Prevalence of Musculoskeletal Disorders Among Mississippi Dental Hygienists in Relation to Operator Positioning and Work Habits

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ISBN 13 :
Total Pages : 130 pages
Book Rating : 4.:/5 (94 download)

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Book Synopsis Prevalence of Musculoskeletal Disorders Among Mississippi Dental Hygienists in Relation to Operator Positioning and Work Habits by : Rebecca M. Barry

Download or read book Prevalence of Musculoskeletal Disorders Among Mississippi Dental Hygienists in Relation to Operator Positioning and Work Habits written by Rebecca M. Barry and published by . This book was released on 2014 with total page 130 pages. Available in PDF, EPUB and Kindle. Book excerpt: Problem Statement: Results of worldwide studies indicate that musculoskeletal disorders (MSDs) are highly prevalent and remain a potential occupational health hazard to practicing dental hygienists. Enduring chronic injury, functional impairments and associated pain, paying for musculoskeletal rehabilitation and treatment, coupled with the need to reduce the number of hours worked or need to leave the profession prematurely all adversely affect the financial stability and quality of life of practicing dental hygienists. Further, risk for developing MSDs has the potential to limit both the retention of existing clinicians as well as the recruitment of future applicants in the dental hygiene workforce. Published studies confirm that collectively, MSDs are an important dental hygiene workforce issue. It is not known how current recommendations for operator positioning and use of ergonomic devices impact development of MSDs and workforce issues among Mississippi dental hygiene practitioners. Purpose: The purpose of this study was four-fold: to determine if self-reported operator positioning correlated with development of MSDs; to determine if operator positioning correlated with time of MSD onset; to assess whether use of ergonomic devices reduced risk for occupational injury; and to measure the impact of MSDs on dental hygiene workforce issues in Mississippi. Knowledge gained from this study may help to identify best strategies to teach students about proper ergonomics to reduce risk for MSDs. Reducing risk for occupational injury is essential to ensure retention of practitioners in the dental hygiene workforce and to maintain quality of life. Methods: A 47 item modified version of the Standardised Nordic Questionnaire was developed and pilot-tested for face and content validity. The online survey was sent to all licensed Mississippi dental hygienists (N=1553), obtaining a 22% response rate. This IRB-approved study utilized a correlational design examining relationships between operator positioning and development and time to onset of MSDs, and impact of MSDs on practice behaviors and workforce retention. Data analyses included descriptive statistics, Pearson Chi-square analysis, and Kaplan Meier survival analysis. Results: Primary sites of MSDs reported by Mississippi dental hygienists included neck (74%), shoulders (61%), wrists/hands (57%) low back (54%) and upper back (45%). There was no significant difference in prevalence of MSDs between those sitting in front of or behind the patient (X2 (1) = 1.67, p=0.196), although survival analysis revealed that those who sat behind the patient developed MSDs sooner (X2 (1) = 3.92, p=0.048). For respondents sitting in the 8:00 -- 12:00 o'clock position, median time for a MSD to develop was 8.5 years, while the median time with the 9:00 -- 12:30 o'clock position was five years. Overall median time to onset of a MSD was also 5 years with a 95% confidence interval (CI) (3.927, 6.073). Further investigation revealed a significant difference between position used and MSDs reported after graduation for the upper back and wrists/hands. Chi-square analysis on positions used resulted in (X2 = 8.09 (1), p=0.004) for the upper back and (X2 = 8.29 (1), p=0.004) for the wrist/hands. Dental hygienists who practiced from the front position (8:00 -- 12:00 o'clock) were more likely to develop MSDs in these two sites as opposed to those who practiced from the back position (9:00 -- 12:30 o'clock). However, regardless of operator position, by 16+ years in practice, 80% (n=272/338) of dental hygienists developed MSDs. There was no significant difference between the early or late onset of a MSD and the need to modify patient work load (X2 = 3.5 (1), p=0.06), need to reduce work hours (X2 = 2.97 (1), p=0.08), need to take time off from work (X2 = 1.96 (1), p=0.16), or the ability to continue to work due to MSDs (X2 = .00 (1), p=0.97). Ergonomic devices e.g., large diameter instruments, swivel handpieces, eyeloupes, saddle stools, were used by only 21.6% (n=73/338) of study participants. Conclusions: The majority of practicing dental hygienists develop MSDs regardless of operator position used. Study participants developed MSDs sooner after entering practice than what has been previously reported in the literature. The data suggests that regardless of operator position used, given enough time, a large percentage of dental hygienists are going to develop MSDs. Less than a quarter of Mississippi dental hygienists in this study used ergonomic devices. Given the high risk for developing MSDs, dental hygiene educators must question whether current teaching strategies regarding proper operator positioning and use of ergonomic devices actually help reduce and/or prevent future MSDs among dental hygienists. Data from this study also suggests that the presence of MSDs may impact quality of life, but does not appear to negatively impact the dental hygiene workforce in Mississippi.

