BMJ Paediatrics Open最新文献

{"title":"Safer Baby Bundle intervention for reducing perinatal mortality in Ethiopia: a quasi-experimental study.","authors":"Mesfin Tadese, Solomon Hailemeskel, Alemayehu Moges, Saba Desta Tessema, Michael Amera Tizazu, Getnet Mitike Kassie","doi":"10.1136/bmjpo-2025-003502","DOIUrl":"10.1136/bmjpo-2025-003502","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of the Safer Baby Bundle (SBB) of care in reducing perinatal mortality in Ethiopia.</p><p><strong>Design: </strong>A quasi-experimental study design was implemented from February to August 2024. The intervention group received the five SBB care package adapted for Ethiopia; improving detection and management of fetal growth restriction, raising awareness and improving care for women with decreased fetal movements, improving awareness of maternal safe going-to-sleep position, improving decision-making about timing of birth for women with risk factors for stillbirth and effective fetal monitoring during labour, and the control group received the standard care. Log-binomial regression analysis was performed to compare the outcome variables.</p><p><strong>Setting: </strong>Four hospitals in North Shewa Zone, Ethiopia.</p><p><strong>Participants: </strong>841 women attending antenatal care were included.</p><p><strong>Outcome measures: </strong>Stillbirth is the death of a baby before or during birth after 28 weeks of gestation in singleton pregnancies without lethal fetal congenital anomalies, whereas, early neonatal death is the death of a newborn occurring before hospital discharge.</p><p><strong>Results: </strong>In this study, the overall stillbirth rate decreased by 24.8%, from 28.6 to 21.5 per 1000 live births, and neonatal mortality reduced by 19.9%, from 35.7 to 28.6 per 1000 live births, although these results were not statistically significant. Additionally, the intervention significantly reduced the incidence of non-reassuring fetal heart rate patterns during labour (adjusted risk ratio (aRR)=0.78, 95% CI 0.64 to 0.95), low birth weight (aRR=0.77, 95% CI 0.60 to 0.98) and the need for neonatal resuscitation (aRR=0.59, 95% CI 0.37 to 0.94). However, there was a concurrent increase in neonatal intensive care unit admissions (aRR=1.42, 95% CI 1.19 to 1.69).</p><p><strong>Conclusion: </strong>The implementation of the SBB, adapted for Ethiopia, was associated with improvements in perinatal health outcomes. Further implementation research to identify causal effects and assess feasibility in Ethiopia and other low-income and middle-income countries is crucial.</p><p><strong>Trial registration number: </strong>https://pactr.samrc.ac.za, PACTR202503889654904.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADHD knowledge, perception and misconceptions among Sudanese elementary school teachers 2022.","authors":"Mohammed Elhadi Badawi Mahjoub, Mohammednour Mukhtar Mohammednour Ali, Shafee S Almahi","doi":"10.1136/bmjpo-2025-003456","DOIUrl":"10.1136/bmjpo-2025-003456","url":null,"abstract":"<p><strong>Background: </strong>Attention deficit hyperactivity disorder (ADHD) is impaired functioning in at least two settings: home and school due to impulsivity, hyperactivity and inattention.Primary school teachers play an essential role in assessing children's behaviour and are often the first ones to recognise a child with ADHD as they are exposed daily to children and play a role in evaluating treatment plans at school. This study aims to assess the knowledge, perception and misconceptions of elementary school teachers in the locality of Khartoum regarding ADHD and to examine the differences in their knowledge in terms of sociodemographic variables.</p><p><strong>Method: </strong>The study uses a descriptive cross-sectional study design conducted at 37 randomly selected elementary schools in the locality of Khartoum in October/November 2022. We applied cluster sampling and used a structured self-administered two-part questionnaire consisting of sociodemographic data and ADHD knowledge scale.</p><p><strong>Results: </strong>The study included 321 teachers, 270 (84.1%) females and 51 (15.9%) males. The mean age of participants was 47.9 (SD = 8.5) years, with an average teaching experience of 21.94 (SD = 10.2) years.The overall knowledge about ADHD was 48.53% (SD = 9.71). Teachers tend to show higher knowledge about ADHD symptoms and relatively poor awareness regarding ADHD treatment. Mean knowledge was higher in teachers with previous experience with an ADHD child.