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Full-Text Articles in Mental and Social Health

Lived Experiences Of Pakistani American Women Who Sought Mental Health Treatment, Marriam Ashraf Jan 2021

Lived Experiences Of Pakistani American Women Who Sought Mental Health Treatment, Marriam Ashraf

Walden Dissertations and Doctoral Studies

AbstractDespite the research on how mental illness manifests in the United States, there is more to be known about mental health in the Pakistani American population. The goal of this qualitative phenomenological study was to understand the lived experiences of Pakistani American women who sought mental health treatment. Ecological theory provided the framework for the study. Data were collected from semi structured interviews with 10 participants via telephone and face-to-face conversations. Data were analyzed using managing, reading, memoing, describing, classifying, interpreting, representing, and visualizing techniques. Findings indicated that seeking help for mental health played a positive role in participants being …


Examining Clinicians' Perspectives Screening For Depression In Patients With Type 2 Diabetes Mellitus, Vickie Lavette Bland Jan 2021

Examining Clinicians' Perspectives Screening For Depression In Patients With Type 2 Diabetes Mellitus, Vickie Lavette Bland

Walden Dissertations and Doctoral Studies

The United States has a significant diabetes problem. This chronic disease affects the body physically and mentally. One of the emotional effects of diabetes is depression. Depression is often present in individuals with diabetes, chiefly in those with type 2 diabetes mellitus (T2DM). While depression is common in T2DM and can interfere with treatment adherence, clinician screening for depression in T2DM patients is low. The purpose of this study was to examine clinicians' attitudes, behaviors, and perceptions concerning screening patients with T2DM for depression. Through a qualitative case study approach centered on reasoned action theory, 3 physicians and 5 nurse …


Coping Skills, Emotional Intelligence, Attachment, And Resilience On Post-Traumatic Stress Disorder In Private Sector Emergency Medical Technicians, Brenda-Joyce Gonzales Orozco Markert-Green Jan 2021

Coping Skills, Emotional Intelligence, Attachment, And Resilience On Post-Traumatic Stress Disorder In Private Sector Emergency Medical Technicians, Brenda-Joyce Gonzales Orozco Markert-Green

Dissertations

Problem

Private sector Emergency Medical Technicians (EMTs) are first responders who respond to traumatic incident scenes along with firefighters and police officers. However, news agencies and the public do not acknowledge private sector EMTs with the same vigor or accolade as public sector EMTs, nor are the risks to life, health, and mental well-being recognized among this population. Thus, the research literature has been sparse regarding how private sector EMTs experience PTSD, and what unique risk factors and needs may be present.

Purpose Statement

The purpose of this study was to examine the relationship between PTSD symptoms and coping skills, …


Experience Of Gender Role Expectations And Negotiation In Second Generation Desi Couples, Deepa Patel Jan 2021

Experience Of Gender Role Expectations And Negotiation In Second Generation Desi Couples, Deepa Patel

Antioch University Dissertations & Theses

Due to the lack of research on the Desi community, this qualitative study was the first of its kind to investigate the process of gender role expectation and negotiation style among second generation Desi couples. Previous research provided awareness of unequal treatment amongst the male and female genders within the patriarchal structure of the Desi community. However, this study provided a unique understanding on Desi couples’ perspective on gender dynamics. Six couples, ages 25- 35, who were married for at least 3 years and identified as second generation Desi were interviewed in order to gain a deeper understanding of gender …


Religious Beliefs And Behaviors As Predictors Of Substance Use In First-Year College Students: A Longitudinal Study, Hannah B. Mcgee Jan 2021

Religious Beliefs And Behaviors As Predictors Of Substance Use In First-Year College Students: A Longitudinal Study, Hannah B. Mcgee

Theses and Dissertations--Psychology

Substance use is prevalent on college campuses (e.g., Douglas et al., 1997) and can create significant negative consequences (Kodjo & Klein, 2002; NIAAA, 2006). Research suggests that religious beliefs and religious behaviors interact to predict risky substance use in first-year undergraduate students, such that students with religious beliefs but no corresponding behaviors are at risk for significant alcohol use and related problems (Brechting et al., 2010; Cole et al., 2020). However, these studies have only been cross-sectional in nature.

