• Title/Summary/Keyword: four causes

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Clinical Characteristics and Adherence of Patients Who Were Prescribed Home Oxygen Therapy Due to Chronic Respiratory Failure in One University Hospital: Survey after National Health Insurance Coverage (한 대학병원에서 조사된 재택산소요법을 받고 있는 환자의 특성과 재택산소요법 처방에 대한 순응도: 건강보험급여전환 후 조사)

  • Koo, Ho-Seok;Song, Young Jin;Lee, Seung Heon;Lee, Young Min;Kim, Hyun Gook;Park, I-Nae;Jung, Hoon;Choi, Sang Bong;Lee, Sung-Soon;Hur, Jin-Won;Lee, Hyuk Pyo;Yum, Ho-Kee;Choi, Soo Jeon;Lee, Hyun-Kyung
    • Tuberculosis and Respiratory Diseases
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    • v.66 no.3
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    • pp.192-197
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    • 2009
  • Background: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. Methods: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. Results: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8${\pm}$7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4${\pm}$3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7${\pm}$4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). Conclusion: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.

Comparison of marginal fit before and after porcelain build-up of two kinds of CAD/CAM zirconia all-ceramic restorations (두 종류의 CAD/CAM 지르코니아 전부도재관의 도재 축성 전후의 변연적합도 비교)

  • Shin, Ho-Sik;Kim, Seok-Gyu
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.5
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    • pp.528-534
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    • 2008
  • Purpose: Marginal fit is one of the important components for the successful prosthodontic restoration. Poor fitting margin of the restoration causes hypersensitivity, secondary caries, and plaque accumulation, which later result in prosthodontic failure. CAD/CAM zirconia all-ceramic restorations, such as $LAVA^{(R)}$ (3M ESPE, St.Paul, MN) and $EVEREST^{(R)}$ (KaVo Dental GmbH, Biberach, Germany) systems were recently introduced in Korea. It is clinically meaningful to evaluate the changes of the marginal fit of the CAD/CAM zirconia systems before and after build-up. The purposes of this study are to compare the marginal fit of the two CAD/CAM all-ceramic systems with that of the ceramometal restoration, before and after porcelain build-up Material and methods: A maxillary first premolar dentiform tooth was prepared with 2.0 mm occlusal reduction, 1.0 mm axial reduction, chamfer margin, and 6 degree taperness in the axial wall. The prepared dentiform die was duplicated into the metal abutment die. The metal die was placed in the dental study model, and the full arch impressions of the model were made. Twenty four copings of 3 groups which were $LAVA^{(R)}$, $EVEREST^{(R)}$, and ceramometal restorations were fabricated. Each coping was cemented on the metal die with color-mixed Fit-checker $II^{(R)}$ (GC Cor., Tokyo, Japan). The marginal opening of each coping was measured with $Microhiscope^{(R)}$ system (HIROX KH-1000 ING-Plus, Seoul, Korea. X300 magnification). After porcelain build-up, the marginal openings of $LAVA^{(R)}$, $EVEREST^{(R)}$,and ceramometal restorations were also evaluated in the same method. Statistical analysis was done with paired t-test and one-way ANOVA test. Results: In coping states, the mean marginal opening for $EVEREST^{(R)}$ restorations was $52.00{\pm}11.94\;{\mu}m$ for $LAVA^{(R)}$ restorations $56.97{\pm}10.00\;{\mu}m$, and for ceramometal restorations $97.38{\pm}18.54\;{\mu}m$. After porcelain build-up, the mean marginal opening for $EVEREST^{(R)}$ restorations was $61.69{\pm}19.33\;{\mu}m$, for $LAVA^{(R)}$ restorations $70.81{\pm}12.99\;{\mu}m$, and for ceramometal restorations $1115.25{\pm}23.86\;{\mu}m$. Conclusion: 1. $LAVA^{(R)}$ and $EVEREST^{(R)}$ restorations in comparison with ceramometal restorations showed better marginal fit, which had significant differences (P < 0.05) in coping state and also after porcelain build-up . 2. The mean marginal opening values between $LAVA^{(R)}$ and $EVEREST^{(R)}$ restorations did not showed significant differences after porcelain build-up as well as in coping state (P > .05). 3. $EVEREST^{(R)}$, $LAVA^{(R)}$ and ceramometal restorations showed a little increased marginal opening after porcelain build-up, but did not show any statistical significance (P > .05).

