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Sim JC, Cha SK, Im SY. Mediating mechanism of posttraumatic growth as buffers of burnout and PTSD among nurses during the COVID-19 pandemic. Front Public Health 2024; 12:1406514. [PMID: 39035185 PMCID: PMC11257865 DOI: 10.3389/fpubh.2024.1406514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
Objective The study aims to investigate factors that prevent burnout (BO) and symptoms of posttraumatic stress disorder (PTSD) while facilitating posttraumatic growth (PTG) among nurses combating the coronavirus disease 2019 (COVID-19) pandemic, with the purpose of validating the mediating effects of PTG. Methods A total of 247 nurses who provided patient care during the COVID-19 pandemic were enrolled, and a questionnaire was used to measure BO, PTSD, and PTG, data on deliberate rumination, emotional expression, adaptive cognitive emotion regulation (CER), maladaptive CER, and social support. The mediation path models for the effects of the predictors on BO and PS through the mediation of PTG were analyzed using the R Lavaan package. Results The results showed that deliberate rumination, emotional expression, and adaptive CER significantly increased PTG, while PTG significantly reduced BO and PTSD symptoms (PSs). However, maladaptive CER did not have a significant effect on PTG and only had significant direct effects on BO and PS. Bootstrapping confirmed that PTG significantly mediated the effects of all predictors. It partially mediated the effects of deliberate rumination and adaptive CER and completely mediated the effects of emotional expression. Conclusion Based on the results, it has been supported that deliberate rumination, emotional expression, and adaptive CER should be addressed as important variables in psychological interventions addressing nurses' adversities during the pandemic. These variables can prevent BO and PS by facilitating PTG.
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Affiliation(s)
- Jae-Chang Sim
- Department of Psychology, Hallym University, Chuncheon-si, Republic of Korea
| | - Sun-Kyung Cha
- Department of Nursing Science, Sunmoon University, Asan-si, Republic of Korea
| | - Sun-Young Im
- Department of Psychology, Hallym University, Chuncheon-si, Republic of Korea
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Wang W, Li Y, Yuan H, Wu X. Interaction between posttraumatic stress symptoms and posttraumatic growth among adolescents who experience an earthquake: A repeated longitudinal study. Appl Psychol Health Well Being 2024; 16:615-631. [PMID: 37947343 DOI: 10.1111/aphw.12507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
For adolescents who experience an earthquake, posttraumatic stress symptoms (PTSSs) and posttraumatic growth (PTG) often co-occur. However, no study has yet examined how the interaction between them changes from the short term to the long term after an earthquake. This study conducted six surveys among local adolescents across three waves after the Wenchuan earthquake, and a directed network of PTSS and PTG co-occurrence was constructed for each wave. It was found that the bridge nodes between PTSSs and PTG were different for each wave. The connection between PTSSs and PTG became loose over time. The incubation effect of PTSSs on PTG was sustained until the middle term but was not observed in the long term. The suppression effect of PTSSs on PTG was only observed in the short term. PTG not only alleviated PTSSs but also exacerbated PTSSs. Finally, the effect of PTSSs on PTG was much stronger than that of PTG on PTSSs. This study suggests that efforts should be made to alleviate specific PTSSs or facilitate specific PTG elements among adolescents for different terms after an earthquake, and PTG is more likely to be an outcome of trauma rather than a strategy for coping with trauma.
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Affiliation(s)
- Wenchao Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
- School of Applied Psychology, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Yang Li
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Hao Yuan
- Pingshan Foreign Languages School, Shenzhen, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
- School of Applied Psychology, Beijing Normal University at Zhuhai, Zhuhai, China
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3
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Shen Q, Fu Q, Mao C. Network analysis of posttraumatic stress and posttraumatic growth symptoms among women in subsequent pregnancies following pregnancy loss. BMC Psychiatry 2024; 24:266. [PMID: 38594684 PMCID: PMC11003179 DOI: 10.1186/s12888-024-05702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Pregnant women who have undergone pregnancy loss often display both posttraumatic stress (PTS) and posttraumatic growth (PTG). However, the precise relationship and structure of symptomatic levels of PTS and PTG have not been well understood. This study aimed to assess the associations between PTS and PTG symptoms in women during subsequent pregnancies following a previous pregnancy loss. METHODS A total of 406 pregnant women with a history of pregnancy loss were included in this study. The Impact of Events Scale-6 (IES-6) and the Posttraumatic Growth Inventory Short Form (PTGI-SF) were used to assess symptoms of PTS and PTG, respectively. The Graphical Gaussian Model was employed to estimate the network model. Central symptoms and bridge symptoms were identified based on "expected influence" and "bridge expected influence" indices, respectively. The stability and accuracy of the network were examined using the case-dropping procedure and nonparametric bootstrapped procedure. RESULTS The network analysis identified PTG3 ("Ability to do better things") as the most central symptom, followed by PTS3 ("Avoidance of thoughts") and PTG6 ("New path for life") in the sample. Additionally, PTS3 ("Avoidance of thoughts") and PTG9 ("Perception of greater personal strength") were bridge symptoms linking PTS and PTG clusters. The network structure was robust in stability and accuracy tests. CONCLUSIONS Interventions targeting the central symptoms identified, along with key bridge symptoms, have the potential to alleviate the severity of PTS experienced by women with a history of pregnancy loss and promote their personal growth.
