Determination of Collimator Helmet Factors for Leksell Gamma Knife 4C Unit Using GAF Chromic EBT3 Film and ImageJ Software.

BACKGROUND: Measurement of Collimator helmet factors (CHF) is an important quality assurance procedure to be performed on Leksell Gamma Knife unit at regular interval to make sure that the interchangeable collimator helmet fit into the source channels without any positional inaccuracy which leads to major treatment error. The primary aim of this study is to measure the CHFs for Elekta Leksell Gamma knife 4C helmets using GafChromic EBT3 film and Image J software. METHODS: GafChromic EBT3 film, EPSON expression 10000 XL scanner and Image J analysis software was used for this study. The calibration curve of GafChromic EBT3 film was generated with known dose values for 14 mm collimator helmet using ImageJ software. The collimator helmet factor (CHF) for 4mm, 8mm and 14 mm collimator helmets were measured by normalizing dose rates of 4mm, 8mm and 14 mm to the dose rate of 18 mm collimator helmet using the previously generated calibration curve. The measured CHF was compared to Elekta reference value and previously published mean values. RESULTS: The measured CHFs were 0.896, 0.958, and 0.986 for 4mm, 8mm and 14mm collimators respectively. The percentage difference obtained was 1.7 %, 0.21 %, 0.1 % between measured values and reference values. CONCLUSION: The measurement of CHFs in LGK 4C unit using GafChromic EBT3 film and ImageJ software is a reliable method to verify the manufacturer quoted CHFs in routine quality assurance procedures.

Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department.

STUDY OBJECTIVE: To determine whether non-invasive ventilation (NIV) delivered by helmet continuous positive airway pressure (hCPAP) is non-inferior to facemask continuous positive airway pressure (fCPAP) in patients with acute respiratory failure in the emergency department (ED). METHODS: Non-inferiority randomized, clinical trial involving patients presenting with acute respiratory failure conducted in the ED of a local hospital. Participants were randomly allocated to receive either hCPAP or fCPAP as per the trial protocol. The primary endpoint was respiratory rate reduction. Secondary endpoints included discomfort, improvement in Dyspnea and Likert scales, heart rate reduction, arterial blood oxygenation, partial pressure of carbon dioxide (PaCO2), dryness of mucosa and intubation rate. RESULTS: 224 patients were included and randomized (113 patients to hCPAP, 111 to fCPAP). Both techniques reduced respiratory rate (hCPAP: from 33.56 ± 3.07 to 25.43 ± 3.11 bpm and fCPAP: from 33.46 ± 3.35 to 27.01 ± 3.19 bpm), heart rate (hCPAP: from 114.76 ± 15.5 to 96.17 ± 16.50 bpm and fCPAP: from 115.07 ± 14.13 to 101.19 ± 16.92 bpm), and improved dyspnea measured by both the Visual Analogue Scale (hCPAP: from 16.36 ± 12.13 to 83.72 ± 12.91 and fCPAP: from 16.01 ± 11.76 to 76.62 ± 13.91) and the Likert scale. Both CPAP techniques improved arterial oxygenation (PaO2 from 67.72 ± 8.06 mmHg to 166.38 ± 30.17 mmHg in hCPAP and 68.99 ± 7.68 mmHg to 184.49 ± 36.38 mmHg in fCPAP) and the PaO2:FiO2 (Partial pressure of arterial oxygen: Fraction of inspired oxygen) ratio from 113.6 ± 13.4 to 273.4 ± 49.5 in hCPAP and 115.0 ± 12.9 to 307.7 ± 60.9 in fCPAP. The intubation rate was lower with hCPAP (4.4% for hCPAP versus 18% for fCPAP, absolute difference -13.6%, p = 0.003). Discomfort and dryness of mucosa were also lower with hCPAP. CONCLUSION: In patients presenting to the ED with acute cardiogenic pulmonary edema or decompensated COPD, hCPAP was non-inferior to fCPAP and resulted in greater comfort levels and lower intubation rate.

Ranking and Rating Bicycle Helmet Safety Performance in Oblique Impacts Using Eight Different Brain Injury Models.

