Resilient Individuals Research Articles

Differences in Autonomy and Health-Related Quality of Life between Resilient and Non-Resilient Individuals with Mild Cognitive Impairment.

The dramatic increase in the number of older people with Mild Cognitive Impairment (MCI) entails a serious public health problem. MCI involves different degrees of dependence that has been previously related to a decrease in Health-Related Quality of Life (HRQoL), due to impairment in the performance of activities of daily living. Resilient coping, as an adaptive coping style, could reduce the associated limitations derived by the characteristic deficits of MCI, and hence improve HRQoL. The principal objective of this work was to compare the level of autonomy (measured in terms of independence in the performance of basic (ADL) and instrumental (IADL) activities of daily living), and HRQoL between resilient and non-resilient individuals with MCI. The results showed a positive relationship between resilience, autonomy, and HRQoL. Hence, resilient participants exhibited higher independence in daily living activities and better HRQoL than non-resilient individuals. Mediation analyses confirmed an indirect influence of resilience on HRQoL through the mediation effect of better performance in IADLs. These findings underline the relevance of resilience as a coping style to compensate deficits in daily living in people with MCI. The inclusion of intervention programs, oriented to the promotion of resilience coping for older adults, might increase the autonomy levels in this population, improving their HRQoL.

Current dysphoria, past major depression, and memory for affective facial expressions

Memory for others’ sad affective facial expressions may be relevant to depression risk, given that biases have been linked to major depression and transient sad mood states. However, no study has addressed whether stable, subclinical dysphoria is associated with similar biases, or whether depression history might moderate a relationship between dysphoria and memory for affective facial stimuli. These questions were examined in the present study. Participants completed an incidental encoding task involving sad, happy, and neutral facial expression stimuli, and then they later completed a recognition memory task. Results indicated that dysphoria alone was not associated with memory differences. Rather, past depression moderated the effect of dysphoria such that dysphoric individuals with past depression showed greater recognition memory for sad faces relative to dysphoric/never depressed and nondysphoric/formerly depressed individuals. Findings are partially consistent with cognitive models of depression and could have implications for interpersonal functioning in susceptible or resilient individuals.

Resistance and resilience to Alzheimer\u2019s disease pathology are associated with reduced cortical pTau and absence of limbic-predominant age-related TDP-43 encephalopathy in a community-based cohort

Alzheimer’s disease neuropathologic change (ADNC) is defined by progressive accumulation of β-amyloid plaques and hyperphosphorylated tau (pTau) neurofibrillary tangles across diverse regions of brain. Non-demented individuals who reach advanced age without significant ADNC are considered to be resistant to AD, while those burdened with ADNC are considered to be resilient. Understanding mechanisms underlying ADNC resistance and resilience may provide important clues to treating and/or preventing AD associated dementia. ADNC criteria for resistance and resilience are not well-defined, so we developed stringent pathologic cutoffs for non-demented subjects to eliminate cases of borderline pathology. We identified 14 resistant (85+ years old, non-demented, Braak stage ≤ III, CERAD absent) and 7 resilient (non-demented, Braak stage VI, CERAD frequent) individuals out of 684 autopsies from the Adult Changes in Thought study, a long-standing community-based cohort. We matched each resistant or resilient subject to a subject with dementia and severe ADNC (Braak stage VI, CERAD frequent) by age, sex, year of death, and post-mortem interval. We expanded the neuropathologic evaluation to include quantitative approaches to assess neuropathology and found that resilient participants had lower neocortical pTau burden despite fulfilling criteria for Braak stage VI. Moreover, limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) was robustly associated with clinical dementia and was more prevalent in cases with high pTau burden, supporting the notion that resilience to ADNC may depend, in part, on resistance to pTDP-43 pathology. To probe for interactions between tau and TDP-43, we developed a C. elegans model of combined human (h) Tau and TDP-43 proteotoxicity, which exhibited a severe degenerative phenotype most compatible with a synergistic, rather than simply additive, interaction between hTau and hTDP-43 neurodegeneration. Pathways that underlie this synergy may present novel therapeutic targets for the prevention and treatment of AD.

