The study of child-parent relationships in families raising children with autism spectrum disorders (ASD) and the assessment of the dynamics of development of a child with ASD are necessary to provide timely psychological personalized assistance to such families.

To study child-parent relations based on the mother’s behavior in an experimental play settings, in families raising children with ASD.

The child-parent relationship was being analyzed through the flannel graph that the child had previously created with fairy tale characters. This evaluation assessed child’s independence level, parent and child engagement levels. The following surveys were used to support these theses: “The interaction of the parents and the child” (IPC) and “Child Rejection Scale” (CRS). The survey sample size included 104 mothers and their children, half were with ASD (average age 7.1), and half were typically developed children (average age 7).

Typically developing children mastered the flannel graph exercise assessment independently; 30% children with ASD did not complete the exercise due to the severity of the disease. Subsequently, among the mothers whose children have ASD 26% refused to participate and the facilitator helped them instead. Statistically significant differences were found on the IPC scales – satisfaction with family relationships; emotional proximity; disciplinary confrontation in the family. CRS identified 13% of mothers of children with ASD with pronounced rejection of children.

The study of child-parent relationships using flannel graph assessment can be helpful in a comprehensive research of ASD and in programming a psychocorrectional work with children, using the child’s proximal development.

The study of voluntary attention is necessary to assess the effectiveness of therapeutic, psychotherapeutic and psychocorrective measures. Evaluation of the effectiveness of treatment by analyzing the dynamics of indicators of voluntary attention of adolescents with endogenous mental pathology is necessary for the development of personalized patient management

To analyze the dynamics of indicators of voluntary attention to memory in adolescents with endogenous mental pathology during treatment.

clinical-catamnestic, pathopsychological methods. We examined 153 patients aged 12-16 years (average-13.7 years) with diagnoses of F21.3, F21.4, F20.8xx3 (ICD-10). The comparison group consisted of 143 healthy peers. Methods children’s color train test, Schulte tables. All subjects were examined twice – at the beginning of therapy and at discharge from the clinic.

Analysis of the results of comparing the dynamics of attention in adolescents with endogenous mental diseases during the initial examination and during repeated examination showed that adolescents with diagnoses of F21.3, F21.4, as well as with a diagnosis of F20.8xx3 improve their attention indicators during repeated examination (at p< 0.01). Adolescents of the experimental group showed better results compared to the control group, which indicates that there is a positive therapeutic dynamics of attention in sick adolescents. Comparison of therapeutic dynamics of attention of adolescents with endogenous mental diseases depending on the diagnosis revealed significant differences. Adolescents from the F21 group performed better than the F20 group (at P< 0.01).

The Study showed the effectiveness of the choice of this methodological tool in assessing the therapeutic dynamics of patients.

Spanish Governmen declared state of emergency in March 2020 to prevent coronavirus COVID-19 from spreading. During September and October 2020, at Child and Adolescent Psychiatry Unit we have attended patients who presented altered eating behaviors whose onset was during lockdown. We report a series of seven cases of adolescent girls between the ages of 11 and 16, who had no previous history of mental illness. During lockdown, they have presented restriction of food and increased physical exercise, with weight loss. Some of these patients have also presented food binges and purging behaviors.

Review the impact of lockdown on eating behavior, specially on weight loss.

Literature review of scientific papers searching in Pubmed.

There are articles that study the variations in eating habits and exercise ocurred during confinement. Most focus on two trends: on the one hand, increased intake and the tendency to a more sedentary life; on the other hand, the worsening of people with a previous diagnosis of eating disorder. However, there is a third trend for which there are few studies: the new appearance of restrictive eating behaviors, together with increased physical exercise, bingeing and purging. This is the case of the patients we present. These studies describe as a possible cause of these alterations that confinement is a novel situation, which generates stress, social isolation, boredom, anxiety and a feeling of loneliness, which can influence self-concept and eating behaviors.

Lockdown has favored a change in eating habits and exercise. More studies are needed on new-onset eating disorders.

This systematic review and meta-analysis fills a lacuna in the existing literature on the prevalence of mental disorders (MD) among young people (YP) in Europe.

