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In 1991 generic voveran sr 100 mg online, a new type of genetic mutation was discovered generic 100 mg voveran sr fast delivery, a dynamic or expansion mutation order 100mg voveran sr with visa, in which the number of triplets in a repeat increases and the length becomes unstable. Nearly 20 diseases, including Huntington’s disease, 2 forms of fragile X syndrome, and myotonic dystrophy, have been linked to trinucleotide repeat expansions. Such repeats are unstable and lead to inheritance patterns at odds with traditional Mendelian genetics. Prediction of Huntington’s disease may never be 100% accurate due to some cases having a borderline number of repeats, i. Trisomy 8 usually results in (usually male) foetal loss, but survival, when it happens, is associated with moderate intellectual 891 disability. Trisomy 892 18 (Edward’s syndrome ) is nearly always lethal in infancy with less than 10% surviving for the first year. Unifactorial (unigenetic) disorders: these are single gene disorders, (the autosomal dominant and recessive disorders and X-linked recessive disorders) the opposite of multifactorial characteristics (Q. Because of high inter-individual variability microsatellites are commonly used as markers for linkage analysis. Xenotransplant: organ or tissue transplanted from one species of animal into another. Mitochondrial chromosomes Mitochondria, highly motile subcellular organelles that fuse and divide (Chan, 2007), contain their own chromosomes. The mitochondrion and its genome are thought to be remnants of a free-living bacterium, probably a proteobacterium. Statins and omega-3 fatty acids (Farzaneh-Far ea, 2010) hold promise in blunting the effects of telomere shortening, as may physical activity. Features include severe mental retardation, microcephaly, holoprosencephaly, deafness, seizures, heart and kidney anomalies, cleft lip/palate, and omphalocele. Unlike nuclear chromosomes that present normally in 2 copies per cell at the most, thousands of copies of mitochondrial chromosomes are present in each cell. Since sperm contain no or very few mitochondria, these mitochondria derive from the mother. Leber’s optic atrophy, leading to blindness in young men, is inherited via mitochondrial genes. The latter condition will affect all the offspring of an affected woman but none of the children of an affected male. Younger cells have longer telomeres than older ones: they become shorter with each cell division. One potential danger of using telomerase would be excessive cell division (cancer). Counselling Genetic counselling is the process by which patients or relatives at risk of a disorder that may be hereditary are advised of the consequences of the disorder, the probability of developing and transmitting it, and of the ways in which this may be prevented or ameliorated. The process is made difficult by a lack of a sufficient number of available generations, lack of post-mortem studies, early death of a parent, illegitimacy, mutations, and a relative lack of experience in assessing people for psychopathology before genetic testing. Counselling for dementing disorders should probably be given in a medical genetics facility by a multidisciplinary team. They also warn against pressuring a couple into terminating a pregnancy simply because they would have to look after a disabled individual. It is important to be sure that the patient understands the nature and implications of the test. Age of onset and clinical severity of myoclonic epilepsy with ragged-red fibres vary widely, even in the same nuclear family, mainly due to heteroplasmy: each sufferer inherits a different mixture of normal and mutated mitochondria from the mother. The Minister for Health (Republic of Ireland) told the Dáil (Lower House of parliament) that the Health Insurance (Amendment) Bill, 2000 retains prohibition on taking genetic testing into account when determining health insurance premiums. The attitudes of those who may share ones genes must be considered,(Shaw, 1987) as must the possible adverse psychological reactions to testees to the results (Kessler, 1987) or the procedure. People may be less likely to take up offers of predictive testing if no treatment is available. Advance directives, time spent with the family, and settling of financial affairs would be important considerations should a test prove positive. Genetic research may ways in which environmental manipulation might mitigate pathogenic endowment from our genes. Pyeritz (1990) pointed out that this would need to be attempted soon after conception. Somatic gene therapy involves the introduction and expression of recombinant genes in somatic cells for the purpose of treating a disease. Modified fibroblasts that produce nerve growth factor have been transplanted in human forebrain to ameliorate the cognitive effects of Alzheimer’s disease. A nucleus taken from a sheep’s mammary gland and implanted into an 901 unfertilised oocyte which has had its genome destroyed. Cloning of rhesus monkeys followed in America, leading to presidential concerns about the cloning of human beings. Cloning of human embryos in order to produce tissues for transplant purposes was reported from America in November 2001. Cloning in humans was thought to be prohibited in Britain under the Human Fertilisation and Embryology Act 1990 but a November 2001 High Court ruling pointed out that such was not the case and led to a governmental reaction to ensure prohibitive legislation. However, in May 2005, the Law Lords ruled that such cloning was not prohibited, i. It regulates assisted reproduction (vide infra) allows scientific investigation into treatments for conditions such as Parkinson’s disease.