Cardiovascular outcomes related to social defeat stress: New insights from resilient and susceptible rats

Stress exposure is an important risk factor for psychiatric and cardiovascular disorders. Two phenotypes related to coping with stress can be observed in rodents that experience chronic social defeat stress (SDS): susceptible, showing social avoidance and behavioral changes related to depression, and resilient, showing none of these alterations. Moreover, a strong correlation exists between depression and the development of or mortality due to cardiovascular diseases. Nevertheless, little is known about cardiovascular alterations related to SDS exposure in those phenotypes or their correlation with depressive-like behaviors. Using a chronic SDS protocol followed by the social interaction test, we identified Wistar rats as resilient or susceptible to SDS. Susceptible animals showed increased depressive-like behaviors with resting tachycardia and decreased heart rate variability (HRV) due to increased sympathetic tone in the heart and a less effective baroreflex. In contrast, resilient rats were protected from these alterations by increased vagal tone, resulting in greater HRV values. To our knowledge, our study is the first to indicate that harmful cardiovascular outcomes are related to depressive-like behaviors in susceptible rats and to suggest a mechanism by which resilient rats are protected from these changes. Also, our results suggest that enhanced HRV and vagal tone may be an important trait in resilient individuals.

Branched-chain amino acids mediate resilience to chronic social defeat stress by activating BDNF/TRKB signaling

How individuals respond to chronic stress varies. Susceptible individuals ultimately develop depression; whereas resilient individuals live normally. In this study, our objective was to examine the effect of branched-chain amino acids (BCAA), commonly used by athletes, on susceptibility to stress. Male C57BL/6 mice were subjected to daily defeat sessions by a CD1 aggressor, for 10 days. On day11, the behavior of mice was assessed using the social interaction test, elevated plus maze and open field. Mice received the BCAA leucine, isoleucine or valine before each defeat session. Furthermore, we examined whether BCAA regulate brain derived neurotrophic factor (BDNF) signaling by using a brain-permeable tropomyosin receptor kinase B (TRKB) inhibitor, ANA-12. We also tested the effect of voluntary exercise and high protein diets on susceptibility to stress. Mice exposed to chronic stress displayed increased susceptibility and social avoidance. BCAA promoted resilience to chronic stress, rescued social avoidance behaviors and increased hippocampal BDNF levels and TRKB activation. Inhibition of TRKB signaling abolished the ability of BCAA to promote resilience to stress and to rescue social avoidance. Interestingly, we found that BCAA activate the exercise-regulated PGC1a/FNDC5 pathway known to induce hippocampal BDNF signaling. Although both voluntary exercise and BCAA promoted resilience to stress, combining them did not yield synergistic effects confirming that they affect similar pathways. We also discovered that high protein diets mimic the effect of BCAA by rescuing social deficits induced by chronic stress and increase Bdnf expression in the hippocampus. Our data indicate that BCAA, exercise and high protein diets rescue susceptibility to stress by activating the hippocampal BDNF/TRKB signaling.

240. A Developmental Perspective on Brain Network Architecture, Nodal Abnormalities and Susceptibility or Resilience to Maltreatment

Childhood maltreatment is an important risk factor for psychopathology. However, some maltreated individuals appear remarkably resilient even though they have the same basic array of imaging abnormalities as maltreated individuals with psychopathology. We seek to identify compensatory brain alterations enabling resilient individuals to maintain mental well-being despite alterations in stress-susceptible structures.

Retos educativos ante los riesgos emergentes en el ciberespacio: claves para una adecuada prevención de la cibervictimización en menores

In just a few years, technological changes have transformed how people interact and communicate with each other, in particular among so-called digital adolescents. The impact of technology on routine activities and mainstream culture has led to an increase in young peoples’ exposure to psychological and criminological risks. As a result of this new psychosocial trend, new educational challenges are appearing and it is becoming more necessary to react to these challenges on the basis of an adequate diagnosis of psychology and pedagogy relating to adolescents. Criminological theories and research have tried to identify risk and protection factors to understand victimisation processes in more depth and improve prevention strategies. In this context, it is necessary to develop educational programs that consider personal, familial, and situational vulnerabilities and weaknesses in order to foster resilient individuals who can successfully confront the risks inherent to cyberspace. By analysing specific forms of cybervictimisation, guidelines based on criminological research and the most frequent victimisation processes will be identified in order to improve design of educational programs focused on parents, educators and potential victims.

