Journal of Nepal Health Research Council最新文献

{"title":"Implementation and Assessment of Facilitation Support for Improving Health Insurance Coverage in Achham.","authors":"Mandeep Pathak, Sanjaya Chand, Sarita Sharma, Pratiksha Dhungana, Prashant Pangeni, Roshan Paudel, Mahesh Shahi, Ramesh Mahar, Ramu Kharel","doi":"10.33314/jnhrc.v24i02.5238","DOIUrl":"https://doi.org/10.33314/jnhrc.v24i02.5238","url":null,"abstract":"<p><strong>Background: </strong>Health insurance is a critical strategy for achieving universal health coverage, reducing out-of-pocket (OOP) healthcare expenditures, and improving access to healthcare services. Despite the implementation of the National Health Insurance Program (NHIP) in Nepal, enrolment and renewal rates remain low, particularly in districts like Achham. This study aimed to assess the effectiveness of facilitation support, delivered through patient navigators, enrolment assistants, and community health workers (CHWs), in increasing health insurance coverage.  Methods: A mixed-methods approach was employed. The descriptive analysis examined enrolment trends and assessed the impact of CHW-led counselling on enrolment and renewal processes. The qualitative component explored program acceptability, adoption, feasibility challenges, and systemic barriers encountered during implementation.   Results: Facilitation supports improved health insurance uptake, leading to a 5.1 percent increase in new enrolments within three months. While awareness of NHIP was high (62.7%), only 37.7 percent of households had at least one insured member, and 43.1 percent of policies were inactive. Among those counselled for renewal, 76.3 percent agreed to enrol or renew, with 71.3 percent successfully completing the process.  Enrolment increased from 57,556 individuals in FY 2079/80 to 58,630 in FY 2080/81, representing a 1.9 percent growth in Achham district. Despite these gains, service gaps persisted; Stakeholders identified limited availability of enrolment assistants, barriers to referrals, activation time, first service point, healthcare service availability, insufficient financial support, stockouts of essential medications, and procedural complexities as key obstacles.    Conclusions: The facilitation strategy improved health insurance enrolment in Achham by addressing awareness, affordability, and procedural barriers. To sustain impact, efforts should focus on reducing Enrolment Assistant dropout rates, improving the referral system, ensuring timely healthcare services for insured individuals, and providing financial support for low-income groups. Scaling up these targeted improvements can enhance NHIP's effectiveness.  Keywords: Barriers; enrolment; feasibility; healthcare; health Insurance.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"24 2","pages":"206-213"},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194844","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":"Spatial Variation of Antibiotic-resistant Escherichia coli along Bagmati River, Kathmandu Valley.","authors":"Sudershan Dhungana, Bindu Ghimire","doi":"10.33314/jnhrc.v24i02.5569","DOIUrl":"https://doi.org/10.33314/jnhrc.v24i02.5569","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistant Escherichia coli has been reported in Bagmati river of Kathmandu Valley; however, studies on its spatial distribution are lacking, despite being essential for effective water management. Therefore, this cross-sectional study was conducted to determine the spatial distribution of antibiotic-resistant E. coli along Bagmati river from March-September 2025.</p><p><strong>Methods: </strong>This work was conducted at Department of Microbiology Tri-Chandra Multiple Campus. Water samples collected in duplicate from fifteen sites of Bagmati river were processed for most probable number count and isolation of E.coli. BOD and DO were calculated by Winkler's titrimetric method. Antibiotic susceptibility test was done by disk diffusion technique. Chi square test, correlation assessment, cluster and factor analysis were conducted.</p><p><strong>Results: </strong>The coliform count, E. coli isolates, Biochemical oxygen demand and dissolved oxygen levels ranged from 5-26,500 MPN/100 mL, 0-42, 1.2-418.75 mg/L, and 8.05-0.15 mg/L, respectively, from Baghdwar to Chobar. No E. coli isolates were recovered from Site 1. Cluster analysis based on these variables classified river into four distinct segments, with Sites 1 and 15 forming separate clusters. Significant differences were observed in antibiotic resistance pattern of E. coli isolates across the sampling sites. Factor analysis further grouped the river sites into five clusters, indicating spatial variation in antimicrobial resistant E. coli along the river continuum.</p><p><strong>Conclusions: </strong>Conventional water quality indicators are insufficient to capture spatial complexity of river health. Integrating fecal contamination and antibiotic resistance patterns provides a more comprehensive assessment of pollution hotspots, supporting targeted management strategies under Nepal's Nationally Determined Contribution (NDC) 3.0.