 years, while caring for patients who are in the thick fog between life and death, I’ve met hundreds of people who have died, were resuscitated, and lived. I’ve long thought that these are the people we should be …
{"title":"Matt Morgan: A living funeral with my friends","authors":"Matt Morgan","doi":"10.1136/bmj.q2884","DOIUrl":"https://doi.org/10.1136/bmj.q2884","url":null,"abstract":"It was a familiar scene in the lead-up to Christmas: husbands looking lost in highly perfumed, dazzlingly lit shops. An expensive lipstick or cashmere scarf, seldom actually wanted, was bought as a surrogate object to represent “I love you.” Parents strained to understand the latest craze in overpriced plastic toys that promised more quality time with their children, away from digital distractions, but which often led to less. I too stood in those shops and bought those scarves and toys for my wife and children. But I’d already bought the perfect present for my friends—a gift that no one wants. For Christmas last year I bought my friends a funeral. This may seem a strange gift, and in many ways it is. Over the past 20 years, while caring for patients who are in the thick fog between life and death, I’ve met hundreds of people who have died, were resuscitated, and lived. I’ve long thought that these are the people we should be …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935113","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}
The prime minister, Keir Starmer, has unveiled new plans to radically transform the NHS in a bid to cut waiting lists.1 One new element is the promise that GPs will be able to order more tests directly, including MRI and CT scans.2 This may speed up the process of reaching a diagnosis, as the relevant investigation will have already been performed by the time the patient sees a specialist, and if no abnormality is found it may be possible to reassure the patient without a hospital appointment. Discussions among GPs on social media reveal huge variations …
{"title":"Helen Salisbury: Is GPs’ access to scans just another transfer of work to general practice?","authors":"Helen Salisbury","doi":"10.1136/bmj.r12","DOIUrl":"https://doi.org/10.1136/bmj.r12","url":null,"abstract":"The prime minister, Keir Starmer, has unveiled new plans to radically transform the NHS in a bid to cut waiting lists.1 One new element is the promise that GPs will be able to order more tests directly, including MRI and CT scans.2 This may speed up the process of reaching a diagnosis, as the relevant investigation will have already been performed by the time the patient sees a specialist, and if no abnormality is found it may be possible to reassure the patient without a hospital appointment. Discussions among GPs on social media reveal huge variations …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935184","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}
John Rogers was born in Bedford to David and Elsie Rogers. John’s parents were born and bred in Wales and he had a lifelong pride in his Welsh connections. He was educated at Bedford School and then studied medicine at Middlesex Hospital Medical School. …
{"title":"John Howell Rogers","authors":"Chris Boutle","doi":"10.1136/bmj.r20","DOIUrl":"https://doi.org/10.1136/bmj.r20","url":null,"abstract":"John Rogers was born in Bedford to David and Elsie Rogers. John’s parents were born and bred in Wales and he had a lifelong pride in his Welsh connections. He was educated at Bedford School and then studied medicine at Middlesex Hospital Medical School. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935098","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}
Charles was born in London and was evacuated to Biggin Hill during the second world war. He studied medicine at University College London, then worked on the house staff at University College Hospital (UCH) before joining the Royal Air Force Institute of Aviation Medicine in 1955 with the rank of flight lieutenant. He had stints working in clinical practice at Hammersmith Hospital and UCH, and research roles in Sheffield and …
{"title":"Charles John Edmonds","authors":"Chris Edmonds","doi":"10.1136/bmj.r18","DOIUrl":"https://doi.org/10.1136/bmj.r18","url":null,"abstract":"Charles was born in London and was evacuated to Biggin Hill during the second world war. He studied medicine at University College London, then worked on the house staff at University College Hospital (UCH) before joining the Royal Air Force Institute of Aviation Medicine in 1955 with the rank of flight lieutenant. He had stints working in clinical practice at Hammersmith Hospital and UCH, and research roles in Sheffield and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935187","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}
The 1990s were characterised by a rise in teenage smoking rates. Nostalgia for that decade shouldn’t see us undo progress against this public health threat, writes Caroline Cerny The 1990s are firmly back in style. From bucket hats to Britpop playlists, the last decade of the 20th century is being celebrated across social media and pop culture. But alongside the harmless nostalgia, a far more unwelcome trend has been revived: the glamorisation of smoking. Recent headlines have highlighted how smoking is creeping back into the spotlight, particularly through influencers and celebrities with massive youth followings. Charli XCX, for example, whose music and aesthetic shaped the “brat summer” trend, described the vibe as “a pack of cigs, a Bic lighter, and a strappy white top with no bra.” At New York Fashion week last year, models strutted down the catwalk smoking cigarettes. There’s even an Instagram account dedicated to showing pictures of high profile, attractive celebrities smoking. This normalisation of smoking risks re-igniting a harmful cultural association between cigarettes and coolness, to which young people are particularly vulnerable. The 1990s were characterised by a troubling rise in teenage smoking rates (12% of 11-15 year olds self-reported as regular smokers),1 fuelled by relentless tobacco brand …
