What Is A Health System Pharmacy? - [Answer Found]

What Is A Health System Pharmacy
Significant financial and clinical considerations should be made when designing an integrated health system since the pharmacy is an essential component. The expense of medicines is continuing its upward trend, and precision medicine is expected to make this burden even greater for consumers financially.

What is the most prevalent example of a health system pharmacy?

Which of the following best describes a nursing home as an example of an institutional pharmacy? The United States is home to more than 5,750 registered establishments that fall under this category of health-system pharmacies. This makes them the sort of pharmacy that is by far the most common.

What is a health system in healthcare?

The World Health Organization defines a health system as “all organizations, people, and activities whose primary aim is to promote, restore, or preserve health.” The following organizations, people, and actions are included in this definition: This covers both attempts to alter the factors that determine health and actions that focus more directly on improving health.

A mother who is staying at home to care for her ill kid
a youngster who is receiving treatment for their condition within the context of the school setting
A person who makes use of vocational rehabilitation programs offered at their place of employment
Programs aimed at changing people’s behaviors, such as those that control vectors, private service providers.
Health insurance organizations, occupational health and safety legislation that includes inter-sectoral action by health staff, for example encouraging the ministry of education to promote female education, which is a well-known determinant of better health are all examples of factors that can be implemented to improve health.

In addition to prevention, promotion, treatment, and palliation, rehabilitation is an important component of comprehensive health care. In an all-encompassing health care system, one of the most important aspects of care provided at both the community and hospital levels is rehabilitation.

It is anticipated that the incorporation of rehabilitation into health care systems (across the continuum of care, at all stages of life, and for a variety of health conditions) will result in improved coordination with medical and other health services as well as accountability, quality assurance, and long-term sustainability.

(6) On the medium and long-term, the implementation of this unified strategy will result in improved distribution of available labor resources, enhanced delivery of rehabilitation services, and enough funding. However, there is data that suggests rehabilitation is not yet properly incorporated into the majority of the world’s health systems.

Individuals in need of rehabilitation services are unable to receive them in a great number of nations across the world. As a component of universal health coverage, the integration of rehabilitation services at all levels of the healthcare system is the most effective strategy for ensuring that these services are accessible to everyone who has a requirement for them.

In order to have a health system that is well-functioning and working in harmony, you need to have health workers who are trained and motivated, an infrastructure that is well-maintained, and a reliable supply of medicines and technologies. Additionally, you need to have adequate funding, solid health plans, and policies that are evidence-based.

The amount of economic growth and the political structure that is now in existence are two of the primary factors that determine how medical care is delivered in any country. The provision of medical care has emerged as a pressing issue on a global scale. Every nation, regardless of whether it has a private, public, or mixed health care system, has issues with regard to the quality, delivery, and cost of the services that are provided.

There is a broad range of health systems across the world, and they often reflect the history, culture, and economic conditions of the states in which they originate. This is similar to the situation with other social institutional frameworks. Although each nation’s health system is designed and developed in line with its own requirements and resources, practically all health systems share certain components, such as public health initiatives like immunization.

In some nations, the planning of the health care system is decentralized throughout a competitive market of private health care providers.
On the other hand, in other nations, there is a concerted effort on the part of governments, trade unions, charities, religious organizations, and other co-ordinated bodies to deliver planned public health care services that are targeted to the populations they serve.

When executed effectively, health care has the potential to make a sizeable contribution to a nation’s economy, as well as to its growth and industrialization efforts. This is in line with the conventional view that it is a significant factor in the promotion of the general physical, mental, and social well-being of people all over the world.

One notable instance of this was the announcement made in 1980 by the World Health Organization (WHO) that smallpox had been eradicated from all parts of the world. This made it the first disease in the annals of human history to be completely eradicated as a result of intentional health care interventions.

Because of the positive effects that rehabilitation has on people, families, and communities, allocating money to rehabilitation services need to be regarded as an investment, rather than a cost. This is because of the value that rehabilitation brings to these groups.

What is ASPH pharmacy?

We are pleased to have you join us. The American Society of Health-System Pharmacists (ASHP) serves as the collective voice of pharmacists who offer patient care in hospitals, health systems, ambulatory clinics, and other healthcare settings covering the whole spectrum of pharmaceutical usage.

What value do pharmacists bring in the healthcare system?

