Behavioral Sleep Medicine最新文献

{"title":"Sleep Apnea Among Gulf War Veterans: An Examination of VA Utilization Rates, Treatment Initiation, and Health Outcomes","authors":"Scott G. Ravyts, Yasmine M. Eshera, Sarah C. Griffin, Tate Halverson, Jeremy L. Grove, Jean C. Beckham, Mary J. Pugh, Nathan A. Kimbrel, Patrick S. Calhoun","doi":"10.1080/15402002.2023.2299675","DOIUrl":"https://doi.org/10.1080/15402002.2023.2299675","url":null,"abstract":"Obstructive sleep apnea (OSA) among veterans is frequently underdiagnosed and undertreated. The present study sought to: 1) characterize the prevalence and rate of treatment of OSA among VA users a...","PeriodicalId":55393,"journal":{"name":"Behavioral Sleep Medicine","volume":"25 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139072432","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":"Maternal Prenatal Depressive Symptoms and Infant Sleep Problems: The Role of Infant Temperament and Sex.","authors":"Cláudia Castro Dias,&nbsp;Tiago Miguel Pinto,&nbsp;Bárbara Figueiredo","doi":"10.1080/15402002.2022.2155162","DOIUrl":"10.1080/15402002.2022.2155162","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to analyze whether (1) infant temperament mediates the impact of maternal prenatal depressive symptoms on infant sleep problems and (2) the mediation role of infant temperament was moderated by the infant's sex.</p><p><strong>Methods: </strong>The sample was comprised of 172 mother-infant dyads. Mothers completed self-reported measures of prenatal and postnatal depressive symptoms, infant temperament (negative affectivity, surgency/extraversion, and orienting regulation), and sleep problems.</p><p><strong>Results: </strong>While controlling for maternal postnatal depressive symptoms, our results revealed that (1) infant negative affectivity at two weeks partially mediated the impact of maternal prenatal depressive symptoms on sleep anxiety at six months, and (2) this mediation is independent of the infant's sex.</p><p><strong>Conclusions: </strong>Our findings provided evidence that negative affectivity can be an early specific marker of sleep anxiety and can partially explain the negative impact of maternal prenatal depressive symptoms on further sleep problems in the infant.</p>","PeriodicalId":55393,"journal":{"name":"Behavioral Sleep Medicine","volume":" ","pages":"695-711"},"PeriodicalIF":3.1,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10380761","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":"Change in Insomnia and Depressive Symptoms During COVID-19: A Prospective Longitudinal Study of Iranian Women with Multiple Sclerosis.","authors":"Dena Sadeghi-Bahmani,&nbsp;Youkhabeh Mohammadian,&nbsp;Laleh Sadeghi Bahmani,&nbsp;Habibollah Khazaie,&nbsp;Nahid Piri,&nbsp;James J Gross,&nbsp;Robert W Motl","doi":"10.1080/15402002.2022.2157417","DOIUrl":"10.1080/15402002.2022.2157417","url":null,"abstract":"<p><strong>Background: </strong>There is some evidence that sleep patterns and psychological health have worsened in the general population as a result of the COVID-19-pandemic. Persons with multiple sclerosis (MS) represent a particularly vulnerable population for COVID-19 infections and effects of restrictions. The present study investigated whether insomnia and depressive symptoms, as well as other MS-related symptoms (i.e. fatigue and paresthesia), changed from before to during the COVID-19-pandemic among persons with diagnosed MS.</p><p><strong>Method: </strong>A sample of 90 Iranian females with MS (mean age; 37.62 years; median EDSS score: 2.5) completed a series of self-rating scales at two time points: Nine months before the COVID-19 outbreak in May 2019 (baseline) and then again during the COVID-19 pandemic in May 2020 (study end). Self-rating questionnaires covered sociodemographic and disease-related information, insomnia, depressive symptoms, fatigue, and paresthesia.</p><p><strong>Results: </strong>Depressive symptoms increased over time with a significant p-value and medium effect size. Symptoms of insomnia increased over time (significant p-value, but small effect size), while no significant changes were observed in fatigue and paresthesia (very small effect sizes). The only predictor for insomnia during the COVID-19 pandemic was insomnia before the COVID-19 pandemic; the only predictor for depressive symptoms during the COVID-19 pandemic was insomnia before the COVID-19 pandemic.</p><p><strong>Conclusions: </strong>Overall, the COVID-19 pandemic and its related social restrictions had significant effects on symptoms of depression and insomnia in this sample of Iranian women with MS, but had no effect on fatigue and paresthesia.</p>","PeriodicalId":55393,"journal":{"name":"Behavioral Sleep Medicine","volume":" ","pages":"741-756"},"PeriodicalIF":3.1,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10615646","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":"Children's Sleep and Externalizing Problems: A Day-to-day Multilevel Modeling Approach.","authors":"Maureen E McQuillan, John E Bates, Caroline P Hoyniak, Angela D Staples, Sarah M Honaker","doi":"10.1080/15402002.2022.2156510","DOIUrl":"10.1080/15402002.2022.2156510","url":null,"abstract":"<p><strong>Background: </strong>Sleep problems and externalizing problems tend to be positively associated, but the direction of this association is unclear.