(not) Moving Up? Women, Do You Know What Skills You Are (most likely) Lacking?

Upward move from middle management requires a particular sets of skills. Do you what they are?

Women, I implore you, if you are interested how to get – or why you are not moving upwards – from that ingrained middle management position even though you are liked, respected and your team works well under your leadership, click here and listen to these 14 minutes that can change your career and your life!

Why is it that in the last 20-30 years we have not closed the gender gap in organizational leadership? Why is it women still make only about 17% of leaders in their organizations? Why is it that if women make 50% of middle management why only less than 1/3 make it to top management?

That’s where the 33% is missing! Wonder no more!

Susan Colantuono is a wonderful un-hurried speaker who make TOTAL sense. I was sitting on my couch going Oh My Gosh, Oh my lord, Oh good grief, Oh my…(you get the picture here!) thinking how much sense it made and wondering why women don’t get to hear THIS very advise? Susan made me see very clearly the amount of work and strides we, as women, made to be now fully represented in ‘middle management’ at 50%, but not any higher. Why? What is the reason? What is the barrier? How do we overcome it as women and as a society together? Are we not educated? Not smart? Not strong? Not decisive or shark-ey enough? Not able to make tough decision? Not willing to stand up to authority? Not willing to risk?  Nah, that can’t be it… Why? Simple, because I KNOW!

And here is why:

Who EVER worked with a team of strong, authoritative, opinionated, educated, fearless, fierce, decisive, responsible, tough, hard-working, life-and-death-facing, crises-decision-making, disastrous-consequences-averting, administration-challenging, patient-advocating, doctors-opposing, and hunger-and-exhaustion-fighting intensive care unit (ICU) Registered Nurses (RNs) – they know better! Our continuous assessment, ongoing analysis, constant prioritization and re-prioritization, fearless leadership, team-building and communication skills, along with our ability to gather data, organize work and people, follow through, administer, implement and survive almost 13 hours of never-ending organized chaos and madness -> don’t tell me we cannot lead an organization where people don’t die if we delay our decision or where people’s health does not deteriorate if our analysis and communication is not performed within few minutes or hours?

What other organizations work under THOSE set of circumstances?

So reflecting upon my own career, thinking back on advise I have received or the words of wisdom I heard and let’s be honest – I never heard this! True, initially, studying nursing, the core objectives were clinical knowledge, taking care of babies and delivering the best nursing practice. Next, during my political science & women’s studies, I have not heard this either – probably thinking we will talk politics or policy (the operative word here “talk” I guess) so we will not need it. Where I finally figured out the importance and the need for a different set of skills, and where I truly comprehended what that aspect & ability could and would mean to an organization, was in Grad School and that was thanks to singing up for a series of  MBA classes over 1 year (2 semesters) at the UM School of Business!

Yes, we were/are told to beef-up on certain skills, skills that would bring us to middle management positions. So we did that. We are now more assertive, we lead projects and teams, we communicate better, we empower and engage others, our teams love to work with us, etc…. HOWEVER, those skills will get us and keep us at the middle management level, especially since the next upwards move requires a very different sets of skills and acumen. Do you know what they are?

Listen up, take notes and put your plan into action!

Educate, engage, empower, enrich.

3Ps of Ebola: Policy, Panic and Public

Treating and transporting an Ebola patient is very challenging.

Treating and transporting an Ebola patient is very challenging.

Friday’s decision by Maine’s District Court Chief Judge Charles LaVerdiere was the first indicator of much-needed public discussion & conversation about public health policies, personal liberties and Ebola.
Current CDC’s guidelines (11/1/2014), guidelines based on the latest scientific facts and gathered research data, clearly state that a person who is showing NO signs or symptoms of Ebola exposure, is NOT contagious, NOT infectious thus poses NO threat to public.

This is how World Health Organization (WHO) and the Mayo clinic describe Ebola infection’s symptoms:
“First symptoms are sudden onset of fever, fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools).”
http://www.who.int  and   http://www.mayoclinic.org

People who have been in direct or possible linear contact with Ebola, are under direct/ active direct monitoring (Chief Judge LaVerdiere’s ruling, 10/31/14) and actively cooperating with state and local public health officials since the monitoring of signs and symptoms of Ebola exposure in persons designated as such is now the responsibility of the local and state health authorities. The moment they will start experiencing any of the above symptoms, they are instructed to contact public health officials and appropriate health authorities immediately, and exposure policies and guidelines will be followed, starting with an isolation room with a bathroom.