The current study assessed longitudinally if the interaction of religious beliefs/behaviors influenced first-year undergraduate student substance use across the early adjustment …


Maternal Depression Trajectories And Child Bmi In A Multi-Ethnic Sample: A Latent Growth Modeling Analysis, Charlotte V. Farewell, Ryley Donohoe, Zaneta Thayer, James Paulson, Jacinda Nicklas, Caroline Walker, Karen Waldie, Jenn A. Leiferman Jan 2021

Maternal Depression Trajectories And Child Bmi In A Multi-Ethnic Sample: A Latent Growth Modeling Analysis, Charlotte V. Farewell, Ryley Donohoe, Zaneta Thayer, James Paulson, Jacinda Nicklas, Caroline Walker, Karen Waldie, Jenn A. Leiferman

Psychology Faculty Publications

Background

Perinatal (antenatal and postpartum) depression impacts approximately 12% of mothers. Perinatal depression can impact everyday functioning for mothers, and the relationship with, and development of, their children. The purpose of this study was to investigate depression trajectories from the antenatal period through 54-months postpartum and associations with child body mass index at 54-months postpartum.

Methods

This study applied latent growth modeling to the Growing Up in New Zealand study, which is a longitudinal pregnancy cohort study that provides nationally representative-level data, to investigate associations between depression at three time points (antenatal, 9-months postpartum, 54-months postpartum) and child body mass …


Minority Stress And Alcohol Use In Sexual Minority Women's Daily Lives, Robin J. Lewis, Kelly A. Romano, Sarah J. Ehlke, Cathy Lau-Barraco, Cassidy M. Sandoval, Douglas J. Glenn, Kristin E. Heron Jan 2021

Minority Stress And Alcohol Use In Sexual Minority Women's Daily Lives, Robin J. Lewis, Kelly A. Romano, Sarah J. Ehlke, Cathy Lau-Barraco, Cassidy M. Sandoval, Douglas J. Glenn, Kristin E. Heron

Psychology Faculty Publications

No abstract provided.


Analysis Of Circadian Rhythm Irregularities On The Health Of Shift Workers, Sahil Rajan Jan 2021

Analysis Of Circadian Rhythm Irregularities On The Health Of Shift Workers, Sahil Rajan

Williams Honors College, Honors Research Projects

Circadian rhythms involve the natural 24 wake-sleep cycle that governs proper maintenance of biological sleep schedules. Circadian rhythm disruption has been associated with health issues such as diabetes, obesity, and mental health disorders such as bipolar and sleep disorders. In this study, a survey method was utilized in order to analyze specific population demographics to determine whether working day or night shifts predisposed individuals to health issues due to disruptions in their circadian rhythms. This study was also carried out to observe popular coping strategies among night shift workers. Of all the variables tested comparing the difference between day and …


College Students' Mental Health And Drug Use Outcomes During The Stay-At-Home Order, Alexander T. Hain Jan 2021

College Students' Mental Health And Drug Use Outcomes During The Stay-At-Home Order, Alexander T. Hain

Cal Poly Humboldt theses and projects

The COVID-19 pandemic has affected people of all ages causing increased drug usage and worsening mental health in addition to hospitalization and death. The current study investigated how the United States’ stay-at-home orders affected the mental health and drug use of young adult college students. This population is of particular interest because young adults are at most risk of drug use developing into addiction. Two hypotheses related to the self-medication hypothesis were investigated: (1) there will be a significant increase in drug use during the stay-at-home order when compared to drug use prior to the stay-at-home order and (2) feelings …


Prevalence And Correlates Of Sex Selling And Sex Purchasing Among Adults Seeking Treatment For Cocaine Use Disorder, Emma C Lathan, Judy H Hong, Angela M Heads, Nicholas C Borgogna, Joy M Schmitz Jan 2021

Prevalence And Correlates Of Sex Selling And Sex Purchasing Among Adults Seeking Treatment For Cocaine Use Disorder, Emma C Lathan, Judy H Hong, Angela M Heads, Nicholas C Borgogna, Joy M Schmitz

