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Introduction: rehabilitation of Anterior Cruciate Ligament (ACL) reconstruction is fundamental component after surgery, but this period is long and sometimes boring. To investigate the feasibility of the Nintendo Wii Fit instead of conventional rehabilitation after Anterior Cruciate Ligament Reconstruction. Material and methods: 43 healthy sedentary men (age: 29.5±7.9yrs, height: 176.3±5.3cm, body weight: 79.6±9.3kg, BMI: 25.6±3.0 kg/cm2) were included into this study. They were randomly separated into two groups: 21 subjects were included in Wii therapy group (group1), while 22 of them were taken in the conventional rehabilitation group (group2). The subjects went through the rehabilitation protocol during 12 weeks. Flexion and extension strengths of knee were assessed by Isomed 2000 isokinetic dynamometer at 60°/s and 180°/s angular velocities, and ACL outcome questionnaire was employed to assess the patients' life quality during the rehabilitation. Student t-test was used for all statistical analysis. This study has 80% power with 5% type 1 error level as statistically significant Results: hypothesis 0: there are efficency of wii therapy as well as standard rehabilitation protocol on muscle strength and quality of life after ACL reconstruction with single-bundle hamstring tendon graft. There were significant differences between both groups in life quality outcome questionnaire at 4th (p=0.03) and 8th weeks (p=0.04) of the rehabilitation. However, there was no significant difference between the groups in terms of peak torque in flexion and extension at 60°/s (p=0.363, p=0.852) and at 180°/s (p=0.914, p=0.694) angular velocities in the 12th week of the rehabilitation. Similarly, there was no significant difference between the groups regarding total work in flexion and extension at 60°/s (p=0.706, p=0.891) and at 180°/s (p=0.807, p=0.539) angular velocities in the12th week. Conclusions: what this study illustrated was that Wii therapy might be used instead of /with combination of conventional rehabilitation as it gives the feeling of competition and makes the rehabilitation more fun after ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the plantar pressure distribution and knee and ankle muscle architecture in women with and without knee osteoarthritis (OA)., Methods: Fifty women with knee OA (mean age = 52.11 ± 4.96 years, mean Body mass index (BMI) = 30.94 ± 4.23 kg/m 2 ) and 50 healthy women as a control group (mean age = 50.93 ± 3.78 years, mean BMI = 29.06 ± 4.82 kg/m 2 ) were included in the study. Ultrasonography was used to evaluate knee and ankle muscles architecture and femoral cartilage thickness. The plantar pressure distribution was evaluated using the Digital Biometry Scanning System and Milleri software (DIASU, Italy). Static foot posture was evaluated using the Foot Posture Index (FPI), and pain severity was assessed using the Visual Analog Scale., Results: The OA group exhibited lower muscle thickness in Rectus Femoris (RF) (p = 0.003), Vastus Medialis (VM) (p = 0.004), Vastus Lateralis (p = 0.023), and Peroneus Longus (p = 0.002), as well as lower Medial Gastrocnemius pennation angle (p = 0.049) and higher Fat thickness (FT) in RF (p = 0.033) and VM (p = 0.037) compared to the control group. The OA group showed thinner femoral cartilage thickness (p = 0.001) and higher pain severity (p = 0.001) than the control groups. FPI scores were higher (p = 0.001) in OA group compared to the control group. The plantar pressure distribution results indicated an increase in total surface (p = 0.027), total load (p = 0.002), medial load (p = 0.005), and lateral load (p = 0.002) on dominant side in OA group compared to the control group., Conclusions: Knee and ankle muscle architecture, knee extensor muscle FT, and plantar pressure distribution in the dominant foot differed in individuals with knee OA compared to the control group., (© 2024 The Author(s). Journal of Foot and Ankle Research published by John Wiley & Sons Australia, Ltd on behalf of Australian Podiatry Association and The Royal College of Podiatry.)