Government’s No #1 responsibility is to protect the public. In order to do so, public health policies must be set and enforced, yet need to be fluid, periodically re-examined and updated based on new scientific data, such as was the case of the latest updated data on CDC website regarding Ebola spread (10/30/2014).  http://www.cdc.gov

We should be setting responsible health policies based on scientific facts and latest research data, not on fear, panic or apprehension. It is up to us, healthcare professionals, relevant government authorities,
industry leaders and public officials, to clearly communicate with the public about latest events, management of the situation, and what to expect. Nothing fuels panic and fear, or breeds chaos, as a lack of information and the perception of a cover-up!

So let’s continue with appropriate monitoring, gathering data, assessing circumstances, updating policies when appropriate, but most importantly, let’s continue with communicating with the public!

Ukraine Today: Political Realism First, Please!

Ukraine Today: Political Realism First, Please!

(original post on humanitarian situation written on Feb 20th, 2014 in Sacramento, CA, USA. Updated based on last week’s cease-fire and political agreements on Feb 24th, 2014 in Sacramento, CA, USA)

 

czech vlajka znak

I was a young Czech nurse when the atrocities were happening in the Balkans, and NOBODY from the EU moved a finger, nobody helped them! I often asked myself what would have I done…?

While I had no influence over it, as after the Velvet Revolution in Czechoslovakia, after 40 years of oppression, and 20 years of Soviet occupation, I finally was allowed to travel abroad and I left home.

I looked after children, cleaned houses and pubs, learned English by myself at nights, held 2-3 jobs in order to follow my dreams of studying and obtaining my Nursing licenses in Canada & USA, only to go further towards my biggest dreams of earning multiple university degrees in global politics, global health & regional development & administration at prestigious U.S. universities (CSUSM and UM). CSU grad kept her ‘eye on the goal’ – San Diego Union-Tribune San Diego Union-Tribune regional newspaper did an interview with me about my road towards BA in Political Science Magna Cum Laude coming from post-Communist country.

To this day, I am ashamed to be European for our utter failure in the Balkans! Seeing the almost unrepairable damage that conflict left until today, over 18 years later, is utterly heartbreaking. We all bear responsibility.

For better or worse, the ONLY leader who proved to LEAD was U.S. President Clinton, who due to the long-standing ‘Monroe Doctrine’ did not and could not put “boots on the ground” as Americans love to say, but instigated aerial raids. President Clinton’s role in this conflict is being discussed even today, however, speaking as someone who has deep historical roots to Peoples abandoned and left ‘behind’ by the Western powers in their time of need, without any help… (i.e. The Munich Agreement of 1938, The Prague Spring of 1968 -> followed by foreign invasion of my beloved homeland by 5 foreign armies, led by, you guessed it, the Soviets and their criminal leader Leonid Brezhnev). Trust me when I tell you, you want help, any help!

California Capitol Sacramento

It is only here, in this country, where we have the incredible luxury to discuss and criticize actions of which we quite often know very little. BUT, let me finish, it is a part of our political system, it is a part of democracy and as a democracy “groupie” myself, I fully respect and admire this system very much. In fact, I have been actively involved in the post-communist transition to democracy and democratization of institution in Czech Republic on the local political level for past 20 years, and it is Job’s job. It is only when you are on the ground, demonstrating against the power that is usurping you and denigrating you, waving your flags, being beaten and shot that you are looking towards the skies hoping to see some allies and The Allies!

 

For my beloved Czechoslovakia in 1968, the year my amazing parents got married and sadly also the year their HOPE and DREAMS were squashed by the Soviet invasion, there were, for very obvious Cold War reasons, no sky allies or any Allies… And we (as in my fellow countrymen, since I was not even ‘an idea’) were looking up and waiting, every day! In the years afterwards, during the deep Normalization process (just a different word for Communistic indoctrination enforced by the Soviets), we were secretly listening to the Radio Free Europe and Voice of America (both I believed financed by the U.S.) in our basements, faced with hard jail time if caught, waiting for hours to hear our country even being mentioned! And this is how people of Ukraine feel today.