Early Result of Surgical Management of the Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (관상동맥-폐동맥 이상 기시증에 대한 수술의 조기 결과)

  • Yoon Yoo Sang;Park Jeong Jun;Yun Tae Jin;Kim Young Hwue;Ko Jae Kon;Park In Sook;Seo Dong Man
    • Journal of Chest Surgery
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    • v.39 no.1 s.258
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    • pp.18-27
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    • 2006
  • Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly, but is one of the most common causes of myocardial ischemia which would result in high mortality within the first year of life. This is our early result of the surgical management for these patients. Material and Method: From June 1989 to July 2003, 6 patients with ALCAPA and one patient with ARCAPA (Anomalous origin of the Right coronary artery from the pulmonary artery) underwent surgical repair. We have reviewed the all medical records, electrocardiogram, chest X-ray and echocardiography retrospectively. Result: Three of the patients were boys and four were girls. The median age at the operation was 5.4 months (Range: 3$\∼$33 months). The average body weight of at the operation was 6.7 kg (Range: 3.7$\∼$11.3 kg). A mean follow up period was 18 months. Only 3 patients were initially diagnosed as ALCAPA. And 3 patients had moderate mitral regurgitation. Immediate coronary artery reimplantation on diagnosis with the aim of restoring a two-coronary system circulation was done. The average bypass time was 114$\pm$37 minutes, and the average aortic cross clamping time was 55$\pm$22 minutes. The average stay of intensive care unit was 5$\pm$3 days, the mean mechanical ventilator time was 38$\pm$45 hours and the hospital stay after operation was 12$\pm$5 days. There were significant improvements in electrocardiogram and chest X-ray of the all patients except one late death patient. The ventricular function showed almost normal recovery after operation; the EF (Ejection Fraction) increased from 41.2$\pm$ 10.3$\%$ to 60.5$\pm$ 15.8$\%$ within 1 month and to 59.8$\pm$13.9$\%$ within 1 year after operation, the SF (Shortening Fraction) increased from 23.6$\pm$4.7$\%$ to 38.6$\pm$8.4$\%$ within 1 month and to 37.4$\pm$7.9$\%$ within 1 year after operation, LVEDDI (Left Ventricular End-diastolic Dimension Index) decreased from 100.8$\pm$25.6 mm/$m^{2}$ to 90.3$\pm$ 19.2 mm/$m^{2}$ within f month and to 79.3$\pm$ 15.8 mm/$m^{2}$ within 1 year after operation. Concomitant mitral repair was done in two patients with anterior mitral leaflet prolapse. In every patient, mitral valve showed less than mild regurgitation during follow up. One late death occurred in which patient Dor procedure was applied 10 months after initial operation due to the dilated cardiomyopathy Conclusion: In the management of this rare and could be fatal Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), early suspicion and correct diagnosis is of most important. But, after diagnosis, immediate restoration of 2 coronary systems could result in good outcome.