Stress and stressors of medical student near-peer tutors during courses: a psychophysiological mixed methods study

BackgroundStructured peer-led tutorial courses are widespread and indispensable teaching methods that relieve teaching staff and contribute to the development of students’ competencies. Nevertheless, despite high general stress levels in medical students and associated increases in psychopathology, specific knowledge of peer tutors’ additional burdens is very limited.MethodsSixty student near-peer tutors from two structured peer-teaching programmes volunteered to participate. On multiple occasions in three different course sessions, we assessed tutors’ subjective stress, affective state, heart rate variability, and salivary cortisol. Additionally, tutors named everyday and course-specific stressors, which were evaluated by means of content analyses.ResultsThe study participation rate was high (63% of all active tutors). The participating tutors are socially well adapted and resilient individuals. They report a variety of stressors such as time pressure, participant characteristics, teacher role demands, and study requirements, but nevertheless display only moderate psychological and physiological stress that decreases over sessions. Tutors’ negative affect in sessions is low; their positive affect is consistently high for senior as well as novice tutors. Tutors rate their courses’ quality as high and quickly recover after sessions.ConclusionsTutors successfully cope with teaching-associated and everyday life demands. The results corroborate the viability and success of current peer-teaching programmes from the tutors’ perspective. This study is the first to comprehensively quantify tutors’ stress and describe frequent stressors, thus contributing to the development of better peer teaching programmes and tutor qualification training.

The Linkage Between Aging, Migration, and Resilience: Resilience in the Life of Older Turkish and Moroccan Immigrants.

ObjectivesOlder immigrants are affected by an accumulation of adversities related to migration and aging. This study investigates resilience in older immigrants by examining the resources they use to deal with these adversities in the course of their lives.MethodsData from 23 life-story interviews with Turkish and Moroccan immigrants aged 60–69 years living in the Netherlands.ResultsThe circumstances under which individuals foster resilience coincide with four postmigration life stages: settling into the host society, maintaining settlement, restructuring life postretirement, and increasing dependency. Resources that promote resilience include education in the country of origin, dealing with language barriers, having two incomes, making life meaningful, strong social and community networks, and the ability to sustain a transnational lifestyle traveling back and forth to the country of origin. More resilient individuals invest in actively improving their life conditions and are good at accepting conditions that cannot be changed.DiscussionThe study illustrates a link between conditions across life stages, migration, and resilience. Resilient immigrants are better able to accumulate financial and social and other resources across life stages, whereas less resilient immigrants lose access to resources in different life stages.

Predicting cognitive resilience from midlife lifestyle and multi-modal MRI: A 30-year prospective cohort study.

BackgroundThere is significant heterogeneity in the clinical expression of structural brain abnormalities, including Alzheimer’s disease biomarkers. Some individuals preserve their memory despite the presence of risk factors or pathological brain changes, indicating resilience. We aimed to test whether resilient individuals could be distinguished from those who develop cognitive impairment, using sociodemographic variables and neuroimaging.MethodsWe included 550 older adults participating in the Whitehall II study with longitudinal data, cognitive test results, and multi-modal MRI. Hippocampal atrophy was defined as Scheltens Scores >0. Resilient individuals (n = 184) were defined by high cognitive performance despite hippocampal atrophy (HA). Non-resilient participants (n = 133) were defined by low cognitive performance (≥1.5 standard deviations (S.D.) below the group mean) in the presence of HA. Dynamic and static exposures were evaluated for their ability to predict later resilience status using multivariable logistic regression. In a brain-wide analysis we tested for group differences in the integrity of white matter (structural connectivity) and resting-state networks (functional connectivity).FindingsYounger age (OR: 0.87, 95% CI: 0.83 to 0.92, p<0.001), higher premorbid FSIQ (OR: 1.06, 95% CI: 1.03 to 1.10, p<0.0001) and social class (OR 1 vs. 3: 4.99, 95% CI: 1.30 to 19.16, p = 0.02, OR 2 vs. 3: 8.43, 95% CI: 1.80 to 39.45, p = 0.007) were independently associated with resilience. Resilient individuals could be differentiated from non-resilient participants by higher fractional anisotropy (FA), and less association between anterior and posterior resting state networks. Higher FA had a significantly more positive effect on cognitive performance in participants with HA, compared to those without.ConclusionsResilient individuals could be distinguished from those who developed impairments on the basis of sociodemographic characteristics, brain structural and functional connectivity, but not midlife lifestyles. There was a synergistic deleterious effect of hippocampal atrophy and poor white matter integrity on cognitive performance. Exploiting and supporting neural correlates of resilience could offer a fresh approach to postpone or avoid the appearance of clinical symptoms.