</p><p><strong>Conclusion: </strong>Elementary school teachers in Khartoum seemed to lack sufficient understanding of ADHD, especially when it came to treatment options. Raising awareness should be prioritised to help students with ADHD.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children missing from the table: reflections from the 78th World Health Assembly.","authors":"Erva Nur Cinar","doi":"10.1136/bmjpo-2025-003724","DOIUrl":"10.1136/bmjpo-2025-003724","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional and prenatal care factors associated with low birth weight among full-term infants in public hospitals of Addis Ababa, Ethiopia.","authors":"Merga Abdissa Aga, Berhanu Teshome Woldeamanuel","doi":"10.1136/bmjpo-2025-003732","DOIUrl":"10.1136/bmjpo-2025-003732","url":null,"abstract":"<p><strong>Background: </strong>Low birth weight (LBW), defined as birth weight less than 2500 g regardless of gestational age, remains a pressing global health issue. It significantly contributes to neonatal mortality (60-80% of deaths), developmental delays and increased risk of chronic diseases in adulthood. Despite interventions, LBW remains prevalent in Ethiopia. This study aimed to identify the key risk factors for LBW in public hospitals in Addis Ababa, with a focus on maternal nutrition and prenatal care two underexplored but modifiable determinants: maternal nutrition and prenatal care.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in 2024 using data from 722 mothers selected via simple random sampling across four public hospitals in Addis Ababa. Birth weight was categorised into low and not low groups. To account for hospital-level variability, a multilevel binary logistic regression model was employed, treating hospitals as random effects, to identify maternal, nutritional and prenatal care factors associated with LBW.</p><p><strong>Results: </strong>The prevalence of LBW was 12%. The multilevel binary logistic regression model revealed significant between-hospital variability in LBW outcomes (variance=0.25; 95% CI: 0.12 to 0.55). Increased odds of LBW were associated with maternal age>34 years (adjusted OR (AOR)=2.51; 95% CI: 1.20 to 5.50), unplanned pregnancy (AOR=1.60; 95% CI: 1.42 to 1.92), family size >4 (AOR=2.15; 95% CI: 1.35 to 3.45), alcohol use during pregnancy (AOR=1.62; 95% CI: 1.28 to 2.01), delayed antenatal care initiation in the third trimester (AOR=1.14; 95% CI: 1.02 to 1.62) and heavy maternal workload (AOR=1.12; 95% CI: 1.01 to 1.64). Protective factors included regular antenatal care follow-up (AOR=0.29; 95% CI: 0.12 to 0.64), eating extra meals during pregnancy (AOR=0.46; 95% CI: 0.22 to 0.87), interpregnancy interval>24 months (AOR=0.55; 95% CI: 0.29 to 0.69), maternal height≥155 cm (AOR=0.49; 95% CI: 0.22 to 0.87) and pre-pregnancy weight≥50 kg (AOR=0.20; 95% CI: 0.06 to 0.46).</p><p><strong>Conclusions: </strong>This study underscores that maternal age, pregnancy planning, family size, antenatal care access and timing, workload, alcohol use and nutritional practices are associated with LBW. The observed variation across hospitals suggests institutional differences may also influence outcomes. Strengthening maternal health programmes and improving hospital-level care could reduce LBW prevalence in Addis Ababa.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the caregiver experience: a cross-sectional study of caregiver burden among those caring for chronically ill children in Jordan.","authors":"Lina Alshadfan, Mohammad Deameh, Aya Alhyary, Mohammad Da'meh, Khaled El-Areidi, Mahmod Sharqi, Ahmad Alkayed, Khaled Da'meh, Osama Alhaj Ali, Ghada Alkhdour, Rahaf Abu-Shai'rah, Basel Akash, Mohammad Alfaouri, Saleh Abualhaj","doi":"10.1136/bmjpo-2025-003610","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003610","url":null,"abstract":"<p><strong>Background: </strong>Caregivers of children with chronic illnesses often experience varying levels of burden, influenced by multiple psychosocial and environmental factors. Understanding the specific sources and determinants of caregiver burden is crucial for developing supportive interventions, particularly in regions where research remains limited.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 352 caregivers to assess the extent and nature of caregiving burden. Burden levels were measured using a validated Arabic version of the Zarit Burden Interview (ZBI-A) questionnaire, and associations with sociodemographic factors were examined.