</p><p><strong>Method: </strong>Day-to-day associations between sleep and behavior were examined in children (N = 22) ages 3-8 with clinical levels of externalizing problems. These children were enrolled in Parent Management Training and behavioral sleep intervention. During assessments before and after treatment, children wore actigraphs for seven days and parents concurrently completed sleep diaries and daily tallies of noncompliance, aggression, and tantrums. Multilevel modeling was used to account for the nested structure of the data, at the day-to-day level (level 1), within assessment points (level 2), and within children (level 3).</p><p><strong>Results: </strong>Late sleep timing and fragmentation were predictive of next-day noncompliance and tantrums, respectively. There were fewer associations for a given day's behavior predicting that night's sleep, although children who showed more aggression and noncompliance at baseline tended to have later bedtimes and sleep onset times compared to other children.</p>","PeriodicalId":55393,"journal":{"name":"Behavioral Sleep Medicine","volume":" ","pages":"712-726"},"PeriodicalIF":2.2,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10261512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007949","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":"Sleep mHealth Applications and Behavior Change Techniques Evaluation.","authors":"Brittany D Lancaster, Rachel Sweenie, Amy E Noser, Caroline M Roberts, Rachelle R Ramsey","doi":"10.1080/15402002.2022.2161548","DOIUrl":"10.1080/15402002.2022.2161548","url":null,"abstract":"<p><strong>Objectives: </strong>Mobile health apps may be an effective way to increase sleep management skills. Although little has been documented about the content and quality of available sleep management apps, providers often make app recommendations to help with sleep self-management. The objective of this study was to systematically evaluate the content and quality of commercially available sleep apps.</p><p><strong>Methods: </strong>Following a systematic search of the Apple App and Google Play stores, 56 sleep management apps were evaluated. App content was evaluated using the taxonomy of behavior change techniques (BCTs), and app quality was assessed using the Mobile App Rating Scale.</p><p><strong>Results: </strong>Sleep management apps included 0-15 BCTs (<i>M</i> = 6.89) and 0-9 sleep BCTs (<i>M</i> = 4.87). App quality ranged from 2.51 to 4.80 (<i>M</i> = 3.78) out of 5.00. Sleepiest Sleep Sounds Stories, ShutEye: Sleep Tracker, and Mintal Tracker: Sleep Recorder included the highest number of sleep BCTs and highest quality scores.</p><p><strong>Conclusions: </strong>While the content and quality of sleep management apps is variable, the findings are promising as many apps included a high number of BCTs and high quality. Although evidence of efficacy through randomized controlled trials is necessary to establish efficacy, this review can aid in app selection in the interim.</p>","PeriodicalId":55393,"journal":{"name":"Behavioral Sleep Medicine","volume":" ","pages":"757-773"},"PeriodicalIF":2.2,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10330944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9766634","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":"Short Sleep Duration in School-Age Children: Differential Factors on Weekdays and Weekends.","authors":"Tiffany B Koa,&nbsp;Jia Xu Seah,&nbsp;Juanita Q W Ong,&nbsp;June C Lo","doi":"10.1080/15402002.2022.2164001","DOIUrl":"10.1080/15402002.2022.2164001","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify school-age children's sleep and parent-associated factors on weekdays and weekends in Singapore, and investigate school-related and parent-related factors associated with short sleep.</p><p><strong>Methods: </strong>In an online survey, 251 parents with a child aged 7-12 y in Singapore reported their child's sleep duration and school start time. Parent-related factors including sleep hygiene (e.g., parent-set bedtime), sleep priority (the amount of sleep respondents allowed their children to trade for other activities), and both parents' sleep durations, were also reported.</p><p><strong>Results: </strong>The prevalence of short sleep among the children was 64.5% on weekdays and 19.5% on weekends. Children's sleep duration increased from 8.42 h on weekdays to 9.45 h on weekends (<i>p</i> < .001). Relative to weekdays, on weekends, parents showed similar increases in sleep durations (<i>p</i> < .001), imposed poorer sleep hygiene on their children (reduced likelihood of setting bedtimes and increased pre-bedtime electronic device use; <i>p</i> < .001), and allowed their children to trade more sleep for interacting with family and friends, social media, gaming, and TV / videos (<i>p</i> < .001). Shorter sleep duration in children was significantly associated with earlier school start time (<i>B</i> = 0.80, <i>p</i> = .02) and poorer sleep hygiene on weekdays (<i>B</i> = 0.16, <i>p</i> < .001), but lower sleep priority (<i>B</i> = 0.05, <i>p</i> = .002) and shorter parental sleep duration on weekends (maternal: <i>B</i> = 0.18, <i>p</i> < .001, paternal: <i>B</i> = 0.17, <i>p</i> = .002).