Apr 28, 2006
PlaydoCAM™ is a free software that allows to use the web camera into a motion-tracking gaming device and play pong or basketball on Mac or PC without installing any new software by the interface mechanism of waving the hands in the air. I tried it and it worked fine...
I think that this technology could be effectively used in home-based training for poststroke hemiplegia
From the CP&B website
TIES that BIND: An Introduction to Domain Mapping as a Visualization Tool for Virtual RehabilitationPatrice L. (Tamar) Weiss, Rochelle Kedar, Meir Shahar
Feasibility, Motivation, and Selective Motor Control: Virtual Reality Compared to Conventional Home Exercise in Children with Cerebral PalsyC. Bryanton, J. Bossé, M. Brien, J. Mclean, A. McCormick, H. Sveistrup
Integrating Haptic-Tactile Feedback into a Video-Capture–Based Virtual Environment for RehabilitationUri Feintuch, Liat Raz, Jane Hwang, Naomi Josman, Noomi Katz, Rachel Kizony, Debbie Rand, Albert "Skip" Rizzo, Meir Shahar, Jang Yongseok, Patrice L. (Tamar) Weiss
Reaching within Video-Capture Virtual Reality: Using Virtual Reality as a Motor Control ParadigmAssaf Y. Dvorkin, Meir Shahar, Patrice L. (Tamar) Weiss
Virtual Reality in the Rehabilitation of the Upper Limb after Stroke: The User?s PerspectiveJ.H. Crosbie, S. Lennon, M.D.J. McNeill, S.M. McDonough
Usability of the Remote Console for Virtual Reality Telerehabilitation: Formative EvaluationJeffrey A. Lewis, Judith E. Deutsch, Grigore Burdea
The Rutgers Arm, a Rehabilitation System in Virtual Reality: A Pilot StudyManjuladevi Kuttuva, Rares Boian, Alma Merians, Grigore Burdea, Mourad Bouzit, Jeffrey Lewis, Devin Fensterheim
Responses to a Virtual Reality Grocery Store in Persons with and without Vestibular DysfunctionSusan L. Whitney, Patrick J. Sparto, Larry F. Hodges, Sabarish V. Babu, Joseph M. Furman, Mark S. Redfern
A Treadmill and Motion Coupled Virtual Reality System for Gait Training Post-StrokeJoyce Fung, Carol L. Richards, Francine Malouin, Bradford J. McFadyen, Anouk Lamontagne
Influences of the Perception of Self-Motion on Postural ParametersE.A. Keshner, K. Dokka, R.V. Kenyon
Immersive Virtual Reality as a Rehabilitative Technology for Phantom Limb Experience: A ProtocolCraig D. Murray, Emma Patchick, Stephen Pettifer, Fabrice Caillette, Toby Howard
Motor Training in the Manipulation of Flexible Objects in Haptic EnvironmentsI. Goncharenko, M. Svinin, Y. Kanou, S. Hosoe
Using Virtual Environment to Improve Spatial Perception by People Who Are BlindOrly Lahav
The Jerusalem TeleRehabilitation System, a New Low-Cost, Haptic Rehabilitation ApproachHeidi Sugarman, Ehud Dayan, Aviva Weisel-Eichler, Joseph Tiran
Human Experience Modeler: Context-Driven Cognitive Retraining to Facilitate Transfer of LearningC.M. Fidopiastis, C.B. Stapleton, J.D. Whiteside, C.E. Hughes, S.M. Fiore, G.A. Martin, J.P. Rolland, E.M. Smith
Application of Virtual Reality Graphics in Assessment of ConcussionSemyon Slobounov, Elena Slobounov, Karl Newell
Virtual Reality Pencil and Paper Tests for Neglect: A ProtocolKenji Baheux, Makoto Yoshizawa, Kazunori Seki, Yasunobu Handa
Virtual and Physical Toys: Open-Ended Features for Non-Formal LearningEva Petersson, Anthony Brooks
Three-Dimensional Virtual Environments for Blind ChildrenJaime Sánchez, Mauricio Sáenz
Effectiveness of Virtual Reality for Pediatric Pain Distraction during IV PlacementJeffrey I. Gold, Seok Hyeon Kim, Alexis J. Kant, Michael H. Joseph, Albert "Skip" Rizzo
Simulating Social Interaction to Address Deficits of Autistic Spectrum Disorder in ChildrenCheryl Y. Trepagnier, Marc M. Sebrechts, Andreas Finkelmeyer, Willie Stewart, Jordana Woodford, Maya Coleman
Starting Research in Interaction Design with Visuals for Low-Functioning Children in the Autistic Spectrum: A ProtocolNarcís Parés, Anna Carreras, Jaume Durany, Jaume Ferrer, Pere Freixa, David Gómez, Orit Kruglanski, Roc Parés, J. Ignasi Ribas, Miquel Soler, Àlex Sanjurjo