Faculty, Staff and Student Publications

Exchange sex places individuals with cocaine use disorder (CUD) at particularly high risk for deleterious safety and health outcomes. A substance use treatment provider who is aware of a patient's exchange sex behavior is better able to provide appropriate screening, care, and/or referral to risk reduction services. However, little is known about exchange sex, especially purchasing, among treatment-seeking adults with CUD. The current study examined the prevalence and correlates of sex selling and sex purchasing among treatment-seeking men and women with CUD (


Customizing Early Intervention Treatment For Psychosis In The Uthealth - Harris County Psychiatric Center, Alia R Warner, Gordon C Shen, Jane E Hamilton, Luca Lavagnino, Scott D Lane Jan 2021

Customizing Early Intervention Treatment For Psychosis In The Uthealth - Harris County Psychiatric Center, Alia R Warner, Gordon C Shen, Jane E Hamilton, Luca Lavagnino, Scott D Lane

Faculty, Staff and Student Publications

High-need, high-cost patients include those with diagnosed serious mental illnesses (e.g., schizophrenia; SMI). They often delay or fail to seek treatment. If they receive treatment, care is often sought from generalist settings (e.g., primary care or emergency medicine) or is suboptimal due to the provision of limited, non-evidence-based intervention and lack of communication, integration, and coordination among providers. This results in high aggregate costs and poor outcomes. Value-based health care requires care coordination to address the medical and social needs of this population. We describe a unique early intervention program for SMI that emanates from an inpatient setting: The Early …


As Time Goes By: Understanding Child And Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury, Linda Ewing-Cobbs, Janelle J Montroy, Amy E Clark, Richard Holubkov, Charles S Cox, Heather T Keenan Jan 2021

As Time Goes By: Understanding Child And Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury, Linda Ewing-Cobbs, Janelle J Montroy, Amy E Clark, Richard Holubkov, Charles S Cox, Heather T Keenan

Faculty, Staff and Student Publications

Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes.

Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from …


Recurrent Nontuberculous Mycobacterial Tenosynovitis, Melissa Kwan, Richard Tupler Jan 2021

Recurrent Nontuberculous Mycobacterial Tenosynovitis, Melissa Kwan, Richard Tupler

Faculty, Staff and Student Publications

Background: Nontuberculous mycobacteria are an uncommon pathogen for musculoskeletal infection and are difficult to treat because of delays in diagnosis, prolonged treatment requiring both antimycobacterial therapy and surgical debridement, and high rates of resistance to antimycobacterial therapy.

Case Report: We report the case of an 88-year-old male with recurrent Mycobacterium avium complex tenosynovitis despite receiving multiple courses of pharmacologic therapy and surgical debridement.

Conclusion: Nontuberculous mycobacterial musculoskeletal infections can be difficult to diagnose and equally difficult to treat. A combination of antimycobacterial therapy and surgical debridement is often required; however, the rate of treatment failure remains high, particularly with rapidly …


“They Let Me Loose, Will You Hold Me Tight?” Adult Adoptees And Their Romantic Partners' Experience Of Attachment After Participating In The Hmt Program, Bethany Baker Jan 2021

“They Let Me Loose, Will You Hold Me Tight?” Adult Adoptees And Their Romantic Partners' Experience Of Attachment After Participating In The Hmt Program, Bethany Baker

Antioch University Dissertations & Theses

Adult adoptees may be blocked from feeling securely attached to their romantic partners and they may not even know it or what to do about it. The literature shows adult adoptees being overrepresented in insecure attachment styles, and not enough attention has been paid to the effect this has had on adoptees in their romantic relationships. In fact, no known study, to date, has provided an attachment-based psychoeducational approach for this marginalized population. The purpose of this introductory qualitative study was to explore the experiences and meaning-making of attachment, specifically related to adoption, for the adult adoptee and their romantic …


Influencing Legislation For Juveniles In The Adult Judicial System: A Phenomenological Examination Of Legal Advocates, Krista F. Franklin Jan 2021

Influencing Legislation For Juveniles In The Adult Judicial System: A Phenomenological Examination Of Legal Advocates, Krista F. Franklin

