Comprehensive child and adolescent nursing最新文献

{"title":"Young People Lost and Found in Transition?","authors":"Nicholas Medforth","doi":"10.1080/24694193.2023.2201317","DOIUrl":"https://doi.org/10.1080/24694193.2023.2201317","url":null,"abstract":"When I was working in practice as Charge Nurse in children’s renal nursing and later as a Nurse Specialist in pediatric hematology in the late 1980s and early 1990s, we were beginning to grapple with the challenge of facilitating a smooth transfer of our teenage patients with long-term conditions such as end-stage renal failure and hemophilia to adult services. Understandably this was a worrying time for both the young people involved and their families. They had come to rely on health-care staff and organizations whom they had grown to trust and rely upon over most of the young person’s life so far and moving on felt like a leap into the dark. In those early days, we aimed to respond to their concerns by organizing joint visits to adult services to give young people and parents a chance to get to know adult service providers and arranged for the young people to be in small peer support groups so that they did not lose all the friends that had been made because of the transfer. Since then, the move to adult services has been recognized as a “transition” process that begins ideally in the early teens, rather than a “transfer” event when a young person reaches age 16 or 18. Consequently, we have seen the development of a wide range of innovative approaches to assessing transition readiness and provision of transition preparation and support programmes in the intervening years. Professional bodies; organizations such as the National Institute for Health and Care Excellence and Social Care Institute for Excellence in the U.K.; service commissioners and service providing organizations and community organizations advocating for young people and families have provided wide-ranging guidance, yet seamless transition is still not experienced by all young people. In health and care services, the process often tends to be led by enthusiastic individual practitioners rather than through universal, comprehensive strategic approaches. This means that many young people still “fall through the net” in their transition to young adulthood, with potential loss to follow up and ongoing support and therefore numerous associated risks to health and emotional wellbeing. Through academic study in applied Psychology, and my own research in the area of Transition (Medforth, 2022; Medforth & Huntingdon, 2018a, 2018b; Medforth et al., 2019) I have come to recognize that transition is a developmental journey experienced by all young people but is also complex and multi-faceted. It involves development across numerous trajectories (sometimes simultaneously) such as education to employability; friendships and relationships; family and independence. For young people who live in complex circumstances such as having a disability, long-term or life-limiting","PeriodicalId":72655,"journal":{"name":"Comprehensive child and adolescent nursing","volume":"46 3","pages":"177-179"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10117253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Neglect of Adolescent Neglect.","authors":"Jayne McMullan, Julia Robinson, Nicky Varley","doi":"10.1080/24694193.2023.2166160","DOIUrl":"https://doi.org/10.1080/24694193.2023.2166160","url":null,"abstract":"This comment paper aims to highlight the prevalence of adolescent neglect. As a society, do we underestimate that adolescence is a time of vulnerability for some young people that can be significantly impacted by neglect and abuse? Child abuse crosses all societal spectrums, and it does not discriminate against age or gender making it one of the largest public health priorities seen globally (UNICEF, 2014). The concept of “child abuse” traditionally conjures images of children, often sad and unkempt. Certainly, in western society, there seems to be a public perception that it is predominantly younger children who are the victims of abuse, yet older children aged between 10 and 17 account for over a third of all children who are subject to child protection plans in England (Department for Education [DfE], 2021). Child abuse, particularly neglect, is widely debated. Many factors influence perceptions of neglect, including demographics, past experiences, and societal norms (Frost, 2021). Historically, it could be viewed that acceptance and tolerance of child neglect has lessened over time, however, to effectively analyze this notion, childhood as a concept must be explored and understood (Cunningham, 2020). Children have been the victims of exploitation and abuse throughout history. In its simplest terms, neglect