This study sets out to estimate the pooled prevalence (PP) of ASD, ADHD, Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), Anxiety Disorder (AD), Depressive Disorder (DD), Eating Disorder (ED), Substance Use Disorders (SUD) and the PP of any of these MD, among 5-to-18-year-old YP living in Europe, based on prevalence rates established in the last five years (LFY).

A search strategy was created following the SPIDER model and conducted on three databases. Studies were also identified from reference lists and grey literature. Eligible studies were evaluated for bias. Trends of prevalence rates across countries, gender and level of education were analysed. The random effects pooled prevalence rate (REPPR) for each MD and for any MD was calculated.

The European REPPR for any mental disorder among YP is 15.5%, translating to almost 1 in 5 YP. ADs are the most common group of MDs with a REPPR of 7.9%, followed by ADHD, ODD, MDD and CD, with REPPR of 2.9%, 1.9%, 1.7% and 1.5% respectively.

A range of challenges towards good mental health are portrayed, including diagnostic limitations, poor awareness on MD, and socioeconomic inequality. It is recommended that these challenges are tackled, and routine screening and early intervention services are developed to improve early identification and prompt treatment. Achieving these goals may positively impact individuals and societies at large, both now and in the future.

The coronavirus crisis has had an impact on the mental health of children and adolescents

Determine how it has affected this population and what mental pathologies are occurring

Literature bibliographic review

School closures and lockdown have been seen to have produced higher levels of anxiety, anger, and sleep and appetite disruption. On the one hand, the children had more anxiety and regressive behaviors, and the adolescents had more isolation, depressive symptoms and even autolytic ideation. The economic crisis and lockdown have affected the family environment, having reported greater situations of domestic violence and substance use among parents. Studies show a prevalence up to 28-34% of post-traumatic stress symptoms among adolescents. In Spain it has been determined that ¼ children present anxiety and / or depression. Their parents noticed in them greater irritability, less concentration and greater feelings of loneliness There has been an increase in addiction to new technologies. This is partly a method of maintaining social relationships, but prolonged use is associated with higher levels of anxiety and depression. Regarding to patients with mental pathology, they have presented greater tantrums, especially ADHD and ASD, due to the loss of structure and routine.

Confinement and fear of COVID have affected mental health of children and adolescents, with anxiety and depression occurring more frequently. Is highlighted the presence of feelings of loneliness among adolescents and the increase in the use of screens. Finally close to 80% of patients who had mental health conditions referred that this crisis had worsed their symtponms

There is a significant problem of unidentified and unaddressed reading disabilities leading to psychiatric problems in children and adolescents because of not having proper tools of assessments in schools. This research proposal can be a revolutionary paradigm in identifying, classifying, modeling, and benefitting children and adolescents with a specific learning disorder (SLD).

The objective of the current research proposal is to provide a framework of our reading program and collect data over time as cohorts to reflect the positive outcomes of the reading program.

After a reading assessment, students with specific reading disabilities will be registered in the program for 10 weeks. Every student will have reading training and CBT on different days of the week via video conference. Data will be collected retrospectively from the initial cohort and subsequent cohorts will be added to the data collection process for a final analysis when 60 students have completed the program.

Initial two weeks of reading training and CBT shows positive and promising results so far.

Children need to be screened at a young age for a reading disability before they struggle academically, and develop psychiatric issues later in life.

The aim of this research proposal is to help us understand, evaluate and benefit children with Specific Learning Disorder (SLD) with our newly setup reading program at RUSH University Medical Center, Department of Child and Adolescent Psychiatry.

During an out-of-hours shift, the initial assessment of a CAMHS patient is performed by the paediatric trainee, usually the paediatric SHO (senior-house-officer). During my placement as a paediatric SHO, I was aware of a gap in formalised metal state examination teaching for paediatric juniors, which would be crucial for a thorough assessment of these patients, and to better guarantee they are safely managed until further assessment.

The aim is to provide a short teaching session on mental state examining of the CAMHS patent to paediatric SHOs in order to improve their confidence in assessment.

In order to assess initial confidence in assessing the mental-state of a CAMHS patient, a pre-teaching questionnaire was given to the paediatric SHOs. A 30-minute teaching session on the mental state exam was then carried out and a post-teaching questionnaire was then given to the same trainees.