</p><p><strong>Results: </strong>The study included 352 caregivers of children with chronic illnesses, with a mean child age of 9.5 years (SD=4.4) and a majority being boys (64.5%). The mean age of the caregivers was 40.3 years (SD=9.2, range: 20-70 years), with most being mothers (83.8%). According to the ZBI-A Score, 38.6% experienced no-to-mild burden, 40.6% reported mild-to-moderate burden and 20.8% faced high burden. The most prominent burden sources were feelings of inadequacy, stress balancing childcare with other responsibilities and insufficient time for self-care (mean: 2.83, 2.61 and 2.47, respectively). Moderate burdens included fatigue, lack of privacy and health deterioration (mean: 2.07, 2.07 and 2.00, respectively), while the lowest level was observed for anger (mean: 1.74). Lower family income and non-attendance of children in school were significantly associated with higher caregiver burden (p=0.04 and 0.02, respectively).</p><p><strong>Conclusion: </strong>Caregiver burden is a significant issue among parents of chronically ill children, shaped by emotional, social and financial stressors. Strengthening school-based support services and addressing financial hardships may substantially reduce caregiver burden and improve family well-being.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"During school reintegration: a qualitative study of parental psychological experiences following paediatric kidney transplantation.","authors":"L V Maomao, Shuo Bai, Jing Huang, Jiwei Qi, Zhuo Shi, Lili Jia","doi":"10.1136/bmjpo-2025-003429","DOIUrl":"10.1136/bmjpo-2025-003429","url":null,"abstract":"<p><strong>Objective: </strong>To understand the psychological experience of parents of children who have undergone kidney transplantation during school reintegration and to provide a basis for developing targeted interventions.</p><p><strong>Method: </strong>Using purposive sampling, parents of 11 children admitted to the paediatric department of a tertiary-level hospital in Jiangsu Province following kidney transplantation from June 2022 to June 2024 were selected as study participants. One-to-one, semistructured in-depth interviews were conducted, and Colaizzi's seven-step analysis was applied to analyse the interview data.</p><p><strong>Results: </strong>Four themes emerged: the dilemma between parental expectations and school acceptance, complexity and ambivalence before returning to school, optimism and gratitude after returning to school and expectation of social support.</p><p><strong>Conclusion: </strong>Parents of kidney-transplanted children face various dilemmas regarding school reintegration. Clinical caregivers should pay attention to their psychological experience of parents, develop personalised intervention systems and enhance the caregivers' coping ability in order to improve the children's quality of life.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validating a codesigned paediatric patient reported experience measure: a study protocol.","authors":"Karlen R Barr, Jessica Nikolovski, James R John, Leslie White, Sarah Elliott, Lynn McCartney, Claire Treadgold, Barb Vernon, Valsamma Eapen","doi":"10.1136/bmjpo-2025-003490","DOIUrl":"10.1136/bmjpo-2025-003490","url":null,"abstract":"<p><strong>Introduction: </strong>Patient reported experience measures (PREMs) are important tools to include the voices of patients in healthcare provision. Children have a right to be included in decisions made about their care. A self-reported, locally validated and standardised paediatric PREM (pPREM) does not exist for use in Australian healthcare settings. Further, existing pPREMs are rarely codesigned with children or developed to be completed by children themselves. This study aims to validate a pPREM that will be completed by children within Australian healthcare settings.</p><p><strong>Methods and analysis: </strong>This study will involve three subphases, engaging children aged 6-11 years old who have had a hospital admission in the past 3 months. First, up to 25 children will participate in cognitive interviews to pilot test pPREM items. Using feedback from the interviews, population testing will occur with about 180 children at six Australian hospitals to determine the validity, reliability and feasibility of the pPREM. The study's implementation process will be evaluated through interviews with approximately 25-30 clinicians, managers and other stakeholders.