HIV Nursing <p><strong>Aims and scope</strong><br /><strong><em>HIV Nursing</em></strong> has been developed as a forum for those at the forefront of caring for people affected by HIV. This peer-reviewed journal is supported by a highly respected Editorial Board drawn from a wide range of nursing specialties. This is further strengthened by an Advisory Panel, whose members make regular contributions to the journal.<strong> ISSN: 1474-7359</strong></p> <p><br /><strong><em>HIV Nursing</em></strong> is intended to provide a medium for communication on issues relating to HIV care, which will be run by the care professionals for those involved in the day-to-day matters affecting the lives of patients.<br />HIV Nursing is listed in the CINAHL, Elsevier, Scopus, Thomson Gale, Mosby Year Book, Cabell’s, INANE and EMNursing databases.<br /><br /><strong>Publication</strong><br />The Journal is printed quarterly and articles are available in print and on the website for NHIVNA members and other subscribers. </p> en-US ( HIV Nursing Society) (Yamini ) Sun, 16 Jan 2022 00:00:00 +0000 OJS 60 Improving HIV Pre-Exposure Prophylaxis (PrEP) Uptake During the COVID-19 Pandemic <p>Background<em>:</em> Acute HIV cases have doubled during the COVID-19 pandemic. We implemented a quality improvement (QI) project to standardize PrEP telehealth at a large metropolitan medical center in a HIV hotspot to ensure PrEP access and uptake. <em>Methods:</em> A 2-arm recruitment approach was implemented from August 31<sup>st</sup>, 2020-December 16<sup>th</sup>, 2020 targeting (1) patients through weekly social medial outreach and (2) providers in high-volume departments through educational in-services and dedicated chart reviews. <em>Results:</em> Provider referrals from the Emergency and Primary Care Departments increased 460% (p=0.03). PrEP users shifted to a majority &lt;35 years old (n=12, 38.7%), but remained mostly Black (n=16, 51.5%) males (n=30, 96.8%). <em>Conclusion:</em> This QI project may have reduced PrEP discontinuation during the pandemic. The low percentage of PrEP users may be related to COVID-19 on clinic follow-up. The younger demographic shift may translate to a larger decrease in HIV transmission given the relative risk of different cohorts</p> Emily Comstock, Camilia James, Robert Hegarty, Yolanda Flores, Tracy Wilson, Rohit Talwani, Eleanor Wilson Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 Determination Level of Nurse’s Practices toward Surgical Wound Care in Karbala Teaching Hospital, Iraq <p><strong>Background</strong>: Wound dressing is one of the major nursing responsibilities. Aseptic technique is mandatory to minimize complications. Effective wound dressing promotes wound healing and leads to early discharge and saving costs.</p> <p><strong>Methods</strong>: Quantitativ study decriptive-cross sectional design selected obtaineed proper answers for the study questions related to wound care parctices potential problem in specific health setting from the period between (5. Jan to 30. May. 2021).</p> <p><strong>Results</strong>: higher percentage 12(40%) of the participants were (26-30) years old. The higher percentage 19(63.33%) of the patient were male. The higher percentage 13 (43.33%) of the participant were diploma.</p> <p><strong>Conclusions:</strong> Responses of the participants were (good) related to overall domains of the practices toward wound car except the participants were (fair) related to surgical wound cleaning</p> Noor Al-Huda Sameer kasim, Wefaqq Mahdi Hadi Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 Linkage to care, HIV + pregnant mothers, and Early Infant Diagnosis: A three years intervention towards the elimination of MTCT in Igbo-Eze North Local Government of Enugu State <p>A three-year research and advocacy programme aimed at establishing the degree of people living with HIV in rural community on one hand, and on the other hand, providing linkage services to the HIV treatment centres. We adopted a cross-sectional study carried out in pre-intervention, intervention and post-intervention phases and a total of 40 116 persons between the ages of &lt;6 months to70 years received the HIV Treatment Services (HTS). This project empowered existing community congregational health structures to create demand for screening and referral for HIV and other chronic illnesses among pregnant and non-pregnant women during weekly church services and other congregational