Journal of tissue viability最新文献

{"title":"Exploring resveratrol-enriched collagen dressings for diabetic foot ulcers: A retrospective study of wound healing outcomes","authors":"İsmail Sezikli,&nbsp;Murat Kendirci","doi":"10.1016/j.jtv.2025.100950","DOIUrl":"10.1016/j.jtv.2025.100950","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic foot ulcers (DFUs) are a common and severe complication of diabetes mellitus, often leading to prolonged hospitalization, high treatment costs, and potential amputations. Despite advances in wound care, current dressing materials often lack bioactive properties to modulate chronic wound environments.</div></div><div><h3>Aim</h3><div>To evaluate the clinical efficacy of resveratrol-enriched collagen dressings compared to standard collagen dressings in the management of Wagner grade 2 diabetic foot ulcers.</div></div><div><h3>Methods</h3><div>This retrospective study included 41 patients with Wagner grade 2 DFUs treated at a diabetic foot clinic. Nineteen patients received resveratrol-enriched collagen dressings, while 22 received standard collagen dressings. Patients were matched based on age, glycemic control (HbA1c), and arterial supply (ABPI). Primary and secondary outcomes included wound size reduction, hospitalization duration, and dressing frequency. Statistical analyses included Student's t-test, Mann–Whitney <em>U</em> test, and Kaplan–Meier survival analysis.</div></div><div><h3>Results</h3><div>The resveratrol group demonstrated significantly greater wound size reduction (49.2 % ± 9.1 vs. 32.8 % ± 8.5; p = 0.021), shorter hospital stay (12.3 ± 2.8 vs. 14.5 ± 3.2 days; p = 0.045), and fewer dressing changes (19.8 ± 5.2 vs. 24.3 ± 6.7; p = 0.038). No adverse events were reported. Improved outcomes were attributed to resveratrol's antioxidant, anti-inflammatory, and antimicrobial effects.</div></div><div><h3>Conclusions</h3><div>Resveratrol-enriched collagen dressings significantly improved clinical outcomes in DFUs, suggesting a promising adjunctive treatment strategy. Further prospective studies are warranted to confirm these findings and explore long-term benefits.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 4","pages":"Article 100950"},"PeriodicalIF":2.4,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of missed interventions on tissue injury outcomes identified via sub-epidermal moisture scanning","authors":"Carl Stewart Yuile ,&nbsp;Vicki Patton","doi":"10.1016/j.jtv.2025.100949","DOIUrl":"10.1016/j.jtv.2025.100949","url":null,"abstract":"<div><h3>Aim</h3><div>Sub-epidermal moisture scanning is an emerging tool for the early detection of hospital-acquired pressure injuries. However, the impact of missed interventions following high SEM readings remains underexplored. This study examined the relationship between intervention compliance, missed interventions, and ΔSEM improvement in patients in an intensive care unit and a rehabilitation unit.</div><div>Sub-epidermal moisture (SEM) scanning is a validated tool for the early detection of hospital-acquired pressure injuries (HAPIs). However, the impact of missed interventions following high SEM readings remains underexplored. This study examines the relationship between intervention compliance, missed interventions, and ΔSEM improvement in patients from an intensive care unit (ICU) and a rehabilitation unit.</div></div><div><h3>Methods</h3><div>This prospective observational study was conducted in a metropolitan ICU and a secondary rehabilitation unit in Australia. Daily SEM scanning was conducted alongside standard HAPI prevention measures. A ΔSEM value ≥ 0.6 triggered clinical interventions. Missed interventions were defined as the absence of additional care following a high ΔSEM reading. Descriptive and inferential statistics were used to explore associations between compliance and ΔSEM improvement.</div></div><div><h3>Results</h3><div>Among 229 patients, including 181 in the rehabilitation unit and 48 in the ICU, high ΔSEM values were observed in 75.5 % and 79.2 % of patients, respectively. SEM-guided interventions were associated with a 63 % reduction in HAPI incidence in the rehabilitation unit and improved ΔSEM outcomes in ICU patients. Three missed interventions resulted in persistent high ΔSEM values in ICU and four in the rehabilitation cohort indicating a potential critical window.</div></div><div><h3>Conclusion</h3><div>Timely interventions following high SEM readings are critical for improving tissue health and reducing HAPI risk. Further research should explore critical windows for responsive care in different patient cohorts. Scanning protocols and interventions should be tailored to specific clinical environments.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 4","pages":"Article 100949"},"PeriodicalIF":2.