scholarly journals Neighborhood environment: the impact of alcohol and tobacco outlets availability on health of people living in a certain area

2021 ◽  
Vol 20 (6) ◽  
pp. 2959
Author(s):  
A. A. Antsiferova ◽  
A. V. Kontsevaya ◽  
D. K. Mukaneeva ◽  
O. M. Drapkina
Keyword(s):  
Risk Factors ◽  
Road Traffic ◽  
Significant Risk ◽  
Drunk Driving ◽  
High Density ◽  
Neighborhood Environment ◽  
Noncommunicable Diseases ◽  
Intersectoral Collaboration ◽  
Smoking Intensity ◽  
The Impact

Alcohol and tobacco consumption remain significant risk factors (RFs) for morbidity and mortality from noncommunicable diseases (NCDs), including cardiovascular ones, in Russia. The main risk factors contributing to NCDs in addition to traditional risk factors and lifestyle also include the neighborhood environment (NE). The term “neighborhood environment” describes the relationship between the area in immediate vicinity of a person's place of residence, environmental factors, social characteristics of the area, which can have both positive and negative effects on human health.The aim of this review was to analyze alcohol and tobacco outlets availability as a factor effecting health of people living in a certain area.It was demonstrated that a high density of alcohol outlets is associated with increased alcohol consumption among both adults and adolescents, with drunk driving and road traffic accidents, injuries, violent crimes, the risk of acute and chronic diseases. A high density of tobacco outlets is associated with an increase in smoking intensity among both adults and adolescents, as well as an increase of secondhand smoke, which increases the risk of NCDs.The consumption of alcohol and tobacco is associated with a significant increase in risk of NCDs, including cardiovascular ones, and injuries, leading to disability and death. The effectiveness of measures aimed at reducing the consumption of alcohol and tobacco may be reduced due to high density of outlets selling these products. It is necessary to conduct studies aimed at assessing the outlets density and its associations with prevalence of RFs and health status of Russian population. These data will stimulate intersectoral collaboration for planning health protection strategy at municipal level.

scholarly journals The impact of socio-demographic factors on the survival of cancer patients in Zimbabwe

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Idika E. Okorie ◽  
Ricardo Moyo ◽  
Saralees Nadarajah
Keyword(s):  
Risk Factors ◽  
Survival Analysis ◽  
Marital Status ◽  
Cancer Patients ◽  
Hazard Rate ◽  
Significant Risk ◽  
Demographic Factors ◽  
Female Cancer Patients ◽  
Socio Demographic Factors ◽  
The Impact

AbstractWe provide a survival analysis of cancer patients in Zimbabwe. Our results show that young cancer patients have lower but not significant hazard rate compared to old cancer patients. Male cancer patients have lower but not significant hazard rate compared to female cancer patients. Race and marital status are significant risk factors for cancer patients in Zimbabwe.

scholarly journals Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 105
Author(s):  
Jatapat Hemapanpairoa ◽  
Dhitiwat Changpradub ◽  
Sudaluck Thunyaharn ◽  
Wichai Santimaleeworagun
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Proportional Hazards Model ◽  
Significant Risk ◽  
Vancomycin Resistance ◽  
Cox Proportional Hazards Model ◽  
Factors Associated ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
The Impact