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"24 2","pages":"221-228"},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Rasuwa Flash Flood: The Potential Use of Artificial Intelligence in Infectious Disease Surveillance.","authors":"Sher Bahadur Pun, Krishna Prasad Acharya","doi":"10.33314/jnhrc.v24i02.5832","DOIUrl":"https://doi.org/10.33314/jnhrc.v24i02.5832","url":null,"abstract":"<p><p>Nepal frequently experiences natural disasters, including floods. On 26 August 2026, the Rasuwa flash floods struck Nepal, resulting in hundreds of deaths, and leaving thousands of people missing. Infectious diseases represent an important public health concern in the aftermath of such disasters. Evidence on the use of artificial intelligence (AI) for post flash flood infectious disease risk assessment remains limited. Here, we discuss the potential integration of AI as a complementary decision-support tool to strengthen infectious disease risk assessment and early warning following Rasuwa flash flood disaster in Nepal. Keywords: Artificial intelligence; Infectious diseases; Nepal; Rasuwa flash flood.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"24 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194794","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":"Advancing Evidence Synthesis for Evidence?Informed Decision Making in Nepal.","authors":"Meghnath Dhimal, Pramod Joshi, Padam Simkhada","doi":"10.33314/jnhrc.v24i02.5870","DOIUrl":"10.33314/jnhrc.v24i02.5870","url":null,"abstract":"<p><p></p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"24 2","pages":"I-III"},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194871","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":"Outcomes of Healthcare-Associated Infections in Respiratory Intensive Care Unit.","authors":"Ranjit Pandey, Ashesh Dhungana, Deepa Kumari Shrestha, Avatar Verma, Ritamvara Oli, Prajowl Shrestha","doi":"10.33314/jnhrc.v24i02.5596","DOIUrl":"10.33314/jnhrc.v24i02.5596","url":null,"abstract":"<p><strong>Background: </strong>Healthcare-associated infections (HAIs) are the major cause of morbidity and mortality. This study aimed to investigate the prevalence, microbiological profile, resistance patterns, risk factors, and outcomes of HAIs in a respiratory ICU (RICU) of a tertiary care hospital in Nepal.</p><p><strong>Methods: </strong>A prospective observational study was conducted in RICU. HAIs were diagnosed according to the CDC criteria. Descriptive statistics were reported as mean (SD) and frequencies. Unpaired t-tests, chi-square tests were used for comparisons, and multivariable logistic regression was used to assess the risk factors.</p><p><strong>Results: </strong>Among 121 ICU admissions, 42 patients developed 50 episodes of HAI, yielding a prevalence of 34.7%. Ventilator-associated pneumonia was the most common HAIs. The most frequently isolated organisms were Acinetobacter baumannii in 42.0% and Klebsiella pneumonia in 18.0%. Both were resistance to Ceftriaxone. Resistance to Piperacillin-tazobactam were 85.8% and 77.8% and to carbapenems were 92% and 90% respectively. Tigecycline resistance was seen in 20% of Acinetobacter isolates and none of the Klebsiella isolates. Sensitivity to Polymyxin B was 100%. Mechanical ventilation, urinary catheters and history of prior hospitalization were the strongest predictors of HAI. Patients who developed HAI had a longer ICU stay (9.5 vs. 5.2 days, p=0.001) and higher mortality (28.6% vs. 13.9%, p=0.04).</p><p><strong>Conclusions: </strong>HAIs, particularly VAP caused by MDR organisms, were common in our ICU and there was a high resistance to beta lactams and carbapenem antibiotics. Low resistance to tigecycline and polymyxin B warrants careful stewardship.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"24 2","pages":"229-236"},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194789","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":"Advancing Research Governance in Nepal: Lessons from the NHRC-ICMR Technical Exposure Visit.","authors":"Namita Ghimire, Ranjana Chataut, Sujata Acharya, Renu Twanabasu, Roshan Bhatta, Puspa Basnet, Aashish Malasi, Sudip Poudel, Aarati Shah, Hari Prasad Dhakal","doi":"10.33314/jnhrc.v24i02.5751","DOIUrl":"https://doi.org/10.33314/jnhrc.v24i02.5751","url":null,"abstract":"<p><p>The Nepal Health Research Council (NHRC) and the Indian Council of Medical Research (ICMR) established a bilateral collaboration under a Memorandum of Understanding (MoU) signed (January 2021) to foster scientific exchange, capacity building, and health research ethics. NHRC officials comprising research officers, ethics administrators and journal office staff completed an exposure visits to the ICMR headquarters in New Delhi in February 2026. The visit's sessions were centered on ethical practices of ICMR's Bioethics Unit such as the functioning of ethics committees, clinical trial registries, quality assurance protocols, research laboratory standards, and responses to emerging bioethical challenges. This observational engagement identified operational models of potential relevance to NHRC's mandates. Information was compiled from site visits, institutional documents, and expert presentations, and synthesized narratively into thematic lessons. This report describes observed approaches to ethical governance, digitalization, and quality assurance that may inform the strengthening of Nepal's research governance framework. Digitalization, updated national guidelines, tiered accreditation of research institutions, public engagement, and systematic human resource development were identified as priority areas for strengthening research governance in Nepal.  