Arbor Day – Love For Our Planet and Those We Hold Close

Arbor Day 2020

Arbor Day – it’s one of those holidays that we don’t take off work for, or exchange gifts. But for our planet, it’s one of the most important holidays of the year. The founder of Arbor Day, Julius Sterling Morton, had a passion for nature, and trees in particular. Originally from New York, Morton settled down in the Midwest, founding this holiday dedicated to trees in Nebraska, the same state A Place At Home was founded. It is estimated that one million trees were planted in Nebraska at the first Arbor Day celebration in 1872.

Impact on our Health and Environment

Trees have a major impact on our environment, and our health. Most people know that trees clean the air. But did you know that each year they remove over 46 million tons of air pollution, just in the United States? In the same amount of time, one mature tree will absorb more than 48 pounds of carbon dioxide from the atmosphere. In exchange, it releases oxygen. It’s no wonder then, that 20 percent of the earth’s oxygen overall is produced in the Amazon Rainforest. And trees don’t just affect our air quality. Studies have shown that just being able to see a tree significantly reduces stress levels and improves quality of life.

Impact on our Heart

Traditionally, people across the world celebrate Arbor Day by planting trees. Not just to be kind to the environment, but to honor loved ones who have passed away. It’s for this reason that Arbor Day, and the Arbor Day Foundation, is near and dear to our hearts. At A Place At Home, trees represent powerful meaning.  Like others, we think of trees as the symbol of the vitality of life, and those that came before us, and those that will carry on after we are gone. It stands for families and ancestors. It stands for strength, stability, and nourishment.

Rooted in Care

For every client we have been honored to care for that passes away, A Place At Home plants trees in their memory. Since 2014, A Place At Home franchise network has planted almost 2,000 trees. Memorials to our clients are growing in Wallowa-Whitman National Forest, Superior National Forest, Chippewa National Forest, Custer-Gallatin National Forest, and Klamath National Forest. Each tree we plant reminds us of how grateful we are to have been touched by the lives of those families and clients.

If you’d like to celebrate this Arbor Day by planting a tree, why not go the extra mile and become a member of the Arbor Day Foundation. First time members get 10 trees free and you can sign up here.

If you or someone you know can benefit from extra support in the home, please reach out to us to see how we can help.

Always Room For More: Amy Dirks

Caregiver of the Month

Caregiver of the month, Amy Dirks, has been a caregiver with A Place At Home for almost three years. She was nominated after going the extra mile to ensure shifts were covered. If she couldn’t do it herself, she made arrangements for someone else to cover them.

Amy has been a caregiver for two decades. After leaving a career as a high school teacher to follow her passion for taking care of others. It’s a passion she comes by honestly. Growing up, her mother was an LPN at a nursing home, taking care of the senior residents there, as well as Amy and her seven siblings. When Amy was 15, her mother’s care extended to encompass Amy’s grandparents, also. 

Like her mother before her, Amy has found herself caring for a family member. She spent two years driving over two hours away from her home each weekend to care for her brother, who has recently passed away after his battle with Lou Gehrig’s Disease. It was important to her brother that anyone caring for him was formally trained to do so. It was important for Amy to be able to care for her brother, so she did the training necessary to become a Certified Nursing Assistant. 

Amy’s sense of responsibility to those in her charge is nothing short of remarkable. When she found out that one of her clients needed care overnight on Easter, Amy was quick to step in, sharing that she couldn’t stand the thought of them laying in bed all night without anyone to attend to their care. Never mind that it was a holiday, and last minute. Amy’s response was, “I’m taking this on myself in case something happens. They come before a lot of my personal needs”.

“Amy is an incredible asset to the A Place At Home family. Not only is she always willing to pick up shifts last minute to help out, but she is always a pleasure to work with. Amy treats all her clients like family and perfectly exemplifies our CARE philosophy.” said Kris Perkins, A Place At Home – Omaha’s Executive Director. 

Amy has a similar regard for A Place At Home, her appreciation for the support she receives from her employer even more evident in the midst of a global pandemic. “I have felt comfortable. Anytime I need something they’re willing to meet me to get supplies. Whatever I need, I know I’m taken care of. I feel that I’m in the right place.” 