Antioch University Dissertations & Theses

INFLUENCING LEGISLATION FOR JUVENILES IN THE ADULT JUDICIAL SYSTEM: A PHENOMENOLOGICAL EXAMINATION OF LEGAL ADVOCATES Krista Franklin Antioch University Seattle Seattle, WA This phenomenological study explores the lived experience of Washington State lawmakers and legal activists regarding their involvement in passing Washington State Senate Bill 5064 in February 2014. In response to the 2012 landmark federal Supreme Court decision, Miller v. Alabama, Senate Bill 5064 reduced the number of crimes for which juveniles could be sentenced as adults to life without parole. Six interviewees were selected from those who testified in Olympia, WA. Individual interviews were conducted in an open-ended …


Divine Narcissism: Raising A Secure Middle-Aged Adult, Rachel Sachs Riverwood Jan 2021

Divine Narcissism: Raising A Secure Middle-Aged Adult, Rachel Sachs Riverwood

Antioch University Dissertations & Theses

Utilizing an arts-based feminist autoethnographic stance and method, this dissertation is an evocative exploration of the process and experience of attempting to develop a cohesive identity and build a secure attachment to the self. The author uses countercultural methods—prioritizing and centralizing her experience and uncovering and acting in defiance of oppressive norms—to identify and experience their impact on her identity and intra- and inter- personal relationships. Various tensions are explored, including the suppression of self and desire, self-objectification, fearful-avoidant attachment, and shame; and their influence on engaging in emotional and sexual intimacy is examined. Critique on the role of female …


The Strategically Broken System: A Grounded Theory Study Of The Clinical Implications Of Immigration Law, Policy, And Practice, Kelle Agassiz Jan 2021

The Strategically Broken System: A Grounded Theory Study Of The Clinical Implications Of Immigration Law, Policy, And Practice, Kelle Agassiz

Antioch University Dissertations & Theses

The majority of clinicians do not receive education pertaining to the legal aspects of immigration in their curriculum, training, or continuing education. In addition, the process of navigating the immigration system has been exacerbated in recent years due to rapid policy changes under the Trump administration, which has contributed to a hostile political climate, particularly for immigrants from Central America and Mexico. Using a classic grounded theory research approach, this study explored the relationship between the psychological implications of immigration and the legal challenges that immigrants face today, with a specific focus on immigration from Central America and Mexico. Through …


Examining The Relationship Between Five Factors Of Mindfulness And Parenting Stress: A Correlational Study Of New Mothers, Jessica L. Lazaro Jan 2021

Examining The Relationship Between Five Factors Of Mindfulness And Parenting Stress: A Correlational Study Of New Mothers, Jessica L. Lazaro

Antioch University Dissertations & Theses

It can be tempting to want to dissociate from the stress of parenting. The implication being that the early years of parenthood are meant to simply be endured. In contrast, mindfully embracing all aspects of parenthood, including the difficult moments, may allow the appreciation of beauty, growth, and connection, which is so essential to the human experience, especially as it relates to the parent-child relationship. As the popularity of mindfulness research increases, so does the information we have about using it with parents in general, and mothers in particular. The current study explores what, if any, relationship exists between levels …


I’M So Satisfied: A Qualitative Approach To Understanding The Process Of Marriage Satisfaction Among African American Couples, Rashida Spence Jan 2021

I’M So Satisfied: A Qualitative Approach To Understanding The Process Of Marriage Satisfaction Among African American Couples, Rashida Spence

Antioch University Dissertations & Theses

The current study uses a strengths-based framework to identify the process of marriage satisfaction among 1 same-sex African American married couple and 5 heterosexual African American married couples. Six themes emerged through qualitative analysis demonstrating that marriage satisfaction is a co-constructed experience created between couples through a series of interactions cultivating healthy conditions that strengthen relationship functioning and promote well-being. Based on the results the experience of marriage satisfaction is formed by the organizing concepts of connection, intentionality, purpose, sentiments of peace, authentic communication, and well-being. Results are discussed in association with existing research, as well as, Self-Determination, and Relationship …


Internet Pornography Addiction In The Treatment Of Heterosexual Dyadic Relationships: A Literature Review, Sarah Ogier-Bloomer Jan 2021

Internet Pornography Addiction In The Treatment Of Heterosexual Dyadic Relationships: A Literature Review, Sarah Ogier-Bloomer