Musculoskeletal Disorders in Connecticut Dental Hygienists Related to Repetitive Motion Trauma from Heavy Work-load, Posture, Job Mechanics and Psychosocial Factors

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ISBN 13 :
Total Pages : 114 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Musculoskeletal Disorders in Connecticut Dental Hygienists Related to Repetitive Motion Trauma from Heavy Work-load, Posture, Job Mechanics and Psychosocial Factors by : Claudia M. Wellington

Download or read book Musculoskeletal Disorders in Connecticut Dental Hygienists Related to Repetitive Motion Trauma from Heavy Work-load, Posture, Job Mechanics and Psychosocial Factors written by Claudia M. Wellington and published by . This book was released on 1998 with total page 114 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Savvy Success

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Publisher : Author House
ISBN 13 : 1477208836
Total Pages : 283 pages
Book Rating : 4.4/5 (772 download)

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Book Synopsis Savvy Success by : Christine A. Hovliaras

Download or read book Savvy Success written by Christine A. Hovliaras and published by Author House. This book was released on 2012-11-15 with total page 283 pages. Available in PDF, EPUB and Kindle. Book excerpt: SAVVY SUCCESS Achieving Professional Excellence and Career Satisfaction in the Dental Hygiene Profession Volume III: Technology-Ethics-Career Success Volume III: Technology-Ethics-Career Success covers new trends occurring in practice to help dental hygienists in time management and efficiency in their positions; use of technology such as digital radiography in practice; trends in polishing practices; the oralsystemic link and its connection to overall wellness; the use of teledentistry to care for access to care populations; ethical decision making; risk management; medical emergencies and tobacco cessation. The seventh unit of Volume III is on Dental Hygiene and Securing Career Satisfaction. Volume III concludes with the importance of lifelong learning; balancing work and personal life; and dental hygiene and career satisfaction focuses on insights that I and other dental hygienists I have interviewed provide on how to achieve career satisfaction and what skills and attributes can assist dental hygienists in reaching this level of happiness and success in their professional careers Glossary of Terms, Index and Appendix in each of the 3 textbooks, Volume I-III of SAVVY SUCCESS includes a Glossary of Terms which defines key terms utilized in the chapters included in each textbook that students, faculty members and practicing dental hygienists can review to define these key words. An index is also included in the three volumes. In Volume III of SAVVY SUCCESS an appendix is included which highlights information from the Chapter 41 author on the ADHA Code of Ethics.

Work-Related Musculoskeletal Disorders

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Publisher : National Academies Press
ISBN 13 : 030959264X
Total Pages : 43 pages
Book Rating : 4.3/5 (95 download)

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Book Synopsis Work-Related Musculoskeletal Disorders by : Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries: The Research Base

Download or read book Work-Related Musculoskeletal Disorders written by Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries: The Research Base and published by National Academies Press. This book was released on 1998-10-29 with total page 43 pages. Available in PDF, EPUB and Kindle. Book excerpt: In May 1998 the National Institutes of Health asked the National Academy of Sciences/National Research Council to assemble a group of experts to examine the scientific literature relevant to work-related musculoskeletal disorders of the lower back, neck, and upper extremities. A steering committee was convened to design a workshop, to identify leading researchers on the topic to participate, and to prepare a report based on the workshop discussions and their own expertise. In addition, the steering committee was asked to address, to the extent possible, a set of seven questions posed by Congressman Robert Livingston on the topic of work-related musculoskeletal disorders. The steering committee includes experts in orthopedic surgery, occupational medicine, epidemiology, ergonomics, human factors, statistics, and risk analysis. This document is based on the evidence presented and discussed at the two-day Workshop on Work-Related Musculoskeletal Injuries: Examining the Research Base, which was held on August 21 and 22, 1998, and on follow-up deliberations of the steering committee, reflecting its own expertise.

