Abstract: Disclosed are methods and systems for automatically estimating the length of an implantable catheter by measuring the pressure decay response to pumping fluid through the catheter. The decay time for a unit fluid pressure pulse generated within the catheter is proportional to the catheter length, i.e. as the catheter length increases so does the decay time. The catheter length can therefore be estimated based on, e.g., the decay time of the pressure pulse. The estimated catheter length can also be analyzed to determine if it is representative of the actual catheter length, or, e.g., is affected by one or more catheter malfunctions including cuts and occlusions. Systems for automatically estimating the catheter length include an implantable catheter, a pumping mechanism, a pressure sensor configured to measure pressure within the catheter, and a processor that calculates the catheter length from a pressure pulse measured while delivering fluid through the catheter.

Abstract: The present invention relates to a method for drug delivery via brain extracellular space (ECS). It includes putting head of patient in an imaging apparatus; generating dynamic images of the brain via the imaging apparatus; delivering drugs into brain ECS of the patient according to the dynamic images and the drugs get to the therapeutic target by simple diffusion along concentration gradient. The present invention also relates to a device for drug delivery via brain ECS. Basing on the self-diffusion delivery (SDD) of drugs in brain ECS, the present invention can deliver drug into the ECS of the brain's relatively safe area in low speed, with small amounts of doses and without extra stress. Therefore, the present invention can reduce delivery time and dose of drugs, relieve injection pressure, decrease damages on normal brain tissue, and reduce the cost of treatment observably.

Abstract: Some embodiments of an infusion pump system can include a controller in which one or more features sets to be provided by the controller are enabled or disabled based upon the particular pump device that is connected to the controller. For example, in some embodiments, one or more advanced features of the controller are available to the user only when a first type of pump device (e.g., having predefined settings stored therein) is connected to the controller, and those advanced features of the controller are disabled when a second type of pump device is connected to the controller.

Abstract: An apparatus, system, and method for storing liquid from a tissue site are presented. The apparatus includes a delivery tube that may have at least one lumen. The delivery tube may be operable to transmit reduced pressure to the tissue site and to receive liquid from the tissue site. The apparatus may also include an absorbent material disposed in the at least one lumen. The absorbent material may be operable to absorb the liquid from the tissue site. The delivery tube may be formed with a number of recesses.

Abstract: A fluid flow device includes a housing configured to releasably mate with a surgical control unit for controlling fluid flow during a surgical procedure. First and second ports measure fluid pressure within a fluid path provided within the housing. The fluid flow device includes a restrictor for restricting fluid flow at a restriction location along the fluid path. The first port is located upstream of the restriction location and the second port is located downstream of the restriction location. A fluid pump is provided within the housing.

Abstract: To facilitate imaging of a patient two different image recording methods are to be carried out at the same time. An auxiliary fluid, for example a contrast medium or a tracer, may be introduced into the body in each image recording method. The invention proposes mixing the two auxiliary fluids in situ immediately before dispensing to the patient. For this purpose it provides an injector with which the auxiliary fluids may be mixed and supplied to the patient. Devices for controlling dispensing of fluid from containers connected to the injector to produce a mixed solution may be electronically controlled by a control unit which calculates the total quantities, and optionally sub-quantities, of auxiliary fluids, which are used for a mixed solution, before activating the devices.

Abstract: Apparatus and methods are described for ensuring that blood transfused into a patient is the correct blood for that patient, is transfused in the correct manner and that a complete audit trail is created that will allow later tracing of blood from donation through to ultimate transfusion.

Abstract: A fluid dispenser is disclosed where a backoff distance is determined and implemented to prevent leakage while dispensing sequentially an accurate, precise amount of fluid substantially independent of the fluid remaining in a syringe-type dispenser. The fluid characteristics of the fluid, e.g. viscosity, surface tension, etc. affect the backoff distance that may be determined heuristically for fluid type, amount of fluid remaining in the syringe and amount to be dispensed. Once the fluid characteristics are known, the dispensing may be accomplished automatically with a processor loading new drive and backoff steps to a motor controller.

