The Process

Consult with an addiction specialist in the privacy of your own home

Meperidine Withdrawal Help - New York

Never ever Quit Giving Up
Our medical professionals get on a mission to serve, assistance, and also elevate the lives of people we serve through Medication- Aided Therapy (MAT). Floor covering is considered the most efficient treatment for opioid use condition by the CDC, SAMHSA, FDA and various other government agencies. We are happy to report 95% of our individuals state they have no withdrawal symptoms at 5 days.


OPIOID WITHDRAWAL New York
What is Opioid withdrawal?To understandopioid withdrawal, it is essential to first comprehend what taking opioids over a long period of time does to ones body. Taking an opioid day-to-day for 3 weeks or longer causes an adjustment in mind chemistry which can be specified as medicine tolerance. This suggests that with time, more of the medication is required to accomplish the very same outcome (euphoria, discomfort control, or control or anxiety/depression). Reliance does not always imply dependency nevertheless, which is characterized by frequently desire as well as continuously busying oneself with the requirement to get more of the drug. If a person who hinges on opioids quits suddenly, they will likely have both physical and emotional signs and symptoms of withdrawal as the body is no more getting a medicine that it hinges on. One of the most common withdrawal signs are flu- like in nature and include:
1. Drippy nose

2. Muscle mass aches

3. Indigestion, queasiness, vomiting, diarrhea

4. Chills/sweats.

5. Quick heartbeat.

6. Goosebumps on the skin.

7. Anxiousness.

8. Lack of ability to sleep.

9. Exhaustion.


There are 2 major methods of entering into withdrawal:.

1) Unexpectedly quiting all opioid usage without tapering down first (spontaneous withdrawal).

2) Taking an opioid villain like naloxone (contained in suboxone) or naltrexone prematurely (precipitated withdrawal).





For How Long Does Opioid Withdrawal Last?
If you ask any person that has experienced opioid withdrawal, the solution is that it is fairly unpleasant and in some circumstances, life- harmful. Withdrawals can begin as early as a few hours as well as generally last 3-5 days. However, depending on the intensity of addiction and the kind of drug used, symptoms may last up to 3-6 weeks (methadone). A harsh general rule is a beginning of signs and symptoms take place after two to three times the half-life of the taken out opioid.
Exists Anything to Make Withdrawals Easier?
While the essential oftreatment for opioid withdrawal, Buprenorphine/Naloxone (Suboxone), focuses on satisfying your bodys physical dependence to opioids and minimizing desires, we likewise have added therapy to assist ease the various other undesirable signs of withdrawal. Below is a checklist of signs with equivalent therapy medications:.
1) Muscle pains, headache- acetaminophen, ibuprofen, as well as naproxen.

2) Muscular tissue spasm- cyclobenzaprine, baclofen, and methocarbamol.

3) Nausea or vomiting, vomiting- tigan, as well as ondansetron.

4) Diarrhea- loperamide, bismuth subsalicylate.

5) Abdominal cramping- dicyclomine.

6) Inability to rest (sleeping disorders) - diphenhydramine, hydroxyzine, melatonin, trazodone, as well as doxepin.

7) Anxiousness, irritation, restlessness- diphenhydramine, hydroxyzine, as well as clonidine.


The Family Members MD Focuses On Opioid Addiction and Withdrawal Therapy.
We offerMedication- helped treatmentwith Buprenorphine/Naloxone (Suboxone) to help patientsovercome opioid addictionand withdrawal. Begin today by setting up a digital check out with among our board- certified medical professionals. Whether youre in the house, at the office, or on lunch break, weve got you covered as well as are here to make healing very easy. Go here to set up currently!


MEDICATION- ASSISTED TREATMENT New York

 
At the Family members MD, we believe there are numerous roadways that lead from dependency to healing
What is Medicine Assisted Therapy (MAT)?

