Beyond Moral Injury and Burnout: Transformative Leadership and Practice in Healthcare with Wendy Dean MD.

    In S5 E 16 I am delighted to welcome Mr Bob Chapman to the podcast. Mr Chapman "The People's CEO" is Chairman and CEO  of St. Louis, MO-based Barry-Wehmiller, a $3.6B global capital equipment and engineering solutions company with more than 12,000 team members. Mr Chapman became the senior executive of Barry- Wehmiller in 1975 at age 30 when the 90-year-old business had $20 million in revenue, outdated technology and a very weak financial position. As you will hear in this conversation despite the obstacles, Chapman applied a unique blend of strategy and culture over the next 45+ years in leading Barry-Wehmiller through more than 130 successful acquisitions.  Over the past two decades, a series of realizations led him away from traditional management practices to Truly Human Leadership--a people-centric approach where his team members feel valued, cared for and integral to the company’s purpose. At Barry-Wehmiller, they have a unique measure of success: by the way they touch the lives of people.       Chapman’s experiences and the transformation he championed were the inspiration behind his 2015 WSJ bestseller Everybody Matters: The Extraordinary Power of Caring for Your People Like Family. The book is co- authored by Raj Sisodia, founder and co-author of Conscious Capitalism. . In 2016, Harvard Business School released a case study featuring Barry-Wehmiller’s unique approach to business, which is now taught at 70+ business schools around the world.      In 2013, Bob and his wife Cynthia launched a nonprofit, Chapman Foundation for Caring Communities, to bring the company’s groundbreaking Listen Like a Leader training to communities. And, in 2015, the Chapman & Co. Leadership Institute was founded to bring Barry-Wehmiller’s trademark culture transformation and leadership training to for-profit organizations.      I am joined here by special guest co-host Dr Chris Edmond ( S 5 E7) and together we have the opportunity to explore the leadership, strategy and culture which define the Chapman and Barry-Wehmiller organisational approach today. Mr Chapman himself credits his success in the face of adversity over the years to the combination of the core tenets of common sense, creativity and a positive attitude.  His story, journey and work are testament to what is possible at the intersection of great business strategy and profound care for people.  He wants everyone to see that caring for people and giving them meaning, purpose and fulfilment through their work is not in disharmony with creating value.  If the key mission and work of this podcast is to mine for the pockets of excellent leadership and practice so that we can all learn and evolve, then we have certainly struck gold again here. Thank you Mr Bob Chapman for generously sharing your time, expertise and wisdom . Links/ References:To Read https://www.barrywehmiller.com/outreach/bookTo Listen https://www.barrywehmiller.com/blogTo Learn and Support https://www.chapmancommunities.org/our-story/https://www.ccoleadership.com The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.

    In S 5 E 15 I am delighted to welcome Fiona McCarthy to the podcast. Fiona is an occupational therapist by background specialising in workplace injury management and return to work. After her career in Occupational Therapy, Fiona became interested in primary prevention of workplace injury. She pursued post-graduate studies in Ergonomics , Safety and Health and Latrobe University. Since then, Fiona has worked in Safety and Wellbeing roles in Government, Higher Education and Health and Aged Care. she hold accreditation as a certified OHS professional and is a full member of the Human Factors Society of Australia.        In this conversation Fiona tells me more about her career trajectory leading to the work she does now consulting in job design, workflow and assisting workplaces with a proactive and primary prevention based approach to psychosocial safety. The core part of this episode focusses on psychosocial hazards and risk, what we mean by these terms and why this matters. Fiona breaks down her approach with some real world examples and very practical pearls. In particular she shares an example of excellent proactive practice in Tasmanian Bakeries, which was a finalist in this year's AIHS awards for best WHS Health and Wellbeing Program. In the final part of the conversation we discuss emerging research on the role of routine work stress as a contributor to psychosocial risk and the relevance of this to frontline responder roles in health and emergency services. Throughout this episode Fiona shares some excellent resources, linked below. Thank you Fiona for your optimistic, evidence and action-driven approach to occupational health, safety and wellbeing. Links / References/ Resources:https://www.linkedin.com/in/fiona-mccarthy-75387abb/https://www.workps.auhttps://data.safeworkaustralia.gov.au/sites/default/files/2024-02/Psychological-health-in-the-workplace_Snapshot_February2024.pdf https://www.aphirm.org.au https://learn.fwc.gov.au/local/catalogue_search/module_overview.php?id=13 https://pmc.ncbi.nlm.nih.gov/articles/PMC3974929/ https://wellbeing.hmc.ox.ac.uk/publications/employee-well-being-outcomes-from-individual-level-mental-health-interventions-cross-sectional-evidence-from-the-united-kingdom/ https://www.blackdoginstitute.org.au/wp-content/uploads/2020/10/BDI20_Workplace_Mental-Health_Toolkit.pdf?utm_medium=email&utm_campaign=Mental%20Health%20Toolkit%20Download&utm_content=Mental%20Health%20Toolkit%20Download+&utm_so The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.

