Palliative medicine reports最新文献

{"title":"Palliative Care Support Improves Quality of Life of Patients with Fibrotic Interstitial Lung Disease.","authors":"Arturo Cortes-Telles, Diana Lizbeth Ortíz-Farias, Julia Carel Martínez-Ponce, Lucy Esther López-Pavón, Marco Antonio Cansino-Torres, Christopher J Ryerson","doi":"10.1177/26892820261463086","DOIUrl":"10.1177/26892820261463086","url":null,"abstract":"<p><strong>Background: </strong>We sought to analyze the effect of a palliative care intervention on quality of life (QoL) in patients with fibrotic interstitial lung disease (fILD).</p><p><strong>Design: </strong>This was a prospective observational study including 14 patients with fILD treated with a bundle of care provided by multidisciplinary specialists in pain and palliative care, a psychologist, physical therapists, and a nutritionist, with all patients initiating 10 mg of morphine sulfate. Measurements at baseline, 30 days, and 90 days included cough, dyspnea, pain, tiredness, nausea, depression, anxiety, sleepiness, appetite, and difficulty sleeping. QoL was recorded using the modified St. George's Respiratory Questionnaire (SGRQ-1). Change over time in each endpoint was analyzed.</p><p><strong>Results: </strong>Baseline assessment reflected an impaired QoL (median SGRQ-1, 91 points). All symptom scores improved at 90 days, with a statistically significant and clinically meaningful 20-point decrease in the SGRQ-1 (<i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>Palliative care intervention improves symptom and QoL in fILD.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"7 ","pages":"26892820261463086"},"PeriodicalIF":1.3,"publicationDate":"2026-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using a Machine-Learning Algorithm to Identify Palliative Care Needs in a Primary Care Population: A Pilot Study.","authors":"Mairead M Bartley, Jordan C Karow, Rachel M Wiste, Ethan P Heinzen, Patrick M Wilson, Gabriel O Demuth, Shusaku W Asai, Curtis B Storlie, Rachel D Havyer","doi":"10.1177/26892820261460679","DOIUrl":"10.1177/26892820261460679","url":null,"abstract":"<p><strong>Context: </strong>Early palliative care can improve end-of-life outcomes, but referrals to palliative care specialists can be delayed in the primary care setting.</p><p><strong>Objective: </strong>This pilot study assessed the effect of a machine-learning algorithm on time to palliative care in a primary care population.</p><p><strong>Methods: </strong>Patients (aged ≥18 years) were eligible if they were empaneled with a primary care provider (PCP) from July 20, 2020, through May 30, 2021. The algorithm evaluated their health records and presented patients who were predicted to have the greatest need for palliative care. Records were then reviewed by palliative care specialists, and patients were randomized in a stepped-wedge fashion to have a referral notification sent to their PCPs if unmet palliative care needs were verified. Time-to-event outcomes were evaluated with Poisson regression models.</p><p><strong>Results: </strong>Of the 127,080 patients evaluated, 934 had their health records presented for review. Some patients were repeatedly presented by the algorithm (total presentations: 1592). In the intervention arm, PCPs were prompted to order a palliative care consultation for 142 patients. The time to 0.1% of the population receiving a palliative care consultation was 60.9 days for the intervention arm versus 71.8 days for the control arm (probability of a shorter time with the intervention, 0.88).</p><p><strong>Conclusion: </strong>A machine-learning algorithm to identify palliative care needs was successfully integrated into a primary care practice. More work is needed to improve the workflow.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"7 ","pages":"26892820261460679"},"PeriodicalIF":1.3,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148650030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underrecognition of Delirium in Palliative Care: A Retrospective Comparison Between Cancer and Noncancer Patient Populations.","authors":"Yoko Suzuki, Yuki Takahashi, Tsubasa Nishihara, Shoko Suzuki, Kota Fukai, Katsunaka Mikami, Makoto Tokuhara, Kenji Yamamoto","doi":"10.1177/26892820261452070","DOIUrl":"10.1177/26892820261452070","url":null,"abstract":"<p><strong>Background: </strong>Delirium is associated with high mortality and substantial patient distress; therefore, early identification and management are crucial. Among patients with cancer receiving palliative care, delirium is highly prevalent yet often underrecognized by attending physicians. Recently, palliative care for patients with noncancer conditions has gained attention. Nonetheless, the prevalence of delirium and the extent of physician awareness in this population remain unclear. This study aimed to clarify these aspects in noncancer patient populations to raise awareness among physicians and provide insights to improve palliative care delivery.