Habituation of the electrodermal response - A biological correlate of resilience?

Current approaches to quantifying resilience make extensive use of self-reported data. Problematically, this type of scales is plagued by response distortions–both deliberate and unintentional, particularly in occupational populations. The aim of the current study was to develop an objective index of resilience. The study was conducted in 30 young healthy adults. Following completion of the Connor-Davidson Resilience Scale (CD-RISC) and Depression/Anxiety/Stress Scale (DASS), they were subjected to a series of 15 acoustic startle stimuli (95 dB, 50 ms) presented at random intervals, with respiration, skin conductance and ECG recorded. As expected, resilience (CD-RISC) significantly and negatively correlated with all three DASS subscales–Depression (r = -0.66, p<0.0001), Anxiety (r = -0.50, p<0.005) and Stress (r = -0.48, p<0.005). Acoustic stimuli consistently provoked transient skin conductance (SC) responses, with SC slopes indexing response habituation. This slope significantly and positively correlated with DASS-Depression (r = 0.59, p<0.005), DASS-Anxiety (r = 0.35, p<0.05) and DASS-Total (r = 0.50, p<0.005) scores, and negatively with resilience score (r = -0.47; p = 0.006), indicating that high-resilience individuals are characterized by steeper habituation slopes compared to low-resilience individuals. Our key finding of the connection between habituation of the skin conductance responses to repeated acoustic startle stimulus and resilience-related psychometric constructs suggests that response habituation paradigm has the potential to characterize important attributes of cognitive fitness and well-being–such as depression, anxiety and resilience. With steep negative slopes reflecting faster habituation, lower depression/anxiety and higher resilience, and slower or no habituation characterizing less resilient individuals, this protocol may offer a distortion-free method for objective assessment and monitoring of psychological resilience.

Lactate is an antidepressant that mediates resilience to stress by modulating the hippocampal levels and activity of histone deacetylases.

Chronic stress promotes depression in some individuals, but has no effect in others. Susceptible individuals exhibit social avoidance and anxious behavior and ultimately develop depression, whereas resilient individuals live normally. Exercise counteracts the effects of stress. Our objective was to examine whether lactate, a metabolite produced during exercise and known to reproduce specific brain exercise-related changes, promotes resilience to stress and acts as an antidepressant. To determine whether lactate promotes resilience to stress, male C57BL/6 mice experienced daily defeat by a CD-1 aggressor, for 10 days. On the 11th day, mice were subjected to behavioral tests. Mice received lactate before each defeat session. When compared with control mice, mice exposed to stress displayed increased susceptibility, social avoidance and anxiety. Lactate promoted resilience to stress and rescued social avoidance and anxiety by restoring hippocampal class I histone deacetylase (HDAC) levels and activity, specifically HDAC2/3. To determine whether lactate is an antidepressant, mice only received lactate from days 12-25 and a second set of behavioral tests was conducted on day 26. In this paradigm, we examined whether lactate functions by regulating HDACs using co-treatment with CI-994, a brain-permeable class I HDAC inhibitor. When administered after the establishment of depression, lactate behaved as antidepressant. In this paradigm, lactate regulated HDAC5 and not HDAC2/3 levels. On the contrary, HDAC2/3 inhibition was antidepressant-like. This indicates that lactate mimics exercise's effects and rescues susceptibility to stress by modulating HDAC2/3 activity and suggests that HDAC2/3 play opposite roles before and after establishment of susceptibility to stress.

Thoughts on relatedness, transformation of self, and a new understanding of mourning

I have elaborated Stern’s theory of the formation, growth, and development of the self to explain how the threat of dissolution of self can result instead in adaptive transformation. His theory also led to my insight that mourning is intrinsic to the process of formation, growth, and development of the self, and my observation that the major work of mourning and transformation of self can be accomplished by resilient individuals in six months.

