Examinando por Materia "Disease"

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Anti-inflammatory effect of Funica Granatum L. in patients with cardiovascular disease
(Universidad Privada Norbert Wiener, 2021-12-20) Marca Lizama, Silvia Lucía; Bohórquez Medina, Sofia Lorena
Over the last few years, researchers have been studying certain phytochemicals present in different foods and their beneficial effect on people's health; polyphenols being one of the most investigated types of phytochemicals. The “Punica granatum” pomegranate has polyphenols such as: ellagic acid, punicalagin, among the most important; They have been studied in different non-communicable conical diseases such as cardiovascular diseases and cancer. In the present secondary research titled as Critical Review: Anti-inflammatory effect of Punica granatum in patients with cardiovascular disease; whose objective was to know the effect of pomegranate consumption on pro-inflammatory biomarkers, serum lipid levels and blood pressure levels. The clinical question was: Would the consumption of pomegranate (Punica Granatum L.) or its bioactive components produce anti-inflammatory effects in patients with cardiovascular disease? The evidence-based nutrition (NuBE) methodology was used. The search of the scientific literature was carried out in Spanish and English. The databases consulted were SCOPUS, WOS, PUBMED/MEDLINE AND EMBASED. 28 articles were found and 9 were selected, for which the CASPe tool was used. The selected study was “The effects of pomegranate supplementation on biomarkers of inflammation and endothelial dysfunction: A meta-analysis and systematic review”. The critical commentary revealed that the consumption of substances derived from pomegranate could help reduce inflammatory biomarkers, as well as serum lipid levels and blood pressure. Future studies are necessary to establish a recommended dose, as a complementary aid to pharmacological treatment.
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Burnout Syndrome and Coping Strategies During the COVID-19 Pandemic in Nurses of the Emergency Service of the Huacho Regional Hospital, 2020
(Universidad Privada Norbert Wiener, 2022-07-10) Díaz Farro, Carlos Enrique; Gamarra Bustillos, Carlos
Burnout syndrome has become an important psychosocial condition in recent years as a result of constant exposure to stressful situations. The scenario experienced by nurses who provide care during the COVID-19 pandemic is exposed to a high risk of contagion, this being a main stress factor for developing symptoms of exhaustion. Objective: Determine the relationship between Burnout Syndrome and Coping strategies during the Covid-19 pandemic in nurses from the emergency service of the Huacho 2020 Regional Hospital. Method: The study will be basic descriptive, observational, non-experimental, cross-sectional and correlational level. The sample will be made up of 50 nurses. To collect the data, the Maslash Burnout Inventory questionnaires will be used for Burnout syndrome and the Coping Estimation Inventory – COPE for coping strategies. To process the data, graphs and frequency tables will be prepared through univariate analysis applying descriptive statistics. Rho Spearman will be used to correlate the variables.
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Characterization of retinopathy of prematurity in a perinatal maternal hospital, Lima 2017-2019
(Universidad Privada Norbert Wiener, 2020-08-30) Espinoza Palomino, Yajahyda Yuliza; Fernández Rengifo, Werther Fernando
Objective: Describe the characteristics of retinopathy of prematurity at a Maternal Perinatal Hospital in Lima during the period 2017-2019. Method: The present investigation has a quantitative approach, in terms of the methodological design it is a descriptive investigation, with the documentary analysis technique and the instrument of the data capture sheet, information was collected from the clinical records. Results: The characteristics were, the predominance of the male sex of the newborn with 60%, due to the type of delivery that the mother had, mostly delivery by cesarean section with 60%, mothers who had chorioamnionitis in 60%, due to the birth weight less than 1000 g in 40%, requirement for oxygen therapy with 60%, those who presented neonatal sepsis in 80%, according to the type of pregnancy single in 92%, gestational age less than 32 weeks with 72%, as for respiratory distress syndrome and intrauterine growth retardation, their percentages are less than 20%. Conclusion: The most important characterizations were: predominantly male gender, cesarean delivery, birth weight less than 1000g, oxygen therapy requirement, neonatal sepsis, type of singleton gestation, gestational age less than 32 weeks, mothers who presented chorioamnionitis, these characteristics being the most relevant and of great significance, they are possible risk factors for developing the disease.
