Falls can kill



We all love the saying, "I've fallen and I can't get up" but do we understand what falling means to a person. 





According to Dr. Sutton:

• Falls are the leading cause of injury in older adults and this can lead to more that 250,000 hip fractures A YEAR!  These fractures result in a 35% mortality rate within the FIRST YEAR of injury.
• 40% of the American population over the age of 62 will experience a fall.  50% of senior citizens fall within the first year of injury.
• 50% of older Americans that are hospitalized for fall-related injuries are discharged to NURSING HOMES.

I don't know about you but this is scary.  We hear about all these diseases; cancer, heart conditions, stroke, etc. that hurt us but falling? 

What Causes Dizziness & Loss of Balance? (Vestibular Disorders)
According to Dr. Sutton:

In most cases, balance problems originate within three systems integrated by the brain: the inner ears; eyes; and our muscles, joints and nerves. The brain processes this information and directs instructions back to our bodies enabling us to walk, turn, and bend easily. If one, or any combination, of these systems develops a problem, then dizziness or a loss of balance will usually occur. Even a sense of being unsteady is a sign that a balance evaluation is needed.
prevent deadly falls

What Can Be Done to Help? (Vestibular Therapy)
In a safe, controlled setting, our clinic will use the latest technology to test your balance and mobility skills. The test is simple, totally painless and non-invasive. If the results reveal a problem, I will personally discuss the findings with you and how we may be able to help you. If you do have a problem that we can help with and you choose to participate in our treatment program, then we will design a training program customized to meet each patient's individual needs.

So....what can you do?  You can take preventative measures!!  Call Premier Back Rehabilitation Center to schedule a Balance evaluation.  They use the latest techniques and tests.

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Ways to feel better; Part 1

How does a person feel better about themselves?

I love the saying "Don't let negative rent space in your head."

With that being said one way to feel better about yourself is to let the negative go.  When we hold negative things in more than just our psychological self suffers or health suffers also.  One thing I like to do is every morning think about something positive.  If you remind yourself before your day starts that there are positive things in your life you will begin the day better.  

When something bad happens....I know it's a cliche but take a few deep breaths.  A positive nothing is better than a negative anything so breathe.  Once you have a chance to breath, and not react, you have a chance to think about the situation.  Now you have three choices:  If you can change it, than change it.  If you can fix it, than fix it.  If you can't do either let it go...don't let it rent space in your head.  I know it's easier said than done but once you practice this it does get better. 

When you forget something, you break something, you don't do something.....let it go.  That second, that minute will never come back to you...all you do is use up future seconds, minutes hours and days worrying about what you cannot change.

Always move forward.  If you get off course than detour back to where you need to be.  It's like a diet....you may slip and have a candy bar but if you get back on track than it was a pleasant detour on your diet.  If you continue down the same road and eat more candy bars than you will get lost.  

Life has a way of getting in the way of our plans.  We get an extra $200.00 bonus out of the blue and our transmission goes out in the car.  We get a day off and plan on enjoying it by reading and doing some light laundry and the kitchen floods and you spend the day cleaning the mess up and fixing the leak.  It happens.  Accept what life throws at you and move on.  

Negative is part of a battery, not an attitude.  Love life, embrace it's imperfections and move forward because what you left behind will only haunt you if you let it.

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Joke of the day: Why we are so tired

WHY WE ARE SO TIRED?

For a couple years I've been blaming it on iron deficient blood, lack of vitamins, dieting and a dozen other maladies. I'm overworked that's the real reason I'm so tired. And I have just worked out why!

• The population of this country is 257 million.
• Of these 103 million are retired!
• That leaves 154 million to do the work.
• Of these 21 million are unemployed.  
• That leaves 133 million to do the work.
• Then there are 84 million in school!
• That leaves 49 million to do the work.
• Of this there are 30 million employed by the federal government.
• That leaves 19 million to do the work.
• Then there are a total the 14,800,000 people who work for State and City Government!
• That leaves 200,000 to do the work.
• There are 188,000 ill and in hospitals!
• That leaves 12,000 to do the work.
• Then there are 11,998 people in Prisons.
• That leaves just 2 people to do the work.