Of course cheap voveran sr 100mg online, these factors which drive bio- Instinctive sleep postures (see in particular chemical requirements are about as diverse as they sections in Chapter 10 on fatigue and could be discount 100 mg voveran sr with mastercard, resulting in the well-established and very naturopathic phenomenon of biochemical individual- fibromyalgia) ity (Williams 1956 generic voveran sr 100 mg free shipping, 1988). Hence, nutrient reference Before the topics of sleep and rest postures are ranges have far less validity than joint range of motion embraced, a key concept to acknowledge is that there reference ranges, for example. No matter With the combination of biomechanical universality what position the body is in, there is stress on certain (relatively undifferentiated physical challenges) and parts more than others. In supine lying, for example, the organizing principle of attractor states, we are able the sacrum counternutates with respect to the innomi- to understand a great deal more about how the human nate, meaning that more stress is placed on the long frame was designed by nature to function. Beach (per- dorsal sacroiliac ligament while less stress is placed sonal communication, 2003) recognized that his on the sacrotuberous ligament (Lee 2005). Instead, a concept of archetypal rest postures (see below) could continuum from very little movement to a lot of be classified as attractor states as they are stable states movement is a better, more accurate way to view the to which the human organism returns consistently body. In life, there is always movement; it’s just the after the relative chaos of daily movement. Tetley suggests that sleep is health what the macronutrients are to biochemical nature’s intrinsic manipulator, with a variety of pos- health: tures helping to maintain function of a variety of joints. Tetley (2000) identifies three primary instinctive sleep postures: 7It is noted that there are very slight differences in gravity 1. These differences are, however, miniscule in comparison with the posture’) influencing effects of biochemical diversity. These are true biomechanical attractor states; states that are returned to day after day and help to ‘re-set’ biome- chanical length–tension relationships. In modern culture, significant resources are invested in finding a soft ‘comfortable’ bed that perhaps is ‘orthopedic’, with an ‘orthopedic’ pillow to help create a good night’s sleep. In most cases, such patients will be unable to extend their thoracic curve fully (a functional range of motion) due to contracture of the described muscles, of the anterior longitudinal liga- ment and other connective tissue changes associated with fixed postural holds. Note: Some patients have a ‘lazy’ upper crossed syndrome where an upper crossed posture may simply reflect lazy postural habits, although the flexibility to be able to return to neutral has been maintained. In most patients who have had an upper crossed syndrome for a prolonged period of time (which is most patients), connective tissue and even bony remodeling will not allow for a reversal of B pathological posture, unless significant and sustained Figure 9. Since to flex/abduct the arm beyond times called the child pose, and other rest postures 140° requires thoracic extension (to use the arm as a such as the full squat and upright kneel. In the natural world it could be argued that sleep (and Sahrmann (2002, 2005) explains that full-range the position in which sleep occurs) is the single biggest flexion or abduction of the shoulder should result in Chapter 9 • Rehabilitation and Re-education (Movement) Approaches 365 the lateral border of the scapula being pulled no more may be used therapeutically as a mobilization than 1 cm beyond the mid-axillary line. In this example we can see that groups (and any animal) is that safety from predators side-lying with the arm raised up as a pillow helps is paramount (Anderson 2000). Most primates sleep to maintain a functional length–tension relationship in elevated locations, though may sleep on the ground between the scapulothoracic muscles and the scapu- during daylight. This is an example of a stable state in that they build a nest to provide a platform in their to which the body returns naturally, in order to main- various arboreal sleeping sites, the one exception tain function – an attractor state. In human groups it should be recog- and in indigenous human populations (Anderson nized that, not only is snoring the aberrant result of 2000, Tetley 2000). This strat- mann et al 2005) – it is also the best signal to any egy may reflect a number of benefits. We can deduce, therefore, that our successful Prone