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Clinical manifestations due to coronavirus and quality of life in oncological patients at the Jesús Nazareno Ayacucho support hospital, period 2020
(Universidad Privada Norbert Wiener, 2021-09-12) Chahuailacc Taipe, Luisa; Gonzales Saldaña, Susan Haydee
Cancer is the uncontrolled growth and spread of cells that can appear anywhere in the body, often invading surrounding tissue and causing metastasis. It can be prevented by controlling risk factors. Treatment consists of chemotherapy, radiotherapy or surgery, if its detection occurs in the initial stages. Covid-19 is a recently discovered infectious disease caused by the coronavirus that affects a large part of the population and is a public health problem that causes serious damage to individuals, families and society; His condition causes a deterioration in the quality of life of the cancer patient, causing high costs in treatment and controls. Aim. Determine how the clinical manifestation of coronavirus is associated with quality of life in cancer patients. Methodology. The present study has a quantitative approach, Hypothetical - deductive method, correlational level, applied type and non-experimental cross-sectional design. On a sample of 56 oncology patients with Covid-19, intentionally selected from a population of 120 oncology patients. Instruments: the FUMAT Questionnaire and Scale, the first of which has been validated by expert judgment. Reliability was determined using Cronbach's Alpha, the contrast statistics will be the Chi square test.
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Determining factors of anemia in 6-month-old infants who attend the growth and development clinic at the Viña San Francisco health post, Santa Anita district, Lima 2019
(Universidad Privada Norbert Wiener, 2020-12-20) Villamar Arce, Sheila Yallily; Fernández Rengifo, Werther Fernando
Introduction: The World Health Organization (WHO) states that anemia affects around 800 million children and women in the world. In Peru, iron deficiency anemia is a serious public health problem affecting 46.6% of children. children at very early ages between 6 months and the first year of life, this situation being the same as that observed in the growth and development clinic of the Viña San Francisco health facility in the Santa Anita district, where the percentage of Anemia in 6-month-old infants reaches 39.8%, a figure that remains high in the first half of 2019 despite the health intervention strategies carried out to reduce cases of anemia in the target population. Objective: Describe the determining factors of anemia in 6-month-old infants. Method: The study has a quantitative approach, descriptive, cross-sectional and prospective, presenting a single main variable, the techniques used were documentary analysis and the interview and the instruments used were the monitoring sheet and the questionnaire applied to the mothers of 6-month-old infants with anemia, the population being the total number of infants, which was 27, constituting a census. Results: During the study period, it was identified that, of the total number of infants with anemia, 70.3% had mild anemia, 25.9% had moderate anemia and 3.7% had severe anemia, with the female sex prevailing with 59.2%. Regarding the determining factors of anemia, present: 25.9% of mothers had a history of anemia during pregnancy, it was identified that 85.1% of infants received iron supplementation at the health facility with timely initiation of the supplement and of them 51.7% consumed it in less than 2 months and 56.5% did not consume it daily, with poor adherence to prophylactic treatment. Regarding the type of feeding, 51.8% of the infants did not receive exclusive breastfeeding, its varieties being mixed, artificial breastfeeding and consumption of cow's milk. 1 infant with a history of prematurity and 2 infants with low birth weight were identified; however, none received prophylactic iron supplementation. 55.5% of infants had their complete vaccination for their age, 70.3% of infants did not have complete growth and development controls for their age. In relation to prevalent diseases, 44.4% of infants with anemia presented diarrheal disease and respiratory infections and of them 3 infants were hospitalized. It has been identified that more than 70% of mothers of infants are unaware of the consequences of anemia during pregnancy, the irreversible effects suffered by the child with anemia in their adult life and the areas of psychomotor development that are affected in the child. with anemia. Conclusions: From the results obtained, it is concluded that the majority of infants in the study had mild or slight anemia, with a predominance of the female sex. A good percentage of the infants began iron supplementation in a timely manner at the health facility. However, More than half of them did not comply with the treatment on a regular basis, identifying difficulties in adherence to treatment. Likewise, infants with a history of prematurity and low birth weight were found who did not receive supplementation despite being infants with a risk factor for anemia, it was found that half of the infants with anemia did not receive exclusive breastfeeding until 6 months, being essential for the prevention of the disease, there is non-compliance with the vaccination schedule and growth and development controls in the infants under study, conditioning the risk of suffering from prevalent diseases such as diarrhea and respiratory infections, as is the case, and at the same time losing the possibility of receiving growth controls and timely nutritional evaluation, it has also been identified that most of mothers interviewed, are unaware of the consequences of anemia in children, which could lead to non-compliance with basic nutritional care in the infant by parents from conception.