Joke:  provided by makemelaugh.com

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Dangers of Energy Drinks

It's 2:00 PM and you look at the clock......Three more hours to go until quitting time. But wait, you still have to stop at the grocery store, go by and pick up your dry cleaning and get home in time to make dinner, clean the mess up and get to your child's recital by 7:00 PM.

2:30 PM at your local convenience store gulping down an energy drink.

How is anyone supposed to do this without any help?

Energy..it seems that when you need the most you have the least so we do the easiest route and buy it, from a can, because it says "energy" on it.  

What we don't realize is the high-caffeinated drinks can lead to dehydration if you mix it with exercise, according to Dee Rollins, RD., Ph.D of the Baylor Regional Medical Center.  

"Effects of Caffeine When Exercising:  Caffeine stimulates urine production, which removes water from the body. If you are already losing water in sweat, losing more in the urine means needing to drink more during exercise."  (http://walking.about.com/od/fluids/a/caffeineenergy.htm)

Avoiding dehydration is simple.  Drink more water!  Need more energy....well that is simple also:  Vitamin B12 shots.

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How to make back to school run smoother

Remember when you thought, "I can't wait until the kids go back to school?"

Did you think it would take so much energy from you for the family to get back into a "normal" routine?



WOW!  The first month of school is tough.  Bedtimes, alarm clocks, homework, lunches, buses, etc.  It can be difficult in the beginning.  The first day seems to go off pretty easy...the kids don't want to go back to school but they are excited about the first day.  After that it's like Christmas morning....Couldn't wait to open the presents only to find.....clothes.

If it was "just school" it may be easier for parents to adjust....but it's not.  It's after school activities such as sports, choir, etc.  How did you do it last year?  It seemed so simple.

Here are some steps to hopefully make it easier for you:

1. Get a calendar!  I know it's difficult but if you take an hour and write everything down on the calendar your life will be easier on those days.  This is also a great activity to do with your children at night.  Bring the calendar out and ask them if anything needs to be added.  After you have added the new activities look to the next week and start planning for those activities.  Make lists for your child(ren) of the tasks they need to do to make the next week run smoothly.  Example:  If there is an activity that you can't get away from work to transport your child than on the list would be for your child to ask their friends if they could "bum a ride."
2. Down Time:  Until the "excitement" of going back to school stops you need down time in the evening...not only for them but for you.  A half hour before (the earliest) bedtime needs to be quiet time.  Avoid anything that would stimulate their minds....this could be loud music, Monday night football, etc.  This is a great time to start bath time....sorry teenagers:  shower time.  You need this as much as they need this!!!
3. Set the alarm clock a half hour earlier than the time the child(ren) need to wake up.  This will give you some much needed peace and quiet before the day begins.  Grab a cup of coffee and go sit outside and relax.
4. Speak in calm tones.  I know this is difficult when one of your children keeps hitting the snooze button and is going to be late but how you start your day will be how your day goes.  Simply whisper in their ear, "time to get up or time to lose your........... you choose."  Every child has something that is not worth losing for five more minutes of sleep.  Very important to follow through if they don't get up!!
5. Allow them 30 minutes of "unwinding" after school.  I grew up in a single parent home so my mother was always working when I got home from school.  I walked in the door and knew I had 1 1/2 hours till she got home.  Homework was much easier to do after I didn't do anything for awhile.  If your child(ren) are in sports and they don't get home until dinner time....still give them time to unwind.  Homework is easier to tackle and complete if they don't have the day's events running through their head.

For your children to be healthy YOU MUST BE HEALTHY!!!  Children learn what they live.  Take care of yourself, remain calm, be organized (but still allow for some spontaneity) and the first weeks back to school will be great.

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Little things to improve your health....DRINK WATER

Water....your body weight is made up of 60% water.  Water is essential to your health because it
"flushes toxins out of vital organs, carries nutrients to your cells and provides a moist environment for ear, nose and throat tissues."  (Mayo Clinic)



8 X 8 has been around for many years.  This is eight ounces of water eight times a day.  Easy enough to remember, right?  Yes, it is easy to remember but it's not enough. 

"The Institute of Medicine determined that an adequate intake (AI) for men is roughly 3 liters (about 13 cups) of total beverages a day. The AI for women is 2.2 liters (about 9 cups) of total beverages a day. "  (Mayo Clinic)

But how much should YOU drink?  The above suggestions are a great starting point. Here is a calculator that can help you as an individual determine exactly how much water YOU should drink per day.

