Pub Date : 2024-01-01DOI: 10.1016/j.acpath.2023.100101
Simone Arvisais-Anhalt MD , Steven L. Gonias MD, PhD , Sara G. Murray MD, MAS
Artificial intelligence and machine learning have numerous applications in pathology and laboratory medicine. The release of ChatGPT prompted speculation regarding the potentially transformative role of large-language models (LLMs) in academic pathology, laboratory medicine, and pathology education. Because of the potential to improve LLMs over the upcoming years, pathology and laboratory medicine clinicians are encouraged to embrace this technology, identify pathways by which LLMs may support our missions in education, clinical practice, and research, participate in the refinement of AI modalities, and design user-friendly interfaces that integrate these tools into our most important workflows. Challenges regarding the use of LLMs, which have already received considerable attention in a general sense, are also reviewed herein within the context of the pathology field and are important to consider as LLM applications are identified and operationalized.
{"title":"Establishing priorities for implementation of large language models in pathology and laboratory medicine","authors":"Simone Arvisais-Anhalt MD , Steven L. Gonias MD, PhD , Sara G. Murray MD, MAS","doi":"10.1016/j.acpath.2023.100101","DOIUrl":"https://doi.org/10.1016/j.acpath.2023.100101","url":null,"abstract":"<div><p>Artificial intelligence and machine learning have numerous applications in pathology and laboratory medicine. The release of ChatGPT prompted speculation regarding the potentially transformative role of large-language models (LLMs) in academic pathology, laboratory medicine, and pathology education. Because of the potential to improve LLMs over the upcoming years, pathology and laboratory medicine clinicians are encouraged to embrace this technology, identify pathways by which LLMs may support our missions in education, clinical practice, and research, participate in the refinement of AI modalities, and design user-friendly interfaces that integrate these tools into our most important workflows. Challenges regarding the use of LLMs, which have already received considerable attention in a general sense, are also reviewed herein within the context of the pathology field and are important to consider as LLM applications are identified and operationalized.</p></div>","PeriodicalId":44927,"journal":{"name":"Academic Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2374289523000337/pdfft?md5=e1909be8c67a87689af4435ecb8fd2c8&pid=1-s2.0-S2374289523000337-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139419246","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}
Pub Date : 2024-01-01DOI: 10.1016/j.acpath.2023.100100
Lydia Pleotis Howell MD , Michael Laposata MD, PhD , Priscilla S. Markwood
{"title":"Collaboration to Improve Emergency Laboratory Response: Open letter from the Open letter from the Association of Pathology Chairs to the Centers for Disease Control & Prevention","authors":"Lydia Pleotis Howell MD , Michael Laposata MD, PhD , Priscilla S. Markwood","doi":"10.1016/j.acpath.2023.100100","DOIUrl":"https://doi.org/10.1016/j.acpath.2023.100100","url":null,"abstract":"","PeriodicalId":44927,"journal":{"name":"Academic Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2374289523000325/pdfft?md5=31d336710c9eb8b2d2096d036dd881db&pid=1-s2.0-S2374289523000325-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682357","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}
Pub Date : 2024-01-01DOI: 10.1016/j.acpath.2023.100103
Mohamed Mokhtar Desouki MD, PhD , Ian S. Hagemann MD, PhD , Thaer Khoury MD , Oluwole Fadare MD , Rohit Bhargava MBBS , Jennifer L. Clark MD, PhD , Michael T. Deavers MD , Julie M. Jorns MD , Ashraf Khan MD , Ediz F. Cosar MD , Rouzan G. Karabakhtsian MD, PhD , Molly E. Klein MD , Andre Pinto MD , Muhammad Ali MD
Published data on combined breast and gynecologic [breast/gyn] surgical pathology fellowship training programs are limited. Our study aimed to survey the landscape of such fellowships in the United States (US), including specific information about their characteristics and the educational activities therein. Using web searches, we identified programs offering combined breast/gyn surgical pathology fellowship training. We developed a 26-item questionnaire asking program directors to report on the characteristics of their fellowship training structure. The search revealed 25 academic based programs offering one-year combined breast/gyn fellowship training, predominantly located (40 %) in the Northeast area. The following data was obtained: 44 % of the programs were accredited by the ACGME, 82 % required >19 weeks of breast and gyn service, and 69.6 % accepted the common application, 54.5 % of programs require completion of a research project for graduation. An annual average of 3000 breast and 3000 gyn cases appears to be the usual volume of cases. Interestingly, only 36 % of the program directors are graduates of a combined breast/gyn fellowship program. In conclusion, we present the most comprehensive and up-to-date census of combined breast/gyn pathology fellowships in the US. Our study provides valuable information on the current state of combined breast/gyn pathology fellowship training. The information will be helpful to current and prospective trainees, as well as program leaders.
