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Articles 1351 - 1380 of 1443

Full-Text Articles in Psychiatry and Psychology

Posttraumatic Stress And Myocardial Infarction Risk Perceptions In Hospitalized Acute Coronary Syndrome Patients, Donald Edmondson, Jonathan A. Shaffer, Ellen-Ge Denton, Daichi Shimbo, Lynn Clemow May 2012

Posttraumatic Stress And Myocardial Infarction Risk Perceptions In Hospitalized Acute Coronary Syndrome Patients, Donald Edmondson, Jonathan A. Shaffer, Ellen-Ge Denton, Daichi Shimbo, Lynn Clemow

Publications and Research

Posttraumatic stress disorder (PTSD) is related to acute coronary syndrome (ACS; i.e., myocardial infarction or unstable angina) recurrence and poor post-ACS adherence to medical advice. Since risk perceptions are a primary motivator of adherence behaviors, we assessed the relationship of probable PTSD to ACS risk perceptions in hospitalized ACS patients (n = 420). Participants completed a brief PTSD screen 3-7 days post-ACS, and rated their 1-year ACS recurrence risk relative to other men or women their age. Most participants exhibited optimistic bias (mean recurrence risk estimate between "average" and "below average"). Further, participants who screened positive for current PTSD (n …


Data Sharing In Neuroimaging Research, Jean-Baptiste Poline, Janis L. Breeze, Satrajit Ghosh, Krzysztof Gorgolewski, Yaroslav O. Halchenko Apr 2012

Data Sharing In Neuroimaging Research, Jean-Baptiste Poline, Janis L. Breeze, Satrajit Ghosh, Krzysztof Gorgolewski, Yaroslav O. Halchenko

Dartmouth Scholarship

Significant resources around the world have been invested in neuroimaging studies of brain function and disease. Easier access to this large body of work should have profound impact on research in cognitive neuroscience and psychiatry, leading to advances in the diagnosis and treatment of psychiatric and neurological disease. A trend toward increased sharing of neuroimaging data has emerged in recent years. Nevertheless, a number of barriers continue to impede momentum. Many researchers and institutions remain uncertain about how to share data or lack the tools and expertise to participate in data sharing. The use of electronic data capture (EDC) methods …


Recommendations For The Use Of Common Outcome Measures In Pediatric Traumatic Brain Injury Research, Stephen R. Mccauley, Elisabeth A. Wilde, Vicki A. Anderson, Gary Bedell, Sue R. Beers, Thomas F. Campbell, Sandra B. Chapman, Linda Ewing-Cobbs, Joan P. Gerring, Gerard A. Gioia, Harvey S. Levin, Linda J. Michaud, Mary R. Prasad, Bonnie R. Swaine, Lyn S. Turkstra, Shari L. Wade, Keith O. Yeates Mar 2012

Recommendations For The Use Of Common Outcome Measures In Pediatric Traumatic Brain Injury Research, Stephen R. Mccauley, Elisabeth A. Wilde, Vicki A. Anderson, Gary Bedell, Sue R. Beers, Thomas F. Campbell, Sandra B. Chapman, Linda Ewing-Cobbs, Joan P. Gerring, Gerard A. Gioia, Harvey S. Levin, Linda J. Michaud, Mary R. Prasad, Bonnie R. Swaine, Lyn S. Turkstra, Shari L. Wade, Keith O. Yeates

Psychiatry and Behavioral Sciences Faculty Publications

This article addresses the need for age-relevant outcome measures for traumatic brain injury (TBI) research and summarizes the recommendations by the inter-agency Pediatric TBI Outcomes Workgroup. The Pediatric Workgroup's recommendations address primary clinical research objectives including characterizing course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements (CDE) Workgroups, the Pediatric TBI Outcomes Workgroup adopted the standard three-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in pediatric TBI from …


A Community-Integrated Home Based Depression Intervention For Older African Americans: Descripton Of The Beat The Blues Randomized Trial And Intervention Costs., Laura N Gitlin, Lynn Fields Harris, Megan Mccoy, Nancy L Chernett, Eric Jutkowitz, Laura T Pizzi Feb 2012