Virtual Reality Assessment of Medication Compliance in Patients with SchizophreniaElizabeth K. Baker, Matthew Kurtz, Robert S. Astur
Reality Check: The Role of Realism in Stress Reduction Using Media TechnologyY.A.W. de Kort, W.A. Ijsselsteijn
Hippocampus Function Predicts Severity of Post-Traumatic Stress DisorderRobert S. Astur, Sarah A. St. Germain, David Tolin, Julian Ford, David Russell, Mike Stevens
BusWorld: Designing a Virtual Environment for Post-Traumatic Stress Disorder in Israel: A ProtocolNaomi Josman, Eli Somer, Ayelet Reisberg, Patrice L. (Tamar) Weiss, Azucena Garcia-Palacios, Hunter Hoffman
Simulation and Virtual Reality in Medical Education and Therapy: A ProtocolMichael J. Roy, Deborah L. Sticha, Patricia L. Kraus, Dale E. Olsen
Virtual Reality Applications to Agoraphobia: A ProtocolGeorgina Cárdenas, Sandra Muñoz, Maribel González, Guillermo Uribarren
Simulating social interaction to address deficits of autistic spectrum disorder in children.
Cyberpsychol Behav. 2006 Apr;9(2):213-7
Authors: Trepagnier CY, Sebrechts MM, Finkelmeyer A, Stewart W, Woodford J, Coleman M
Autistic spectrum disorder (ASD) is diagnosed on the basis of impairment in reciprocal social interaction and language, and rigidity of behavior. This brief paper describes the development of an experimental intervention for preschool children newly diagnosed with ASD. The rationale for this intervention is the hypothesis that failure to attend to social cues in very early life, of itself, may bear a large share of responsibility for core social and communicative deficits. The intervention, therefore, uses eye-tracking to monitor and trigger rewards for attention to facial expression and direction of gaze.
Apr 26, 2006
Doctors and nurses who treat heart-failure patients get a chance to feel and experience what heart failure is really like.
Symptoms of heart failure include difficulty breathing, feeling tired, heart palpitations and tightness in the chest.
Doctors and nurses are placed inside Heart FXPod [<http://www.heartfxpod.com/>], created for Astra-Zeneca, which simulates what it is like for their patients.
They use the pedals to walk like a heart-failure patients and use headphones to be trapped in the patient's world
The doctors and nurses are strapped in a pneumatic vest that inflates and suddenly makes it difficult for them to breathe.
It is virtual reality, but it is a little more real than some might like.
"Severe chest tightness. So now I know what my patients go through," said Dr. Siva Srinivasan, of Thomas Jefferson University Hospital.
Srinivason said that after the simulator, he might treat his patients differently.
The Heart FXPod is a multi-sensory interactive simulation that leaves you with no doubt what it's like when your heart fails to provide enough oxygen and blood flow to your body.
If someone trying the pod gets scared they have the ability to stop it.
Dr. Paul Mather directs the Advanced Heart Failure Center at the Jefferson Heart Institute.
"Everyone has sympathy towards other human beings. I think that's part of our human element. But empathy, where you can actually feel what another person is going through as opposed to just feeling sorry for them, is different. I think if we can marry that feeling to the science of medicine, it will make for a better health care provider," Mather said.
Mather said that about 15 years ago, heart failure was a death sentence. Now, doctors can help it regress and patients can often end up living good lives.
Apr 25, 2006
From Smart Mobs
Instant messaging, favored by chatting teens and office gossips, is a growing tool for therapists counseling people on everything from smoking cessation to sexual-abuse trauma, reports the Pioneer Press.