is a failure to meet the basic needs of a child or young person. Neglect has been highlighted in serious case reviews (SCRs) as a significant contributing factor in many cases, but in the adolescent age range, it is pointedly higher (Brandon et al., 2013; Sidebotham et al., 2016). Adolescent neglect is a phenomenon that is frequently disregarded, yet widely acknowledged as having a negative impact upon development and outcomes for young people and adults (Naughton et al., 2017). In the UK, the Munro review of Child Protection (Munro, 2011) provided clear recognition of the unique risks faced by adolescents, with recommendation to all professionals for vigilance and the need for customized early interventions. Hicks and Stein (2015) importantly note that, within the United Kingdom (UK), academic exploration of the neglect of children has tended to focus on the issue in its entirety, as opposed to considering adolescent neglect as a separate concern. Comparative enquiry with the United States of America (USA) prompts similar findings, reflective of UK literature (Vanderminden et al., 2019). Childhood is a period of rapid developmental changes, and it requires a more nuanced approach; this is of particular significance when considering definitions for neglect, combined with stages of development, and the age of the child. Adolescence is a point of momentous transition socially, psychologically, emotionally, and biologically. Whilst there is","PeriodicalId":72655,"journal":{"name":"Comprehensive child and adolescent nursing","volume":"46 2","pages":"98-101"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9689440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Lifelong Learning Perceptions of Pediatric Nurses and Self-Confidence and Anxiety in Clinical Decision-Making Processes.","authors":"Mukaddes Demir Acar,&nbsp;Cemre Gul Kilinc,&nbsp;Osman Demir","doi":"10.1080/24694193.2023.2171507","DOIUrl":"https://doi.org/10.1080/24694193.2023.2171507","url":null,"abstract":"<p><p>This study was conducted to evaluate the relationship between lifelong learning perceptions of pediatric nurses and self-confidence and anxiety in clinical decision-making processes. One of the most important ways to adapt to change in the developing and changing health care environment worldwide and in evidence based nursing care is lifelong learning. The most essential characteristics of a lifelong learner are reflection, questioning, enjoying learning, understanding the dynamic nature of knowledge and engaging in learning by actively seeking learning opportunities so that evidence-based nursing care can be achieved. Pediatric nurses were included in this descriptive, correlational and cross-sectional study. The study was based on pediatric nursing in the pediatric clinics of a hospital in the capital of <b> </b>Turkiye between April and July 2021. It was determined that the mean scores of lifelong learning differed according to gender, education level, length of service in the profession and the unit in which each individual worked, and these differences were statistically significant. Pediatric nurses' lifelong learning level explained the three subdimensions of self-confidence in clinical decision-making. The results of the regression analysis indicate that lifelong learning levels of the pediatric nurses did not significantly predict their scores on the subdimensions of anxiety with clinical decision-making scale. Positive effects on clinical decision-making in the nursing process can be achieved if the tendencies of pediatric nurses toward lifelong learning are sufficient. Assessing nurses' lifelong learning perceptions is an essential step toward implementing evidence-based care for pediatric patients. Clinical decision-making skills can be supported by increasing nurses' lifelong learning awareness.</p>","PeriodicalId":72655,"journal":{"name":"Comprehensive child and adolescent nursing","volume":"46 2","pages":"102-113"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9493729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Family-Centered Care to Child Health and Diseases Nursing Course via Distance Education.","authors":"Sevil Çınar Özbay,&nbsp;Özkan Özbay,&nbsp;Handan Boztepe","doi":"10.1080/24694193.2023.2166159","DOIUrl":"https://doi.org/10.1080/24694193.2023.2166159","url":null,"abstract":"<p><p>The aim of this study was to determine the impact of an online Child Health and Diseases Nursing course emphasizing family-centered care upon the perceptions of nursing students toward family-centered care. A one-group pretest-posttest model was used in this study. The research participants consisted of 88 students studying at X University, Faculty of Health Sciences, Department of Nursing. While 67.1% of the students stated that there were obstacles in implementing family-centered care, 73.9% stated that there were no facilitating elements in implementing of family-centered care. A statistically significant difference was found between the mean scores of the students' posttest family-centered care attitude and parents' attitude at the end of the training. This study provides insights into family-centered care, which could be used in crafting policies and interventions in nursing education in Turkey. Such insights could foster positive perceptions of family-centered care among student nurses.