     In S5 E14 I am delighted to welcome Pedja Stojicic, MD, MPH to the podcast. Dr  Stojicic is an instructor for the DrPH Program at Harvard T.H. Chan School of Public Health teaching two courses - Enabling Teams and Enabling Large System Change. Pedja is passionate about enabling health leaders to use community organizing practices to advocate for equitable health and well-being. He currently serves as an executive lead for People, Power, Health https://www.peoplepowerhealth.org/ .        In the past, he has worked with the CMS, Center for Public Health Leadership, Primary Care Progress, Way to Wellville, Healthcare Anchor Network, Center for Health Progress, and many others. Previously, Dr. Stojicic has served as president and executive director of Youth of JAZAS, a Serbian NGO fighting HIV/AIDS, and as a consultant for the Ministry of Health of the Republic of Serbia implementing health care financing reform. Dr. Stojicic completed a fellowship at the Harvard Kennedy School studying Leadership and Organizing with Prof. Marshall Ganz and later worked as a member of Ganz’s HKS Teaching Team. As a life-long activist, he currently serves on the advisory board of Leading Change Network, one of the largest global networks of social movement leaders.     In this incredible conversation Pedja tells us his own story of self before elaborating on the concept of narrative leadership and the practice and pedagogy  of community organising to enable positive social, environmental and political change. We discuss the story arc of Self, Us and Now ( articulated by Professor Marshall Ganz in his book People. Power, Change)  and why finding voice as clinicians and articulating our own story is a key first step to bringing others with us, building collective agency and taking action.      I learn more about work at People, Power, Health and HEART, an advocacy training program for courageous clinicians.      In challenging and uncertain times it is hard not to be inspired and energised by Dr Stojicic who aptly describes himself as  intellectual pessimist but action optimist. This conversation is an empowering call to individual and collective action. "Empowerment of individuals and communities is absolutely central. Getting the community involved in organising their own destiny has to be a key part of it" Professor Sir Michael MarmotLinks / References / Further Reading:Dr Pedja Stojicichttps://www.linkedin.com/in/pedjastojicic/People, Power, Health https://www.peoplepowerhealth.org/HEART program - advocacy training for courageous clinicianshttps://www.peoplepowerhealth.org/heartPeople, Power, Change Professor Marshall Ganz https://www.hks.harvard.edu/publications/people-power-change-organizing-democratic-renewal  The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.

Welcome to milestone episode 75! Thank you to past guests for generously contributing their time, expertise and wisdom to the podcast and inspiring me and many listeners. Thank you to everyone listening for continuing to support and grow this podcast and platform. Five years on this passion project still brings me joy and energy.        I can't think of a more fitting guest and topic to celebrate #75 than Dr Andrew Wines current president of podcast sponsor The Medical Benevolent Association of NSW-ACT.      The Medical Benevolent Association of NSW-ACT is a registered ACNC charity run by Doctors for Doctors and their families. MBA NSW-ACT provides counselling and short-term financial assistance through times of crisis, illness, accident, mental health conditions, grief and loss of income to help Doctors and their families in NSW and ACT to recover and return to independence and wherever possible their vocation.      Dr  Andrew Wines is an orthopaedic surgeon specialising in reconstructive surgery of the foot and ankle in adults and children. He obtained his Bachelor of Medicine and Bachelor of Surgery degree from the University of Sydney in 1994 and was awarded his fellowship in orthopaedic surgery from the Royal Australasian College of Surgeons in 2002.      He has been associated with the MBA NSW-ACT for 28 years joining initially as a councillor in his intern year. He has subsequently held a number of roles within the  organisation including secretary, treasuring, vice president and now president. In 2003 he was awarded a Churchill fellowship in 2003 to assess support services available to doctors and their families in Europe      Dr Wines holds a number of other leadership roles including in research and has made a considerable contribution to the Australian Orthopaedic Association. He is currently the second vice President and Treasurer of the AOA and will be President in 2026.  At various stages he has been chair of the Champions of Change, Surgical Performance and Accreditation Committees and a member of the Professional Standards, Continuing Professional Development, Federal Training and Audit and Risk Committees. He is the founding Treasurer of the International Orthopaedic Diversity Association, which now has over 2000 members worldwide.        In this conversation Andrew shares his own powerful story which led him to become involved with the work of the MBA very early in his career and we discuss the work and impact of the MBA NSW-ACT past, present and looking ahead. Thank you Dr Wines, this episode is a wonderful testament to the work of the charity over many years. Find out more information about the MBA support service and how you can donate here : https://www.givenow.com.au/mbanswOther links/ references:https://podcasts.apple.com/au/podcast/the-mind-full-medic-podcast/id1513559414?i=1000610327863https://www.orthopaedicdiversity.org The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.

