W. Albrich, M. Pride, S. Madhi, J. Callahan, P. Adrian, R. French, N. V. Niekerk, V. Souza, K. Jansen, K. Klugman
{"title":"New Pneumococcal Diagnostics---further ahead or more confused?","authors":"W. Albrich, M. Pride, S. Madhi, J. Callahan, P. Adrian, R. French, N. V. Niekerk, V. Souza, K. Jansen, K. Klugman","doi":"10.1007/BF03399439","DOIUrl":"https://doi.org/10.1007/BF03399439","url":null,"abstract":"","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"3 1","pages":"61 - 79"},"PeriodicalIF":6.8,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF03399439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"52101341","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":"Pneumococcal Pneumonia---Risky Business","authors":"D. Murdoch, V. Picot, M. Messaoudi, J. Telles","doi":"10.1007/BF03399446","DOIUrl":"https://doi.org/10.1007/BF03399446","url":null,"abstract":"","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"41 1","pages":"246 - 281"},"PeriodicalIF":6.8,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF03399446","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"52101719","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}
Pub Date : 2014-10-14DOI: 10.15172/pneu.2014.5/482
K. F. O'Grady, P. Torzillo, K. Frawley, A. Chang
Despite the importance of paediatric pneumonia as a cause of short and long-term morbidity and mortality worldwide, a reliable gold standard for its diagnosis remains elusive. The utility of clinical, microbiological and radiological diagnostic approaches varies widely within and between populations and is heavily dependent on the expertise and resources available in various settings. Here we review the role of radiology in the diagnosis of paediatric pneumonia. Chest radiographs (CXRs) are the most widely employed test, however, they are not indicated in ambulatory settings, cannot distinguish between viral and bacterial infections and have a limited role in the ongoing management of disease. A standardised definition of alveolar pneumonia on a CXR exists for epidemiological studies targeting bacterial pneumonias but it should not be extrapolated to clinical settings. Radiography, computed tomography and to a lesser extent ultrasonography and magnetic resonance imaging play an important role in complicated pneumonias but there are limitations that preclude their use as routine diagnostic tools. Large population-based studies are needed in different populations to address many of the knowledge gaps in the radiological diagnosis of pneumonia in children, however, the feasibility of such studies is an important barrier.
{"title":"The radiological diagnosis of pneumonia in children","authors":"K. F. O'Grady, P. Torzillo, K. Frawley, A. Chang","doi":"10.15172/pneu.2014.5/482","DOIUrl":"https://doi.org/10.15172/pneu.2014.5/482","url":null,"abstract":"Despite the importance of paediatric pneumonia as a cause of short and long-term morbidity and mortality worldwide, a reliable gold standard for its diagnosis remains elusive. The utility of clinical, microbiological and radiological diagnostic approaches varies widely within and between populations and is heavily dependent on the expertise and resources available in various settings. Here we review the role of radiology in the diagnosis of paediatric pneumonia. Chest radiographs (CXRs) are the most widely employed test, however, they are not indicated in ambulatory settings, cannot distinguish between viral and bacterial infections and have a limited role in the ongoing management of disease. A standardised definition of alveolar pneumonia on a CXR exists for epidemiological studies targeting bacterial pneumonias but it should not be extrapolated to clinical settings. Radiography, computed tomography and to a lesser extent ultrasonography and magnetic resonance imaging play an important role in complicated pneumonias but there are limitations that preclude their use as routine diagnostic tools. Large population-based studies are needed in different populations to address many of the knowledge gaps in the radiological diagnosis of pneumonia in children, however, the feasibility of such studies is an important barrier.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"5 1","pages":"38 - 51"},"PeriodicalIF":6.8,"publicationDate":"2014-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2014.5/482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67244702","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}
Pub Date : 2014-09-22DOI: 10.15172/pneu.2014.5/481
J. Rylance, P. Waitt
Clinical prognostc scores are increasingly used to streamline care in well-resourced setngs. The potental benefts of identfying patents at risk of clinical deterioraton and poor outcome, delivering appropriate higher level clinical care, and increasing efciency are clear. In this focused review, we examine the use and applicability of severity scores applied to patents with community acquired pneumonia in resource poor setngs. We challenge clinical researchers working in such systems to consider the generalisability of existng severity scores in their populatons, and where performance of scores is suboptmal, to promote eforts to develop and validate new tools for the beneft of patents and healthcare systems.