Did you know that when you are thirsty...you are ALREADY dehydrated?  When you are thirsty that is your body's final attempt to tell you it needs fluids. 

The Signs and Symptoms of Dehydration (according to Symptoms of Dehydration)

Symptoms of dehydration usually begin with thirst and progress to more alarming manifestations as the need for water becomes more dire. The initial signs and symptoms of mild dehydration in adults appear when the body has lost about 2% of it's total fluid. These mild dehydration symptoms are often (but not limited to):

Thirst
Loss of Appetite
Dry Skin
Skin Flushing
Dark Colored Urine
Dry Mouth
fatigue or Weakness
Chills
Head Rushes

If the dehydration is allowed to continue unabated, when the total fluid loss reaches 5% the following effects of dehydration are normally experienced:

Increased heart rate
Increased respiration
Decreased sweating
Decreased urination
Increased body temperature
Extreme fatigue
Muscle cramps
Headaches
Nausea
Tingling of the limbs

Do yourself a favor:  Go get a glass of water.  Do your body a favor:  Keep drinking water.

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Little things to keep you healthy: Don't drink your Calories

Don't let Liquid Calories do this to you

Ya, ya, ya....we hear this all the time.  To lose weight or not to gain weight don't drink your Calories. 

Let's focus on the obvious first:  Weight gain.  Being overweight will harm your health in many aspects:  Bones, joints, heart...just to name a few. 

The consumption of sugar-sweetened beverages has been linked to rising rates of obesity in the United States. The standard explanation is that energy-containing liquids are less satiating than are solid foods. However, purely physiologic mechanisms do not fully account for the proposed links between liquid sugar energy and body weight change.  (American Journal of Clinical Nutrition)

We just don't realize how many calories come from what you drink.....unless you pay attention.  Sugars in liquid form are absorbed rapidly into our bodies.  When this happens:  Newton said it best:  For every action there is an equal and opposite reaction, your body will react in many ways including: weight gain, diabetes, heart disease and some research says; even cancer. 

"A nine-year study followed older adults who drank diet soda daily. The results showed a 48 percent higher risk of stroke, heart attack and death, even after adjusting for other risk factors. Arguably, this study hasn't been published in a peer-review journal and may have other confounding factors. However, as a nutritionist who has observed patterns of America's intake of artificial sweeteners, I've seen their long-term effects firsthand. Research on these sugar substitutes connects diet soda consumption to metabolic syndrome, chronic kidney disease, and Type 2 Diabetes."  (Carrie Wiatt, M.S., Diabetic Connect)

We all know that weight gain can lead to heart disease and high sugar intake can lead to Diabetes.  The question is this:  Is your health worth replacing your high sugar liquid calories with water?  I am lucky I never got "addicted" to soda but I have friends who are.  Take it one day at a time:  Let's face it.....water has been, will always be the best choice to drink.  To begin with replace one soda, energy drink, etc. with water for one week and I bet you won't even notice losing that sugary drink.  Keep going and each week replace another.  By the time you have replaced all sugary drinks with water I bet you won't even miss them. 

Don't get your energy from liquid calories.  Vitamin B12 shots work so much better and are so much healthier for you!!

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Little things people do that harm your health...not sleeping

Why is it that we, as humans, KNOW we need to get sleep to be healthy...yet we don't. 




Ever watch a cat or dog stay up for hours when they are tired?  No.  They sleep when they need to sleep.  This is a great video if you need to learn how to sleep.

According to WebMD there are 10 things YOU should HATE about "lack of sleep."

