Journal of paediatrics and child health最新文献

{"title":"Long-Term Neurodevelopmental Outcomes of the SAFE Early Intervention in Infants at Risk: A Randomised Controlled Trial","authors":"Ramazan Yildiz,&nbsp;Ayse Yildiz,&nbsp;Umut Apaydin,&nbsp;Pelin Atalan Efkere,&nbsp;Kivilcim Gucuyener,&nbsp;Ibrahim Murat Hirfanoglu,&nbsp;Bulent Elbasan","doi":"10.1111/jpc.70191","DOIUrl":"10.1111/jpc.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Early intervention for infants at risk of cerebral palsy (CP) plays a critical role in improving neurodevelopmental outcomes. Recently, approaches emphasising infant active participation and family collaboration have shown greater effectiveness compared to traditional methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to evaluate the effects of the SAFE early intervention approach on cognitive, language, and motor development in infants at risk for CP, in comparison to conventional neurodevelopmental treatment (NDT) practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this randomised controlled trial, 46 infants were assigned to either the SAFE intervention group (<i>n</i> = 23) or the control group receiving NDT-based care (<i>n</i> = 23). The intervention lasted for 3 months, with developmental assessments conducted at 6 and 12 months using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant improvements were observed in motor and language composite scores in the SAFE group between baseline (T1) and the 3-month follow-up (T2), while cognitive scores showed a non-significant increase. Compared to the control group, the SAFE group demonstrated significantly higher scores across all Bayley-III domains at T2. However, the time × group interaction was significant in favour of the SAFE group for motor scores, while cognitive scores favoured the control group. No significant interaction was observed for language scores. Over time, both groups showed developmental progress in various domains, with the SAFE group exhibiting significant motor gains from T1 to T3. The control group showed significant cognitive improvements from T1 and T2 to T3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The SAFE early intervention model appears to be a feasible and effective approach for infants at risk for CP, especially before a formal diagnosis is made. Its focus on active infant participation, family engagement, and enriched environments supports improved motor development outcomes.</p>\u0000 \u0000 <p>\u0000 <b>Trial Registration:</b> NCT06930482</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 10","pages":"1662-1670"},"PeriodicalIF":1.4,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Chair","authors":"Mick O'Keeffe","doi":"10.1111/jpc.70181","DOIUrl":"10.1111/jpc.70181","url":null,"abstract":"&lt;p&gt;ADHD? The referral questioned, succinctly.&lt;/p&gt;&lt;p&gt;I perused the checklist that had been included in the paperwork.&lt;/p&gt;&lt;p&gt;My eyes settled on this line item;&lt;/p&gt;&lt;p&gt;\u0000 &lt;i&gt;Fidgets with hands or feet or squirms in seat&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;I pondered this. Fascinating that the capacity to sit still, squirm-free, has become a KPI of modern living.&lt;/p&gt;&lt;p&gt;No doubt there are myriad circumstances where &lt;i&gt;not&lt;/i&gt; sitting still is socially unacceptable, a life disrupter for the subject.&lt;/p&gt;&lt;p&gt;In that arbitrary social construction we call a classroom. Family mealtimes. When part of a theatre audience. Behind the wheel of a car. Umpiring a tennis match on Wimbledon centre court. Operating a high-rise crane…&lt;/p&gt;&lt;p&gt;I pictured warnings from teachers' past. ‘Don't rock on your chair!’. This always seemed a nanny state prohibition to me. Is it a big deal, really? Let the child rock!&lt;/p&gt;&lt;p&gt;I glanced at the clock (time management), snapped myself out of my reverie (redirected my attention), skimmed my notes (organisation) and invited my patient to join me from the waiting room.&lt;/p&gt;&lt;p&gt;Charlie, a vibrant young man of early primary school age, bounded into the room. He was followed, less enthusiastically, by his mother.&lt;/p&gt;&lt;p&gt;As the consultation got underway, I became aware of movement to my right. Legs bounced, tentatively at first, then with more conviction. Fingers wandered towards my computer keyboard. Charlie's upper body started to sway dramatically, like a flagpole in a cyclone.&lt;/p&gt;&lt;p&gt;Rising in parallel was Charlie's mother's agitation.