A Community-Integrated Home Based Depression Intervention For Older African Americans: Descripton Of The Beat The Blues Randomized Trial And Intervention Costs., Laura N Gitlin, Lynn Fields Harris, Megan Mccoy, Nancy L Chernett, Eric Jutkowitz, Laura T Pizzi

Center for Applied Research on Aging and Health Research Papers

ABSTRACT: BACKGROUND: Primary care is the principle setting for depression treatment; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended standard of care. Older African Americans are at high risk for depression due to elevated rates of chronic illness, disability and socioeconomic distress. There is an urgent need to develop and test new depression treatments that resonate with minority populations that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness. METHODS/DESIGN: Beat the Blues (BTB) is a single-blind parallel randomized trial to assess efficacy of a non-pharmacological intervention to …


Medical Evaluation And Triage Of The Agitated Patient: Consensus Statement Of The American Association For Emergency Psychiatry Project Beta Medical Evaluation Workgroup, Kimberly Nordstrom, Leslie S. Zun, Michael P. Wilson, Victor Stiebel, Anthony T. Ng, Benjamin Bregman, Eric L. Anderson Feb 2012

Medical Evaluation And Triage Of The Agitated Patient: Consensus Statement Of The American Association For Emergency Psychiatry Project Beta Medical Evaluation Workgroup, Kimberly Nordstrom, Leslie S. Zun, Michael P. Wilson, Victor Stiebel, Anthony T. Ng, Benjamin Bregman, Eric L. Anderson

Psychiatry and Behavioral Sciences Faculty Publications

Numerous medical and psychiatric conditions can cause agitation, some of these causes are life threatening. It is important to be able to differentiate between medical and non-medical causes of agitation so that patients can receive appropriate and timely treatment. This article aims to educate all clinicians in non-medical settings, such as mental health clinics, and medical settings on the differing levels of severity in agitation, basic triage, use of de-escalation, and factors, symptoms, and signs in determining whether a medical etiology is likely. Lastly, this article focuses on the medical workup of agitation when a medical etiology is suspected or …


Vitamin D: Does It Play A Role In Psychiatry, Mukesh Mohan Bhimani Feb 2012

Vitamin D: Does It Play A Role In Psychiatry, Mukesh Mohan Bhimani

Department of Psychiatry

No abstract provided.


Reintegration Of Child Soldiers In Burundi: A Tracer Study, Mark J.D. Jordans, Ivan H. Komproe, Wietse A. Tol, Aline Ndayisaba, Theodora Nisabwe, Brandon A. Kohrt Jan 2012

Reintegration Of Child Soldiers In Burundi: A Tracer Study, Mark J.D. Jordans, Ivan H. Komproe, Wietse A. Tol, Aline Ndayisaba, Theodora Nisabwe, Brandon A. Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

No abstract provided.


Evaluating Psychiatric Patients’ Attitudes Of A Shared Electronic Medical Record, Edward R. Norris Md, Fapa, Fapm, Julia R. Correll Ba, Jamie Bongiovi Lcsw, David Dylewski Ms, Gail Stern Msn, Michael Kaufmann Md Jan 2012

Evaluating Psychiatric Patients’ Attitudes Of A Shared Electronic Medical Record, Edward R. Norris Md, Fapa, Fapm, Julia R. Correll Ba, Jamie Bongiovi Lcsw, David Dylewski Ms, Gail Stern Msn, Michael Kaufmann Md

Department of Psychiatry

No abstract provided.


Hemicrania Continua Headache In A Veteran With Post Traumatic Stress Disorder And Major Depressive Disorder Without Traumatic Brain Injury, Brandon A. Kohrt, Erica Duncan Jan 2012

Hemicrania Continua Headache In A Veteran With Post Traumatic Stress Disorder And Major Depressive Disorder Without Traumatic Brain Injury, Brandon A. Kohrt, Erica Duncan

Psychiatry and Behavioral Sciences Faculty Publications

Hemicrania continua is a headache characterized by chronic unremitting unilateral pain associated with ipsilateral autonomic findings. This type of headache responds to high-flow oxygen and indomethacin. This case report describes a male veteran with posttraumatic stress disorder (PTSD) and major depressive disorder who suffers from comorbid hemicrania continua. The psychiatric symptoms were recalcitrant to psychopharmacological intervention. However, when the patient's hemicrania continua was treated appropriately, the patient's psychiatric symptoms also abated. This case demonstrates the need to address physical comorbidities that may exacerbate psychiatric disorders, such as PTSD.