Antioch University Dissertations & Theses

The following dissertation provides a thorough literature review of internet pornography and internet pornography addiction for psychologists treating heterosexual couples in therapy and those training said clinicians. Factors that contribute to the development of compulsive sexual behavior are discussed, as well as how the addiction is maintained through reinforcing cycles. Factors including neuropsychological effects of neurotransmitters on the pleasure-reward system, insecure attachment, and childhood development provide insight into the manifestation of an addiction to pornography. Therefore, a thorough literature review on these aspects is necessary for current clinicians, as well as for those who are training clinicians. In addition, questionnaires …


Parents Of Non-Binary Children: Stories Of Understanding And Support, Brooks Bull Jan 2021

Parents Of Non-Binary Children: Stories Of Understanding And Support, Brooks Bull

Antioch University Dissertations & Theses

Parents of non-binary children undergo profound changes as they learn to first understand and then support their child. In order to provide family therapists with a foundation from which to work with these families, a thorough review of the literature is provided as well as a narrative research study. Chapter one provides an introduction to the topic of non-binary gender and transgender identities, defines the terms non-binary, transgender, and transsexual, and clarifies the conceptual frameworks at use in the dissertation: social constructionism and transfeminism. Chapter two is a review of peer-reviewed literature on therapy with children and adolescents who identify …


Clinical Supervisors' Experiences Addressing Age And Generational Cohort Affiliations With Counseling Supervisees, Susan N. Golden Jan 2021

Clinical Supervisors' Experiences Addressing Age And Generational Cohort Affiliations With Counseling Supervisees, Susan N. Golden

Antioch University Dissertations & Theses

Diversity of cultural identities, such as abilities, age and generational cohort affiliation, and socioeconomic status and the practice of clinical supervision are rarely addressed in the professional counseling literature. Subsequently, there is a need for a greater understanding of how expanded cultural identities are addressed by clinical supervisors in the practice of clinical supervision. This research study focused specifically on how age and generational cohort affiliation are addressed as a cultural consideration by clinical supervisors during the practice of clinical supervision. For this study, the Interpretive Phenomenological Analysis research approach was utilized to answer the research questions: 1. How do …


From Military Service To Diakonia: A Training Program For Clergy Ministering To Veterans, Danielle Xanthos Jan 2021

From Military Service To Diakonia: A Training Program For Clergy Ministering To Veterans, Danielle Xanthos

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Many veterans opt to seek the support of clergy before mental health professionals. Most clergy, however, are unfamiliar with the nuances of the veteran culture and experience. Mental health professionals who specialize in working with the veteran population can collaborate with clergy to bridge this gap of care to mutually develop a better understanding of veteran culture and symptoms of mental health conditions common among the veteran population, and by equipping clergy with basic tools that promote psychological and spiritual wellbeing. Special consideration is given to the concept of moral injury and the application of Acceptance and Commitment Therapy, illustrating …


The Rise In Use Of Emotional Support Animals By College Students: The Impact Of Parenting Styles, Misty G. Smith, Samantha Ballard, Jill Willis Jan 2021

The Rise In Use Of Emotional Support Animals By College Students: The Impact Of Parenting Styles, Misty G. Smith, Samantha Ballard, Jill Willis

Journal of Higher Education & Student Affairs

As the generational context of higher education shifts, a rise of Emotional Support Animals (ESA) and mental health concerns are present for students on college campuses. While previous studies have aimed to address the relevancy and controversy of ESAs in higher education as well as their effectiveness in supporting individuals, less research has explored underlying factors that contribute to the use of an ESA. The purpose of this study was to explore the parenting behaviors of parents/caregivers of students with ESAs in comparison to parents/caregivers of students without ESAs. An embedded mixed methods design was used. Participants completed the Parenting …


Strategic Implications Of Covid-19: Considerations For Georgia’S Rural Health Providers, Bettye A. Apenteng, Linda Kimsey, Charles Owens, Samuel T. Opoku, Angela Peden, William Mase Jan 2021

Strategic Implications Of Covid-19: Considerations For Georgia’S Rural Health Providers, Bettye A. Apenteng, Linda Kimsey, Charles Owens, Samuel T. Opoku, Angela Peden, William Mase