activities. The congregation health structures was supported with Treatment Linkage Specialist (TLS) to increase linkage to care of identified HIV positive clients and to overcome HIV-related stigma and discrimination in 25 rural communities of Enugu-Ezike, Enugu State. We used simple descriptive statistics to present HTS results. Our findings show that non-pregnant women represent the highest number (888 or 54.81%) of HIV positives, indicating 5.3538 prevalence rate over the three years of the survey. Adult males are the second highest (459 or 28.33%) HIV positives at a prevalence rate of 5.4127, pregnant women are reported as the third highest (122 or 7.53%) HIV positive with 1.7319 prevalence rate. Mother-to-child-transmission (MTCT) of HIV continuous to occur in the rural communities as children aged 5-9 years and less than 6 months – 4 years represent 2.6% and 2.3% of HIV positive persons respectively. The TLS strategy has, however, to a large extent reduced the poor linkage to care/treatment from the 41.4% linkages in 2018 to 91.8% and 98.3% in 2019 and 2020 respectively. This is a reflection of increased access to HIV testing services and the Treatment Linkage Specialists who bridge the gaps observed in the HIV care spectrum in Enugu-Ezike communities. Although preventing MTCT of HIV remains a difficult task in rural areas due to poverty and illiteracy, robust evidence shows that improved linkage services to care treatment centres will increase awareness level of PMTCT. &nbsp;</p> Ejike Kenneth Nwene, Emeka Okekeze, Uzor Nkwonta, Nnenna Okonkwo, May Okeke, Chiamaka Ezike and J. Tochukwu Omenma Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 Studying anti-inflammatory action of Cordia myxa fruit extract on induced chronic stress model in male rats and expected improvement in depression treatment in humans <p>Depression is one of the most common phsychiatric diseases that treated with variety of medications that have significant problems to human health and increased suicide rates. Herbal medications have recently gained a lot of interest in the treatment of depression due to their safety, efficacy, and cost-effectiveness, so this study was aimed to evaluate effects of <em>C.Myxa </em>fruit extract on the model of chronic unpredictable stress (CUS) and the proinflammatory cytokine IL-6 in male rat’s brains. Therefore, sixty male rats were divided into six groups. Group1 (control) was neither exposed to CUMS nor received any treatment while group 2 was exposed to CUMS for 24 days with normal saline treatment for 14 days, group 3 was exposed to CUMS for 24 days and received 10 mg/kg fluoxetine daily on day 10 for 14 days, and group 4, 5 and 6 were exposed to CUMS for 24 days and received <em>C.Myxa </em>extract (125,250 and 500 mg/kg respectively) on day 10 for 14 days. The antidepressant effect of fluoxetine and <em>C.Myxa </em>extract were evaluated by using sucrose preference test and open field test. At the end of the experiments, animals were sacrificed by decapitation, and interleukin 6 level determined by enzyme linked immunosorbent assays kit (Elisa) in rat’s brain tissues. in groups 3, 4, 5 and 6, the means of sucrose preference index (SPI) on day10 significantly decreased (<em>P-value </em>&lt;0.05) as compared with day 0, while the means of SPI on day 25 of groups 3,4,5 and 6 significantly increased (<em>P-value</em> &lt;0.05) as compared with day10. In group 2, the mean of SPI significantly decreased (<em>P-value </em>&lt;0.05) as compared with group 1, while in groups 3, 4, 5, and 6 the means of SPI significantly increased (<em>P-value </em>&lt;0.05) as compared with group 2 on day 25. Open field test (OFT) showed that in groups 2, 3, 4, 5 and 6, the means of Rearing frequencies on day10 significantly decreased (<em>P-value </em>&lt;0.05) as compared with day 0, while the means of&nbsp; Rearing frequencies on day 25 of groups 3,4,5 and 6 significantly increased (<em>P-value</em> &lt;0.05) as compared with day10. In group 2, the mean of Rearing frequencies significantly decreased (<em>P-value </em>&lt;0.05) as compared with group 1, while in groups 3, 4, 5, and 6 the means of Rearing frequencies, significantly increased (<em>P-value </em>&lt;0.05) as compared with group 2 on day 25’</p> <p>In terms of the Interleukin-6 levels, The means of the IL-6 concentrations in brain tissue of group 2 significantly increased (<em>P-value </em>&lt;0.05) as compared with group1, while in