We are amalgamate of our previous experiences, and I really do “FEEL” the past plight, hurts and betrayals of my people and my country. Well, visiting every concentration camp around during yearly school ‘day trips’ since 2nd grade left DEEP scars and nightmares in my soul. At the same time, it also cemented such un-moveable human resolve, built foundation for my ‘Fight-or-Flight‘ (political & systemic) response, and cemented my strong sense of protection, responsibility for others, and especially for those weaker and unable to look after themselves => any more questions why I am a nurse, political operator and a humanitarian? Nope, did not think so.

We have a collective responsibility and we have obligations.

Now as a proud (dual Czech and) U.S. citizen and a highly degreed and educated RN and a political operator, at this point my love & passion for politics, strategy and campaign goes away and my nursing and humanitarian responsibility takes over. That is exactly WHY I DO politics, to PREVENT bloodshed! However, once you cross over a certain threshold, it is no longer about my ability “to do” politics but about my ability to “take care of people”. People need help no matter who is shooting at them and my nursing training and practice precludes me from judging my patients, and that I had some I did not like in my 15+years! Period.

I wrote an article last May 2013 year asking  Should the EU Care About Syria? The Balkans, Anybody?

Now, the question is HOW much, WHO should and WHY “they” should be concerned over Ukraine! ‘They’ as in the now portrayed as Evil The West / EU vs. the always evil East / Russia.

I don’t know about you, but I picked my ‘evil’ long time ago (and we are very happy together, thank you very much). I already lived under devil dominant depressing doormat of freedom-non-existent Soviets. I will pick The West in any shape or form, any time … and yes, I will get lots of criticism for it, but I am strong I can take it.
What I will never do, however, is to apologize for my views of Russia. I lived it, I survived it, I got out. Thank god I now have my beautiful blue U.S. passport!

Ukraine today is at the crossroads.

Country is divided, economically bankrupt, feels betrayed and lied to, plus people are in deep mourning. However, on the other hand, once the elation of a certain part of population over ‘their’ victory will wean off and reality of bad economy, current lack of leadership, deposed president MIA and the looming threat of Russia not far away will set in, people of Ukraine will have a lot to deal with. During my research, I found ONE thing they all agree upon (well, mostly) – they want to keep Ukraine united, as in NOT split in the Western and Easter / Russian parts. If I were at the negotiating table, I would hold on to this and would NOT let go…

 

I do hope those strong and determined people are ready, prepared and aware that much harder task is ahead of them! Sitting across from your political opponents and rival who you hold responsible (and vice-versa) for what just transpired, will truly show how dedicated and serious about DEMOCRACY the people of Ukraine really are.

Knowing how Russian tyrant Putin feels about Ukraine since he considers it to be a part of his Mother Russia and the center of Pravoslav religion, holding them hostage at will over access to natural gas and other resources and aid … and hearing as a freedom loving and globe-trotting Czech the same tyrant Putin saying that he ALSO consider my Czech Republic to be still under his sphere of influence, my heart stopped!

We’ve already been there, it was hell, and nobody wants to go back…

It is my unequivocal belief we all have global roles to play, we all can help and serve wherever we can.

Thus I am able to feel the plight, fear, resolve but also the uncertainty of people of Ukraine today.

Ukraine has difficult times ahead, and nation-buidling, state-craft and democratization of institutions while re-building trust in government and placing transparency into old systems are amongst the MOST difficult and HARDEST of social and political projects. Look at the U.S. how they are struggling with it around the world, and they have been living it for well over 200 years! Now look at the post-communist countries of Eastern Europe having their “freedoms” for about 20 years… Need I say more?

Hippocrates, the Original Public Health Care Worker?

Hippocrates, the Original Public Health Care Worker?

Recently, I watched a videotaped lecture by the famed Dr. Carl Taylor, MD DrPH (1916-2010), the founding father of then-new academic discipline called International Health. Dr. Taylor’s lecture, taped few years before he died at the age of 93, was called The Key Studies of Primary Health Care and it was available on the Johns Hopkins open access website. This interesting lecture was actually a part of Dr. Taylor’s teaching curriculum at the Department of International Health that he established at his beloved Johns Hopkins. His love, however, was to travel around all corners of the earth and help communities empower themselves!