Abstract: The invention relates to a pump unit (1), replaceably attachable to a reusable backend (6) of an injection arrangement (7) for delivering a liquid medicament, the pump unit (1) comprising a medicament inlet (1.1), a medicament outlet (1.2) and a pump (2) for delivering the liquid medicament from the inlet (1.1) to the outlet (1.2), wherein a medicament container (4) is arranged in the pump unit (1), wherein a fluid communication between the medicament container (4) and the pump (2) is establishable when the pump unit (1) is attached to the reusable backend (6).

Abstract: A fluidic media detection system for detecting a presence of fluidic media includes a first housing portion adapted to be carried by a user; a second housing portion configured to be selectively operatively engaged with and disengaged from the first housing portion, the second housing portion for supporting a reservoir having an interior volume for containing fluidic media; a fluid conduit supported by one of the first housing portion and the second housing portion for providing fluid communication between the reservoir and the user when the first housing portion and the second housing portion are operatively engaged; and at least one interactive element, positioned near a portion of the fluid conduit, that interacts with the fluidic media when the fluidic media is present in the fluid conduit.

Abstract: A compact medical pump includes a linear peristaltic pumping mechanism driven by a motor located within a periphery of a belt of the pumping mechanism. The motor drives a gear set that drives a driving pulley which engages the belt having the rollers. A battery for the pump is positioned adjacent to the gear set. The pump includes a controller and user interface for operating the pumping mechanism as a function of pumping parameters input via the user interface. The controller may sense motor current and determine fluid path characteristics based on the sensed current.

Abstract: An apparatus, method and program product detects an occlusion in a fluid line by determining if a relationship between force measurements departs from an expected relationship.

Abstract: We describe electromechanical systems for IV control. Based on dripping speed measurement by video processing technique, we adjust the position of the presser to press the dripping tube to the appropriate position to control the dripping speed. To do this mechanically, the processing unit issues commands to a stepper motor to control its rotation, and either a leadscrew or its variants, or a cam, is used to translate motor's rotation into presser's linear motion. When the processing unit detects that the dripping is finished, the device will also cut the dripping off immediately with the presser.

Abstract: The invention relates to a pump unit (2), replaceably attachable to a reusable backend (3) of an injection arrangement (1) for delivering a liquid medicament, the pump unit (2) comprising a medicament inlet (2.1), a medicament outlet (2.2) and a peristaltic pump for delivering the liquid medicament from the inlet (2.1) to the outlet (2.2), the peristaltic pump comprising a pump rotor (2.3) and a pump hose (2.4), the pump hose (2.4) partially arranged around the pump rotor (2.3), the pump rotor (2.3) having protrusions (2.5) for engaging the pump hose (2.4), wherein a fixing side (2.6) of the pump unit (2) facing a reusable backend (3) when attached has a recess (2.7) in the shape of a circular arc for allowing a correspondingly shaped stop (3.1) protruding from the reusable backend (3) to enter into the pump unit (2) so as to support the pump hose (2.4) from an outer side opposite the pump rotor (2.3) thus allowing the protrusions (2.5) to locally squeeze the pump hose (2.4) against the stop (3.

Abstract: A method comprises measuring a volume of fluid delivered per pump stroke for each of a plurality of substantially identical medical pumps. The substantially identical medical pumps each have a fixed stroke length. The method further comprises: storing indications of the measured volumes on one or more data storage mediums; and for each of the plurality of substantially identical medical pumps, generating a separate therapy control program based on the indication of the measured volume associated with that one of the plurality of substantially identical medical pumps.

Abstract: A fluid delivery system having a closed-loop control process for delivering a medical fluid to a patient. A fluid infusion system includes a pump for delivering a fluid to a patient via an administration tube. A flow sensor associated with the administration tube provides an indication of the actual flow rate of fluid in the administration tube. Such a flow sensor may comprise a positive displacement flow sensor constructed using micro-fabrication and/or micro-molding techniques. A reader reads the actual flow rate signal and provides an indication to a controller for controlling the pump. The flow rate information can also be used for providing status information, such as the existence of a blockage in the fluid delivery system.

Abstract: A device is employed that can be retrofit onto existing feed pumps to remediate the problem of fluid aspiration in patients being fed through a feeding tube from the pump. In one embodiment the feeding pump is plugged into the device which is plugged into a power outlet. A patient angle sensor triggers power cutoff to the pump and stoppage of fluid flow. The angle sensor and operating program may be part of a smart phone. Power to the pump may be shut off due to a Bluetooth signal from the smart phone to a Bluetooth controlled power strip into which the pump is plugged to receive power.