</p><p><strong>Conclusions: </strong>Delaying school start times may be effective in increasing school-age children's sleep duration on weekdays, while family-based interventions designed to enhance sleep hygiene, priority of sleep over other activities, and parents' sleep durations can benefit children's sleep duration on both weekdays and weekends.</p>","PeriodicalId":55393,"journal":{"name":"Behavioral Sleep Medicine","volume":" ","pages":"774-786"},"PeriodicalIF":3.1,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10468670","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 Novel Behavioral Sleep Medicine Education Workshop Designed to Increase Trainee Psychologists' Knowledge and Skills in Insomnia Management.","authors":"Hailey Meaklim,&nbsp;Imogen C Rehm,&nbsp;Moira F Junge,&nbsp;Melissa Monfries,&nbsp;Gerard A Kennedy,&nbsp;Romola S Bucks,&nbsp;Lisa J Meltzer,&nbsp;Melinda L Jackson","doi":"10.1080/15402002.2022.2164766","DOIUrl":"10.1080/15402002.2022.2164766","url":null,"abstract":"<p><strong>Objectives: </strong>Despite the clear influence of poor sleep on mental health, sleep education has been neglected in psychology training programs. Here, we develop a novel behavioral sleep medicine (BSM) education workshop, the Sleep Psychology Workshop, designed for integration within graduate psychology programs. We also examined the potential efficacy and acceptability of the workshop to upskill trainee psychologists in sleep and insomnia management.</p><p><strong>Methods: </strong>The Sleep Psychology Workshop was developed using a modified Delphi Method. Eleven trainee psychologists completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the workshop, delivered as three, two-hour lectures (total of six hours). Sleep knowledge, attitudes, and practice assessments were completed pre-and post-intervention using the GradPsyKAPS Questionnaire. A focus group and 6-month follow-up survey captured feedback and qualitative data.</p><p><strong>Results: </strong>Trainees' sleep knowledge quiz scores (% correct) increased from 60% to 79% pre- to post-workshop (<i>p</i> = .002). Trainees' self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep disturbances increased, along with their confidence to manage insomnia (all <i>p</i> < .02). Participant feedback was positive, with 91% of trainees rating the workshop as \"excellent\" and qualitative data highlighting trainees developing practical skills in BSM. Six months post-intervention, 100% of trainees endorsed routinely asking their clients about sleep, with 82% reporting improvements in their own sleep.</p><p><strong>Conclusions: </strong>The Sleep Psychology Workshop is a potentially effective and acceptable introductory BSM education program for trainee psychologists, ready for integration within the graduate psychology curriculum.</p>","PeriodicalId":55393,"journal":{"name":"Behavioral Sleep Medicine","volume":" ","pages":"787-801"},"PeriodicalIF":3.1,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10490264","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":"Post-Stroke Insomnia Increased the Risk of Cognitive Impairments: A Hospital-Based Retrospective Cohort Study.","authors":"Faizul Hasan,&nbsp;Muhammad Solihuddin Muhtar,&nbsp;Dean Wu,&nbsp;Hsin-Chien Lee,&nbsp;Yen-Chun Fan,&nbsp;Ting-Jhen Chen,&nbsp;Hsiao-Yean Chiu","doi":"10.1080/15402002.2023.2165491","DOIUrl":"10.1080/15402002.2023.2165491","url":null,"abstract":"<p><strong>Objectives/background: </strong>Insomnia is a common sleep complaint among patients who had a stroke and has been recognized as an independent risk factor for cognitive impairment. However, the relationship between poststroke insomnia and cognitive impairment over time is under-researched. Therefore, we examined the association between poststroke insomnia and the risk of cognitive impairment.</p><p><strong>Participants: </strong>Stroke participants who had a stroke and were 20 years and older.</p><p><strong>Methods: </strong>This multicenter hospital-based retrospective cohort study with a 13-year follow-up period (2004-2017). The diagnosis of stroke, insomnia, and cognitive impairment was based on the International Classification of Diseases. The study participants who experienced a stroke were divided into two cohorts: those who also had insomnia and those who did not have insomnia. A Cox proportional-hazards regression model was used.</p><p><strong>Results: </strong>A total of 1,775 patients with a mean age of 67.6 years were included. Of these patients, 146 and 75 patients were diagnosed with insomnia and cognitive impairment during the follow-up period, respectively. The cumulative incidence of cognitive impairment in the stroke with insomnia cohort was significantly lower than that in the stroke without insomnia cohort (log-rank test, <i>P</i> < .001). The adjusted hazard ratio and 95% confidence interval (CI) of the stroke with insomnia cohort indicated a higher risk of cognitive impairment compared with the stroke without insomnia cohort (adjusted hazard ratio: 2.38; 95% CI: 1.41-4.03).