Journal of Pediatric Hematology-Oncology Nursing最新文献

{"title":"Evidence-Based Recommendations for School Integration Programs Following Cancer: A Systematic Review.","authors":"Clifton P Thornton, Mary Jo Gamper, Lisa B Carey, Elaina Parrillo, Juliana Paré-Blagoev, Lisa Jacobson, Kathy Ruble","doi":"10.1177/27527530261486401","DOIUrl":"https://doi.org/10.1177/27527530261486401","url":null,"abstract":"<p><p>BackgroundA cancer diagnosis interrupts typical schooling for children with cancer, revoking an essential social health determinant for this vulnerable population. This makes school integration programs a critical component of care. Unfortunately, there is little evidence addressing how to improve school transitions. This systematic review aims to assess the impact of school integration programs on academic, psychosocial, and educational outcomes. Additionally, the review aims to inform best practice for facilitating successful school integration following diagnosis.MethodA comprehensive literature search identified 12,184 articles, 15 of which were retained for this review. To be included, articles must have evaluated a school transition program for children (<21 years of age) diagnosed with cancer.ResultsEffective school integration programs were those that provided precision-based support from transdisciplinary teams and facilitated communication between the clinical, school, and family units. The use of school liaisons and integrating neuropsychologists into the oncology clinic were particularly impactful. Information-based programs and in-services did not yield significant improvements in outcomes.DiscussionEvidence-based solutions to schooling after cancer include a diverse set of resources that match individual family needs, facilitate communication, and link families with existing educational supports. Use of transdisciplinary teams and precision care principles to link families to existing resources is effective.</p>","PeriodicalId":29692,"journal":{"name":"Journal of Pediatric Hematology-Oncology Nursing","volume":" ","pages":"27527530261486401"},"PeriodicalIF":1.6,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149239701","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":"Discharge Planning in Children With Cancer: Components, Strategies, and Outcomes-A Scoping Review (2021-2025).","authors":"Nurbaeti Ramli, Suni Hariati, Kadek Ayu Erika","doi":"10.1177/27527530261486402","DOIUrl":"https://doi.org/10.1177/27527530261486402","url":null,"abstract":"<p><p>BackgroundEffective discharge planning is essential for safe transitions from hospital to home for children with cancer, yet practices vary widely and depend on family readiness, health literacy, and available resources. However, evidence describing its key components and effective delivery remains limited. This scoping review aimed to map contemporary evidence on the components, implementation strategies, outcomes, and contextual factors influencing discharge planning for children with cancer.MethodsThe review followed the Joanna Briggs Institute Scoping Review Framework and was reported according to PRISMA-ScR. We searched PubMed, ScienceDirect, Wiley, SAGE, and EBSCO, supplemented by secondary searching, for studies published between 2021 and 2025. Eligible studies included children with cancer and their caregivers and addressed discharge planning or hospital-to-home transition education. Twenty studies met the criteria. Two researchers independently extracted and verified the data, and findings were synthesized through thematic categorization aligned with the scoping review objectives.ResultsMost studies were conducted in high-income countries, with limited evidence from middle-income settings. Four core components consistently emerged: structured and staged education, caregiver readiness assessment, nurse-led multidisciplinary coordination, and post-discharge follow-up. Commonly reported strategies included teach-back and multimodal education. Reported outcomes included improvements in caregiver preparedness, confidence, and medication safety, as well as reduced preventable readmissions.DiscussionDischarge planning for children with cancer is commonly described as effective when structured, family-centered, multidisciplinary, and delivered in clear stages with standardized support. These findings underscore the need for context-specific discharge models and further intervention studies to strengthen continuity of care and reduce preventable complications.