ancestors – those who survived to perpetuate their genes into our current gene pool – did not have a 1. Rib compression may result in: have enough ‘give’ in them, so that they can resist • mobilization/synovial fluid imbibition of external compression without buckling or breaking. This would correlate with which, in turn, stimulates parasympathetic what is known of muscle length norms (Kendall et al tone. Similarly, the hip-knee-ankle-foot complex should be able to accept full internal or external rota- In addition to these benefits, one of the major tion in order that, under load, the medial or lateral threats to many ground-dwelling primates is being border of the foot (respectively) can rest against the trampled by elephants. In an instinctive sleep may allow early detection of approaching large posture, therefore, the body should be resting on a firm animals. Flexed arms and legs result in no exposure of If the body is unable to achieve this, it is not because flexor creases: the position is dysfunctional, but because the body is • minimizes exposure of superficial arteries dysfunctional. So the question arises, do we want to make the body • helps retain body heat comfortable within its state of dysfunction, or do we • leaves only bony extensor surfaces (knees, want to optimize its function? Rib compression means increased abdominal states that the craniocervical region of the spine should excursion during breathing and lateral rotate approximately 90° in either direction. Sleep- breathing on the non-compressed side, which ing prone, therefore, would equate perfectly with 366 Naturopathic Physical Medicine Zygomatic Medial border Aponeurosis of gluteus arch (right) of scapula medius muscle Coracoid process Acromion Styloid process of radius Lateral process of calcaneal tuberosity Medial epicondyle Anterior superior of humerus iliac spine Medial border of the calcaneus Medial epicondyle of femur Figure 9. Note: The legends attaching to the figure do not necessarily identify those structures that are in touch with the floor, as discussed in the text maintaining this full 90° range of motion, assuming Reflex points on the bony prominences of the medial that the individual hasn’t gone through an extended epicondyle of the elbow, the zygomatic arch of the period where pillows and soft, forgiving mattresses cheek, the anterior superior iliac spine and the medial have allowed sleep in a non-rotated position and condyle of the femur, for example, will be stimulated where range of motion has been lost. Eventually the pain stimu- Reflexlocomotion lus will become sufficient that the body will reflex- Vojta (2006) takes this concept one step further by ively move. This, according to Vojta (2006), is what looking at how the nervous system may react to such triggers infantile development of the reptilian crawl. Vojta proposed and developed the The reptilian crawl is one the first examples of left– theory that periosteal reflex points on the bony promi- right brain integration, developing before the mam- nences of the body are stimulated by sustained body- malian crawl (Goldfield 1995, Hartley 1995, Morris weight pressure. That, it could be said, is an richest and largest sensory organ is not the skin, the efficient system. This tonic Interestingly, many people are highly defensive about stimulation may result in changes in muscle tension their sleep postures! A secondary function of the type I Creep mechanoreceptor is to suppress pain, so this may also The mechanical phenomenon in the tissues of the aid in effective sleep and/or rest. And with the tone of creep is both a load-dependent and time-dependent the postural muscles already stimulated by type I activity. The 3-minute figure presented by McGill was afferent drive, the equivalent of a feed-forward joint based on the posterior ligaments of a loaded lumbar stability mechanism will be in place to allow the body spine, but if the load is reduced, the time taken to to move safely during unconscious sleep. In general, mechanoreceptors are activated at period which could correspond more closely with the 25% of the stimulation required to activate the noci- 8- to 9-minute movement interlude described by ceptors (Dvorak & Dvorak 1990). At the in advance of the resting individual perceiving pain point at which the magnitude of afferent stimulus (which would result in an adrenal response – antago- exceeds the threshold level at the cord, an efferent nistic to sleep), first the postural, then the phasic drive will occur and spontaneous movement will be system will be activated to move the joint from its generated to move the body into a new position (Slos- potentially detrimental position of stretch.