Health Policy & Community Health: Faculty Publications

Whether rural hospitals and providers have seen a surge in COVID-19 cases or a reduction in patients seeking care since the pandemic began, their financial condition has been negatively impacted. Many providers have now received some emergency funding through the Coronavirus Aid, Relief, and Economic Security Act and the Payroll Protection Program but these are likely only short-term fixes. For many, the crisis has exacerbated already existing problems. Notable among these problems are volume declines, supply chain disruptions, and workforce concerns. While these problems require immediate action, two longer-term systemic changes to rural healthcare delivery are needed to address them. …


A Comparison Of Health Habits Between Nursing And Non Nursing Majors, Reilly K. Gilmour Jan 2021

A Comparison Of Health Habits Between Nursing And Non Nursing Majors, Reilly K. Gilmour

Honors Theses and Capstones

No abstract provided.


Estimated Glomerular Filtration Rate And The Racial Multiplier: Clinical Implications And Current Attitudes, Brittney A. Spooner Jan 2021

Estimated Glomerular Filtration Rate And The Racial Multiplier: Clinical Implications And Current Attitudes, Brittney A. Spooner

Honors Theses and Capstones

Chronic kidney disease (CKD) is associated with high morbidity and mortality and has high and increasing incidence worldwide. CKD is characterized by a reduction in glomerular filtration rate (GFR), but as GFR is difficult to measure directly, estimated glomerular filtration rate (eGFR) equations have been created to measure serum creatinine levels as a function of GFR. Some eGFR equations contain a racial multiplier that increases the eGFR of black patients, causing a spurious increase in reported kidney function. This study included a literature search that collected information on the rationale behind the multipliers usage and a survey that gathered information …


Journeying Through Uncharted Territory: The Role Of Humour In Adaption Of Undergraduate Nursing Students In Their First Year Of Study, Marie-Josée Boulianne Jan 2021

Journeying Through Uncharted Territory: The Role Of Humour In Adaption Of Undergraduate Nursing Students In Their First Year Of Study, Marie-Josée Boulianne

Theses

Newly graduated nurses adapting to their professional role have been studied, mainly in their first year of practice. The development of coping strategies, acculturation and other adaptations to the nursing world begin at the onset of the educational journey. Understanding how these manifest early in the formative years can enable educators to tailor nursing programs to assist the future nurse to develop positive coping mechanisms and help pave the way to a successful transition into practice. This research aimed to identify elements conducive to positive adaptation and wellbeing of nursing students during their first year of nursing studies, including the …


A Fluctuating Sense Of Power Is Associated With Reduced Well-Being, Eric M. Anicich, Michael Schaerer, Jake Gale, Trevor A. Foulk Jan 2021

A Fluctuating Sense Of Power Is Associated With Reduced Well-Being, Eric M. Anicich, Michael Schaerer, Jake Gale, Trevor A. Foulk

Research Collection Lee Kong Chian School Of Business

Social power research has been limited by theoretical and methodological traditions that prioritize static comparisons of high and low-power states. This is a crucial limitation given power’s inherently dynamic nature. Accordingly, Anicich and Hirsh (2017a) recently developed a theoretical framework related to the consequences of vertical code-switching – i.e., the act of alternating between behavioral patterns directed toward higher-power and lower-power interaction partners – known as the approach-inhibition-avoidance (AIA) theory of power. Across five main studies and two supplemental studies, we present the first empirical test of this theory using a mix of survey, experimental, and experience-sampling methods. We demonstrate …


Evaluation Of A Division I Mid-Major University’S Student-Athlete Mental Health Program, Heather M. Swanson Jan 2021

Evaluation Of A Division I Mid-Major University’S Student-Athlete Mental Health Program, Heather M. Swanson

University of the Pacific Theses and Dissertations

The following executive summary provides high level findings of a student-athlete mental health program (SAMHP) at a National Collegiate Athletic Association Division I mid-major university. Various elements of the SAMHP were evaluated to create a well-rounded understanding of the program to determine sustainability, goals, and stakeholder expectations. Findings from this study provided insight on stakeholder needs, program successes, and implications for program improvements.