Journal of Applied Gerontology最新文献

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Failure to Re-identify and Manage Known Dementia Associated With Hospital Readmission and LOS: A Retrospective Cohort Study. 未能重新识别和管理与医院再入院和LOS相关的已知痴呆:一项回顾性队列研究。
IF 2 3区 医学
Journal of Applied Gerontology Pub Date : 2025-08-26 DOI: 10.1177/07334648251368428
Kara Cappetta, Luise Lago, Jan Potter, Lyn Phillipson
{"title":"Failure to Re-identify and Manage Known Dementia Associated With Hospital Readmission and LOS: A Retrospective Cohort Study.","authors":"Kara Cappetta, Luise Lago, Jan Potter, Lyn Phillipson","doi":"10.1177/07334648251368428","DOIUrl":"https://doi.org/10.1177/07334648251368428","url":null,"abstract":"<p><p>The extent to which known dementia is re-identified and managed during hospitalization and the impact of this on patient outcomes warrant investigation. Among 7,919 patients with an index admission coded with dementia between 1 July 2006 to 30 June 2015 in a regional health district in Australia, we examined total length of stay (LOS) and Difference from Expected LOS (using mixed linear regression and quantile regression), and 30-day readmission (using a generalized linear mixed model). In models adjusted for age, complexity, specialty, and discharge destination, uncoded stays had significantly shorter total LOS (β = -2.9, 95% CI: -3.5, -2.3) and Difference from Expected LOS (β = -5.2, 95% CI: -5.8, -4.6). Quantile regression results confirmed these findings but were smaller in effect size. People without dementia coded were 1.2 times more likely to be re-readmitted (95% CI: 1.1, 1.3) than when coded. Consistent re-identification and active management of known dementia is needed to improve long-term patient and health system outcomes.</p>","PeriodicalId":47970,"journal":{"name":"Journal of Applied Gerontology","volume":" ","pages":"7334648251368428"},"PeriodicalIF":2.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974415","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}
引用次数: 0
The Role of Technology Use and Employment Status in Shaping Social Engagement Among Older Americans. 技术使用和就业状况在塑造美国老年人社会参与中的作用。
IF 2 3区 医学
Journal of Applied Gerontology Pub Date : 2025-08-25 DOI: 10.1177/07334648251369265
Jaesung Lee, Jay O'Shields, Allison Dunnigan
{"title":"The Role of Technology Use and Employment Status in Shaping Social Engagement Among Older Americans.","authors":"Jaesung Lee, Jay O'Shields, Allison Dunnigan","doi":"10.1177/07334648251369265","DOIUrl":"https://doi.org/10.1177/07334648251369265","url":null,"abstract":"<p><p>Social engagement is critical for healthy aging, yet older adults often face challenges due to retirement and unequal access to technology. Although prior studies have examined employment and technology use separately, little is known about how they jointly influence social engagement. This study addresses that gap by investigating their independent and combined associations on social engagement. Using data from the 2022 National Health and Aging Trends Study (NHATS), the analysis includes 5,195 community-dwelling Medicare beneficiaries aged 65 and older. Weighted multivariate regression models assessed how different patterns of Information and Communication Technology (ICT) use and employment status relate to social engagement. Results indicate that both ICT use and employment independently predict higher levels of social engagement. These findings suggest that digital inclusion and continued workforce participation may offer distinct, complementary avenues for promoting social engagement. The study supports efforts to expand digital literacy and age-friendly employment opportunities to enhance well-being in later life.</p>","PeriodicalId":47970,"journal":{"name":"Journal of Applied Gerontology","volume":" ","pages":"7334648251369265"},"PeriodicalIF":2.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974364","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}
引用次数: 0
Responses to Covid-19 and Research Participation Among Older African Americans. 老年非裔美国人对Covid-19的反应和研究参与。
