Family Medicine and Community Health最新文献

{"title":"fRAP 2.0: a community engagement method applied to cervical cancer disparities among Hispanic women.","authors":"Autumn M Kieber-Emmons, Susan E Hansen, Michael Topmiller, Jaskaran Grewal, Carlos Roberto Jaen, Benjamin F Crabtree, William L Miller","doi":"10.1136/fmch-2023-002601","DOIUrl":"10.1136/fmch-2023-002601","url":null,"abstract":"<p><p>focused Rapid Assessment Process (fRAP) 2.0 is a community engagement approach combining geospatial mapping with rapid qualitative assessment in cyclical fashion within communities to capture multifactorial and multilevel features impacting primary care problems. fRAP 2.0 offers primary care researchers a methodology framework for exploring complex community features that impact primary healthcare delivery and outcomes. The fRAP 2.0 study design expands the fRAP from a sequential design to a cyclical process of geospatial mapping and rapid qualitative assessment in search of modifiable contextual factors. Research participants are stakeholders from various socioecological levels whose perspectives inform study outcomes that they may use to then become the agents of change for the very problems they helped explore. Here, we present a proof-of-concept study for fRAP 2.0 examining disparities in cervical cancer mortality rates among Hispanic women in Texas. The primary outcomes of interest are features at the community level, medical health system level and regional government policy levels that offer opportunities for collaborative interventions to improve cervical cancer outcomes. In this study, geospatial mapping of county and ZIP code-level variables impacting postdiagnosis cervical cancer care at community, medical and policy levels were created using publicly available data and then overlaid with maps created with Texas Cancer Registry data for cervical cancer cases in three of the largest population counties. Geographically disparate areas were then qualitatively explored using participant observation and ethnographic field work, alongside 39 key informant interviews. Roundtable discussion groups and stakeholder engagement existed at every phase of the study. Applying the fRAP 2.0 method, we created an action-oriented roadmap of next steps to improve cervical cancer care disparities in the three Texas counties with emphasis on the high disparity county. We identified local change targets for advocacy and the results helped convene a stakeholder group that continues to actively create on-the-ground change in the high-disparity county to improve cervical cancer outcomes for Hispanic women.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056821","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":"Survey of international experts on research priorities to improve care for healthy ageing.","authors":"Matteo Cesari, Yuka Sumi, Hyobum Jang, Jotheeswaran Amuthavalli Thiyagarajan, Yejin Lee, Rachel Albone, Marco Canevelli, Monica R Perracini, Andrew M Briggs, Anshu Banerjee","doi":"10.1136/fmch-2023-002703","DOIUrl":"https://doi.org/10.1136/fmch-2023-002703","url":null,"abstract":"","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894564","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":"Global lessons on delivery of primary healthcare services for people with non-communicable diseases: convergent mixed methods.","authors":"Robert Mash, Lisa R Hirschhorn, Inayat Singh Kakar, Renu John, Manushi Sharma, Devarsetty Praveen","doi":"10.1136/fmch-2023-002553","DOIUrl":"10.1136/fmch-2023-002553","url":null,"abstract":"<p><strong>Objective: </strong>To extract key lessons on primary healthcare (PHC) service delivery strategies for non-communicable diseases (NCD) from the work of researchers funded by the Global Alliance for Chronic Diseases (GACD).</p><p><strong>Design: </strong>A convergent mixed methods study that extracted data using a standardised template from research projects funded by the GACD that focused on PHC. The strategies implemented in these studies were mapped onto the PHC Performance Initiative framework. Semistructured qualitative interviews were conducted with researchers from purposefully selected projects to understand the strategies and contextual factors in more depth.</p><p><strong>Setting: </strong>PHC contexts from low or middle-income countries (LMIC) as well as vulnerable groups within high-income countries. Projects came from all regions of the world, particularly East Asia and Pacific, sub-Saharan Africa, South Asia, Latin America and Caribbean.</p><p><strong>Participants: </strong>The study extracted data on 84 research projects and interviewed researchers from 16 research projects.