Proponents say the text-based conversations are appealing because they're fast and anonymous — users can log onto a number of online services and connect with therapists who know them only by screen names. But many in the mental-health community say the format is too impersonal for effective treatment and should be only an adjunct to face-to-face counseling.
... Text messaging, critics say, doesn't allow therapists to pick up on important visual cues to a patient's true state of mind.
"What one gleans as a psychiatrist in a clinical assessment is not just from the words one says but from the emotions," says Paul Appelbaum, a psychiatry professor at Columbia University and past president of the American Psychiatric Association. He says doctors need to assess the way a person walks, sits, smiles or tears up.
Toward brain correlates of natural behavior: fMRI during violent video games.
Hum Brain Mapp. 2006 Apr 20;
Authors: Mathiak K, Weber R
Modern video games represent highly advanced virtual reality simulations and often contain virtual violence. In a significant amount of young males, playing video games is a quotidian activity, making it an almost natural behavior. Recordings of brain activation with functional magnetic resonance imaging (fMRI) during gameplay may reflect neuronal correlates of real-life behavior. We recorded 13 experienced gamers (18-26 years; average 14 hrs/week playing) while playing a violent first-person shooter game (a violent computer game played in self-perspective) by means of distortion and dephasing reduced fMRI (3 T; single-shot triple-echo echo-planar imaging [EPI]). Content analysis of the video and sound with 100 ms time resolution achieved relevant behavioral variables. These variables explained significant signal variance across large distributed networks. Occurrence of violent scenes revealed significant neuronal correlates in an event-related design. Activation of dorsal and deactivation of rostral anterior cingulate and amygdala characterized the mid-frontal pattern related to virtual violence. Statistics and effect sizes can be considered large at these areas. Optimized imaging strategies allowed for single-subject and for single-trial analysis with good image quality at basal brain structures. We propose that virtual environments can be used to study neuronal processes involved in semi-naturalistic behavior as determined by content analysis. Importantly, the activation pattern reflects brain-environment interactions rather than stimulus responses as observed in classical experimental designs. We relate our findings to the general discussion on social effects of playing first-person shooter games. Hum. Brain Mapping 2006. (c) 2006 Wiley-Liss, Inc.
Apr 20, 2006
Via VRPSYCH mailing list
The Institute of Rural Health at the Idaho State University has announced the following webconferencing session:
Online Communities and Virtual Worlds for Patient and Caregiver Self-Help Groups
Meeting Date and Time: APRIL 20, NOON-1:00 PM MDT (Mountain Daylight Time)
Presenter: John Lester
Online communities offer a unique opportunity for patients and caregivers to share experiences and emotional support with people across the world. John Lester will discuss his experiences with Braintalk Communities (www.braintalk.org), which offers hundreds of forums and chatrooms for self-help support groups focused on a wide range of neurological disorders.
Started in 1993, Braintalk continues to explore new models of online communities and support. John will describe the growth and evolution of Braintalk as well as his work using the 3-d virtual world of Second Life ( www.secondlife.com) to create new online communities supporting people dealing with Asperger's Syndrome, Cerebral Palsy, and Stroke Survivors. He will also summarize how different groups of patients and caregivers can use vastly different communication modalities to help them deal with unique conditions.
John Lester Bio:
John Lester joined Linden Lab (the creators of Second Life) in 2005, bringing experience in online community development as well as a background in the fields of healthcare and education. Previously he was the Information Technology Director in the Neurology Service at Massachusetts General Hospital, where he pioneered the use of the web in 1993 to create online communities for supporting patients dealing with neurological disorders. He also held an academic appointment at Harvard Medical School , where he created online collaborative environments for professors and students to advance the case-based teaching method in medical education. John created and continues to manage BrainTalk Communities, a non-profit organization who's mission is to provide online environments for patient and caregiver self-help groups focused on neurological disorders.
HOW TO JOIN THE WEBCONFERENCE?
Cut and paste the entire link below including the meeting_id in the address text box of your internet browser.
Meeting Date and Time: Apr 20, 2006 NOON to 1:00 PM (MDT)
This conference session is an open one and DOES NOT REQUIRE A PASSWORD. Thus, you only need to enter your name on the sign in page and log in without entering a password.
Please note: If your computer has a microphone and speakers you will be able to talk and hear while you are in the Elluminate session. If you do not have a microphone, you can still interact with your peers and the speaker through text chat.