Objectives: This study aimed to compare the functional outcomes of patients undergoing fixed-bearing medial unicompartmental knee arthroplasty (UKA) classified as either varus or neutral based on their postoperative femorotibial angle (FTA), with the goal of evaluating the impact of FTA on functional results., Patients and Methods: A total of 38 knees of 35 patients (27 females, 8 males; mean age: 63.6±7.1 years; range, 52 to 75 years) were included in this retrospective study. The data was collected between December 15, 2020, and January 15, 2021. Patients were categorized into two groups based on their postoperative FTA. The neutral group consisted of patients with an FTA range of 5.1° to 7.4°, while the varus group included patients with an FTA range of 0.1° to 4.8°. Knee Outcome Osteoarthritis Score (KOOS), Visual Analog Scale (VAS) scores, sit to stand test results, and six minute walk test data were analyzed., Results: The mean follow-up was 42.0±19.3 months. The postoperative VAS score for the varus group was 0.95±0.99, whereas the neutral group had a VAS score of 2.19±1.83 (p=0.021). The mean KOOS for the varus group was 88.01±7.88, whereas the neutral group had a mean KOOS score of 78.46±13.69 (p=0.006)., Conclusion: In patients undergoing UKA, mild varus alignment could yield superior early and midterm functional outcomes compared to a neutral femorotibial angle.

Objective: The aim of the study is to compare the effects of Kinesio taping and night splinting along with physical therapy intervention on symptoms in patients with moderate carpal tunnel syndrome undergoing rehabilitation., Design: In this double-blind, randomized controlled trial, 45 patients with moderate carpal tunnel syndrome were included and randomly assigned to three groups: Kinesio taping group ( n = 15), night splinting group ( n = 15), and control group ( n = 15). All patients received 20 physical therapy intervention sessions. The primary outcome was self-reported disability status measured by the Boston Carpal Tunnel Questionnaire, and secondary outcomes were pain and paresthesia (rest, activity, and night) measured by the Numeric Rating Scale. Outcomes were recorded at baseline and 4 wks., Results: All patients showed clinically meaningful improvements for all outcome measures over time ( P < 0.05). The intergroup analysis revealed that the Kinesio taping group demonstrated better results in all measures than the night splinting ( P < 0.05) except for pain during activity ( P = 0.054), at night ( P = 0.191), and paresthesia at rest ( P = 0.575). In addition, the Kinesio taping group showed better outcomes than the control group ( P < 0.05) except for the activity pain ( P = 0.022). However, there were negligible differences between night splinting and control group ( P > 0.05)., Conclusion: Kinesio taping in combination with physical therapy intervention is more effective than night splinting in combination with physical therapy intervention or physical therapy intervention alone and may be recommended., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The systematic review aimed to investigate the effects of kinesio taping on the lower extremity kinetics and kinematics after a musculoskeletal disorder., Method: Randomized controlled studies reported kinetic or kinematic outcomes (such as joint moment force or angular displacement) in the lower extremity with musculoskeletal disorders were included. A systematic literature search of Web of Science, Scopus, PubMed, EBSCO, and PEDro databases was performed up to 28 February 2021. Meta-analysis was performed, when possible, by using mean difference (MD) and standard mean difference (SMD)., Results: Ten randomized controlled trials met the inclusion criteria. The results of a meta-analysis based on included studies show that the use of kinesio taping has similar effects on the kinetics of the lower extremities with musculoskeletal disorders or the control group. These effects do not change between 0 and 24 h, 1 and 15 days, and 15 and 30 days (SMD = 0.01, 95% CI -0.30 to 0.31, p  = 0.21)., Conclusion: This study provides insufficient evidence to prove the effect of kinesio taping on lower extremity kinetics and kinematics on patients with musculoskeletal disorders in shorter and longer terms. Methodologically well-designed studies are needed to show the effectiveness of kinesio tape on lower extremity kinetics and kinematics after a musculoskeletal disorder in short and longer terms.IMPLICATIONS FOR REHABILITATIONThe present evidence does not support the effects of Kinesio tape on lower extremity kinetics in patients with a musculoskeletal pathologyMore evidenced based studies are still needed to show the effects of kinesio taping on lower extremity kinetics in patients with a musculoskeletal pathologyThis meta-analysis demonstrated that kinesio taping had no effect for up to 30 days within the scope of the results obtained from the studies, except for the immediate effect of the application.