Paired sample Wilcoxons signed rank test found that training significant improved trainees’ confidence in taking a psychiatric mental state exam (p= 0.005, r = 0.628), and improved their confidence in presenting a mental state exam (p = 0.0041, r = 0.6420).

Being able to confidently assess the mental state of a CAMHS patient in an on call shift is important for the initial assessing paediatric trainee. However this is often not taught in the paediatric curriculum and trainees have expressed some anxiety in performing this assessment overnight, before a more comprehensive assessment by a CAMHS professional. A simple teaching session may help to reduce this anxiety and improve trainees’ confidence.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopment disorder characteristically compromising of three persistent symptoms; Inattention, hyperactivity and impulsivity. Within the Tameside and Glossop CCG continuous performance tests from the company QbTech are used to aid diagnosis.

The aim of this research is to evaluate the effectiveness of using both the QbCheck (triage tool) and QbTest (diagnostic tool) concordantly in the diagnostic pathway of ADHD in young people.

20 Patients who had undergone both performance tests were identified and then five components evaluated in the QbCheck were then compared to the QbTest results.

In the five areas identified by both the QbTest and QbCheck up to 80% had the same outcomes in the two tests. However, in one area (hyperactivity) only 60% of QbChecks outcomes were replicated by the QbTest. The symptom of inattention most commonly correlated between the two tests. The average wait between tests was 9.8 months. 100% of those who scored on QB Check, received diagnosis of ADHD, suggesting high referrer specificity.

QbCheck diagnostic outcomes are comparable to patients who have undergone both the QbCheck and QbTest, only having one of these continuous performance tests making up the ADHD diagnostic pathway could be cost and time saving in the pathway to diagnosis. As QbCheck can be completed within the child’s school this reduces the number of clinic appointments that need to be attended by patients and their families.

Anorexia nervosa is often associated with the development of depressive disorders.

Skillful dissimulation of the true causes of fasting in adolescents leads to diagnostic errors and delayed adequate therapy.

The study design includes clinical psychopathological, somatic-neurological, and psychological methods for examination of 54 adolescent girls aged 12-14, with a recurrent depression, and factors determine disorders in alimentary behavior (anorexia nervosa) in teen-agers. The following psychological tests were performed: Children’s Depression Rating Scale Revised, Columbia - Suicide Severity Rating Scale, Mendelevitch - Yakhin Scale to establish a neurotic state.

in all adolescent girls with anorexia nervosa depressive disorders were present in prepuberty. Behavioral syndrome and aggressive vulnerability prevailed in the structure of depression. Cognitive component was represented in the form of unstable type of poor memory and decreased rate of sensorimotor reactions with episodic recurrent attacks of bulimia. Our model of therapeutic intervention included: behavioral intervention, intravenous administration of Cerebrolysin 10,0 with 0,9 % Sodium chloride 200,0 (No.15). Therapeutic neuroplasticity, multimodal effect, and a disease - modifying therapy effects in short terms provide regression of emotional-cognitivity.

In adolescent girls with a recurrent depression anorexia nervosa has specific features that require early differentiation, neurotropic and neurodegenerative therapy.

The modality of assessment used at a University Clinical Practice in Brazil is interventive psychodiagnosis in which the active participation of children and families is considered. Orientation is given following the input provided by children and their parents.

Evaluating the use of an electronic form to be fulfilled during the observation of a child’s play in psychological session.

A child at the age of 5yrs 4m was brought for psychological assessment with the complaint of aggressiveness and irritability. His parents answered the Child Behavior Checklist (CBCL -1 1/12 5 yrs) and the Psychology interns had to observe the child’s play and fulfill an electronic form in which the choice of toys and plays, motricity, creativity, symbolic abilities, frustration tolerance, adequation with reality were verified.

The results of CBCL indicated that the child was within the clinical range regarding anxiety and depression along with somatic complaints. The indicators observed in the electronic form such as rigidity in the modality of play, the lack of adequate ability of impersonating in role-playing, the difficulty of using creativity during play unless he was guided by peers or the Psychology interns and the constant anguish of separating himself from his parents were crucial for parents’ orientation. The psychological treatment lasted five months and benefited from the information obtained through the form once the symptoms of irritability and aggressiveness were reduced.

This modality of assessment can be instructional for parents and may also reduce financial and time costs once provides specific indicators to observe during play.