Community Distribution on Mountain Forest Vegetation of the Gyebangsan Area in the Odaesan National Park, Korea (오대산 국립공원 계방산 일대 삼림식생의 군락분포에 관한 연구)

  • Kim, Chang-Hwan;Oh, Jang-Geun;Kang, Eun-Ok;Yun, Chil-Sun;Lim, Jin-Keun
    • Korean Journal of Ecology and Environment
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    • v.47 no.3
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    • pp.135-145
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    • 2014
  • The mountain forest vegetation of Gyebangsan (1,577 m) in Odaesan National Park is classified into deciduous broad-leaved forest, mountain valley forest, coniferous forest, subalpine coniferous forest, subalpine deciduous forest, plantation forest, and other vegetation which includes Actinidia argute community and agricultural land. As for the number of communities distributed in the each forest vegetation which were categorized by the physiognomy classification, deciduous broad-leaved forest had 33 communities, mountain valley forest 41 communities, coniferous forest 8 communities, subalpine coniferous forest 4 communities, subalpine deciduous forest 2 communities, plantation forest 6 communities and other vegetation 4 communities. Regarding the distribution rate of communities in the vegetation, in the deciduous broad-leaved forest. Quercus mongolica community accounted for 80.226% with $30,909,942.967m^2$, followed by Quercus variabilis community of 2.771% with $1,067,479.335m^2$. 55.463% of deciduous broad-leaved forest in the Gyebangsan had Quercus mongolica as a dominant or second dominant species. In the mountain valley forest, Fraxinus rhynchophylla - Juglans mandshurica community accounted for 10.955%. And there were ten mixed communities having Fraxinus rhynchophylla and upper layer at a similar level of coverage, taking up 32.776%. In the coniferous forest, Pinus densiflora and the community living with Pinus densiflora accounted for 100%, showing that the coniferous forest has the community with Pinus densiflora as a dominant species at upper layer. For other vegetation, subalpine coniferous forest had a total of four communities including Abies holophylla - Quercus mongolica community, and accounted for 4.980% of vegetation area of Odaesan National Park. Two communities including Betula ermani - Cornus controversa community were found in the subalpine deciduous forest, taking up 0.006% of total vegetation area of Odaesan National Park. Regarding plantation forest, Larix leptolepis was planted the most with 51.652%, followed by Betula platyphylla var. japonica with 38.975%, and Pinus koraiensis with 7.969%. These three species combined accounted for 98.565%. In conclusion, the forest vegetation found in the Gyebangsan of Odaesan National Park has Quercus mongolica as a dominant species at the top layer. A lot of other communities related with this species are expected to be quickly replaced due to vegetation succession and climatic causes. Therefore, Quercus mongolica is expected to become the main species in the deciduous broad-leaved forest, Fraxinus rhynchophylla, Juglans mandshurica and Fraxinus mandshurica in the mountain valley forest. Around the border line between deciduous broad-leaved forest and mountain valley forest, highly humid valley area is expected to be quickly taken up by Cornus controversa and Fraxinus mandshurica, and the slope area by Quercus mongolica. However, in the subalpine coniferous forest, the distribution rate of deciduous broad-leaved trees is expected to increase due to climate warming.

Clinical Manifestations of the Lung Involvement in Behçet's Syndrome (Behçet 증후군에서 폐침범의 임상양상에 관한 고찰)