{"title":"Selective breast/gynecologic pathology fellowship training in the United States: Experience of program directors","authors":"Mohamed Mokhtar Desouki MD, PhD , Ian S. Hagemann MD, PhD , Thaer Khoury MD , Oluwole Fadare MD , Rohit Bhargava MBBS , Jennifer L. Clark MD, PhD , Michael T. Deavers MD , Julie M. Jorns MD , Ashraf Khan MD , Ediz F. Cosar MD , Rouzan G. Karabakhtsian MD, PhD , Molly E. Klein MD , Andre Pinto MD , Muhammad Ali MD","doi":"10.1016/j.acpath.2023.100103","DOIUrl":"https://doi.org/10.1016/j.acpath.2023.100103","url":null,"abstract":"<div><p>Published data on combined breast and gynecologic [breast/gyn] surgical pathology fellowship training programs are limited. Our study aimed to survey the landscape of such fellowships in the United States (US), including specific information about their characteristics and the educational activities therein. Using web searches, we identified programs offering combined breast/gyn surgical pathology fellowship training. We developed a 26-item questionnaire asking program directors to report on the characteristics of their fellowship training structure. The search revealed 25 academic based programs offering one-year combined breast/gyn fellowship training, predominantly located (40 %) in the Northeast area. The following data was obtained: 44 % of the programs were accredited by the ACGME, 82 % required >19 weeks of breast and gyn service, and 69.6 % accepted the common application, 54.5 % of programs require completion of a research project for graduation. An annual average of 3000 breast and 3000 gyn cases appears to be the usual volume of cases. Interestingly, only 36 % of the program directors are graduates of a combined breast/gyn fellowship program. In conclusion, we present the most comprehensive and up-to-date census of combined breast/gyn pathology fellowships in the US. Our study provides valuable information on the current state of combined breast/gyn pathology fellowship training. The information will be helpful to current and prospective trainees, as well as program leaders.</p></div>","PeriodicalId":44927,"journal":{"name":"Academic Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2374289523000350/pdfft?md5=509a805e5a33e1375584765896ebee1b&pid=1-s2.0-S2374289523000350-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139737743","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}
Pub Date : 2023-12-27DOI: 10.1016/j.acpath.2023.100102
Kevin Carnevale MD , Ritcha Saxena MD , Geoffrey A. Talmon MD , Amy Lin MD , Osvaldo Padilla MD, MPH , Regina A. Kreisle MD, PhD
Pathology education is taught using different curricula in the United States (USA) and abroad. We evaluate and compare the hours spent in different forms of pathology teaching such as lectures, team-based learning (TBL), problem-based learning (PBL), and other methods taught in general and systemic pathology amongst different medical schools within the USA and outside the USA. The total number of lecture hours taught in general and systemic pathology combined was greater in outside schools than within the USA (141 h vs 97.8 h, respectively). Three subjects in general pathology and six subjects in systemic pathology had a significantly greater lecture hours in outside medical schools. The greatest difference was the hours spent in labs were longer for both general and systems pathology in schools outside the USA. The overall utilization of PBL in general and systemic pathology teaching combined was much greater outside the USA compared to within the USA (average overall hours PBL – 97.2 outside vs 16.5 in the USA), however, the reverse was observed for using TBL (average overall hours TBL – 59.5 outside vs 84.5 in USA). Average hours used with other methods of teaching was also greater in outside medical schools compared to USA medical schools (80.8 h vs 44 h, respectively). Pathology teaching in both general and systemic pathology has more extensive lecture hours, laboratory hours, PBL, and other methods of teaching pathology in outside medical schools with different curricula than USA medical schools. TBL is utilized more extensively in USA medical schools.