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Affiliation(s)
- Qiaoqiao Shen
- Department of Epidemiology, School of Public Health, Southern Medical University, 510515, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Qi Fu
- Department of Epidemiology, School of Public Health, Southern Medical University, 510515, Guangzhou, Guangdong, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, 510515, Guangzhou, Guangdong, China.
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Yuan GF, Liu C, Li X, Fung HW, Wong MYC, Lam SKK, An Y, Feng X. Hurting myself to cope: Using network analysis to understand the association between perceived stigma and non-suicidal self-injury functions among men who have sex with men in China. Arch Psychiatr Nurs 2024; 48:43-50. [PMID: 38453281 DOI: 10.1016/j.apnu.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/04/2023] [Accepted: 01/05/2024] [Indexed: 03/09/2024]
Abstract
Prior studies have demonstrated that perceived stigma is robustly associated with risky and life-threatening behaviors, including non-suicidal self-injury (NSSI), among men who have sex with men (MSM). However, studies regarding the relationship between perceived stigma and NSSI are limited. The present study aimed to investigate the network structure of perceived stigma and NSSI functions, along with bridge nodes, to elucidate how they co-exist. A sample of 2610 Chinese MSM (mean age = 23.99, age range: 18-68 years) was recruited from an online survey platform. All participants completed a web-based survey with measures of perceived stigma and NSSI functions. Results indicated that 'negative attitudes towards homosexuality' and 'disappointment in gay son' were identified as the most central nodes in the perceived stigma network, whereas 'seeking attention' and 'influencing others to change' ranked highest on centrality in the NSSI network. Two bridge connections were exhibited within the combined perceived stigma and NSSI network model: 'unwelcoming in public' and 'avoiding unpleasant tasks' from perceived stigma and NSSI communities, respectively. This is among the first studies investigating the co-occurrence between perceived stigma and NSSI from the network approach. Our findings provide an empirically-based perspective on the importance of family- and community-based interventions, with potential clinical implications for reducing NSSI among sexual and gender minority groups.
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Affiliation(s)
- Guangzhe Frank Yuan
- School of Education Science, Leshan Normal University, Leshan, China; Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Caimeng Liu
- School of Education Science, Leshan Normal University, Leshan, China.
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Hong Wang Fung
- Department of Social Work, Faculty of Social Sciences, The Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Ming Yu Claudia Wong
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong
| | - Stanley Kam Ki Lam
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
| | - Yuanyuan An
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.
| | - Xueyou Feng
- Center for Mental Health Education and Counseling, Guangzhou College of Commerce, Guangzhou, China
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Yuan GF, Qiao S, Li X. Bridging internalized HIV stigma and depressive symptoms among people living with HIV in China during the COVID-19 pandemic: a network analysis. Front Public Health 2024; 11:1306414. [PMID: 38249397 PMCID: PMC10796684 DOI: 10.3389/fpubh.2023.1306414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Previous research has documented that HIV-related stigma may be a significant trigger of mental health problems among people living with HIV (PLWH). However, less is known about how internalized HIV stigma is linked to depressive symptoms among PLWH during the COVID-19 pandemic. The current study sought to explore the network structure of internalized HIV stigma and depressive symptoms, along with bridge nodes, to elucidate how they co-exist. Participants were 1,197 Chinese PLWH (64.3% male, Mage = 41.52, SD = 9.20) who completed the measurements of internalized HIV stigma and depressive symptoms during the early phase of the COVID-19 outbreak (May 2020). Results revealed that "ashamed of having HIV" was identified as the most central nodes in the internalized HIV stigma network, whereas "mind wandered during tasks" ranked highest on centrality in the depressive symptoms network. Two bridge connections were exhibited within the combined internalized HIV stigma and depressive symptoms network model: "inferiority due to HIV" and "gloomy feelings" from internalized HIV stigma and depressive symptoms communities, respectively. This study is one of the first to examine the co-occurrence of internalized HIV stigma and depressive symptoms in the context of the COVID-19 pandemic using a network approach. These findings have potential clinical implications for mitigating depressive symptoms in populations facing socioeconomic disadvantage and vulnerability.