If this is the first time you will be using Elluminate, you may be prompted to download some software which may take anywhere from 2 to 20 minutes depending upon your Internet connection speed. We advise you to get your PC ready to access the webconference a day or two before the scheduled date of the talk. You can pre-configure your system with the required software by going to the support page located at:
Elluminate Help Desk Tel Numbers: 866-388-8674 option 2, 703-464-9158
Apr 18, 2006
Read the full report on Clinical Psychiatry News
Apr 07, 2006
Video-capture virtual reality system for patients with paraplegic spinal cord injury.
J Rehabil Res Dev. 2005 Sep-Oct;42(5):595-608
Authors: Kizony R, Raz L, Katz N, Weingarden H, Weiss PL
This article presents results from a feasibility study of a video-capture virtual reality (VR) system used with patients who have paraplegic spinal cord injury (SCI) and who need balance training. The advantages of the VR system include providing the user with natural control of movements, the ability to use as many parts of the body as are deemed suitable within the context of therapeutic goals, and flexibility in the way the system can be adapted to suit specific therapeutic objectives. Thirteen participants with SCI experienced three virtual environments (VEs). Their responses to a Short Feedback Questionnaire showed high levels of presence. We compared performance in the environments with a group of 12 nondisabled participants. Response times for the patient group were significantly higher and percentage of success was significantly lower than that for the nondisabled group. In addition, significant moderate correlations were found between performance within a VE and static balance ability as measured by the Functional Reach Test. This study is a first step toward future studies aimed at determining the potential of using this VR system during the rehabilitation of patients with SCI.
Mar 29, 2006
from BBC NEWS
By Gareth Mitchell
Presenter, Digital Planet, BBC World Service
Playing virtual reality computer games may help treat the condition known as amblyopia, or lazy eye, say researchers. In patients with amblyopia, one eye works better than the other. Because the amblyopic eye is inferior for some reason, the brain decides to use the good eye. Over time, the neural connection to the bad eye becomes gradually weaker in favour of the good eye. The traditional way of fixing the problem is for patients to force the bad eye to work harder by wearing a patch over the good eye. The treatment usually involves patching for around 400 hours and can cause the eyes not to work together, resulting in double vision.
"Traditionally VR has been used to present realistic environments in 3D so you imagine you're there because of the depth of the world around you," said Richard Eastgate of the university's Virtual Reality Applications Research Team.
"But we're using VR to make something unrealistic. You could call it virtual unreality," he told Digital Planet...
Read the full story from BBC NEWS
The Use of Video Capture Virtual Reality in Burn Rehabilitation: The Possibilities.
J Burn Care Res. 2006 March/April;27(2):195-197
Authors: Haik J, Tessone A, Nota A, Mendes D, Raz L, Goldan O, Regev E, Winkler E, Mor E, Orenstein A, Hollombe I
We independently explored the use of the Sony PlayStation II EyeToy (Sony Corporation, Foster City, CA) as a tool for use in the rehabilitation of patients with severe burns. Intensive occupational and physical therapy is crucial in minimizing and preventing long-term disability for the burn patient; however, the therapist faces a difficult challenge combating the agonizing pain experienced by the patient during therapy. The Sony PlayStation II EyeToy is a projected, video-capture system that, although initially developed as a gaming environment for children, may be a useful application in a rehabilitative context. As compared with other virtual reality systems the EyeToytrade mark is an efficient rehabilitation tool that is sold commercially at a relatively low cost. This report presents the potential advantages for use of the EyeToytrade mark as an innovative rehabilitative tool with mitigating effects on pain in burn rehabilitation. This new technology represents a challenging and motivating way for the patient to immerse himself or herself in an alternate reality while undergoing treatment, thereby reducing the pain and discomfort he or she experiences. This simple, affordable technique may prove to heighten the level of patient cooperation and therefore speed the process of rehabilitation and return of functional ability.
Mar 25, 2006
Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3D games.