La construcción subjetiva de la experiencia: un análisis de la memoria y la resiliencia en sentido educativo

En este artículo se lleva a cabo un análisis teórico de la memoria y la resiliencia en sentido educativo para examinar las prácticas docentes dirigidas a la promoción de estas cualidades en el educando de cualquier nivel educativo. La pertinencia de este estudio se justifica por la necesidad de repensar el sentido de ciertos elementos y prácticas escolares, como la memorización, que están en la base de los procesos de enseñanza y aprendizaje, para que la labor docente esté fundamentada sobre unos principios alcanzados de manera racional y crítica y no esté meramente instalada en el terreno perezoso de la costumbre, la simple opinión o la autoridad. Se defenderá que la construcción del sujeto de sus experiencias, vertebradora de su identidad, puede modularse educativamente mediante un tratamiento específico de ambas capacidades estudiadas: mediante un cuidado deliberado de la memoria y un fomento de la resiliencia. Además de señalar los caracteres específicos tanto de la memoria como sentido interno, por una parte, como del sujeto resiliente, por otra, se pondrá de manifiesto un cierto modo de ser negativo que es común a ambos, y que afecta al sujeto de los aprendizajes de manera análoga. Este componente negativo que los constituye tiene relación con la construcción de la propia identidad personal y, por tanto, con la noción de experiencia. Se pondrá de manifiesto cómo la noción de experiencia es la base vertebradora de ambos conceptos, en un caso porque la origina, y en el otro porque sirve para interpretarla y sacarle partido.

Remote Patient Management in Peritoneal Dialysis: Opportunities and Challenges.

Telehealth describes the use of information and communication technologies to deliver healthcare remotely. Given the twin healthcare pressures of demographic change, where increased numbers of people suffer long-term conditions and there is requirement to deliver care ever more cost effectively, there is a considerable need to make the best use of these technologies in the redesign of clinical services. The opportunity for telehealth in peritoneal dialysis (PD) is to strengthen an already enabled population of resilient individuals who undertake their treatment in the community while at the same time providing the opportunity for more people to have their treatment at home. Relevant to this discussion are the challenges that characterize PD. In many parts of the world, uptake is low, technique survival is disappointing, and access to the therapy is impacted by a range of factors such as socioeconomic status, ethnic minority status, and social isolation. There are barriers to learning the technique that may be physical, educational or cognitive, and support by a family member or paid carer may be required. Can remote monitoring impact these factors - and would its widespread use build confidence in patient perceptions that would enable more people to benefit from home dialysis? For that to happen, a clear sighted goal is required for the development of high quality evidence that examines the opportunities and challenges around its use, and understands the needs of all stakeholders. This is key for appropriate and patient-centered implementation that benefits healthcare outcomes, which matter to patients and to those who provide healthcare. This will not happen by accident and must be carefully built into the plan for the roll out and evaluation of these technologies.

The Effect of Emotional Resilience on Job Performance of Executives in Selected Private Sector Organizations in Sri Lanka

When operating in a complex work environment, it is obvious that the companies will have to face many challenges and changes. This will create a stressful work environment for the employees who are working. It is mandatory to have more resilient employees, who can quickly recover from the stress, as it affects directly to their low performance. The sole purpose of this study is to identify the impact of the ability of the individuals to quickly bounce back from the stressful situations and how does it impact on employees’ work performance. The study was an explanatory cross-sectional in nature. The simple random sampling technique has been used as the sampling method. The researcher distributed a questionnaire among the participants in the selected sample which encompasses 74 respondents from three selected companies where two companies are possessing 25 employees each and 24 employees from another company consists of executive level employees. In addition, the items of the questionnaire were extracted from a standard and well-tested measurement scale. Descriptive statistics, correlation and regression were used to analyze the collected data set in order to get in to a statistically supported conclusion. The findings have revealed that there is a significant relationship between the emotional resilience and the employee performance and also there is a impact comes from the employees’ emotional resilience on the employees’ work performance and the results depicted that 24.4% of an impact comes from emotional resilience. The findings of the research study will be beneficial for the companies who will hire more resilient individuals, who can quickly adapt and who can quickly recover from the hectic situations.

Resilience and Poly-Victimization among Two Cohorts of Norwegian Youth.