</p>","PeriodicalId":72655,"journal":{"name":"Comprehensive child and adolescent nursing","volume":"46 2","pages":"83-97"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9848585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Was on the Parents' Minds? Changes Over Time in Topics of Person-Centred Information for Mothers and Fathers of Children with Cancer.","authors":"Anders Ringnér,&nbsp;Maria Björk,&nbsp;Cecilia Olsson","doi":"10.1080/24694193.2023.2168790","DOIUrl":"https://doi.org/10.1080/24694193.2023.2168790","url":null,"abstract":"<p><p>Acquiring information about one's child's cancer diagnosis is a complex and ever-changing process, and parents' needs change over time. As yet, we know little about what information parents require at different stages of their child's illness. This paper is part of a larger randomized control trial studying the parent-centered information given to mothers and fathers. The aim of this paper was to describe the topics addressed in person-centered meetings between nurses and parents of children with cancer and how those changed over time. Using qualitative content analysis, we analyzed nurses' written summaries of 56 meetings with 16 parents and then computed for each topic the percentage of parents who brought it up at any time during the intervention. The main categories were Child's disease and treatment (addressed by 100% of parents), Consequences of treatment (88%), Emotional management for the child (75%), Emotional management for the parent (100%), Social life of the child (63%), and Social life of the parent (100%). Different topics were addressed at different points in time, and fathers raised more concerns about the child's emotional management and the consequences of treatment than mothers. This paper suggests that parental information demands change over time and differ between fathers and mothers, implying that information should be person-centered. Registered at Clinicaltrials.gov (NCT02332226).</p>","PeriodicalId":72655,"journal":{"name":"Comprehensive child and adolescent nursing","volume":"46 2","pages":"114-125"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9487002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>\"All in One: Fear, Happiness, Faith\"</i> A Qualitative Study on Experiences and Needs of Turkish Mothers of Infants with Congenital Heart Disease.","authors":"Ayşe Ay,&nbsp;Sevil Çınar Özbay,&nbsp;Handan Boztepe,&nbsp;Eda Gürlen","doi":"10.1080/24694193.2023.2190398","DOIUrl":"https://doi.org/10.1080/24694193.2023.2190398","url":null,"abstract":"<p><p>Having an infant with congenital heart disease (CHD) may cause difficulties and changes in mothers' life. This study was aim to explore the experiences and needs of Turkish mothers of infants with CHD. The study was carried out with the descriptive phenomenological method from qualitative research. The study sample included 18 mothers having infants in the age range of 0 to 2 years with CHD. The data were collected using a sociodemographic data form and a semi-structured interview form. The data obtained from the interviews were evaluated using the content and thematic analysis methods. Four main themes and sub-themes emerged from the qualitative data. \"Effect of getting a diagnosis\" with two sub-themes (emotional changes and a protective mother-infant relationship), \"All emotions in one\" with two sub-themes (fearing of death and torn between fear and hope), \"Influences on a mother's life\" with three sub-themes (forgetting herself, getting away from siblings' lives and relations with spouse), and stressors with three sub-themes (loss of control, physical care and unfulfilled needs). The results of the study provide insight into how Turkish mothers subjectively experience life after CHD. Mothers expected healthcare professionals to support and understand their experiences and needs. Healthcare professionals need to create an environment for mothers to cope with emotional difficulties, gain knowledge and care skills, and adapt to their lives.