IF 2 3区 医学
Journal of Applied Gerontology Pub Date : 2025-08-22 DOI: 10.1177/07334648251369670
Katrail Davis, Erika Pugh, Robbie Beyl, Isabella Manrique, Jasmine Taylor, Matthew Calamia, Owen Carmichael, Robert L Newton
{"title":"Responses to Covid-19 and Research Participation Among Older African Americans.","authors":"Katrail Davis, Erika Pugh, Robbie Beyl, Isabella Manrique, Jasmine Taylor, Matthew Calamia, Owen Carmichael, Robert L Newton","doi":"10.1177/07334648251369670","DOIUrl":"https://doi.org/10.1177/07334648251369670","url":null,"abstract":"<p><p>Despite higher risk of Covid-19 and barriers to health care for older African Americans, there have been few studies examining the effects of Covid-related risk perception on engagement in health behaviors and biomedical research in this population. Survey data on Covid-19-related health beliefs were collected from 236 older African Americans between October 2021 and January 2022. Data were analyzed using chi-square analyses and linear models. Participants reported high rates of access to, use of, and engagement in Covid-19 related preventative health materials and behaviors. Perceived risk for contracting Covid-19 was associated with a higher likelihood of engagement in preventative health behaviors, but not to participation in biomedical research. Those who reported more Covid-19 risk factors did not engage in more health behaviors. Participants were most likely to report an interest in virtual research participation. Those with increased life disruptions due to Covid-19 were more likely to be interested in research.</p>","PeriodicalId":47970,"journal":{"name":"Journal of Applied Gerontology","volume":" ","pages":"7334648251369670"},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974388","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}
引用次数: 0
Identifying Care and Support Needs Profiles for Home-Based Aged Care: A Latent Class Analysis Using Routinely Collected Aged Care Assessment Information. 识别居家老年护理的护理和支持需求概况:使用常规收集的老年护理评估信息进行潜在分类分析。
IF 2 3区 医学
Journal of Applied Gerontology Pub Date : 2025-08-20 DOI: 10.1177/07334648251366720
Rachel McKittrick, Alison M Hutchinson, Elizabeth Manias, Martin Hensher, Liliana Orellana
{"title":"Identifying Care and Support Needs Profiles for Home-Based Aged Care: A Latent Class Analysis Using Routinely Collected Aged Care Assessment Information.","authors":"Rachel McKittrick, Alison M Hutchinson, Elizabeth Manias, Martin Hensher, Liliana Orellana","doi":"10.1177/07334648251366720","DOIUrl":"https://doi.org/10.1177/07334648251366720","url":null,"abstract":"<p><p>This study identified care and support need profiles for people requiring home-based aged care and explored profile associations with socio-demographic and psychosocial factors. The study utilized cross-sectional aged care assessment data for 94,975 Victorians (mean age 84 [SD = 7.6] years) eligible for Australian Government-funded home-based aged care (Home Care Package) (January 2019-June 2022). Latent class analysis identified seven profiles (P1 to P7). P1, the largest profile (<i>n</i> = 23,487, 24.7%), included those with predominantly basic needs, for example, housework (93%) and shopping (68%). Needs gradually increased from P1 to P7. P7 (<i>n</i> = 9,274, 9.8%) included those with the most advanced needs, for example, showering (99%), medication management (99%), walking (89%), short-term memory loss (99%), and disorientation to time (93%). Individuals living alone were under-represented in higher-need profiles (P4 to P7). The identified profiles provide valuable insights to optimize care management, service-type requirements, and workforce skills tailored to the needs of people within each profile.</p>","PeriodicalId":47970,"journal":{"name":"Journal of Applied Gerontology","volume":" ","pages":"7334648251366720"},"PeriodicalIF":2.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974356","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}
引用次数: 0