Prior to we start talking about therapy for opioid addiction, it is necessary to understand what is specified as opioid addiction. Opioid dependency is defined by a solid, uncontrollable desire to eat opioid medicines, also when they are no longer clinically needed. Opioid dependency continues to be at epidemic degrees in the U.S and the numbers are only anticipated to increase. Below are some fast facts:

-More than 263,000 people passed away from opioid overdose from 1999 to 2020 (21 years).
-More than 75,000 people passed away from opioid overdose in simply this previous year ending in April 2021.
-10.1 million people misused prescription opioids this past year.
-Overdose fatalities involving opioid have actually enhanced at the very least 6 times considering that 1999.

Its clear that opioids have a high potential for creating dependency in people, even when they are taken as suggested. Although there are multiple roadways torecovery, just one is referred to as the most effective by the CDC as well as authorized by multiple federal firms (FDA, SAMHSA, and other firms), and that is Medication- assisted treatment.Medication- assisted treatment( FLOOR COVERING) includes the use of drug, together with cognitive or behavioral therapy, to offer a holistic method to treatingopioid dependency.

Here at The Household MD, we integrate cutting side technology with MAT treatment inLong Island CityNew York.
Although floor covering has actually saved millions of clients from opioid related problems as well as fatality, less than 20% of those experiencing opioid dependency have accessibility to it.In enhancement to geographical constraints, there is a shortage of physicians that are trained in its application. According to SAMHSA, much less than 7 percent of medical professionals are successfully waivered to deal with opioid dependency. Tele- floor covering services, like we provide atThe Family members MD, is one means to boost access to look after those who might not otherwise have the ability to do so due to set you back, lack of accessibility to or absence of accessibility of recommending medical professionals.

The M inMATstands for certain FDA approved medication that is used to lower yearnings and physiologic dependence on opioids. While there are numerous formulations and manufacturers, all of them can be summarized in 3 medications:.
1) Buprenorphine.
2) Methadone.
3) Naltrexone.
The first two, buprenorphine as well as methadone, are both partial and also full opioid agonists specifically, whereas naltrexone is an opioid antagonist. While all three are approved for treatment of opioid addiction, maybe the best one for a lot of patients is buprenorphine/naloxone (Suboxone) as a result of its desirable profile. Given that it is only a partial agonist, it stops the feelings of ecstasy when taken, lowers yearnings at the exact same time, as well as prevents IV shot. For this reason, buprenorphine/naloxone (Suboxone) is the only FDA accepted therapy that is recommended at The Household MD. With higher than 95% of individuals withdrawal free at 5 days, our outcomes are a testimony to our know-how when managing opioid dependency. Set up a visit now to talk about more just how we can best assist you attain enduring soberness.


SHIFT FROM METHADONE New York.


What is Methadone?

Methadone is one of three medicines that is FDA accepted for the therapy of opioid use.
problem, as aMedication- assisted treatment( FLOOR COVERING). It is the very first of the MAT medications (accepted in the 1960s) and is the most greatly researched.Unlike the various other 2 drugs that are made use of in MAT, methadoneis a full opioid agonist, which implies it brings all the threats that any kind of other opioid off the street would certainly have.These include bliss, threat of respiratory clinical depression, opportunity of overdose, and hallucinations to name a few things. Because of this, other MAT drugs such asSuboxonehave now end up being more preferred because of its marginal side effect account. Long Island City New York.



For How Long Does Methadone Withdrawal Last?

If switching fromMethadoneto one more floor covering medication, such asSuboxone, it is first crucial to.
decrease the amount of methadone one is on to 30 mg daily for at the very least one week. When secure on this dose, methadone is ceased entirely and suboxone started as soon as mild- modest withdrawal signs begin to set in, which is generally after 36 hours however may differ depending upon addiction intensity. After three to five days, withdrawal is typically complete and also patient is now effectively on Suboxone.

The Family Members MD Specializes in Methadone Addiction as well as Withdrawal Treatment.

We provide Medication- assisted therapy with Buprenorphine/Naloxone (Suboxone) to aid patients.
gotten over methadone addictionand withdrawal.Get began today by scheduling a virtual see with one of our board- accredited doctors.Whether youre at home, at the workplace, or on lunch break, weve obtained you covered as well as are here to make recuperation easy.Click here to schedule currently.

