Iodine for Hypothyroidism: Friend or Foe?

Iodine for hypothyroidism is a controversial topic, with experts on both ends of the spectrum arguing for and against its use. But if you have hypothyroidism, or know someone who does, it’s important to understand that iodine is often not a preferred form of treatment, and in many cases can make your condition worse.

Before we delve into why that is, you’re probably wondering about all of the good things you’ve heard about iodine, so allow us to explain…

Your Thyroid Needs Iodine to Function

Your body does not make iodine on its own, which means you must get it through your food. If you don’t get enough, you will be unable to make sufficient amounts of thyroid hormone.

Your thyroid depends on iodine to produce two hormones, triiodothyronine (T3) and thyroxine (T4). The numbers in these hormone names are actually a marker of how many iodine atoms are attached, with T4 containing 4 atom molecules, then releasing one to convert into T3, the hormone’s active form.

It’s estimated that 2 billion people worldwide — including 266 million school-age children — have insufficient iodine intake,[1] and the resulting iodine deficiency is, in fact, the most common cause of hypothyroidism (underactive thyroid) worldwide.

If you have an iodine-deficient diet then eating iodine-rich foods like seaweed and even supplementing with iodine can quickly help to remedy the problem… but it’s important to realize that in the United States iodine deficiency is not a major cause of hypothyroidism, and in many cases treating the condition with iodine is a major health disaster.

Iodine Deficiency is NOT a Major Cause of U.S. Hypothyroidism Cases

Iodine levels in food vary greatly depending on soil and seawater concentration of iodine. Because of this it can be difficult to get sufficient iodine from diet alone, especially if you live in an area with iodine-deficient soil. To remedy this, the United States adds iodine to most table salt, which means you’re not only getting extra iodine when you salt your food, but also when you eat processed foods, which are typically heavily salted with iodized salt.

Many animal feeds in the United States are also supplemented with iodine and as a result dairy products are also good food sources of this nutrient.

There have, however, been signs that iodine intakes in the United States have been dropping, possibly due to increased numbers of people cutting back on their salt intake, but data from the latest study available, the National Health and Nutrition Examination Survey 2003-2004, suggests that most Americans are still getting enough.[2]

So, in the United States, iodine deficiency is not considered to be a major cause of hypothyroidism, except in specific at-risk groups, such as those who do not consume iodized salt (including that in processed foods), fish or seaweed, or women who are pregnant.

That said, cases of hypothyroidism are widespread in the United States, impacting nearly 4 percent of the population, [3] including 13 million who have not been diagnosed and are unaware they have the condition. [4]

If iodine deficiency is not the problem, then what is?

The Most Common Cause of Hypothyroidism in the United States

Hypothyroidism in the United States is most often the result of an autoimmune disease called Hashimoto’s thyroiditis, or Hashimoto’s disease, which causes your immune system to mistakenly attack, and destroy, the thyroid.

The disease typically begins with inflammation of your thyroid gland (thyroiditis) that over time impairs the ability of your thyroid to produce enough hormones, and eventually leads to underactive thyroid, or hypothyroidism.

The exact causes of Hashimoto’s are unknown, but it’s likely the result of a combination of factors including:

  • A virus or bacteria that triggers the response
  • Genetics/family history
  • Gender (women are more likely to have Hashimoto’s)
  • Other environmental factors

However, and this is an important point, excess iodine may also worsen the condition.

Increasing Iodine May Worsen Hypothyroidism

There’s no arguing that iodine is a crucial nutrient for your body… but in the case of hypothyroidism, more is not always better.

Studies show that giving iodine to people who had adequate or excessive iodine intake could actually trigger hypothyroidism and autoimmune thyroiditis.

Research also suggests that iodine actually increases the activity of the thyroid peroxidase (TPO) enzyme, and increased antibodies to this enzyme are common in Hashimoto’s patients. It is the interaction between the TPO enzyme and the antibodies that leads to inflammation and destruction of the thyroid. In other words, too much iodine can actually make Hashimoto’s worse.

Remember, since most hypothyroidism cases in the United States are due to Hashimoto’s disease, NOT iodine deficiency, this study could apply to you…

Be Very Careful if Your Health Care Practitioner Automatically Recommends Iodine for Hypothyroidism

Many health care practitioners in the United States do not understand the complexities of thyroid function and will routinely recommend iodine supplements for people with hypothyroidism. This approach will, unfortunately, be detrimental for some.