The prevalence of enterococcal infection, especially E. faecium, is increasing, and the issue of the impact of vancomycin resistance on clinical outcomes is controversial. This study aimed to investigate the clinical outcomes of infection caused by E. faecium and determine the risk factors associated with mortality. This retrospective study was performed at the Phramongkutklao Hospital during the period from 2014 to 2018. One hundred and forty-five patients with E. faecium infections were enrolled. The 30-day and 90-day mortality rates of patients infected with vancomycin resistant (VR)-E. faecium vs. vancomycin susceptible (VS)-E. faecium were 57.7% vs. 38.7% and 69.2% vs. 47.1%, respectively. The median length of hospitalization was significantly longer in patients with VR-E. faecium infection. In logistic regression analysis, VR-E. faecium, Sequential Organ Failure Assessment (SOFA) scores, and bone and joint infections were significant risk factors associated with both 30-day and 90-day mortality. Moreover, Cox proportional hazards model showed that VR-E. faecium infection (HR 1.91; 95%CI 1.09–3.37), SOFA scores of 6–9 points (HR 2.69; 95%CI 1.15–6.29), SOFA scores ≥ 10 points (HR 3.71; 95%CI 1.70–8.13), and bone and joint infections (HR 0.08; 95%CI 0.01–0.62) were significant risk factors for mortality. In conclusion, the present study confirmed the impact of VR-E. faecium infection on mortality and hospitalization duration. Thus, the appropriate antibiotic regimen for VR-E. faecium infection, especially for severely ill patients, is an effective strategy for improving treatment outcomes.

scholarly journals Cisplatin Ototoxicity: Examination of the Impact of Dosing, Infusion Times, and Schedules In Pediatric Cancer Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Miranda L. Camet ◽  
Anne Spence ◽  
Susan S. Hayashi ◽  
Ningying Wu ◽  
Jennifer Henry ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Model Building ◽  
Significant Risk ◽  
The Body ◽  
Sensorineural Hearing ◽  
Cycle Number ◽  
Pediatric Cancer Patients ◽  
The Impact

BackgroundSensorineural hearing loss is a well-known side effect of cisplatin (CDDP). There is limited research on the effect of dosing, infusion times, and schedules of cisplatin administration and their impact on hearing loss.MethodsA retrospective review of 993 pediatric patients’ medical and audiological charts from August 1990 to March 2015 was conducted using stringent inclusion criteria to characterize patients with hearing loss. 248 of these patients received CDDP. Of these, 216 patients had sufficient CDDP infusion data to assess for sensorineural hearing loss attributable to CDDP and its associated risk factors. Chart reviews were performed to extract clinical data including CDDP dosing information. Demographic and clinical characteristics were summarized by descriptive statistics, and univariate and multivariate logistic regressions were performed to examine the relationship between hearing loss and specific parameters of cisplatin administration (amount infused per dose, prescribed infusion time, total number of doses, number of doses per cycle, number of cycles, cumulative cisplatin exposure). Stepwise variable selection procedure was performed in the multivariate model building to extract the best subset of risk factors for the prediction of hearing loss and worsening ototoxicity grade using an established ototoxicity grading scale from the International Society of Pediatric Oncology (SIOP).ResultsA total of 153 patients with complete medical and audiologic data were evaluable for analysis. Hearing loss was identified in 72.6% of the patients. Multivariate analysis revealed that age [OR=0.90 (0.84-0.97), p-value=0.0086], radiation to any part of the body, [OR=3.20 (1.29-7.93), p-value=0.012], amount infused per dose (mg/m2) [OR=1.018 (1.002-1.033), p-value=0.029], and cumulative cisplatin exposure (mg/m 2) [OR=1.004 (1-1.008), p-value=0.027] were associated with hearing loss. Similar associations were also found between these risk factors and worsening SIOP grade.ConclusionIn one of the largest studies examining the influence of CDDP dosing and schedules on hearing loss, we found the amount of CDDP infused per dose is a significant risk factor. Considerations in designing regimens that reduce the amount of CDDP infused per dose may reduce the risk of hearing loss. Randomized prospective trials are needed.

Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Acquisition in Roommate Contacts of Patients Colonized or Infected With MRSA in an Acute-Care Hospital

2008 ◽  
Vol 29 (7) ◽  
pp. 600-606 ◽  
Author(s):  
Christine Moore ◽  
Jastej Dhaliwal ◽  
Agnes Tong ◽  
Sarah Eden ◽  
Cindi Wigston ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Acute Care ◽  
Significant Risk ◽  
Acute Care Hospital ◽  
Skin Lesions ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
The Impact

Objective.To identify risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in patients exposed to an MRSA-colonized roommate.Design.Retrospective cohort study.Setting.A 472-bed acute-care teaching hospital in Toronto, Canada.Patients.Inpatients who shared a room between 1996 and 2004 with a patient who had unrecognized MRSA colonization.Methods.Exposed roommates were identified from infection-control logs and from results of screening for MRSA in the microbiology database. Completed follow-up was defined as completion of at least 2 sets of screening cultures (swab samples from the nares, the rectum, and skin lesions), with at least 1 set of samples obtained 7–10 days after the last exposure. Chart reviews were performed to compare those who did and did not become colonized with MRSA.Results.Of 326 roommates, 198 (61.7%) had completed follow-up, and 25 (12.6%) acquired MRSA by day 7–10 after exposure was recognized, all with strains indistinguishable by pulsed-field gel electrophoresis from those of their roommate. Two (2%) of 101 patients were not colonized at day 7–10 but, with subsequent testing, were identified as being colonized with the same strain as their roommate (one at day 16 and one at day 18 after exposure). A history of alcohol abuse (odds ratio [OR], 9.8 [95% confidence limits {CLs}, 1.8, 53]), exposure to a patient with nosocomially acquired MRSA (OR, 20 [95% CLs, 2.4,171]), increasing care dependency (OR per activity of daily living, 1.7 [95% CLs, 1.1, 2.7]), and having received levofloxacin (OR, 3.6 [95% CLs, 1.1,12]) were associated with MRSA acquisition.Conclusions.Roommates of patients with MRSA are at significant risk for becoming colonized. Further study is needed of the impact of hospital antimicrobial formulary decisions on the risk of acquisition of MRSA.

scholarly journals Systematic literature review of risk factors for cervical cancer in the Chinese population

2018 ◽  
Vol 14 ◽  
pp. 174550651881659 ◽  
Author(s):  
Xiao Li ◽  
Shang Ying Hu ◽  
Yunkun He ◽  
Leyla Hernandez Donoso ◽  
Kelly Qiao Qu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Chinese Population ◽  
Eastern China ◽  
Significant Risk ◽  
China National Knowledge Infrastructure ◽  
The Impact

Objectives: Human papillomavirus is the necessary cause of cervical cancer, in particular the human papillomavirus-16/18 strains, which have been detected in ~70% of all cervical cancer cases worldwide. This study aims to assess whether other cofactors, which might be specific for the Chinese population, are involved in the development of cervical cancer. These findings may support the future direction of cervical cancer prevention. Study Design: Systematic literature review. Methods: The following databases were searched: MEDLINE, MEDLINE-IN-PROCESS, EMBASE, China National Knowledge Infrastructure, Wanfang Data and Chongqing VIP Information. The target population were adolescents or adults from mainland China. All observational studies irrespective of intervention or comparator reporting risk factors for cervical cancer were included. The Newcastle-Ottawa Scale was used to assess study quality. The impact of each outcome was reported in numerical terms. Results: A total of 2,676 articles were screened. A total of 21 articles met the inclusion criteria. All studies were case-controlled designs mostly conducted in hospitals of South-Eastern China. A total of 18 studies reported lifestyle behaviours as significant influencing factors in the development of cervical cancer. Sexual behaviour, gestational factors, screening history, disease history and socio-demographics status were reported as significant risk factors for cervical cancer development. Conclusion: This review provides an up-to-date insight of current cervical cancer risk factors in China. Due to the heterogeneity of the results, further evaluation is recommended to determine the association of these risk factors to the overall risk of cervical cancer.

scholarly journals TP6.1.4 Risk factors for post-cholecystectomy bile duct injuries: Systematic review and meta-analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rowan Burns ◽  
Katie Connor ◽  
Ahmed Sherif ◽  
Stephen Wigmore
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Meta Analysis ◽  
Grey Literature ◽  
Significant Risk ◽  
Major Complication ◽  
Male Gender ◽  
Significant Heterogeneity ◽  
The Impact ◽  
Emergent Surgery