Collecting, Sharing, and Using Information for Person-Centered Dementia Care: Perspectives of Residents, Care Partners, and Staff in Low-Resource Long-Term Care Settings. 收集、共享和使用以人为中心的痴呆症护理信息:低资源长期护理环境中居民、护理伙伴和工作人员的观点。
IF 2 3区 医学
Journal of Applied Gerontology Pub Date : 2025-08-17 DOI: 10.1177/07334648251369666
Sarah Holmes, Alison Rataj, Jing Wang, Michael Lepore, Nancy Kusmaul, Laura Davie, Yoon Chung Kim, Briana Murray, Kirsten Corazzini
{"title":"Collecting, Sharing, and Using Information for Person-Centered Dementia Care: Perspectives of Residents, Care Partners, and Staff in Low-Resource Long-Term Care Settings.","authors":"Sarah Holmes, Alison Rataj, Jing Wang, Michael Lepore, Nancy Kusmaul, Laura Davie, Yoon Chung Kim, Briana Murray, Kirsten Corazzini","doi":"10.1177/07334648251369666","DOIUrl":"https://doi.org/10.1177/07334648251369666","url":null,"abstract":"<p><p>This study explored stakeholder perspectives on how information is collected, shared, and used to support person-centered dementia care in low-resource long-term care settings. This qualitative study was conducted in four long-term care settings situated in federally designated medically underserved areas (two rural, two urban). In-depth semi-structured interviews were conducted with administrative leaders (<i>n</i> = 7), direct care staff (<i>n</i> = 20), and residents (<i>n</i> = 16) with their care partners (<i>n</i> = 16), with transcripts thematically analyzed using NVivo14. Identified themes describe perspectives on collecting, sharing, and using information about residents: diverse mechanisms for collecting information; channels for sharing information; ethical considerations for information sharing; and person-centered approaches. These findings shed light on what matters most to residents with dementia and care providers for optimizing information collection and sharing to deliver high-quality dementia care within low-resource settings.</p>","PeriodicalId":47970,"journal":{"name":"Journal of Applied Gerontology","volume":" ","pages":"7334648251369666"},"PeriodicalIF":2.0,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875923","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}
引用次数: 0
Palliative Care Needs of Older Adults With and Without Dementia During Post-Acute Care in Skilled Nursing Facilities. 老年痴呆患者和非老年痴呆患者急性期后护理在熟练护理机构的姑息治疗需求。
IF 2 3区 医学
Journal of Applied Gerontology Pub Date : 2025-08-17 DOI: 10.1177/07334648251363646
Joan G Carpenter, Elisha Oduro, Nancy Hodgson, Shijun Zhu, Merve Gurlu, Mary Ersek, Laura C Hanson
{"title":"Palliative Care Needs of Older Adults With and Without Dementia During Post-Acute Care in Skilled Nursing Facilities.","authors":"Joan G Carpenter, Elisha Oduro, Nancy Hodgson, Shijun Zhu, Merve Gurlu, Mary Ersek, Laura C Hanson","doi":"10.1177/07334648251363646","DOIUrl":"10.1177/07334648251363646","url":null,"abstract":"<p><p>Seriously ill older adults, including those living with Alzheimer's disease and related dementias (ADRD), often receive disease-focused rehabilitative care in skilled nursing facilities (SNF) with little consideration for their palliative care (PC) needs. Using baseline data from a pilot pragmatic clinical trial (<i>N</i> = 52), we conducted a cross-sectional study to compare the clinical characteristics and the PC needs of older adults with and without ADRD receiving SNF care. Functional decline was the most common global indicator for palliative care among both groups. While there was no statistically significant difference in PC needs between the two groups, the most prevalent PC needs for all were pain (63.5%), feeling anxious or worried (59.6%), family and friends being anxious or worried (57.7%), and need for information (46.2%). Older adults with and without an ADRD diagnosis who are admitted to post-acute SNF care may benefit from universal screening and tailored PC services.</p>","PeriodicalId":47970,"journal":{"name":"Journal of Applied Gerontology","volume":" ","pages":"7334648251363646"},"PeriodicalIF":2.0,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12363659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875924","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}