Make no mistake, events in today’s world have had an impact on Amy. She’s grateful to still be working, sharing, “COVID-19 impacted me 100%. I can’t go into facilities now so I don’t endanger my clients. I have confidence we are all taking the same precautions to not spread it. It takes everyone to get through this.”

We are grateful for Amy’s dedication to her clients, and for her approach to caregiving, which she says comes from a book she read as a child titled, There’s Always Room for One More, the story of a Scottish man who welcomes anyone in need into his heart and home, regardless of how full his house becomes. Amy feels the same way about her role caring for others: “There’s always room for one more person that needs help to bed at night. No matter what the call is, I do it.”

Interested in becoming a caregiver?

Does Amy’s story resonate with you? Apply for a job with A Place at Home today and join the ranks of essential personnel that are so desperately needed, where they are needed – in the lives and homes of seniors in the Omaha community! Consider becoming a caregiver and apply to join our team today.

Caregiver Studying to be Neurosurgeon: Marcos Lopez

Marcos Lopez was named caregiver of the month for December.

Moving from Grand Island, Nebraska to Omaha in 2017, Marcos began his field of study in neuroscience, minoring in Physics and Chemistry at the University of Nebraska-Omaha.

Marcos’ family doesn’t come from a medical background, but his father did inspire him to always be curious. “He said it’s good to learn a little about everything. He liked to help people. It didn’t matter what it was. He was always trying to help someone else out,” said Marcos.

Since 2018, Marcos has been impacting the lives of our clients by helping them age gracefully in the comfort of their own home. His three years of education have made him a very effective professional caregiver, but it will also aid him in how he approaches his future patients as a Neurosurgeon

“I like all my clients. They say interesting things sometimes and it sticks. I go to classes or other shifts and use what I learn. They also tell me to live my life and enjoy every moment.”

Students in the medical field working as caregivers are perhaps some of the most prepared professionals in the field. Marcos advised his peers to also consider becoming a caregiver. “It’s good to get out there and work anything medical. I know people that haven’t worked in this field and they try to get into med school, and they won’t let them since they don’t have the experience, or they end up not liking the work.”

Balancing a work and class schedule is hard, especially in a challenging program like neuroscience. Marcos said it’s helped him learn to manage his time better. “Med school is not easy. There’s a lot to do but [A Place At Home] is really flexible so I can decide what time I can work and then make sure I get studying done for school.”

Marcos enjoys his job as a caregiver, sharing, “I think that everyone deserves to live their life without an obstacle stopping them. I think its good to be able to help them out so they can live their life.”

Are you a student looking for an opportunity to gain more experience in the healthcare industry? Consider becoming a caregiver and apply to join our team today.

Tips for Seniors Living With Diabetes

Diabetes is a great health concern in America which is why November is National Diabetes Month, a time to bring attention to the disease. According to the Center for Disease Control, over 30 million Americans suffer from diabetes, with 25% of these patients being 65 years or older. Fortunately, seniors living with diabetes can manage the disease. The best approach to combating diabetes is understanding what it is, how to prevent it, and how to treat it.

What is Diabetes?

Diabetes is a condition characterized by high blood glucose levels brought about because the body does not properly process food into energy, and as a result, your blood sugar levels become too high.

The body’s glucose levels are controlled by a hormone called insulin. The pancreas produces insulin. In the case of type 1 diabetes, the pancreas cannot produce enough insulin. Patients suffering from type 1 diabetes are given insulin injections. Approximately 5% of adult diabetes cases are type 1.

Symptoms of Type 1 Diabetes

  • Significant loss of weight
  • A deep hunger
  • Urinating frequently
  • Fatigue
  • Unusual thirst

In Type 2 diabetes, the pancreas either cannot make enough insulin or cannot effectively use what it produces. Type 2 diabetes occurs among people over the age of 40 years. About 95% of adult diabetes cases are type 2.

Symptoms of Type 2 Diabetes

  • Slow-healing wounds
  • Depression
  • Numbness in your feet or hands
  • Blurred vision
  • Confusion
  • Any Diabetes Type 1 Symptoms

Causes and Complications of Diabetes

Studies have linked diabetes to genetics, lifestyle, and aging. The major risk factors for seniors living with diabetes are being overweight and living a sedentary lifestyle. Diabetes is also inherited. All of these risk factors affect people differently.