  • Park, Kwang Joo;Park, Seung Ho;Kim, Sang Jin;Kim, Hyung Jung;Chang, Joon;Ahn, Chul Min;Kim, Sung Kyu;Lee, Won Young
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.5
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    • pp.763-773
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    • 1996
  • Background : Behçet's syndrome is a chronic multisystemic disease affecting many organs such as skin, mucosa, eye, joint, central nervous system and blood vessels. Lung involvement occurs in 5% of Behçet's syndrome and is thought to be due to the pulmonary vasculitis leading to thromboembolism, aneurysm and arteriobronchial fistula. Pulmonary vasculitis in Behçet's syndrome is a unique clinical feature, differing from other vasculitis affecting the lung and is one of the major causes of death. Therefore, we examined the incidence, the clinical features, the radioloic findings and the clinical courses of the lung involvement in Behçet's syndrome. Methods: We retrospectively reviewed the medical records and radiologic studies of 10 cases of the lung involvement in Behçet's syndrome diagnosed at Yongdong Severance Hospital and Severance Hospital from 1986 to 1995. We analysed the clinical features, the radiological findings, the treatment modalities and the clinical courses. Results: 1) The incidence of the lung involvement in Behçet's syndrome was 2%(10/487). The male to female ratio was 8 : 2 and the mean age was 34 years. The presenting symptom was hemoptysis in 5 of 10 cases, and massive hemoptysis was noted in 2 cases. Other pulmonary symptoms were cough(6/10), dyspnea(4/10), and chest pain(2/10). Other manifestations were oral ulcers(10/10), genital ulcers(9/10), skin lesions(7/10), and eye lesions(6/10). 2) The laboratory findings were nonspecific. The posteroanterior views of chest radiographies showed multiple infiltrates(6/10), nodular or mass-like opacities(4/10), or normal findings(2/10). The chest CT scans showed multifocal consolidations(6/8), and aneurysms of the pulmonary aneries(4/8). The pulmonary angiographies were performed in 3 cases, and showed pulmonary artery aneurysms in 2 cases. The ventilation-perfusion scans in 2 cases of normal chest x-ray showed multiple mismatched findings. 3) The patients were treated with combination therapy consisting of corticosteroids, cyclophosphamide, and colchicine or anticoagulant agents. Surgical resection was performed in one case with a huge aneurysm. 4) We have followed up nine of ten cases. Three cases are well-being with medical therapy, two cases are severely disabled now and four cases died due to massive hemoptysis, massive pulmonary embolism, or sepsis. Conclusion : Pulmonary vasculitis is a main feature of the lung involvement of Behçet's syndrome, causing hemorrhage, aneurysmal formation, and/or thromboemboism. The lung involvement of Behçet's syndrome is uncommon but is one of the most serious prognostic factors of the disease. Therefore, an aggressive diagnostic work-up for early detection and proper treatment are recommended to improve the clinical course and the survival.

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The Usefulness of Noninvasive Positive Pressure Ventilation in Patients With Acute Respiratory Failure after Extubation (기관내 관 제거 후 발생한 급성 호흡부전에서 비침습적 양압 환기법의 유용성)

  • Na, Joo-Ock;Lim, Chae-Man;Shim, Tae-Sun;Park, Joo-Hun;Lee, Ki-Man;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Koh, Youn-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.3
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    • pp.350-362
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    • 1999
  • Background: Acute Respiratory failure which is developed after extubation in the weaning process from mechanical ventilation is an important cause of weaning failure. Once it was developed, endotracheal reintubation has been done for respiratory support. Noninvasive Positive Pressure Ventilation (NIPPV) has been used in the management of acute or chronic respiratory failure, as an alternative to endotracheal intubation, using via nasal or facial mask. In this study, we evaluated the usefulness of NIPPV as an alternative method of reintubation in patients who developed acute respiratory failure after extubation. Method: We retrospectively analyzed thirty one patients(eighteen males and thirteen females, mean ages $63\pm13.2$ years) who were developed acute respiratory failure within forty eight hours after extubation, or were extubated unintentionally at medical intensive care unit(MICU) of Asan Medical Center. NIPPV was applied to the patients. Ventilatory mode of NIPPV, level of ventilatory support and inspiratory oxygen concentration were adjusted according to the patient condition and results of blood gas analysis by the attending doctors at MICU. NIPPV was completely weaned when the patients maintained stable clinical condition under 8 $cmH_2O$ of pressure support level. Weaning success was defined as maintenance of stable spontaneous breathing more than forty eight hours after discontinuation of NIPPV. Respiratory rate, heart rate, arterial blood gas analysis, level of pressure support, and level of PEEP were monitored just before extubation, at thirty minutes, six hours, twenty four hours after initiation of NIPPV. They were also measured at just before weaning from NIPPV in success group, and just before reintubation in failure group. Results: NIPPV was successfully applied to thirty-one patients of thirty-two trials and one patient could not tolerated NIPPV longer than thirty minutes. Endotracheal reintubation was successfully obviated in fourteen patients (45%) among them. There was no difference in age, sex, APACHE III score on admission at MICU, duration of intubation, interval from extubation to initiation of NIPPV, baseline heart rate, respiratory rate, arterial blood gas, and $PaO_2/FiO_2$ between the success and the failure group. Heart rate and respiration rate were significantly decreased with increase $SaO_2$ after thirty minutes of NIPPV in both groups(p<0.05). However, in the patients of failure group, heart rate and respiratory rate were increased again with decrease in $SaO_2$ leading to endotracheal reintubation. The success rate of NIPPV treatment was significantly higher in the patients with COPD compared to other diseases(62% vs 39%) (p=0.007). The causes of failure were deterioration of arterial blood gas without aggravation of underlying disease(n=9), aggravation of undelying disease(n=5), mask intolerance(n=2), and retained airway secretion(n=l). Conclusion: NIPPV would be a useful therapeutic alternative which can avoid reintubation in patient who developed acute respiratory failure after extubation.