Keywords: Bioethics; capacity building; ethics committees; international cooperation; technology assessment.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"24 2","pages":"237-244"},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194812","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":"Factors Related to Late Intrauterine Fetal Death in a Tertiary Level Hospital: A Retrospective Study.","authors":"Rupesh Singh Basnyat, Suman Tamrakar, Abha Shrestha, Kumari Twayana, Jyoti Dahal, Amartya Dahal, Prabesh Gautam","doi":"10.33314/jnhrc.v24i02.5131","DOIUrl":"https://doi.org/10.33314/jnhrc.v24i02.5131","url":null,"abstract":"<p><strong>Background: </strong>Intrauterine fetal death (IUFD) is an unfortunate perinatal occurrence with serious global and local impacts. Despite improved diagnostic methods, a significant fraction of stillbirths remains unexplained, especially in resource-constrained settings such as Nepal. Thus, the present study aimed to determine the frequency and associated characteristics of late intrauterine fetal death (?28 weeks) in a tertiary-level hospital in Nepal.</p><p><strong>Methods: </strong>A retrospective descriptive study was conducted at Dhulikhel Hospital, Nepal, from January 2024 to January 2025. Medical records from 36 women with late IUFD (?28 weeks of gestation) were reviewed. Data on sociodemographic variables, obstetric history, antenatal care (ANC) attendance, and fetal factors were gathered and analyzed using descriptive statistics.</p><p><strong>Results: </strong>The mean maternal age was 27.3 ± 6.3 years, with most women (88.9%) in the age group between 20-34 years. The majority were multigravida (80.6%) and had attended at least four ANC visits (83.3%). The mean gestational age at delivery was 35.8 ± 4.1 weeks, with a mean fetal birth weight of 1905±834 grams. 41.7% of fetuses weighed less than 1500 grams. Male fetuses prevailed (61.1%). Surprisingly, 80.6% of instances were unexplained. Fetal malpresentation (8.3%), hypertensive disorders (5.6%), and other maternal comorbidities were all identifiable variables.</p><p><strong>Conclusions: </strong>This study highlights a high proportion of unexplained stillbirths despite appropriate antenatal care in a tertiary care setting.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"24 2","pages":"201-205"},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194846","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":"Clinical Presentation, Management and Outcome of Heart Failure Patients.","authors":"Dipanker Prajapati, Birat Krishna Timalsena, Sujata Adhikari, Suraksha Dhungana, Rolina Dhital, Amrit Bogati, Reeju Manandhar, Md Sajjad Safi, Sushant Kharel, Vijay Ghimire, Pratik Thapa, Rahul Yadav, Srijana Khadka, Ankita Gaha Tanlami, Bijita Joshi, Sujata Ghimire, Jyoti Thapa, Rabi Malla, Chandra Mani Adhikari","doi":"10.33314/jnhrc.v24i02.5102","DOIUrl":"10.33314/jnhrc.v24i02.5102","url":null,"abstract":"<p><strong>Background: </strong>Heart failure is a major public health issue with rising hospitalizations and high mortality. This study was conducted to assess the clinical presentation, management and outcome of heart failure patients presenting to a tertiary care hospital.</p><p><strong>Methods: </strong>A prospective, observational study was conducted at a tertiary cardiac center in Nepal over a period of six months among admitted patients aged 18 years and above with heart failure. Data on demographics, etiology, treatment, and outcomes were collected via structured interviews, chart review, clinical observation, phone calls and follow-up. Etiologies were defined per standard criteria and patients were categorized according to the clinical and echocardiographic diagnosis.</p><p><strong>Results: </strong>Among 1523 patients included, the mean age of the cohort was 61.5 ± 14.9 years, and 62.0 % were male. Coronary artery disease (65.8%) was the most common etiology, followed by idiopathic dilated cardiomyopathy (15.0%) and rheumatic heart disease (7.2%). Acute coronary syndrome (39.9%) was the primary aggravating factor. Guideline-directed medical therapy use included Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker (68.5%), Beta-blockers (66.1%), and Mineralocorticoid Receptor Antagonists (61.2%); however, the use of Sodium-Glucose Cotransporter-2 inhibitors was low (15.2%). Device therapy was rare (0.26%). The overall mortality rate was 12.7%, comprising 4.7% in-hospital mortality and 7.9% 90-day mortality.