{"title":"Pneumonia severity scores in resource poor settings","authors":"J. Rylance, P. Waitt","doi":"10.15172/pneu.2014.5/481","DOIUrl":"https://doi.org/10.15172/pneu.2014.5/481","url":null,"abstract":"Clinical prognostc scores are increasingly used to streamline care in well-resourced setngs. The potental benefts of identfying patents at risk of clinical deterioraton and poor outcome, delivering appropriate higher level clinical care, and increasing efciency are clear. In this focused review, we examine the use and applicability of severity scores applied to patents with community acquired pneumonia in resource poor setngs. We challenge clinical researchers working in such systems to consider the generalisability of existng severity scores in their populatons, and where performance of scores is suboptmal, to promote eforts to develop and validate new tools for the beneft of patents and healthcare systems.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"5 1","pages":"30 - 37"},"PeriodicalIF":6.8,"publicationDate":"2014-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2014.5/481","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67244877","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}
Pub Date : 2014-09-11DOI: 10.15172/pneu.2014.4/463
F. Lim, D. Lehmann, Aoiffe McLoughlin, C. Harrison, Judith Willis, C. Giele, A. Keil, H. Moore
Australian Aboriginal people have among the highest rates of invasive pneumococcal disease (IPD) worldwide. We investigated clinical diagnosis, risk factors, comorbidities and vaccine coverage in Aboriginal and non-Aboriginal IPD cases. Using enhanced surveillance, we identified IPD cases in Western Australia, Australia, between 1997 and 2007. We calculated the proportion with risk factors and comorbidities in children (<5 years) and adults (=15 years), as well as adults living in metropolitan and non-metropolitan regions. We then calculated the proportion of cases eligible for vaccination who were vaccinated before contracting IPD. Of the 1,792 IPD cases that were reported, 355 (20%) were Aboriginal and 1,155 (65%) were adults. Pneumonia was the most common diagnosis (61% of non-Aboriginal and 49% of Aboriginal adult IPD cases in 2001–2007). Congenital abnormality was the most frequent comorbidity in non-Aboriginal children (11%). In Aboriginal children, preterm delivery was most common (14%). Ninety-one percent of non-Aboriginal and 96% of Aboriginal adults had one or more risk factors or comorbidities. In non-Aboriginal adults, cardiovascular disease (34%) was the predominant comorbidity whilst excessive alcohol use (66%) was the most commonly reported risk factor in Aboriginal adults. In adults, comorbidities were more frequently reported among those in metropolitan regions than those in non-metropolitan regions. Vaccination status was unknown for 637 of 1,082 cases post-July 2001. Forty-one percent of non-Aboriginal and 60% of Aboriginal children were eligible for vaccination but were not vaccinated. Among adults with risk factors who were eligible for vaccination and with known vaccination status, 75% Aboriginal and 94% non-Aboriginal were not vaccinated. An all-of-life immunisation register is needed to evaluate vaccine coverage and effectiveness in preventing IPD in adults.