A Survey of Work-related Musculoskeletal Complaints Among Dental Hygienists in Kentucky

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ISBN 13 :
Total Pages : 124 pages
Book Rating : 4.:/5 (525 download)

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Book Synopsis A Survey of Work-related Musculoskeletal Complaints Among Dental Hygienists in Kentucky by : RaeAnne Szeluga

Download or read book A Survey of Work-related Musculoskeletal Complaints Among Dental Hygienists in Kentucky written by RaeAnne Szeluga and published by . This book was released on 2000 with total page 124 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Work-Related Musculoskeletal Disorders

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Publisher : National Academies Press
ISBN 13 : 0309063973
Total Pages : 240 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Work-Related Musculoskeletal Disorders by : National Research Council

Download or read book Work-Related Musculoskeletal Disorders written by National Research Council and published by National Academies Press. This book was released on 1999-04-11 with total page 240 pages. Available in PDF, EPUB and Kindle. Book excerpt: Estimated costs associated with lost days and compensation claims related to musculoskeletal disorders-including back pains and repetitive motion injuries-range from $13 billion to $20 billion annually. This is a serious national problem that has spurred considerable debate about the causal links between such disorders and risk factors in the workplace. This book presents a preliminary assessment of what is known about the relationship between musculoskeletal disorders and what may cause them. It includes papers and a workshop summary of findings from orthopedic surgery, public health, occupational medicine, epidemiology, risk analysis, ergonomics, and human factors. Topics covered include the biological responses of tissues to stress, the biomechanics of work stressors, the epidemiology of physical work factors, and the contributions of individual, recreational, and social factors to such disorders. The book also considers the relative success of various workplace interventions for prevention and rehabilitation.

Work-Related Musculoskeletal Disorders

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Publisher : National Academies Press
ISBN 13 : 0309173248
Total Pages : 239 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Work-Related Musculoskeletal Disorders by : National Research Council

Download or read book Work-Related Musculoskeletal Disorders written by National Research Council and published by National Academies Press. This book was released on 1999-03-11 with total page 239 pages. Available in PDF, EPUB and Kindle. Book excerpt: Estimated costs associated with lost days and compensation claims related to musculoskeletal disorders-including back pains and repetitive motion injuries-range from $13 billion to $20 billion annually. This is a serious national problem that has spurred considerable debate about the causal links between such disorders and risk factors in the workplace. This book presents a preliminary assessment of what is known about the relationship between musculoskeletal disorders and what may cause them. It includes papers and a workshop summary of findings from orthopedic surgery, public health, occupational medicine, epidemiology, risk analysis, ergonomics, and human factors. Topics covered include the biological responses of tissues to stress, the biomechanics of work stressors, the epidemiology of physical work factors, and the contributions of individual, recreational, and social factors to such disorders. The book also considers the relative success of various workplace interventions for prevention and rehabilitation.

Handbook of Musculoskeletal Pain and Disability Disorders in the Workplace

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Publisher : Springer Science & Business Media
ISBN 13 : 1493906127
Total Pages : 511 pages
Book Rating : 4.4/5 (939 download)

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Book Synopsis Handbook of Musculoskeletal Pain and Disability Disorders in the Workplace by : Robert J. Gatchel

Download or read book Handbook of Musculoskeletal Pain and Disability Disorders in the Workplace written by Robert J. Gatchel and published by Springer Science & Business Media. This book was released on 2014-05-08 with total page 511 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book addresses the complexity of preventing, diagnosing, and treating musculoskeletal pain and disability disorders in the workplace. Divided evenly between common occupational pain disorders, conceptual and methodological issues, and evidence-based intervention methods, this comprehensive reference presents current findings on prevalence, causation, and physical and psychological aspects common to these disorders. Attention is given to working-world concerns, including insurance and compensation issues and AMA guidelines for disability evaluations. Also, specialized chapters offer lenses for understanding and administering the best approaches for treating specific pain disorders, and explore what workplaces can do to accommodate affected employees and prevent injuries from occurring in the first place.