groups 3, 4, 5, and 6 the means of the IL-6 concentrations in brain tissue significantly decreased (<em>P-value </em>&lt;0.05) as compared with group 2. In conclusion, <em>C. Myxa </em>has an antidepressant-like activity and reversed the stress-induced IL-6 higher levels</p> Yasser Jasib Habeeb, Selman Mohammed Selman, Alaa Jeafer Mehrath Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 ASSOCIATED RISK FACTORS OF HIV STATUS IN ETHIOPIA: MULTILEVEL ANALYSIS <p><strong>Background:</strong> HIV is a virus spread through certain body fluids that attacks the body’s immune system, specifically the CD4 cells. In Ethiopia, the general trend of the prevalence rate varies across each year and in each region. &nbsp;The purpose of the current study was to identify the most risk factors Related to the HIV status of individuals in Ethiopia. &nbsp;</p> <p><strong>Methodology</strong>: The data for this study were taken from Ethiopia Demographic and Health Survey conducted in 2016 (EDHS 2016). &nbsp;Voluntarily HIV testing interviewers collected finger-prick blood specimens from women age 15-49 and men age 15-59 who consented to HIV testing. &nbsp;The analysis was conducted by binary logistic regression and multilevel logistic regression model.</p> <p><strong>Results: </strong>Among 26692 individuals included in the study, 55.1 % (14719) and 44.9 % (11973) were female and male individuals respectively. The prevalence of HIV/AIDS infection among VCT individuals was estimated to be 1.5% and varied by demographic, socio-economic, HIV Awareness, and sexual behavior factors of individuals. This study revealed that HIV awareness, sex, age at first sex, region, age, educational level, and place of residence were significant determinants of the HIV status of an individual. The odds of being HIV infected for a female individual was about 1.938 times the odds of male individuals and it implies that statistically significant. The odd of Individuals found in the Gambella region was 13.35 times being HIV positive than the odd of Individuals in the Tigray region.</p> <p><strong>Conclusion:</strong> The regional variation in the HIV status of an individual is statistically significant. In addition, HIV Awareness, sex, residence, educational level, and age at first sex were also found to be significant determinants of variation in HIV status of individuals among regions.</p> Setegn Bayabil*, Solomon Sisay Mulugeta, Selamawit Getachew Wassihun, Alebachew Taye Belay Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 Evaluation of VEGFR1 and VEGFR2 levels in Iraqi patients with DFU <p>Diabetes mellitus causes diabetic foot ulcers, “which are the leading cause of non-traumatic lower extremity amputations (up to 88 %)”. We aimed to show the serum levels of VEGFR1 and VEGFR2 in T2DM patients with and without DFU. A total of 90 subject including patients who have T2DM (N=30), with DFU (N=30), and healthy subjects (N=30) were enrolled in this study. The serum levels of vascular endothelial growth factor receptor (VEGFR1 and VEGFR2) were determined by enzyme-linked immunosorbent assay (ELISA) method. When comparing the DFU group to the T2DM and control groups, the serum level of VEGFR1 was significantly lower in the DFU group (P= 0.0024 and P= 0.0026, respectively). There was a significant decrease in DFU in serum level of VEGFR2 when comparing to control group (P=0.0313). Positive correlations were found between the levels of glucose and VEGFR1, in the T2DM group, also a positive correlations were found between VEGFR2, and glucose levels, in the DFU group. We conclude that concentrations of VEGFR 1 and 2 in DFU patients are lower than those of control subjects, it could indicate that damage to the endothelial vessels lead to decreased concentration of these receptors in the DFU group. &nbsp;The positive correlation between glucose and VEGFR2 levels suggests that glucose abnormalities seen in diabetics may play a role in angiogenesis modulation</p> Hajir Khalil Ismail*, Salma Abdul-rudha Abass, Isam Noori Salman Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 Comparisons in hematological characteristics between diabetic and non-diabetic individuals in the Covid-19 cohort <p>Medical records were retrospectively reviewed onthe clinical, imaging, Patients with confirmed COVID-19 who were hospitalized between March 1, 2020, and April 15, 2020, were studied for clinical and laboratory features. Each patient had a thorough clinical record that included their COVID-19 medical history as well as physical and laboratory exams. Median levels of serum VCM-1 in covid-19 patients with diabetic were higher than in comparison the median levels of covid-19 patients without diabetic, 179.30 (103.24) pg/ml versus 183.75 (124.34) pg/ml, the difference was non-significant (P = 0.302).