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144907630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the association between pressure ulcers and sitting in adults: What does it mean for all of us?","authors":"M Stephens, C A Bartley, D S Chester Bessell, C Greenwood, A Marshall, S Neill, S Rooney, S Rose, S A Scattergood, P R Worsley","doi":"10.1016/j.jtv.2025.100937","DOIUrl":"https://doi.org/10.1016/j.jtv.2025.100937","url":null,"abstract":"<p><p>This third version of the seating guidelines aims to deliver a practical guide, using the most up to date research and evidence on pressure ulcer prevention and management. This guide can be applied to adults who remain seated for extended periods of time across health and social care settings. In the UK, over 700,000 patients are affected by pressure ulcers each year; 180,000 of those are newly acquired and their treatment is estimated to cost the NHS £3.8 million every day. Therefore, guidelines that have been written for people living or working in health and social care are essential. Within the guidelines the authors explore how and where pressure ulcers develop when seated, the potential risk factors, the best possible seated position, ideal seating assessment, and who might be involved and what interventions can one expect after a seating assessment. The guidelines then go on to examine cushion and static chair selection, cushion covers, wheelchairs, and the use of tilt, recline, and elevating leg rests. Finally there is an examination of self-help strategies to prevent pressure ulcers, the key outcomes for those who remain seated for long periods and standards for procuring and testing cushions and static chairs.</p>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":" ","pages":"100937"},"PeriodicalIF":2.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors of dependence-related skin lesions in neonatal units: A multicentre study across Spanish hospitals","authors":"Evelin Balaguer López ,&nbsp;Isabel María Mora Morillo ,&nbsp;Pablo Buck Sainz-Rozas ,&nbsp;María Carmen Rodríguez Dolz ,&nbsp;Laura Plá Marzo ,&nbsp;Pablo Garcia Molina","doi":"10.1016/j.jtv.2025.100945","DOIUrl":"10.1016/j.jtv.2025.100945","url":null,"abstract":"<div><h3>Aim</h3><div>This study aimed to obtain updated epidemiological indicators of dependence-related skin lesions (DRSLs) in neonatal units of Spanish hospitals and to analyze preventive interventions and risk factors associated with DRSL development.</div></div><div><h3>Materials and methods</h3><div>A multicentre, observational, cross-sectional prevalence study was conducted across three data collection phases in 12 Spanish hospitals with neonatal units, and included 398 hospitalised neonates. Data collection was based on direct observation, clinical record review, and caregiver interviews. The Neonatal Skin Risk Assessment Scale (e-NSRAS) was used to assess DRSL risk. Demographic variables, risk factors, and preventive measures were also analyzed.</div></div><div><h3>Results</h3><div>DRSL prevalence was 29.4 %. Moisture-related lesions (18.6 %) were the most common, especially in intermediate care, followed by pressure injuries (13.07 %), more prevalent in intensive care, and friction-related lesions (3.02 %). Non-invasive mechanical ventilation and urinary catheterisation were significantly associated with DRSL occurrence. Additionally, 34 % of neonates were classified as at risk of pressure injuries.</div></div><div><h3>Discussion</h3><div>A high DRSL prevalence was observed among hospitalised neonates, exceeding rates reported in other national and international studies. The e-NSRAS appears unsuitable for assessing all DRSL types. The use of multiple medical devices was associated with higher DRSL rates, and preventive measures were often applied late or inadequately. Study limitations include those typical of cross-sectional studies, such as representativeness, confounding factors, and sample size.</div></div><div><h3>Conclusion</h3><div>DRSLs are a prevalent issue in Spanish neonatal units. The development and implementation of targeted preventive measures, along with the adaptation of assessment tools, are critical for enhancing the quality of neonatal care.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 4","pages":"Article 100945"},"PeriodicalIF":2.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an evidence-based protocol for the prevention of perioperative pressure injuries in pediatric cardiac surgery: A Delphi study","authors":"Xiangai Ma ,&nbsp;Jialu Fan ,&nbsp;Jiehui Wang ,&nbsp;He Lin","doi":"10.1016/j.jtv.2025.100948","DOIUrl":"10.1016/j.jtv.2025.100948","url":null,"abstract":"<div><h3>Aim</h3><div>Pediatric patients undergoing cardiac surgery are at high risk for perioperative pressure injuries (PPIs). This study aimed to develop an evidence-based protocol for the prevention of PPIs in pediatric cardiac surgery.</div></div><div><h3>Methods</h3><div>A literature review was conducted to identify and summarize the existing evidence on PPI prevention in pediatric cardiac surgery to construct an initial protocol. Two rounds of Delphi surveys were then performed to refine the protocol. The expert panel consisted of 20 multidisciplinary professionals from five tertiary hospitals, including nurses, surgeons, and anesthesiologists, 85 % of whom possess more than 20 years of clinical experience. The mean values of importance and feasibility of each indicator were calculated. Reliability of the Delphi method assessed by valid response rate, authority coefficient (Cr), coefficient of variation (CV) and Kendall’ W coefficient (Kendall’ W).