{"title":"Risk factors and comorbidities for invasive pneumococcal disease in Western Australian Aboriginal and non-Aboriginal people","authors":"F. Lim, D. Lehmann, Aoiffe McLoughlin, C. Harrison, Judith Willis, C. Giele, A. Keil, H. Moore","doi":"10.15172/pneu.2014.4/463","DOIUrl":"https://doi.org/10.15172/pneu.2014.4/463","url":null,"abstract":"Australian Aboriginal people have among the highest rates of invasive pneumococcal disease (IPD) worldwide. We investigated clinical diagnosis, risk factors, comorbidities and vaccine coverage in Aboriginal and non-Aboriginal IPD cases. Using enhanced surveillance, we identified IPD cases in Western Australia, Australia, between 1997 and 2007. We calculated the proportion with risk factors and comorbidities in children (<5 years) and adults (=15 years), as well as adults living in metropolitan and non-metropolitan regions. We then calculated the proportion of cases eligible for vaccination who were vaccinated before contracting IPD. Of the 1,792 IPD cases that were reported, 355 (20%) were Aboriginal and 1,155 (65%) were adults. Pneumonia was the most common diagnosis (61% of non-Aboriginal and 49% of Aboriginal adult IPD cases in 2001–2007). Congenital abnormality was the most frequent comorbidity in non-Aboriginal children (11%). In Aboriginal children, preterm delivery was most common (14%). Ninety-one percent of non-Aboriginal and 96% of Aboriginal adults had one or more risk factors or comorbidities. In non-Aboriginal adults, cardiovascular disease (34%) was the predominant comorbidity whilst excessive alcohol use (66%) was the most commonly reported risk factor in Aboriginal adults. In adults, comorbidities were more frequently reported among those in metropolitan regions than those in non-metropolitan regions. Vaccination status was unknown for 637 of 1,082 cases post-July 2001. Forty-one percent of non-Aboriginal and 60% of Aboriginal children were eligible for vaccination but were not vaccinated. Among adults with risk factors who were eligible for vaccination and with known vaccination status, 75% Aboriginal and 94% non-Aboriginal were not vaccinated. An all-of-life immunisation register is needed to evaluate vaccine coverage and effectiveness in preventing IPD in adults.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"4 1","pages":"24 - 34"},"PeriodicalIF":6.8,"publicationDate":"2014-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2014.4/463","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67244936","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}
Pub Date : 2014-03-16DOI: 10.15172/pneu.2014.4/416
M. Alpers
This review of pneumonia in the tropics is based on experience with respiratory infectons in Papua New Guinea since the 1970s. It discusses ideas, principles, historical aspects of pneumonia research and the need to work with people in the community. In order to understand pneumonia in a tropical setng and evaluate new interventons it is essental to study the ecosystem of the causatve infectons, within the host and the community and between interactng microorganisms. Vaccines are much-needed preventve tools, and for pneumonia in a highly endemic setng the preventon of severe and fatal disease takes priority over the preventon of infecton. In this setng mild infecton plays an important role in preventng severe disease. For achieving long-term sustainable outcomes, sometmes ‘less is more’. A multpronged approach is required to control and prevent pneumonia, and in devising new ways of doing so. This includes appropriate and accessible clinical care, a clean, smoke-free environment, good nutriton and a range of vaccines. Also required are persistent advocacy from the global scientfc community and strong engagement with and by the communites that bear the burden of disease. Beter health care must be pursued in conjuncton with raising literacy rates and reducing poverty.
{"title":"Reflections on pneumonia in the tropics","authors":"M. Alpers","doi":"10.15172/pneu.2014.4/416","DOIUrl":"https://doi.org/10.15172/pneu.2014.4/416","url":null,"abstract":"This review of pneumonia in the tropics is based on experience with respiratory infectons in Papua New Guinea since the 1970s. It discusses ideas, principles, historical aspects of pneumonia research and the need to work with people in the community. In order to understand pneumonia in a tropical setng and evaluate new interventons it is essental to study the ecosystem of the causatve infectons, within the host and the community and between interactng microorganisms. Vaccines are much-needed preventve tools, and for pneumonia in a highly endemic setng the preventon of severe and fatal disease takes priority over the preventon of infecton. In this setng mild infecton plays an important role in preventng severe disease. For achieving long-term sustainable outcomes, sometmes ‘less is more’. A multpronged approach is required to control and prevent pneumonia, and in devising new ways of doing so. This includes appropriate and accessible clinical care, a clean, smoke-free environment, good nutriton and a range of vaccines. Also required are persistent advocacy from the global scientfc community and strong engagement with and by the communites that bear the burden of disease. Beter health care must be pursued in conjuncton with raising literacy rates and reducing poverty.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"4 1","pages":"1 - 7"},"PeriodicalIF":6.8,"publicationDate":"2014-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2014.4/416","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67244720","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}
Pub Date : 2013-07-27eCollection Date: 2013-01-01DOI: 10.15172/pneu.2013.2/264
Penelope L Chapman
Commentary Pneumonia - Forgotten No More Chapman, P.L. Pneumonia is the leading cause of death in children worldwide and kills an estimated 1.2 million children under the age of five every year; more than AIDS, malaria and tuberculosis combined. Relatively few resources have been committed to addressing the problem of childhood pneumonia, particularly in resource poor settings. Yet effective interventions are available but reach too few children.