The high cognitive abilities named executive functions (EF) are responsible for emotional regulation and for goal-oriented behavior. EF are frequently disrupted in anxiety disorders and negatively affect daily function and quality of life (QoL). Nevertheless, EF evaluation is usually performed in the laboratory using neuro-psychological assessments that refer to specific components (such as working memory, inhibition), but lacks a comprehensive profile of EF and the expressions in real life context.

To elaborate the knowledge about EF in daily life of children/youth with psychiatric disorders, by comparing their EF to those of healthy controls, using an ecological measure that imitates daily life scenarios; To examine the relationship between EF and QoL in the study group.

Participants were 49 children and youth aged 8-18 years: 25 subjects with psychiatric (mainly anxiety) disorders and 24 healthy controls. The children’s parents completed a socio-demographic questionnaire, the Child Behavior Checklist (CBCL) to profile emotional difficulties; The Behavior Rating Inventory of Executive Functions (BRIEF) which examines EF components related to meta-cognition and behavioral regulation; and the Pediatric Quality of Life Inventory (Peds-QoL).

The study group had more EF difficulties [reduced behavioral regulation (F=31.81; p<.001) and metacognition (F=26.25; p<.001)], and lower QoL. In the study group, EF difficulties correlated with reduced physical, emotional, social, and school-related QoL.

EF should be evaluated in children/youth with psychiatric disorders, by ecological evaluation that reflect the difficulties in daily life. This may focus intervention on child’s specific needs and improve the outcomes in terms of better function, development and QoL.

Deficits in social cognition have been reported in people at ultra-high risk (UHR) of psychosis exclusively using socio-cognitive tasks and in adolescent and young adult mixed population.

Aim of this study was (1) to assess subjective experience of social cognition in adolescent help-seekers identified through UHR criteria, (2) to explore its significant correlations with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally its stability after a 24-month follow-up period.

Participants [51 UHR, 91 first-episode psychosis (FEP), and 48 non-UHR/FEP patients], aged 13–18 years, completed the comprehensive assessment of at-risk mental states and the GEOPTE scale of social cognition for psychosis.

In comparison with non-UHR/FEP patients, both UHR and FEP adolescents showed significantly higher GEOPTE total scores. After 12 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE “Social Cognition” subscore. In the UHR group at baseline, GEOPTE scores had significant positive correlations with general psychopathology, positive and negative dimensions. Across the 2-year follow-up period, social cognition subscores specifically showed more stable associations with general psychopathology and negative symptoms.

Social cognition deficits are prominent in UHR adolescents and similar in severity to those of FEP patients at baseline. However, these impairments decreased over time, presumably together with delivery of targeted, specialized models for early intervention in psychosis.

The difficulties in social interaction present in individuals with autism spectrum conditions may are related with the abnormal attentional processing of emotional information. Specifically, it has been hypothesized that the hypersensibility to threat shown by individuals with autism may explain an avoidance behaviour. However, this hypothesis is not supported by research and the underlying psychological mechanisms of social interaction in autism still unclear.

The aim of the present study was to examine attentional processing biases by administering a computer-based attentional task in a sample of 27 children with autism spectrum conditions and 25 typically developed participants (age 11-15 years).

The initial orienting of attention, the attention al engagement, and the attentional maintenance to different emotional scenes in competition (i.e. happy, neutral, threatening and sad) were measured by recording the eye movements during a 20 seconds free-viewing task.

The main findings were: i) children with autism spectrum conditions showed an initial orientating bias towards threatening stimuli; and ii) while typically developed children revealed an attentional engagement and attentional maintenance bias towards threatening stimuli, children with autism spectrum conditions did not.

The findings of the present study are consistent with the affective information processing theories and shed light on the underlying mechanisms of social disturbances in autism spectrum conditions.

Autistic Spectrum Condition is often characterized by the presence of deficits in social interaction. An abnormal attentional processing may explain these difficulties, as it has been suggested that individuals with autism spectrum conditions may have problems with orienting attention to socially relevant stimuli and/or inhibiting their attentional responses to irrelevant ones.

The aim of the current study is to shed light on this issue by the assessment of the attentional orienting and inhibitory control to emotional stimuli (angry, happy, and neutral faces).