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Affiliation(s)
- Guangzhe F. Yuan
- School of Education Science, Leshan Normal University, Leshan, Sichuan, China
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shan Qiao
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Spiller TR, Na PJ, Merians AN, Duek O, Ben-Zion Z, Tsai J, von Känel R, Harpaz-Rotem I, Pietrzak RH. Changes in mental health among U.S. military veterans during the COVID-19 pandemic: A network analysis. J Psychiatr Res 2023; 165:352-359. [PMID: 37595331 DOI: 10.1016/j.jpsychires.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/17/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
Increases of symptoms of posttraumatic stress disorder (PTSD), anxiety and depression have been observed among individuals exposed to potentially traumatic events in the first months of the COVID-19 pandemic. Similarly, associations among different aspects of mental health, such as symptoms of PTSD and suicidal ideation, have also been documented. However, studies including an assessment prior to the onset and during the height of the pandemic are lacking. We investigated changes in symptoms of PTSD, depression, anxiety, suicidal ideation, and posttraumatic growth in a population-based sample of 1232 U.S. military veterans who experienced a potentially traumatic event during the first year of the pandemic. Symptoms were assessed prior to (fall/winter 2019) and one year into the pandemic (fall/winter 2020). We compared changes in symptom interrelations using network analysis, and assessed their associations with pandemic-related PTSD and posttraumatic growth symptoms. A subtle increase in psychopathological symptoms and a decrease in posttraumatic growth was observed one year into the pandemic. The peripandemic network was more densely connected, and pandemic-related PTSD symptoms were positively associated with age, anxiety, worst-event PTSD symptoms, and pandemic-related posttraumatic growth. Our findings highlight the resilience of veterans exposed to a potentially traumatic event during the first year of a pandemic. Similarly, the networks did not fundamentally change from prepandemic to one year into the pandemic. Despite this relative stability on a group level, individual reactions to potentially traumatic events could have varied substantially. Clinicians should individualize their assessments but be aware of the general resilience of most veterans.
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Affiliation(s)
- Tobias R Spiller
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Addie N Merians
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Or Duek
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ziv Ben-Zion
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jack Tsai
- U.S. Department of Veterans Affairs National Center on Homelessness Among Veterans, Tampa, FL, USA; School of Public Health, University of Texas Health Science Center at Houston, TX, USA
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ilan Harpaz-Rotem
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Psychology, Yale University, New Haven, CT, 06510, USA
| | - Robert H Pietrzak
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
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7
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Using network analysis to explore the key bridge symptoms between posttraumatic stress symptoms and posttraumatic growth among survivors 10 years after the Wenchuan earthquake in China. J Psychiatr Res 2022; 150:173-179. [PMID: 35390697 DOI: 10.1016/j.jpsychires.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 11/23/2022]
Abstract
Despite previous research has illustrated there is high-coexistence between posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) in the aftermath of traumatic events, few studies have conceptualized the coexistence mechanism of the two psychological phenomena. Using the network analysis, this study aimed to identify the key bridge symptoms and compare sex differences between PTSD symptoms and PTG elements in survivors 10 years after the Wenchuan earthquake in China. A total of 744 survivors 10 years after the Wenchuan earthquake in China completed self-reported questionnaires on demographics, PTSD symptoms (4-item of Posttraumatic Stress Disorder Checklist), and PTG (10-item of Posttraumatic Growth Inventory). Network analysis was used to identify the network structure of PTSD symptoms and elements of PTG, along with bridge symptoms. Additionally, sex differences in the network structure were compared by the Network Comparison Test. Results revealed that the network of PTSD symptoms and elements of PTG was robust to stability and accuracy tests. The key bridge symptoms in the network were "Stronger religious faith", "Changed priorities", and "Easily startled". There were significant differences in network global strength across sex, and network structure across the severity of property loss other than house damage. Future interventions targeting the three key bridge symptoms are expected to relieve the severity of PTSD and promote growth following exposure to traumatic events.