Providers of medical care Pharmacists have the obligation of providing patients with medications and services that are effective, safe, and of high quality in order to produce the best possible outcomes for patients’ health. Because of this, it is essential for pharmacists to have expertise in their field and knowledge that is up to date in order to provide individualized information and guidance to their patients.

What is an example of a health system?

The term “healthcare systems” refers to any organizations or sets of laws that are currently in existence and are intended to both prepare for and provide individuals with medical treatment. Examples of healthcare systems include organizations that offer medical insurance coverage.

What are the 4 components of a healthcare system?

Figure 1–1 demonstrates that a health care delivery system comprises four functional components, which are referred to as the quad-function model. These components are known as financing, insurance, delivery, and payment.

What are the 4 health systems?

By Mimi Chung – As a result of the recent rejection of revised proposals for health care in the United States by the Senate of the United States, the various health care systems in other nations have attracted substantial interest among the general public.

In the United States, one’s access to medical treatment might vary greatly depending on his or her particular set of life circumstances.
A person’s ability to receive insurance of any type, if any at all, can be affected by a variety of life circumstances, including job, military service, and age.
Investigating the advantages and disadvantages of each may shed light on other approaches to changing the healthcare policy in the United States.

The Beveridge Model, the Bismarck Model, the National Health Insurance Model, and the out-of-pocket Model are the four primary types of health care delivery systems that have been proposed. In practice, most nations have a combination of these methods, even though they normally only have one health care system that is the same for the majority of their inhabitants.

This is despite the fact that in principle these categories have different policy separations.
These divisions are useful for separating various schools of thought on health care policy; but, when deciding whether or not there is room for improvement, it is important to take into account the policies of each nation.

Beveridge’s model for an universal health service funded by a single payer Countries such as the United Kingdom, Spain, New Zealand, and Cuba are some examples. The Veterans Health Administration in the United States provides a relevant example. In 1948, Sir William Beveridge was the first person to conceptualize what would later become known as the Beveridge Model.

This system, which originated in the United Kingdom and has since extended to several regions throughout Northern Europe and the rest of the world, is frequently centralized through the development of a national health service. Because the government operates as a single payer, it effectively eliminates market competition and, as a result, manages to keep prices relatively low.

Because of the patient’s contribution to the system in the form of taxes, he or she does not have to pay any out-of-pocket costs following an appointment or procedure related to medical treatment. This makes it possible for health care to be provided free of charge at the point of service.

Within this framework, the vast majority of those working in the health care industry are government workers.
The concept of health as a fundamental human right is essential to this framework.
As a result, the government guarantees universal coverage, which means that each citizen has the same access to medical treatment as any other person.

Because the government is the only payer in this healthcare system, expenses are able to be maintained at a minimum while at the same time benefits are uniform across the country. One of the most popular complaints about this approach is that it frequently results in lengthy waiting lines.

Because of the universal guarantee of access to medical care, over usage of the system may result in rising expenditures. There is concern that the implementation of a single-payer national health service in the United States would result in an increase in the demand for all procedures, including those that are deemed to be medically unnecessary, because individuals would not be responsible for the upfront costs associated with receiving these services.

On the other hand, there are other experts who disagree with this concern and state that the existing policies in the United States squander an equal amount of money insuring the uninsured. Another matter of immediate worry is how the government would react to an emergency.

It is possible that financing for health services may fall in the event of a hazardous national emergency, such as a war or a health catastrophe.
This will make the financial burden that is inherently associated with a big inflow of patients even more difficult to bear.
In such a scenario, the distribution of emergency funds needs to be carefully considered in advance of the crisis.

A model for communal health insurance based on the Bismarck system Countries Such As Germany, Belgium, Japan, And Switzerland Are Some Examples Employer-based health care plans and some facets of the Medicaid program are relevant examples for the United States.

Otto von Bismarck devised the Bismarck model of healthcare, which is characterized by a greater degree of decentralization, during the tail end of the 19th century.
In this arrangement, funding for health insurance comes from both employers and workers.
Individuals who are working have access to “sickness funds,” which are formed by mandatory payroll dedications.

In addition, private insurance policies cover anybody who is working, regardless of any pre-existing diseases they may have. The organizations that offer medical care are almost always run by private businesses, but the money that make up social health insurance are deemed public.