If not well managed, diabetes can cause serious health conditions. These complications may include:

  • Vision problems
  • Thinning arteries
  • Heart disease
  • Foot complications
  • Kidney problems

Another severe consequence attributed to diabetes is hearing loss. The National Institutes of Health states that hearing loss is common among adults suffering from diabetes compared to those without the condition. Research has linked diabetes with the destruction of the blood vessels and nerves in the inner ear.

Physical Activity and Controlling Diabetes

Suffering from diabetes is not a hindrance to one’s physical activity. Walking 20-30 minutes at least three times a week is enough to improve your body’s utilization of glucose. Additionally, exercise improves cholesterol and blood pressure, burns calories, relieves stress, lowers the risk of stroke and heart disease, and increases your flexibility and strength.

Here are some tips you should practice during an exercise session and always consult a doctor before you engage in any tedious exercise program:

  • Check your glucose levels. Make sure it does not go beyond 300mg/dL. Check these levels before, during, and after engaging in physical activity
  • Eat a snack or fruit, or drink some juice or milk if your glucose levels are under 100mg/d
  • Carry snacks when going for exercises

In some cases, exercise and diet are not sufficient to control diabetes. Oral medication may be required to boost your levels of insulin or assist your body’s potential to use insulin. Also, as you grow older, your body synthesizes less insulin. Therefore, regardless of what drugs you consume, your diet, or how much physical activity you engage in, you may still require insulin injections.

Food Tips For Seniors Living With Diabetes

The American Association of Diabetes recommends the following food tips for adults who are above 55 years old:

  • Substitute fries with fruits and vegetables
  • Start your meals with a salad or broth-based soup
  • Stay away from buffets
  • Eat light desserts
  • Practice the Diabetes Plate Method
  • Use dressings and sauces on the side

Summing it up

The American Association of Diabetes vouches for the following tips for seniors with diabetes:

  • Eat the right foods at the right rations
  • Engage in physical activity
  • Monitor your blood glucose levels
  • Take any prescription given by your doctor
  • Avoid cigarette smoking
  • Gather as much information as you can regarding diabetes

We’re Here to Help

For seniors living with diabetes, and their loved ones, A Place At Home provides customized in-home senior care options. Your health depends on you. If you need additional help contact A Place At Home today!

Resources Available For Family Caregivers

National Family Caregivers Month is a time to recognize the sacrifices made by 90 million Americans providing voluntary care to their loved ones.

The economic value of unpaid caregiving services provided to an adult with limitations was estimated at $470 billion in 2013, according to the AARP. This amount exceeded what was spent on home care and nursing services combined. With nearly one in five United States citizens projected to be 65 years of age or older by the year 2030, the number of family caregivers is only expected to rise.

For the last two decades, Presidents have recognized November as National Family Caregivers Month to honor the millions of selfless Americans who dedicate their time and resources to be a caregiver to a loved one who wishes to remain at home.

The Caregiver Action Network (CAN) is a non-profit organization providing free education, peer support, and resources to family caregivers across the country. Their theme this year is #becarecurious to encourage family caregivers across the country to ask questions, explore options and share in the care decisions that affect the health and well‐being of their loved ones.

There are innumerable sacrifices made by caregivers as they tend to daily tasks such as shopping, food preparation, housekeeping, laundry, transportation, and giving medication. These tasks can expand into dressing, grooming, bathing, researching information on diseases and tending to financial matters.

Caregiving can sometimes get extremely overwhelming and the person providing care can become overworked. They can find it difficult to enjoy their loved one because it all begins to feel like work. Print these 10 helpful tips from CAN for yourself or a caregiver in your life to ensure they continue to mindful of their own health as well. You can also read these self-care tips for caregivers.

A Place at Home: Trust Us for Compassionate Senior Care

At A Place At Home senior care, we know that sometimes you need a break from your caregiving duties. When you find it difficult to juggle work, family, household, and caregiving for a loved one, that’s when we step in. Whether you just need a few hours or 24/7 care—we are here to provide compassionate care solutions, where and when you need us. We offer a continuum of care for seniors ranging from in-home care services and care coordination to senior living alternatives. Contact us today for more information.

Connecting With Veterans: Amber Dean

Caregiver of the Month

Amber Dean was named Caregiver of the Month for October.

Amber became a caregiver by following in the footsteps of her mom, Aunts, and cousins. “I come from a long line of CNA’s in my family. We have a passion to help others,” Amber said.