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The Study of Korean-style Leadership (The Great Cause?Oriented and Confidence-Oriented Leadership) (대의와 신뢰 중시의 한국형 리더십 연구)

  • Park, sang ree
    • The Journal of Korean Philosophical History
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    • no.23
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    • pp.99-128
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    • 2008
  • This research analyzes some Korean historical figures and presents the core values of their leaderships so that we can bring up the theory of leadership which would be compatible with the current circumstances around Korea. Through this work, we expected that we would not only find out typical examples among historical leaders but also reaffirm our identities in our history. As a result of the research, it was possible to classify some figures in history into several patterns and discover their archetypal qualities. Those qualities were 'transform(實事)', 'challenge(決死)', 'energize(風流)', 'create(創案)', and 'envision(開新)' respectively. Among the qualities, this research concentrated on the quality of 'challenge', exclusively 'death-defying spirit'. This spirit is the one with which historical leaders could sacrifice their lives for their great causes. This research selected twelve figures as incarnations of death-defying spirit, who are Gyebaek(階伯), Ganggamchan(姜邯贊), Euljimundeok(乙支文德), Choeyoung(崔瑩),ChungMongju(鄭夢周), Seongsammun (成三問), Yisunsin(李舜臣), Gwakjaewoo(郭再祐), Choeikhyeon(崔益鉉), Anjunggeun(安重根), Yunbonggil(尹奉吉), Yijun(李儁). Through analyzing their core values and abilities and categorizing some historical cases into four spheres such as a private sphere, relations sphere, a community sphere, and a society sphere, we came to find a certain element in common among those figures. It was that they eventually took the lead by showing the goal and the ideal to their people at all times. Moreover, their goals were always not only obvious but also unwavering. In the second chapter, I described the core value in a private sphere, so called '志靑靑'. It implies that a leader should set his ultimate goal and then try to attain it with an unyielding will. Obvious self-confidence and unfailing self-creed are core values in a private sphere. In the third chapter, I described the core value in a relative sphere, the relationship between one and others. It is '守信結義'. It indicates that a leader should win confidence from others by discharging his duties in the relation with others. Confidence is the highest leveled affection to others. Thus, mutual reliance should be based on truthful sincerity and affection toward others. Stubbornness and strictness are needed not to be prompted by pity simultaneously. In the fourth chapter, I described the core value in a community sphere. It is '丹心合力'. For this value, what are required to a leader are both his community spirit and his loyalty to one's community. Moreover, the strong sense of responsibility and the attitude of taking an initiative among others are also required. Thus, it can be said that the great power to conduct the community is so called fine teamwork. What's more, the attitude of the leader can exert a great influence on his community. In the fifth chapter, I described the core value of death defying spirit in the society sphere. This value might be more definite and explicit than other ones described above. A leader should prepare willingly for one's death to fulfill his great duties. 'What to do' is more important for a leader than 'how to do'. That is to say, a leader should always do righteous things. Efficiency is nothing but one of his interests. A leader must be the one who behaves himself always according to righteousness. Unless a leader's behaviors are based on righteousness, it is absolutely impossible that a leader exerts his leadership toward people very efficiently. Thus, it can be said that a true leader is the one not only who is of morality and but also who tries to fulfill his duties.