Previous research shows that there is a significant and positive relationship between being a victim of violence and experiencing high levels of psychological problems among young people. Conversely, resilience is negatively associated with psychological problems among young people in general, and this negative association is particularly strong among victims of violence. Our study examines resilience among young people (aged ≥ 18 years) who reported being victims of multiple forms of violence during childhood and adolescence using data from two national youth surveys administered in Norway in 2007 (N = 7033) and 2015 (N = 4531), respectively. We first compared the score of resilience, as measured by the Resilience Scale for Adolescents (READ), and the prevalence of poly-victimization, as identified by the number of young people in our study who were exposed to three of the four forms of violence (i.e., non-physical violence, witnessing violence against parents, physical violence, and sexual abuse). Second, we tested our hypothesis using our data and found that resilience—individuals’ capacity to handle adversity, as well as their use of social and cultural resources when facing adversity—moderates the association between poly-victimization and the onset of psychological problems.

Susceptibility or Resilience to Maltreatment Can Be Explained by Specific Differences in Brain Network Architecture

BackgroundChildhood maltreatment is a major risk factor for psychopathology. However, some maltreated individuals appear remarkably resilient to the psychiatric effects while manifesting the same array of brain abnormalities as maltreated individuals with psychopathology. Hence, a critical aim is to identify compensatory brain alterations that enable resilient individuals to maintain mental well-being despite alterations in stress-susceptible regions. MethodsNetwork models were constructed from diffusion tensor imaging and tractography in physically healthy unmedicated 18- to 25-year-old participants (N = 342, n = 192 maltreated) to develop network-based explanatory models. ResultsFirst, we determined that susceptible and resilient individuals had the same alterations in global fiber stream network architecture using two different definitions of resilience: 1) no lifetime history of Axis I or II disorders, and 2) no clinically significant symptoms of anxiety, depression, anger-hostility, or somatization. Second, we confirmed an a priori hypothesis that right amygdala nodal efficiency was lower in asymptomatic resilient than in susceptible participants or control subjects. Third, we identified eight other nodes with reduced nodal efficiency in resilient individuals and showed that nodal efficiency moderated the relationship between maltreatment and psychopathology. Fourth, we found that models based on global network architecture and nodal efficiency could delineate group membership (control, susceptible, resilient) with 75%, 82%, and 80% cross-validated accuracy. ConclusionsTogether these findings suggest that sparse fiber networks with increased small-worldness following maltreatment render individuals vulnerable to psychopathology if abnormalities occur in specific nodes, but that decreased ability of certain nodes to propagate information throughout the network mitigates the effects and leads to resilience.

FACTORS ASSOCIATED WITH REMAINING FREE FROM FUNCTIONAL LIMITATIONS DESPITE SOCIOECONOMIC ADVERSITY

AbstractThis study aimed to identify factors that protect individuals exposed to lifelong socioeconomic adversity from developing functional limitations in old age. Data from 1,973 participants in the MRC National Survey of Health and Development (United Kingdom) were used. Functional Limitations was defined as experiencing difficulty with any daily activity. Socioeconomic adversity had three levels based on life course trajectories. We compared psychosocial factors and health-related behaviours between a “resilient” group (high adversity but no functional limitations) and five groups with other combinations of adversity and limitations. Compared to other individuals with high adversity, resilient individuals had higher adolescent self-management, a lower likelihood of smoking, obesity, and childhood illness, and were more often physically active. Marital status and contact frequency were not associated with resilience. Results suggest that a combination of psychological and behavioural characteristics across life is required to be physically resilient in the face of socioeconomic adversity.

Interpersonal Psychotherapy With Expressive Art for Depression in a Psycho-Oncology Context

The following case outlines the use of interpersonal psychotherapy (IPT) with integrated expressive art practices over 10 sessions in treatment of AF, a 62-year-old Caucasian female presenting with depression as a psycho-oncology outpatient. AF’s presentation was in the context of a history of diagnosis and treatment of melanoma, several family losses to cancer, long-standing dysthymia and recurrent major depressive episodes, and relocation from interstate following marriage separation. IPT was delivered to address AF’s identified core problem area of interpersonal sensitivities, while expressive art exercises played a role of creative self-reflection and exploration. At the conclusion of therapy, AF demonstrated not only elimination of clinical symptoms of depression and anxiety but also growth as a newly resilient and enlivened individual. Theoretical, research, and intervention implications for treatment of depression in broad and specific to psycho-oncology contexts are discussed.