In certain nations, such as France and Korea, there is only one insurer; in other countries, such as Germany and the Czech Republic, there may be several insurers, some of which compete with one another and others of which do not (Japan).
The government maintains stringent pricing limits, regardless of the quantity of insurers in the market, and insurance companies do not generate a profit.

These provisions make it possible for the government to exert a level of control over the costs of medical services that is comparable to that which the Beveridge model provides. The necessity that individuals obtain health insurance via their places of employment has both positive and negative effects.

These steps guarantee that persons who are currently employed will have access to the necessary medical treatment in order to maintain their jobs and ensure a productive labor force.
The Bismarck model allocates resources in a manner that prioritizes those who are able to make financial contributions.

This is due to the fact that the original intent of the model was not to offer universal health care. The model faces a number of challenges as a result of the shift in mentality from viewing health care as a privilege for employed citizens to viewing it as a right for all citizens.

These challenges include the question of how to provide care for people who are unable to work or who may not be able to afford contributions.
Concerns that are more immediate and practical include how to deal with aging populations, with an uneven number of citizens who are retired compared to citizens who are employed, and how to remain competitive in attracting international companies that may prefer locations that do not require such payroll dedications.

Single-payer national health insurance is the focus of the National Health Insurance Model. Examples include the countries of Canada, Taiwan, and South Korea Importance for the United States: comparable to Medicare Both the Bismarck and the Beveridge models have been incorporated into various components of the National Health Insurance concept.

Both the Beveridge and the Bismarck models include the government serving as the only payer for medical operations.
However, under the Bismarck model, healthcare providers are independent businesses.
The universal insurance policy does not generate a profit and does not reject legitimate claims.
In recent years, there has been a trend for countries that have health care systems similar to Beveridge to incorporate characteristics of Bismarck or vice versa.

As a consequence of this tendency, the health care policies in a number of countries, such as Hungary and Germany, have been trending toward the mixed model. It is possible to get into private insurance contracts in certain nations, such as Canada, for citizens who would choose to do so.

Hospitals are able to preserve their autonomy by striking a healthy balance between public insurance and private practice, which also helps reduce the number of internal issues caused by insurance policies. The cost of therapy is typically not a significant barrier for patients, and most of the time, individuals have a say in which medical professionals treat them.

This approach, similar to the Beveridge model, provides coverage for the majority of medical operations regardless of the patient’s income. Because the government handles the processing of all claims and decreases the amount of service duplication, this approach may also reduce the expenses that are associated with the administration of health insurance.

The possibility of having to wait a significant amount of time before receiving treatment is perhaps the most common criticism leveled against these systems.
Patients who are waiting to be seen in some professions, such as neurosurgery, may endure lengthy delays before they can consult with a medical professional.

Waitlists are not restricted to elective operations or other non-emergency treatments. According to a survey that was conducted by Viberg et al. in 2013, the majority of nations, including Australia, Canada, and Italy, perceive waiting times to be a critical problem in terms of their health policy.

Hip replacement surgery in Canada comes with wait times that can range anywhere from 42 to 178 days, depending on the province. The aging of the population as a demographic trend and the over use of health resources in circumstances where they are not immediately necessary are both concerns that threaten the long-term viability of this approach.

The market-driven health care system known as the out-of-pocket payment model Rural communities in India, China, Africa, and South America are some examples. Treatment for those who are uninsured or underinsured is comparable to this. Relevance to the United States In less developed countries that lack the resources necessary to provide widespread medical care, patients are required to pay for their own medical operations out of their own personal funds.

The impoverished are unable to obtain quality medical treatment because they do not have sufficient funds.
Regrettably, this state of affairs is typical in the vast majority of nations due to the fact that only the wealthiest nations have developed health care systems.
In these places, there is a correlation between differences in wealth and differences in health outcomes.

Income level has a significant impact on a variety of decisions pertaining to health care in the United States. Adults in the United States are more likely to have untreated conditions and visit a doctor less frequently than adults in Canada, despite the fact that adults in the United States are more likely to rate the quality of their care as either extremely high or low in frequency.

Adults in Canada are more likely to respond in a moderate manner to questions regarding the quality of their care.
Disparities in care that are caused by a person’s socioeconomic level and ethnicity can be observed in all nations, however they are often more prominent in the United States of America than they are in locations such as Canada.