&lt;/p&gt;&lt;p&gt;‘Sit still!’ she hissed.&lt;/p&gt;&lt;p&gt;Here we go again. Give the young man a break!&lt;/p&gt;&lt;p&gt;‘It's okay’ I said, with a reassuring smile.&lt;/p&gt;&lt;p&gt;Within a few minutes, Charlie had worked his way to the edge of his seat. He continued to wriggle. Suddenly, a tipping point was reached. Both he and the chair descended rapidly towards the floor. In belated pursuit of his mother's advice, limbs flailing, Charlie desperately attempted to regain his seat. The chair refused to co-operate, and was propelled backwards with startling velocity.&lt;/p&gt;&lt;p&gt;I surveyed the scene.&lt;/p&gt;&lt;p&gt;Charlie lay spreadeagled on the floor. His mother had fallen silent, aghast.&lt;/p&gt;&lt;p&gt;And the chair?&lt;/p&gt;&lt;p&gt;In an unlikely physical achievement, the legs of the chair had pierced the thin clinic walls, leaving it suspended firmly in place.&lt;/p&gt;&lt;p&gt;A transformation. No longer a mundane item of office furniture. I was now the proud curator of a thought-provoking piece of installation art.&lt;/p&gt;&lt;p&gt;Potential titles for the work sprang to mind.&lt;/p&gt;&lt;p&gt;Please Take Your Seat.&lt;/p&gt;&lt;p&gt;A Different Perspective.&lt;/p&gt;&lt;p&gt;Driving Me Up the Wall.&lt;/p&gt;&lt;p&gt;Charlie's mother, however, was not in the mood to appreciate the aesthetic. An extra layer of tension had been added to an already highly-strung encounter.&lt;/p&gt;&lt;p&gt;‘Don't worry, this sort of thing happens all the time’ I said, unconvincingly.&lt;/p&gt;&lt;p&gt;We wrapped up soon after, a lingering awkwardness guaranteed by the intrusion of the newly positioned chai","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 10","pages":"1697-1698"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.70181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Intravenous Cannula Splinting Approaches to Reduce Complications in Neonates: A Randomised Controlled Trial.","authors":"Meagan Roff, Melinda Newton, Emma Yeomans, Pramod Pharande, Abdul Razak, Atul Malhotra","doi":"10.1111/jpc.70192","DOIUrl":"https://doi.org/10.1111/jpc.70192","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catastrophic Congenital Hemangioma Resulting in Neonatal Death","authors":"Shrey Sharma,&nbsp;Cathryn Poulton,&nbsp;Adrian Charles,&nbsp;Neil Powers,&nbsp;Connull Leslie,&nbsp;Anne Halbert","doi":"10.1111/jpc.70184","DOIUrl":"10.1111/jpc.70184","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 10","pages":"1689-1691"},"PeriodicalIF":1.4,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric Enterococcal Bacteremia: An Exploration of the Clinical Impact With Emphasis on Antibiotic Resistance.","authors":"Ayse Cakil Guzin, Irem Ceren Erbas, Silem Ozdem Alatas, Hatice Karaoglu Asrak, Elif Alacam, Mahmut Cem Ergon, Eda Karadag-Oncel, Nursen Belet","doi":"10.1111/jpc.70180","DOIUrl":"https://doi.org/10.1111/jpc.70180","url":null,"abstract":"<p><strong>Aim: </strong>Enterococci can cause serious infections in children, such as bloodstream infections. The aim of this study was to analyse the antibiotic resistance patterns of enterococci, identify associated risk factors, guide appropriate treatment strategies and evaluate the impact on clinical outcomes.</p><p><strong>Methods: </strong>This retrospective observational study was conducted at a tertiary-level university hospital in Türkiye and included patients under 18 years of age who were diagnosed with enterococcal bacteremia between January 2013 and May 2023. All positive Enterococcus spp. blood cultures were evaluated, and contaminated and clinically insignificant blood cultures were excluded. Analyses and comparisons were made of ampicillin and vancomycin resistance profiles, clinical outcomes of healthcare-associated infection (HAI) and community-acquired infection (CAI) and antimicrobial resistance trends were documented throughout the study period.</p><p><strong>Results: </strong>In a total of 98 enterococcal bloodstream infections, E. faecium was the most common species (40.8%), and the resistance rates to ampicillin and vancomycin among all enterococci were 52% and 12.2%, respectively. In the multivariate model, the odds ratio of ampicillin resistance was higher in those with non-neonatal infection [odds ratio (OR): 6.098; 95% confidence interval (CI): 1.034-35.958; p = 0.046], prior antibiotic use (OR: 5.013; 95% CI: 1.497-16.787; p = 0.009), persistent bacteremia (OR: 8.204; 95% CI: 1.028-65.475; p = 0.047) and inappropriate initial treatment (OR: 11.252; 95% CI: 3.288-38.504; p < 0.001). The study findings indicated that antibiotic resistance did not impact clinical outcomes; although the number of vancomycin-resistant enterococci (VRE) cases was low, no mortality was observed among these patients at our hospital.