引用次数: 0
Understanding Trauma in the Context of Direct Care Work in Nursing Homes. 在疗养院直接护理工作的背景下理解创伤。
IF 2 3区 医学
Journal of Applied Gerontology Pub Date : 2025-08-11 DOI: 10.1177/07334648251364015
Alfred Boakye, Jennifer Craft Morgan, Candace L Kemp, Antonius D Skipper
{"title":"Understanding Trauma in the Context of Direct Care Work in Nursing Homes.","authors":"Alfred Boakye, Jennifer Craft Morgan, Candace L Kemp, Antonius D Skipper","doi":"10.1177/07334648251364015","DOIUrl":"10.1177/07334648251364015","url":null,"abstract":"<p><p>Direct care workers (DCWs) experience job quality challenges such as heavy workload, low pay, and few benefits. Layered risks such as the COVID-19 pandemic and systemic racism have impacted DCWs, made them more vulnerable, and increased turnover and the precarity of the long-term care system and residents' care. Drawing from qualitative interviews collected from 25 direct care workers, this study seeks to understand and describe the DCWs' experiences of trauma during COVID-19 and how these experiences affect their ability to provide care. Findings suggest that DCWs are often crippled with challenges stemming from the impact of COVID-19, work-related factors, and personal factors. Understanding the intersection of trauma provides a detailed contextual description of care work, which is important for developing practical coping strategies, either at the personal or organizational levels, and developing more refined trauma-informed initiatives to build resilience and support DCWs.</p>","PeriodicalId":47970,"journal":{"name":"Journal of Applied Gerontology","volume":" ","pages":"7334648251364015"},"PeriodicalIF":2.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822902","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}
引用次数: 0
The Moderating Effect of Physical Activity on the Association Between Cognition and Depression Among Middle-Aged and Older Adults: A Differential Analysis by European Regions. 体力活动对中老年认知与抑郁关系的调节作用:欧洲地区的差异分析
IF 2 3区 医学
Journal of Applied Gerontology Pub Date : 2025-08-11 DOI: 10.1177/07334648251364013
Marcelo de Maio Nascimento, Adilson Marques, Gerson Ferrari, Élvio Rúbio Gouveia, Andreas Ihle
{"title":"The Moderating Effect of Physical Activity on the Association Between Cognition and Depression Among Middle-Aged and Older Adults: A Differential Analysis by European Regions.","authors":"Marcelo de Maio Nascimento, Adilson Marques, Gerson Ferrari, Élvio Rúbio Gouveia, Andreas Ihle","doi":"10.1177/07334648251364013","DOIUrl":"https://doi.org/10.1177/07334648251364013","url":null,"abstract":"<p><p>This study aimed to investigate the moderating effect of moderate-to-vigorous physical activity (MVPA) on the association between cognition and depression in individuals aged 50 years or older living in 27 European countries and to explore differences between four European regions (West, North, South, East). Categorical moderation analysis was performed with 41,878 individuals using data from the SHARE database. The variables analyzed were depression (EURO-D scale), Cognition Index (CogId), and self-reported MVPA. Western and Northern European regions indicated higher CogId and MVPA scores and lower depression than those in the South and East. MVPA frequency proved to be a significant moderator on the association between cognition and depression, with notable differences between regions. Especially in Southern and Eastern Europe, it would be important to create strategies that promote MVPA, which is fundamental to the mental and cognitive health of middle-aged and older adult populations.</p>","PeriodicalId":47970,"journal":{"name":"Journal of Applied Gerontology","volume":" ","pages":"7334648251364013"},"PeriodicalIF":2.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822901","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}
引用次数: 0
Better State Support for Family Caregivers Linked to Lower Hospitalization Rates Among Older Adults Living With Dementia. 国家对家庭照顾者的更好支持与老年痴呆症患者住院率降低有关。
IF 2 3区 医学