</p><p><strong>Conclusions: </strong>Coronary artery disease is the commonest etiology, with Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker as the commonest prescription, followed by Beta-blockers and Mineralocorticoid Receptor Antagonists, with device therapy being rare, with an overall mortality of 12.7%.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"24 2","pages":"190-200"},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194854","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":"Clinical profile and Pattern of Mandibular Fractures.","authors":"Ishfa Banu Haque, Sandhya Joshi, Kishor Bhandari, Gaurav Karna","doi":"10.33314/jnhrc.v24i02.5491","DOIUrl":"10.33314/jnhrc.v24i02.5491","url":null,"abstract":"<p><strong>Background: </strong> Mandibular fractures are a major component of maxillofacial trauma due to the prominent anatomical position in facial skeleton. Their prevalence, etiology, and injury patterns vary across age groups and are influenced by environmental and geographical factors. This study aims to analyze clinical, demographic profile and pattern of mandibular fractures presenting over a period of 5 years in a tertiary institute.</p><p><strong>Methods: </strong> An observational retrospective study was conducted over a 5-year period from hospital record of National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal. Data of all reported mandibular fracture cases were collected and analyzed based on age, gender, mechanism of injury, fracture site, and monthly variation.</p><p><strong>Results: </strong> A total of 839 mandibular fractures were recorded among 395 patients, with 331 males and 64 females. The most affected age group was 21-30 years (41.8%), while the least affected was 0-10 years (1.0%). Road traffic accidents were the leading cause (60.5%), followed by falls (24.5%), interpersonal violence (13.6%) and sports injuries (1.0%). Road traffic accidents were most common in young adults, whereas falls were more frequent at the extremes of age. Combination fractures involving multiple mandibular sites were more common (33.7 %) than single-site fractures. Among single-site fractures, Parasymphysis (25.1%) was most frequently involved, followed by condyle (13.4 %) and angle (11%). A higher incidence of cases was observed in December followed by July, and August. There was significant association between age group and etiology (p=0.001) and age group and fracture site (p=0.008).</p><p><strong>Conclusions: </strong>  Road Traffic Accident are the leading cause of mandibular fracture in young adults with multiple site combination mandibular fracture being the commonest.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"24 2","pages":"214-220"},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194810","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":"Emotional Intelligence among Undergraduate Physiotherapy Students at Kathmandu University School of Medical Sciences: A Cross-Sectional Study.","authors":"Deepak Joshi, Smriti Dhakal, Bipin Ghimire","doi":"10.33314/jnhrc.v24i01.4682","DOIUrl":"https://doi.org/10.33314/jnhrc.v24i01.4682","url":null,"abstract":"<p><strong>Background: </strong>Emotional intelligence (EI) is the ability to use emotional awareness to guide thoughts and actions. In students, particularly in medicine and physiotherapy, higher EI enhances academic performance, self-awareness, social connectedness, and the ability to form meaningful patient relationships. Higher EI in healthcare professionals is associated with better clinical performance, empathetic patient care, and greater job satisfaction. This study aimed to determine EI in undergraduate physiotherapy students and identify its association with academic performance and year of study.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at Kathmandu University School of Medical Sciences among undergraduate physiotherapy students. EI was measured using the Schutte Self Report Emotional Intelligence Test. EI scores were categorized as low (33-110), average (111-137), and high (138-165). The Pearson test was used to assess the correlation between EI scores and academic performance, while ANOVA was used to assess the association between EI scores and year of study.</p><p><strong>Results: </strong>A total of 102 students were included, of which 86% were female. The mean EI score was 125.63 indicating average status. The majority of students (80%) demonstrated average EI, while 15% had high EI, and 5% had low EI. There was no statistically significant relationship of EI with year of study and academic performance.</p><p><strong>Conclusions: </strong>The findings revealed that most students demonstrated an average level of EI, suggesting that they were reasonably competent in recognizing their own and others' emotions, regulating their emotions, and engaging positively with others. Exploring various factors influencing students' EI presents a promising avenue for future research.</p>","PeriodicalId":16380,"journal":{"name":"Journal of Nepal Health Research Council","volume":"24 1","pages":"13-16"},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813166","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}