Accordingly buy voveran sr 100 mg without prescription, the translated text does not feign to be an original (as happens with domestication) discount 100 mg voveran sr fast delivery, so that “the crucial role of the source culture is stressed discount voveran sr 100 mg free shipping, foreign identity highlighted and the influence of the target culture minimised” (Szarkowska 2005). In brief, translational choices move along the two opposite ends of the domestication-foreignization continuum, according to the intended audience’s needs and identities. In the present case, since both the needs of the test practitioners and the potential end-users’ identities must be kept in full view, domestication has to be the main thrust. Metaphors are both 112 Lucia Abbamonte / Flavia Cavaliere grounded in our bodily experience, or embodied cognition (Varela/ Thompson/Rosch 1991; Pfeifer/Bongard 2006), and imaginatively structured. Indeed, the physical environment, cultural context and communicative situation play a foreground role for a given (sub-)culture or cultural group by permeating general domains of their experience, thus generating cultu- rally-bound ways of conceptualizing experience, which are referred to as ‘cultural conceptualizations’ (Sharifian 2003). A common and feasible taxonomy for classifying culture-bound metaphors can be found in Kövecses’ classification in congruent metaphors, alternative 4 For example, the similarity between the English and Iraqi Arabic metaphorical expressions show that the universality of orientational metaphors (i. The most comprehensive explanation of ‘embodiment’ and ‘embodied mind’ in Cognitive Linguistics can be found in Lakoff/Johnson (1999: 4): “Reason is not disembodied, as the tradition has largely held, but arises from the nature of our brains, bodies, and bodily experience: […] the very structure of reason itself comes from the details of our embodiment. Instead, it is shaped crucially by the peculiarities of our human bodies, by the remarkable details of the neural structure of our brains, and the specifics of our everyday functioning in the world. Translating Tests of Pragmatic Language 113 metaphors and metaphors unique to a given culture (2006:155-158), which are the most challenging for translators, as will be illustrated in our examples. To translate most verbally expressed humour, the abili- ty to switch frames of reference is required, which implies that careful attention must be paid to the ‘cultural turn’ (Attardo 2002; Cavaliere 2008; Bassnett 2014). In particular, the evaluation focuses on the students’ ability to monitor and appraise the effectiveness of the response to resolve the social problem situation. Translating Tests of Pragmatic Language 115 The time needed to administer the test amounts to 60-70 minutes ap- proximately, and the procedure is as follows: each item is slowly read by the counselor/special educator to the perspective patient/student: if s/he does not respond in 15 seconds, the item may be repeated but not altered, nor abbreviated. Linguistic data For some of the items to be effectively translated in a different language, some shifts at the lexical level are required, and different strategies will be necessary, corresponding to higher-lower degrees of complexity. Lexical shifts In the following item, we note that a lexical shift for ‘skateboard’ would not be necessary in current translations, since skateboards can now be found in every Italian playground, and they are designated with the original English term, whereas 20 years ago translators would have used monopattino. Item Stimulus Correct Response Guidelines 9 Picture Book Page 9 – ‘Talking to the The response must indicate that Teacher’ topic maintenance and Matt was telling his teacher a story appropriate topic change are about the beach and a sailboat. In translating the following item, lexical shifts are deemed necessary: Item Stimulus Correct Response Guidelines 16 Picture Book Page 16 – ‘The Slumber The response must reflect a Party’ consideration of her father’s Cindy was having a slumber party with tired, frustrated or angry mood 2 of her friends. The ‘slumber party’ situation is a recent one in Italy, where it is the traditional cultural practice for children to sleep in their home, and inferior distances between the Italian homes (usually flats/apartments) make ‘sleep overs’ less necessary. So, for a 2014 rendering, the items could be translated with a light ‘domestica- tion’ process: one lexical shift (slumber → pigiama), and one name change (Cindy →Martina). Matt polite apology and an explanation gave her a cheese sandwich and forgot that he forgot to tell her that they to tell her that they were out of peanut were out of peanut butter. Picture Book Page 11 – ‘The The response must gauge the Baseball Game’ welcoming, positive mood of the Brad was watching some older kids two waiting boys or the group as a start to play a baseball game. He whole, making some reference to wanted to play too, but he was not one or both, and use a polite sure they would let him play with request to play with them. Among the cultural elements which are specific to given societies, irony and humorous allusions can be the most difficult to render, as we will presently see. Picture Book Page 6 – ‘Picking Up The response must address that Kate’ Mom introduced her message by Mom was supposed to pick up Kate at using indirect language and 4:00. Apart from insights from