The purpose of this study was to investigate the effects of edema, pain, and range of motion of knee by sterile kinesio taping within 3 days after ACLR. We hypothesized that sterile taping which is a new material of kinesio taping reduces knee pain and swelling and improves knee range of movement after ACLR. Fifty-sixth subjects who underwent an elective ACLR with were randomized into intervention(n=28) and control groups(n=28). Subjects from both groups received standardized postoperative physiotherapy. Pain by VAS, total ROM of the knee, and circumferential girth were measured at the first, second- and third-day post-surgery. There were found statistically significant differences in all study parameters within each group. Comparison of the study parameters between both groups revealed a statistical significance at various time points except the reduction of pain in the taping group in the early postoperative phase (between the first and second day) (P<0.05). There was no statistical significance in the reduction of swelling or improvement of knee total ROM with kinesio taping. This study showed that sterile kinesio taping reduced pain, improved ROM of the knee and decreased edema in the early post-operative period after ACLR.

Background: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries., Methods: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years., Results: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved., Conclusion: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

Context: Although functional effects of kinesio taping (KT) have been widely studied, its effects on contractile properties of the target muscle remain unclear. Tensiomyography is suitable for quantifying muscle stiffness and rate of force development upon imposed twitch contraction., Objective: To test the hypothesis that KT has effects on contractile properties of targeted muscle using tensiomyography., Design: Prospective cohort study., Settings: Performance laboratory of a sports rehabilitation center., Participants: A total of 11 healthy volunteers., Interventions: Tensiomyography measurements before KT facilitation technique applied (pre-KT), 45 minutes, and 24 hours after KT (post-KT1 and post-KT2, respectively) without removing the tape., Main Outcome Measures: Maximal radial displacement, contraction time, delay time, sustain time, relaxation time, and velocity of contraction., Results: Significant effects were shown for maximal radial displacement (P = .004), contraction time (P = .013), relaxation time (P = .035), and velocity of contraction (P = .0033), but not for delay time (P = .060) and sustain time (P = .078). Post hoc testing indicated a significant decrease in maximal radial displacement for post-KT1 only (from 6.33 [1.46] to 4.87 [2.14] mm), and a significant increase in contraction time for both post-KT1 and post-KT2 (from 30.87 [11.39] to 39.71 [13.49] ms, and 37.41 [14.73] ms, respectively). Post hoc testing also showed a significant decrease in relaxation time for post-KT2 (from 65.97 [53.43] to 47.45 [38.12] ms), and a significant decrease in velocity of contraction for both post-KT1 and post-KT2 (from 0.22 [0.08] to 0.15 [0.09] mm/s, and 0.16 [0.07] mm/s), respectively., Conclusion: The findings indicate that KT leads to an increased muscle stiffness and a reduced muscle rate of force production despite the facilitation technique applied.

Purpose: Repetitive and asymmetric movements in tennis can result in biomechanical adaptation in shoulder joint. The aim of this study was to investigate the differences in shoulder range of motion (ROM), strength, and functional performance tests between the dominant and nondominant shoulders, as well as to identify gender differences in junior tennis players., Methods: Forty-two junior tennis players (age mean: 11.3 [1.2] y, body mass index 18.3 [2.4] kg/m2) were included in the study. Shoulder internal rotation (IR), external rotation (ER) ROM, and total ROM, IR and ER isokinetic strength and closed kinetic chain upper-extremity stability, seated medicine ball throw used, grip hold tests were applied bilaterally. Paired sample t test and Student t test were used to compare the differences., Results: ER ROM was greater, while IR ROM and total ROM were lower on the dominant shoulder (all P values < .05). Nineteen players had glenohumeral IR deficit (IR ROM difference >13°). The players had a greater ER strength on the dominant side and similar IR strength between shoulders. There was significant difference in seated medicine ball throw results between the dominant and nondominant sides (P < .001). The mean distance for bilateral seated medicine ball throw was 377.02 (85.70) m, and closed kinetic chain upper-extremity stability results were calculated as a mean of 15.85 (1.72) touches. Differences between the genders: total ROM of the dominant shoulder was higher in female players (P = .045), the IR PT/BW at 60°/s angular speed was higher in male players' dominant shoulder (P = .030), and closed kinetic chain upper-extremity stability performance was higher in male players (P = .019)., Conclusions: Adolescent tennis players demonstrated differences in strength, ROM, and functional performance results between the dominant and nondominant shoulders. Gender differences were also seen in the aforementioned parameters in junior tennis players. Determining these differences may improve our understanding of sport-specific shoulder joint adaptations in tennis.

