Dr. Charles Mayo conferred upon Alice Magaw the title of "mother of anesthesia," for her many achievements in the field of anesthesiology, particularly her mastery of the open-drop inhalation technique of anesthesia utilizing ether and chloroform and her subsequent publishing of her findings. Numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts. The AANA promulgates education and practice standards and guidelines and affords consultation to both private and governmental entities regarding nurse anesthetists … CRNAs work as independent providers and are independently licensed and legally responsible and accountable for their own practices in Texas. The AANA promulgates education, and practice standards and guidelines, and affords consultation to both private and governmental entities regarding nurse anesthetists and their practice. Military nurse anesthetists have been honored and decorated by the United States and foreign governments for outstanding achievements, dedication to duty, and competence in treating the seriously wounded. Bankert, M. Watchful Care: A History of America's Nurse Anesthetists. The AANA developed and implemented a certification program in 1945 and instituted mandatory recertification in 1978. Early in their history, nurse anesthetists were challenged by lawsuits claiming they were illegally practicing medicine. OANA is a statewide professional organization of Certified Registered Nurse Anesthetists (CRNA's). Nurse anesthetists are advanced practice registered nurses who have been providing quality anesthesia services in the United States for nearly 150 years. In addition to this, they also monitor patients post-procedure while they're recovering from anesthesia. The NBCRNA office will be closed December 24 - 25. She accepted that position, eventually retiring from that institution in 1948. The Association's federal government affairs office is maintained in Washington, D.C. References She became the first president of MoANA and later served as president of the American Association of Nurse Anesthetists (AANA), our parent organization. American Association of Nurse Anesthetists (AANA) Founded in 1931, the American Association of Nurse Anesthetists is the professional association representing nearly 54,000 certified registered nurse anesthetists and student registered nurse anesthetists nationwide. South Carolina Association of Nurse Anesthetists. The nurse anesthesia credential means that I am one of the most qualified anesthesia experts in health care today! 1953. Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program. 120 Worthington, OH 43085 Phone: (614) 228-4733 | Fax : (614) 221-1989 info@sccrna.org. The Missouri Association of Nurse Anesthetists (MoANA) has more than 1236 members. Nurse anesthetists are educated at the graduate level in programs that encompass both academic and clinical study in the specialty of anesthesia. The American Association of Nurse Anesthetists (AANA) is the professional association for Certified Registered Nurse Anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs). MoANA was founded in 1935 by 15 charter members, including Helen Lamb of St. Louis. Michael E. Conti, PhD, CRNA Today, the CRNA credential is well recognized as an indicator of quality and competence. We provide not only safe care to our patients but care on an unparalleled level. It’s the only professional association devoted solely to VA CRNAs. KANSAS ANESTHESIA PROVIDERS Coverage by … NBCRNA has opened the search for its next CEO. The American Association of Nurse Anesthetists (AANA) is the professional association for Certified Registered Nurse Anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs). For more than 80 years, the New Jersey Association of Nurse Anesthetists (NJANA) has been dedicated to advancing the nurse anesthesia profession, protecting our members, and advocating for safe and accessible anesthesia care. Latest news. Nurses were the first professional group to provide anesthesia services in the United States. The most famous nurse anesthetist of the nineteenth century, Alice Magaw, worked at St. Mary's Hospital (1889), in Rochester, Minn. That hospital, established by the Sisters of St. Francis and operated by Dr. William Worrell Mayo, later became internationally recognized as the Mayo Clinic. In academic health centers, they were frequently responsible for the education of other nurses, medical interns, and physicians. Together, Dr. Mayo and Ms. Magaw were instrumental in establishing a showcase of professional excellence in anesthesia and surgery. The podcasts will cover all components of the CPC Program, frequently asked questions, how to get