scientific lin- guistic literature, in our increasingly multi-cultural societies, practical suggestions as to how to handle and gauge humour come from popular manuals for cross-cultural training for educators, such as, for example: Humour in the classroom lightens things up, but it takes care and practice to get it right. While situational humour translates well, word plays often use a high level of language; using words with more than one meaning, playing with homophones or complex constructions. Picture Book Page 20 – ‘Talking to The response must indicate that the Counselor’ the given-new (shared informa- Cindy was telling the counselor about tion) base is ignored and that the a problem with another girl. Picture Book Page 24 – ‘Talking The response must include some about a Friend’ indication that the given-new Matt talked and talked about his (shared information) base is friend. Picture Book Page 24 – ‘Talking The response must make about Summer Vacation’ reference to the fact that given- Chad started talking about his summer new base has been ignored (more vacation. As explained in the ‘Correct Response Guidelines’ above, a physiological English- speaking communicator should be able to understand and explain that the ‘given-new base’ is ignored. Picture Book Page 21- ‘The Sailboat The response must indicate Race’ that the topic content is far Brad told Matt about the sailboat races he too detailed and tedious and had seen. Interestingly enough, some recent research in the domain of comparative translation studies (Morini/Zacchi 2002) seems to under- mine the ‘universality’ of such ‘verbosity-opposing’ prescriptions, typically labelled as ‘appropriate telling’. English source texts and their translations in Italian, highlight systemic differences, including Translating Tests of Pragmatic Language 123 the lower sentence and word number and the inferior mean sentence length of the English source texts (Ianich 2006: 8-9). It could be inferred that the greater ‘conciseness’ of the English texts as compared to the over-detailed explicitation of the Italian texts can be mainly explained in terms of the Italian preference for more complex syntactic formulations. However, relatively little is known about culture-specific variation, though differences are found across the languages, especially from the anthropological perspective. Comparative studies of English and Italian highlight consistent differences in styles of verbal interactions, especially as regards turn-taking, which, in gist, is less strictly ob- served in Italian as compared to Anglo-Saxon contexts. In some countries students interrupt teachers with questions or to challenge something that’s been said, but in others it is very rude to interrupt even if the class has gone overtime, the teacher’s made a mistake, or students haven’t understood. Some students politely wait their turn and don’t get to say anything, while others dominate the conversation, jumping in at every opportunity, or interrupting. Item Stimulus Correct Response Guidelines 13 Picture Book Page 13 – ‘The The response must include a Interruption’ reference to turn taking and Matt was hanging up his poster. Picture Book Page 29 – ‘Hanging Up The response must include Pictures’ recognition that the teacher is Cindy was hanging up pictures on the occupied with her task and wall at school. She needed help, but she may not be open to knew that the teacher was very, very busy interruption, so that use of a grading papers and did not want to be polite, formal excuse for disturbed.

Depression and self-rated One of the main findings in this pilot study of women quality of life improved but no improvements with initially severe pain due to long-standing and inca- were observed in sleep order voveran sr 100mg on-line, ability for activities pacitating fibromyalgia was that they experienced a sub- and anxiety purchase voveran sr 100mg on line. Previously cheap voveran sr 100mg visa, it has been reported in a consisting of medical care from the clinic nurse double-blind study of 48 women with fibromyalgia or physician (Alnigenis et al 2001). However, that connective tissue massage gives pain relief in no impact on pain, depression, well-being and one-third of the treated women (Brattberg 1999). The greatest benefits were Exercise and fibromyalgia noted in areas of mood and depression, as well as in reduced pain levels (Field et al 2003). All symptoms showed favorable progress during a Supervised and graduated exercise 4-week period with manual lymph drainage therapy. Fibro- Relaxation and flexibility comprised upper and myalgia patients who attempt to begin an exercise lower limb stretches and relaxation techniques. As the program often experience an increase in muscle classes continued, more techniques were introduced, pain which may discourage them from continuing to progressing through progressive muscle relaxation, work on improving their level of fitness. Pellegrino release-only relaxation and visualization, cue- (1997) notes that a prescribed, supervised exercise controlled relaxation and differential relaxation. This program is beneficial for fibromyalgia patients, and occupied the whole 1-hour class. It is worth noting, however, that in both only groups the tender point counts had fallen significantly 2. Such a program After 12 months fewer participants in the aerobic can include walking, water aerobics, using an exercise group fulfilled the criteria for