</p><p><strong>Results: </strong>Research projects came from all regions of the world, and mainly focused on diabetes (35.3%), hypertension (28.3%) and mental health (27.6%). Mapped onto the PHC Performance Initiative framework: 49.4% focused on high-quality PHC (particularly the comprehensiveness of NCD care, 41.2%); 41.2% on the availability of PHC services (particularly the competence of healthcare workers, 36.5%); 35.3% on population health management (particularly community-based services, 35.3%); 34.1% on facility organisation and management (particularly team-based care, 20.0%) and 31.8% on access (particularly digital technology, 23.5%). Most common strategies were task shifting and training to improve the comprehensiveness of NCD care through community-based services. Contextual factors related to inputs: infrastructure, equipment and medication, workforce (particularly community health workers), finances, health information systems and digital technology.</p><p><strong>Conclusion: </strong>Key strategies and contextual factors to improve PHC service delivery for NCDs in LMICs were identified. These strategies should combine with other strategies to strengthen the PHC system as a whole, while improving care for NCDs.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual and geospatial factors associated with receipt of colorectal cancer screening: a state-wide mixed-level analysis.","authors":"Jennifer E Bayly, Mara A Schonberg, Marcia C Castro, Kenneth J Mukamal","doi":"10.1136/fmch-2024-002983","DOIUrl":"https://doi.org/10.1136/fmch-2024-002983","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) is the second leading cause of cancer death in US adults but can be reduced by screening. The roles of individual and contextual factors, and especially physician supply, in attaining universal CRC screening remains uncertain.</p><p><strong>Methods: </strong>We used data from adults 50-75 years old participating in the 2018 New York (NY) Behavioural Risk Factor Surveillance System linked to county-level covariates, including primary care physician (PCP) density and gastroenterologist (GI) density. Data were analysed in 2023-2024. Our analyses included (1) ecological and geospatial analyses of county-level CRC screening prevalence and (2) individual-level Poisson regression models of receipt of screening, adjusted for socioeconomic and county-level contextual variables.</p><p><strong>Results: </strong>Mean prevalence of up-to-date CRC screening was 71% (95% CI 70% to 73%) across NY's 62 counties. County-level CRC screening demonstrated significant spatial patterning (Global Moran's I=0.14, p=0.04), consistent with the existence of county-level contextual factors. In both county-level and individual-level analyses, lack of health insurance was associated with lower likelihood of up-to-date screening (ß=-1.09 (95% CI -2.00 to -0.19); adjusted prevalence ratio 0.68 (95% CI 0.60 to 0.77)), even accounting for age, race/ethnicity and education. In contrast, county-level densities of both PCPs and GIs were completely unassociated with screening at either the county or individual level. As expected, other determinants at the individual level included education status and age.</p><p><strong>Conclusion: </strong>In this state-wide representative analysis, physician density was completely unassociated with CRC screening, although health insurance status remains strongly related. In similar screening environments, broadened insurance coverage for CRC screening is likely to improve screening far more effectively than increased physician supply.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727943","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":"Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: a territory-wide target trial emulation","authors":"Cuiling Wei, Vincent Ka Chun Yan, Camille Maringe, Wenxin Tian, Rachel Yui Ki Chu, Wenlong Liu, Boyan Liu, Yuqi Hu, Lingyue Zhou, Celine Sze Ling Chui, Xue Li, Eric Yuk Fai Wan, Ching Lung Cheung, Esther Wai Yin Chan, William Chi Wai Wong, Ian Chi Kei Wong, Francisco Tsz Tsun Lai","doi":"10.1136/fmch-2024-002834","DOIUrl":"https://doi.org/10.1136/fmch-2024-002834","url":null,"abstract":"Objectives Older individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19. Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals have rarely been examined. This study aims to examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged 85 years or above with multimorbidity. Design Retrospective cohort study emulating a randomised target trial using electronic health records. Setting We used data from the Hospital Authority and the Department of Health in Hong Kong, which provided comprehensive electronic health records, COVID-19 confirmed case data, population-based vaccination records and other individual characteristics for the study. Participants Adults aged 85 years or above with multimorbidity who were discharged after hospitalisation for COVID-19 between January 2020 and August 2022. Interventions Attending a general outpatient within 30 days of last COVID-19 discharge defined the exposure, compared to no outpatient visit. Main outcome measures Primary outcome was all-cause mortality within one year. Secondary