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and determinants of zero vegetable and fruit consumption among Bangladeshi children under 2: a community-based cross-sectional study.","authors":"Md Fuad Al Fidah, Md Nafis Fuad, Sharif Mohammad, Syeda Sumaiya Efa","doi":"10.1136/bmjpo-2025-003554","DOIUrl":"10.1136/bmjpo-2025-003554","url":null,"abstract":"<p><p>This study estimated the prevalence and determinants of zero vegetable and fruit (ZVF) consumption among children aged 6-23 months, using data from the 2019 Multiple Indicator Cluster Survey, Bangladesh (n=6668). The prevalence of ZVF was 44.1%. Lower odds of ZVF were observed among older children and those whose mothers had higher levels of education, media exposure or belonged to wealthier households. In contrast, children with recent illnesses and urban residents had higher odds of ZVF. Targeted interventions for younger and socioeconomically disadvantaged children, alongside maternal nutrition education, are essential to promote fruit and vegetable intake in early childhood.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a machine learning-based prediction model for serious bacterial infections in febrile young infants.","authors":"Jun Sung Park, Reenar Yoo, Soo-Young Lim, Dahyun Kim, Min Kyo Chun, Jeeho Han, Jeong-Yong Lee, Seung Jun Choi, Seak Hee Oh, Jong Seung Lee, Jina Lee","doi":"10.1136/bmjpo-2025-003548","DOIUrl":"10.1136/bmjpo-2025-003548","url":null,"abstract":"<p><strong>Background: </strong>To develop and validate machine learning (ML)-based models to predict serious bacterial infections (SBIs) in febrile infants aged ≤90 days.</p><p><strong>Methods: </strong>This retrospective study analysed data from febrile infants (≥38.0℃) aged ≤90 days. The development dataset comprised data from patients who visited the Seoul Asan Medical Center between 2015 and 2021, whereas the validation dataset included data from those who visited the centre from January 2022 to August 2023. Logistic regression (LR) and eXtreme Gradient Boosting (XGB) were used to develop the models for predicting SBIs, which were then compared with traditional rule-based models.</p><p><strong>Results: </strong>The study included data from 2860 patients: 2288 (80%) in the development dataset and 572 (20%) in the validation dataset. SBIs were confirmed in 482 patients (21.0%) in the development dataset and 131 (22.9%) in the validation dataset. The XGB and LR models showed excellent performance with areas under the curve of 0.990 and 0.981 in development, and 0.989 and 0.985 in validation datasets. In validation, both models demonstrated superior specificity (82.3-87.0% vs 46.2-72.2%) and positive predictive value (61.5-68.5% vs 34.4-49.8%) compared with traditional rule-based models, while maintaining perfect sensitivity and negative predictive value (both 100% vs 81.7-100% and 92.0-100%, respectively) without any false negatives. Urinalysis, C-reactive protein and procalcitonin were identified as top-tier features in the XGB model.</p><p><strong>Conclusions: </strong>The ML-based prediction model demonstrated robust performance, with superior specificity and perfect sensitivity, which may enhance the accuracy of SBI detection and reduce the costs associated with false positives.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periviable birth: Legal landscape in Indian jurisprudence.","authors":"Shivashankar Diggikar, Karthik Nagesh, Nanditta Batra","doi":"10.1136/bmjpo-2025-003798","DOIUrl":"10.1136/bmjpo-2025-003798","url":null,"abstract":"<p><p>Periviability represents a complex threshold where there is a triangulation of medical capabilities, ethical judgement and the right of the infant to live. In India, with its disproportionate burden of preterm births, the management of infants born at the margins of viability (typically <28 weeks of gestation) remains fraught with legal and ethical challenges. We critically explore the legal contours surrounding the care of periviable neonates from an Indian medico-legal perspective in this article. Despite lacking a uniform national consensus on viability thresholds, Indian jurisprudence confers personhood to neonates at birth, irrespective of gestational age, thereby guaranteeing constitutional protection under Article 21. However, in the absence of explicit guidelines and robust systemic infrastructure, physicians and families must navigate resuscitation decisions amid legal uncertainty, cost constraints and moral complexity. Judicial precedents have mandated life-saving interventions for viable neonates born alive post medical termination attempts, reinforcing the right to care. We discuss the limitations of legal doctrines such as parental autonomy, leave against medical advice and advance directives when applied to neonates who cannot consent for obvious reasons. We also highlight challenges arising from evolving tort liability, procedural lapses and resource inequity in neonatal care.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}