Fundamentals of Periodontal Instrumentation and Advanced Root Instrumentation

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Publisher : Lippincott Williams & Wilkins
ISBN 13 : 1975121074
Total Pages : 1896 pages
Book Rating : 4.9/5 (751 download)

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Book Synopsis Fundamentals of Periodontal Instrumentation and Advanced Root Instrumentation by : Jill Gehrig

Download or read book Fundamentals of Periodontal Instrumentation and Advanced Root Instrumentation written by Jill Gehrig and published by Lippincott Williams & Wilkins. This book was released on 2018-07-16 with total page 1896 pages. Available in PDF, EPUB and Kindle. Book excerpt: Publisher's Note: Products purchased from 3rd Party sellers are not guaranteed by the Publisher for quality, authenticity, or access to any online entitlements included with the product. Walking dental hygiene students step-by-step through the “how to”—not just the “what” and “why”—of using periodontal and root instruments, this 8th Edition of Jill Gehrig’s definitive resource features new chapters, new online technique videos, updated coverage of the latest evidence-based techniques and equipment, and an expanded array of online teaching and learning resources. Designed to make it easy for students to learn instrumentation, this practical book first takes students through basic skills—patient positioning, intraoral finger rests, and basic instrumentation—then covers advanced techniques, including assessment of periodontal patients and instrumentation of the root branches of multirooted teeth, root concavities, and furcation areas. • Stand-alone modules provide step-by-step instructions for each major instrument classification (sickle scalars, universal curets, area-specific curets, etc.), providing instructors with maximum teaching flexibility. • Module outlines make it easy for students to locate specific information. • Chapter-opening learning objectives help students recognize and study important concepts. • A step-by-step format allows students to work independently and at their own pace—fostering autonomy and decision-making skills. • Key terms help students learn a whole new dental vocabulary as they move through the text. • Study aids, including boxes, tables, and flow charts, visually reinforce important content and permit quick reference during technique practice and at-home review. • Case-based patient experiences and critical thinking activities encourage students to apply concepts to clinical situations and help develop problem-solving skills. • Skill evaluation checklists guide student practice, promote self-assessment skills, and provide benchmarks for faculty evaluation of skill attainment. • Thirty-two FREE online videos (12 new to this edition) demonstrate instrumentation techniques.

Beyond Biomechanics

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Publisher : CRC Press
ISBN 13 : 020397462X
Total Pages : 289 pages
Book Rating : 4.2/5 (39 download)

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Book Synopsis Beyond Biomechanics by : Steve Sauter

Download or read book Beyond Biomechanics written by Steve Sauter and published by CRC Press. This book was released on 2005-08-12 with total page 289 pages. Available in PDF, EPUB and Kindle. Book excerpt: There is now widespread recognition that psychosocial factors play a key role in the aetiology, perpetuation, management and prevention of cumulative trauma disorders CTDs. This text addresses the strength, direction and importance of links between psychosocial factors and CTDs.; The book's contributors examine critically current research data, identify potential link mechanisms, and recommend measures for control and prevention. Topics covered include socio-organizational psychology, medical anthropology, occupational medicine, rehabilitation, orthopaedics, job stress and ergonomic interventions. The book aims to demystify the concept of the "psychosocial", so as to promote and assure effective prevention in the workplace.