Bicycle helmets are shown to offer protection against head injuries. Rating methods and test standards are used to evaluate different helmet designs and safety performance. Both strain-based injury criteria obtained from finite element brain injury models and metrics derived from global kinematic responses can be used to evaluate helmet safety performance. Little is known about how different injury models or injury metrics would rank and rate different helmets. The objective of this study was to determine how eight brain models and eight metrics based on global kinematics rank and rate a large number of bicycle helmets (n=17) subjected to oblique impacts. The results showed that the ranking and rating are influenced by the choice of model and metric. Kendall's tau varied between 0.50 and 0.95 when the ranking was based on maximum principal strain from brain models. One specific helmet was rated as 2-star when using one brain model but as 4-star by another model. This could cause confusion for consumers rather than inform them of the relative safety performance of a helmet. Therefore, we suggest that the biomechanics community should create a norm or recommendation for future ranking and rating methods.

Managing head injury risks in competitive skateboarding: what do we know?

OBJECTIVES: The broad objective of this paper is to inform policy, practice and research regarding the management of head injury risks in competitive skateboarding. The main motivation for the current study was the question of mandating helmet use in competitive skateboarding. The specific aims are to present current knowledge on (A) head injury risks in skateboarding, (B) preliminary biomechanical data on falls and head injury risks in a selection of competitive skateboarding events similar to those planned for the Summer Olympics, (C) standards for skateboard-styled helmets and (D) impact performance of helmets commonly used in skateboarding. METHODS: A narrative review of the published literature on head injuries in skateboarding was conducted. Videos of skateboarding competitions from Vans Park Professional League, Street League Skateboarding and Dew Tour were reviewed to describe crashes and falls. Standards databases including the International Organization for Standardization (ISO), British Standards Institution (BSI), Snell, United States Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (ASTM) were searched for skateboarding-styled helmet standards. A sample of helmets considered suitable for skateboarding was tested in standard impact tests. RESULTS: The majority of previous literature focused on the paediatric population in a recreational setting with little data from competitive skateboarding. Head injuries comprised up to 75% of all injuries and helmet use was less than 35%. Video analysis identified high rates of falls and crashes during competitive skateboarding, but also a capacity for the athletes to control falls and limit head impacts. Less than 5% of competitive skateboarders wore helmets. In addition to dedicated national skateboard helmet standards, there are several national standards for skateboard-styled helmets. All helmets, with the exception of one uncertified helmet, had similar impact attenuation performance; that is, at 0.8 m drop height, 114-148 g; at 1.5 m, 173-220 g; and at 2.0 m, 219-259 g. Impact performance in the second impact was degraded in all helmets tested. CONCLUSION: Helmets styled for skateboarding are available 'off the shelf' that will offer protection to the head against skull fractures and intracranial injuries in competitive skateboarding. There is an urgent need to commence a programme of research and development to understanding and control head injury risks.

Patinetes, no todo se evita con el casco / Scooters; not everything is prevented with the safety helmet

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Decreased Injury Rate Following Mandated Headgear Use in Women's Lacrosse.

INTRODUCTION: There has been controversy regarding whether headgear use in women's lacrosse will affect the rate of head and musculoskeletal injuries. The purpose of this study was to investigate the effect of mandated headgear use on the rate of head and musculoskeletal injuries in high school women's lacrosse. METHODS: This was a prospective cohort study of eight high school women's lacrosse teams and their game op-ponents who were mandated to wear F3137 headgear for the 2017 and 2018 seasons. Athletic trainers documented all injuries that occurred as a result of participation on the lacrosse teams. Injury rates in the headgear cohort were compared to a retrospective (control) cohort from the High School Reporting Information Online injury data reports. RESULTS: Over the study period, 17 total injuries were reported in the headgear cohort during 22,397 exposures for an injury rate of 0.76 injuries per 1,000 athlete-exposures. The headgear cohort demonstrated significant decreases in rates of in-game head and face injury (RR 0.141, 95% CI [0.004, 0.798]), in-game concussion (RR 0.152, 95% CI [0.004, 0.860]), and practice trunk and extremity injury (RR 0.239, 95% CI [0.049, 0.703]) when compared to the control cohort. CONCLUSION: Mandated use of headgear was shown to be effective at lowering the rate of head or face injury and concussions in women's lacrosse. Additionally, mandated headgear use was also shown to lower the rate of injury to body locations other than the head or face during practice. To our knowledge, this is the first study to demonstrate a decrease in injury rates associated with ASTM approved headgear in women's lacrosse.