Abstract Aims Bile duct injury (BDI) is a major complication of cholecystectomy resulting in long-term consequences. The relatively low incidence (0.23% – 1.5%) of BDI makes the identification of risk factors challenging. The aim of this study was to systematically analyse available literature on BDI post-cholecystectomy to provide an update on the incidence and determine current risk factors. Methods The study was pre-registered on PROSPERO (CRD42020177318). A search was conducted of MEDLINE, EMBASE, Scopus, Cochrane Central, Web of Science databases and the grey literature from inception to February 2020. 1583 unique papers were identified and screened for eligibility. English language, retrospective and prospective studies were included where the population age was > 16 and underwent cholecystectomy. Results Outcomes analysed were incidence of BDI and risk estimates for possible risk factors. 30 studies (6,420,667 patients) were included in the meta-analysis. Gender, BMI>30, acute cholecystitis (AC), emergent surgery, the operative approach, intraoperative cholangiography (IOC) and the impact of surgeon’s experience were analysed. Male gender and AC were determined to be statistically significant risk factors (OR 1.25 (1.13-1.39)) and 1.74 (1.27-2.39) respectively). Furthermore, IOC use was found to be significantly associated with BDI risk (OR 1.27 (1.17 – 1.37), while BMI>30, open surgical approach, emergent surgery and surgeon’s experience were not statistically significant; however, significant heterogeneity among included studies limited the interpretation of these factors. Conclusion Male gender and AC were found to be predictors of BDI, while better quality evidence is needed to show the effect of other factors.

scholarly journals Epidemiology, risk factors and outcomes of bloodstream infection caused by ESKAPEEc pathogens among hospitalized children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoshan Peng ◽  
Wei Zhou ◽  
Yu Zhu ◽  
Chaomin Wan
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Bloodstream Infection ◽  
Pediatric Population ◽  
Significant Risk ◽  
University Hospital ◽  
Hospitalized Children ◽  
Previous Surgery ◽  
Significant Difference ◽  
The Impact

Abstract Background Bloodstream infection (BSI) resulting from ESKAPEEc pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp) is relevant to high mortality and economic cost. Data concerning the impact of BSI due to ESKAPEEc in pediatric population was virtually scant. Our purpose was to summarize the epidemiology, risk factors and outcomes of ESKAPEEc BSI among hospitalized children. Methods Inpatients diagnosed with BSI with definite etiology between January 2016 and December 2018 were enrolled retrospectively at the West China Second University Hospital. Data were systematically reviewed on patients’ clinical characteristics and laboratory findings to ascertain independent predictors, clinical features and outcomes. Results Of the 228 patients with BSI, 174 (76.3%) were caused by ESKAPEEc (124 MDR-ESKAPEEc). Multivariate analysis demonstrated that premature and/ or low birth weight (odds ratio [OR] = 2.981, P = 0.036), previous surgery and/or trauma (OR = 5.71, P = 0.029) and source of urinary tract infection (OR = 10.60, P = 0.004) were independently associated with ESKAPEEc BSI. The independent risk factor for MRD-ESKAPEEc BSI was nosocomial infection (OR = 3.314, P = 0.037). The overall mortality rate in patients with ESKAPEEc BSI was 14.4% (25/174), and no significant difference was ascertained in mortality between MRD-ESKAPEEc and non-MRD ESKAPEEc BSI groups (13.7% vs. 11.4%, P = 0.692). In addition, previous surgery and/or trauma, thrombocytopenia, and mechanical ventilation were significant risk factors for mortality caused by ESKAPEEc BSI. Conclusions More than two-thirds of BSI among hospitalized children were caused by ESKAPEEc. Previous surgery and/or trauma, thrombocytopenia and mechanical ventilation increased the risk rate for mortality in ESKAPEEc BSI. The risk factors ascertained could assist physicians to early suspect ESKAPEEc BSI and MDR ESKAPEEc BSI.