Abstract: A method for treatment of COPD, hypertension, and left ventricular hypertrophy, and chronic hypoxia including creation of an artificial arterio-venous fistula and installation of a flow mediating device proximate the fistula. The flow mediating device is operated to limit flow as medically indicated to provide the optimum amount of bypass flow.

Abstract: A fluid delivery system having a closed-loop control process for delivering a medical fluid to a patient. A fluid infusion system includes a pump for delivering a fluid to a patient via an administration tube. A flow sensor associated with the administration tube provides an indication of the actual flow rate of fluid in the administration tube. Such a flow sensor may comprise a positive displacement flow sensor constructed using micro-fabrication and/or micro-molding techniques. A reader reads the actual flow rate signal and provides an indication to a controller for controlling the pump. The flow rate information can also be used for providing status information, such as the existence of a blockage in the fluid delivery system.

Abstract: An enteral feeding set for an enteral feeding pump having a control system for controlling operation of the pump to supply nutrient liquid to a patient through the enteral feeding set loaded in the pump, a source of electromagnetic radiation operatively connected to the control system of the pump for emitting electromagnetic radiation, and an electromagnetic radiation detector operatively connected to the control system for receiving the electromagnetic radiation and providing an indication to the control system that the feeding set is properly loaded in the pump. The feeding set includes a conduit for carrying nutrient liquid to a patient. A safety interlock includes a light pipe for providing a passage of the electromagnetic radiation from the source of electromagnetic radiation to the electromagnetic radiation detector only when the safety interlock is loaded in the pump such that nutrient liquid flow to the patient is regulated by the pump.

Abstract: Some embodiments an infusion pump system can be used to determine a user's total insulin load (TIL) that provides an accurate indication of the insulin previously delivered to the user's body which has not yet acted. In particular embodiments, the TIL can account for both the bolus deliveries and the basal deliveries that have occurred over a period of time. Such information may be useful, for example, when the infusion pump is operated in conjunction with a continuous glucose monitoring device.

Abstract: The present invention relates to a blood sugar level control system equipped with an insulin dispensing device 2 and a blood sugar measuring device 3. An attachment mechanism 4 is provided which serves to couple the insulin dispensing device 2 and said blood sugar measuring device 3 in a relatively movable manner. Preferably, the attachment mechanism 4 is constructed so that the blood sugar measuring device 3 is movable or slidable with respect to the insulin dispensing device 2. A blood sugar level control system can be provided which includes a blood sugar measuring device and an insulin dispensing device without using an adapter. Accordingly, it is possible to avoid a cost rise due to an increase in the number of parts as required. In addition, it is possible to prevent the blood sugar level control system from being unable to be used due to the loss of an adapter in the form of a different part.

Abstract: A system and method of accurately pumping a fluid using tubing of variable inner diameter and material is disclosed. The disclosed pump comprises a pumping mechanism configured to compress and release a portion of a flexible tube to cause fluid to flow along the flexible tube, a gauging apparatus, and a vacuum apparatus. The gauging apparatus is configured to determine the inner diameter of the flexible tube, which value is used in calibrating the pumping rate of the pump. The vacuum apparatus is configured to reduce the ambient pressure in a volume surrounding the portion of the flexible tube, thereby causing the flexible tube to fully expand to its original outside diameter when the flexible tube is released by the pumping mechanism.

Abstract: Devices, systems and methods for delivering one or more drugs to one or more internal body locations (such as the cerebrospinal fluid) are disclosed. In various aspects, the systems and methods may involve catheters having infusion sections with permeable membranes that develop significant back pressure to enhance uniform delivery of the drug over an infusion section; catheters that have two or more infusion sections spaced apart along the length of the same catheter, catheters that include two or more infusion sections serviced by independent lumens (such that, e.g., different drug solutions can be delivered to the different infusion sections); implantable drug delivery systems with pumps and multiple reservoirs from which drugs can be delivered; systems that are capable of delivering drug solutions with selected densities; etc.