The Prevention and Reduction of Muscoskeletal Pain Through Chair-side Stretching Among Dental Hygiene Students

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ISBN 13 :
Total Pages : 57 pages
Book Rating : 4.:/5 (1 download)

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Book Synopsis The Prevention and Reduction of Muscoskeletal Pain Through Chair-side Stretching Among Dental Hygiene Students by : Whitni H. Nye

Download or read book The Prevention and Reduction of Muscoskeletal Pain Through Chair-side Stretching Among Dental Hygiene Students written by Whitni H. Nye and published by . This book was released on 2017 with total page 57 pages. Available in PDF, EPUB and Kindle. Book excerpt: Musculoskeletal disorders (MSD) are among the most commonly reported injuries in the workforce today. There is a particularly high prevalence among dental professionals, and dental hygienists are significantly affected with a high risk for the development of MSD. Recent research has shown that the incidence of MSD begins early on during students’ academic and clinical training. The aim of this study was to determine the effectiveness of implementing chair-side stretching exercises for musculoskeletal (MSK) pain prior to clinic sessions for dental hygiene students enrolled in an accredited dental hygiene program. Senior dental hygiene students were divided into a treatment and control group where the treatment group completed a set routine of chair-side stretches before each clinic session for 10.43 weeks. All participants completed a modified version of the Standardized Nordic Questionnaire three times throughout the study. The sum of MSK pain scores showed significant differences (p=0.03) between the treatment and control group, as did the hands and wrists pain severity score (p=0.04). Hierarchical multiple regression revealed a model that explained 38.2% of the variance in MSK pain (p=0.021). The majority of participants in the treatment group felt that chair-side stretching neither improved nor worsened their MSK pain. However, more than half felt that chair-side stretching made them more conscious of their ergonomic practice while treating patients. The findings from this study suggest that consistent chair-side stretching may have a benefit to reducing and preventing MSK pain, particularly within the hand and wrist region. Future research is still needed to determine effective treatment and interventions to reduce MSK pain, particularly for the neck, shoulders, and lower back during professional training. Further work will provide future clinicians with the necessary instruction to prevent the development of MSD.

Musculoskeletal Disorders and the Workplace

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Publisher :
ISBN 13 :
Total Pages : 520 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Musculoskeletal Disorders and the Workplace by : Panel on Musculoskeletal Disorders and the Workplace

Download or read book Musculoskeletal Disorders and the Workplace written by Panel on Musculoskeletal Disorders and the Workplace and published by . This book was released on 2001-05-25 with total page 520 pages. Available in PDF, EPUB and Kindle. Book excerpt: The panel has assembled the science base supporting current concepts of musculoskeletal disorders as they relate to the workplace, ranging from tissue biology through the variety of mechanical, organization. and psychosocial factors operating in the complex environment of the workplace. They also consider clinical expressions of such disorders as acted on and modified by the interaction of individuals with the range of influences and responses that characterize their milieu. c. Book News Inc.

The Effectiveness of the Posturedontics Stretching/strengthening Program for Dental Hygienists in Prevention of Work-related Musculoskeletal Disorders

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Publisher :
ISBN 13 :
Total Pages : 172 pages
Book Rating : 4.:/5 (56 download)

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Book Synopsis The Effectiveness of the Posturedontics Stretching/strengthening Program for Dental Hygienists in Prevention of Work-related Musculoskeletal Disorders by : Linda Alexander

Download or read book The Effectiveness of the Posturedontics Stretching/strengthening Program for Dental Hygienists in Prevention of Work-related Musculoskeletal Disorders written by Linda Alexander and published by . This book was released on 2004 with total page 172 pages. Available in PDF, EPUB and Kindle. Book excerpt:

A History of Dental Hygiene and the Mississippi Dental Hygienists Association

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Publisher :
ISBN 13 :
Total Pages : 32 pages
Book Rating : 4.:/5 (169 download)

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Book Synopsis A History of Dental Hygiene and the Mississippi Dental Hygienists Association by : Elizabeth Kimmons

Download or read book A History of Dental Hygiene and the Mississippi Dental Hygienists Association written by Elizabeth Kimmons and published by . This book was released on 1958* with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Statistics on Work-related Musculoskeletal Disorders

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Publisher :
ISBN 13 : 9781760288259
Total Pages : 12 pages
Book Rating : 4.2/5 (882 download)

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Book Synopsis Statistics on Work-related Musculoskeletal Disorders by :

Download or read book Statistics on Work-related Musculoskeletal Disorders written by and published by . This book was released on 2016 with total page 12 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Effect of Autonomy and Organizational Climate on Well-being of Dental Hygienists

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Publisher :
ISBN 13 :
Total Pages : 25 pages
Book Rating : 4.:/5 (124 download)