scholarly journals Influence of Tumor Thrombus on Occurrence of Distant Venous Thromboembolism and Survival in Patients With Renal Cell Carcinoma After Surgery

2019 ◽  
Vol 25 ◽  
pp. 107602961882328 ◽  
Author(s):  
Hyunkyung Park ◽  
Chang Wook Jeong ◽  
Hyeongdong Yuk ◽  
Ja Hyeon Ku ◽  
Hyeon Hoe Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Cell Carcinoma ◽  
Venous Thromboembolism ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Tumor Thrombus ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Increased Risk ◽  
The Impact

Tumor thrombus is a unique characteristic of renal cell carcinoma (RCC). However, only a few studies have reported its clinical influence on the occurrence of venous thromboembolism (VTE). This study aimed to clarify the influence of tumor thrombus and other risk factors for VTE and to elucidate the impact of tumor thrombus on survival outcomes. We retrospectively reviewed data from patients with RCC who underwent radical or partial nephrectomy from September 1999 to August 2015 at Seoul National University Hospital. A total of 2762 patients were enrolled. The 1- and 5-year cumulative incidences of VTE were 0.5% ± 0.1% and 1.5% ± 0.3%, respectively. During a median follow-up of 39.0 months (95% confidence interval [CI], 37.1-41.0 months), deep vein thrombosis occurred in 13 patients and pulmonary embolism in 15 patients. Patients with tumor thrombus (diagnosed by surgical pathology findings) had a significantly higher incidence of VTE than those without thrombus (odds radio 8.160, 95% CI, 1.480-45.004). Older age (≥60 years) and higher preoperative C-reactive protein (>0.5 mg/dL) were also significant risk factors for VTE. Additionally, tumor thrombus was independently associated with worse progression-free survival (PFS) but not with overall survival (OS) in multivariable analysis (hazard ratio [HR] 1.916, 95% CI, 1.295-2.834 for PFS; HR 1.164, 95% CI, 0.755-1.793 for OS). In conclusion, the incidence of VTE was relatively low in patients who underwent surgery for RCC. Nevertheless, patients with tumor thrombus had an increased risk of VTE and should be closely monitored for VTE.

Early signs of airflow restriction and cardiovascular damage in conditionally healthy smokers

2021 ◽  
Vol 31 (1) ◽  
pp. 57-65
Author(s):  
V. A. Nevzorova ◽  
E. A. Kondrashova ◽  
D. Yu. Bogdanov ◽  
Zh. V. Bondareva
Keyword(s):  
Risk Factors ◽  
Left Ventricle ◽  
Longitudinal Strain ◽  
Myocardial Dysfunction ◽  
Blood Pressure Measurement ◽  
Myocardial Damage ◽  
Combustion Products ◽  
Noncommunicable Diseases ◽  
Smoking Intensity ◽  
Brachiocephalic Arteries