The percentage of people who do not have health insurance varies widely from state to state, starting as low as 3.6% in Massachusetts and reaching as high as 20.6% in Texas. In the United States, the percentage of people without health insurance was at 13% in the year 2015.

In Congress, the discussion on expanding coverage while also reducing expenses is still going strong; any new information might significantly alter these estimates. **** When it comes to putting up a structure for the provision of medical care, various nations confront a variety of challenges. A approach that is successful in one nation is not likely to be totally transferable to another country due to differences in the health issues, priorities, and mentalities of the people in each nation.

It is vital to adopt a health care system in the United States that is fair and just to all residents, not just the wealthy, and analyzing the consequences of alternative models, even though this can be a hard process, is essential. Its design need to be the product of a concerted effort on the part of policy experts, health providers, lawmakers, and many other stakeholders, all of whom are interested in finding solutions to the several challenging facets of the current health insurance market.

What are the 3 goals of a healthcare system?

What hospital pharmacists do

The beginning and some background information – We are approximately three decades into a concerted effort on the part of both the government and industry to reform our health care system. This is primarily due to the fact that it is so expensive, but it is also due to the fact that we have fallen behind other developed countries on most measures of population health.

Recent improvement strategies have acknowledged the significance of primary care and have incorporated both the “Care Model,” which was developed by Ed Wagner and colleagues, as well as the “Patient-Centered Medical Home” principles, which were developed and adopted by the three most important primary care professional associations.

For these measures to be successful, there must be a stricter adherence to evidence-based clinical practice standards, as well as the use of information technology such as electronic records, registries, and information sharing platforms, and more efficient collaboration.

The “Triple Aims” are a framework that was proposed by Donald Berwick, who is the President Emeritus and Senior Fellow at the Institute for Healthcare Improvement as well as the former Director of the Centers for Medicare and Medicaid Services.
Reformers are using this framework to measure the success of their efforts to reform the healthcare system.

The improvement in the quality of care that is delivered, the improvement in patient outcomes, and the reduction in the cost of treatment are what are referred to as the Triple Aims. Some have proposed adding a fourth Aim, which is to improve the quality of life for those who provide medical care.

A variety of experiments are now being conducted on a local and regional level as a result of the formation of the Centers for Medicare and Medicaid Innovations center.
The majority of these proposals contain payment changes intended to improve primary care (for example, paying for care coordination and registries) as well as incentives to encourage physicians to provide treatment that is evidence-based.

A great number of private experiments, such as “Value-Based Purchasing” and “Direct Primary Care,” are also currently being done by health systems, insurance firms, and new enterprises that are involved in the health care industry. The majority of these studies are centered on enhancing existing care procedures and decreasing associated expenses.

In most cases, the outcomes that are being measured are intermediate outcomes such as hemoglobin A1c and blood pressure, rates of utilization of emergency and hospital services, and patient satisfaction.
These are outcomes that can be obtained in a short amount of time using data that is readily available.

Concerns have been voiced by clinicians regarding these measurements; nevertheless, because the financial concerns are so forward-looking, there appears to be little desire for debate or for really innovative alternatives. Nevertheless, before we continue too much further down the path we are on, it could be important to examine our fundamental beliefs about health and the purpose of health care.

This is particularly important due to the fact that our disease-oriented approach to health care may be one of the drivers of increasing costs.
To put it another way, before we start offering financial incentives for value-based care, we need to make sure that everyone involved—patients, clinicians, payers, and policymakers—are on the same page regarding the meaning of “health” and the role that it plays in determining the worth of medical treatment.

For the sake of this conversation, I will define value in the same way that it is commonly defined in the business world, which is as the ratio of quality to cost (quality/cost).

What are the elements of a health system?

Instead, it is organized according to the framework established by the WHO, which categorizes health systems into six fundamental aspects, or ‘building blocks,’ as follows: I service delivery; (ii) health workforce; (iii) health information systems; (iv) access to essential medicines; (v) financing; and (vi) leadership and governance (see Figure 1).

Why is the healthcare system important?

The prevention of illnesses and an overall improvement in quality of life are both benefits of receiving high-quality medical treatment. The Healthy People 2030 initiative focuses on enhancing the quality of health care and ensuring that all individuals have access to the necessary medical treatments.