Acceso abierto
Effectiveness of an educational intervention in children to improve the level of knowledge, attitudes and practices about washing hands before consuming food
(Universidad Privada Norbert Wiener, 2019-09-29) Francia Niño de Guzmán, Lourdes Durley; Bonilla Asalde, César Antonio
Objective: Analyze the Effectiveness of an educational intervention in children to improve knowledge, attitudes and practices of hand hygiene before consuming food, interventions to improve healthy lifestyles. Materials and Methods: Simple, observational systematic verification of research results, identifying relevant studies to answer specific questions of community practice. The search was based on complete articles, which were used in critical reading, using the grade system to assign the strength of suggestion. The articles are: Israel 10% (01/10), Cuba 10% (01/10) Ethiopia 10% (01/10) Mexico 20% (02/10) Venezuela 10% (01/10) Spain 10% (01 /10) Australia 10% (01/10) Nepal 10% (01/10) and Brazil 10% (01/10). Results: The results related to hand washing before eating food indicate that not all children have the knowledge, adequate practices and hygiene materials required for adequate hygiene, therefore there will not be a complete and effective activity for the practice. healthy. Conclusions: The effectiveness of the level of knowledge, practices and attitudes about hand washing before eating food prevents diseases in children and their caregivers, is reflected in hygiene and hand washing practices.
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Effectiveness of an educational intervention to change lifestyles in patients with arterial hypertension
(Universidad Privada Norbert Wiener, 1905-07-09) Montero Jara, Elsa Ruth; Pantigoso Gutierrez, Pascuala Paulina; Bonilla Asalde, César Antonio
Educational programs will improve the quality of life in patients with high blood pressure and are effective because they play a valuable role in modifying lifestyles and preventing coronary risk factors, which will reduce morbidity and mortality from this disease.
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Effectiveness of educational interventions in the prevention of breast cancer
(Universidad Privada Norbert Wiener, 2019-09-22) Aguirre Pillaca, Sulmit Dionicia; Tarazona Flores, Carlos Liborio; Uturunco Vera, Milagros Lizbeth
Objective: Systematize evidence on the effectiveness of educational interventions in the prevention of breast cancer. Materials and Methods: use of the GRADE system. Databases: Elservier, Cochrane, Google Scholar, Scielo, Medline and Pubmed, studies from Spain 30%, Cuba-20% and studies from Peru, Colombia, Mexico, Brazil and the United Kingdom account for 10% each. quasi-experimental 70% systematic reviews 20% and prospective observational 10%. Results: The articles agree on the effectiveness of educational interventions in the prevention of breast cancer Conclusions: The population must put into practice healthy lifestyles, practice self-care, which entails periodic medical examinations, self-examination, ruling out diseases, participation in health campaigns etc.
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Effectiveness of group education vs. individual education to improve the quality of life of patients with Diabetes Mellitus
(Universidad Privada Norbert Wiener, 1905-07-09) Silva Valencia, Teresa Isabel; Wong Valerio, Miryam Luisa; Remuzgo Artezano, Anika
Objective: Determine the effectiveness of group health education compared to individual education in improving the quality of life of patients with Diabetes Mellitus. Material and method: Retrospective systematic bibliographic search and review. The search was restricted to articles with full text and with a time limit of 10 years, and was carried out in the databases PudMed, Index de Enfermería, Scielo, Evidentia, Cochrane during the month of February 2016. Results: They were chosen 10 articles obtaining the following data: the application of group education has a great impact on the level of knowledge about the disease, as demonstrated in 100% of the articles reviewed, improving adherence to the treatment (66.6%), raising self-care levels (83.3%), achieving behavioral changes in relation to diet and physical activity (50%), therefore controlling biochemical parameters such as glucose (83.3%), and physical such as weight and BMI (33.3%) also shows other indicators such as: no diabetic complications (16.6%) which translate into a decrease in emergency care due to hyper or hypo glycemia. Conclusions: In this bibliographic review, group education is highlighted as the most effective method for the transmission of important knowledge. It also shows us the impact it causes as a means for socialization and the exchange of experiences. Structured group education as a complement to individual education appears necessary and extremely important to improve the quality of life and metabolic control of people with diabetes.