1. Accidents.  We all know what can happen when you are driving and fall asleep...people die.  Maybe what you didn't know was "sleep deprivation was a factor in some of the biggest disasters in recent history: the 1979 nuclear accident at Three Mile Island, the massive Exxon Valdez oil spill, the 1986 nuclear meltdown at Chernobyl, and others."
2. Lack of sleep "dumbs you down."  (WebMD's words not mine):  Sleep helps you think so lack of sleep; "First, it impairs attention, alertness, concentration, reasoning, and problem solving. This makes it more difficult to learn efficiently.Second, during the night, various sleep cycles play a role in“consolidating” memories in the mind. If you don’t get enough sleep, you won’t be able to remember what you learned and experienced during the day."
3. Causes serious health issues: "Sleep disorders and chronic sleep loss can put you at risk for:
   Heart disease
   Heart attack
   Heart failure
   Irregular heartbeat
   High blood pressure
   Stroke
   Diabetes
   According to some estimates, 90% of people with insomnia -- a sleep disorder characterized by trouble falling and staying asleep -- also have another health condition."
4. No sleep, no sex drive:  "Sleep specialists say that sleep-deprived men and women report lower libidos and less interest in sex. Depleted energy, sleepiness, and increased tension may be largely to blame."
5. Depression:  "Insomnia and depression feed on each other. Sleep loss often aggravates the symptoms of depression, and depression can make it more difficult to fall asleep. On the positive side, treating sleep problems can help depression and its symptoms, and vice versa."
6. Ages your skin:  "When you don’t get enough sleep, your body releases more of the stress hormone cortisol. In excess amounts, cortisol can break down skin collagen, the protein that keeps skin smooth and elastic."
7. Where did I put my.......?  Forgetfulness:  "In 2009, American and French researchers determined that brain events called“sharp wave ripples” are responsible for consolidating memory. The ripples also transfer learned information from the hippocampus to the neocortex of the brain, where long-term memories are stored. Sharp wave ripples occur mostly during the deepest levels of sleep."
8. Weight Gain:  "According to a 2004 study, people who sleep less than six hours a day were almost 30 percent more likely to become obese than those who slept seven to nine hours.  Recent research has focused on the link between sleep and the peptides that regulate appetite. 'Ghrelin stimulates hunger and leptin signals satiety to the brain and suppresses appetite,' says Siebern. Shortened sleep time is associated with decreases in leptin and elevations in ghrelin.”
9. May increase death:  "In the “Whitehall II Study,” British researchers looked at how sleep patterns affected the mortality of more than 10,000 British civil servants over two decades. The results, published in 2007, showed that those who had cut their sleep from seven to five hours or fewer a night nearly doubled their risk of death from all causes. In particular, lack of sleep doubled the risk of death from cardiovascular disease."
10. Impairs Judgement:  "Sleep-deprived people seem to be especially prone to poor judgment when it comes to assessing what lack of sleep is doing to them. In our increasingly fast-paced world, functioning on less sleep has become a kind of badge of honor. But sleep specialists say if you think you’re doing fine on less sleep, you’re probably wrong. And if you work in a profession where it’s important to be able to judge your level of functioning, this can be a big problem."

This is just an overview on what the affects of "lack of sleep" can cause.  To read in more detail visit WebMD.

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Things that harm your health....staying inside

Skin Cancer is the biggest fear that most have when you are told to get outside....but did you know that avoiding the sun has higher health risks than getting moderate sun exposure while using precautions such as sunscreen?  A good way to view sunlight is the same as we view most everything...in moderation. 

According and copied (they say it so well) from Natural Heath Restored:

 

 

 

So, what are the benefits of sunlight? Check out this long list!

• One of the major benefits of sunlight is that it helps fruits, vegetables, and grains to grow and be healthy. It also helps animals and us humans to grow and develop as well.
• A definite plus of sunshine is that it gives you a healthy looking complexion. It will make your skin smooth with an irresistible healthy glow.
• If you get regular exposure to sunlight, it will help protect your skin in the long run. That is because your body will build up a natural resistance to the harmful effects of ultraviolet light.
• If you allow your skin to get moderately tanned, it will be more resistant to infections and sunburns than if your skin is not tanned.
• The ultraviolet rays in sunshine act as a natural antiseptic. These rays can kill viruses, bacteria, molds, yeasts, fungi, and mites in air, water, and on different surfaces including your skin.
• Getting some sun tends to help clear up different skin diseases such as acne, boils, athletes foot, diaper rash, psoriasis, and eczema.
• Another of the main benefits of sunlight is that it stimulates your appetite and improves your digestion, elimination, and metabolism.
• Getting your daily dose of sunshine will enhance your immune system. It increases the number of white blood cells in your blood. It also helps them to be better fighters in their mission to destroy germs.
• Sunshine encourages healthy circulation. It also stimulates the production of more red blood cells which increases the amount of oxygen in your blood.
• Sunlight is one of the most effective healing agents that exists.
• Feeling down? One of the major benefits of sunlight is that it will soothe your nerves and boost your mood leaving you with a renewed sense of well-being. Sunlight increases the production of endorphins and serotonin in your brain which will definitely leave you feeling much better.
• Getting enough sunlight during the day can help you sleep better at night. If you are exposed to natural light during the day, it will increase your melatonin output at night. Melatonin is a natural hormone made by our bodies. It enhances sleep and slows down the aging process.
• The healing properties of the sun are excellent for people who are suffering from various diseases and ailments.
• Sunlight helps to balance out your hormones. It may even help to relieve certain symptoms of PMS.
• Sunlight improves the function of your liver and helps it to break down toxins and wastes that could lead to cancer and other diseases.
• If you've got swollen, arthritic joints, sunlight may help lower your pain levels.
• Sunlight is an effective treatment for jaundice.
• According to some studies on the benefits of sunlight, exposure to the sun may decrease your risk of breast, colon, and prostate cancers.
• Sunlight helps your body convert a form of cholesterol that is present in your skin into vitamin D. This results in lower blood cholesterol levels. Click here to read more about the benefits of vitamin D.
• Other benefits of sunlight include the life-giving energy it gives to your organs and the way it helps to strengthen and vitalize your body.