Technol Health Care. 2006;14(1):19-27
Authors: Bouchard S, Côté S, St-Jacques J, Robillard G, Renaud P
Buying or creating a virtual reality (VR) software is very costly. A less expensive alternative could be to modify already existing 3D computer games. The goal of this study is to assess the effectiveness of in virtuo exposure in the treatment of arachnophobia using modified 3D games. Participants were 10 women and 1 man. Virtual worlds were created using the game editor of a 3D computer game (Half-Lifetrade mark), modified to offer graduals hierarchies of fearful stimuli (spiders). Analyses revealed significant improvement between pre and post results on the behavioral avoidance test, the Spider Beliefs Questionnaire, and perceived self-efficacy. These promising results suggest that therapy using virtual reality exposure via a modified computer game is useful in the treatment of arachnophobia.
Mar 07, 2006
A preliminary report on the use of virtual reality technology to elicit craving and cue reactivity in cocaine dependent individuals.
Addict Behav. 2006 Mar 1;
Authors: Saladin ME, Brady KT, Graap K, Rothbaum BO
In the present feasibility study, we developed a 3-dimensional virtual "crack" cocaine environment and evaluated the environment's ability to elicit subjective craving and cue reactivity (i.e., subjective emotional responding, heart rate and skin conductance) in 11 crack cocaine dependent individuals. Each of the seven 3-D crack cocaine scenes in the cocaine environment depicted actors engaging in a range of using-related behaviors (i.e., smoking crack) whereas the neutral environment contained scenes depicted 3-D aquariums with active aquatic life (baseline measures were obtained following immersion in the neutral environment). Results indicated that craving was significantly elevated during the cocaine-related scenes as compared to baseline. Craving varied by scene content, with scenes depicting active cocaine use eliciting the highest levels of craving. Heart rate was significantly higher in four of the scenes with drug use content and positive affect (i.e., happiness) ratings were significantly lower during cocaine scenes as compared to baseline. Overall, the results suggest that a standardized and stimulus rich virtual reality environment effectively elicits craving and physiologic reactivity. Such technology has potential utility in the development and refinement of exposure-based behavioral and pharmacological interventions for substance use disorders.
Mar 05, 2006
Improving the accuracy of the diagnosis of schizophrenia by means of virtual reality.
Am J Psychiatry. 2006 Mar;163(3):512-20
Authors: Sorkin A, Weinshall D, Modai I, Peled A
Feb 22, 2006
Baram, Yoram PhD; Miller, Ariel MD, PhD
Neurology. 66(2):178-181, January 24, 2006.
Feb 14, 2006
Via the Presence-Listserv
(the following excerpt is from the original article published in the Observer)
Inspired by Star Trek's holodeck, a virtual reality theatre will be built for treatment and therapy purposes at the Cleveland Hearing and Speech Center. The theatre is titled, "Immersive Virtual Reality Cave Simulator" (IVR-Cave).
Under the guidance of Stacy Willams, an assistant professor in communication services at Case, the construction on the theater will be complete by April 2006. Williams formulated the concept of the room with inspiration from Star Trek while she was working on her master's degree.
"I was intrigued by the whole holodeck concept, and at the time [when working on a masters degree], I was learning the importance of carry-over techniques, or generalizing what you learn in therapy to a natural environment," Williams said.
With this new simulator, therapists will get a chance to show patients real-life scenarios in a controlled environment, before they are out on their own in the real world...
Read full article
Feb 02, 2006
A meta-analysis of the training effectiveness of virtual reality surgical simulators.
IEEE Trans Inf Technol Biomed. 2006 Jan;10(1):51-8
Authors: Haque S, Srinivasan S
The increasing use of virtual reality (VR) simulators in surgical training makes it imperative that definitive studies be performed to assess their training effectiveness. Indeed, in this paper we report the meta-analysis of the efficacy of virtual reality simulators in: 1) the transference of skills from the simulator training environment to the operating room, and 2) their ability to discriminate between the experience levels of their users. The task completion time and the error score were the two study outcomes collated and analyzed in this meta-analysis. Sixteen studies were identified from a computer-based literature search (1996-2004). The meta-analysis of the random effects model (because of the heterogeneity of the data) revealed that training on virtual reality simulators did lessen the time taken to complete a given surgical task as well as clearly differentiate between the experienced and the novice trainees. Meta-analytic studies such as the one reported here would be very helpful in the planning and setting up of surgical training programs and for the establishment of reference 'learning curves' for a specific simulator and surgical task. If any such programs already exist, they can then indicate the improvements to be made in the simulator used, such as providing for more variety in their case scenarios based on the state and/or rate of learning of the trainee.