</p><p><strong>Methods: </strong>We retrospectively reviewed 1540 inpatients receiving palliative care at a university hospital in Japan between January 2018 and December 2023. Psychiatric diagnoses, referral reasons, physical diagnoses, and demographic information were analyzed.</p><p><strong>Results: </strong>In the noncancer group, the number of annual referrals to palliative care increased during the study period (from 7 to 66). Both the cancer and noncancer groups were commonly referred for pain, dyspnea, anxiety, insomnia, and delirium. Compared with the cancer group, the noncancer group was more likely to receive a psychiatric diagnosis (45.7% vs. 57.6%) and had a higher prevalence of delirium (12.9% vs. 21.5%). In the noncancer group, the proportion of referrals citing psychiatric symptoms was higher (38.5% vs. 54.2%), whereas the frequency of delirium underrecognition was comparable to that in the cancer group (59.6% vs. 71.0%).</p><p><strong>Conclusion: </strong>Underrecognition of delirium in palliative care settings is a common issue in both cancer and noncancer patient populations. Enhancing physician awareness may improve palliative care quality in these populations.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"7 ","pages":"26892820261452070"},"PeriodicalIF":1.3,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moxibustion as Supportive Therapy for Opioid-Induced Constipation in Patients with Advanced Cancer: A Case Series.","authors":"Kanae Kanda, Akitsu Murakami, Nlandu Roger Ngatu, Tomohiro Hirao, Akihito Harusato","doi":"10.1177/26892820261454476","DOIUrl":"10.1177/26892820261454476","url":null,"abstract":"<p><strong>Background: </strong>Opioid-induced constipation (OIC) is a common adverse effect of opioid therapy in cancer patients, often persisting despite laxatives and peripherally acting μ-opioid receptor antagonists. Moxibustion, a traditional thermal therapy applied to acupuncture points, has been proposed as a supportive option, but clinical evidence for OIC remains scarce. This study evaluated the clinical outcomes and feasibility of moxibustion for OIC in advanced cancer patients.</p><p><strong>Methods: </strong>We conducted a prospective case series at Kagawa University Hospital (April 2023-July 2025). Ten patients with advanced cancer and clinically diagnosed OIC were included. Eligibility required Eastern Cooperative Oncology Group performance status 0-2 and no prior chronic constipation. Moxibustion was delivered twice weekly for three weeks (six sessions) to standardized abdominal, hand, and foot acupoints using a ceramic warming device. Constipation severity was assessed with the Constipation Assessment Scale (CAS). Secondary outcomes included laxative use, stool form, and Edmonton Symptom Assessment System-Revised.</p><p><strong>Results: </strong>Eight patients improved in CAS scores (mean change -2.8, SD: 3.0; <i>p</i> = 0.012) and sustained it at four-week follow-up (-2.5, SD: 2.7; <i>p</i> = 0.022). All patients reduced laxative use, and several achieved normalization of stool form. No treatment-related adverse events occurred.</p><p><strong>Conclusions: </strong>This case series indicates moxibustion is a feasible and safe complementary therapy for OIC in advanced cancer, with the potential to reduce symptom burden and medication use. While limited by small sample size and lack of control, the findings support further trials to confirm its role in integrative palliative care.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"7 ","pages":"26892820261454476"},"PeriodicalIF":1.3,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Cure in Advanced Cancer: Preserving Function, Dignity, and Participation Through Palliative Rehabilitation.","authors":"Mohammad A Chaudhary","doi":"10.1177/26892820261435973","DOIUrl":"10.1177/26892820261435973","url":null,"abstract":"<p><p>Advances in oncology have extended survival for many individuals with cancer; however, a substantial proportion now live with advanced or incurable disease for prolonged periods. In this context, goals of care shift from cure to comfort, autonomy, and quality of life. Despite this, cancer care systems often remain disease-centered and symptom-focused, with less attention to functional ability and participation. This Special Report argues that preservation of function should be recognized as a central goal of advanced cancer care, as function directly supports dignity, autonomy, and participation. When functional decline is unaddressed, symptom control alone is insufficient to prevent dependence, caregiver burden, and social withdrawal. Palliative rehabilitation aligns rehabilitation principles with palliative care by optimizing function and participation within progressive illness. Interventions such as activity modification, energy conservation, assistive devices, environmental adaptation, and caregiver education enable continued engagement in meaningful activities. Despite growing recognition of supportive care needs, palliative rehabilitation remains inconsistently integrated into cancer services. Strengthening its integration into clinical pathways and health systems is essential for delivering holistic, person-centered care in advanced cancer.