If you are truly deficient in iodine, then supplementation or increased dietary intake is necessary. But if not, additional iodine will most likely only trigger or worsen your thyroid troubles.

So if your health care practitioner recommends iodine supplementation without any real evidence that you’re deficient, it’s a red flag to take note of. A second opinion from a practitioner who understands the complex role of iodine in hypothyroidism — and can discuss with you its benefits versus risks — is likely warranted.

References

1. Food and Nutrition Bulletin 2008 Sep;29(3):195-202.

2. Thyroid. 2008 Nov;18(11):1207-14.

3. Thyroid. 2007 Dec;17(12):1211-23.

4. Archives of Internal Medicine 2000;160:526-534.

Top 50 Iron Rich Foods – Boost Your Energy and Beat Low Iron Symptoms

Increasing your intake of iron rich foods should not be too difficult. All it takes is for you to know which of the foods you eat are rich in iron, and start planning your meals accordingly. Sadly, the extent of most people’s knowledge, when it comes to iron and iron rich foods, is just too limited.

 

For a quick read on where to start you can read our article on Foods with an Iron Punch, but here we’ll give a much more in depth overview of the best iron Rich Foods complete with their Iron content.

 

The data has been extracted from the USDA National Nutrient Database for Standard Reference Release 22 from September 2009 which contains all the nutritional data for well over 7,000 food items. Unfortunately you can’t just download the database and do a quick sort on Iron content to give you the best Iron Rich Foods. Actually you can, but the problem is that the list you get won’t be very helpful in your daily life as the top items would be things like freeze dried parsley, dried thyme, beluga meat, cumin seed and all kinds of other foods you wouldn’t eat in large enough quantities to help you load up on Iron.

 

We have done the hard work for you and have carefully reviewed the USDA database and compiled this list of Top 50 Iron Rich Foods and have listed them by category so you know that when you eat meat what meat to choose, when you buy vegetables what to put in your shopping cart and when you need a quick snack what can help you boost your iron intake in just a few minutes.

 

This list is not a complete list of the iron content of all possible food items – if you don’t see it here it just means it isn’t particularly high on Iron.

 

Eat these Iron Rich Foods, combine them with Iron Absorption Enhancers, avoid Iron Absorption Inhibitors and you’ll be well on your way to boost your Iron levels and get rid of those Low Iron Symptoms!

 

Breakfast Cereals

Fortified breakfast cereal is one of your best bets to boost your Iron intake and below is a short list of some of them. As you can see eating just a single serving of these will give you around 18 mg Iron, but bear in mind that the typical absorption rate of a healthy adult is only approximately 10% to 15% of dietary iron. So drink a glass of Orange juice with your cereal to boost your absorption. Also, bear in mind that the last two items in this last are dry, i.e. before you have added milk or water to them!

  • Ralston Enriched Bran Flakes: 27 mg/cup
  • Kellog’s Complete Oat Bran Flakes: 25 mg/cup
  • General Mills Multi-Grain Cheerios: 24 mg/cup
  • Kellog’s All-Bran Complete Wheat Flakes: 24 mg/cup
  • Malt-O-Meal, plain, dry: 92 mg/cup
  • Cream of Wheat, instant, dry: 51 mg/cup

Meat

Red meat is high on iron and it comes in the heme form you body most easily absorbs; typically 15% to 35% of heme iron is absorbed by your body. Organ meats are the best sources of iron within the meat category and of these liver is probably the most popular so we’ve included it the list since we don’t know too many people who’ll eat spleen or lungs we’ve excluded these kinds of organs. If you like liver then go for goose liver expensive, but very nice! or at least opt for pork liver instead of beef liver. When you opt for red meat in your diet add some less standard options like Emu, Ostrich or Duck instead of beef.