involved with the NBCRNA, and more. Delphos E. Price Jr., MSNB, CRNA, APRN The AANA Foundation supports the profession through award of education and research grants to students, faculty, and practicing CRNAs. Today, nurse anesthetists work in a variety of settings such as: The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. (Surgery, Gynecology and Obstetrics, 3:795.). Management Office 400 W. Wilson Bridge Road, Ste. . Management Office 400 W. Wilson Bridge Road, Ste. I can’t imagine doing anything else. CRNAs have long been the primary anesthesia professionals in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, and trauma stabilization services. The names of two CRNAs killed in the Vietnam War are engraved on the Vietnam Memorial Wall in Washington, D.C. (1LT Jerome Olmsted, CRNA, and 1LT Kenneth Shoemaaker, CRNA). Advocacy - Advancing CRNA practice and ensuring patient access to safe, cost-effective anesthesia care. Published by the AANA The practice of anesthesia is a recognized specialty within the profession of nursing, and nurse anesthetists are essential to the … Since 1975, credentialing of nurse anesthesia educational programs and the certification/recertification of nurse anesthetists has been a function of the AANA autonomous multidisciplinary councils. Publication of the Study on Implementation of IFNA Standards in Switzerland. Welcome to CANA. OANA is a statewide professional organization of Certified Registered Nurse Anesthetists (CRNA's). According to the BLS, "overall employment of nurse anesthetists, nurse midwives, and nurse practitioners is projected to grow 26 percent from … Photos by Lisa Nipp. New York: Continuum. Nearly 90% if all CRNAs working in Kansas belong to this professional organization the American Association of Nurse Anesthetists (AANA). What is a Nurse Anesthetist? AANA membership includes more than 50,000 CRNAs and SRNAs, representing over 90 percent of the nurse anesthetists in the United States. It accounts for 32.8% of all malpractice claims against nurse practitioners, according to the Nurse Practitioner Claim Report: 4th Edition. In fact, according to the American Association of Nurse Anesthetists (AANA), CRNAs are the sole providers in nearly 100 percent of the rural hospitals for some states. The American Association of Nurse Anesthetists, or AANA as it is commonly known, is a professional body aimed at keeping the standards in the domain of nurse anesthesia high. Nurse anesthetists have been held as prisoners of war, suffered combat wounds during wartime service, and have lost their lives serving their country. “Since 2004, the American Association of Colleges of Nursing has called for doctoral preparation for all advanced practice registered nurses, including certified registered nurse anesthetists (CRNAs),” says Robert Rosseter, AACN spokesman. Nurse anesthetists have been providing anesthesia care to patients in … Nurse Practitioner Case Study: Failure to Diagnose. All Rights Reserved. The CRNA credential validates my competency and right to practice as a professional. See More at our Youtube channel! A certified registered nurse anesthetist (CRNA) is an advanced-practice nurse who is certified in anesthesia. Their record of patient safety is excellent. These nurses work alongside anesthesiologists, surgeons, dentists, podiatrists, and other healthcare professionals to ensure the safe administration of anesthesia. The Association of Veterans Affairs Nurse Anesthetists is the voluntary, professional organization of certified registered nurse anesthetists employed by the Department of Veterans Affairs. Staff Nurse Anesthetist The American Association Of Nurse Anesthetists. Assistant Program Director, Assistant Professor American Association of Colleges of Nursing. Today, more than 44,000 CRNAs and nurse anesthesia students practice in all 50 states, providing anesthesia services to all segments of the population including substantial numbers of Medicare, Medicaid, public employee, veteran, and indigent patients. The Tennessee Association of Nurse Anesthetists (TANA) is a nonprofit corporation whose purpose is to advance the profession of nurse anesthesia, to advocate Certified Registered Nurse Anesthetists as high- quality anesthesia providers, to enhance the art and science of nurse anesthesia and to facilitate the provision of safe, accessible, affordable, high quality anesthesia care. Throughout my career the CRNA credential represents advocacy: advocacy for our patients, for our scope of practice, and for the education of the next generation of CRNAs. To listen, check out our podcast page where you can also download episodes to listen at your