Grab your sunscreen and go outside!!!  There are so many health benefits to getting natural sunlight and with the right protection you can enjoy the best of both worlds. 

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Things that harm your health....not relaxing

We live in a world that is moving so fast and we feel like we have to keep up.  Technology has evolved so much that our "down time" is spent on Facebook, Twitter, Linkedin and other social media sites.  If we aren't in front of the computer we are in front of the TV, outside working or playing but none of these will help you relax.


To truly relax you have to do nothing.  Our bodies AND our brains need this down time.  You don't have to spend hours doing this but a few minutes a day will change your life and how to view your life.

We all know how to relax on a beach so take a good look at this picture.....close your eyes.  Now imagine yourself lying on the beach.  Take a few moments and enjoy the sun, the sand and the sound of the ocean.  This is a great video to watch and listen to while you are relaxing.

If you would like to learn more relaxing techniques the Mayo Clinic has some great ways to relax.

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Understanding Degenerative Disc Disease

Pain in the neck has never impacted so much.  Although Degenerative Disc Disease is not technically a "disease" it is placed in this category because of the changes that it causes your spinal discs go through as you age.  Degenerative Disc Disease is most common in your lower back (lumbar region) and your neck (cervical region).





Spinal Discs are part of your spine.  They are soft compressible discs that separate the bones (vertebrae) that make up your spine.  They are to your spine as shocks are to your car:  They absorb the shock for the spine allowing it to flex, bend and twist.

Causes for disc damage are:

1. Osteoarthritis:  which is the breakdown of the tissue that protects and cushions your joints.
2. Herniated disc, an abnormal bulge or breaking open of a spinal disc.
3. Spinal stenosis, the narrowing of the spinal can (the open space in which houses your spinal cord).

There are many causes for Degenerative Disc Disease that come from age to sudden injury.  

As we age our spinal discs break down which can lead to loss of fluid in your discs.  This will reduce the ability for your discs to absorb shocks as well by making the discs less flexible.  

Tiny tears or cracks in the outer layer of the disc causes the disc to break open.  Inside each disc there is jellylike material that is forced out through the tears or cracks which cause the disc to bulge, break open or break into fragments.  People who smoke, do heavy physical work or are more likely to have symptoms of Degenerative Disc Disease.

I have a extruded herniated disc at C6, C6, C7 (For those who don't remember C is for Cervical region) that was caused by the sudden injury of a car accident.  This particular injury is when the "jellylike" material is forced out of the disc.  I did not have any pain for the first three weeks and then it was like putting your sweet child to bed one night to have them wake up as a teenager.  It caused extreme pain, numbness or tingling in my right fingers that lead to the right hand and eventually to the entire arm.  

Symptoms are different for different people.  Some of the same injuries will cause different degrees of pain.  If the cervical region is affected than will, more often than not, affect the harm.  When the lumbar region is affected than the pain may be in the back, buttock or leg.  

I know that some days I would not experience any pain but numbness or tingling was extreme.  Other days it would be the opposite.  If I slept a certain way it was worse or if I turned my neck suddenly it would cause symptoms.  I never knew what activity or movement would cause what symptom as it never made any sense to me.