It is possible to promote both health and well-being by assisting health care workers in communicating more effectively with one another.
The development of strategies to ensure that medical professionals are informed of treatment recommendations and suggested services is another essential component of improving health.

Some persons are unable to access the necessary medical treatment because they do not have health insurance or because they reside in locations that are too remote to be served by providers that offer the necessary services. It is possible for more individuals to receive the treatment they require if measures are taken to expand access to medical services.

What is the difference between a pharmacist and a clinical pharmacist?

By Zippia Expert – Nov.10, 2021 A clinical pharmacist is a type of pharmacist that undertakes activities that extend beyond the normal dispensing and processing of orders. A typical pharmacist is only responsible for these two aspects of the job. In addition to this, a clinical pharmacist is trained to optimize the selection of medications, establish doses, and oversee the work of other pharmacists.

In order to be qualified for this sort of work, a clinical pharmacist would normally have completed a residency program as well as received certification from a specialist board. Additionally, a clinical pharmacist is able to operate in a wider number of settings than other types of pharmacists. While the typical scope of practice for a pharmacist is restricted to working in hospitals and community pharmacies.

Places of Employment for Clinical Pharmacists: Physicians’ offices Emergency departments Outpatient clinics Care facilities for the elderly

Can a clinical pharmacist prescribe drugs?

It’s possible that clinical pharmacists can write prescriptions for your medications just like your regular doctor can. It is possible for clinical pharmacists to collaborate with their counterparts working in other areas of the healthcare system, such as the community pharmacy or the hospital.

Is clinical pharmacist a doctor?

References cited –

Acronym for the American College of Clinical Pharmacy (June 2008). (Downloadable Portable Document Format) “The definition of clinical pharmacy.” Doi: 10.1592/phco.28.6.816
Pharmacotherapy, 28(6):816–817
Identifiers: PMID 18503408 and S2CID 45522678
^ Cvikl, M. , & Sinkovič, A. (2020). A look back at the interventions carried out by a clinical pharmacist while working in an intensive care unit for medical patients.495-501 are the pages that make up the fourth edition of the Bosnian Journal of Basic Medical Sciences. https://doi. org/10.17305/bjbms
Thomas D. (November 2018). Clinical Pharmacy Education, Practice, and Research is a book that can be purchased with the ISBN number 9780128142776.
“BPS Specialties” “BPS Specialties”
“Advanced Practice Pharmacist” and “Advanced Practice Pharmacist” are both terms for the same profession. Retrieved 2019-01-28 .
hsc.unm.edu is where you may get your “Pharmacist Clinician Certification,” according to the University of New Mexico’s College of Pharmacy. Retrieved 2019-01-28 .
“NCBOP: Clinical Pharmacist Practitioners,” which may be found online at www.ncbop.org. Retrieved 2019-01-28 .
^ “U.S. Medicine” . www.usmedicine.com is the web address. Retrieved 2019-01-28 .
Download the PDF document titled “Economic Evaluations of Clinical Pharmacy Services: 2001–2005.” ACCP, and Pharmacotherapy. This page was retrieved on April 28th, 2016.
“About Clinical Pharmacists” is the link to the article. ACP stands for the American College of Clinical Pharmacy. Retrieved 2015-10-20 .
Greer N., Bolduc J., Geurkink E., Rector T., Olson K., Koeller E., MacDonald R., and Wilt TJ (April 2016). “Pharmacist-led Chronic Disease Management: A Systematic Review of Effectiveness and Harms Compared With Usual Care.” [cited in:] “Pharmacist-led Chronic Disease Management: The Annals of Internal Medicine, volume 165, number 1, pages 30–40. doi: 10.7326/M15-3058 . PMID 27111098 . S2CID 37107856 .
“Collaborative drug treatment management (CDTM)”, Pharmacist’s Letter/Letter. Prescriber’s 25: 250801.2009. “Collaborative drug therapy management (CDTM)”.
“Collaborative Practice Agreements,” American Medical Association for the Care of Patients, 17 September 2010. You are viewing a version of this page that was archived on September 17, 2010. This page was retrieved on April 28th, 2016.
^ Hoti K, Hughes J, Sunderland B (2011-04-30). “An increased prescription function for pharmacists – an Australian viewpoint” [An expanded prescribing role for pharmacists] doi: 10.4066/AMJ.2011.694. PMC 3562903. PMID 23393515. The Australasian Medical Journal.4 (4): 236–42.
An Exposition on the Role of the Clinical Pharmacist Practitioner in the State of North Carolina Professional Pharmacists of North Carolina Association.23 May 2005. You are viewing a version that was archived on May 23, 2005. This page was retrieved on April 28th, 2016.