 

  

How it functions
It is necessary to initial stop all methadone use. You must wait up until you have light to moderate withdrawal signs (normally 12- 72 hours) before taking your initial dosage of Suboxone. If it is taken prematurely, it can require you right into precipitated withdrawal, which is both extremely uneasy and might be dangerous. Continue as directed by your medical professional and thats it. Normally 95% of our people do not have any withdrawal signs after the very first 5-7 days of starting Suboxone. You may additionally ask for extra medicine to help relieve withdrawal symptoms to make sure that you can proceed with your day to day activities (job, school, etc) without missing a beat.


 

TREATMENT FOR NORCO WITHDRAWAL Long Island City New York 

 What is Norco?

Norco is a mix discomfort drug, consisting of both acetaminophen and hydrocodone. It is used to deal with modest to serious discomfort. Hydrocodone, which is the addictiveopioidcontained withinNorco, is stemmed from either codeine or thebaine as well as it is one of the most regularly suggested opioid in the United States. It is normally for short-term discomfort and is frequently utilized as an antitussive (coughing suppressant). When abused, it can additionally be squashed as well as grunted. It takes around 10 to half an hour for you to feel the impacts ofNorcowhen taken as well as impacts can last as much as 4 to 6 hrs. Other brand name which contain both hydrocodone as well as acetaminophen are Lortab, Vicodin, Lorcet- HD, Hycodan, as well as Vicoprofen.


The Length Of Time Does Norco Withdrawal Last?

The beginning ofwithdrawal symptomsroughly begins concerning six to twelve hrs after last usage. Symptoms normally peak around day three and also are generally substantially lowered by 7 to ten days. Often it is possible to last longer than 10 days depending on the extent of the addiction and it varies on an instance by situation basis.


The Household MD Specializes in Norco Dependency and Withdrawal Treatment

We offerMedication- assisted treatmentwith Buprenorphine/Naloxone (Suboxone) to aid clients overcomeNorcoaddiction andwithdrawal. Begin today by scheduling a virtual check out with one of our board- certified medical professionals. Whether youre at home, at work, or on lunch break, weve obtained you covered and also are right here to make healing simple. Visit this site to schedule currently.





Just how it functions
It is very important to very first stop all Norco use. You have to wait up until you have moderate to modest withdrawal symptoms (typically 12- 72 hours) before taking your initial dose of Suboxone. If it is taken too early, it can compel you right into precipitated withdrawal, which is both extremely uneasy as well as might be dangerous. Continue as routed by your doctor which it. Usually 95% of our patients do not have any kind of withdrawal signs and symptoms after the initial 3-5 days of startingSuboxone. You might also ask for added medicine to assist alleviate withdrawal symptoms so that you can proceed with your day to day activities (work, school, and so on) without skipping a beat.

TREATMENT FOR OXYCODONE WITHDRAWAL Long Island City New York


What is Oxycodone?

Oxycodone is a prescription opioid medicine that was initially made in 1916 from thebaine, an ingredient of poppy plant. It is made use of for treatment of modest to extreme discomfort and also is recognized for being very habit forming. It typically begins to control discomfort within fifteen minutes and also can for up to 6 hours with the instant launch formulation. It is likewise offered under the brand names Roxicodone and OxyContin (which is the extensive launch type), among others. The extended release kind is slowly released right into the body and offers all the time discomfort control. Due to the slower beginning, it has much less possibility for abuse compared tooxycodonewhich has a quicker onset of action.



For How Long Does Oxycodone Withdrawal Last?

The onset ofwithdrawal symptomsroughly starts about eight to twelve hrs after last usage. Signs usually peak around day three and hardly ever last longer than 5 to 7 days. As always, there can be an extended withdrawal stage depending on the severity of addiction and depending upon specific variables.