Sex and Sport Differences in College Lacrosse and Soccer Head Impact Biomechanics.

PURPOSE: Sport-related head impact biomechanics research has been male-centric and focused primarily on American football and ice hockey, which do not address popular sports in which both sexes participate. The purpose of this study was to quantify college female and male lacrosse and soccer head impact biomechanics. METHODS: Head impact biomechanics were collected from college lacrosse and soccer players across two Division 1 college athletic programs (96 female athletes, 141 male athletes; age, 19.8 ± 1.3 yr; height, 174.8 ± 9.2 cm; mass, 72.4 ± 11.7 kg). We deployed helmetless head impact measurement devices (X2 Biosystems xPatch) before each event. Peak linear and rotational accelerations were log-transformed for random intercepts general linear mixed models, and subsequently categorized based on impact magnitude for additional categorical analyses. RESULTS: Most linear (69.4%) and rotational (72.3%) head impact accelerations sustained by our study cohort were categorized as mild. On average, male athletes sustained impacts with higher linear accelerations than females (P = 0.04), and lacrosse athletes sustained higher linear acceleration impacts than soccer athletes (P = 0.023). Soccer athletes sustained significantly higher-magnitude impacts during competitions versus practices (linear, P < 0.001, rotational, P < 0.001), whereas lacrosse athletes sustained higher-magnitude impacts during practices versus competition (linear, P < 0.001; rotational, P < 0.001). Male athletes sustained higher accelerations in competitions versus practice (linear, P = 0.004; rotational, P < 0.001), whereas female athletes sustained higher accelerations in practice versus competitions (linear, P < 0.001; rotational, P = 0.02). There were no interactions between sex and sport on impact magnitude. CONCLUSIONS: Male athletes and lacrosse athletes experience higher-magnitude head impacts. Given the limited literature in this area, future research should continue characterizing head impact biomechanics in women's and nonhelmeted sports as well as validate nonhelmeted head impact technologies.

Low-level light therapy using a helmet-type device for the treatment of androgenetic alopecia: A 16-week, multicenter, randomized, double-blind, sham device-controlled trial.

INTRODUCTION: Androgenetic alopecia is the most common form of hair loss in both sexes. In recent studies, low-level light therapy (LLLT) has been established as an effective treatment for alopecia. The purpose of this study was to evaluate the safety and efficacy of LLLT using a new helmet-type device for the treatment of androgenetic alopecia. METHOD: A randomized, sham device-controlled, double-blind clinical trial was conducted at 2 institutions. Sixty participants diagnosed with androgenetic alopecia aged from 19 to 65 years were recruited. LLLT was performed through a helmet-type device that emitted light with a mean output power of 2.36 mW/cm at a wavelength of 655 nm. Participants were divided into 2 groups, which respectively used the experimental device and a sham device. After tattooing at the central point of the vertex, phototrichograms at that point were obtained at 0, 8, and 16 weeks. The primary endpoint of the study was the difference in the rate of change of hair density between the test group and the control group. RESULTS: Comparing the results at baseline and week 16, the experimental group showed an increase in hair density of 41.90 hairs/cm and an increase in hair thickness of 7.50 µm, whereas the control group showed an increase of 0.72 hairs/cm and a decrease of 15.03 µm, respectively (P < .001). No adverse events or side effects occurred. CONCLUSION: LLLT showed a significant effect on increasing hair density in patients with androgenetic alopecia. LLLT could be a safe and effective treatment for androgenetic alopecia in both sexes.

Helmet use among motorcycle riders in Ho Chi Minh City, Vietnam: results of a five-year repeated cross-sectional study.