Journal of Applied Gerontology Pub Date : 2025-08-11 DOI: 10.1177/07334648251365673
Espérance Mutoniwase, Zijing Cheng, Xueya Cai, Yue Li
{"title":"Better State Support for Family Caregivers Linked to Lower Hospitalization Rates Among Older Adults Living With Dementia.","authors":"Espérance Mutoniwase, Zijing Cheng, Xueya Cai, Yue Li","doi":"10.1177/07334648251365673","DOIUrl":"10.1177/07334648251365673","url":null,"abstract":"<p><p>This study examined whether better state LTSS performance in caregiver support (LTSS-CG), independent of LTSS spending, is associated with lower hospitalizations among community-dwelling older adults with dementia. Using Health and Retirement Study data (2012-2020) linked to the LTSS-CG state rankings, we analyzed hospitalization outcomes (any hospitalization, total hospital nights, total stays) for 6,755 participants. Multivariable regression models showed that worse LTSS-CG rankings were significantly associated with increased hospitalizations. Compared to states with \"Excellent\" LTSS-CG rankings, the odds of hospitalization were 35.13%, 36.09%, and 46.69% higher for \"Good,\" \"Fair,\" and \"Poor\" categories, respectively. Similarly, hospital stays and nights increased across lower-ranking categories. Findings suggest that better LTSS-CG is associated with lower hospitalization risks, highlighting the importance of accessible, high-quality LTSS for caregiver support in improving health outcomes and lowering dementia-related healthcare costs. This underscores the need for policies promoting caregiver support to foster healthy aging.</p>","PeriodicalId":47970,"journal":{"name":"Journal of Applied Gerontology","volume":" ","pages":"7334648251365673"},"PeriodicalIF":2.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822899","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}
引用次数: 0
Physical Activity and Mobility Impairment Across the Frailty Spectrum Among the Oldest Old: Insights From the Brazilian Longitudinal Study of Aging (ELSI-Brazil). 在最老的老年人中,身体活动和行动障碍:来自巴西老龄化纵向研究(ELSI-Brazil)的见解。
IF 2 3区 医学
Journal of Applied Gerontology Pub Date : 2025-08-11 DOI: 10.1177/07334648251367133
Ziyue Wang, Jemimah O Bakare, Ricardo A de Oliveira, André P Dos Santos, Jéssica F C Cordeiro, Lucimere Bohn, Qing Han, Emerson Sebastião
{"title":"Physical Activity and Mobility Impairment Across the Frailty Spectrum Among the Oldest Old: Insights From the Brazilian Longitudinal Study of Aging (ELSI-Brazil).","authors":"Ziyue Wang, Jemimah O Bakare, Ricardo A de Oliveira, André P Dos Santos, Jéssica F C Cordeiro, Lucimere Bohn, Qing Han, Emerson Sebastião","doi":"10.1177/07334648251367133","DOIUrl":"https://doi.org/10.1177/07334648251367133","url":null,"abstract":"<p><p>This study analyzed data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) to examine the prevalence of frailty and its association with physical activity (PA) and mobility impairments in a nationally representative sample of older adults aged 80 and older in Brazil. ELSI-Brazil is a national resource that investigates aging-related health, psychosocial, and economic factors to inform public policies promoting healthy aging. Data from 1,171 participants were analyzed using chi-square tests, ANOVA, and logistic regression adjusted for confounders. About 14% were classified as frail, 73% as pre-frail, and 13% as robust. Frail individuals were less likely to meet PA guidelines (OR = 12.95; 95% CI [6.44-26.08]) and had higher odds of short-distance walking impairment (OR = 1.88; 95% CI [1.02-3.48]) compared to their robust counterparts. Our findings suggest a relatively low prevalence of frailty among Brazil's oldest old but indicated a significant association with physical inactivity and mobility impairment.</p>","PeriodicalId":47970,"journal":{"name":"Journal of Applied Gerontology","volume":" ","pages":"7334648251367133"},"PeriodicalIF":2.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822900","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}
引用次数: 0
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