Jan 28, 2006
Effect of tutorial input in addition to augmented feedback on manual dexterity training and its retention
Effect of tutorial input in addition to augmented feedback on manual dexterity training and its retention.
Eur J Dent Educ. 2006 Feb;10(1):24-31
Authors: Wierinck E, Puttemans V, van Steenberghe D
Abstract Virtual reality (VR) simulators can be used as tools in manual dexterity training. The visual feedback guides the subject towards proper performance but creates, at the same time, some dependency on this feedback. To overcome this drawback, the effect of adjunct tutorial input on motor learning behaviour was examined. Novice dental students were randomly assigned to one of two training groups or to a non-training control group, given the task of preparing a geometrical class 1 cavity in phantom teeth. The feedback (FB) group trained under augmented visual feedback conditions, provided by the VR system (DentSim(TM)). The feedback-plus (FB+) group received, in addition, standardised expert input to enrich the augmented feedback information. The control group, consisting of same year students, did not participate in any training programme. All preparations were evaluated by the VR scoring system. Performance analyses revealed an overall trend towards significant improvement with practice for the training groups. Performance of the FB+ group was most accurate across training. After 1 day and 3 weeks of no practice, both training groups outperformed the control group. After 4 months, however, only the FB+ condition was significantly more accurate than the control group. The same tendency was noted for the transfer tests. Consequently, cavity preparation experience on a VR system under the condition of frequently provided feedback supplemented with expert input was most beneficial to long time learning.
Jan 20, 2006
Motor learning: its relevance to stroke recovery and neurorehabilitation
Curr Opin Neurol. 2006 Feb;19(1):84-90
Authors: Krakauer JW
PURPOSE OF REVIEW: Much of neurorehabilitation rests on the assumption that patients can improve with practice. This review will focus on arm movements and address the following questions: (i) What is motor learning? (ii) Do patients with hemiparesis have a learning deficit? (iii) Is recovery after injury a form of motor learning? (iv) Are approaches based on motor learning principles useful for rehabilitation? RECENT FINDINGS: Motor learning can be broken into kinematic and dynamic components. Studies in healthy subjects suggest that retention of motor learning is best accomplished with variable training schedules. Animal models and functional imaging in humans show that the mature brain can undergo plastic changes during both learning and recovery. Quantitative motor control approaches allow differentiation between compensation and true recovery, although both improve with practice. Several promising new rehabilitation approaches are based on theories of motor learning. These include impairment oriented-training (IOT), constraint-induced movement therapy (CIMT), electromyogram (EMG)-triggered neuromuscular stimulation, robotic interactive therapy and virtual reality (VR). SUMMARY: Motor learning mechanisms are operative during spontaneous stroke recovery and interact with rehabilitative training. For optimal results, rehabilitation techniques should be geared towards patients' specific motor deficits and possibly combined, for example, CIMT with VR. Two critical questions that should always be asked of a rehabilitation technique are whether gains persist for a significant period after training and whether they generalize to untrained tasks.
Jan 11, 2006
A virtual reality scenario for all seasons: the virtual classroom.
CNS Spectr. 2006 Jan;11(1):35-44
Authors: Rizzo AA, Bowerly T, Buckwalter JG, Klimchuk D, Mitura R, Parsons TD
Treatment and rehabilitation of the cognitive, psychological, and motor sequelae of central nervous system dysfunction often relies on assessment instruments to inform diagnosis and to track changes in clinical status. Typically, these assessments employ paper-and-pencil psychometrics, hands-on analog/computer tests, and rating of behavior within the context of real-world functional environments. Virtual reality offers the option to produce and distribute identical "standard" simulation environments in which performance can be measured and rehabilitated. Within such digital scenarios, normative data can be accumulated for performance comparisons needed for assessment/diagnosis and for treatment/rehabilitation purposes. In this manner, reusable archetypic virtual environments constructed for one purpose can also be applied for applications addressing other clinical targets. This article will provide a review of such a retooling approach using a virtual classroom simulation that was originally developed as a controlled stimulus environment in which attention processes could be systematically assessed in children with attention-deficit/hyperactivity disorder. This system is now being applied to other clinical targets including the development of tests that address other cognitive functions, eye movement under distraction conditions, social anxiety disorder, and the creation of an earthquake safety training application for children with developmental and learning disabilities.