Johns Hopkins hospital, Baltimore MD

Currently, I am taking Health for All Through Primary Health Care class through Johns Hopkins, and if we realize that by all accounts the most important Alma Ata Conference was held in 1978, that we are faced with a certain crisis of unfulfilled Millennium Development Goals (MDG) by 2015, and that more people live in abject poverty today than ever before – we begin to truly appreciate the genius of Dr. Carl Taylor’s approach and his vision for not only health care as such, but for PRIMARY HEALTH CARE especially!

images-2

WHY is primary or community health care THE point? Simple: If the government doesn’t do it for you (i.e. the Top-Down model) the people must do it for themselves (Bottom-Up model)… Hopefully with some help and guidance from global health or international organizations, sure, but by leading themselves nonetheless.

As for me, I would have never believed I would be interested in a discipline that does not have all the critical & intensive bells and whistles that only Code Blue, cardiac arrests, Swan-Ganz and ICP or resuscitation in hallways can provide and only critical intensive nursing can deliver. However, as my professional development began to move forward, I very slowly started to move away from all that acute rush in hospitals to seeing ‘Public Health’ from not only an administrator point of view, but also from the level of public health policy.

And that’s where it really hits you!

Saving people’s lives one by one thus making a difference in my patients and their families lives in ICU or OR or ER or PACU was wonderful and I loved every minute of my 13+ years on 2 continents and 3 countries! But, if you really want to make a difference, difference on a much broader global scale that is, you must look at the discipline of Public Health – and specifically, International or Global Public Health (as is my Masters Degree) through a different set of eyes and through completely different prism.

And this why I LOVE it so much!

In order to be successful and effective here, you must fully understand the intricacies of health care / patient care delivery, from there you must be abreast on how to deliver said services in a department or an organization, which is finally leading you to realization you can have influence through your earned knowledge and understanding over global issues, politics and public policies that are determined by international decisions via foreign policies. Those in turn deeply affect all those other social determinants of health which decide the actual individual health and well being – or not – of your people. … when they come to ICU and I can save them…

The astounding combination of my 3 professional loves and passions:  [Global] Healthcare, Politics & Administration all lead to my overall passion and I believe a certain inner sense of Global Public Health Administration. And that is why I slowly moved, over the span of several years and large sums of money for university education) from all the bells and whistles in intensive and critical care units to a global view of social determinants of health, determinants affected by political decisions.

296986_10150318999750909_142351656_n

From Dr. Taylor’s lecture, we learned that the idea behind ‘community-based primary health care‘ is as ancient and as old as Hippocrates himself, as he began to treat sick people in the open, as in village squares where every person from the village could come and offer advice on treatment and getting better! While I don’t really agree with openly spreading germs to the village, the fact that Hippocrates did not isolate the sick, that he did not put them somewhere ‘away’ from the others, shows his initial foresight of holistic / community approach to healing and showed his outlook to the future foundation for community-based primary health care.

What I also did not know is that it was Hippocrates who first started to separate medicine from public health as he started to recognize that different geographical areas meant different patterns of diseases. That was a major fork in the road for healthcare where medicine has clearly different goals and different strategies from community-based primary health care.

images-3

Dr. Carl Taylor stated that in the early days, U.S. physicians viewed primary care as ‘individual’ care, while following approach originating in South Africa encompassed and recognized all aspects of health care in its Community Oriented Primary Care approach (COPC). Here again, many years after Hippocrates, we see the resurgence of the core idea that community is at the center of “health” and well-being of an individual thus of the collective “health” of the whole community.

In a historic context, I would compare this community centered resurgence of the South African (and later American and Israeli) approach to the recent resurgence of the principles of the Alma Ata Declaration. Lancet article (Walley et all. 2008) clearly states that the community-based or community-centered approach to public health is going through a re-birth of sorts as more and more studies show that Dr. Taylor’s SEED-scale approach, which clearly encompasses Kerrer’s South African COPC model, is an approach that takes all other, not only health and disease, but also other social determinants of health in account when dealing with “health“.

Walley says: “The emphasis must shift from single intervention to creating integrated, long-term sustainable and ethical health systems…” Nobody, not the U.N. or any NGO, can achieve this Alma Ata-centered goal without dealing with a host of other determinants. Sadly, for our global health care objectives, those determinants are decided and implemented (-or not-) by sovereign national governments.

images-1                   

Herein resides the problem.