The Family MD Specializes in Oxycodone Dependency and also Withdrawal Treatment

We offerMedication- helped treatmentwith Buprenorphine/Naloxone (Suboxone) to aid clients overcomeoxycodone addictionandwithdrawal. Get going today by scheduling an online go to with among our board- licensed medical professionals. Whether youre in your home, at the workplace, or on lunch break, weve got you covered as well as are right here to make recovery easy. Visit this site to arrange now.

 

 

Just how it functions
It is very important to initial stop all oxycodone use. You must wait up until you have light to moderatewithdrawal signs and symptoms( normally 12- 72 hours) prior to taking your first dosage of Suboxone. If it is taken too early, it can require you right into precipitated withdrawal, which is both really awkward and also may be dangerous. Proceed as guided by your doctor and thats it. Generally 95% of our patients do not have any kind of withdrawal signs and symptoms after the initial 3-5 days of starting Suboxone. You might additionally ask for added medicine to aid alleviate withdrawal symptoms to make sure that you can continue with your day to day tasks (work, school, and so on) without missing a beat.

TREATMENT FOR FENTANYL WITHDRAWAL Long Island City New York


What is Fentanyl?

Fentanyl is a synthetic opioid, which means that it is created by pharmaceutical firms in the laboratory. It is a really effective opioid and has to do with 50- 100 times more stronger than morphine. Due to its strength, it is mainly being made use of for pain monitoring treatment of cancer cells clients. Of note, lots of customers are uninformed they are purchasingfentanyllaced items when they buy opioids. Distributors do this due to the fact that it makes drugs less costly, boosts strength, boosts addictive buildings, and as a result, makes thesefentanyllaced medications very hazardous also in little dosages. Beginning to activity is three to five minutes if utilized intravenously. Other common kinds that it is produced in is as a transdermal patch (Duragesic), as a lozenge called lollipops (Aqtic), and in an injectable form (Sublimaze).



How Much Time Does Fentanyl Withdrawal Last?

The onset ofwithdrawal symptomsroughly begins about six to twelve hrs after last usage. Signs generally come to a head around day 3 as well as hardly ever last longer than 5 to seven days. However, it might occur depending on the intensity of dependency or case by instance basis.

The Family Members MD Specializes in Fentanyl Dependency and Withdrawal Therapy

We offerMedication- aided treatmentwith Buprenorphine/Naloxone (Suboxone) to help clients overcomefentanyladdiction andwithdrawal. Begin today by setting up a virtual see with among our board- certified physicians. Whether youre in the house, at work, or on lunch break, weve got you covered and are below to make healing easy. Click on this link to set up now.





Exactly how it works
It is essential to first stop all Fentanyl usage. You have to wait up until you have mild to modest withdrawal signs (typically 12- 72 hrs) before taking your initial dose ofSuboxone. If it is taken too early, it can force you right into precipitated withdrawal, which is both very unpleasant as well as may threaten. Continue as directed by your doctor and thats it. Generally 95% of our patients do not have any withdrawal symptoms after the first 3-5 days of beginning Suboxone. You might additionally ask for added medication to assist reduce withdrawal signs and symptoms to make sure that you can continue with your daily activities (job, institution, etc) without avoiding a beat.

TREATMENT FOR OXYMORPHONE/OPANA WITHDRAWAL Long Island City New York

 

What is Oxymorphone?

Oxymorphoneis a very potentopioidindicated for the treatment of extreme discomfort. It is more typically recognized asOpanaor Numorphan. It is considerably more powerful than morphine and also is used to deal with pain that is unresponsive to other opioid drugs. In 2017, the FDA asked the maker of oxymorphone to remove its item from the US market as well as because has been unavailable in the United States. However, prolonged release oxymorphone formulations are still offered in the US because of its a little lower abuse capacity. The immediate launch manages pain 5-10 mins if taking IV, as well as after thirty minutes if taken by mouth, and after that last 3-4 hours. If taking the prolonged release, pain control lasts 12 hrs.

 

How Long Does Oxymorphone/Opana Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four to forty eight hours after last use. Symptoms typically intensify at two to five days and peak during the first week.
 