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8
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Kangaslampi S, Peltonen K, Hall J. Posttraumatic growth and posttraumatic stress - a network analysis among Syrian and Iraqi refugees. Eur J Psychotraumatol 2022; 13:2117902. [PMID: 36186157 PMCID: PMC9518504 DOI: 10.1080/20008066.2022.2117902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Traumatic events related to war and displacement may lead to development of posttraumatic stress symptoms (PTSS), but many war trauma survivors also report experiencing posttraumatic growth (PTG). However, the phenomenon of PTG remains poorly understood among refugees. Previous findings are also contradictory on whether more PTSS associate with PTG and what specific symptoms or aspects of growth may account for any possible link. OBJECTIVE AND METHOD Here, we aimed to better understand posttraumatic growth among refugees, especially its structure and most important constituent elements, as well as how it associates with PTSS. We employed regression and network analysis methods with a large sample (N = 3,159) of Syrian and Iraqi refugees living in Turkey self-reporting on PTG and PTSS. RESULTS We found PTG and PTSS to be clearly distinct phenomena. Still, they often co-occurred, with a positive, slightly U-shaped relationship found between levels of PTSS and PTG. The main bridge between the constructs was identified from intrusive symptoms to having new priorities in life, although new priorities were more peripheral to the overall network structure of PTG. Meanwhile, discovering new psychological strengths and abilities and a new path in life emerged as elements most central to PTG itself. CONCLUSIONS Many refugees report elements of PTG, even as they suffer from significant PTSS. The two phenomena appear distinct but positively associated, supporting the idea that intense cognitive processing involving distress may be necessary for growth after trauma. Our findings may inform efforts to support refugee trauma survivors in finding meaning and perhaps even growth after highly challenging experiences.
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Affiliation(s)
- Samuli Kangaslampi
- Faculty of Social Sciences / Psychology, Tampere University, Tampere, Finland
| | - Kirsi Peltonen
- Department of Psychology, University of Turku, Turku, Finland.,INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Jonathan Hall
- Department of Peace and Conflict Research, Uppsala University, Uppsala, Sweden
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Yuan GF, Shi W, Elhai JD, Montag C, Chang K, Jackson T, Hall BJ. Gaming to cope: Applying network analysis to understand the relationship between posttraumatic stress symptoms and internet gaming disorder symptoms among disaster-exposed Chinese young adults. Addict Behav 2022; 124:107096. [PMID: 34469784 DOI: 10.1016/j.addbeh.2021.107096] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/17/2022]
Abstract
Research has demonstrated that posttraumatic stress disorder (PTSD) is associated with internet-related problematic behaviors. However, studies have not explored the linkage between PTSD symptoms and internet gaming disorder (IGD) symptoms. The current study aimed to investigate the relationship between posttraumatic stress symptoms (PTSS) and IGD symptoms via network analysis. We conducted a cross-sectional study with 341 Chinese young adults directly exposed to a typhoon and examined the network structure of PTSS and IGD symptoms, along with bridge symptoms, to elucidate how they co-occur. Results indicated that 'avoiding external reminders' and 'anhedonia' were identified as the most central symptoms in the PTSD network, whereas 'preoccupation,' 'gaming despite harms', and 'loss of control' ranked highest on centrality in the IGD network. Two bridge symptoms emerged within the combined PTSD and IGD network model: 'concentration difficulties' and 'conflict due to gaming' from among the PTSS and IGD symptoms, respectively. These findings reveal novel associations between PTSS and IGD symptoms and provide an empirically-based hypothesis for how these two disorders may co-occur among individuals exposed to natural disasters.
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Affiliation(s)
- Guangzhe Frank Yuan
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Wei Shi
- Institute for Disaster Management and Reconstruction, Sichuan University, People's Republic of China.
| | - Jon D Elhai
- Department of Psychology, University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606, USA; Department of Psychiatry, University of Toledo, 3000 Arlington Ave., Toledo, OH 43614, USA
| | - Christian Montag
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Kay Chang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Todd Jackson
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Brian J Hall
- New York University (Shanghai), Shanghai, People's Republic of China.
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