Using Portable Computers To Increase The Efficiency Of Evaluating Psychiatric Emergencies – A Pilot Program, Anthony Buchman Lcsw, Edward R. Norris Md, Fapa, Fapm, Rosanne Teders Lcsw, Michael Kaufmann Md Jan 2012

Using Portable Computers To Increase The Efficiency Of Evaluating Psychiatric Emergencies – A Pilot Program, Anthony Buchman Lcsw, Edward R. Norris Md, Fapa, Fapm, Rosanne Teders Lcsw, Michael Kaufmann Md

Department of Psychiatry

No abstract provided.


An Automated Internet Application To Help Patients With Bipolar Disorder Track Social Rhythm Stabilization., Daniel Z Lieberman, Susan Swayze, Frederick K Goodwin Nov 2011

An Automated Internet Application To Help Patients With Bipolar Disorder Track Social Rhythm Stabilization., Daniel Z Lieberman, Susan Swayze, Frederick K Goodwin

Psychiatry and Behavioral Sciences Faculty Publications

This column describes a pilot study of a fully automated, Internet-based program that provides a key element of interpersonal and social rhythm therapy, a form of psychotherapy shown to be effective in the treatment of bipolar disorder when combined with mood-stabilizing medication. Participants (N=64) recorded the time they completed activities of daily living and their mood at the time of each entry. After 90 days they demonstrated a 31% increase in social rhythm stability and a small, though statistically significant, decrease in symptoms of abnormal mood. Internet-based programs can enhance access to a best practice in the management of bipolar …


Factors Related To Psychiatric Readmissions In A Large Community Academic Hospital, William Stern, Edward R. Norris Md, Fapa, Fapm, Karen Burke Rn, Julia R. Correll Ba, Michael Kaufmann Md Nov 2011

Factors Related To Psychiatric Readmissions In A Large Community Academic Hospital, William Stern, Edward R. Norris Md, Fapa, Fapm, Karen Burke Rn, Julia R. Correll Ba, Michael Kaufmann Md

Department of Psychiatry

No abstract provided.


Smart Rehabilitation For The 21st Century: The Tampa Smart Home For Veterans With Traumatic Brain Injury, Jan Jasiewicz, William D. Kearns, Jeffrey Craighead, James L. Fozard, Steven Scott, Jay Mccarthy Oct 2011

Smart Rehabilitation For The 21st Century: The Tampa Smart Home For Veterans With Traumatic Brain Injury, Jan Jasiewicz, William D. Kearns, Jeffrey Craighead, James L. Fozard, Steven Scott, Jay Mccarthy

Rehabilitation and Mental Health Counseling Faculty Publications

No abstract provided.


Evidence Based Treatment Of Schizophrenia: Do We Know Enough, Faheem Khan, Haider A Naqvi May 2011

Evidence Based Treatment Of Schizophrenia: Do We Know Enough, Faheem Khan, Haider A Naqvi

Department of Psychiatry

No abstract provided.


Response To An Abnormal Ovarian Cancer-Screening Test Result: Test Of The Social Cognitive Processing And Cognitive Social Health Information Processing Models, Michael A. Andrykowski, Edward J. Pavlik Apr 2011

Response To An Abnormal Ovarian Cancer-Screening Test Result: Test Of The Social Cognitive Processing And Cognitive Social Health Information Processing Models, Michael A. Andrykowski, Edward J. Pavlik

Behavioral Science Faculty Publications

All cancer screening tests produce a proportion of abnormal results requiring follow up. Consequently, the cancer-screening setting is a natural laboratory for examining psychological and behavioural response to a threatening health-related event. This study tested hypotheses derived from the social cognitive processing and cognitive-social health information processing models in trying to understand response to an abnormal ovarian cancer (OC) screening test result. Women (n = 278) receiving an abnormal screening test result a mean of 7 weeks earlier were assessed prior to a repeat screening test intended to clarify their previous abnormal result. Measures of disposition (optimism, informational coping style), …