Health does not happen in a vacuum! Very rarely do people get sick out of nowhere…

Health” happens as a result of… or a consequence to… certain political actions or social events.
The primary public health care problem we are discussing here, is a problem originating in poverty, lack of potable water, lack of safe environment, lack of developed infrastructure, lack of knowledge and awareness, and lastly, as a lack of political will.

images

That is why I applaud the resurgence of the Alma Ata principles taught by Dr. Carl Taylor and the ongoing recognition of the variety of other important aspects that influence, directly or indirectly, the overall status of public health and primary health care in particular.

In fact, it was Hippocrates who preceded Alma Ata Declaration with his vision, when he involved and engaged the whole community in the treatment and planning of healing solutions… And that concept is THE cornerstone of  Alma Ata Declaration!

A Mid-Career Czech-up: how do you stack up in 100 words?

A Mid-Career Czech-up: how do you stack up in 100 words?

Wondering how your career looks like in 100 words?

Ever wondered how would your career look like all nicely and neatly summarized (since nothing in life is that simple) all the while looking visually appealing ?

I copied & pasted my professional positions, projects & endeavors in public health, healthcare and politics from my LinkedIn profile and used the amazing wordle.net to see what have I been really up to for the past 13 years in my let’s say all-encompassing career and how does it stack up to what I feel are my professional passions & interests with what I think I’ve done and accomplished in my career so far.

I must say I am (one-could-almost-say) pleased to see my career in a shape for which I worked, studied and sacrificed so much, AND most importantly as we continue to evolve, for one that is leading toward a better defined shape that keeps on toning and strengthening those already ‘shapely’ areas, keeps on finding new ways of doing, seeing, understanding things… all the while never seizing an opportunity to learn from wise, humble, accomplished and interesting people along the way… AND yet staying true to my ongoing professional calling, my passion and my dedication.

Yes, ALL this in 100 words, no kidding!

Yes, wordle.net can summarize it way better than me, that’s for sure…

How would your mid-career check-up look like?

Is ‘population diversity & behaviors’ to blame for lower U.S. life expectancy…?

Government Spending

Government Spending (Photo credit: Tax Credits)

Last week I posted article asking a pertinent question “If U.S. Spending is so Outrageous, Are We Getting the BEST?”

https://marketahouskova.wordpress.com/2013/04/22/if-u-s-health-care-spending-is-so-outrageous-are-we-getting-the-best-2/

The answer is “kind of”.

We do have the best technological and medical advancements in the world, and our acute care and treatments can deliver miracles.  We don’t have to wait 4-6 month for a surgery, we mostly get timely care, good care, and we do have great outcomes. However, as wonderful as that is, it does not impact the overall measurements of ‘life expectancy’ as it falls under the category of ‘acute care’ and we do really well here.

It is injuries or conditions lasting more than 6 months that are considered ‘chronic’ and require ongoing management, ongoing medication, follow-up doctors visits, repeated test, etc… and that’s where the U.S. is seriously lacking. So yes, while we are very good at acute care, we lack in chronic care management – and that does impact the overall ‘life expectancy’ and quality of life.

Which brings me to the fact that even after spending over $8,000 per capita in overall healthcare expenditure in 2010 (the highest in the world) , the U.S. has a lower life expectancy compared to other OECD nations. Why is that? Is “healthcare”  to blame? Is “public health” to blame? Or is it due to our “population diversity and behaviors“?  I have heard many  blaming it on the “diversity & behaviors” part, but in that case a question remains –  isn’t it the health and life expectancy of the whole population, no matter what diversity groups it includes, that makes for ‘life expectancy’ studies, surveys and measurements?

I agree with you that our diverse population is an integral part of our society, however, it is 21st Century and everybody knows that if you want to live longer and have a good quality of life, when you are not feeling well or have certain episodes – you should go see a doctor. And this is where the crux of “it is population diversity & behaviors fault” argument weakens, as 50 million of low-income working Americans (yes, majority about 80% are working and 82% are legal citizens) DO NOT have options or access to a non-acute or preventive care, so they go without seeing a doctor, without taking medications, and without ongoing management of preventable conditions – NOT because of their population diversity or behaviors – but because under the current system they have no viable option for obtaining health plans!