{"title":"Smoking’s pop culture revival is an unwelcome throwback for public health","authors":"Caroline Cerny","doi":"10.1136/bmj.q2883","DOIUrl":"https://doi.org/10.1136/bmj.q2883","url":null,"abstract":"The 1990s were characterised by a rise in teenage smoking rates. Nostalgia for that decade shouldn’t see us undo progress against this public health threat, writes Caroline Cerny The 1990s are firmly back in style. From bucket hats to Britpop playlists, the last decade of the 20th century is being celebrated across social media and pop culture. But alongside the harmless nostalgia, a far more unwelcome trend has been revived: the glamorisation of smoking. Recent headlines have highlighted how smoking is creeping back into the spotlight, particularly through influencers and celebrities with massive youth followings. Charli XCX, for example, whose music and aesthetic shaped the “brat summer” trend, described the vibe as “a pack of cigs, a Bic lighter, and a strappy white top with no bra.” At New York Fashion week last year, models strutted down the catwalk smoking cigarettes. There’s even an Instagram account dedicated to showing pictures of high profile, attractive celebrities smoking. This normalisation of smoking risks re-igniting a harmful cultural association between cigarettes and coolness, to which young people are particularly vulnerable. The 1990s were characterised by a troubling rise in teenage smoking rates (12% of 11-15 year olds self-reported as regular smokers),1 fuelled by relentless tobacco brand …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935186","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}
Improving the NHS has to be weighed alongside improving population health Two narratives emerged from Wes Streeting’s first appearance before the House of Commons Health and Social Care Committee on 18 December 2024.1 The first focused on the pressures faced by the NHS, notwithstanding funding increases announced in October’s budget. In discussion with members of the committee, Streeting showed that he has moved on from campaigning to governing in acknowledging the hard choices that must be made. Intense discussions are underway between the Secretary of State for Health and Social Care, the Department of Health and Social Care, and NHS England, working in the looming shadow of the Treasury on how this funding should be used. The outcome of these negotiations will be revealed in annual planning guidance for the NHS, now expected later in January 2025. Despite the additional funding announced in October’s budget, 2025/26 promises to be a very tight year for the NHS in the face of rising demand for care in different sectors. Reducing waiting times for elective care will require funding increases in view of Keir Starmer’s commitment to …
{"title":"Health ministers in England face hard choices in 2025","authors":"Chris Ham","doi":"10.1136/bmj.r10","DOIUrl":"https://doi.org/10.1136/bmj.r10","url":null,"abstract":"Improving the NHS has to be weighed alongside improving population health Two narratives emerged from Wes Streeting’s first appearance before the House of Commons Health and Social Care Committee on 18 December 2024.1 The first focused on the pressures faced by the NHS, notwithstanding funding increases announced in October’s budget. In discussion with members of the committee, Streeting showed that he has moved on from campaigning to governing in acknowledging the hard choices that must be made. Intense discussions are underway between the Secretary of State for Health and Social Care, the Department of Health and Social Care, and NHS England, working in the looming shadow of the Treasury on how this funding should be used. The outcome of these negotiations will be revealed in annual planning guidance for the NHS, now expected later in January 2025. Despite the additional funding announced in October’s budget, 2025/26 promises to be a very tight year for the NHS in the face of rising demand for care in different sectors. Reducing waiting times for elective care will require funding increases in view of Keir Starmer’s commitment to …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935183","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}
The UK government is looking to accelerate clinical trials in dementia research by building a new trial ready cohort. Richard Milne and colleagues argue that the potential of this cohort to deliver better, more equitable trials and treatments will be limited unless the complex ethical challenges are tackled The UK government has committed to leading the world in clinical trials and to “transforming treatment for dementia.”1 This commitment continues implementation of O’Shaughnessy’s recommendations on commercial clinical trials in the UK.2 It includes establishing “clinical trial delivery accelerators”—multidisciplinary teams working to widen access to research, hasten recruitment, and embed trials in the UK medical research infrastructure. The first of these to be announced was the dementia trial accelerator.3 A core component of the dementia accelerator is the trial ready cohort, a pool of pre-screened potential trial participants. We argue that the potential of trial ready cohorts is unproven and suggest that their ability to contribute to dementia research relies on tackling the distinctive ethical challenges that they present. The dementia field has been the “graveyard of drug discovery.”4 Clinical trials in the field have had an almost 100% lack of success, involving nearly 200 000 participants and costing over $40bn.5 Despite recent US Food and Drug Administration approvals, the effectiveness and clinical value of the new drugs remain contested, as illustrated by the European Medicine Agency’s recent negative advice on lecanemab.67 Reasons for the lack of success include the focus on a small number of treatment targets8 and features of the clinical trial system such as poor study design and difficulty recruiting trial participants.9 The difficulty has been compounded as drug development has shifted from treatment towards preventing dementia among people at risk.10 This necessitates recruitment outside of clinical dementia populations and …