The Family MD Specializes in Oxymorphone Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome oxymorphone addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

 

How it works

It is essential to initial quit all oxymorphone usage. You should wait until you have light to moderate withdrawal signs and symptoms (normally 12- 72 hrs) before taking your initial dose of Suboxone. If it is taken too early, it can compel you right into precipitated withdrawal, which is both very awkward as well as might threaten. Continue as directed by your medical professional which it. Usually 95% of our clients do not have anywithdrawalsymptoms after the very first 5-7 days of startingSuboxone. You might likewise ask for additional drug to help ease withdrawal signs and symptoms so that you can continue with your everyday tasks (work, school, and so on) without skipping a beat.

TREATMENT FOR TRAMADOL WITHDRAWAL Long Island City New York

 

What is Tramadol?

When it was at first approved in 1995, tramadol was not considered an opiate even though its device of activity was similar. However, because of all the situations of abuse as well as addiction, the FDA ultimately designated tramadol as an abused substance in 2014. Compared with other illegal drugs however, tramadol has less capacity for abuse. As a result of this, tramadol is among the many typical therapies for osteo arthritis as well as various other uncomfortable problems.


The Length Of Time Does Tramadol Withdrawal Last?

The start of withdrawal signs and symptoms about begins about thirty- six to seventy- two hours after last use. Symptoms usually last 5 to 8 days. As always, there can be an extended withdrawal phase depending upon the severity of dependency and also depending on specific variables.


The Family Members MD Concentrates On Tramadol Dependency and also Withdrawal Treatment

We provide Medication- assisted therapy with Buprenorphine/Naloxone (Suboxone) to help people overcome tramadol dependency as well as withdrawal. Start today by scheduling an online check out with among our board- certified physicians. Whether youre at home, at work, or on lunch break, weve got you covered as well as are here to make recovery easy. Click on this link to set up now.

 

 

How it works

It is necessary to initial quit all tramadol use. You must wait up until you have light to modest withdrawal signs (generally 12- 72 hours) before taking your first dosage of Suboxone. If it is taken prematurely, it can compel you right into precipitated withdrawal, which is both really uncomfortable and may threaten. Proceed as directed by your doctor and thats it. Usually 95% of our patients do not have any kind of withdrawal symptoms after the first 3-5 days of beginning Suboxone. You may also request additional drug to aid relieve withdrawal symptoms to ensure that you can proceed with your daily activities (job, institution, and so on) without avoiding a beat.TRAMADOL

TREATMENT FOR CODEINE WITHDRAWAL Long Island City New York

 

 What is Codeine?

Codeine is an opiate that is commonly found is prescription- grade cough suppressants. Tylenol 3, a popular painkiller, is codeine combined with acetaminophen. Because codeine- based cough syrups are less regulated that some other opiates considered to be more dangerous (Such as morphine and oxycodone), it is relatively easy to start getting and abusing it. Once ingested, codeine is converted into morphine in the body, thus producing similar effects but to a lesser degree.  

 

 How Long Does Codeine Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four hours after last use. Symptoms typically intensify at one to three days and peak during the first week. The final phase of codeine withdrawal can last anywhere from one week after last dose and can linger for months.

The Family MD Specializes in Tramadol Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome tramadol addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

 

How it works

It is important to first stop all methadone use. You must wait until you have mild to moderate withdrawal symptoms (generally 12- 72 hours) before taking your first dose of Suboxone. If it is taken too early, it can force you into precipitated withdrawal, which is both very uncomfortable and may be dangerous.  Continue as directed by your doctor and that’s it. Generally 95% of our patient’s do not have any withdrawal symptoms after the first 5-7 days of starting Suboxone. You may also request additional medication to help ease withdrawal symptoms so that you can continue with your day to day activities (work, school, etc) without skipping a beat .

TREATMENT FOR MORPHINE WITHDRAWAL Long Island City New York

 

 What is Morphine?

Morphine is considered the classic opioid analgesic with which other painkillers are compared. It is a non- synthetic narcotic that is derived from opium and has a high potential for abuse. Traditionally morphine was almost exclusively used by injection, but the variety of pharmaceutical forms that it is marketed as today supports its use by oral and other routes of administration.  