Development of a complex failure prediction system using Hierarchical Attention Network (Hierarchical Attention Network를 이용한 복합 장애 발생 예측 시스템 개발)

  • Park, Youngchan;An, Sangjun;Kim, Mintae;Kim, Wooju
    • Journal of Intelligence and Information Systems
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    • v.26 no.4
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    • pp.127-148
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    • 2020
  • The data center is a physical environment facility for accommodating computer systems and related components, and is an essential foundation technology for next-generation core industries such as big data, smart factories, wearables, and smart homes. In particular, with the growth of cloud computing, the proportional expansion of the data center infrastructure is inevitable. Monitoring the health of these data center facilities is a way to maintain and manage the system and prevent failure. If a failure occurs in some elements of the facility, it may affect not only the relevant equipment but also other connected equipment, and may cause enormous damage. In particular, IT facilities are irregular due to interdependence and it is difficult to know the cause. In the previous study predicting failure in data center, failure was predicted by looking at a single server as a single state without assuming that the devices were mixed. Therefore, in this study, data center failures were classified into failures occurring inside the server (Outage A) and failures occurring outside the server (Outage B), and focused on analyzing complex failures occurring within the server. Server external failures include power, cooling, user errors, etc. Since such failures can be prevented in the early stages of data center facility construction, various solutions are being developed. On the other hand, the cause of the failure occurring in the server is difficult to determine, and adequate prevention has not yet been achieved. In particular, this is the reason why server failures do not occur singularly, cause other server failures, or receive something that causes failures from other servers. In other words, while the existing studies assumed that it was a single server that did not affect the servers and analyzed the failure, in this study, the failure occurred on the assumption that it had an effect between servers. In order to define the complex failure situation in the data center, failure history data for each equipment existing in the data center was used. There are four major failures considered in this study: Network Node Down, Server Down, Windows Activation Services Down, and Database Management System Service Down. The failures that occur for each device are sorted in chronological order, and when a failure occurs in a specific equipment, if a failure occurs in a specific equipment within 5 minutes from the time of occurrence, it is defined that the failure occurs simultaneously. After configuring the sequence for the devices that have failed at the same time, 5 devices that frequently occur simultaneously within the configured sequence were selected, and the case where the selected devices failed at the same time was confirmed through visualization. Since the server resource information collected for failure analysis is in units of time series and has flow, we used Long Short-term Memory (LSTM), a deep learning algorithm that can predict the next state through the previous state. In addition, unlike a single server, the Hierarchical Attention Network deep learning model structure was used in consideration of the fact that the level of multiple failures for each server is different. This algorithm is a method of increasing the prediction accuracy by giving weight to the server as the impact on the failure increases. The study began with defining the type of failure and selecting the analysis target. In the first experiment, the same collected data was assumed as a single server state and a multiple server state, and compared and analyzed. The second experiment improved the prediction accuracy in the case of a complex server by optimizing each server threshold. In the first experiment, which assumed each of a single server and multiple servers, in the case of a single server, it was predicted that three of the five servers did not have a failure even though the actual failure occurred. However, assuming multiple servers, all five servers were predicted to have failed. As a result of the experiment, the hypothesis that there is an effect between servers is proven. As a result of this study, it was confirmed that the prediction performance was superior when the multiple servers were assumed than when the single server was assumed. In particular, applying the Hierarchical Attention Network algorithm, assuming that the effects of each server will be different, played a role in improving the analysis effect. In addition, by applying a different threshold for each server, the prediction accuracy could be improved. This study showed that failures that are difficult to determine the cause can be predicted through historical data, and a model that can predict failures occurring in servers in data centers is presented. It is expected that the occurrence of disability can be prevented in advance using the results of this study.