     In S5 E12 I am delighted to introduce Dr Josh Case to the podcast. Josh is a medical doctor, software developer, startup founder and author. He is passionate about making the world's healthcare systems safer and more efficient by applying new and existing technology and by building the capability for individual clinicians to make change.     In this conversation Josh describes his early experiences of combining his dual skills as clinician and software developer to create tech solutions to improve the time and cost efficiency and reduce complexity of some of the administrative tasks required of his colleagues. We discuss some of the challenges of and opportunities  for intrapreneurship within the healthcare system.  A key thread relates to the need to maintain the necessary core business of healthcare and the safety, quality and clinical governance around this but also integrate innovation with a concomitant quality improvement process. I particularly loved his reflections about building the needed organisational architecture and internal networking to create cultures of safety, innovation and change.      We share a passion for clinician wellbeing and Josh has a unique lens on the medical workforce landscape through GoLocum. Again this leads to questions about how we can create the much needed agility, flexibility and investment and value of generalist skills needed to match demand and supply across the country going forward.       There will need to be a part 2 to this conversation as I suspect I barely scratched the surface here. Thank you Josh      Links / References:Dr Josh Case https://www.linkedin.com/in/josh-case/https://joshcase.devhttps://golocum.com.auOther links:https://www.digitalhealthfest.com.au  The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.

      In S 5 E 11 I am delighted welcome Dr Bethan Richards to the podcast.   Dr Richards is a Staff Specialist Rheumatologist at Royal Prince Alfred Hospital, Sydney and Deputy Director of the Institute for Musculoskeletal Health. In 2019, following her return from Stanford, Bethan had the honour of being appointed Chief Medical Wellness Officer in Sydney Local Health District – an Australian first. She is also the District’s inaugural MDOK Centre Director.            Throughout her career, Dr Richards has had extensive experience and a passion for designing and implementing mentoring, teaching, leadership and wellbeing programs. Following a successful pilot in junior medical staff, her evidence based BPTOK wellbeing program is now being rolled out to over 14,000 staff in Sydney Local Health District as MyDistrictOK (MDOK). Dr Richards is a national thought leader and researcher in the field of workplace wellbeing and has advised and mentored local, national and international organisational leaders on how to improve healthcare staff burnout and promote professional fulfilment.        This is a conversation I have wanted to have on the podcast for some time but feel we have reached a fitting and opportune juncture to have now.       It is hard to go first. This podcast celebrates the trailblazers and change makers in healthcare, business academia, sport and beyond. Many of my guests, like Bethan,  have gone first as innovators, movers and shakers, so that they might make the path easier for those of us who follow and are coming after.       This is a high level conversation in which Bethan discusses her healthcare organisational wellbeing work and journey to date from pitch to pilot, through iteration and scaling with a strategic and clinical governance framework and lens. She looks ahead at how we can collectively progress the work incorporating into national safety, quality and accreditation standards.  This is a masterclass at the intersection of leadership, strategy and innovation from someone who has been learning whilst doing and whose consistent and persistent efforts have afforded us a blueprint for healthcare organisational workforce wellbeing reform. This is the episode to listen to more than once, share with your colleagues and executive and healthcare leadership teams. Thank you Bethan for all the work that you do. On we sail.  References/Links/Related Reading:https://mdok.org.auPractical Pathways to Workplace Wellbeing Sydney Local Health District  https://vimeo.com/showcase/11091788https://beamtree.com.au/papers-publications/recommendations-to-sustain-our-humans-in-healthcare/ https://wellmd.stanford.edu/about/model-external.html https://wellmd.stanford.edu/knowledge-hub/courses-conferences/cwo-course.htmlhttps://catalyst.nejm.org/doi/full/10.1056/CAT.20.0266 The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.