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"7 ","pages":"26892820261435973"},"PeriodicalIF":1.3,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining Advance Care Planning and Identifying Quality Indicators: A Case Study on Key Stakeholders' Perspectives in Singapore.","authors":"Woan Shin Tan, Penny Lun, Wai Min Wong, James Low, Raymond Ng","doi":"10.1177/26892820261457343","DOIUrl":"10.1177/26892820261457343","url":null,"abstract":"<p><strong>Background: </strong>In recent years, several regions have evolved their own definitions of advance care planning (ACP). Country-specific characteristics may affect local definitions, goals, and quality assessment.</p><p><strong>Objective: </strong>To obtain collective views of key opinion leaders in Singapore regarding the target population, scope, and goals of ACP, and to propose a list of quality indicators that could be used to monitor and evaluate its progress and impact.</p><p><strong>Design: </strong>A World Café methodology was used to facilitate group discussions among participants involved in ACP-related work across a range of settings including acute hospitals, community hospitals, primary care clinics, nursing homes, community care organizations, nursing homes, and universities. To define the target population, scope, and goals of ACP, three distinct exercises were conducted within the World Café session, from which main insights were synthesized and reported.</p><p><strong>Results: </strong>A total of 34 ACP leaders, administrators, facilitators, and researchers representing 25 organizations participated. ACP was conceived to be an ongoing process of exploring an individual's personal beliefs, values, and health care preferences in relation to current and future medical care, together with their families and loved ones. To balance respecting the voice of the individual a with operational efficiency, organizations can deploy structural and process quality indicators to guide goal achievement.</p><p><strong>Conclusion: </strong>We have established the intended target population, scope, and goals necessary to inform the implementation of ACP. Critical quality indicators were identified to support the monitoring and evaluation of the program's progress across different implementation stages in Singapore.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"7 ","pages":"26892820261457343"},"PeriodicalIF":1.3,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination Therapy with Pregabalin and Morphine Relieves Dinutuximab-Induced Pain in a 3-Year-Old Girl: A Case Report.","authors":"Maiko Akazawa, Yuki Shigetsura, Kazuko Kawakatsu, Naomi Matsuyama, Hirohito Kubota, Tomohiro Terada, Kazuki Shimada","doi":"10.1177/26892820261452103","DOIUrl":"10.1177/26892820261452103","url":null,"abstract":"<p><strong>Introduction: </strong>Opioids are commonly initiated prior to dinutuximab (DIN)-an anti-disialoganglioside 2 antibody used in the treatment of neuroblastoma-and continued for approximately 2 hours after administration to manage DIN-associated pain. However, pain control remains insufficient with standard opioid treatment.</p><p><strong>Methods: </strong>We treated a 3-year-old girl with high-risk neuroblastoma who received DIN after tandem transplantation. During the first treatment cycle, despite scheduled morphine therapy, she developed abdominal pain rated as 5 on the Faces Pain Scale (FPS; range 0-5, where 0 indicates no pain and 5 indicates the worst pain), indicating the need for higher doses, prolonged infusion, and additional bolus analgesia. The dosing period and DIN dosage in the second cycle were similar to those in the first cycle. To improve pain control during the second cycle, pregabalin was initiated at a dose of approximately 1 mg/kg/day 3 days prior to DIN administration.</p><p><strong>Results: </strong>This approach significantly reduced abdominal pain, with the maximum FPS score decreasing to 2.</p><p><strong>Conclusion: </strong>This case highlights that adding pregabalin to standard opioid therapy can contribute to improved management of DIN-induced pain.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"7 ","pages":"26892820261452103"},"PeriodicalIF":1.3,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Letter:</i> Loneliness and Artificial Companionship in Palliative Care.","authors":"Shisei Tei, Junya Fujino","doi":"10.1177/26892820261452100","DOIUrl":"10.1177/26892820261452100","url":null,"abstract":"","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"7 ","pages":"26892820261452100"},"PeriodicalIF":1.3,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Extubation in Critically Ill Patients: A Retrospective Study of Timing, Prior Expressions of Will, Sedation, and Outcomes.","authors":"Rodolfo Moraes Silva, Francielem Guglielmo Vilela, Marília Adler Galvão da Silva, Luisa Gabrielly Silva Israel, Melissa Perin","doi":"10.1177/26892820261452090","DOIUrl":"10.1177/26892820261452090","url":null,"abstract":"<p><strong>Objective: </strong>To characterize palliative extubation (PE) as a clinical and ethical process in critically ill patients in a public hospital in Brazil, focusing on timing of palliative care (PC) involvement, shared decision-making, symptom management, and outcomes.