She has been a caregiver since 1999, spending the last five years with A Place At Home – Omaha. With ten children and seven grandchildren, Amber was relieved to find an employer “that understands when things come up.” She finds APAH – Omaha to be a very family-oriented company.

About being selected Caregiver of the Month, Dani Sloan, HR Director of  APAH – Omaha, said “Amber is consistent, reliable, dependable, and epitomizes our “We are CARE” philosophy.”

Amber recalled her first clients when she started working here, “They were a couple and one had dementia and the other did not. They were fun to be with and kept saying they’d adopt me if they could.”

Amber also finds that many of the clients she cares for usually request her to come back. She said, “I connect with a lot of my clients. It seems like I’m with a lot of veterans and my husband is a veteran. It gives me a foot in the door to connect with them. They love to hear how my husband’s service animal is doing.”

She currently provides care for a veteran in Bennington who, like her step-son, was also in the Navy. She prepares his meals, runs to the grocery store and helps clean his home.

Ultimately, Amber shared, her goal is to be a nurse. “I’m in the mentoring program. A Place At Home helped me get a mentor to further my education as an RN,” said Amber.

Find an RN Mentor

A Place At Home has been collaborating with the Nebraska Action Coalition – Future of Nursing to provide a foundation to connect emerging nurse leaders with experts across the nursing profession. Five caregivers from A Place At Home have been matched with mentors since the program started this year.

This free program is available to all A Place At Home caregivers. Once matched with a mentor they will provide helpful resources and general guidance for navigating nursing school and other roadblocks along the path through nursing school. If you are an A Place At Home caregiver, contact Kris Kircher, Executive Director of APAH – Omaha, at 402-932-4646 for more information and to join the program.

If you are interested in becoming a caregiver, apply online today.

Bringing Confidence Back to Seniors: Keva Nero

Caregiver of the Month

Keva has been a caregiver for 22 years and landed in Nebraska after she and 19 of her family members were displaced by Hurricane Katrina in 2005. 

In August of 2005, nearly 80% of New Orleans flooded after the levees failed during Hurricane Katrina. Keva Nero and her family found themselves displaced along with more than a million other people in the Gulf Coast region. Keva’s brother took in 20 family members, including Keva, while they found new housing and jobs in the area.

Keva originally wanted to be an RN, but after having her second child she decided to try out being a CNA first so she could learn more in the field before taking that next big step. What she found was a job she loved that has now lasted 22 years.

“I love it. I love working to help people. You get to meet new people and learn about their different needs. You learn more and more about different things and get more experience,” said Keva. While she attended Hamilton College to become a Medical Assistant, she found great interest in researching illnesses suffered by her family members so she could better serve them. This education has really advanced her knowledge and skills ultimately making her a better CNA today.

Keva’s approach to caregiving is to bring confidence back into the client’s life. Keva feels that if we keep feeding someone the message that they can’t do something anymore, then they’ll really believe they can’t. “A lot of them say they can’t and it just brings them down after being so independent for so long. It makes them feel good to get them involved where they can. Even if it’s just opening up the bread, let them do something,” Keva shared.

Keva was selected as Caregiver of the Month after APAH office staff received compliments raving about how well she was caring for one of the clients. They commended her for being intuitive to his needs, consistent and knowledgable. Keva said, “I’m warm-hearted and I love people whether you’re my family or not. I treat them as if they are my family. It’s about caring. When you’re in this field, you have to have a passion for other people’s feelings. I’m not here for a check, I’m here to help.”

Keva is a true inspiration for perseverance and a genuine caregiver’s heart. Congratulations on being Caregiver of the Month for A Place At Home!

A Place at Home: Trust Us for Compassionate Senior Care

At A Place at Home senior care, we know that our in-home caregivers make us great. Our careful hiring practices and high standards ensure that seniors receive compassionate, reliable assistance with the activities of daily life. Our senior support services are planned around the senior’s individual needs – and designed to maintain their dignity and independence. A Place at Home caregivers genuinely enjoy caring for others. Together, we work to provide each senior the opportunity to live their best life. Apply now or contact us to inquire about becoming a caregiver with us.