</p>","PeriodicalId":29692,"journal":{"name":"Journal of Pediatric Hematology-Oncology Nursing","volume":" ","pages":"27527530261486402"},"PeriodicalIF":1.6,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149239719","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":"Intervention to Support Families of Survivors of Pediatric Brain Tumor: A Scoping Review.","authors":"Akemi Matsuzawa, Keita Sasaki","doi":"10.1177/27527530261486407","DOIUrl":"https://doi.org/10.1177/27527530261486407","url":null,"abstract":"<p><p>BackgroundFamilies of pediatric brain tumor survivors (PBTS) have unique needs. However, few evidence-based interventions have been developed specifically for families of PBTS. Therefore, this scoping review aimed to identify interventions that provide support to PBTS and their families.MethodWe conducted a scoping review based on methodological frameworks. A comprehensive literature search was conducted using MEDLINE, CINAHL, Web of Science, and Ichushi Web databases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR).ResultsPostscreening, 20 articles were included. Interventions and programs for those survivors and their families were categorized into six types: (a) social skills and problem-solving programs, (b) working-memory training programs, (c) physical training programs, (d) comprehensive follow-up programs (e.g., multiprofessional support and school liaison programs), (e) family relationship programs, and (f) community-based peer support programs. Of all included studies, six involved group-based programs. Of 14 individual-based interventions, six involved online-based programs. Most studies focused on survivors and parents participating in evaluations of interventions or surrogate evaluations; however, few studies focused on the family as a unit.DiscussionPBTS and their families require comprehensive and sustainable interventions in the community. Interventions addressing the needs of the entire family affected by PBTS are needed to improve care quality and advance evidence-based practice. The findings of this scoping review provide a foundation informing future interventions targeted toward families with PBTS.</p>","PeriodicalId":29692,"journal":{"name":"Journal of Pediatric Hematology-Oncology Nursing","volume":" ","pages":"27527530261486407"},"PeriodicalIF":1.6,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149239629","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":"Living With Transfusion-Dependent Thalassemia: Adolescents' Journey Toward Normalcy-A Phenomenological Study.","authors":"Ala' Mohammad Al-Hamad, Khulood Kayed Shattnawi","doi":"10.1177/27527530261486388","DOIUrl":"https://doi.org/10.1177/27527530261486388","url":null,"abstract":"<p><p>BackgroundPatients with beta-thalassemia who require regular blood transfusions experience a high level of burden from the disease. To date, no in-depth Jordanian research has targeted this population, particularly those who have transfusion-dependent beta-thalassemia (TDT). This study aimed to gain a deeper understanding of the lived experiences of Jordanian adolescents enduring TDT.MethodQualitative research utilizing a phenomenological descriptive approach was applied in this study, using semistructured, face-to-face interviews with a purposive sample of 17 adolescents with TDT. The interviews were conducted using an interview guide and recorded with permission. Transcripts were analyzed using a thematic approach to identify themes and subthemes.ResultsThree main themes emerged from the data analysis. The first, \"The multifaceted burdens of thalassemia,\" captured the daily struggles of living with TDT. Participants revealed challenges that interfered with various aspects of their lives. The second theme, \"Personal growth and resilience,\" highlighted participants' ability to overcome these challenging circumstances, demonstrating their resilience. The last theme explored the concept of \"normalcy\" and its sources for adolescents with TDT.ConclusionThis study discloses that \"normalcy\" is an active process of adjustment and management. Ultimately, the resilience allows the adolescents to frame thalassemia as a manageable life challenge, yet this perspective does not wipe away the significant burdens they must recurrently bear.</p>","PeriodicalId":29692,"journal":{"name":"Journal of Pediatric Hematology-Oncology Nursing","volume":" ","pages":"27527530261486388"},"PeriodicalIF":1.