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included adult patients who underwent PE between January 2022 and December 2024. Data were obtained from a prospectively maintained institutional PC database and medical records. Variables included demographics, comorbidities, functional status, reasons for intubation, timing of PC consultation, family conferences, opioid use, palliative sedation, and outcomes. Descriptive analyses were performed.</p><p><strong>Results: </strong>Among 447 patients evaluated by the PC team, 122 (27.3%) underwent PE. The mean age was 69.7 years, and 51.6% were female. Half had a Palliative Performance Scale score ≤60 before admission. The mean time from hospital admission to PC consultation was 8.3 days. Family conferences were conducted in all cases (mean: 1.5 per patient), and extubation occurred within three days of the conference in 92.6%. Opioids were used in 77.0% of patients, predominantly morphine; palliative sedation was required in 21.3%, always with midazolam. In-hospital mortality was 91.8%, while 8.2% were discharged. Among deaths, 50% occurred on the same day as extubation, whereas others survived from hours to 31 days.</p><p><strong>Conclusions: </strong>In this cohort, PE was integrated into a structured, family-centered process involving interdisciplinary consensus and individualized symptom management. The variability in survival after extubation supports its interpretation as withdrawal of disproportionate treatment rather than an intervention intended to hasten death, underscoring the importance of early PC integration in intensive care settings.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"7 ","pages":"26892820261452090"},"PeriodicalIF":1.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Associated Factors of Depressive Symptoms in Bereaved Family Members of Terminally Ill Cancer Patients Receiving Home Care.","authors":"Ryo Yamamoto, Tatsuya Morita, Kotaro Hashimoto, Asumi Nakamura, Taketoshi Ozawa, Tomoyuki Koga, Kazuhiro Hisajima, Masahiro Goshima, Keijiro Miyake, Takamichi Matsuki, Nobuyuki Miyata, Yasuhiro Saito, Masakatsu Shimizu, Yousuke Kimura, Yoshiyuki Kamiyama, Hideki Shishido, Kazushi Nakano, Yasunori Muraoka, Manabu Tamura, Maiko Kodama, Sen Otomo, Takuya Shinjo, Jun Hamano","doi":"10.1177/26892820261450405","DOIUrl":"10.1177/26892820261450405","url":null,"abstract":"<p><strong>Background: </strong>Bereavement is a known risk factor for depression; however, the prevalence of depression and its associated factors among family members who provided home care for terminally ill cancer patients remains unclear.</p><p><strong>Objectives: </strong>This study aimed to investigate the prevalence of probable depression and associated factors among bereaved family members of cancer patients who died at home in Japan.</p><p><strong>Design: </strong>A multicenter cross-sectional study within a prospective cohort using a self-administered questionnaire survey of bereaved family members.</p><p><strong>Setting/subjects: </strong>Twenty facilities across Japan participated. Bereaved family members of adult cancer patients who died at home were surveyed.</p><p><strong>Measurements: </strong>Depression was assessed using the Japanese version of the Patient Health Questionnaire-9, with probable depression defined as a total score of ≥ 10.</p><p><strong>Results: </strong>Among 195 bereaved family members, 23 (11.8%; 95% CI: 7.3-16.3%) screened positive for probable depression. Factors significantly associated with depression included unpreparedness for death (OR 11.0; 95% CI 2.8-43.8), caregiver's poor physical condition while providing care (OR 7.4; 95% CI 1.4-39.2), patient dyspnea within one week before death (OR 4.5; 95% CI 1.3-15.6), and use of antipsychotics at the start of home care (OR 6.3; 95% CI 1.2-32.2).</p><p><strong>Conclusions: </strong>A substantial minority of bereaved family members screened positive for probable depression after providing home care. In addition to effective symptom management, especially for dyspnea and addressing neuropsychiatric instability (as indicated by the need for antipsychotics), during home care, ensuring that family members are adequately informed about the patient's condition and addressing their physical well-being may help reduce the risk of depression in bereaved family members.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"7 ","pages":"26892820261450405"},"PeriodicalIF":1.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}