  • Goose liver, raw: 31 mg / 100g
  • Pork liver, cooked: 18 mg / 100g
  • Chicken liver, cooked: 13 mg / 100g
  • Lamb liver, cooked: 10 mg / 100g
  • Beef liver, cooked: 7 mg / 100g
  • Emu, cooked: 7 mg / 100g
  • Ostrich oyster, cooked: 5 mg / 100g
  • Quail meat, raw: 5 mg / 100g
  • Duck breast, raw: 5 mg / 100g
  • Beef, steak, cooked: 4 mg / 100g
  • Beef, ground, cooked: 3 mg / 100g

Fish and Shellfish

Fish is not often considered as a good source of iron and most finfish is indeed not, only the oily fish like mackerel and sardines provide you with a decent amount of iron. So when you want to eat fish, opt for oily fish which gives you the most iron and is high in omega-3 too. When you add shellfish into the equation suddenly we find some of the best Iron Rich Foods you can find, especially clams think clam chowder. A quick comparison with the meat category shows that octopus or cuttlefish beat all the regular meats in terms of iron content and are only outdone by liver. So, it’s time to add some stir fried squid to your weekly menu.

  • Clams, canned, drained solids: 28 mg / 100g
  • Clams, cooked: 28 mg / 100g
  • Fish caviar, black and red: 12 mg / 100g
  • Cuttlefish, cooked: 11 mg / 100g
  • Octopus, cooked: 10 mg / 100g
  • Oyster, medium sized, cooked: 10 mg / 100g
  • Anchovy, canned in oil: 5 mg / 100g
  • Shrimp, cooked: 3 mg / 100g
  • Sardine, canned in oil: 3 mg / 100g
  • Mackerel, cooked: 2 mg / 100g

Vegetables

Vegetables are an essential part of your diet, full of essential nutrients and most people don’t eat enough of them, but when it comes to Iron most vegetables are not too hot. If you choose your vegetables carefully then can use vegetables to help you boost your iron levels, especially if you include some iron absorption enhancers in your diet as the non-heme iron in vegetables is not easily absorbed by your body. Vegetables in the Top 50 Iron Rich Foods include various beans, potato skins, tomatoes and green leafy vegetables like spinach, chard and parsley. Chili con carne, which combines meat, kidney beans and tomato sauce, makes an excellent Iron Rich Recipe, but so does a white bean salad with plenty of fresh parsley and light vinaigrette.

  • Mushrooms, morel, raw: 12 mg / cup
  • Tomatoes, sun-dried: 5 mg / cup
  • Potato skins, baked: 4 mg / skin
  • Parsley, raw: 4 mg / cup
  • Soybeans, boiled: 9 mg / cup
  • Spinach, boiled, drained: 6 mg / cup
  • Tomato sauce, canned: 9 mg / cup
  • Lentils, boiled: 7 mg / cup
  • Hearts of palm, canned: 5 mg / cup
  • White Beans, canned: 8 mg / cup
  • Kidney beans, boiled: 5 mg / cup
  • Chickpeas, boiled: 5 mg / cup
  • Pinto Beans, frozen, boiled: 3 mg / cup
  • Lima beans, boiled: 4 mg / cup
  • Hummus, commercial: 6 mg / cup
  • Swiss Chard, boiled, chopped: 4 mg / cup
  • Asparagus, canned: 4 mg / cup
  • Chickpeas, canned: 3 mg / cup
  • Tomatoes, canned: 3 mg / cup
  • Sweet potato, canned, mashed: 3 mg / cup
  • Endive, raw: 4 mg / head

Nuts and Seeds

Nuts and seeds are great Iron Rich Foods in that they have a pretty high iron content and are so versatile that you can eat them in many ways. A quick snack on some cashew nuts is filling, healthy and gives plenty of iron – tasty too! Pumpkin seeds and sunflower seeds can be easily toasted and added to a salad for a nice crunch and an iron boost. Sesame seeds are used in a variety of Asian dishes and all of these can be used in baking or as a quick addition to your breakfast cereal. Just make sure you always have some in the house and you’ll soon find many ways to add them into your day-to-day food.

  • Sesame seeds, whole, dried: 21 mg/cup
  • Pumpkin seeds and squash seed kernels, dried: 11 mg/cup
  • Sunflower seed kernels, toasted: 9 mg/cup
  • Cashew nuts, dry roasted, halves and whole: 8 mg/cup
  • Pistachio nuts, dry roasted: 5 mg/cup
  • Almonds, whole kernels, blanched: 5 mg/cup

Fruit

Fresh fruit is not rich in Iron, but dried fruit like apricots, peaches or prunes are great Iron Rich Snacks to eat in between meals or to add to various recipes. The one thing you must remember about fresh fruit is that most of it contains a lot of Vitamin C and since Vitamin is an Iron Absorption Enhancer eating fresh fruit or vegetables high in Vitamin C with your meal can greatly boost the amount of iron your body actually absorbs.