Caregivers: Making An Impact Isn’t Always Easy

Courtney-Lynn Styba

A Place At Home (APAH) welcomes compassionate Caregivers who believe that caring for others is one of the most important roles they can possess. APAH believes in the “We are CARE” philosophy which is a commitment to the core values of being Compassionate, Accountable, Respectful, and Ethical. The values are incorporated into every dealing A Place at Home has with the families it serves, our employees and caregivers, and the entire metropolitan Omaha community as a whole.

At times it’s difficult for others to understand the commitment that goes into serving with sensitivity and understanding, advocating for mutual trust and consideration while maintaining the highest standards and morals. Making a difference in someone’s life isn’t always easy or pretty. It takes a special person to understand the impact they are making even when the waters aren’t always smooth. Below is an insightful look into one caregiver’s life. Her name is Courtney-Lynn Styba and this is her story:

I used to be offended when I said I was a health care assistant and people would reply, “oh, so a glorified a** wiper”. I’d struggle to explain to them that it really didn’t matter how much poop I’d see in a day, you forget all about it. And what most people don’t understand is, it really IS glorified. It’s the most humbling, tenderhearted experience to be apart of. And call it what you want, but nothing will do it justice. Sure, there’s a lot of feces and bedpans, a lot of blood and tubes, a lot of catheters and supps. There’s a lot of hitting and grabbing, punching and yelling. But there is also a lot of love, hugs, dancing and hand-holding. It’s not all pads, bed baths and poop. It goes a lot deeper than cleaning up after some “senile” Senior.

What it really is, is breaking the news 15 times in an hour to a devastated wife, that her husband died 30 years ago, each time breaking her heart more and more. It’s holding someone’s hand while they scream in pain that they are experiencing mentally, leaving them crippled in bed for days, weeks, months. It’s continuously redressing a patient who is confused whether it’s daytime or nighttime and maintaining a happy joyful heart as you explain to them that it’s morning time. It’s noticing your patient likes music, but can’t express it- so you sing to them when you get them ready just to see their smile. It’s maintaining a loving heart when you’ve been hit by your patient because you’ve been trying to clean them, and they’re scared of being hurt. It’s wandering around the halls holding your patient’s hand as they cry out in loneliness and brokenheartedness because their family never comes to visit them, even though their family left 30 minutes prior. It’s remembering their favorite food, snack, drink, it’s knowing their life inside and out and making sure that each person is treated as if they are a person. It’s talking about death and helping them prepare, reminiscing on experiences, it’s learning about their life and listening to their sweetheart’s stories. It’s crying together, laughing together, it’s everything tragic and beautiful at the same time. It’s explaining that they might not remember you tomorrow, but assuring them you are coming back to regain your trust and respect every day. It’s working 14 days in a row just to build the relationship to make the patient’s life more comfortable. It’s crying on your drive home because you lost a patient that day. It’s caring about them so much you lay awake at 3am wondering how they’re doing. It’s holding back someone’s hair and scratching their back as they vomit into their bed because their medications make them sick to their stomach. It’s reminding them that they are loved, no matter what nasty parts of them you’re experiencing. It’s reminding them that they are heard, valued, noticed and loved regardless of their status, race, origin, or religion.

There is something so special about being the person that holds someone as they take their last breath. Or knowing that you are possibly the last person they will see before they die. It makes you want to be a better person, it makes you want to give as much of yourself as you can just to make someone’s like a little bit better. Yes, this includes pad changes to prevent skin breakdown, yes, it means giving them a bath as they’ve been covered in their own feces, yes, it means that I will sit for 45 minutes just to help someone drink a small cup of water. Yes, it means that I will patiently listen to a story from somebody who is incapable of forming sentences. No, I will not strike back when I get called nasty names, or get hit across the arm, or kicked in the leg. I will love this person in a way they can understand, in a way they can feel safe. I will not give up on these people just because their brains are throwing them into defense mode and they are incapable of using words to describe what they need.

With a happy heart, I will go to great lengths, not because it’s my job or my title, but because I love my patients as they are my family and want to make a difference in the lives of those I love. Being a health care assistant is more work than I ever thought, but I have been immensely blessed with patience and love for the people I am honored to care for. It is pretty damn hard, but worth EVERY single moment.

THIS is what it looks like to love so deeply every single day.