What are the 3 goals of a healthcare system?

What hospital pharmacists do

Recent improvement strategies have acknowledged the significance of primary care and have incorporated both the “Care Model,” which was developed by Ed Wagner and colleagues, as well as the “Patient-Centered Medical Home” principles, which were developed and adopted by the three most important primary care professional associations.

The “Triple Aims” are a framework that was proposed by Donald Berwick, who is the President Emeritus and Senior Fellow at the Institute for Healthcare Improvement as well as the former Director of the Centers for Medicare and Medicaid Services. Reformers are using this framework to measure the success of their efforts to reform the healthcare system.

A number of local and regional experiments have begun since the Centers for Medicare and Medicaid Innovations center was established.
These experiments are being conducted in the United States.
The majority of these proposals contain payment changes intended to improve primary care (for example, paying for care coordination and registries) as well as incentives to encourage physicians to provide treatment that is evidence-based.

In most cases, the outcomes that are being measured are intermediate outcomes such as hemoglobin A1c and blood pressure, rates of utilization of emergency and hospital services, and patient satisfaction.
These are outcomes that can be obtained in a short amount of time using data that is readily available.

This is particularly important due to the fact that our disease-oriented approach to health care may be one of the drivers of increasing costs.
To put it another way, before we start offering financial incentives for value-based care, we need to make sure that everyone involved—patients, clinicians, payers, and policymakers—are on the same page regarding the meaning of “health” and the role that it plays in determining the worth of medical treatment.

For the sake of this conversation, I will define value in the same way that it is commonly defined in the business world, which is as the ratio of quality to cost (quality/cost).

What are the elements of a health system?

What is the difference between health system and health care services?

An Answer to the Problem of Ambiguity – After hearing how uncommon it is to find consistency in references to health care or healthcare, it is simple to become disheartened and assume that there is no need to differentiate between the two. However, there is one possibility, and that is to use the two names to refer to quite different concepts.

According to the post that was made on the Arcadia blog about this topic, there may be a solution to the chaos that results from utilizing healthcare, health care, and even health-care.
“The two-word phrase “health care” refers to the activities performed by providers.
Simply said, healthcare is an organizational structure.

In order to obtain the first, we must first obtain the second “according to Dr. Waldman, who writes at the website Medical Malprocess. This distinction is more akin to a distinction between the singular and the plural, in some respects. Visits to patients and the dispensing of medication are two examples of the activities that fall under the umbrella term “health care.” The industry of healthcare is the framework through which individuals obtain the medical attention they require.

This seems like an important difference to be able to make, given all the talk that has been going on about the healthcare business! ISI provides complete translation services, ranging from patient care to insurance, and regardless of how you want to define healthcare or health care, if you work in a medical-related industry and require the assistance of expert translators, ISI has you covered.

Make sure to get in touch with us now!

Why is health care system important?

One of the most important components of both society and the economy is the provision of medical care. The International Labor Organization (ILO) supports the core concepts underlying the human right to health care and social security. There are considerable beneficial benefits that may be had on individual and public health, as well as on economic growth and development, when social health protection and equitable access to excellent health care are provided.

The health industry is not just a significant economic sector but also a significant employment sector, with significant job-creation potential. Nevertheless, one of the most significant obstacles to achieving the goal of providing universal access to health care is the worldwide scarcity and unequal distribution of skilled health staff.

Underscoring the importance of the role that the healthcare industry plays in driving overall economic expansion is the United Nations High-level Commission on Health Employment and Economic Growth’s recommendation for investments in the healthcare workforce.

It is absolutely necessary to provide health care employees with decent pay in order to deliver high-quality care.
Through sectoral labor standards and social dialogue, the International Labor Organization (ILO) works in collaboration with the World Health Organization (WHO) to promote supportive, enabling, and healthy work environments for the health workforce.

This is done through the ILO-OECD-WHO Working for Health Programme, among other initiatives. The ILO also supports the improvement of working conditions and labor relations in the health sector.