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Effectiveness of nursing educational intervention to reduce sedentary lifestyle in office workers
(Universidad Privada Norbert Wiener, 2020-02-08) Gonzales Ureta, Elsa Carmen; Obando Santos, Lesly Vanesa; Basurto Santillán, Ivan Javier
Objective: Systematize scientific articles. Methodology: It is a systematic, observational, retrospective search engine review. Sciencedirect, Pubmed, Elsevier and Scielo, Results: 70% (7/10) of the research reviewed mentions that homogeneous interventions of “provision of educational information plus physical activity” have had relevant results to reduce sedentary lifestyle in office workers . While 20% (2/10) of the studies only provided the “information dimension”, these have had lower results in their implementation. Likewise, 10% (1/10) of the studies only provided “physical activity”, a study that managed to achieve the standard of physical activity required per day. Conclusions: 7/10 scientific evidence concluded that the mixed intervention of “physical activity plus “information” is sustained over time to reduce sedentary lifestyle and illness in office workers. 2/10 evidence concludes that working on a single indicator “information provision” has little relevance to achieving behavioral change. While 1/10 study shows that working on a single indicator “physical activity” is extremely effective, but for the medium time.
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Effectiveness of palliative care to improve the quality of life of children with cancer
(Universidad Privada Norbert Wiener, 2020-01-25) Velasquez Palma, Diana Noemí; Maynaza Machaca, Inés; Uturunco Vera, Milagros Lizbeth
Objective: Systematize evidence on the effectiveness of palliative care to improve the quality of life in children with cancer. MATERIAL AND METHOD: The study is a systematic observational and retrospective review of articles with full text, in which their grade or quality of evidence was identified according to the Grade System. The population was made up of 10 articles obtained from the following databases in Pubmed, Medline, Embase, Cochrane Library, Dialnet, Scielo, and Lilacs search engines. Of which 90% (9/10) correspond to systematic reviews and 10% (1/10) to literature reviews, of these 60% (6/10) correspond to the United States, 10% to the United Kingdom ( 1/10), Germany 10% (1/10), Canada 10% (1/10), and Colombia 10% (1/10). Results: Of the 10 articles reviewed, 100% demonstrate that palliative care is effective in improving the quality of life in children with cancer. Conclusions: 100% of the articles show that palliative care is effective in improving the quality of life in children with cancer; helping in the prevention and relief of pain, anguish, reducing stress levels, anxiety, and fear associated with the disease; raising their quality of life, both for the physical, emotional and spiritual well-being of the child and their family.
Acceso abierto
Effectiveness of psychoeducation in family acceptance of patients with mental disorders
(Universidad Privada Norbert Wiener, 1905-07-08) Parina Campos, Kelli; Gamarra Bustillos, Carlos
Objective: Determine the effectiveness of psychoeducation in family acceptance of patients with mental disorders. Material and Method: This study was carried out based on systematic reviews that are an observational and retrospective research design, which synthesizes the results of multiple primary investigations. And it is constituted by the bibliographic review of 10 scientific articles published and indexed in scientific databases, no older than ten years and that respond to articles published in Spanish. Data collection was carried out through a bibliographic review of both national and international research articles, whose main topic was psychoeducation for families with mental disorders. Results: it was determined that 90% of the families who received psychocoeducation improved their family member's acceptance since it allowed them to better understand the disease and respond appropriately to its manifestations, promoting clinical improvement and adherence to treatment. Conclusions: Psychoeducation improves the attitude of families towards mental illness, achieving acceptance by the family member, greatly improving the quality of life and health for this group of patients.
Desconocido
Effectiveness of the nursing educational intervention to strengthen the self-care of patients with heart failure
(Universidad Privada Norbert Wiener, 1905-07-09) Salazar Calderón, Katherine; Amésquita Ortiz, Ana Cecilia; Gómez Gonzales, Walter Edgar
Objectives: Determine the effectiveness of nursing educational intervention in the self-care of patients with heart failure. Materials and Methods: Systematic review of 8 articles which allow us to analyze the positive impact of the educational intervention provided by the nursing professional to patients with heart failure. In the final selection, 8 articles were chosen, we found that 37.5% (3) correspond to Colombia, 25% (02) to Brazil, 25% (02) to Spain, while with 12.5% (01) we find Mexico . Results: In this systematic review of the total number of articles analyzed, 100% affirm that nursing educational interventions are effective for the self-care of patients with heart failure. The nursing educational intervention must be individualized and comprehensive when addressing the patient with Heart Failure, promoting self-care and containing aspects such as weight control, salt and fluid restriction, medications, exercise, diet and symptoms of worsening of the disease. Conclusions: All studies show that nursing intervention contributes beneficially to the self-care of patients with heart failure.