Background: Functional balance training is crucial for both rehabilitation and prevention. A Dynamic Innovative Balance System (DIBA) is readily available for utilization in both functional and postural control training in a wide variety of dynamic conditions., Purpose: The purpose of this study was to compare the effectiveness of the DIBA and standard balance training tools on dynamic and static balance., Study Design: Randomized controlled trial., Methods: Thirty-six healthy males (18 to 32 years) were randomly assigned to group DIBA (n=18) or to the control group (n=18) who performed balance training using a balance board, a wobble board, the BOSU, or a soft cushion block for eight weeks. Each participant was assessed before training, at the end of the fourth and eighth week by using the Flamingo balance test (FBT) for assessing static balance ability and using Y-Balance Test (YBT) for dynamic balance ability., Results: No significant differences were found in FBT and YBT between the DIBA and control groups at the end of fourth week (p>0.05). However, at the end of the eighth week, the DIBA group demonstrated statistically significantly better balance ability on the anterior component of YBT (p=0.001) and FBT (p=0.024) than controls., Conclusion: The results of this study suggest that the DIBA was effective in both static and dynamic balance training and it may be used alongside other balance tools in a clinical setting. Further studies should include in lower extremity problems to confirm that DIBA training adaptations are transferred to clinical improvements in performance and balance qualities., Level of Evidence: 2d.

Background: The purpose of this study was to compare the effectiveness of rehabilitation approaches in individuals with low back pain (LBP) on pain, spinal mobility, disability, and muscular strength., Methods: Ninety volunteers were included and divided into four groups depending on the rehabilitation approach: group 1, soft tissue mobilization techniques and stabilization exercises (n=24; 11 females [F], 13 males [M]); group 2, Kinesio Taping and stabilization exercises (n=24; 12F, 12M); group 3, stabilization exercises (n=22; 11F, 11M); and group 4, reflex therapy and stabilization exercises (n=20; 10F, 10M). Visual Analog Scale for pain intensity, an isokinetic evaluation for strength at 60°/s and a side-plank position test for trunk stabilization were measured before and assessed at the beginning, after a 4-week treatment and during 4 weeks of follow-up. The functional status was evaluated with the Oswestry Disability Index., Results: Individuals in all groups showed similar decrease in pain after the treatment and at 1-month follow-up, but there were no significant differences in pain levels between the groups (P<0.05)., Conclusion: All therapeutic approaches were found to be effective in diminishing pain and thus helpful in increasing strength and stabilization in patients with LBP.