OBJECTIVE: In Vietnam, motorcycle riders comprise about three-quarters of road traffic fatalities, the most common cause of which is head injuries that can be prevented by wearing a helmet. This study aims to assess helmet-wearing behaviors in Ho Chi Minh City, the largest city in Vietnam. METHODS: Eight rounds of observational studies were conducted in six randomly selected locations between July 2015 and April 2019. Given the multinomial nature of the outcome measure (not wearing a helmet; wearing a substandard helmet; wearing an unstrapped standard helmet; wearing a strapped standard helmet), a multinomial model was developed to estimate the level and trend of helmet use and identify the related individual and environmental factors. FINDINGS: A total of 479,892 motorcycle riders were observed, over 90 % of whom were wearing helmets (range over the eight rounds: 92.5 %-96.0 %). However, the prevalence of correct helmet use (defined as wearing a strapped standard helmet) gradually declined from 80.8 % in round 1-55.6 % in round 8. Results from a multinomial model showed the probability of wearing a strapped standard helmet had declined by 22.4 percentage points from round 3 to round 8 while holding other factors constant (95 % CI: 21.8-23.0). The prevalence of correct use is 11.3 percentage points higher for adults than for children (95 % CI: 10.5-12.1). During the same period, unstrapped standard helmet use increased by 24.5 percentage points (95 % CI: 24.1-24.9); substandard helmet use declined but remained high. CONCLUSION: The upward trend of incorrect helmet wearing behaviors and wearing substandard helmets sends a rallying call for multisectoral interventions.

Equestrian Helmet Standards: Do They Represent Real-World Accident Conditions?

The use of helmets in equestrian sports has reduced the occurrence of traumatic brain injuries although, despite improvements to helmets, concussion remains a common injury. Currently, equestrian helmets are designed to pass certification standards involving a linear drop test to a rigid surface, while most concussions in equestrian sports result from oblique impacts to a compliant surface. The purpose of this study was to: (1) Compare the head kinematics and brain tissue response of the current equestrian helmet standard (EN1) and proposed standard EN13087-11 (EN2) to those associated with reconstructions of real-world equestrian concussion accidents. (2) Design a test protocol that would reflect the real-world conditions associated with concussion in equestrian sports. (3) To assess the protective capacity of an equestrian helmet using the flat turf and 45° turf proposed test protocols. Results for reconstructions of real-world concussions were obtained from a previous study (Clark et al. in J. Sci. Med. Sport 23:222-236, 2020). Using one jockey helmet model, impact tests were conducted according to the EN1 and EN2 protocols. Additionally, helmeted and unhelmeted tests were conducted at 5.9 and 6.0 m/s on to flat turf and 45° turf anvils for front, front-boss and rear-boss impact locations. The results demonstrated EN1 and EN2 both had higher magnitude accelerations and shorter duration impacts than reconstructed real-world concussive impacts. Impacts to turf anvils, on the other hand, produced similar head kinematics compared to the reconstructed real-world concussive impacts. Additionally, this study demonstrated that helmeted impacts significantly decreased rotational kinematics and brain tissue response below what is associated with unhelmeted impacts for oblique falls. However, the head kinematics and brain tissue response associated with these helmeted falls were consistent with concussion, suggesting that scope exists to improve the capacity of equestrian helmets to protect against concussion.

Existing Laws to Combat Road Traffic Injury in Nepal and Bangladesh: A Review on Cross Country Perspective.

BACKGROUND: Road traffic accidents is a leading cause of injury and death globally. The consequences of road traffic accidents are prominent in developing countries that can least afford to meet the health services, economic and societal challenges. Nepal and Bangladesh are two developing country of South Asia who bear a large share of burden due to road traffic injuries. METHODS: A non-systematic review of relevant documents using Google scholar and PubMed as well as review of relevant legal documents was done. RESULTS: Nepal and Bangladesh have traffic laws including all the key risk factors as recommended by the World Health Organization except the child restraint systems laws. The existing laws for both countries include speed, drunk driving, use of seatbelts and motorcycle helmet, driver license, vehicle condition, overloading and accident related compensations.In both the countries for post-crash response, national emergency care access number has partial coverage and in Nepal there are some provisions related to trauma registry.Vulnerable groups are pedestrians with majority of male and higher mortality found in rural areas than urban areas for both the countries. CONCLUSIONS: Both the countries have traffic laws that focus on the prevention of road traffic accidents and protection of victims. However, amendments in the existing laws are required for confronting immediate challenges of increasing accidents and injuries that both the countries face every year.

Skiing and snowboarding head injury: A retrospective centre-based study and implications for helmet test standards.