  • Apricots, dehydrated low-moisture: 8 mg/cup
  • Peaches, dehydrated low-moisture: 6 mg/cup
  • Prunes, dehydrated low-moisture: 5 mg/cup
  • Olives, canned jumbo: 0.3 mg / olive
  • Currants, dried: 5 mg/cup
  • Apricots, dried, sulfured, uncooked: 4 mg/cup
  • Blueberries, canned: 7 mg/cup

Iron Rich Snacks

Apart from the nuts and dried fruit there are quick and easy Iron Rich Snacks which you can simply buy in the supermarket and use as a instant Iron Booster. Below or some examples, but if you’re planning to buy some bars or drinks then you need to remember to check the nutrition labels on the actual products you buy as the actual Iron content can vary greatly from brand to brand and even from product to product within the same brand.

  • Nestle Supligen, canned supplement drink 9 mg / can
  • Snickers Marathon Honey Nut Oat Bar: 8 mg / bar
  • Snickers Marathon Double Chocolate Nut Bar 8 mg / bar
  • Snickers Marathon Multigrain Crunch Bar: 8 mg / bar
  • Pretzels, soft: 6 mg / large
  • Trail mix, regular: 3 mg / cup

Eggs:

Dairy products are not high in Iron, but do contain a lot of calcium and calcium has been known to act as a Iron Absorption Inhibitor so you should try and eat calcium rich foods separate from your Iron Rich Foods as much as possible. Eggs are not too high in Iron, but egg yolks are not too bad and if you can find fresh goose eggs they could be used in a great Iron Rich Breakfast!

  • Goose Egg, whole: 5 mg / egg
  • Egg yolk, raw: 7 mg iron / cup
  • Egg, scrambled: 3 mg iron / cup

The Importance of Physical Fitness

In its most general meaning, physical fitness is a general state of good physical health. Obtaining and maintaining physical fitness is a result of physical activity, proper diet and nutrition and of course proper rest for physical recovery. In its simplest terms, physical fitness is to the human body what fine-tuning is to an engine. It enables people to perform up to their potential. Regardless of age, fitness can be described as a condition that helps individuals look, feel and do their best. Thus, physical fitness trainers, describe it as the ability to perform daily tasks vigorously and alertly, with left over energy to enjoy leisure-time activities and meet emergency demands. Specifically true for senior citizens, physical fitness is the ability to endure, bear up, withstand stress and carry on in circumstances where an unfit person could not continue.

In order for one to be considered physically fit, the heart, lungs, and muscles have to perform at a certain level for the individual to continue feeling capable of performing an activity. At the same time, since what humans do with their bodies directly affects the state of mind, fitness influences to some degree qualities such as mental alertness and emotional expression.

Physical fitness is often divided into the following categories in order for people to be able examine its components or parts. Particularly, physical fitness is judged by:

1. Cardiovascular endurance: This is the ability of the body to deliver oxygen and nutrients to tissues and to remove wastes over sustained periods of time.

2. Muscular strength & endurance: Strength deals with the ability of the muscle to exert force for a brief time period, while endurance is the ability of a muscle, or group of muscles, to sustain repeated contractions or to continue to apply force against an inert object.

3. Flexibility: This denotes the ability to move joints and use muscles through their full range of motion.

4. Body composition: Considered as one of the components of fitness, composition refers to the body in terms of lean mass (muscle, bone, vital tissue, and organs) and fat mass. Actually, the optimal ratio of fat to lean mass is an indication of fitness. Performing the right set of exercises can help people get rid off body fat and increase or maintain muscle mass.

Foodservice and Restaurant Merchandising 101

Visual food merchandising is one of the hottest trends in the restaurant, foodservice and hospitality industry today, which is the fine art of presenting your products in a way that gets your customers to buy, as well as bringing your products to life with eye-catching displays of freshness, color, quality and abundance.

A great food merchandising program paired with cross-merchandising strategies will help to increase your restaurant or foodservice operations’ sales significantly, as well as boost customer satisfaction and return business.