</p> Rana Masheel Salim Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 Quality of Life Among People Living with HIV/AIDS Attending Care Support and Treatment Program: A Triangulation Approached <p><strong>Purpose:</strong> Despite the many studies for quality of life (QoL) among people living with HIV (PLWH), there are a few studies of triangulation in-depth analysis that investigate the contents of the QoL of PLWH condition. We identified QoL of PLWH who attend Care, Support, and Treatment (CST) program through Community Home Based Care (CHBC).</p> <p><strong>Methods:</strong> A triangulation design in which qualitative data were complemented and verified the quantitative data following characteristics of the QoL among 96 of PLWH. A self-administered questionnaire was used to access characteristics and QOL of PLWH. Then, focus group discussion was perform to collect qualitative data and analysed using thematic analyses. Structural equation modeling (SEM) was used to test the factors influenced QoL of PLWH.</p> <p><strong>Results:</strong> After completion of the qualitative and quantitative data analysis, the two data sets were compared to examine (dis)congruence of the findings. In addition, we created a joint display of qualitative and quantitative findings to describe the characteristic of QoL of PLWH who attend CST program through CHBC. Regarding, Structural Equation Modeling with Partial Least Square test, spiritual is related to adherence of PLWH. Then, adherence and support system are influenced of QoL of PLWH. Furthermore, the characteristic of QoL of PLWH were varied that describe on social knowledge and belief HIV, biophysical aspect, psychological aspect, social aspect, and support system.</p> <p><strong>Conclusion:</strong> CST through CHBC is improved QoL among PLWH. Therefore, QoL of PLWH should be improved to support their caring need in community with integrated multilevel intervention approach.</p> Tantut Susanto, Hanny Rasny, Latifa A. Susumaningrum, Eka A. Septiyono, Rismawan A. Yunanto, Ira Rahmawati Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 Single nucleotide polymorphism of TNF alpha relationship with some serum factors in kidney injury patients <p>Acute and chronic kidney injury represent a great health problem worldwide&nbsp; .The current study aimed to investigate the correlation between TNF alpha levels and its single nucleotide polymorphism for kidney injury patients . Eighty blood samples were collected from kidney failure patients who admitted to hemodialysis unit at marjan hospital , Hilla –Iraq . serum concentrations of TNF a show highly increased in patients compared with healthy persons but there is no significant differences appear between patients before and after hemodialysis . Molecular investigations for TNF a -380 A/C single nucleotide polymorphism show increase in homozygous genotype AA than heterozygous AC and homozygous CC with a percentage of 60 ,30&nbsp; and 10 % respectively .sodium and potassium concentrations also reveals a noticeable variations after hemodialysis processes.</p> Abdalnabi J Abid*, Seenaa J Allawande Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 A Preliminary Study of Spiritual Practices and Spiritual Well-Being among Women Living with HIV in Suphanburi province, Thailand <p>HIV is one of the leading causes of death among adult age women in Thailand. There is a growing body of research that shows the potential health benefits of spirituality among people living with HIV. This preliminary study examined two dimensions of spirituality (spiritual practices (SP) and spiritual well-being (SWB)) among a sample of Thai women living with HIV. Guided by Fitzpatrick’s Model of Life Meaning (2008), data were collected from a sample of 100 women living with HIV recruited through an HIV clinic in a community hospital in Suphanburi province, Thailand. The three most frequently reported spiritual practices were family activities, listen to/play music, and visiting a temple or quiet place. A high level of spiritual well-being was evident among the participants, and a significant relationship was shown between spiritual well-being and spiritual practices. Developing interventions that harness the benefits of spirituality have the potential for health benefits for Thai women living with HIV.