</div></div><div><h3>Results</h3><div>Consensus was reached on 4 first-level items, 15 s-level items, and 27 third-level items for the PPI prevention protocol. The valid response rates for the two Delphi rounds were 83.3 % and 100 %, respectively, with Cr of 0.905 and 0.901, CV of less than 0.25, and Kendall’ W of 0.172 and 0.142 (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>The developed PPI prevention protocol for pediatric cardiac surgery is both scientific and feasible, providing a reference for perioperative nurses to implement systematic and standardized PPI prevention care.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 4","pages":"Article 100948"},"PeriodicalIF":2.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving concordance with long-term compression therapy amongst people with venous hypertension and lower leg ulceration: A Delphi study- patient cohort","authors":"Chloe Jansz ,&nbsp;William McGuiness ,&nbsp;Sonja Cleary","doi":"10.1016/j.jtv.2025.100947","DOIUrl":"10.1016/j.jtv.2025.100947","url":null,"abstract":"<div><div>Concordance rates for compression therapy (CT) among patients with venous leg ulcers (VLU) have consistently been suboptimal, despite efforts to understand influencing factors [2–4]. VLUs arise as a complication of chronic venous insufficiency (CVI), where venous incompetence or stenosis causes increased capillary permeability, fluid retention, and eventual ulceration [1].</div><div>CT is the established gold standard for managing CVI and preventing VLUs. CT works by enhancing venous return, reducing venous pressure, and minimising stasis. However, ensuring patient concordance to CT remains a challenge.</div><div>A Delphi study explored factors affecting CT concordance among VLU patients. The study identified 16 facilitators and 18 barriers, offering insights into the complexities of patient concordance. The study's analysis using the Kendall W Coefficient showed moderate consensus among participants regarding these influencing factors [9].</div><div>Efforts to improve CT concordance may benefit from addressing the identified barriers while leveraging facilitators, with a focus on personalised care approaches to enhance outcomes.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 4","pages":"Article 100947"},"PeriodicalIF":2.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of surgery-related pressure injury with infrared thermal camera in the postoperative intensive care unit","authors":"Onur Çor ,&nbsp;Arzu Özcan İlçe ,&nbsp;Yavuz Demiraran","doi":"10.1016/j.jtv.2025.100944","DOIUrl":"10.1016/j.jtv.2025.100944","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to monitor skin temperature in pressure-prone areas of post-surgical patients in the intensive care unit using an infrared thermal camera and to examine the factors influencing the development of pressure injuries.</div></div><div><h3>Methods</h3><div>This prospective descriptive study was conducted on patients admitted to the intensive care unit following surgery lasting more than two hours. Skin temperature differences between the sacrum, right and left gluteal regions, and right and left heels, compared to reference regions, were measured using an infrared thermal camera. Measurements were taken immediately upon admission to the intensive care unit. The correlation between patients' clinical conditions and observed temperature differences was analyzed.</div></div><div><h3>Results</h3><div>The study included 59 patients and involved 590 thermographic evaluations. Temperature differences were identified between the reference areas and the right heel (−3.61 °C), left heel (−3.34 °C), left gluteal region (−2.9 °C), right gluteal region (−2.89 °C), and sacrum (−2.47 °C). A statistically significant correlation (p &lt; 0.05) was found between patient age, albumin and hemoglobin levels, and temperature differences.</div></div><div><h3>Conclusions</h3><div>Temperature differences between the high-risk body parts of patients at risk of pressure injury after long-term surgery were measured using an infrared thermal camera. It is observed that, hypoalbuminemia, and low hemoglobin levels affect the temperature difference in the sacrum, gluteal region, and heels in a statistically significant way especially in advanced age. The infrared thermal camera proved to be more effective than the Braden Risk Assessment Scale in assessing skin for pressure injury risk. Further studies with larger sample sizes are recommended to confirm these findings.