</p><p><strong>Conclusion: </strong>Antibiotic resistance in enterococci is common in children with underlying diseases and HAIs. The early empirical glycopeptide therapy consideration for high-risk patients is supported by the prevalence of ampicillin resistance. These findings underline the importance of continuous local surveillance to guide appropriate empiric antibiotic selection and highlight the need for further research into long-term resistance trends and paediatric-specific treatment strategies.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in the Pain Score Evaluation of the Nurse, Mother and Child During Peripheral Vascular Access.","authors":"Emel Sezici, Deniz Yigit","doi":"10.1111/jpc.70178","DOIUrl":"https://doi.org/10.1111/jpc.70178","url":null,"abstract":"<p><strong>Background: </strong>Children may experience pain due to medical procedures. Pain has short-term and long-term negative effects on children. Therefore, accurate assessment of pain is key to appropriate intervention. This study was conducted to determine the concordance or differences between pain reported by the child, mother and nurse during intravenous access.</p><p><strong>Aims: </strong>The aim of this study was to determine agreement or differences between child, mother and nurse-reported pain during intravenous access.</p><p><strong>Method: </strong>This descriptive study was conducted with 307 children aged 3-6 years and their mothers. Wong-Baker Faces Pain Rating Scale and Data Collection Form were used for data collection. Descriptive statistics, Shapiro-Wilk, Mann-Whitney U, Kolmogorov-Smirnov, Kruskal-Wallis and Cohen's kappa tests were used to evaluate the data.</p><p><strong>Results: </strong>The children had a mean age of 4.72 ± 1.11 years, and 18.9% (n = 58) had prior experience with intravenous access. The average number of vascular accesses last year was found to be 1.66 ± 0.80 times. The average pain assessment scores reported by the child, mother and nurse were 4.21 ± 0.84, 3.56 ± 1.62 and 3.18 ± 0.80, respectively. In pairwise comparisons, it was found that there was no agreement between mother and child, nurse and child and mother and nurse (p > 0.05).</p><p><strong>Conclusion: </strong>During intravenous access, the highest pain assessment scores were reported by children, parents and nurses, respectively. This situation revealed that the perceived pain level differed depending on the assessor.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising Incidence of Type 2 Diabetes (T2D) Among Children and Adolescents Under 15 Years Over a 28-Year Period (1995-2023): Insights From a Regional Diabetes Service in Auckland, New Zealand.","authors":"Leo Smith, Saw Shi Hui, Han Dug Yeo, Jacqui Alexander, Craig Jefferies","doi":"10.1111/jpc.70182","DOIUrl":"https://doi.org/10.1111/jpc.70182","url":null,"abstract":"<p><strong>Aim: </strong>To review the incidence of children and adolescents with type 2 diabetes from a regional diabetes service in New Zealand.</p><p><strong>Method: </strong>A retrospective review analysed prospectively gathered data on T2D patients in a treatment referral cohort from January 1995 to December 2023, aged under 15 years.</p><p><strong>Result: </strong>Between 1995 and 2023, 226 cases of paediatric type 2 diabetes (T2D) were identified. The incidence rate increased by 8.3% per year during this period. From 2020 to 2023, the overall incidence rate of T2D was 5.81 per 100 000. Incidence rates among ethnic minority groups, including Pacific peoples, Māori, and other ethnicities (Asian, Middle Eastern, Latin American, and African), were 10.3, 9.84, and 2.63 per 100 000, respectively. New Zealand European youth had an incidence rate of 0.45 per 100 000.</p><p><strong>Conclusion: </strong>Over the past 30 years, the incidence of children and adolescents with T2D in Auckland has increased, particularly among high-risk ethnic groups. This highlights the importance of identifying high-risk subpopulations with unmet needs, implementing targeted interventions, and planning effective healthcare services to achieve equitable health outcomes.