The benefits of eye-catching food merchandising displays and cross- merchandising techniques are immediate. Sales will increase between 15 percent to 300 percent if you have done a proper job with your merchandising program Your staff’s morale will also be raised from the improved surroundings and satisfied customers.

Running a foodservice operation takes much more than just displaying the usual information like the “daily special”. As an operator, you must consider what will lure your customers into your operation in the first place. Here are some basic merchandising rules and tips to follow:

1. Make it look appetizing

You should build your food displays so that customers can see them from all angles of your facility. Use nothing but the freshest ingredients and colorful food items to catch their attention. Display your food items using uniquely shaped plates and dishes with different textures. Use terra cotta and other environmentally conscious colors, and incorporate natural wood and bamboo to create a more modern, clean and sleek image.

For example, the addition of a simple, thick, wooden board placed inside a standard glass display unit for sandwiches emphasizes to customers that the sandwiches have just been freshly made. Without the board, the sandwiches look start and naked, and allows customers to wonder how long they have been sitting there, since a glass and steel display unit tends to evoke a sense of coldness and emptiness. The cutting board helps to add warmth and life to the display unit.

2. Place products on a slant and use color

Food is always displayed better when placed on a slant and not lying flat. Show your customers your products! Tilted European-style wooden racks are a great merchandising tool to display breads, pies, pastries, and other products, creating an inviting display to tempt your customers to buy.

Color is one of the most important factors when dealing with food displays. Many food products tend to come from the brown and beige palettes, so is necessary to brighten up your operation with greens, reds, oranges and yellows, to also create a fresh and healthy look. Consider looking at what items you might already have on hand in your kitchen, pantry and stockrooms that might add mouthwatering color and substance to your display.

3. Use cross-merchandising techniques to use higher sales

For cafeterias and market-style operations, cross-merchandising is an excellent opportunity to upsell by placing the right foods together. Soups, sandwiches and potato chips should be placed in the same area, while coffee and tea should be served right next to desserts. Side orders and salads could be split. For example, small containers of salad could be packaged and placed on ice next to the grill, as well as stationed next to the sandwiches. Also try different varieties of cream cheese next to bagels, or fresh fruit and whipped cream next to cake and ice cream. Coffee and tea is a great partner to bakery items. Sales of beautifully packaged coffee will soar when placed next to bakery items.

4. Use the cash-wrap area

The cash-wrap area is prime real estate for merchandising. Proper merchandising of additional retail products at the cash-wrap area will help you increase average checks. Use your cash-wrap area for last minute sales of coffee, soda, desserts, candies and chocolate bars, and create an irresistible display of goods that customers cannot refuse.

5. Proper signage points the way to increased revenues

Proper signage can help you tell customers what you need to tell them when you are unable to offer them personal attention. It is very important to be clean, concise and to the point when designing the signage for your operation. Make it as easy as possible for customers to purchase food items by providing proper signage that inform your customers about your products so they will buy them. Signage can be displayed in all shapes and sizes, and should be used accordingly. Use branded mini cards to label and price your products, and write short descriptions of the item detailing the ingredients you used or your cooking method. If you insist on handwriting your signs, be sure to make them legible and graphically appealing.

Heart Disease – What Is The Difference Between Organic Heart Disease And Degenerative Heart Disease?

Although Heart Disease is the main cause of death in the Western World it is amazing how little the general public actually know about it.

For example very few people realize that there isn’t just one type of Heart Disease. In fact there are at least ten different types and these fall into two distinct categories – Organic and Degenerative.

The major difference between Organic and Degenerative Heart Disease is their causes.

Organic refers to a situation where the organ (the heart) is damaged by a specific event. This can also be referred to as “acute”, which simply means that it happened suddenly or over a short period of time. Degenerative Heart Disease (sometimes referred to as “chronic”) is caused by gradual deterioration over a long period of time.

There are two types of Organic H.D. – Congenital and Rheumatic .

Defects that occur at birth are classed as Congenital Heart Disease. These may affect the heart itself : it may not have developed normally during pregnancy, the wall of the heart may be damaged (hole in the heart), or the blood vessels may be underdeveloped. These defects may be hereditary or more likely have been caused by external factors such as drugs or infection during pregnancy. They are normally diagnosed at birth or in early childhood but it is not uncommon for the symptoms to occur for the first time in adulthood..