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 4","pages":"Article 100944"},"PeriodicalIF":2.4,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a predictive formula for arterial complete occlusion pressure in upper and lower limbs during blood flow restriction","authors":"María García-Arrabé,&nbsp;Ángel González-de-la-Flor,&nbsp;Federico Salniccia,&nbsp;Javier López-Ruiz,&nbsp;Guillermo García-Pérez-de-Sevilla","doi":"10.1016/j.jtv.2025.100946","DOIUrl":"10.1016/j.jtv.2025.100946","url":null,"abstract":"<div><div>Blood flow restriction (BFR) is an innovative technique widely utilized in sports and rehabilitation for enhancing muscle strength and hypertrophy with low-load exercises. A critical factor for its efficacy and safety is determining the appropriate limb occlusion pressure (LOP). This study aimed to develop predictive formulas for estimating LOP in the upper and lower limbs based on anthropometric and hemodynamic variables, enabling a standardized and personalized approach to BFR application.</div><div>A cross-sectional observational study was conducted with 39 healthy participants aged 18–40 years. Variables such as systolic and diastolic blood pressure, limb circumferences, and BMI were analyzed. LOP was measured by two independent raters using Doppler ultrasound, and multiple linear regression models were developed for each limb. Results showed that systolic blood pressure and limb circumferences were key predictors for LOP in both upper and lower limbs, explaining 39.5 % and 40.9 % of the variance, respectively. BMI was not a significant predictor in either model.</div><div>High intra- and inter-rater reliability of LOP measurements was demonstrated, with intraclass correlation coefficients (ICC) of 0.99 for intra-rater and 0.98 for inter-rater reliability, indicating excellent agreement. The standard error of measurement (SEM), ranged from 1.08 to 4.10 mmHg across measures, while the minimum detectable change (MDC), ranged from 2.99 to 11.37 mmHg.</div><div>The findings provide a reliable framework for personalizing BFR protocols, improving safety and efficacy while reducing variability in clinical and sports settings. Future research should validate these formulas in diverse populations and explore their application during exercise.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 4","pages":"Article 100946"},"PeriodicalIF":2.4,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADVERTISEMENT - JTV - CONFERENCE 2026 210X280MM","authors":"","doi":"10.1016/S0965-206X(25)00089-0","DOIUrl":"10.1016/S0965-206X(25)00089-0","url":null,"abstract":"","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 3","pages":"Article 100941"},"PeriodicalIF":2.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical reconstruction (SR) to treat severe pressure ulcers (SPU) in the UK: a mixed-methods analysis of surveys of healthcare professionals","authors":"Maria Pufulete ,&nbsp;Matthew Hackney ,&nbsp;Christalla Pithara-McKeown ,&nbsp;Abby O'Connell ,&nbsp;Una Adderley ,&nbsp;Nicky Cullum ,&nbsp;Matthew J. Ridd ,&nbsp;Jeremy Rodrigues ,&nbsp;Jason KF. Wong ,&nbsp;Barnaby C. Reeves ,&nbsp;Jo C. Dumville","doi":"10.1016/j.jtv.2025.100938","DOIUrl":"10.1016/j.jtv.2025.100938","url":null,"abstract":"<div><h3>Background</h3><div>We surveyed primary and secondary care health professionals to describe the care and referral pathways for treatment, including surgical reconstruction (SR), for patients with a severe pressure ulcer (SPU).</div></div><div><h3>Methods</h3><div>We administered three online surveys comprising closed and open-ended questions (free text comment boxes) to healthcare professionals working in primary care, nurses who look after patients with severe PUs in any setting and surgeons (11, 30 and 22 questions, respectively). Participants were recruited through professional organisations, contacts of study team members and through social media. We calculated descriptive statistics for the closed questions and used principles of thematic analysis to analyse the free text comments.</div></div><div><h3>Results</h3><div>There were 59 primary care (76 % GPs), 146 nurse and 45 surgeon respondents. Most nurses worked in hospitals (60 %) or the community (55 %) and almost all (93 %) were trained in wound care. Most surgeons were plastic surgeons (79 %) in consultant roles (81 %). Over half of primary care respondents did not know SR is a treatment option to close SPUs and had never referred patients with SPUs to secondary care for a surgical opinion. Nearly three quarters of nurses (72 %) considered SR for a SPU and over half (54 %) believed that SR to close a SPU should be more widely available. Surgeons reported that SR was not performed for most referred SPU patients; but two thirds (68 %) believed that SR should be more widely available. There was good agreement about which patients are suitable for SR. The free-text analysis identified both system-level (e.g. lack of care pathways, dedicated multidisciplinary teams, resources) and patient-level (e.g. patient lifestyle, behaviour and preferences) factors influencing patients’ access to SR.</div></div><div><h3>Conclusions</h3><div>Our surveys highlighted that nurses and surgeons agree about which SPU patients are suitable for SR but lack of awareness, the absence of an established referral pathway and lack of multidisciplinary teams are barriers to access to SR.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 4","pages":"Article 100938"},"PeriodicalIF":2.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}