 S5 E 10 Welcome to our first podcast bookclub! In this episode I am delighted to re-joined by two friends of the podcast and previous guests Dr Jonathan Fisher and Dr Anna Baverstock. If you haven't had a chance to listen to my conversations with Anna and Jonathan, press pause and listen here: Deep Listening, brave conversations and the goal of connection with Dr Anna Baverstock https://www.buzzsprout.com/1091279/14939038-deep-listening-brave-conversations-and-the-goal-of-connection-with-dr-anna-baverstock.mp3?download=trueTraining the Mind and healing the heart with Dr Jonathan Fisher  https://www.buzzsprout.com/1091279/12417943-training-the-mind-and-healing-the-heart-with-dr-jonathan-fisher-md.mp3?download=trueWhat does it even mean to lead with heart? Why does this matter ? What does the science say and how do we master the art? What are the heart-centred, innately human qualities, traits and practices needed for leading self and team in the organisations of today and tomorrow? These are some of the rich conversations myself and Anna Baverstock delve into in our upcoming podcast with author Jonathan Fisher, MD, FACC as we dissect his incredible book Just One Heart.  Part memoir, part practical manual Just One Heart has something for everyone. Thank you Jonathan for your gift to the world.Video Link to our conversation will be posted on the podcast website here: https://www.themindfullmedicpodcast.com/homeJust One Heart can be ordered here:https://www.amazon.com.au/dp/1636760007?ref_=mr_referred_us_au_au The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.

"The intersection of medicine, business and courageous creativity is where I've spent most of my career" Wendy Dean MD     In S5 E9 I am delighted to introduce another "heavy hitter" in healthcare thought leadership and transformational practice, Wendy Dean MD, president and co-founder of Moral Injury of Healthcare. Dr Dean is an alum of Smith College and the University of Massachusetts Medical School. She trained in surgery and psychiatry at Dartmouth Hitchcock Medical Center. After practicing for a decade, Wendy worked for the US Army, where she managed regenerative medicine research funding and guided strategy for a $70M investment in the emerging field of hand and face transplants. In that position, and as a senior executive at a large nonprofit in Washington, D.C., she worked closely with both the civilian and military medical communities, and many government agencies--BARDA, NIH, WHOSTP, NASA, DARPA--to develop novel strategies to restore form, function and appearance to ill and injured service members. She remains part of those communities as a board member and prize judge.          In describing her mission she says,"My focus now is on finding innovative ways to make medicine better for both patients and physicians through my own non-profit and by helping new talent and new ventures realize their big ideas."               Farming, fencing, photography, and riding big, opinionated horses keeps me focused outside of work.               In this conversation Wendy discusses the concept and definition of moral injury in medicine, how it is distinct but can co-exist with burnout, the implication of this for medical systems and organisations and the evolution of her own thinking and practice in this area since the publication of the OpEd she co-authored in 2018 "Clinicians aren't burning out they are suffering from moral injury". We discuss her book "If I Betray these Words" from idea to fruition and the challenges and opportunities of elevating clinical voices through story. The major part of this conversation is directed towards transformational leadership and practice in the modern day "business" of healthcare. Who is doing it well and what is working well? Wendy's commitment to mission and purpose and willingness to challenge her own and our collective thinking and practice permeates this entire episode. Thank you for energising me and for all the work that you do to move us forward towards a brighter future for healthcare. Links/References/Reading/Listening:https://wendydeanmd.comhttps://www.linkedin.com/in/wendy-dean-md/https://www.fixmoralinjury.org/what-is-moral-injuryhttps://www.penguinrandomhouse.com/books/718606/if-i-betray-these-words-by-wendy-dean-and-simon-talbot/ https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/https://podcasts.apple.com/au/podcast/43cc/id1715895952 The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.