Odor Fear Conditioning Modifies Piriform Cortex Local Field Potentials Both During Conditioning And During Post-Conditioning Sleep, Dylan C. Barnes, Julie Chapuis, Dipesh Chaudhury, Donald A. Wilson Mar 2011

Odor Fear Conditioning Modifies Piriform Cortex Local Field Potentials Both During Conditioning And During Post-Conditioning Sleep, Dylan C. Barnes, Julie Chapuis, Dipesh Chaudhury, Donald A. Wilson

Publications and Research

Background: Sleep plays an active role in memory consolidation. Sleep structure (REM/Slow wave activity [SWS]) can be modified after learning, and in some cortical circuits, sleep is associated with replay of the learned experience. While the majority of this work has focused on neocortical and hippocampal circuits, the olfactory system may offer unique advantages as a model system for exploring sleep and memory, given the short, non-thalamic pathway from nose to primary olfactory (piriform cortex), and rapid cortex-dependent odor learning.

Methodology/Principal Findings: We examined piriform cortical odor responses using local field potentials (LFPs) from freely behaving Long-Evans hooded rats over …


Spirituality And Depression In Parents With Children In Oncology Or Hematology Treatment, Kurt D. Soell Jan 2011

Spirituality And Depression In Parents With Children In Oncology Or Hematology Treatment, Kurt D. Soell

Walden Dissertations and Doctoral Studies

The psychological burden of cancer treatment affects not only child patients but also their parents. There is extensive literature on the positive influence of spirituality on the cancer patient. But there is a gap in the literature on the potential healing influence of spirituality on the parent of the cancer or hematology patient. The purpose of this study was to examine the relationship between spirituality and parents' levels of depression and anxiety during their child's hematological or oncology treatment. Using the transtheoretical model of change, a purposive sample of 48 parents of children undergoing cancer or hematology treatment completed a …


A Proposed Mechanism For Drug-Induced Nightmares, Isaac Brezner Jan 2011

A Proposed Mechanism For Drug-Induced Nightmares, Isaac Brezner

The Science Journal of the Lander College of Arts and Sciences

The following is the introduction of this article: The fields of neuropharmacology and psychopharmacology are known to be highly connected, despite our severe lack of knowledge in these fields. One of the many overlaps between the two fields is sleep, which itself entails many mechanisms and events which are, as of yet, unexplainable. From the perspective of either field, one of the most mysterious events occurring during sleep is dreaming. From the cause of dreams to their content, little is known about them or their more sinister subclassification: nightmares. In this field of disturbed dreaming, neuropharmacology makes a large intrusion …


A Double-Blind, Randomized, Placebo Controlled Trial Of Ramelteon For The Treatment Of Insomnia And Mood Stability In Patients With Euthymic Bipolar Disorder (Poster), Edward R. Norris Md, Fapa, Fapm, Karen Burke Rn, Julia R. Correll Ba, Ken Zemanek Md, Joel Lerman Md, Michael Kaufmann Md Jan 2011

A Double-Blind, Randomized, Placebo Controlled Trial Of Ramelteon For The Treatment Of Insomnia And Mood Stability In Patients With Euthymic Bipolar Disorder (Poster), Edward R. Norris Md, Fapa, Fapm, Karen Burke Rn, Julia R. Correll Ba, Ken Zemanek Md, Joel Lerman Md, Michael Kaufmann Md

Department of Psychiatry

No abstract provided.


What Is The Safety And Efficacy Of Tarenflurbil (R-Flurbiprofen) In Mild To Moderate Alzheimer’S Disease?, Lauren Viscount Jan 2011

What Is The Safety And Efficacy Of Tarenflurbil (R-Flurbiprofen) In Mild To Moderate Alzheimer’S Disease?, Lauren Viscount

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine what is the safety and efficacy of Tarenflurbil (R-flubiprofen) in mild to moderate Alzheimer’s Disease.


Does Beta Amyloid Immunization Reduce Amyloid Plaques And Preserve Cognitive Function In Patients With Alzheimer’S Disease?, Andrea Sasin Jan 2011

Does Beta Amyloid Immunization Reduce Amyloid Plaques And Preserve Cognitive Function In Patients With Alzheimer’S Disease?, Andrea Sasin

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this systematic review is to examine the efficacy of beta amyloid immunization in reducing amyloid plaques and preserving cognitive function in patients with Alzheimer’s disease (AD).