{"title":"Pathology teaching in different undergraduate medical curricula within and outside the United States: a pilot study","authors":"Kevin Carnevale MD , Ritcha Saxena MD , Geoffrey A. Talmon MD , Amy Lin MD , Osvaldo Padilla MD, MPH , Regina A. Kreisle MD, PhD","doi":"10.1016/j.acpath.2023.100102","DOIUrl":"https://doi.org/10.1016/j.acpath.2023.100102","url":null,"abstract":"<div><p>Pathology education is taught using different curricula in the United States (USA) and abroad. We evaluate and compare the hours spent in different forms of pathology teaching such as lectures, team-based learning (TBL), problem-based learning (PBL), and other methods taught in general and systemic pathology amongst different medical schools within the USA and outside the USA. The total number of lecture hours taught in general and systemic pathology combined was greater in outside schools than within the USA (141 h vs 97.8 h, respectively). Three subjects in general pathology and six subjects in systemic pathology had a significantly greater lecture hours in outside medical schools. The greatest difference was the hours spent in labs were longer for both general and systems pathology in schools outside the USA. The overall utilization of PBL in general and systemic pathology teaching combined was much greater outside the USA compared to within the USA (average overall hours PBL – 97.2 outside vs 16.5 in the USA), however, the reverse was observed for using TBL (average overall hours TBL – 59.5 outside vs 84.5 in USA). Average hours used with other methods of teaching was also greater in outside medical schools compared to USA medical schools (80.8 h vs 44 h, respectively). Pathology teaching in both general and systemic pathology has more extensive lecture hours, laboratory hours, PBL, and other methods of teaching pathology in outside medical schools with different curricula than USA medical schools. TBL is utilized more extensively in USA medical schools.</p></div>","PeriodicalId":44927,"journal":{"name":"Academic Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2374289523000349/pdfft?md5=c147d09fc5fd72b50aab6ff2567df3fc&pid=1-s2.0-S2374289523000349-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139050544","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}
Pub Date : 2023-12-19DOI: 10.1016/j.acpath.2023.100099
Alexander Ngo , Saumya Gupta , Oliver Perrine, Rithik Reddy, Sherry Ershadi, Daniel Remick MD
Artificial intelligence (AI) may have a profound impact on traditional teaching in academic settings. Multiple concerns have been raised, especially related to using ChatGPT for creating de novo essays. However, AI programs such as ChatGPT may augment teaching techniques. In this article, we used ChatGPT 3.5 to create 60 multiple choice questions. Author written text was uploaded and ChatGPT asked to create multiple choice questions with an explanation for the correct answer and explanations for the incorrect answers. Unfortunately, ChatGPT only generated correct questions and answers with explanations in 32 % of the questions (19 out of 60). In many instances, ChatGPT failed to provide an explanation for the incorrect answers. An additional 25 % of the questions had answers that were either wrong or misleading. A grade of 32 % would be considered failing in most courses. Despite these issues, instructors may still find ChatGPT useful for creating practice exams with explanations—with the caveat that extensive editing may be required.