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Efficacy of arteriovenous fistula versus central venous catheter in patients with chronic kidney disease
(Universidad Privada Norbert Wiener, 1905-07-09) Flores Mesias, Kelly; Ttito Condori, Rosa; Remuzgo Artezano, Anika
Material and Method: Study design was of a systemic, observational and prospective review type, it was carried out through the review of international research articles. The population of 09 articles published in English and Spanish in the database: Pubmed, Scielo, Lilacs, Medline Results: The reviewed studies show that of the total of 09 articles, 100% show that AVFs are more effective Conclusions : AVFs have greater effectiveness compared to CVCs in hemodialysis patients with lower risk of infection, lower cost, it is an indicator of quality, lifestyle (image, self-esteem), safe, fast and greater durability of treatment throughout your illness.
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Efficacy of the use of racecadotril compared with the use of other treatments to reduce the hypersecretion of water and electrolytes in the intestine in children under 5 years of age with acute diarrhea
(Universidad Privada Norbert Wiener, 2022-10-09) Aquino Santana, Pablo Alex; Dolorier Dolorier, Liz Erika; Bonilla Asalde, César Antonio
We can conclude that, like the other authors, racecadotril is an effective medication for the initial treatment of children under 5 years of age with acute diarrheal disease compared to other treatments, by demonstrating a decrease in the number of stools at the beginning of therapy. It was determined that the use of this medication within the therapy for EDAs is recommended, since the adverse effects presented by this drug are minor compared to other medications used for this type of diseases.
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Factors associated with peritonitis in patients at the peritoneal dialysis unit Hospital Guillermo Almenara Essalud, Lima, 2020
(Universidad Privada Norbert Wiener, 2020-12-06) Sanabria Bazán, Esmeralda Lita; Mori Castro, Jaime Alberto
General Objective: To analyze the factors associated with peritonitis in patients in the Peritoneal Dialysis Unit of the Guillermo Almenara Essalud Hospital. Material, Methods: Quantitative approach, non-experimental correlational methodological design, cross-sectional. Simple random probability sampling. Population: Population 242 patients, period January - December 2019. Inclusion criterion over 18 years of age, exclusion criterion under 18 years of age. Conceptual definition of the main variable factors associated with peritonitis: Risk factors such as diabetes, race, obesity, climates, nose infections and stress. Cloudy peritoneal fluids assumed to be peritonitis, due to inflammation of the peritoneum due to the entry of microorganisms into the peritoneal cavity, through intraluminal, transmural and hematogenous routes. Operational definition of the main variable factors associated with peritonitis: Response obtained by instrument Sociodemographic Variables: Age, Sex, Education, person responsible for care, origin. Clinics: Treatment time, Disease causing chronic renal failure, Therapy modality: CAPD and DPA, Related to the occurrence of Peritonitis: Causal Germ, Number of episodes. Data collection technique You will use a data collection form, you will use SPSS 25 for analysis, preparation of tables and graphs. Statistical analysis methods You will apply descriptive statistics, frequency tables for sociodemographic data, and measures of central tendency.
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Healthy lifestyle and nutritional status in older adults with heart failure in outpatient consultation in a specialized institute - 2022
(Universidad Privada Norbert Wiener, 2022-10-16) Candioti Pacheco, Jhoanna Abigail; Montoro Valdivia, Marcos Antonio
The health problem related to heart failure has caused difficulties in the person by generating heart disease and hypertension causing an inadequate lifestyle, but this must be guided and controlled appropriately, through doctor's instructions referring changes in daily actions carried out. by caregivers or by family members who help patients with this diagnosis. Among these changes is organizing and improving nutrition, having physical activities for patients and consuming additives that help to constantly improve the assimilation of the disease, in order to achieve a quality of life in the patient, for this it is also The proper development of nutrition is essential to adapt and face your diagnosis with an adequate nutritional status.