</p>","PeriodicalId":72655,"journal":{"name":"Comprehensive child and adolescent nursing","volume":"46 2","pages":"126-141"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9498723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidencing Enquiry Based Learning: An Innovative Approach to Educating Children and Young People's Nursing Students.","authors":"Margaret Crowley,&nbsp;Wendy Mcinally,&nbsp;Nicola Goodall,&nbsp;Janet Webb","doi":"10.1080/24694193.2023.2171157","DOIUrl":"https://doi.org/10.1080/24694193.2023.2171157","url":null,"abstract":"<p><p>This discussion paper gives an overview of an innovative online distance learning pre-registration BSc (Hons) Children and Young People's nursing program underpinned by Enquiry-Based Learning pedagogy. Whilst the program is delivered to all four fields of practice (Adult, Children and Young People, Learning Disability, and Mental Health), in all four nations of the UK (England, Scotland, Wales, and Northern Ireland), the focus here is Children and Young People's nursing. Nurse education programs are delivered in accordance with the Standards for Nurse Education developed by the professional nursing body in the UK. This online distance learning curriculum uses a life-course perspective for all fields of nursing. Students develop the general knowledge and skills to care for all people across the life course but as the program progresses, they learn how to care for people within their own field of practice in greater depth. The educational context of the Children and Young People's nursing program highlights that the use of Enquiry-Based Learning can help address some of the challenges faced by Children and Young People's nursing students. A critical evaluation of Enquiry-Based Learning and its use within the curriculum concludes that Enquiry-Based Learning provides Children and Young People's nursing students with the graduate attributes of being able to communicate with infants, children, young people, and their families, adopt critical thinking to clinical settings and have an ability to find, generate, or synthesize their own knowledge in order to lead and manage evidence-based quality care for infants, children, young people, and their families in a variety of care settings and within interprofessional teams.</p>","PeriodicalId":72655,"journal":{"name":"Comprehensive child and adolescent nursing","volume":"46 2","pages":"142-157"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9849113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Does Sepsis Kill So Many Children?","authors":"Edward Alan Glasper","doi":"10.1080/24694193.2023.2206361","DOIUrl":"https://doi.org/10.1080/24694193.2023.2206361","url":null,"abstract":"Emeritus Professor Alan Glasper from the University of Southampton discusses the difficulty in spotting signs of sepsis in sick children. Across the world, sepsis in childhood is the potential severe and life-threatening aftermath following infection. It is notoriously difficult to detect in the initial stages and if not spotted by the vigilant health-care professional can be deadly. A child can develop sepsis as the result of any type of infection. In neonates for example, untreated infections during pregnancy can be transmitted from the mother to a new-born leading to neonatal sepsis. This more so than in older babies, can present with nonspecific signs that quickly progress to full blown sepsis with accompanying elevated mortality and morbidity rates. Although difficult to detect especially during the early stages of the condition, it can be prevented and treated if identified in a timely manner by a health-care professional. Even if sepsis is established in the infected infant, the disease may still be contained successfully if treatment is commenced promptly. Although relatively rare during childhood, sepsis still claims the lives of 2 or 3 children each day in the UK. It is because the presenting signs and symptoms associated with childhood sepsis are so very nonspecific that it makes the identification of sepsis in young children challenging to identify for parents, guardians, and doctors and nurses (Karas, 2020). Sepsis can be so sudden in onset that it can result in a child being virtually moribund within hours. Across the world, thousands of children are affected by the disease with more than 75,000 children developing sepsis each year in the USA. The Sepsis Alliance, which is a sepsis awareness charity in the USA, strives to increase awareness of sepsis among members of the public and health-care professionals. This charity claims that 200 children per day in the USA develop sepsis with the number of child victims increasing year on year leading to the death of 7000 children annually in the country. Furthermore, up to a third of COMPREHENSIVE CHILD AND ADOLESCENT NURSING 2023, VOL. 46, NO. 2, 79–82 https://doi.org/10.1080/24694193.2023.2206361","PeriodicalId":72655,"journal":{"name":"Comprehensive