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184767","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":"Challenges of Treatment Decisions for Children With Hematological Malignancies Who Relapse After Hematopoietic Stem Cell Transplant: A Health Care Provider Perspective.","authors":"Deborah Tomlinson, Sonia Lucchetta, Sarah Alexander, Sumit Gupta, Erilda Kapllani, Tal Schechter-Finkelstein, Jane Lowry, Joerg Krueger","doi":"10.1177/27527530261448471","DOIUrl":"10.1177/27527530261448471","url":null,"abstract":"<p><p>BackgroundWhen a child or adolescent's disease relapses following hematopoietic stem cell transplantation (HSCT), families are often presented with the complex decision to pursue further treatment with curative intent. This study aims to describe the experiences of health care professionals (HCPs) regarding choices after the first HSCT and factors influencing decision-making.MethodThis qualitative study included staff and trainee physicians, nurse practitioners, and nurse coordinators. All participants had experience caring for children who had received HSCT. Sampling was purposive. We applied a descriptive phenomenological study design using semistructured interviews. Interviews were recorded and transcribed. Two researchers analyzed and coded transcript data. Themes and subthemes were identified. Ranking and scoring of the importance of factors, using a visual analogue scale (VAS) ranging from 0 to 10, that could influence decision-making were examined.ResultsA total of 32 HCPs participated. We identified four themes: (a) navigating self; (b) factors affecting decisions; (c) child and family support; and (d) decision-making biases. There were 12 subthemes. When ranking importance in a list of nine factors, higher ranking was associated with chance of cure, child's quality of life, and the child's preference of treatment. Importance scoring for these three factors plus risks of severe short- and long-term health issues received the highest scores (VAS 9 or 10).DiscussionProviding treatment with curative intent and involving the child in decision-making were important to HCPs. Chance of cure, child preference, quality of life, and risks of health issues were important factors. HCPs should consider the introduction of a palliative care team and discuss the chance of cure.</p>","PeriodicalId":29692,"journal":{"name":"Journal of Pediatric Hematology-Oncology Nursing","volume":" ","pages":"282-293"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832918","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":"Diet, Gastrointestinal Symptoms, and Health-Related Quality of Life in Children With Solid Tumors Receiving Chemotherapy.","authors":"Avery Giffen, Caitlin I Webster, Melissa Martin, Kathryn S Sutton, Thomas Olson, Hye In Noh, Deborah Watkins Bruner, Jinbing Bai","doi":"10.1177/27527530261462150","DOIUrl":"10.1177/27527530261462150","url":null,"abstract":"<p><p>BackgroundChildren undergoing chemotherapy often experience gastrointestinal (GI) symptoms, negatively impacting health-related quality of life (HRQOL). Although macro- and micronutrients have been associated with GI symptoms and HRQOL following cancer diagnosis, more evidence is needed in pediatric oncology populations. This study examines how dietary intake is associated with GI symptoms and HRQOL in children with solid tumors undergoing chemotherapy.MethodThis secondary analysis used the Block Kids Food Screener to assess intake of macro- and micronutrients; the Pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events to measure GI symptoms; and the PedsQL 4.0 to evaluate HRQOL. Logistic and adjusted linear regression models were used to examine how dietary intake was associated with GI symptoms and HRQOL.ResultsThis study included 57 children with a mean age of 13.8 years (<i>SD</i> = 3.5). The majority were male (64.9%) and non-Hispanic White (43.9%). Increased vitamin C was associated with reduced nausea, while increased carbohydrates and beta-carotene were correlated with reduced diarrhea and increased vitamin E with reduced constipation. Increased total fat increased the odds of diarrhea. Higher protein and selenium and lower carbohydrates and vitamin C were associated with better physical HRQOL. A positive association between vitamin A and social HRQOL was noted.ConclusionHigher intakes of carbohydrates, beta-carotene, vitamin C, and vitamin E and lower intake of fat were associated with fewer GI symptoms, while greater consumption of protein, selenium, and vitamin A and lower carbohydrates were linked to improved HRQOL. Findings provide preliminary evidence for development of nutritional plans for pediatric patients undergoing chemotherapy.