Abstract: A system for controlling administration of medical fluid includes a fluid passageway to which is attached a first flow regulator, a second flow regulator, and a flow detector. The system also includes a controller for controlling the first and second flow regulators in response to a measurement taken by the flow detector of fluid movement in the fluid passageway. The first flow regulator, such as a pump, is configured to maintain fluid movement at flow values greater than an unrestricted flow value. The second flow regulator, such as a variable adjustable valve, is configured to maintain fluid movement at a flow value less than the unrestricted flow value. A method of controlling administration of medical fluid includes obtaining a target flow value, moving fluid through the disposable assembly, taking a measurement of fluid movement in the disposable assembly, and actuating a flow regulating apparatus.

Abstract: When consumable part such as pressure-resistant cover (300) is installed on a chemical solution injector (100), consumption degree data is read from storage means such as an RFID chip of the consumable part and temporarily held. If the consumption degree updated according to the use of the consumable part exceeds the consumption criteria, a replacement preliminary warning is outputted and the updated consumption degree data is written in the consumption storage means (310) of the consumable part. Since the consumption degree of a consumable part installed on a mechanical device is automatically detected and a replacement preliminary warning is issue to the user at an adequate timing, continuous use of a totally consumed part, unnecessary replacement of a non-totally consumed part is prevented.

Abstract: An intelligent remote-controlled portable intravenous injection and transfusion system includes a fluid storage unit (A), a transfusion needle (B), a transfusion tube (C) and a fluid supply driving unit (D). The fluid storage unit (A) is formed by a portable bag (A1) and a fluid storage bag (A2) therein. The fluid supply driving unit (D) includes a peristaltic pump (2), which is provided in a portable flip-shell formed by a lower case (5), an upper cover (6) and a rotational axis (7), and its drive device (1), a power (13), a controller having MSF module and the second wireless signal transmitter/receiver unit. The second wireless signal transmitter/receiver unit is connected to the I/O of the controller. The first wireless signal transmitter/receiver unit is provided in a healthcare monitor room, and connected to the I/O of a computer installed with a controlling software.

Abstract: A fluid management system with a detection circuit for detecting whether an attached surgical device is operational. The fluid management system changes at least one operation mode when the surgical device is detected as being operational. The fluid management system may include inflow, outflow, or inflow/outflow capabilities, and monitors at least one signal characteristic of an AC power signal provided to the surgical device.

Abstract: A device is provided for controlling the depth of sedation of a respirated patient. The device includes a respirator (2) and a sensor array (1) for detecting the tidal volume and/or the respiration rate of the patient being respirated. A computing unit (5) is provided for calculating the measured values determined with the sensor array (1). A drug regulating unit (3), a drug dispensing unit (4), and a central control device (6) are provided. The central control device (6) has stored desired values for the drug concentration to be dispensed as a function of a preselected depth of sedation corresponding to the corresponding variability over time of the tidal volume and/or respiration rate. The drug regulating unit (3) sets the drug dispensing unit (4) as a function of the tidal volume detected and/or the respiration rate for a preselected depth of sedation of the patient.

Abstract: An apparatus for use with a fluid cartridge is disclosed. The apparatus includes a percutaneous port including an interior configured to receive the fluid cartridge, an implantable operative portion operably connected to the percutaneous port, a cartridge sensor configured to sense movement of the fluid cartridge relative to the percutaneous port, and a controller.

Abstract: A pressure sensing chamber having a tubing extension extending through the chamber. The tubing contains a plurality of ports so as to allow the purging of air from the chamber, but the ports are sized so that bubbles entering the tubing cannot easily flow into the chamber.

Abstract: A system for automatically monitoring an infusion in a patient receiving an infusion from a fluid source, the system including: an infusion monitoring device comprising: a fluid valve, disposed in a fluid connection between the fluid source and the patient, and operable for preventing or allowing the flow of fluid from the fluid source to the patient; a variable volume chamber, fluidly coupled between the fluid valve and the patient, for allowing the creation of a pressure differential between the variable volume chamber and the patient; and a fluid inspection window, disposed in the fluid connection between the variable volume chamber and the patient, for allowing a view of fluid drawn from the patient into the infusion monitoring device when the fluid valve is closed and the variable volume chamber creates a negative pressure differential between the variable volume chamber and the patient.

Abstract: A fluid cartridge including a housing, a needle extending from the housing and a plurality of circumferentially spaced sensible members carried by the housing such that each of the sensible members is circumferentially spaced from the other sensible members, and apparatus including such a cartridge in combination with a partially implantable medical device.