A Concept Mapping Needs Assessment Of Young Families With Parental Cancer, Richard P. Durant Jan 2011

A Concept Mapping Needs Assessment Of Young Families With Parental Cancer, Richard P. Durant

Antioch University Dissertations & Theses

The purpose of this research is to investigate the support needs of young families living with and beyond a parental diagnosis of cancer. The sample includes 56 participants comprised of 31 professional stakeholders and 25 patient stakeholders affiliated with the Charles R. Wood Cancer Center. It was hypothesized there would be differences in how the groups of stakeholders rated needs in terms of importance, satisfaction, and utilization. Differences in ratings are thought to be barriers to effective program development. While not a formal research hypothesis, it was anticipated other program development barriers germane to naturalistic clinical settings would emerge from …


Growing Organizational Capacity To Facilitate The Streamlining Of Patients With Psychiatric Disorders In A Community Academic Health Network; An Eight Year Review, Edward R. Norris Md, Fapa, Fapm, Michael W. Kaufmann Md, David B. Burmeister Do, Muhamad Aly Rifai Md, Laurence P. Karper Md, Ralph A. Primelo Md Nov 2010

Growing Organizational Capacity To Facilitate The Streamlining Of Patients With Psychiatric Disorders In A Community Academic Health Network; An Eight Year Review, Edward R. Norris Md, Fapa, Fapm, Michael W. Kaufmann Md, David B. Burmeister Do, Muhamad Aly Rifai Md, Laurence P. Karper Md, Ralph A. Primelo Md

Department of Psychiatry

No abstract provided.


Gender Difference In Age At Onset Of Schizophrenia: A Cross Sectional Study From Pakistan, Imama Naqvi, Muhammad Murtaza, Muhammad Ressam Nazir, Haider Ali Naqvi Oct 2010

Gender Difference In Age At Onset Of Schizophrenia: A Cross Sectional Study From Pakistan, Imama Naqvi, Muhammad Murtaza, Muhammad Ressam Nazir, Haider Ali Naqvi

Department of Psychiatry

OBJECTIVE: To validate the effect of gender on age at onset of schizophrenia in a developing country

METHODS: Medical records of 252 patients diagnosed with schizophrenia according to DSM-IV criteria at a tertiary care hospital in Karachi, Pakistan between 2002 and 2008 were reviewed using a structured questionnaire. Age at onset was defined as age at onset of psychotic symptoms, age at first contact with a health care provider and age at first hospitalization. Socio-demographic variables were reported using descriptive statistics and all measures of age at onset were compared across gender using t-test.

RESULTS: There were 119 women and …


18F-Fallypride Binding Potential In Patients With Schizophrenia Compared To Healthy Controls, Douglas S. Lehrer, Bradley T. Christian, Cemil Kirbas, Meicheng Chiang, Shawn Sidhu, Holly Short, Binquan Wang, Bingzhi Shi, King Wai Chu, Brian Merrill, Monte S. Buchsbaum Sep 2010

18F-Fallypride Binding Potential In Patients With Schizophrenia Compared To Healthy Controls, Douglas S. Lehrer, Bradley T. Christian, Cemil Kirbas, Meicheng Chiang, Shawn Sidhu, Holly Short, Binquan Wang, Bingzhi Shi, King Wai Chu, Brian Merrill, Monte S. Buchsbaum

Psychiatry Faculty Publications

Background: Molecular imaging of dopaminergic parameters has contributed to the dopamine hypothesis of schizophrenia, expanding our understanding of pathophysiology, clinical phenomenology and treatment. Our aim in this study was to compare 18F-fallypride binding potential BPND in a group of patients with schizophrenia-spectrum illness vs. controls, with a particular focus on the cortex and thalamus. Methods: We acquired 18F-fallypride positron emission tomography images on 33 patients with schizophrenia spectrum disorder (28 with schizophrenia; 5 with schizoaffective disorder) and 18 normal controls. Twenty-four patients were absolutely neuroleptic naïve and nine were previously medicated, although only four had a lifetime neuroleptic exposure of …


The Development Of Attribute Dominance In The Knowledge Base, Marc A. Lindberg Ph.D. Jul 2010

The Development Of Attribute Dominance In The Knowledge Base, Marc A. Lindberg Ph.D.