</p>","PeriodicalId":29692,"journal":{"name":"Journal of Pediatric Hematology-Oncology Nursing","volume":" ","pages":"273-281"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537232","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":"Adolescent and Young Adult Cancer Survivorship: A Concept Analysis.","authors":"Brandy Boeger, Stacey Crane","doi":"10.1177/27527530261424182","DOIUrl":"10.1177/27527530261424182","url":null,"abstract":"<p><p>BackgroundWith an estimated 2.1 million adolescent and young adult (AYA) cancer survivors in the United States, this population experiences disproportionate long-term treatment effects, financial toxicity, psychosocial distress, and disruptions to identity formation. Historically, AYA survivorship has been grouped with either pediatric or adult survivorship models, overlooking the unique needs of this population. The aim of this concept analysis was to define AYA cancer survivorship as a distinct entity.MethodsA concept analysis using Walker and Avant's method was performed. A literature review using CINAHL, PubMed, and PsycINFO databases was conducted and yielded 7,203 articles. Titles and abstracts were reviewed, and 56 key articles were included.ResultsFour defining attributes of AYA Cancer Survivorship emerged: establishing a new normal, redefining identity, relational changes, and the complexity of navigating post-cancer care. The primary antecedent was a cancer diagnosis between the ages of 15 and 39 years. AYA cancer survivorship has physical, psychosocial, financial, and vocational consequences. These consequences can vary in intensity and can persist throughout the duration of their lives.DiscussionAYAs navigate emerging adulthood, identity formation, intimate relationships, financial independence, and career development. These factors compound the impact of cancer treatment, making AYAs vulnerable to psychosocial distress, vocational disruption, and financial toxicity. There is a need to develop holistic care models tailored to the unique interconnected needs of this growing population. Future efforts must aim to build clinical guidelines and develop models of care that empower AYA survivors to thrive beyond cancer.</p>","PeriodicalId":29692,"journal":{"name":"Journal of Pediatric Hematology-Oncology Nursing","volume":" ","pages":"305-328"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945236","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":"Assessing the Efficacy of Essential Oil Aromatherapy on Children Undergoing Port Access: A Pilot Randomized Control Trial.","authors":"Renee Allison Nolen, Keejeong Ryu, Victor Ritter, Robert Bennett, Annette S Nasr","doi":"10.1177/27527530261462142","DOIUrl":"10.1177/27527530261462142","url":null,"abstract":"<p><p>BackgroundPort access can be a significant source of distress for pediatric oncology patients. This study sought to identify whether essential oil aromatherapy effectively reduces anxiety and pain associated with port access for pediatric oncology patients.MethodThis randomized control pilot study assigned participants (<i>N</i> = 19) by age (4-8 years, 9-13 years, and 14-18 years) to either a control group who received standard of care (<i>n</i> = 10) or an intervention group who received standard of care and aromatherapy (<i>n</i> = 9), for a total of 49 control port accesses and 50 aromatherapy intervention port accesses. Participants reported anxiety using the Visual Facial Anxiety Scale on entering the Infusion Lab before port access. They reported pain after port access using either the 0-10 Likert scale or the Wong-Baker Faces Scale.ResultsYounger participants (4-8 years) demonstrated a greater reduction in post-aromatherapy anxiety scores (<i>p</i> = .008). Overall, no significant difference was observed in the reported post-port access pain scores of the intervention and control groups (<i>p</i> = .7). Significant associations across all treatment groups (<i>p</i> < .001) and all age groups (<i>p</i> < .001) were found between post-intervention anxiety and post-access pain scores. The number of visits showed no significant associations with either post-aromatherapy pain (<i>p</i> = .6) or anxiety scores (<i>p</i> = .4).DiscussionEssential oil aromatherapy may effectively reduce reported anxiety scores among younger patients, though this study was underpowered due to its small sample size, and further research is needed to determine the extent of its efficacy.