{"title":"Pneumonia - Forgotten no more.","authors":"Penelope L Chapman","doi":"10.15172/pneu.2013.2/264","DOIUrl":"https://doi.org/10.15172/pneu.2013.2/264","url":null,"abstract":"Commentary Pneumonia - Forgotten No More Chapman, P.L. Pneumonia is the leading cause of death in children worldwide and kills an estimated 1.2 million children under the age of five every year; more than AIDS, malaria and tuberculosis combined. Relatively few resources have been committed to addressing the problem of childhood pneumonia, particularly in resource poor settings. Yet effective interventions are available but reach too few children.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"2 ","pages":"33-36"},"PeriodicalIF":6.8,"publicationDate":"2013-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2013.2/264","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215571","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 : 2013-04-10DOI: 10.15172/pneu.2013.2/245
S. A. Kim, P. Kilgore
There are limited examples of population-based approaches that engage a broad range of stakeholders for prevention of pneumonia. In 2010, a multi-dimensional public-private partnership was established around World Pneumonia Day (WPD) in Seoul, Korea and included the following components: a) formation of an expert advisory group, b) creation of educational materials tailored for lay persons, c) creation of a dedicated WPD internet website in the local language, d) organisation of a WPD venue in central Seoul, e) creation of video and social networking messages for wide distribution, and f) engagement of parents, health-care professionals, public health agencies and policymakers. This project directly engaged 7 expert health professionals, 5 national- and city-level health facilities, and parents from communities. The program reached out to 70,560 persons including 25,200 persons who were contacted in person at publicly-held WPD events. An educational video produced for WPD was aired in the Seoul subway and visible to several million persons riding subway lines that aired the pneumonia public service announcements over a two-month period (February to March, 2011). In addition, the Korean WPD website experienced 4,975 page views with 3,338 visitors and the micro blog associated with this site hosted 82 posts from site visitors. Based on participant numbers and contact volumes achieved in this project, the Korean WPD program was widely accepted and proved to be a highly effective in reaching a large audience to advocate for pneumonia prevention. One key to success of this program appears to be the unique public-private partnership around a major health issue. The methods and tools developed in this program have excellent potential for adaptation and application in other countries where pneumonia may be an under recognised problem among the general public.