fibromyalgia; exercise bicycle, or performing a low impact by this time only 75 (55%) participants still met these aerobic program diagnostic criteria. The goal is to achieve improvement, but also to achieve a stable baseline For people with fibromyalgia prescribed graded aerobic exercise is an effective treatment that leads to 4. Compliance is a consider- relaxation and flexibility able problem, giving high dropout rates. Future strategies to (male and female, age range 18–70 years), evaluated increase the efficacy of exercise as an intervention the effect on their conditions of either graded cardio- should confront the issue of compliance. Potential vascular fitness exercise or relaxation and flexibility strategies include additional cognitive behavioral activities, to which they were randomly assigned. Both forms of intervention helped a good number Exercise therapy comprised an individualized of participants, although clearly aerobic activity pro- aerobic exercise program, mostly walking on tread- duced the most benefit. When people first started classes cost, high-benefit outcome should be seen as offering they usually did two periods of exercise per class a beacon for individuals in chronic pain. Sadly, despite periods of 25 minutes at an intensity that made them obvious benefits, individuals commonly slip back into sweat slightly while being able to talk comfortably in old habits, abandon exercise regimes and return to complete sentences. Exercise routines should be introduced condition and how to manage it, with a group who gradually – see the protocol used by Richards & Scott attended these same lectures but who also received (2002) described above (page 458) – with caution and six 1-hour sessions of physical training. Unsupervised home exercising is probably with doing nothing in similar patients) were untreated unwise until the individual has attended classes during this entire study but received treatment after where the degree, intensity and timing of exercise can it was over. Patients participated Fitness, flexibility and strengthening in the study for 3 weeks (total of 15 sessions). Patients were evaluated by the number In another study (Martin et al 1996) the benefits of of tender points, visual analog scale for pain, exercise (fitness, flexibility and strengthening) pro- Beck’s Depression Index and Fibromyalgia grams were compared with relaxation exercises in a Impact Questionnaire for functional capacity. In Both groups of patients (those doing active exercise, group 1, there were statistically significant and those doing relaxation) met three times a week differences in number of tender points, visual for 6 weeks to carry out their routines under supervi- analog scores, Beck’s Depression Index and sion. At the start, both groups had the same amount Fibromyalgia Impact Questionnaire scores after of pain, stiffness, etc. Six months exercises, 18 completed the course, along with 20 (of later, in group 1, there was still an the 30) in the relaxation group. Both groups showed improvement in the number of tender points (p an improvement in the number and sensitivity of <0. However, cises were much improved compared with the relax- there was no statistical difference in Beck’s ation group. What this study shows is that a number Depression Index scores compared to the of people (about a third) fall out of such programs for control group (p >0. Those that complete their mostly complain about pain, anxiety, and the assignments usually benefit, and exercising appropri- difficulty in daily living activities. Results showed a significant combined with six sessions of education decrease in pain and high blood pressure (Mannerkorpi et al 2000). The conclusion individuals were randomized to a treatment was that a combined spa and physical therapy and a control group. The treatment group program may help to decrease pain and was advised to ‘match the pool exercise to improve hemodynamic response in patients their threshold of pain and fatigue’. All participants stayed for treatment group, to a significant degree, in 10 days at a Dead Sea spa. Physical functioning and tenderness floats in warm water sourced from hot springs moderately improved in both groups. The various methods of balneotherapy in the Dead double-blind, placebo-controlled trial involved 35 Sea area. A significant improvement was found weeks) on a surface ‘magnetized at a magnet surface in dolorimetric threshold readings after the field strength of 1100 gauss, delivering 200–600 gauss treatment period in women. The controls slept on a sham non- was that balneotherapy appears to produce a magnetized pad. The results showed that patients statistically significant, substantial sleeping on the magnetized pads experienced a sig- improvement in the number of active joints nificant decrease in overall pain, fatigue and total and tender points in both male and female muscle pain score, and also showed improvement in patients. A placebo effect was noted in that both pool exercise (temperate temperature) groups reported being less tired on waking. Symptoms most effectively when used in combination may begin just before menstruation starts or as long (massage, movement, relaxation, exercise, etc. In most women, symptoms • Manual lymphatic drainage and extremely light disappear by the time menstruation has finished. Chiropractic and • Various forms of exercise (aerobic, graduated menstrual/premenstrual symptoms weight training, etc.