{"title":"Challenges associated with the development of “trial ready cohorts” for dementia prevention trials","authors":"Richard Milne, Edo Richard, Carol Brayne","doi":"10.1136/bmj-2024-080275","DOIUrl":"https://doi.org/10.1136/bmj-2024-080275","url":null,"abstract":"The UK government is looking to accelerate clinical trials in dementia research by building a new trial ready cohort. Richard Milne and colleagues argue that the potential of this cohort to deliver better, more equitable trials and treatments will be limited unless the complex ethical challenges are tackled The UK government has committed to leading the world in clinical trials and to “transforming treatment for dementia.”1 This commitment continues implementation of O’Shaughnessy’s recommendations on commercial clinical trials in the UK.2 It includes establishing “clinical trial delivery accelerators”—multidisciplinary teams working to widen access to research, hasten recruitment, and embed trials in the UK medical research infrastructure. The first of these to be announced was the dementia trial accelerator.3 A core component of the dementia accelerator is the trial ready cohort, a pool of pre-screened potential trial participants. We argue that the potential of trial ready cohorts is unproven and suggest that their ability to contribute to dementia research relies on tackling the distinctive ethical challenges that they present. The dementia field has been the “graveyard of drug discovery.”4 Clinical trials in the field have had an almost 100% lack of success, involving nearly 200 000 participants and costing over $40bn.5 Despite recent US Food and Drug Administration approvals, the effectiveness and clinical value of the new drugs remain contested, as illustrated by the European Medicine Agency’s recent negative advice on lecanemab.67 Reasons for the lack of success include the focus on a small number of treatment targets8 and features of the clinical trial system such as poor study design and difficulty recruiting trial participants.9 The difficulty has been compounded as drug development has shifted from treatment towards preventing dementia among people at risk.10 This necessitates recruitment outside of clinical dementia populations and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935193","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}
Christine Laine, Dianne Babski, Vivienne C Bachelet, Till W Bärnighausen, Christopher Baethge, Kirsten Bibbins-Domingo, Frank Frizelle, Laragh Gollogy, Sabine Kleinert, Elizabeth Loder, João Monteiro, Eric J Rubin, Peush Sahni, Christina C Wee, Jin-Hong Yoo, Lilia Zakhama
Authors, institutions, funders, and editors must be alert to the dangers A growing number of entities misrepresent themselves as scholarly journals for financial gain despite not meeting scholarly publishing standards.12 As editors and members of the International Committee of Medical Journal Editors (ICMJE), we receive queries about these “predatory” or “pseudo” entities and are subject to their deception when they target our authors and reviewers. The number of predatory journals is difficult to accurately determine but was estimated at more than 15 000 in 2021.3 While the ICMJE recommendations include warnings about predatory publishing,4 the committee believes that the large number of increasingly bold predatory entities warrants shining a bright light on them and considering actions stakeholders can take to counter their deceptive efforts. The practices that these entities employ include aggressive solicitation of manuscript submissions; the promise of extremely rapid turnaround times; and a lack of transparency about article submission, processing, and even withdrawal charges. Predatory journals may claim that they follow legitimate editorial and publishing practices but do not actually conduct peer review or such functions as archiving journal content, managing potential conflicts of interest, enabling corrections, and responding to author queries in a timely manner. In egregious cases, the “published” articles never appear despite authors having paid the requested fees. Predatory journals often use journal names and branding features that mimic well established journals. They may falsely state that they are members of or follow the recommendations of respected organisations such as the Committee on Publication Ethics, the Council of Science Editors, …
{"title":"Predatory journals: what can we do to protect their prey?","authors":"Christine Laine, Dianne Babski, Vivienne C Bachelet, Till W Bärnighausen, Christopher Baethge, Kirsten Bibbins-Domingo, Frank Frizelle, Laragh Gollogy, Sabine Kleinert, Elizabeth Loder, João Monteiro, Eric J Rubin, Peush Sahni, Christina C Wee, Jin-Hong Yoo, Lilia Zakhama","doi":"10.1136/bmj.q2850","DOIUrl":"https://doi.org/10.1136/bmj.q2850","url":null,"abstract":"Authors, institutions, funders, and editors must be alert to the dangers A growing number of entities misrepresent themselves as scholarly journals for financial gain despite not meeting scholarly publishing standards.12 As editors and members of the International Committee of Medical Journal Editors (ICMJE), we receive queries about these “predatory” or “pseudo” entities and are subject to their deception when they target our authors and reviewers. The number of predatory journals is difficult to accurately determine but was estimated at more than 15 000 in 2021.3 While the ICMJE recommendations include warnings about predatory publishing,4 the committee believes that the large number of increasingly bold predatory entities warrants shining a bright light on them and considering actions stakeholders can take to counter their deceptive efforts. The practices that these entities employ include aggressive solicitation of manuscript submissions; the promise of extremely rapid turnaround times; and a lack of transparency about article submission, processing, and even withdrawal charges. Predatory journals may claim that they follow legitimate editorial and publishing practices but do not actually conduct peer review or such functions as archiving journal content, managing potential conflicts of interest, enabling corrections, and responding to author queries in a timely manner. In egregious cases, the “published” articles never appear despite authors having paid the requested fees. Predatory journals often use journal names and branding features that mimic well established journals. They may falsely state that they are members of or follow the recommendations of respected organisations such as the Committee on Publication Ethics, the Council of Science Editors, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935197","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}
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