        In S5 E8 I am delighted to welcome Dr Jess Morgan to the podcast.  Dr Morgan is a UK based paediatrician who spent 11 years as a junior doctor in the NHS. In 2019, after experiencing burnout and mental illness, she left medicine altogether. Jess threw herself into a new career as a primary teacher, completing her PGCE during the Covid pandemic and then teaching her own class. More recently, she decided to return to medicine and is still navigating this journey. Jess has developed a passion for promoting and improving doctors’ mental health and wellbeing. Some listeners may know Jess as The Bipolar Doc, a twitter alias she has kept secret until very recently. By speaking and writing honestly about her own humanity and vulnerability, Jess has grown a large community of followers. She is currently a leadership fellow at the Royal College of Paediatrics and Child Health working on a project to support paediatricians to have long, sustainable and thriving careers in the profession.       In this conversation Jess shares some more of her story and describes how her experiences have motivated her and given her courage to be a leading voice and advocate for her colleagues and determination to help build a safer more supportive healthcare system and culture.  We discuss her current work with the RCPCH and her ambassador role with Doctors in Distress, a UK charity dedicated to providing mental wellbeing support to healthcare workers.  Jess shares her teaching and presenting wisdom with a short masterclass in meeting your listeners and learners where they are and taking them where you want them to go, ending with a practical take home and call to action.      Jess's creativity, joy of learning, teaching and passionate advocacy permeate this entire conversation. I feel very grateful to have her in my tribe. Thank you Jess. Links/references/resources:Dr Jess Morgan https://x.com/doc_bipolarhttps://thebipolardoc.wordpress.comUK Doctors and NHS Practitioners :https://doctors-in-distress.org.ukhttps://www.practitionerhealth.nhs.ukhttps://www.bma.org.uk/advice-and-support/your-wellbeing/wellbeing-support-services/sources-of-support-for-your-wellbeinghttps://aboutwellbeingltd.co.uk/wp-content/uploads/2024/06/international-practitioner-health-summit-jun-2024.pdfAMA/AMSA traffic light guide https://www.ama.com.au/articles/amacdt-x-amsa-mental-health-support-traffic-light-guideTo read:https://harpercollins.co.uk/pages/listen-kathryn-mannixTo listen:https://www.themindfullmedicpodcast.com/Wellbeing leadership CPD:https://wellmd.stanford.edu The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.

        In S5 E7 I am delighted to welcome Dr Chris Edmond to the podcast. Dr Edmond is an occupational medicine physician based in Jersey. He is the Medical Director of WorkHealth (Channel Islands) Ltd, the Channel Islands’ only dedicated occupational health provider, and also holds Non-Executive Directorships at several non-profit organisations in the field of health and wellbeing in Jersey. Before qualifying in medicine in 2011, Chris worked in a variety of roles including strategy manager for a corporate bank, service improvement manager in the NHS, ran a web-design business and worked as a mental health support worker in East London, giving a him a relatively unique perspective on the drivers of health and health equity. Chris is passionate about applying public health and whole-systems lenses to his work in occupational health, and sees the workplace as a key driver of both good and poor health. He believes that by leveraging a preventative health approach in the workplace employers can be a key player in solving the nations health, productivity and wellbeing challenges.        I have been following Chris's work and reading his regular column for some time now. In this conversation we discuss his professional background, his current work and role as an occupational physician including the holistic scope of occupational medicine considering and caring for individuals in the context of their work and lives.  We discuss data and implementation science with respect to evidence-based practice in occupational medicine and work-place health interventions, wider governance, policy and leadership across the occupational environment before turning the lens on our clinical colleagues and the potential value occupational physicians could contribute going forward.      Chris's passion, and purpose-driven quest to improve health, wellbeing and professional fulfilment for everyone in the workplace and beyond permeates this entire conversation. I felt energised by our conversation but Chris acknowledges the challenges and pitfalls of advocating and agitating for positive change and progress. His call to action is one of courage, collaboration and humility. Thank you Chris for the work that you do.Links/References:Dr Chris Edmondhttps://x.com/chrismedmondhttps://www.linkedin.com/in/chris-edmond-767271154/ https://www.workhealth.je/about/https://whatworkswellbeing.orgReading recommendations :https://www.triarchypress.net/the-whitehall-effect.htmlhttps://www.penguinrandomhouse.com/books/317935/everybody-matters-by-bob-chapman-and-raj-sisodia/Subscribe/Rate/Review/Share this episode with a colleague : https://podcasts.apple.com/au/podcast/the-mind-full-medic-podcast/  The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.