An antisaccade task (with both prosaccade and antisaccade blocks) was applied to a final sample of 29 children with autism spectrum conditions and 27 children with typical development.

The main findings were: i) children with autism spectrum condition committed more antisaccade error when seeing angry faces than happy or neutral faces, while children with typical development committed more antisaccade errors when seeing happy faces than neutral faces, and ii) latencies in the prosaccade and antisaccade blocks were associated with the severity of autism symptoms.

These results suggest that children with autism spectrum conditions show an impaired inhibitory control when angry faces are presented. This bias to negative high-arousal information is congruent with affective information-processing theories suggesting that threatening stimuli induce an overwhelming response in autism. From a clinical perspective, therapeutic strategies that focus on shifting attention to emotional stimuli may improve autism symptomatology and their socials functioning.

Psychiatric comorbidities, including depressive and anxiety disorders, are common in individuals with autism spectrum disorder (ASD). Use of conventional therapies for treating depression and anxiety are of limited efficacy in individuals with ASD making treatment a challenging field. Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe and efficacious technique in major depressive disorder, and a similar approach could yield therapeutic benefits in ASD.

The aim of this case study is to present the effectiveness of rTMS in a 17 year old patient diagnosed with ASD and comorbid major depression disorder with anxiety symptoms.

This is a case study of a male adolescent aged 17, diagnosed with ASD and comorbid major depression disorder with anxiety symptoms, suicidal ideation and aggressive behavior. The protocol applied was 4 weeks of daily rTMS sessions. This involved rTMS to the left dorsomedial prefrontal cortex (10 Hz, 3.000 pulses/120% motor threshold) to treat depressive symptoms and to the right (50Hz, 600 pulses/ 120%motor threshold) to treat anxiety symptoms. Assessments were conducted using the BDI, PHQ-9 and GAD-7 scales at baseline and one month follow up. Suicidal ideation and aggressive behavior were assessed by a clinician at same intervals.

Patient showed overall improvement in scores both in depression and anxiety scales. Suicidal Ideation and aggressive behavior showed significant reduction. No side effects were recorded during therapy.

Our findings suggest that the use of rTMS therapy in adolescents in the autistic spectrum and comorbid major depression disorder and anxiety symptoms is an efficacious and safe therapeutic treatment option.

The effects of bullying can be both physical and emotional, and they can last for many years. Children that experience verbal and physical bullying are at a greater risk of developing depression later on in life, compared with children who did not.

This study aims to look into the relationship between bullying, depressive symptomatology and suicidal thoughts in adolescents of high schools in Lushnje.

Three questionaires (the Beck Depression Inventory; the Bully/victim Behavior / Victim Behavior Questionnaire by Olweus; the Suicide Questionnaire) were circulated online and were completed by 400 adolescents from 2 high schools in a small city in Albania between September-November 2019. Data has been analysed using the Software Package for Social Sciences for Windows v. 22.0 (SPSS Inc. Chicago, IL).

We found significant positive correlation between bullying (victimization) and the level of depression (r (n = 400) =. 300, p≤.05), and significant positive correlation of bullying (cause) with level of depression (r (n = 400) =. 160, p≤.05) but lower than in victimes. The victims of bullying have higher levels of depression and vice versa. We found higher rate of depression in female adolescents with the average (M = 14.710, ds = 11.263) compared to boys with the average (M = 9.609, ds = 10.723). There is an important positive correlation of suicidal ideation with the level of depression (r (n = 400) =. 616, p≤.05).

Being either a bully or a victim of bullying seems to increase the chances of being affected by depression and suicidal thoughts

Children with conduct problems (CP) exhibit problematic externalizing behaviors that violate the rights of others and/or societal norms, are likely to present with comorbid psychological problems, engage in high-risk behaviours during adolescence and in turn, display poorer prospective health in adulthood. However, little known about their adolescent quotidian behaviors, such as their sleep behaviours, which may contribute to these poorer outcomes.

Using a sample designed to assess the longitudinal consequences of CP, the current study examines how histories of CP and comorbidity with depressive symptoms and/or attention-hyperactivity problems are associated with sleep difficulties during adolescence.