Rheumatic Heart Disease can be the result of a bout of rheumatic fever. Occurrences have decreased considerably due to the use of antibiotics to treat rheumatic fever.

There are at least eight specific diseases, which fall into the category of Degenerative Heart Disease. The common factors within this category are that the disease has progressed gradually and that there is no specific event that has caused it.

The vast majority of people who are diagnosed with Heart Disease have some form of degenerative heart disease. This is the form of disease that is the target of the awareness campaigns and is the type that we can help to prevent by our lifestyles choices.

Nursing Informatics – Integrating Health Care With Information Technology

What is Nursing Informatics?

Nursing Informatics is the integration of clinical nursing with information management and computer processes. It is a relatively new focus in health care that combines nursing skills with information technology expertise. Nurse informatics specialists manage and communicate nursing data and information to improve decision making by consumers, patients, nurses and other health care providers.

The nursing process has four main steps: planning, implementation, evaluation, and assessment. However, because information management is integrated into the nursing process and practice, some nursing communities identify a fifth step in the nursing process: documentation. Documentation and patient-centered care are the core components of the nursing process. Automated documentation is vitally important, not just for nursing, but for all patient care. Up-to-date, accurate information at each step of the nursing process is the key to safe, high quality patient-centered care.

The successful implementation of information systems in nursing and health care requires the following: First, it is necessary to have well designed systems that support the nursing process within the culture of an organization. The second requirement is having the acceptance and integration of information systems into the regular workflow of the nursing process and patient care. Finally, it is important to have resources that can support the previously mentioned factors. One of the most effective and valuable resources a healthcare organization can add is a Nurse informatics specialists.

Nursing Informatics Specialists

Nursing Informatics Specialists are expert clinicians with an extensive clinical practice background. These individuals have experience in utilizing and implementing the nursing process. These nurses have excellent analytical and critical thinking skills. They also understand the patient care delivery workflow and integration points for automated documentation. Having additional education and experience with information systems is also important for this occupation. Finally, Nursing Informaticists are excellent project managers because of the similarity between the project management process and the nursing process.

To be competitive in this field one should become familiar with relational databases by taking a class about database structure. They should also become competent and comfortable with MS Office, especially Excel, Access and Visio.

Why these jobs are Important to Healthcare?

Nurse and health informatics bring a great deal of value to patients and the health care system. Some examples of how they provide value include:

  • Provide Support to the nursing work processes using technology
  • Increasing the accuracy and completeness of nursing documentation
  • Improving the nurse’s workflow
  • Automating the collection and reuse of nursing data
  • Facilitating analysis of clinical data
  • Providing nursing content to standardized languages

HIMSS and RHIO

To provide some background on the field of healthcare/nursing informatics, there are some governing bodies for this field. The Healthcare Information and Management Systems Society (HIMSS) is the main governing body for health care and nursing informatics professionals. This group, formed in 2004, has the following four goals: NI awareness, education, resources (including websites), and RHIO (Regional Health Information Organization).

RHIOs are also known as Community Health Information Networks (CHINs). These are the networks that connect physicians, hospitals, laboratories, radiology centers and insurance companies.They all share and transmit patient information electronically through a secure system. Those organizations that are a part of RHIOs have a business interest in improving the quality of healthcare being administered.

Steps to a Job in This Field

To enter into the nursing informatics field, typically you need a minimum of a four year degree. There are specific health informatics degrees available. Earning your Bachelor’s of Science in Nursing (BSN) is also a requirement before sitting for the ANCC certifications test for Nursing Informatics. Some individuals start with just a two year degree or diploma, but continue on to earn their BSN before becoming certified. Although there are several different routes for getting into the field, the most favored manner is to earn a Master’s in Nursing Informatics from the start, however, most individuals start their career prior to earning their master’s degree.

Most nurses who are in the informatics field start in a specialty area, such as the Intensive Care Unit (ICU), Perioperative Services (OR), Med-Surg, Orthopedic Nursing, or Oncology, just to name a few, and work in that specialty field for an extended period. Working in a specialty area helps nurses get to know the normal working processes and routines as well as understand the patient care process in their specialty. They usually are experts at their specialty and then develop interests in computerized documentation or some other technological healthcare focus. They then tend to gradually move into an information systems clinical support role.

If you have an interest in nursing and technology, this might be a career that can match both of these skills into one rewarding job.