BACKGROUND: Head injury occurs in up to 47% of skiing or snowboarding injuries and is the predominant cause of death in these sports. In most existing literature reporting injury type and prevalence, head injury mechanisms are underreported. Thus, protective equipment design relies on safety evaluation test protocols that are likely oversimplified. This study aims to characterize severity and mechanism of head injuries suffered while skiing and snowboarding in a form appropriate to supplement existing helmet evaluation methods. METHODS: A 6-year, multicentre, retrospective clinical record review used emergency databases from two major trauma centres and Coroner's reports to identify relevant cases which indicated head impact. Records were investigated to understand the relationships between helmet use, injury type and severity, and injury mechanism. Descriptive statistics and odds ratios aided interpretation of the data. FINDINGS: The snow sport head injury database included 766 cases. "Simple fall", "jump impact" and "impact with object" were the most common injury mechanisms while concussion was observed to be the most common injury type. Compared to "edge catch", moderate or serious head injury was more common for "fall from height" (OR = 4.69; 95% CI = 1.44-16.23; P = 0.05), "jump impact" (OR = 3.18; 95% CI = 1.48-7.26; P = 0.01) and "impact with object" (OR = 2.44; 95% CI = 1.14-5.56; P = 0.05). Occipital head impact was associated with increased odds of concussion (OR = 7.46; 95% CI = 4.55-12.56; P = 0.001). INTERPRETATION: Snow sport head injury mechanisms are complex and cannot be represented through a single impact scenario. By relating clinical data to injury mechanism, improved evaluation methods for protective measures and ultimately better protection can be achieved.

UK military helmet design and test methods.

The aim of this paper was to provide the military medical community with an expert summary of military helmets used by HM Armed Forces. The design of military helmets and test methods used to determine the fragmentation and non-ballistic impact protection are discussed. The helmets considered are Parachutist, Combat Vehicle Crewman, Mk6, Mk6A, Mk7 and VIRTUS. The helmets considered provide different levels of fragmentation and non-ballistic impact protection dictated by the materials available at the time of the helmet design and the end-user requirement. The UK Ministry of Defence defines the area of coverage of military helmets by considering external anatomical features to provide protection to the brain and the majority of the brainstem. Established test methods exist to assess the performance of the helmet with respect to the threats; however, these test methods do not typically consider anatomical vulnerability.

Proposed injury thresholds for concussion in equestrian sports.

OBJECTIVES: Equestrian helmets are designed to pass certification standards based on linear drop tests onto rigid steel surfaces. However, concussions in equestrian sports occur most commonly when a rider is thrown off a horse and obliquely impacts a compliant surface such as turf or sand. This paper seeks to elucidate the mechanics of such impacts and thereby propose corresponding thresholds for the occurrence of concussion that can improve equestrian helmet standards and designs. DESIGN: The present study examined the biomechanics of real-world equestrian accidents and developed thresholds for the occurrence of concussive injury. METHODS: Twenty-five concussive and 25 non-concussive falls in equestrian sports were reconstructed using a combination of video analysis, computational and physical reconstruction methods. These represented male and female accidents from horse racing and the cross-country phase of eventing. RESULTS: The resulting thresholds for concussion [59g, 2700rad/s2, 28rad/s, 0.24 (MPS), 6.6kPa and 0.27 (CSMD10) for 50% risk] were consistent with those reported in the literature and represent a unique combination of head kinematic thresholds compared to other sports. Current equestrian helmet standards commonly use a threshold of 250g and a linear drop to a steel anvil resulting in less than 15ms impacts. This investigation found that concussive equestrian accidents occurred from oblique impacts to turf or sand with lower magnitude and longer duration impacts (<130g and >20ms). This suggests that current equestrian helmet standards may not adequately represent real-world concussive impact conditions and, consequently, there is an urgent need to assess the protective capacity of equestrian helmets under real-world conditions.

Event-specific impact test protocol for ice hockey goaltender masks.