744 participants from an ongoing longitudinal study in Québec, Canada were assessed for CP and comorbidities when they were 6 to 10-years-old. They were classified as without CP, CP only, CP and depressive symptoms, CP and attention-hyperactivity problems, or CP, depressive symptoms and attention-hyperactivity problems based on parent and teacher-reported indices. Sleep difficulties were assessed 7 years later, using self and parent-reported indices. Regression analyses controlling for sex, age, family income, maternal education and medications were conducted.

demonstrated that youth and parents from all CP groups reported more sleep difficulties than youth without histories of CP. Participants from the CP, depressive symptoms and attention-hyperactivity problem group reported more sleep difficulty than all other groups, while their parents did not.

These findings suggest that histories of CP, regardless of comorbidity, predispose youth to future sleep difficulties and highlight the importance of incorporating self and parental indices of sleep as well as examining the effect of comorbidity.

APA describes Gender dysphoria (GD) as the conflict between a person’s physical or assigned gender and the gender with which he/she/they identify. Recently DSM-V renamed gender identity disorder as “gender dysphoria”. This change in terminology removes the ‘pathology’ from being transgender, which is not a mental health condition.

To systematically summarise available evidence in this important but less researched field.

A comprehensive review was carried using the PubMed/ Medline database.

Formal epidemiological studies of gender dysphoria in children and adolescents have not been conducted. The true prevalence os gender dysphoria is unknown around the world because of the varying definitions, different cultural norms and lack of data. Individuals who identify as transgender are vulnerable, and have higher rates of psychiatric comorbility compared with the general population. Gender dysphoria, gender identity disorder or transsexualism is a psychological condition that requires care and multiple health professionals.

The natural history of gender identity for children who express gender nonconforming or transgender identities is an area of active research. In addition, there is a lack of guidelines to approach these patients.

Bullying is a major problem worldwide and Chile is no exception. Whole school-based antibullying programs offer an opportunity for preventing bullying at school. The KiVa antibullying program has been evaluated in Finland and other European countries, showing preventive effects on self-reported bullying victimization and bullying perpetration.

To test the effectiveness of a culturally adapted version of the KiVa antibullying program in socio-economically vulnerable schools in Santiago, Chile.

We did a cluster randomized controlled trial in 5th and 6th graders at socially vulnerable schools. Schools were randomly assigned (1:1:1) to three groups: full KiVa group (including the online game), partial KiVa group (did not include the online game), and control group in which the regular school curriculum was implemented. The primary outcome was self-reported bullying victimization, measured with the Olweus Bully/Victim Questionnaire-Revised version (OBVQ-R). Students were assessed at the end of the academic year (November 2016) and 12 months later at the end of the academic year (November 2017). This trial is registered with ClinicalTrials.gov, number NCT02898324.

We included 39 schools (13 in each group). The baseline survey included a total of 5923 participants, and the endpoint survey included 3968 participants. Participants in the partial KiVa group had lower victimization and lower witnessing bullying at school at the endpoint survey than those in the control group. There was no effect of the full KiVa group. No effects were found for bullying perpetration in any of the comparisons between arms.

The KiVa antibullying Program had small effects in its implementation in Chile.

The acts of violence committed by adolescents are becoming increasingly more common, generating problems of a diverse nature.

To study the main characteristics of violent adolescent examined in a forensic psychiatric assessment.

This is a retrospective study which examined the expert files of the subjects aged between 14 and 20 years charged with violence, which were examined in the context of criminal psychiatric expertise in the psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia), between January 2002 and December 2018.

Our study included 34 forensic psychiatric assessments. The male sex was predominant (94,1%). The mean age was 19,2 years. The perpetrators were unmarried (100%), with a primary school level or less (55,9%), and low socioeconomic level in all cases. They had personal criminal records in 20,6% One-fifth had experienced emotional deprivation in childhood. The father was described as violent in 20,6% of cases. The most common diagnosis were antisocial personality disorder (55,9%) and mental retardation (29,4%). The main offences were homicide and attempted homicide (47.1%), assault and battery (26,5%) and sexual offences (20,6%). The experts had concluded to a “non-criminal responsibility” in 38,2% of cases.

The knowledge of epidemiology of violence perpetrated by adolescents highlights the need for targeted research, policy and programming responses for its prevention.

No significant relationships.