Abstract: Medicinal fluid delivery systems and methods for priming the same are disclosed. The systems may be configured to measure an electro-transmissive quality of a medicinal fluid when: medicinal fluid is dispensed into a fluid delivery path, a proximal end of the fluid delivery path is in contact with a first electrode, and the distal end of the fluid delivery path is in contact with a second electrode. Methods for priming medicinal fluid delivery systems may include dispensing a medicinal fluid through a fluid delivery path, sensing an electro-transmissive quality of the medicinal fluid, and determining that the fluid delivery path is full based on the electro-transmissive quality.

Abstract: An injection system includes an injector for injecting a fluid into a patient and a controller in operative communication with the injector for control thereof. The controller controls a diagnostic injection of the fluid based upon at least one mathematical model individualized to the patient. The model(s) are determined by collecting data corresponding to a time response curve resulting from at least one test injection of the fluid into the patient. The time response curve represents a response of a region of interest of the patient over time due to the fluid passing therethrough. An imaging system having such an injection system is also disclosed, as is a system for effecting a medical procedure. A method of delivering such a fluid to a patient using such an injection system is also disclosed, as is a method of modeling propagation of such a fluid in a patient.

Abstract: A volume of fluid moved by a pump, such as a pump in an APD system, may be determined without direct measurement of the fluid, such as by flow meter, weight, etc. For example, a volume of a pump chamber (181) (having a movable element that varies the volume of the pump chamber) may be determined by measuring pressure in the pump chamber and a reference chamber, both while the two chambers are isolated from each other, and after the two chambers are fluidly connected so that pressures in the chambers may equalize. Equalization of the pressures may be assumed to occur in an adiabatic way, e.g., a mathematical model of the system that is based on an adiabatic pressure equalization process may be used to determine the pump chamber volume.

Abstract: A battery/self powered electronic pressure gauge having electronic measurement, control, output, and display capability is described having the flexibility of using a sampling rate that is variable, based on either a random sampling scheme or one that learns from the history of use during the previous minutes, hours, days, months, etc. The variable sampling rate enables extended operational time before replacement of the battery. The pressure gauge can be configured to sense “intent” to change pressure in the outlet line and to revise its sampling protocol. This “intent” can be defined by the detection of the proximity of a user's hand to the pressure regulator.

Abstract: A system for delivering a fluid comprising cells to tissue of a patient includes a container holding an injection fluid and a powered drive. A sensor system provides a measurement indicative of at least shear forces on the cells to a control system. Based at least in part on this measurement, the control system is adapted to transmit a control signal to the powered drive for pressurizing the contents of the container to deposit cells within the tissue of a patient via a fluid path and a patient interface. As an example, the cells can be pregenitor or stem cells.

Abstract: A system and method for automatically adjusting a Continuous Cycling Peritoneal Dialysis (“CCPD”) therapy to minimize the potential for excess intra-peritoneal volume. The adjustments are made at the end of the drain, just prior to the next fill. The adjustments short the next fill, if necessary, to limit the intra-peritoneal volume, add a cycle, if necessary, to use all of the available dialysis solution and will average the remaining dwell time to maximize the therapeutic benefit of the therapy in the allotted time. In another embodiment, a tidal therapy using trended patient UF data is provided.

Abstract: Programmable infusion systems and method for controlled infusion of diagnostic or therapeutic substances (e.g., drugs, biologics, fluids, cell preparations, etc.) into the bodies of human or animal subjects.

Abstract: A drug administration controller has a sensor that generates a sensor signal to a physiological measurement device, which measures a physiological parameter in response. A control output responsive to the physiological parameter or a metric derived from the physiological parameter causes a drug administration device to affect the treatment of a person, such as by initiating, pausing, halting or adjusting the dosage of drugs administered to the person.

Abstract: An apparatus, method and program product detects an occlusion in a fluid line by determining if a relationship between force measurements departs from an expected relationship.

Abstract: A rapid infusion system for the intravenous delivery of fluids at standard and rapid flow rates. The system includes a pump assembly, a drive assembly to power the pump, and a fluid containment system that keeps the infused fluid out of direct contact with the pump assembly and that is preferably disposable and removable. In one embodiment the drive assembly includes a differential drive that interacts with more than one motor. In one embodiment, the pump assembly includes a roller pump and the pump chamber is a collapsible, preformed tube that is preferably attached to a pump cartridge frame. Optionally, the system includes a self-leveling drip chamber and the fluid containment system is disposable and includes a pump cartridge containing the drip chamber and the pump chamber, I.V. tubing, outlet infusion tubing, and a heater cartridge.