Psychology Faculty Research

Two cuing, free-recall studies were conducted to test Bach and Underwood's (1970) hypothesis that acoustic encoding is dominant among second graders and semantic encoding is dominant among sixth graders. When retrieval cues were presented with to-be-remembered items at both input and output (Experiment 1), and when cues were presented only at output (Experiment 2), semantic cues were more efficient in elevating recall than were acoustic cues for both second and sixth graders. When these and other results generally found using recognition, sorting, incidental learning, and free-recall experimental designs are compared, it seems plausible that item presentation and memory-testing formats interact …


The Role Of Gender In Single Vs Married Individuals With Bipolar Disorder., Daniel Z Lieberman, Suena H Massey, Frederick K Goodwin Jul 2010

The Role Of Gender In Single Vs Married Individuals With Bipolar Disorder., Daniel Z Lieberman, Suena H Massey, Frederick K Goodwin

Psychiatry and Behavioral Sciences Faculty Publications

BACKGROUND: Despite the importance of marriage as a source of social support, it has been largely neglected in studies of bipolar disorder; and differential effects on men and women have not been explored.

METHODS: Data on episodes of depression, mania, and mixed states were collected for the previous 2 years from a sample of 282 bipolar individuals using the National Institute of Mental Health Life Chart Methodology.

RESULTS: Effects unique to women included the following: Bipolar women were significantly more likely to be married. Married women had fewer episodes of depression during the past 2 years than never-married women, and …


A Randomized Comparison Of Online And Paper Mood Charts For People With Bipolar Disorder., Daniel Z Lieberman, Tammas F Kelly, Lanny Douglas, Frederick K Goodwin Jul 2010

A Randomized Comparison Of Online And Paper Mood Charts For People With Bipolar Disorder., Daniel Z Lieberman, Tammas F Kelly, Lanny Douglas, Frederick K Goodwin

Psychiatry and Behavioral Sciences Faculty Publications

BACKGROUND: Longitudinal mood instability is the essential feature of bipolar disorder, however most rating scales are cross sectional in nature, and focus on acute symptoms. By contrast, the NIMH Life Chart Methodology (LCM) characterizes in detail the severity, duration, and frequency of mood episodes. Adherence to daily rating, however, tends to be low. In this study an online version of the LCM, designed to enhance adherence, was compared to the standard paper version.

METHODS: Patients from a mood disorders specialty clinic were randomized to the standard LCM or an online, open-source adaptation. The online version used hypertext links embedded in …


Desvenlafaxine In Major Depressive Disorder: An Evidence-Based Review Of Its Place In Therapy., Daniel Z Lieberman, Suena H Massey Jun 2010

Desvenlafaxine In Major Depressive Disorder: An Evidence-Based Review Of Its Place In Therapy., Daniel Z Lieberman, Suena H Massey

Psychiatry and Behavioral Sciences Faculty Publications

INTRODUCTION: Desvenlafaxine, the active metabolite of venlafaxine, is a serotonin norepinephrine reuptake inhibitor (SNRI) recently approved for the treatment of major depressive disorder. It is one of only three medications in this class available in the United States.

AIMS: The objective of this article is to review the published evidence for the safety and efficacy of desvenlafaxine, and to compare it to other antidepressants to delineate its role in the treatment of depression.

EVIDENCE REVIEW: At the recommended dose of 50 mg per day the rate of response and remission was similar to other SNRIs, as was the adverse effect …


Evaluation Of Concurrent Medications Pre- And Post Initiation Of Long-Acting Injectable Antipsychotic Therapy, Lindsay Pokallus Pharmd, Laurence Karper Md, Jessica Price Pharmd, Bcps Jan 2010

Evaluation Of Concurrent Medications Pre- And Post Initiation Of Long-Acting Injectable Antipsychotic Therapy, Lindsay Pokallus Pharmd, Laurence Karper Md, Jessica Price Pharmd, Bcps

Department of Pharmacy

No abstract provided.