</p>","PeriodicalId":29692,"journal":{"name":"Journal of Pediatric Hematology-Oncology Nursing","volume":"43 5","pages":"294-304"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148986","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":"Feasibility and Nurse Acceptability of Dexmedetomidine Use During I-131 MIBG Therapy in Pediatric Patients With Neuroblastoma.","authors":"Jennifer Spidle, Jean C Solodiuk, Megan Lurvey, Alexis Day, Elaine Lambrinos, Jennifer Costa","doi":"10.1177/27527530261424227","DOIUrl":"10.1177/27527530261424227","url":null,"abstract":"<p><p>BackgroundI-131 metaiodobenzylguanidine (MIBG) therapy effectively treats high-risk neuroblastoma but exposes caregivers and healthcare providers to radiation risks. Managing patient anxiety and agitation is essential for safety. Dexmedetomidine has shown potential as an anxiolytic, but its feasibility and acceptability in this setting are underexplored. This quality improvement (QI) project aimed to evaluate the feasibility and nurse acceptability of dexmedetomidine anxiolysis in our patient population.MethodA retrospective chart review was conducted for pediatric patients who received dexmedetomidine during MIBG therapy between January and June 2023. Feasibility was assessed through adverse events, vital sign changes, and dose adjustments. Nurse acceptability was evaluated using a questionnaire adapted from the Theoretical Framework of Acceptability and a follow-up focus group.ResultsSeven patients received the full MIBG dose with dexmedetomidine and experienced no adverse events. Minor, transient vital sign changes were noted, and all patients adhered to radiation safety protocols. Ten nurses completed the acceptability questionnaire; 100% reported that dexmedetomidine was easy to administer, promoted patient safety, and supported safe MIBG administration. Ninety percent found dexmedetomidine to be an acceptable anxiolytic. Focus group participants (<i>n</i> = 3) identified themes surrounding intravenous access challenges and the need for improved interdisciplinary communication.DiscussionDexmedetomidine appeared to be a feasible and acceptable anxiolytic for pediatric patients receiving MIBG therapy in this small, single-unit QI project. Practice changes included a preadmission multidisciplinary huddle, interdisciplinary huddle requests for clinical concerns, and a dexmedetomidine administration standard operating procedure. This project underscores the importance of multidisciplinary collaboration and nurse feedback in refining clinical practice.</p>","PeriodicalId":29692,"journal":{"name":"Journal of Pediatric Hematology-Oncology Nursing","volume":" ","pages":"258-268"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164642","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":"Navigating the Shadows of Stigma in Sickle Cell Disease: A Phenomenological Study.","authors":"Abby O Seydel, Mary J Isaacson, Brandon M Varilek","doi":"10.1177/27527530261424176","DOIUrl":"10.1177/27527530261424176","url":null,"abstract":"<p><p>BackgroundThe purpose of this study was to explore the experience of stigma among young adults living with sickle cell disease (SCD) using a hermeneutic phenomenological design.MethodSeven young adults diagnosed with SCD participated in semi-structured interviews to explore their experience of stigma as young adults living with SCD. Interviews were transcribed verbatim and analyzed using interpretive phenomenology.ResultsThe participants' narratives revealed an overarching theme of <i>the shadows,</i> representing their experience with stigma. The three subthemes further define how they navigate the shadow of stigma and move through varying degrees of dark and light to balance authenticity and protection. Subthemes include (a) the umbra-darkness, (b) the penumbra-dark and light collide, and (c) the antumbra-light.DiscussionThis study reveals the complex realities of young adults with SCD as they navigate stigma. Each narrative reinforced how stigma is ever-present in their experiences in healthcare, the public, and among family and friends. This research can help health professionals understand the influence stigma has on how young adults with SCD perceive themselves, interact with others, and engage in health-seeking behaviors and highlights the need to address stigma as a structural barrier to health equity.</p>","PeriodicalId":29692,"journal":{"name":"Journal of Pediatric Hematology-Oncology Nursing","volume":" ","pages":"205-215"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843639","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}