Abstract: A remote healthcare method is applied to a healthcare server and includes the steps of receiving detected information from a physiological parameter detecting instrument, reading a patient identification code and a physiological parameter from the detected information, reading an identification datum and a medical history datum matched with the patient identification code from a history database according to the identification code, reading a disease matched with the disease classification code and a corresponding pathological symptom from the disease database according to at least one disease classification code in the medical history data, screening a corresponding matched pathological symptom from the pathological symptoms according to the read physiological parameter to create a self-perceived list, transmitting the self-perceived list to the physiological parameter detecting instrument, and waiting for a receipt of the selected option of the pathological symptom for determining an appropriate medical dos

Abstract: In a liquid medicine injecting system, an open route is formed in which a liquid medicine flows from a container that contains the liquid medicine to a blood vessel of a biological body via a micro-pump, a flow volume sensor, and a tube. A back pressure from the biological body directly operates against the micro-pump via the open route. When the flow volume of the liquid medicine is constant, power of the micro-pump has a constant relationship with the back pressure. The flow volume of the liquid medicine is adjusted to be a target volume by controlling the power of the micro-pump, and the power of the micro-motor is monitored. An abnormal injecting state of the liquid medicine caused by such as pulling out of an injection needle from the biological body is immediately detected with high accuracy based on the monitored result of the power of the micro-pump.

Abstract: An ambulatory medical device for detecting acceleration, temperature, and/or humidity conditions in or around the medical device is provided. The medical device includes one or more acceleration, thermal, and/or humidity sensors which detect acceleration, temperature, and/or humidity conditions in or around the medical device. In response to detected conditions, the medical device may, among other things, alter the operation of the device, provide an alarm or warning to the user, or transmit data about the detected conditions to another device.

Abstract: A urological medical system for performing a controlled hydrodistention of the urinary bladder for treating a bladder dysfunction problem comprised of a programmed CPU with associated computer equipment for facilitating an automatic control of a treatment procedure to be performed on a patient, a saline solution warmer, a saline solution pump, a four-way catheter wherein a channel is provided for monitoring the pressure within the bladder during the procedure, a syringe for infusing a medicine through the catheter and a strapping device to secure the syringe and to slidingly engage the catheter to a leg of the patient. Desired parameters are monitored during the procedure and a desired pressure is maintained in the bladder for a predetermined time to perform the controlled hydrodistention of the urinary bladder.

Abstract: A method comprises measuring a volume of fluid delivered per pump stroke for each of a plurality of substantially identical medical pumps. The substantially identical medical pumps each have a fixed stroke length. The method further comprises: storing indications of the measured volumes on one or more data storage mediums; and for each of the plurality of substantially identical medical pumps, generating a separate therapy control program based on the indication of the measured volume associated with that one of the plurality of substantially identical medical pumps.

Abstract: Examples disclosed herein include methods and systems for automatically estimating the length of an implantable catheter by measuring the pressure decay response to pumping fluid through the catheter. The decay time for a unit fluid pressure pulse generated within the catheter is proportional to the length of the catheter, i.e. as the length of the catheter increases so does the decay time. The catheter length can therefore be estimated based on, e.g., the decay time of the pressure pulse. The estimated catheter length can also be analyzed to determine if it is representative of the actual length of the catheter, or, e.g., is affected by one or more catheter malfunctions including cuts and occlusions.

Abstract: An infusion pump, including: a microprocessor; a drip chamber; a drip tube with an end in the drip chamber; and an illumination system: with a light source for transmitting light through the drip chamber to a drop of fluid suspended from the drip tube; and for controlling illumination properties of the light transmitted to the drop. The pump includes an optical system for: receiving light transmitted through the drop; and transmitting, to the microprocessor, data regarding the received light. The microprocessor: generates, using the data, an image of the drop; locates, using the image, an outer edge of the drop to define a boundary of the drop; integrates an area enclosed by the boundary; and calculates a volume of revolution for the drop with respect to an axis for the drop that intersects the end of the drip tube, assuming symmetry of the drop with respect to the axis.