Goaltenders in the sport of ice hockey are at high risk for concussions from falls to the ice, player collisions and puck impacts. However, current methods used to certify helmets only consider head accelerations for drop tests which may not describe all common injury mechanisms relating to concussion. The purpose of this study was to describe the characteristics of 3 events associated with concussions for ice hockey goaltenders. A helmeted medium National Operating Committee on Standards for Athletic Equipment (NOCSAE) headform was impacted under conditions representing 3 injury events. Three impact locations' velocities were selected for each event based on video analysis of real-world concussive events. Peak resultant linear acceleration, rotational acceleration and rotational velocity of the headform were measured. The University College Dublin Brain Trauma Model (UCDBTM) was used to calculate maximum principal strain (MPS) and von Mises stress in the cerebrum. Each impact event produced a unique dynamic response and brain stress and strain values. This demonstrates that a single impact event (i.e. falls) cannot adequately describe all impact events. As a result, impact protocols which assess multiple impact events such as the protocol described in this study should be used to evaluate ice hockey goaltender masks.

Factors influencing protective equipment use by mountain bikers: Implications for injury prevention.

AIM: To assess the attitudes of mountain bikers to the use of protective equipment and quantify the use of such equipment. METHOD: This was a prospective cohort study using an online questionnaire, offered to bikers participating in a series of Enduro races. The attitudes towards various factors that might contribute to a rider's choice to use protective equipment were quantified based on their responses to the questions. The actual reported use of various types of protective equipment was the outcome measure. The correlations between the factors and actual use were analysed for statistical significance, to assess their relative importance. RESULTS: Equipment use was similar in racing and non-racing settings and could be increased. 55% had experienced an injury requiring a week or more off work. Perceptions of the benefits, costs, cues, comfort and potential injury severity proved to be well correlated with the choice to use equipment, while harm, danger and exposure to media influences did not.

How safe are standard certified motorcycle safety helmets? Malaysian postal delivery riders scenario.

Objective: The objective of this study was to determine the proportion of motorcycle safety helmets (MSHs) used by postal delivery riders (PDRs) that comply with the Standards and Industrial Research Institute of Malaysia's (SIRIM) MSH standard guidelines and identify factors that contribute toward compliance of used MSHs with the standards. Methods: The presence of SIRIM certification label, the status of MSH, type of chinstrap, MSH crash history, and duration of MSH use were observed. The dependent variable was the results of the SIRIM testing procedures (SIRIM tests). MSHs that passed the SIRIM tests were considered "standard certified" MSHs. Results: The odds of the complimentary MSHs passing all of the SIRIM tests were 3.7 times the odds of the self-purchased MSHs passing the tests. The odds of MSHs with the SIRIM certification label passing all of the SIRIM tests were 24.2 times the odds of MSHs without the SIRIM certification label, and the odds of MSHs used <3 years passing the SIRIM tests were 3.75 times the odds of the MSHs used ≥3.8 years. Conclusion: PDRs provided with complimentary MSHs with the SIRIM certification label by the employer for their daily delivery routines and duration of MSH used for less than 3 years were found to be safe MSHs for male occupational riders in Malaysia.

Repeated Impacts Diminish the Impact Performance of Equestrian Helmets.

Context: During thoroughbred races, jockeys are placed in potentially injurious situations, often with inadequate safety equipment. Jockeys frequently sustain head injuries; therefore, it is important that they wear appropriately certified helmets. Objective: The goals of this study are (1) to perform impact attenuation testing according to ASTM F1163-15 on a sample of equestrian helmets commonly used by jockeys in the United States and (2) to quantify headform acceleration and residual crush after repeat impacts at the same location. Participants and Design: Seven helmet models underwent impact attenuation testing according to ASTM F1163-15. A second sample of each helmet model underwent repeat impacts at the crown location for a total of 4 impacts. Setting: Laboratory. Intervention: Each helmet was impacted against a flat and equestrian hazard anvil. Main Outcome Measures: Headform acceleration was recorded during all impact and computed tomography scans were performed preimpact and after impacts 1 and 4 on the crown to quantify liner thickness. Results: Four helmets had 1 impact that exceeded the limit of 300g. During the repeated crown impacts, acceleration remained below 300g for the first and second impacts for all helmets, while only one helmet remained below 300g for all impacts. Foam liner thickness was reduced between 5% and 39% after the first crown impact and between 33% and 70% after the fourth crown impact. Conclusions: All riders should wear a certified helmet and replace it after sustaining a head impact. Following an impact, expanded polystyrene liners compress, and their ability to attenuate head acceleration during subsequent impacts to the same location is reduced. Replacing an impacted helmet may reduce a rider's head injury risk.