Tobacco smoking is one of the most widespread and at the same time difficult to control risk factors for chronic noncommunicable diseases, which make the most significant contribution to the mortality. Smoking intensity, development of airflow restrictions, and damage to vascular endothelium are connected to the accelerated development of atherosclerosis. At the same time, there is no evidence of a possible relationship between the development of myocardial dysfunction and exposure to tobacco combustion products. It is of interest to study the incidence of airflow restrictions, arterial hypertension, and markers of early damage to target organs - the brachiocephalic arteries (BCA) and myocardium, in so-called relatively healthy smoking individuals. The aim of the study was to describe the incidence of airflow restrictions, hypertension, the state of the brachiocephalic arteries, and indicators of global and regional longitudinal strain of the left ventricle (GLSLV and RLSLV) in actively smoking conditionally healthy individuals. Methods. 100 active smokers were examined (smoking person index or ICH > 10 (17 ± 2 packs/year)) at the mean age of 48,80± 0,68years. 55% of the patients were male. The diagnosis of COPD was made based on spirometry values before and after the test with bronchodilators (400 mcg of salbutamol) (FEV1/FVC < 70% and FEV1 increase <12% of the initial values). Blood pressure measurement, duplex scanning of brachiocephalic arteries, transthoracic echocardiography with GLSLV and RLSLV with 17-segment division by Strain method were performed in all patients. Results. COPD was diagnosed in 35% of the patients, hypertension - in 45%. Evaluation of BCA showed increased thickness of intimamedia complex in the patients with hypertension (р= 0.002) and a significantly higher degree of stenosis and number of plaques in patients with concomitant COPD and hypertension. Type 1 diastolic dysfunction of LV was detected both in patients with hypertension and in the patients with COPD, but it was most common in the patients with concomitant COPD and hypertension. The GLSLV values did not change in all patients, but the RLSLV values depended on the segment (basal, medial, apical) and were significantly lower in the patients with concomitant COPD and hypertension. Conclusion. Tobacco combustion products not only are risk factors of airflow restriction and systemic vascular dysfunction, but also cause preclinical myocardial damage, a marker of which is a violation of the longitudinal strain of the left ventricle.

Abstract 1316: Preclinical Atherosclerosis in Primary Antiphospholipid Syndrome: The Impact of Oxidative Properties of High Density Lipopoprotein

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Marietta Charakida ◽  
Julian Halcox ◽  
Joanna Batuca ◽  
Ann Donald ◽  
Shirish Sangle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Arterial Stiffness ◽  
Systolic Blood Pressure ◽  
Cardiovascular Risk Factors ◽  
Antiphospholipid Syndrome ◽  
High Density ◽  
Primary Antiphospholipid Syndrome ◽  
The Impact

Background: Antiphospholipid syndrome (APS) is characterised by increased thrombogenicity and/or pregnancy morbidity in the presence of raised levels of antiphospholipid antibodies (aPL). Increased oxidative properties of high density lipoprotein (HDL)(decreased activity of paraoxonase (PON)) is associated with increased risk for atherosclerosis and has been described in APS. The impact of PON on atherosclerotic disease progression in APS is unclear. We therefore examined the effect of PON on intima media thickness (IMT), and pulse wave velocity (PWV) in patients with positive aPL. Methods: We studied 77 women with positive aPL (aPL) aged 46.6±1.2 yrs (mean±SE) and a control group of 77 women aged 47.5±1.2 yrs matched for traditional cardiovascular risk factors. High resolution ultrasound was used to determine carotid IMT. Arterial stiffness was assessed non-invasively by carotid-radial PWV. PON activity was assessed by measuring p-nitrophenol formation and activity expressed as nmoles p-nitrophenol/ml serum/minute. Results: APL patients had significantly increased IMT and PWV compared to controls (0.75±0.02mm vs 0.65±0.01mm, p<0.001 and 9.14±0.18 m/s vs 8.56±0.21m/s, p<0.05 respectively). PON activity was significantly reduced in aPL compared to controls (91.5[64.3, 05.1]mmol/ml/min, median[IQR] vs 103.1[80.4, 111.5] mmol/ml/min, p<0.006). Although PON activity was not associated with vascular measures in controls, an inverse association was noted in aPL patients (r=−0.26 [cIMT] and r=−0.23 [PWV], both p<0.05). In multivariate analysis, accounting for cardiovascular risk factors, PON activity (β=−0.42, p<0.001), age (β=0.33, p<0.001) and systolic blood pressure (β=0.24, p<0.05) were independent determinants of cIMT while PON activity (β=−0.32, p<0.01) and systolic blood pressure (β=0.28, p<0.05) remained the only independent predictors of PWV in aPL positive patients. Conclusions: APS is associated with increased arterial stiffness and carotid intimal thickening. Paraoxonase activity is inversely associated with IMT and PWV in ApL positve patients. These findings indicate that oxidative stress may play an important role in the development of atherosclerosis in patients with primary antiphospholipid syndrome.

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