child and adolescent nursing","volume":"46 2","pages":"79-82"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9636454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Busyness on the Therapeutic Relationship, Nursing Activities and Teamwork: An Ethnography.","authors":"Melinda Simpson-Collins,&nbsp;Margaret Fry,&nbsp;Suzanne Sheppard-Law","doi":"10.1080/24694193.2022.2160517","DOIUrl":"https://doi.org/10.1080/24694193.2022.2160517","url":null,"abstract":"<p><p>To explore a notion of busyness within the context of pediatric acute care and how this influences the therapeutic relationship, nursing activities and teamwork between pediatric nurses and families. Ethnography was the research design. Semi-structured interviews and non-participant observation were used for data collection, which was undertaken in a level four pediatric inpatient unit in Sydney, New South Wales Australia. Brewer's (2000) ethnographic framework for analysis and interpretation was utilized and findings are presented as a realist tale. Interviews with 10 pediatric nurses and 10 parents, and 40 h of non-participant observations were conducted. Three themes are presented, which detail the cultural dimensions of busyness: i) the meaning of busyness; ii) relationships within the pediatric nursing team; and iii) shaping the therapeutic relationship. This ethnography identified how pediatric nurse and parental expectations and collaborative partnerships were re-shaped by busyness. Importantly, the ethnography has presented how busyness is perceived by pediatric nurses and parents, which require new negotiations and a rebalance of workload. Findings have implications for the healthcare workforce and organizational structure. Future research is required to explore how different ways of working better support the pediatric nurse and families during busyness.</p>","PeriodicalId":72655,"journal":{"name":"Comprehensive child and adolescent nursing","volume":"46 1","pages":"65-77"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9245249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Respiratory Syncytial Virus (RSV) Infection in Children Be Eliminated Through Immunization?","authors":"Edward Alan Glasper","doi":"10.1080/24694193.2023.2182593","DOIUrl":"https://doi.org/10.1080/24694193.2023.2182593","url":null,"abstract":"Emeritus Professor Alan Glasper from the University of Southampton discusses the quest to immunize children against the Respiratory Syncytial Virus (RSV) which is a major cause of hospital admission in children with bronchiolitis under five years of age. In January 1975, I was working on the respiratory ward at the East London branch of London’s Great Ormond Steet Hospitals (The National Archives, 2023). The disease the staff feared most in babies and young children under two years of age after whooping cough was bronchiolitis. Caused by RSV, bronchiolitis has been the scourge of families for generations especially during the winter period, leading to bed capacity pressures in many children’s hospitals around the world. Although RSV infection can be a minor illness, it can also be life threatening, especially in infants. In the USA, for example, RSV is the commonest cause of both bronchiolitis and pneumonia. Every year in the UK, approximately 20,000 children who have no underlying health issues require treatment in hospital for RSV infection which is about 3% of the birth cohort. Importantly, most children will become infected by RSV by their second birthday (Handforth et al., 2000). Elsewhere across the globe, the numbers of children infected by RSV are immense, and in 2015, for example, some 33 million children developed lower respiratory illness caused by this virus, with 3.2 million requiring hospital care and this led to about 59,000 deaths, with the majority of them from lowand middle-income countries (García et al., 2010). The world is still reeling from the Covid pandemic which stubbornly refuses to loosen its hold on mankind and now forms part of a perfect storm with the emergence of new highly infectious strains of influenza viruses. News reports suggest that China is currently experiencing 60,000 deaths per month from Covid, and as new strains of the virus mutate, countries around the world continue to fear further manifestations of the pandemic. Despite a decrease in the number of RSV infections during the pandemic when societal lockdowns were imposed in many countries around the world, a resurgence in RSV COMPREHENSIVE CHILD AND ADOLESCENT NURSING 2023, VOL. 46, NO. 1, 5–7 https://doi.org/10.1080/24694193.2023.2182593","PeriodicalId":72655,"journal":{"name":"Comprehensive child and adolescent nursing","volume":"46 1","pages":"5-7"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}