{"title":"Advocacy for pneumonia prevention in Korea: a multi-dimensional program organised around World Pneumonia Day","authors":"S. A. Kim, P. Kilgore","doi":"10.15172/pneu.2013.2/245","DOIUrl":"https://doi.org/10.15172/pneu.2013.2/245","url":null,"abstract":"There are limited examples of population-based approaches that engage a broad range of stakeholders for prevention of pneumonia. In 2010, a multi-dimensional public-private partnership was established around World Pneumonia Day (WPD) in Seoul, Korea and included the following components: a) formation of an expert advisory group, b) creation of educational materials tailored for lay persons, c) creation of a dedicated WPD internet website in the local language, d) organisation of a WPD venue in central Seoul, e) creation of video and social networking messages for wide distribution, and f) engagement of parents, health-care professionals, public health agencies and policymakers. This project directly engaged 7 expert health professionals, 5 national- and city-level health facilities, and parents from communities. The program reached out to 70,560 persons including 25,200 persons who were contacted in person at publicly-held WPD events. An educational video produced for WPD was aired in the Seoul subway and visible to several million persons riding subway lines that aired the pneumonia public service announcements over a two-month period (February to March, 2011). In addition, the Korean WPD website experienced 4,975 page views with 3,338 visitors and the micro blog associated with this site hosted 82 posts from site visitors. Based on participant numbers and contact volumes achieved in this project, the Korean WPD program was widely accepted and proved to be a highly effective in reaching a large audience to advocate for pneumonia prevention. One key to success of this program appears to be the unique public-private partnership around a major health issue. The methods and tools developed in this program have excellent potential for adaptation and application in other countries where pneumonia may be an under recognised problem among the general public.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"64 1","pages":"26 - 32"},"PeriodicalIF":6.8,"publicationDate":"2013-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2013.2/245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67244285","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}
Pub Date : 2013-02-14eCollection Date: 2013-01-01DOI: 10.15172/pneu.2013.2/244
Diana C Otczyk, Allan W Cripps
Pneumonia is the leading cause of morbidity and mortality in children younger than 5 years. Vaccines are available against the main bacterial pathogens Haemophilus influenzae type b and Streptococcus pneumoniae. There are also vaccines against measles and pertussis; diseases that can predispose a child to pneumonia. Partners such as the Global Alliance for Vaccines and Immunisation (GAVI), the Hib Initiative, the Accelerated Development and Introduction Plan for pneumococcal vaccines and the Measles Initiative, have accelerated the introduction of vaccines into developing countries. Whilst significant improvements in vaccine coverage have occurred globally over the past decade, there still remains an urgent need to scale-up key pneumonia protection and treatment interventions as identified in the Global Action Plan for the Prevention and Control of Pneumonia (GAPP). There is promise that global immunisation will continue to improve child survival. However, there are several challenges to vaccine implementation that must first be addressed, including: a lack of access to under-served and marginalised populations; inadequate planning and management; a lack of political commitment; weak monitoring and surveillance programmes and assured sustainable finance and supply of quality vaccines. There is an urgent need to increase global awareness of the devastation that pneumonia brings to the worlds poorest communities.
{"title":"Delivering vaccines for the prevention of pneumonia - programmatic and financial issues.","authors":"Diana C Otczyk, Allan W Cripps","doi":"10.15172/pneu.2013.2/244","DOIUrl":"https://doi.org/10.15172/pneu.2013.2/244","url":null,"abstract":"<p><p>Pneumonia is the leading cause of morbidity and mortality in children younger than 5 years. Vaccines are available against the main bacterial pathogens <i>Haemophilus influenzae</i> type b and <i>Streptococcus pneumoniae</i>. There are also vaccines against measles and pertussis; diseases that can predispose a child to pneumonia. Partners such as the Global Alliance for Vaccines and Immunisation (GAVI), the Hib Initiative, the Accelerated Development and Introduction Plan for pneumococcal vaccines and the Measles Initiative, have accelerated the introduction of vaccines into developing countries. Whilst significant improvements in vaccine coverage have occurred globally over the past decade, there still remains an urgent need to scale-up key pneumonia protection and treatment interventions as identified in the Global Action Plan for the Prevention and Control of Pneumonia (GAPP). There is promise that global immunisation will continue to improve child survival. However, there are several challenges to vaccine implementation that must first be addressed, including: a lack of access to under-served and marginalised populations; inadequate planning and management; a lack of political commitment; weak monitoring and surveillance programmes and assured sustainable finance and supply of quality vaccines. There is an urgent need to increase global awareness of the devastation that pneumonia brings to the worlds poorest communities.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"2 ","pages":"16-25"},"PeriodicalIF":6.8,"publicationDate":"2013-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2013.2/244","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215570","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}
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