Objective: Our aim was to investigate the effect of body mass index (BMI) levels on quadriceps and hamstring strength and functional outcomes up to 6 months after anterior cruciate ligament reconstruction (ACLR) with hamstring tendon autograft (HTG)., Design: Prospective, controlled study., Setting: University clinical laboratory., Patients: Ninety-one participants who had undergone unilateral ACLR with HTG were divided into 2 groups according to their BMI. The participants whose BMI were between 18.5 and 24.9 kg/m were included in group 1 (n = 50, age: 27.2 ± 6.7 years, BMI: 22.3 ± 1.6 kg/m) and those whose BMI > 24.9 kg/m were included in group 2 (n = 41, age: 30.2 ± 6.9 years, BMI: 28.0 ± 2.4 kg/m)., Interventions: Quadriceps and hamstring strength, functional performance including hop, jump, and balance performance, and IKDC score., Main Outcome Measures: Maximum voluntary isometric contraction of the quadriceps and hamstring muscles and the body mass were measured at 1, 3, and 6 months after surgery. Absolute peak torques and normalized peak torques to body weight for both limbs were recorded. Functional outcomes were evaluated at 6 months after surgery., Results: Normalized quadriceps strength improvement was lower in group 2 when compared with group 1 (F(2,178) = 6.23, P = 0.003). Group 2 also demonstrated lower scores in functional performance (P < 0.05). Normalized hamstring and absolute quadriceps and hamstring strength improvement was not affected by higher BMI level (P > 0.05)., Conclusions: Higher BMI levels adversely affect quadriceps strength capacity and performance in patients who have undergone ACLR with HTG. Clinicians should consider BMI levels of patients when assessing and targeting muscle recovery because it could negatively affect the success of the ACLR rehabilitation.

Objective: The aim of this study was to compare the effects of Kinesio Taping and compression stockings on pain, edema, functional capacity and quality of life in patients with chronic venous disease (CVD)., Design: This is a prospective, randomized, controlled, single-blind clinical trial., Setting: The study was conducted in a physiotherapy and rehabilitation unit of a university hospital., Subjects: A total of 62 patients with early-stage CVD were allocated to either an experimental group or a control group., Interventions: Experimental group ( n  = 29) received Kinesio Taping intervention once a week for four weeks, while control group ( n  = 29) received compression stockings for four weeks. All patients additionally undertook an exercise training programme including calf muscle pump exercises, flexibility exercises and diaphragmatic breathing., Main Measures: Visual analogue scale, lower limb circumference measurements, 6-minute walk test and Short Form 36 questionnaire were applied before and after four weeks of treatment., Results: Control group showed statistically significant improvements in pain ( P  < 0.001), ankle circumferences (right, P  = 0.002; left, P  = 0.037), calf circumferences (right, P  = 0.020; left, P  = 0.022), knee circumference (left, P  = 0.039) and thigh circumferences (right, P  = 0.029; left, P  = 0.002) compared with experimental group. There were no significant differences between groups with respect to functional capacity and quality of life ( P  > 0.05). Both groups significantly improved 6-minute walk distance ( P  < 0.001) and Short Form 36 physical component summary (experimental group, P  = 0.002; control group, P  = 0.006)., Conclusion: This study demonstrated that Kinesio Taping and compression stockings revealed similar improvements of functional capacity and quality of life in patients with CVD. The symptoms of pain and edema caused by CVD can be decreased more efficiently with compression stockings than Kinesio Taping intervention.

Kalaycioglu, T, Apostolopoulos, NC, Goldere, S, Duger, T, and Baltaci, G. Effect of a core stabilization training program on performance of ballet and modern dancers. J Strength Cond Res 34(4): 1166-1175, 2020-The aim of this study was to investigate the effects of a core stabilization training (CST) program on performance of university-level ballet and modern dancers. Twenty-four dancers between the ages of 18 and 24 years participated in the study. Core stabilization training was performed for 45-60 minutes per day, 3 days a week, for 8 weeks. For 2 days, the training was conducted by an experienced physiotherapist, and the other day, each participant exercised on his or her own. Evaluation of physical fitness parameters included vertical jump performance, flexibility, dynamic balance, coordination, proprioception, muscle, and hip flexion isokinetic strength measures. Wilcoxon signed rank test was used to compare pre- and post-test values. Statistically significant increases in vertical jump performance, dynamic balance, proprioception, and coordination parameters between pre- and post-training (p < 0.05) were observed. After the CST program, peak torque values for the hip flexor muscle isokinetic test of the dancers decreased (p < 0.05). Therefore, the results suggest that the CST program might be used to improve several physical fitness parameters such as jumping, proprioception, coordination, and dynamic balance. Such improvements will aid in the development of artistic skills for university modern dancers.