</p> Natawan Khumsaen, Supannee Peawnalaw, Panarat Chenchob Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 Evaluation of Practice of Prescribing and Monitoring Anticoagulants Among Hospitalized Iraqi Patients <p><strong>Background: </strong>Anticoagulant drugs are lifesaving agents that are prescribed for millions of patients annually. It is essential in the treatment of atrial fibrillation, acute myocardial infarction, as well as deep venous thrombosis. Inaccuracies of their use will lead to life-threatening complications such as bleeding. This study was designed to evaluate and explore the prescribing practice of anticoagulants in the internal medicine ward of Al-Sadr Medical City, Al-Najaf governorate, Iraq.</p> <p><strong>Materials and Methods: </strong>The present&nbsp;study is a prospective, survey-based, that was carried out in&nbsp;the wards of internal medicine at Al-Sadr&nbsp;Medical City, during the period from October/2020 to April/2021.</p> <p><strong>Results: </strong>20% of the patients admitted to the ward, were treated with anticoagulants and the rate of their prescribing in respect to all medications administered by the patients was 13%, enoxaparin is being the most commonly prescribed anticoagulant (51%), then unfractionated heparin (40%) and least one was the oral anticoagulant warfarin (9%). Most cases used the anticoagulant drug as monotherapy (92%), and only 8% used combined anticoagulants. The dose range of enoxaparin was about (4000 IU - 6000 IU) and the most frequent dose of enoxaparin reached was (10000 IU), the dose of heparin was about (5000 IU) and for warfarin was 5mg per day. The monitoring of the anticoagulant agents' activity was found to be very rare (8%).</p> <p><strong>Conclusion: </strong>The most prescribed anticoagulant was the low molecular weight heparin, and the monitoring of anticoagulants was poor.</p> Qayssar Joudah Fadheel, Rana Talib Naser, Hayder Abdul-Amir Al-Hindy * Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 Assessment of the Nurse's Knowledge about post-operative Nursing Care in Al-Hillah Teaching hospitals <p><strong>Background</strong>: After surgery, post-operative patients with numerous infectious issues require further attention. Since infection is more likely to occur near the surgical site, post-operative care is particularly critical at this point.</p> <p><strong>Objectives:</strong> To assessment knowledge about&nbsp;&nbsp; post-operative nursing care in All-Hillah teaching hospitals.</p> <p><strong>Methodology</strong><strong>:</strong> A descriptive study design selective to carry out the study in order to assessment of nurse’s knowledge about post-operative in Al-Hillah teaching hospitals from the period 1<sup>th</sup> September 2018 to 15<sup>th</sup> April 2019. Nonprobability sample consistent of (50) nurses and questionnaire survey were employed to collect data which involved demographical data, general information and items related to the nurse’s knowledge.</p> <p><strong>Results: </strong>The majority of sample age were between 24-35 years.</p> <p><strong>Conclusion: </strong>The levels of the nurse’s knowledge (early care and late care) of post-operative nursing care is poor.</p> <p><strong>Recommendation</strong>: Educational program can be designed, constructed and administrated to nurses, to increase nurses’ knowledge about post-operative nursing care</p> Amenah Abd AL-Hassan Jabur*, Ali Ahmed Kadhim, Ghufran Hameed Hussein, Ghadeer Hameed Hussein, Ghufran Sabah Hider, Aliaa Faris Mansour Copyright (c) 2022 Sun, 16 Jan 2022 00:00:00 +0000 HIV/AIDS knowledge and attitude assessment among women of child-bearing age in Iraq <p>The study was carried out in the outpatient clinics in Al-Yarmouk teaching hospital in Baghdad city for a period of 5 months extending from January 2020 to May 2021. A total of 400 women were included in the study sample. A systematic random sampling method was used. All married and unmarried women in reproductive age group (15 -50 years) consulting the clinics during the study were eligible for inclusion in study sample. The questionnaire was developed in three main sections: reproductive health related issues, family planning related issues and&nbsp;&nbsp; HIV related