 

How Long Does Morphine Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four hours after last use. Symptoms typically intensify at one to three days and peak during the first week.

The Family MD Specializes in Morphine Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome morphine addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

 

 

How it works

It is important to first stop all morphine use. You must wait until you have mild to moderate withdrawal symptoms (generally 12- 72 hours) before taking your first dose of Suboxone. If it is taken too early, it can force you into precipitated withdrawal, which is both very uncomfortable and may be dangerous. Continue as directed by your doctor and that’s it. Generally 95% of our patient’s do not have any withdrawal symptoms after the first 5-7 days of starting Suboxone. You may also request additional medication to help ease withdrawal symptoms so that you can continue with your day to day activities (work, school, etc) without skipping a beat .

TREATMENT FOR HYDROMORPHONE WITHDRAWAL Long Island City New York

 
What is Hydromorphone?

Hydromorphone, also commonly known as dilaudid, is an opioid medication used to treat severe pain. It is a semi- synthetic opioid that is derived from morphine, however it is 2-8x more potent than morphine. It has higher addictive potential because of its shorter duration to onset and causes greater sedation. It is used to treat pain that is not controlled by other opiate medications.  

 

 How Long Does Hydromorphone Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four to eight hours after last use. Symptoms typically intensify and peak at one to two days. After three days the symptoms should start to subside and are generally resolved after the first week.

The Family MD Specializes in Hydromorphone Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome hydromorphone addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

  

How it works

It is important to first stop all hydromorphone use. You must wait until you have mild to moderate withdrawal symptoms (generally 12- 72 hours) before taking your first dose of Suboxone. If it is taken too early, it can force you into precipitated withdrawal, which is both very uncomfortable and may be dangerous. Continue as directed by your doctor and that’s it. Generally 95% of our patient’s do not have any withdrawal symptoms after the first 5-7 days of starting Suboxone. You may also request additional medication to help ease withdrawal symptoms so that you can continue with your day to day activities (work, school, etc) without skipping a beat .
 

TREATMENT FOR MEPERIDINE WITHDRAWAL Long Island City New York

What is Meperidine?

The trademark name version of Meperidine is called Demerol. It has a misuse prospective comparable to that of morphine, yet it needs to not be made use of for treatment of persistent discomfort. Meperidine should just be used in the therapy of acute episodes of serious discomfort due to the risk of seizures from the accumulation of meperidine metabolites, specifically normeperidine, if it is utilized long term. Along with seizures, it can additionally trigger serotonin disorder if utilized in combination with certain medications. It is offered in intramuscular, subcutaneous, intravenous, syrup, and tablet types.



For How Long Does Meperidine Withdrawal Last?

The beginning of withdrawal symptoms approximately begins regarding three- twenty four hrs after last use. Signs commonly peak around 3 days and begin to decrease in strength after the very first week. Some signs and symptoms may be presented for an extended period of time depending upon the intensity of the dependency.

The Family MD Focuses On Meperidine Addiction and Withdrawal Therapy

We offer Medication- assisted therapy with Buprenorphine/Naloxone (Suboxone) to help people overcome Meperidine addiction as well as withdrawal. Get started today by setting up a virtual go to with one of our board- certified physicians. Whether youre in the house, at the office, or on lunch break, weve obtained you covered and also are here to make healing simple. Visit this site to set up now.







How it works

It is essential to initial stop all Meperidine use. You need to wait up until you have mild to modest withdrawal signs (generally 12- 72 hours) prior to taking your initial dosage of Suboxone. If it is taken prematurely, it can compel you right into precipitated withdrawal, which is both extremely uneasy as well as may be dangerous. Continue as directed by your doctor and thats it. Normally 95% of our individuals do not have any withdrawal symptoms after the initial 5-7 days of beginning Suboxone. You might also request additional medication to help alleviate withdrawal symptoms to make sure that you can proceed with your day to day tasks (job, institution, and so on) without avoiding a beat.