outcomes included mortality from respiratory, cardiovascular and cancer causes. Results A total of 6183 eligible COVID-19 survivors were included in the analysis. The all-cause mortality rate following COVID-19 hospitalisation was lower in the general outpatient visit group (17.1 deaths per 100 person-year) compared with non-visit group (42.8 deaths per 100 person-year). After adjustment, primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival (difference in 1-year survival: 11.2%, 95% CI 8.1% to 14.4%). We also observed significantly better survival from respiratory diseases in the general outpatient visit group (difference in 1-year survival: 6.3%, 95% CI 3.5% to 8.9%). In a sensitivity analysis for different grace period lengths, we found that the earlier participants had a general outpatient visit after COVID-19 discharge, the better the survival. Conclusions Timely primary care consultations after COVID-19 hospitalisation may improve survival following COVID-19 hospitalisation among older adults aged 85 or above with multimorbidity. Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population’s recovery and well-being. No data are available. The data custodian has not given permission for data sharing.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141612898","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":"Performance of generative pre-trained transformers (GPTs) in Certification Examination of the College of Family Physicians of Canada.","authors":"Mehdi Mousavi, Shabnam Shafiee, Jason M Harley, Jackie Chi Kit Cheung, Samira Abbasgholizadeh Rahimi","doi":"10.1136/fmch-2023-002626","DOIUrl":"10.1136/fmch-2023-002626","url":null,"abstract":"<p><strong>Introduction: </strong>The application of large language models such as generative pre-trained transformers (GPTs) has been promising in medical education, and its performance has been tested for different medical exams. This study aims to assess the performance of GPTs in responding to a set of sample questions of short-answer management problems (SAMPs) from the certification exam of the College of Family Physicians of Canada (CFPC).</p><p><strong>Method: </strong>Between August 8th and 25th, 2023, we used GPT-3.5 and GPT-4 in five rounds to answer a sample of 77 SAMPs questions from the CFPC website. Two independent certified family physician reviewers scored AI-generated responses twice: first, according to the CFPC answer key (ie, CFPC score), and second, based on their knowledge and other references (ie, Reviews' score). An ordinal logistic generalised estimating equations (GEE) model was applied to analyse repeated measures across the five rounds.</p><p><strong>Result: </strong>According to the CFPC answer key, 607 (73.6%) lines of answers by GPT-3.5 and 691 (81%) by GPT-4 were deemed accurate. Reviewer's scoring suggested that about 84% of the lines of answers provided by GPT-3.5 and 93% of GPT-4 were correct. The GEE analysis confirmed that over five rounds, the likelihood of achieving a higher CFPC Score Percentage for GPT-4 was 2.31 times more than GPT-3.5 (OR: 2.31; 95% CI: 1.53 to 3.47; p<0.001). Similarly, the Reviewers' Score percentage for responses provided by GPT-4 over 5 rounds were 2.23 times more likely to exceed those of GPT-3.5 (OR: 2.23; 95% CI: 1.22 to 4.06; p=0.009). Running the GPTs after a one week interval, regeneration of the prompt or using or not using the prompt did not significantly change the CFPC score percentage.</p><p><strong>Conclusion: </strong>In our study, we used GPT-3.5 and GPT-4 to answer complex, open-ended sample questions of the CFPC exam and showed that more than 70% of the answers were accurate, and GPT-4 outperformed GPT-3.5 in responding to the questions. Large language models such as GPTs seem promising for assisting candidates of the CFPC exam by providing potential answers. However, their use for family medicine education and exam preparation needs further studies.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11138270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing innovation to help meet the needs of elders: field testing an electronic tool to streamline geriatric assessments across healthcare settings.","authors":"Limor Adler, Zorian Radomyslsky, Miri Mizrahi Reuveni, Eduardo Schejter, Ilan Yehoshua, Yakov Segal, Sara Kivity, Etti Naimi, Mor Saban","doi":"10.1136/fmch-2024-002729","DOIUrl":"10.1136/fmch-2024-002729","url":null,"abstract":"<p><strong>Background: </strong>As populations age globally, effectively managing geriatric health poses challenges for primary care. Comprehensive geriatric assessments (CGAs) aim to address these challenges through multidisciplinary screening and coordinated care planning. However, most CGA tools and workflows have not been optimised for routine primary care delivery.</p><p><strong>Objective: </strong>This study aimed to evaluate the impact of a computerised CGA tool, called the Golden Age Visit, implemented in primary care in Israel.