</p><p><strong>Conclusions: </strong>Patients who had a stroke and were diagnosed with insomnia exhibited a substantial increased risk of cognitive impairment over time.</p>","PeriodicalId":55393,"journal":{"name":"Behavioral Sleep Medicine","volume":" ","pages":"802-810"},"PeriodicalIF":3.1,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10490266","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":"The Effect of Cognitive Behavioral Therapy for Insomnia (CBT-I) on Cardiometabolic Health Biomarkers: A Systematic Review of Randomized Controlled Trials.","authors":"Kimberly L Savin, Taylor L Clark, Perla Perez-Ramirez, Tara S Allen, Maíra Tristão Parra, Linda C Gallo","doi":"10.1080/15402002.2022.2154213","DOIUrl":"10.1080/15402002.2022.2154213","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the effectiveness of Cognitive Behavioral Therapy for Insomnia (CBT-I) on cardiometabolic health biomarkers.</p><p><strong>Method: </strong>Cochrane CENTRAL, Embase, Medline, and PsycINFO were searched, and records were screened by two independent reviewers. Inclusion criteria were adult population, delivery of CBT-I, randomized controlled trial design, ≥1 cardiometabolic health outcome, and peer-review. Hedge's <i>g</i> effect sizes were calculated, and the quality of the evidence was appraised using the Cochrane Risk of Bias 2 tool.</p><p><strong>Results: </strong>After screening 1649 records, 15 studies were included (total N = 2067). Inflammatory markers (CRP, IL-6, TNF-α), blood pressure (SBP, DBP), and glycemic regulation (HbA1c) were most frequently reported (in ≥3 studies each). HbA1c and CRP were reduced in the CBT-I group compared to the control group (in 3 studies each). Effects varied or were null for IL-6, TNF-α, SBP, and DBP. Six studies were judged as low, four as moderate, and five as high risk of bias.</p><p><strong>Conclusion: </strong>CBT-I was most consistently associated with improved HbA1c and CRP, which are relatively temporally stable, suggesting influences on enduring habits rather than short-term behavior changes. High risk of bias limits the interpretation of findings. Methodologically adequate studies are needed to better understand cardiometabolic effects of CBT-I.</p>","PeriodicalId":55393,"journal":{"name":"Behavioral Sleep Medicine","volume":" ","pages":"671-694"},"PeriodicalIF":2.2,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10244489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9589016","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":"Parental Discontent with Infant Sleep During the First Two Years of Life.","authors":"Margreet W Harskamp-van Ginkel,&nbsp;Nicola L E Imkamp,&nbsp;Lieke van Houtum,&nbsp;Tanja G M Vrijkotte,&nbsp;Yassmina Ben Haddi-Toutouh,&nbsp;Mai J M Chinapaw","doi":"10.1080/15402002.2022.2156867","DOIUrl":"10.1080/15402002.2022.2156867","url":null,"abstract":"<p><strong>Background: </strong>Problematic sleep in infants can have a high impact on families. We examined parental discontent with infant sleep in the first six months of life and parent-perceived problematic sleep during the second year of life.</p><p><strong>Methods: </strong>We used Sarphati Cohort data of 1471 children. During periodic youth health care visits in the first six months of life, professionals registered parental discontent with infant sleep. In the second year of life, parents filled out the Brief Infant Sleep Questionnaire (BISQ), from which we defined parent-perceived problematic sleep and BISQ-defined problematic sleep. We examined the association of parental discontent with infant sleep during the first six months with both BISQ-derived outcomes up to age two, using multivariable logistic regression analysis.</p><p><strong>Results: </strong>26% of parents were discontented with infant sleep during the first six months of life. During the second year of life, 27% of the parents perceived their child's sleep as problematic, and 9% of the infants had BISQ-defined problematic sleep. Early parental discontent with infant sleep was associated with parent-perceived problematic sleep [adjusted OR 2.50 (95% CI 1.91-3.28)], and BISQ-defined problematic sleep [adjusted OR 1.88 (1.11-3.17)].</p><p><strong>Conclusions: </strong>Early registered parental discontent with infant sleep was a predictor of parent-perceived problematic sleep in early toddlerhood. Registering parental discontent during infancy might enable professionals to identify a group of infants at risk for later problematic sleep. We recommend screening and parental support for sleep difficulties in an early stage.</p>","PeriodicalId":55393,"journal":{"name":"Behavioral Sleep Medicine","volume":" ","pages":"727-740"},"PeriodicalIF":3.1,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10566132","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}