{"title":"ChatGPT 3.5 fails to write appropriate multiple choice practice exam questions","authors":"Alexander Ngo , Saumya Gupta , Oliver Perrine, Rithik Reddy, Sherry Ershadi, Daniel Remick MD","doi":"10.1016/j.acpath.2023.100099","DOIUrl":"https://doi.org/10.1016/j.acpath.2023.100099","url":null,"abstract":"<div><p>Artificial intelligence (AI) may have a profound impact on traditional teaching in academic settings. Multiple concerns have been raised, especially related to using ChatGPT for creating <em>de novo</em> essays. However, AI programs such as ChatGPT may augment teaching techniques. In this article, we used ChatGPT 3.5 to create 60 multiple choice questions. Author written text was uploaded and ChatGPT asked to create multiple choice questions with an explanation for the correct answer and explanations for the incorrect answers. Unfortunately, ChatGPT only generated correct questions and answers with explanations in 32 % of the questions (19 out of 60). In many instances, ChatGPT failed to provide an explanation for the incorrect answers. An additional 25 % of the questions had answers that were either wrong or misleading. A grade of 32 % would be considered failing in most courses. Despite these issues, instructors may still find ChatGPT useful for creating practice exams with explanations—with the caveat that extensive editing may be required.</p></div>","PeriodicalId":44927,"journal":{"name":"Academic Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2374289523000313/pdfft?md5=a10c566ba8cc29483c2eb3deca716a25&pid=1-s2.0-S2374289523000313-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138839306","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}
Pub Date : 2023-10-01DOI: 10.1016/j.acpath.2023.100096
Jordan Franco BS , Nancy S. Morris PhD, ANP , Mark K. Fung MD, PhD
Health literacy has been defined and studied as an important component of a patient's ability to understand and obtain appropriate healthcare. However, a laboratory component of health literacy, as it pertains to the understanding of laboratory tests and their results, has not been previously defined. An analysis of readily available health literacy tools was conducted to determine laboratory testing-specific content representation. One hundred and four health literacy tools from a publicly available database were analyzed. Many of the health literacy tools were found to be lacking items related to laboratory testing. Of the health literacy tools that did contain a laboratory component, they were categorized pertaining to the laboratory test/testing content. Emerging from this process, eight competencies were identified that encompassed the entire range of laboratory-related aspects of health literacy. We propose that these eight competencies form the basis of a set of competencies needed for one to access, interpret, and act on laboratory results–a capacity we are referring to as “laboratory literacy.”
{"title":"Defining and identifying laboratory literacy as a component of health literacy: An assessment of existing health literacy tools","authors":"Jordan Franco BS , Nancy S. Morris PhD, ANP , Mark K. Fung MD, PhD","doi":"10.1016/j.acpath.2023.100096","DOIUrl":"https://doi.org/10.1016/j.acpath.2023.100096","url":null,"abstract":"<div><p>Health literacy has been defined and studied as an important component of a patient's ability to understand and obtain appropriate healthcare. However, a laboratory component of health literacy, as it pertains to the understanding of laboratory tests and their results, has not been previously defined. An analysis of readily available health literacy tools was conducted to determine laboratory testing-specific content representation. One hundred and four health literacy tools from a publicly available database were analyzed. Many of the health literacy tools were found to be lacking items related to laboratory testing. Of the health literacy tools that did contain a laboratory component, they were categorized pertaining to the laboratory test/testing content. Emerging from this process, eight competencies were identified that encompassed the entire range of laboratory-related aspects of health literacy. We propose that these eight competencies form the basis of a set of competencies needed for one to access, interpret, and act on laboratory results–a capacity we are referring to as “laboratory literacy.”</p></div>","PeriodicalId":44927,"journal":{"name":"Academic Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2374289523000283/pdfft?md5=07f2b7480d8e8d4de107d2074a20f2a4&pid=1-s2.0-S2374289523000283-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91993091","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}
Pub Date : 2023-10-01DOI: 10.1016/j.acpath.2023.100094
Alex P. Tannenbaum MD , Cullen M. Lilley MD, MS, MA
The field of pathology is facing an inflection point where the demand for pathology services is not being met by a corresponding rise in recruitment into the field. Many of the myths about the field of pathology have been dispelled elsewhere, but there have not been many formal accounts of the experience medical students’ face when finding their path to pathology. Because of challenges in the visibility of pathology as a specialty and not simply a subject required for United States Medical Licensing Examination Step 1, students tend to fall into one of two categories: early differentiators or late discoverers. Here, we provide anecdotal accounts of these two paths at institutions with different curricular designs and provide a first-hand account of the challenges we faced and opportunities discovered in our journeys to pathology. Based on these experiences, we offer suggestions for ways to address some of the issues medical students must navigate when trying to explore pathology in curricula not built for such exploration.