APAH currently has the pleasure of scheduling nearly 70 similar caregivers to Omaha community seniors. When it comes to senior care, and in particular, in-home senior care, we consider our employees the best in the business because of our commitment to our core values. If you feel inspired by the impact you can make in someone’s life, want to be apart of a team that cares as well as a company that leads with its values, develop your skills through training and career advancement opportunities, be recognized and rewarded for your passionate adherence to our core values, you’ll find yourself right at home with us.

Apply online today. We look forward to having you as part of the Omaha-based A Place at Home family.

 

Credit and consent courtesy of Courtney-Lynn Styba

An Angel Among Us: Donna Bird

Caregiver of the Month

Donna Bird named A Place At Home’s August Caregiver of the Month.

She recently became a caregiver with A Place At Home a couple of months back, but in that time, she has gone above and beyond to give her clients the best care possible. “What I love most about being a caregiver is the people I work with. All of them are sweet, sweet people,” said Donna.

Donna is from southwest Kansas where she was working on her Master’s Degree in Social Work. She said, “I was one semester away from being an RN. It really makes me better in the homes because I understand what I’m working with medically.”

Donna has been a caregiver for 27 years. She said one of the most touching moments in her career happened recently with a gentleman she was assigned to provide care to by A Place At Home.

“We really bonded. He went into hospice shortly after we met and from that point on, he let go. What was so beautiful through that whole thing was I knew he needed to see me one last time before he died. That’s just how close we were. The last day I went in there, I shaved his face really good with the razor, gave him a really nice sponge bath, I would talk to him and his eyes would open and he’d look directly at me so he understood what I was saying. I would always sit by his bed and put my hand on his so he knew he was never alone. It was very touching. When I left the next day he passed away. But he needed to see me one more time before he died.”

The family was extremely grateful that Donna came into his life, even if it was briefly. “His wife thought I was the best thing that ever happened to him. His daughter said I was an angel, as much as I helped her cope through this process. The card they sent me, what they said…I’ll save it for the rest of my life. I will never ever forget this family.”

Donna felt this connection and timing was a miracle. “The Lord put me there for that very reason.”

While the family expressed how important Donna was to them, she said the impact on her was equally moving, “They were thankful to me…but do you know what they did for me? There are no words to describe it. They thought I did a lot for them…but oh, what it did for me. There’s not enough words or tears that could ever tell anyone what it meant to me to be with him.”

Become A Caregiver

A Place at Home caregivers genuinely enjoy caring for others. Together, we work to provide each senior the opportunity to live their best life. Apply now or contact us to inquire about becoming a caregiver with us.

Avoiding Sepsis in Seniors

Often when a senior comes down with an infection, their immune system will respond to protect them. Infections could include anything from pneumonia, influenza, or a UTI to kidney, abdominal, or bloodstream infections. Sepsis occurs when the chemicals released into the bloodstream via the immune system overreact and end up causing inflammation throughout the entire body instead.

If you or a loved one has recently been in the hospital for a procedure, use a catheter or other invasive apparatus, there are three stages of sepsis to be aware of so you can seek medical attention and receive treatment sooner. Severe cases of sepsis in seniors can lead to septic shock, which is a medical emergency.

Stage 1: Sepsis includes 2 or more of the following symptoms.

  • Infection
  • High fever above 101ºF or below 96.8ºF
  • Heart rate higher than 90 bpm
  • Rapid breathing higher than 20 breaths per minute

Stage 2: Severe Sepsis occurs when there is organ failure and one or more of the following symptoms.

  • Difficulty breathing
  • Decreased urination
  • Changes in mental state
  • Low platelet count
  • Patches of discolored skin
  • Abnormal heart speed and rate
  • Chills due to falling body temperature
  • Unconsciousness
  • Extreme weakness

Stage 3: Septic Shock happens when the symptoms of severe sepsis go untreated. In this stage, the blood pressure will dramatically drop, and the results can be fatal.

You can prevent sepsis by staying up to date on your vaccinations for the flu, pneumonia and other infections, practice good hygiene, and get immediate care if signs of an infection develop. Always treat urinary tract infections promptly and clean all skin wounds promptly.

While anyone can get sepsis, seniors are at a greater risk since their immune system weakens as they age. Sepsis can quickly progress to septic shock if not treated. If two or more of the symptoms above raise red flags, seek immediate medical attention. If you or a loved one experiences frequent infections, reach out to us today to see how we can help you manage your care.