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Book Synopsis Effect of Autonomy and Organizational Climate on Well-being of Dental Hygienists by : Erica Rose Parks

Download or read book Effect of Autonomy and Organizational Climate on Well-being of Dental Hygienists written by Erica Rose Parks and published by . This book was released on 2020 with total page 25 pages. Available in PDF, EPUB and Kindle. Book excerpt: While certain dental procedures may cause musculoskeletal problems in dental hygienists, the emotional labor when aiding patients to feel at ease in the dental chair can cause mental problems. Experiencing the physical and mental demands consistently and over time may lead dental hygienists to reduce hours or quit the profession if they do not have autonomy at work or if the organizational climate is unsupportive. The objective of this study was to investigate the association between musculoskeletal disorders, autonomy and organizational climate and the outcomes of likelihood of leaving practice and salutogenic health. This cross-sectional study was conducted via an online survey of registered Washington State dental hygienists between February and March 2020. Participants answered questions about musculoskeletal disorder symptoms using the Nordic Musculoskeletal Questionnaire and organizational climate using the Work Experience Measurement Scale (WEMS). The main outcomes were the single item on likelihood to leave practice in the next two years and the Salutogenic Health Indicator Scale (SHIS). Adjusted prevalence ratios (PR) and 95% confidence intervals were calculated using robust Poisson multivariable regression models. Results: In the adjusted analysis, the highest quartile of musculoskeletal symptoms (PR= 1.57, 95% CI=1.05-2.36), and low supportive working conditions (PR=1.48, 95% CI= 1.15-1.92) were associated with higher likelihood of leaving practice. Quartiles 2 to 4 of musculoskeletal symptoms (low quartile: PR = 6.14, 95% CI = 2.32-16.29; moderate: PR = 4.32, 95%CI=1.62-11.54; high: PR = 2.97, 95%CI=1.07-8.23), and middle and high tertiles of internal working experience (moderate: PR =5.08, 95% CI = 1.65-15.65; high: PR =6.19, 95% CI = 1.89-20.28) were associated with higher salutogenic health. Our research indicates that organizational climate and autonomy are important factors influencing the well-being and retention of clinical dental hygienists. Appropriate training and education in healthcare management and wellbeing are needed and both dental hygienists and their employers (most often dentists) need to foster supportive working environments.

Work-related Musculoskeletal Disorders Among the Female Cath Lab Population

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Publisher :
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (14 download)

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Book Synopsis Work-related Musculoskeletal Disorders Among the Female Cath Lab Population by : Kristen Detton Carter

Download or read book Work-related Musculoskeletal Disorders Among the Female Cath Lab Population written by Kristen Detton Carter and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The current body of literature has found a high correlation between work-related musculoskeletal disorders (WMSDs) and time spent in the cardiac catheterization lab (cath lab); however, there is a meager amount of research directed at the female population.1 It has been shown that in other work environments, there is a difference in female orthopedic injuries vs. male orthopedic injuries. 1, 2, 3 This quantitative study aimed to determine the prevalence of musculoskeletal disorders among cath lab professionals and further identify the variability in WMSDs among male and female professionals. The Nordic Musculoskeletal Questionnaire is a self-reported work-related musculoskeletal injury questionnaire. The survey was distributed through social media to reach a representative sample of US cath lab professionals. 531 individuals responded to the questionnaire, and 394 participants were eligible to participate in the study. Musculoskeletal symptoms were experienced by 99% percent of the participants at least once in the last twelve months. 84% of the total participants were female and reported that their most common area of pain was the lower back and cervical regions. The remaining 15 % were male and reported that their most common pain area was the lower back and lower extremity regions. The largest group, 322 (82%), stated they'd experienced lower back pain in the last 12 months. Several gender-based differences exist among cath lab professionals. Differentiation between gender disorders can be related to size, ergonomics of the individuals in the cath lab, positioning of the equipment, and ergonomic training and education. Further research is needed to address the ergonomic hurdles female cath lab professionals face and future directions cath labs can take to educate and train female/all professionals to decrease musculoskeletal disorders, retain a healthy workforce, and attract new professionals.