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Hematological indicators and severity in patients with dengue treated at the II Tarapoto-EsSalud hospital, January to July 2023
(Universidad Privada Norbert Wiener, 2023-12-06) Rodríguez Palomino, Luisa Victoria; Avelino Callupe, Paul Fortunato
One of the major public health challenges of the 21st century is dengue, a vector-borne disease common worldwide. In 2020, America registered over 2.3 million dengue cases, the highest number in the region. In Peru, numerous cases of dengue have been reported across different regions since 1990, and Tarapoto is one of the endemic areas. Thus, it is important to study the characteristics of the virus for rapid diagnosis and avoid confusion with other diseases with similar symptoms, including leptospirosis and other prevalent infections in the region. Hematological indicators are useful for evaluating, diagnosing, and predicting dengue severity. Currently, vector eradication remains the only method for controlling the disease, and understanding these hematological indicators is crucial for early infection identification. The purpose of this study is to analyze the relationship between hematological indicators and dengue severity in patients at Hospital II Tarapoto-Essalud, from January to July 2023.
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Impact of mobbing on nursing staff
(Universidad Privada Norbert Wiener, 2019-08-18) Echevarria Mendivil, Magdalena Yurisa; Quiroz Luyo, Mónica Cecilia; Perez Siguas, Rosa Eva
Objective: Systematize the evidence of the impact of mobbing on Mental Health and Quality of Care in nursing staff. Material and methods: The Systematic Review is scientific research that has as its unit of analysis original studies that outline the effects of multiple scientific investigations. Of which 80% of the Systematic Review type and 20% of the descriptive, cross-sectional study type. Results: 10 scientific articles were reviewed, of which 100% (10/10) report that mobbing has an impact on the mental health of nursing staff: having professional results with low self-esteem, obsessive-compulsive disorders and a great emotional impact on severe cases suicide attempts. Somatization and physical health problems also present problems for the organization; 5 of the 10 articles indicate that the most sensitive age is under 30 years old and those over 45 years old, the areas where the highest number of cases were reported were in the hospitalization and emergency area. Conclusion: Of the 10 articles reviewed, 10 conclude that mobbing has a negative impact on mental health, especially in nursing professionals. Impact on Physical Health: Psychosomatic diseases, muscle tensions, gastrointestinal diseases; in the organization: decrease in the quality of care, resulting in problems in user safety.
Acceso abierto
Knowledge about intestinal parasitosis in mothers of children aged 3 to 5 years from an initial educational institution in Lima Este - 2019
(Universidad Privada Norbert Wiener, 2021-02-07) Paucar Mendoza, Edith; Cárdenas de Fernández, María Hilda
Aim. Determine the knowledge about intestinal parasitosis in mothers of children aged 3 to 5 years from an Initial Educational Institution in Lima Este -2019. Material and method. The study has a quantitative approach and a descriptive non-experimental design, the sample was made up of 72 mothers of children from 3 to 5 years old from the I.E.I. N°0041 El Bosquecito, the survey technique was used and the instrument was a questionnaire. Results. It was found that of 100% (72) of mothers, 53% (38) do not know and 47% (34) know about intestinal parasitosis. In the case of conceptual aspects; 69% (50) do not know and 31% (22) know; Regarding clinical manifestations, 61% (44) do not know and 39% (28) know; Regarding transmission routes, 65% (47) do not know and 35% (25) know and about prevention measures, 60% (43) do not know and 40% (29) know. Conclusions. The majority of mothers do not know about intestinal parasitosis, making healthy habits difficult for mothers to avoid intestinal parasitosis that would affect the growth and development of their children. In particular, most mothers do not know about conceptual aspects, limiting the recognition of a parasite and the different intestinal parasites that their children can contract; Also, the majority of mothers do not know about the clinical manifestations, making it difficult to early identify symptoms of a parasitic disease that would cause possible complications in the health of their children; Furthermore, the majority of mothers do not know about the transmission routes, making it difficult for mothers to avoid the spread of intestinal parasitosis; and finally, the majority of mothers do not know about preventive measures, limiting the acquisition and development of a culture of healthy behaviors in the person, family and community that would generate the appearance and/or increase in cases of intestinal parasitosis.