issues. The Knowledge regarding HIV/AIDS: (Having heard about AIDS &amp;source of information, Cause of AIDS, Modes of transmission, Segregation of AIDS patients important or not. Results: A significant association between age, occupation and educational level of women with knowledge (hearing) about AIDS (p&lt;0.001). Marital status was not Significantly associated with that hearing (p&gt;0.005). the sources of knowledge about AIDS were; 83.8% from mass media (TV/radio), 31.2% from magazine/newspaper, the distribution of women according to their knowledge about AIDS as follow: 58.8 % knew that AIDS is caused by a virus and 82.9% knew it as an infectious disease, as well as about 40.2% said that AIDS is a fatal disease, and 75.1% believed that infected persons should be avoided and &nbsp;the modes of AIDS transmission, 90.8 % of women said by sexual intercourse, 59.2% by using contaminated needles. on the other hand, the percentages of women who had misconception about the mode of AIDS transmission were as follow: 24.3% by using toilet and swimming facilities, 21.7 % by eating with AIDS person and 15.6% by insect bite. About diseases classified as STDs: 56.8% said that AIDS is STDs, while 34.8% and 22.8 %of women said that gonorrhea and syphilis respectively are STDs. also, the opinion of these women about using of condom as a method for prevention of transmission of STDs, 58.8% of them didn't knew what is the condom, 13.7 % had a negative attitude towards it, only 27.5% of them knew the benefit of using condom in preventing STDs transmission. the ways of prevention of STDs, 61% of women said by avoiding illegal (extramarital) sexual relation, 44.3 % by premarital examination. Conclusions: Sociodemographic variables significantly associated with knowledge towards RH and AIDS, although most of them had good knowledge about AIDS but some of them still had misconceptions about modes of transmission and some of them thought that AIDS persons should be segregated from the community. The majority of women surveyed had poor knowledge about the condom and&nbsp;&nbsp;&nbsp;&nbsp; its role in preventing STDs/AIDS.</p> Dr. Ashwaq Ridha Abdulsada, Dr. Dalya Talal Fathi Al-Azzawi, Sally Saad Zaidan, Dr.Dunya Saad Zaidan Copyright (c) 2022 Tue, 05 Apr 2022 00:00:00 +0000 THE SOCIO-ECONOMIC CONCEPT THAT FORECASTS THE IMPACT OF HIV/AIDS ON THE ECONOMIC SYSTEM <p>Nearly HIV/AIDS has infected 58 million people, and 22 million have died since the first cases were recorded twenty years ago. Over the last two years, the world community has come to the conclusion that HIV/AIDS poses a risk to growth, security, and economic prosperity. Over the previous ten years, a few studies have looked at the impact on workers and their businesses. further which effects the country’s economy. The Aids illness is a primary concern for all health experts in all countries, and it adds serious social disadvantages to societies all over the world. A few make the argument that the Aids pandemic has decelerated the pace of growth in so many nations gross national product (GNP) significantly lowered by more than 1% for every 10% HIV incidence. Those around contend that HIV/AIDS has had only a small effect on the macroeconomy so far. Because many variables other than HIV/AIDS influence economic growth, evaluating the impact of HIV/AIDS on financial outlook experimentally is difficult. This manuscript, on the other hand, discusses a few factors that HIV/AIDS has on the economy.</p> Dr. Prashant Tripathi, Dr. Priyanka Shukla Copyright (c) 2022 Tue, 05 Apr 2022 00:00:00 +0000 PREDICTION OF HIV-1 PROGRESSION USING K NEAREST NEIGHBOR MACHINE LEARNING ALGORITHM <p>In the health context, the method of a teaching machine was used to identify possible candidates for preliminary prevention (preliminary preliminary). The technology of artificial intelligence&nbsp; has greatly affected the progress of the medical area. In the ConnectionOfConcept phase, the use of other types contains machine learning with Smart Componregated and Social Media, and guarantees real-time risk to ensure the disclosure of HIV Sero, as well as virtual reality technology, as well as HIV chatbots. Studies on HIV ML's prevention are also used in duke production. progress. HIV&nbsp; can be predicted using algorithms and machine learning&nbsp; methodologies.</p> Mohammad Nazmul Hasan Maziz, Mohammad Abdur Rashid, Farzana Yasmin Copyright (c) 2022 Tue, 05 Apr 2022 00:00:00 +0000