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Risk Factors for the Recurrence of Chronic Tic Disorder in Children.","authors":"Miao Jing, Yanping Wang, Jingbo Ma, Xiaoyue Hu, Lin Zhang, Ying Hua, Jianbiao Wang","doi":"10.1111/jpc.70170","DOIUrl":"https://doi.org/10.1111/jpc.70170","url":null,"abstract":"<p><strong>Objective: </strong>To identify risk factors for recurrence in children with chronic tic disorders after 1 year of medication treatment and 6 months post-medication discontinuation.</p><p><strong>Methods: </strong>A two-phase hybrid design study was conducted at Wuxi Children's Hospital, involving 124 paediatric patients with chronic tic disorders treated between January 2020 and December 2022. After 1 year of medication treatment, patients were categorised into relapse and no relapse groups based on recurrence within 6 months post-medication discontinuation. Clinical data from both groups were compared, and multivariate binary logistic regression analysis was used to determine independent risk factors for recurrence.</p><p><strong>Results: </strong>Significant differences were found between the relapse and no relapse groups in age (p = 0.003), white blood cell count (p = 0.001), Mycoplasma pneumoniae antibody IgM (p = 0.009), tic characteristics (p = 0.025), and medication treatment (p = 0.001). Binary logistic regression analysis identified Mycoplasma pneumoniae antibody IgM (OR = 4.797, 95% CI: 1.826-12.605) and vocal tics (OR = 8.202, 95% CI: 2.751-24.455) as independent risk factors for recurrence. Age (OR = 0.519, 95% CI: 0.335-0.803) and Aripiprazole (OR = 0.091, 95% CI: 0.031-0.271) were identified as protective factors.</p><p><strong>Conclusion: </strong>Mycoplasma infection, and vocal tics are significant risk factors for recurrence in children with chronic tic disorders. Increased age and the use of aripiprazole may serve as protective factors and be considered for clinical management of chronic tic disorders in children.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolving Landscape of CHD Genetics: A Contemporary Guide to Genetic Testing and Management.","authors":"Bridget R O'Malley, Gary F Sholler, Janine Smith, Gillian M Blue","doi":"10.1111/jpc.70176","DOIUrl":"https://doi.org/10.1111/jpc.70176","url":null,"abstract":"<p><p>Congenital heart disease (CHD) is the most common birth defect, affecting an estimated 9.4/1000 infants globally. The genetics of CHD is complex, with most cases thought to have multifactorial aetiology, implicating both genetic and environmental factors. Over the last decade, advances in genomic technologies have enabled significant discoveries in the field, with over 170 genes associated with human CHD to date. Further, the diagnostic yield in some patient subgroups is now comparable with other monogenic diseases such that genetic testing is increasingly part of routine CHD care with greater clinical utility. In line with these advances, genetic testing recommendations have been developed to inform and facilitate appropriate genetic testing in CHD patients, including who, when, why, and how to test. In this review, we explore the current understanding of the CHD genetics landscape and how this has evolved, also with respect to the often-evidenced comorbidities present in many patients, including those with syndromic presentations. We discuss practical considerations of genetic testing in CHD, including the type and timing of the testing, diagnostic yields across specific patient groups, patients most likely to benefit from the testing, psychosocial impacts, and the broader implications on clinical care and management. Further, we outline the value and utility of genetic testing for patients and families in line with our experience at the first paediatric CHD genetic clinic in Australia. Finally, we explore future directions for genetic testing in CHD, including the applicability and appropriateness of universal genetic testing in the prenatal and neonatal setting.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystic Fibrosis Detected on Abdominal Imaging: Pancreatic Atrophy With Fat Deposition in an 8-Year-Old Girl","authors":"Yoichi Odahara,&nbsp;Mao Mizuta,&nbsp;Shuhei Norimoto,&nbsp;Yusuke Ishida,&nbsp;Naoya Morisada,&nbsp;Yoshinobu Akasaka,&nbsp;Yasuo Nakagishi","doi":"10.1111/jpc.70179","DOIUrl":"10.1111/jpc.70179","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 10","pages":"1686-1688"},"PeriodicalIF":1.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}