Context: Kinesio taping (KT) is a popular taping technique used in the recovery process; however, in the relevant literature, there is no real consensus on its efficacy., Objective: To investigate whether rectus femoris KT application after delayed onset muscle soreness enhances recovery of muscle soreness, edema, and physical performance., Participants: A total of 22 healthy amateur male athletes participated in this study., Design: Randomized, crossover study., Setting: Human performance laboratory of the university., Interventions: Participants performed an exercise protocol inducing delayed onset muscle soreness. They accomplished 2 distinct trials, with or without KT. The washout period between trials was 6 weeks. For the KT condition, KT inhibition technique was used and applied immediately after exercise bilaterally on rectus femoris., Main Outcome Measures: Range of motion, muscle soreness, and edema were measured at baseline, 30 minutes, 24, 48, and 72 hours postexercise. Dynamic balance, sprint, and horizontal jump were evaluated at similar time frame except for 30-minute postexercise., Results: The findings showed that there were no significant differences between the KT group (KTG) and control group for all outcome variables (P > .05). Muscle soreness returned to baseline values 72 hours postexercise only within the KTG (P > .05). Although the horizontal jump performance decreased substantially from baseline to 24 and 48 hours postexercise only within the control group (P < .05), the performance increased significantly from 24 to 72 hours postexercise within the KTG (P < .05). Balance increased significantly from baseline to 48 hours postexercise (P < .05) in both groups. Balance also increased significantly from baseline to 72 hours postexercise only within the KTG (P < .05). The effect size of soreness which is our primary outcome was large in both groups (r > .5)., Conclusions: KT is favorable in the recovery of muscle soreness after delayed onset muscle soreness. KT has beneficial effects on horizontal jump performance and dynamic balance.

Background: The foot and ankle are important factors that provide balance and functional performance in older adults at risk of falling. It is important that proper posture of the foot via techniques such as taping and orthoses to increase contact with the ground. The purpose of this study was to investigate for a two-week period and prolonged effects (fourteen days) of Kinesio tape on the level of functional performance, balance, muscle strength of the lower extremities, pain, and functional independence when Kinesio tape was applied to the foot and ankle of older adults., Methods: Randomized trial. Forty-two older adults aged 65 years or more were selected randomly into one of two groups (KT: N.=22, control: N.=20). KT was used on the ankle and food of older adults for a two-week period. Participants were evaluated using the Visual Analog Scale, Berg Balance Scale, Timed Up and Go Test, Mini-Mental State Examination, 30-Second Sit to Stand test and Functional Independent Measurement instrument., Results: A significant difference was found between baseline and following application in the TUG and the BBS scores (P=0.001 and P<0.0001, respectively) in the Kinesio tape group., Conclusions: Our results show that KT improves balance and functional performance and reduces the risk of falling among older adults.

Adult overhead athletes without a history of shoulder injury show scapular adaptations. There is a lack of detailed assessment of scapular kinematics in junior overhead athletes. This study aims to investigate three-dimensional scapular kinematics in junior overhead athletes. We recruited a total of 20 junior tennis players and 20 healthy children without participation in any overhead sports in this study. Bilateral scapular kinematic data were recorded using an electromagnetic tracking device for scapular plane glenohumeral elevation. The data were further analysed at 30°, 45°, 60°, 90° and 120° during glenohumeral elevation and lowering. Statistical comparisons of the data between groups (junior overhead athletes and non-overhead athletes) and sides (serve dominant and non-dominant shoulders of the overhead athletes) were analysed with the ANOVA. Comparisons showed that, in general, the scapula was more upwardly rotated and anteriorly tilted in overhead athletes when compared to non-overhead athletes, however there was no side-to-side differences when serve dominant and non-dominant shoulders compared in junior overhead athletes. The serve dominant arm of junior overhead athletes had alternations in scapular kinematics when compared with the non-overhead athletes. These findings provide clinical evaluation implications and the need for clinicians to assess for potential adaptations in junior overhead athletes.