</p><p><strong>Methods: </strong>This study employed a quasiexperimental mixed-methods design to evaluate outcomes associated with the Golden Age electronic health assessment tool. Quantitative analysis used electronic medical records data from Maccabi Healthcare Services, the second largest health management organisation (HMO) in Israel. Patients aged 75 and older were included in analyses from January 2017 to December 2019 and January 2021 to December 2022. For patients, data were also collected on controls who did not participate in the Golden Age Visit programme during the same time period, to allow for comparison of outcomes. For physicians, qualitative data were collected via surveys and interviews with primary care physicians who used the Golden Age Visit SMARTEST e-assessment tool.</p><p><strong>Results: </strong>A total of 9022 community-dwelling adults aged 75 and older were included in the study: 1421 patients received a Golden Age Visit CGA (intervention group), and 7601 patients did not receive the assessment (control group). After CGAs, diagnosis rates increased significantly for neuropsychiatric conditions and falls. Referrals to physiotherapy, occupational therapy, dietetics and geriatric outpatient clinics also rose substantially. However, no differences were found in rates of hip fracture or relocation to long-term care between groups. Surveys among physicians (n=151) found high satisfaction with the programme.</p><p><strong>Conclusion: </strong>Implementation of a large-scale primary care CGA programme was associated with improved diagnosis and management of geriatric conditions. Physicians were also satisfied, suggesting good uptake and feasibility within usual care. Further high-quality studies are still needed but these results provide real-world support for proactively addressing geriatric health needs through structured screening models.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11103227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Storylines of family medicine IV: perspectives on practice—lenses of appreciation","authors":"W. Ventres, Leslie A Stone, Radeeb Akhtar, Jeffrey M Ring, Lucy M Candib, Erick Messias, Ronald M Epstein, Marc Tunzi, Amy L Lee, Christopher P. Morley, Carina M Brown, David Slawson, Jill Konkin, David G Campbell, I. Couper, Susan Williams, Robert Brooks, Lucie Walters","doi":"10.1136/fmch-2024-002791","DOIUrl":"https://doi.org/10.1136/fmch-2024-002791","url":null,"abstract":"Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘IV: perspectives on practice—lenses of appreciation’, authors address the following themes: ‘Relational connections in the doctor–patient partnership’, ‘Feminism and family medicine’, ‘Positive family medicine’, ‘Mindful practice’, ‘The new, old ethics of family medicine’, ‘Public health, prevention and populations’, ‘Information mastery in family medicine’ and ‘Clinical courage.’ May readers nurture their curiosity through these essays.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794767","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":"Storylines of family medicine IX: people and places—diverse populations and locations of care","authors":"W. Ventres, Leslie A Stone, Emad R Abou-Arab, Julio Meza, David S Buck, Jerome W Crowder, J. Edgoose, Alexander Brown, Ellen J Plumb, Amber K Norris, Jay J Allen, Lauren E Giammar, John E Wood, Scott M. Dickson, G. A. Brown","doi":"10.1136/fmch-2024-002826","DOIUrl":"https://doi.org/10.1136/fmch-2024-002826","url":null,"abstract":"Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘IX: people and places—diverse populations and locations of care’, authors address the following themes: ‘LGBTQIA+health in family medicine’, ‘A family medicine approach to substance use disorders’, ‘Shameless medicine for people experiencing homelessness’, ‘‘‘Difficult” encounters—finding the person behind the patient’, ‘Attending to patients with medically unexplained symptoms’, ‘Making house calls and home visits’, ‘Family physicians in the procedure room’, ‘Robust rural family medicine’ and ‘Full-spectrum family medicine’. May readers appreciate the breadth of family medicine in these essays.","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776300","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":"Discussing menstrual health in family medicine","authors":"Allison R Casola, Alice Renaud, Ashwini Kamath Mulki","doi":"10.1136/fmch-2023-002149","DOIUrl":"https://doi.org/10.1136/fmch-2023-002149","url":null,"abstract":"Menstrual health is a general biological marker for many cisgender women, transgender men and non-binary people. Despite more than half of the population being people who menstruate, stigma, lack of conversation and pressing social needs around menstrual health persists throughout medicine.[1][1]","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561659","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}