Premier Back Rehabilitation Center, PC can help you with these type of injuries.  It is essential that you get to a Doctor with the latest technology to discover these injuries as soon as possible.  Don't waste months on treatments that won't help.  Get your answers ASAP!

Tell me about your stories.

Information provided by WebMD

Obesity and the diseases it can cause

First off you need to find out if you are in the group that is considered obese....you can use this calculator to determine a rough idea if you are in that category.




The answer may have scared you....because when we think of obese we think of 100 pounds overweight.  If you fall into the category, or if you are close, this information is essential to you.

According to LSIA Medical Laboratory there are 20 diseases or condition that can be attributed to obesity.

1. Diabetes
2. Cancer
3. Congestive Heart Failure
4. Enlarged Heart
5. Pulmonary Embolism
6. Polycystic Ovarian Syndrome
7. Gastro esophageal Reflux Disease
8. Fatty Liver Disease
9. Hernia
10. Erectile Dysfunction
11. Urinary Incontinence
12. Chronic Renal Failure
13. Lymph edema
14. Cellulitis
15. Stoke
16. Pickwickian Syndrome
17. Depresion
18. Osteoarthritis
19. Gout
20. Gallbladder Disease

To learn about each of these disease please click the link of LSIA Medical Laboratory.

The U.S. Surgeon General warns about premature deaths caused by obesity.

• Estimated 300,000 deaths PER YEAR is caused by obesity and obesity related diseases.
• The risk of death increases as weight increases.
• If you are between the age of 30-64 even 10-20 pounds overweight increases your risk of death.
• If your BMI is 30> you increase your risk of premature death by 50-100%.

We have tended to live to eat instead of eat to live.  We have over indulged ourselves to early deaths.  It's never too late to take control of your life!

If you need help with this contact Premier Back Rehabilitation Center, PC as they are trained to help you with this.

What is Metabolism anyway?

• Ever watched a thin person eat everything in site and then some?  
• Ever wonder why that person can do that and you can't?

Metabolism is what the difference is.  Metabolism is the process your body uses to get or make energy from the food you eat.

Food is made up of:

• Proteins:  According to Health-Alicious-Ness the foods with the highest protein are Cheese, Mature (Large) Beans, Lean Veal and Beef, Roasted Pumpkin, Squash and Watermelon seeds, Lean Meats such as Chicken, Turkey, Lamb and pork, Fish such as Tuna, Anchovies and Salmon, Fish Eggs such as Roe and Caviar, Yeast Extract Spread, Lobster and Crab, Lentils, Pulses and Peanuts.
• Carbohydrates: According to Dietdecide Bad Carbohydrates: White bread (hoagies, rolls, sandwich bread), Corn cereal (corn flakes, pops, etc.), Simple sugar (gatorade powder, kool aid, raw sugar), Pasta, Pretzels, Potato, Potato chips, Cupcakes, Cookies, Cake, Candies, Jelly, Jams, Pudding, Custards and White Rice.  Good Carbohydrates:   Almonds, Apples, Arugula, Asparagus, Avocados, Bananas, Blueberries, Black Beans, Broccoli, Brown Rice, Cauliflower, Celery, Eggs, Garbanzo Beans, Grapes, Hummus, Oranges, Quinoa (Quinoa Feta Spinach Salad), Romaine Lettuce, Shrimp, Strawberries, Sunflower Seeds, Sweet Potato, Watermelon, Wheat Flour, Whole Wheat Bread, Whole Wheat Hot Dog Buns (Nutrisystem Turkey Hot Dog) and Zucchini.
• Fats:  According to The Food Chart - Fats provide energy to our body. Fats provide more than twice as much energy as either carbohydrate or protein. About 33-35% of our daily calories intake is in the form of fats. Fat is made up of mainly fatty acids. There are three types of fatty acids: saturated fatty acids, polyunsaturated fatty acids and monounsaturated fatty acids. The proportion of these fatty acids, as stated in the fat food chart below, is different in fat-containing food.  Click on the link for a complete chart of fats.

When you have a metabolic disorder you have an abnormal chemical reaction in your body that disrupts the process your body uses to get or make energy from the food you eat.  Diabetes is an example of this.

When you want to loose weight and diet and exercise is not working contact Premier Back Rehabilitation Center, PC for a free consultation to about your body's metabolism.