This clearly and directly impacts the overall life expectancy and thus the overall quality of healthcare we as ‘all Americans’ get.
If 1 in 5 Americans don’t have access to health care – it seriously impacts all of us in terms of loss of economic potential, loss of productivity, and in the end, in an increase in overall health care spending.

I ask again, does $8,000 per capita (twice as much as others developed nations) deliver the best health care to our society? Does it…?

Now, since we established that “population diversity & behaviors” are not to blame for lower U.S. life expectancy, is it a fault of healthcare, or public health? The answer is “yes” as the status of U.S. health care and it’s overall total health care spending and expenditures is a direct result and implication of U.S. health policies implementations. States are responsible for health care but federal government plays its role in Medicare, Medicaid, CHIP & other programs.

Medicaid, for example, by covering health care needs of pregnant women and prenatal care is not only delivering health care, but also implementing a U.S. public health policy. Smoking cessation programs – public health issue, or health care issue? Both, as continued smoking leads to lung cancer, COPD, emphysema etc… and that is very costly in terms of health care spending. Public health programs are offering smoking cessation in order to prevent future health care spending, a clear integration of health care and public health policies.

Without proper public health policies we will not be able to deliver proper health care to our diverse population. Clear and simple.

P.S.

Yes, while certain “diverse” behaviors cause increase in health care spending (i.e. smoking, bad diet etc..), if we look at it closer – these behaviors span all socio-economic levels, not only diverse population often mentioned. So we are back at the beginning, why the U.S. has lower life expectancy that other OECD nations? The one clear answer is that it is not due to “population diversity and behaviors”.

.

Issues to ponder about U.S. emergency response in a small pox sentinel event [1/2]

http://rt.com/news/uk-smallpox-terror-threat-379/

(this post is as a response to the above mentioned article)

My area of expertise is NOT discussing the threat level colors with national security experts and advisors arguing about a possible impending terror plot using biological weapons. I leave that complicated and complex discussion and decision-making to those experts, and God be with them and us…

My area of expertise is program administration, infrastructure coordination and immediate implementation of emergency response policies such as putting the correct SOPs to work, dealing with and trying to protect the first responders, dealing with city & hospital command centers, dealing with local,  state and federal agencies, organizing teams and rolling out regional plans… and of course managing & administering it all in the most productive, cost effective, safe and human capital most efficient way.

Reading about the split view between the US and UK on the response to small pox threat, while out of my area of expertise, nonetheless all I see in this are the problematic areas of such sentinel event response starting with the politics of preventing public panic, not knowing the degree of events we would be dealing with as the latency of small pox is up to 3 weeks and they are highly infectious – and that’s just for starters!
In today’s globalized and inter-connected world we would be probably looking at pandemic situation where 2 million doses of US vaccines – even when and if administered at the most opportune time to the right people – would barely scratch the surface of such disaster.    …Would antivirals save lives? In time?
So yes, from the administrator point of view, a band-aid solution… and didn’t we learn, band-aid solutions cause more damage and are followed by increased public anger and outrage plus are usually way more costly in the end?

The political and societal fall out of such health security threat sentinel event would reach heights we have never seen before with Twitter, Instagram, Facebook, instant messaging, YouTube, Pintrest etc… It would be up to the administrators and the politicians to calm and reassure the population that all the necessary steps are being taken… Are they? Would they?
Again, we are talking about small pox with 3 weeks prodromal stage, highly infectious spread and don’t forget – scary looking, as I can already see the horrible images floating on Instagram, YouTube and being posted on FB and the enormous public panic &  fear that would create as a result, because in today’s inter-connected and globalized world we all are much closer to one another, both literally and figuratively speaking.
(Highly developed, skilled and organized social crises media management during emergency response is and will be an indispensable and absolutely vital part of any emergency planning, preparedness and response).

So both countries better return to the point of origin and start thinking of the proper procedures, administration and coordination of such wide-spread effort with proper planning, training, established (and properly working and functioning!) channels of communications, assigned priorities, tasks, set ways of decision-making during such sentinel events – with proper management and foresight into what may come.
Without well prepared and well though-out massive plans of response, the division of views between the US and the UK on this issue will sadly be completely irrelevant.