{"title":"Perspectives from two recent medical school graduates on exposure to pathology during undergraduate medical education: A narrative inquiry","authors":"Alex P. Tannenbaum MD , Cullen M. Lilley MD, MS, MA","doi":"10.1016/j.acpath.2023.100094","DOIUrl":"10.1016/j.acpath.2023.100094","url":null,"abstract":"<div><p>The field of pathology is facing an inflection point where the demand for pathology services is not being met by a corresponding rise in recruitment into the field. Many of the myths about the field of pathology have been dispelled elsewhere, but there have not been many formal accounts of the experience medical students’ face when finding their path to pathology. Because of challenges in the visibility of pathology as a specialty and not simply a subject required for United States Medical Licensing Examination Step 1, students tend to fall into one of two categories: early differentiators or late discoverers. Here, we provide anecdotal accounts of these two paths at institutions with different curricular designs and provide a first-hand account of the challenges we faced and opportunities discovered in our journeys to pathology. Based on these experiences, we offer suggestions for ways to address some of the issues medical students must navigate when trying to explore pathology in curricula not built for such exploration.</p></div>","PeriodicalId":44927,"journal":{"name":"Academic Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/65/main.PMC10568268.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239635","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}
Pub Date : 2023-10-01DOI: 10.1016/j.acpath.2023.100093
Karen Tew BS , Jesse Kresak MD , Stacy G. Beal MD
Faculty from the University of Florida Department of Pathology, Immunology, and Laboratory Medicine developed an asynchronous, fully virtual pathology elective for medical students that emphasizes both foundational pathology concepts as well as the role of pathologists in the broader health system. The program includes ten core modules as well as several selective modules which allows students to tailor their coursework to better align with their desired specialty. After completing each module, students were required to concisely summarize the topic in the form of a 280-character tweet. Students were surveyed immediately after finishing the course and again one year after finishing the course to assess the effectiveness of the course in teaching students about pathology. Survey results showed significant improvement in student knowledge about the field of pathology and high levels of satisfaction with the course content and delivery. The tweet summaries required in the course provided a unique challenge for students. Although the course was initially developed in response to the COVID-19 pandemic, enrollment has continued steadily through 2023. Our study suggests that online pathology electives can be an effective way to increase medical student exposure to pathology and facilitate learning about the field of pathology, especially among students who may not ultimately pursue a career in pathology.
{"title":"Increasing medical student awareness of pathology through a virtual, asynchronous pathology elective","authors":"Karen Tew BS , Jesse Kresak MD , Stacy G. Beal MD","doi":"10.1016/j.acpath.2023.100093","DOIUrl":"10.1016/j.acpath.2023.100093","url":null,"abstract":"<div><p>Faculty from the University of Florida Department of Pathology, Immunology, and Laboratory Medicine developed an asynchronous, fully virtual pathology elective for medical students that emphasizes both foundational pathology concepts as well as the role of pathologists in the broader health system. The program includes ten core modules as well as several selective modules which allows students to tailor their coursework to better align with their desired specialty. After completing each module, students were required to concisely summarize the topic in the form of a 280-character tweet. Students were surveyed immediately after finishing the course and again one year after finishing the course to assess the effectiveness of the course in teaching students about pathology. Survey results showed significant improvement in student knowledge about the field of pathology and high levels of satisfaction with the course content and delivery. The tweet summaries required in the course provided a unique challenge for students. Although the course was initially developed in response to the COVID-19 pandemic, enrollment has continued steadily through 2023. Our study suggests that online pathology electives can be an effective way to increase medical student exposure to pathology and facilitate learning about the field of pathology, especially among students who may not ultimately pursue a career in pathology.</p></div>","PeriodicalId":44927,"journal":{"name":"Academic Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10560767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215516","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}