convenience. You’ll gain … Additionally, nurse anesthetists have been the main providers of anesthesia care to U.S. military personnel on the front lines since WWI, including current conflicts in the Middle East. Get resources on-the-go with NBCRNA Engage: The NBCRNA Podcast. The Association of Veterans Affairs Nurse Anesthetists is the voluntary, professional organization of certified registered nurse anesthetists employed by the Department of Veterans Affairs. The AANA promulgates education, and practice standards and guidelines, and affords consultation to both private and governmental entities regarding nurse anesthetists and … The AANA is actively involved in the development of federal and state healthcare policy, and offers consultation and data sources regarding CRNA practice to both public and private entities. American Association of Nurse Anesthetists; American Association of Nurse Assessment Coordinators; American Association of Nurse Attorneys; American Association of Nurse Life Care Planners; American Association of Nurse Practitioners; American Association of Occupational Health Nurses; American Association of Spinal Cord Injury Nurses Established in the late 1800s, nurse anesthesia has since become recognized as the first clinical nursing specialty. 120 Worthington, OH 43085 Phone: (614) 228-4733 | Fax : (614) 221-1989 info@sccrna.org. Nurse anesthetists administer anesthesia and provide care to patients before, during, and after therapeutic, surgical, obstetrical, and diagnostic procedures. CRNAs are the “top Gun” of APRNs due to our education and clinical experience during school and practice. The American Association of Colleges of Nursing (AACN), a trade group that represents private and public schools of nursing nationwide, also welcomes the change. Founded in 1931, the AANA is the professional association representing more than 37,000 nurse anesthetists nationwide. 1989. KANA itself dates back to 1931 and is the professional association of CRNAs who preside or practice in the region. Nurse anesthetists, the first healthcare providers dedicated to the specialty of anesthesia, have their roots in the 1800s, when nurses first gave anesthesia to … The earliest existing records documenting the anesthetic care of patients by nurses were those of Sister Mary Bernard, a Catholic nun who assumed her duties at St. Vincent's Hospital in Erie, Pa. in 1877. Founded in 1931, the AANA is the professional association representing more than 37,000 nurse anesthetists nationwide. Legislative Office 1122 Lady Street, Suite 1102 Columbia, SC 29201 Phone: (803) 931-0696 Although nurse anesthesia educational programs existed prior to World War I, the war sharply increased the demand for nurse anesthetists and, consequently, the need for more educational programs. American Association of Nurse Anesthetists (AANA) advances patient safety, practice excellence, and its members' profession. As a leader I am proud to offer my time to my fellow colleagues to help them grow, and to protect them in times of needs and changes. About the NBCRNA The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) is the nation’s certifying body for the initial, continued and subspecialty certification of the more than 55,000 Certified Registered Nurse Anesthetists (CRNAs). As advanced practice nurses, CRNAs administer more than 34 million anesthetics in the United States each year. Normal business hours resume December 28. More than 90 percent of all U.S. nurse anesthetists, including CRNAs and nurse anesthesia students, belong to the association. The American Society of PeriAnesthesia Nurses represents the interests of over 55,000 nurses who practice in preanesthesia and postanesthesia care, outpatient surgery, and pain management. The role of the Certified Registered Nurse Anesthetist (CRNA) is vital to healthcare in Texas. OutPatient Anesthesia Specialists- Wilmington, DE.  I am proud to be called a Nurse anesthetist and dedicate this web site to the advancement of its practitioners and students. The AANA and its members advocate for changes to the nation’s healthcare system which increase anesthesia patient safety and affordability of anesthesia services, maximize patient access to care, support patients’ rights to receive care from the providers of their choice, and ensure nurse anesthesia educational opportunities. It makes a great public statement for the profession. Nurse anesthetists, the first healthcare providers dedicated to the specialty of anesthesia, have their roots in the 1800s, when nurses first gave anesthesia to … | Terms of Use. Hundreds of physicians and nurses from the United States and throughout the world came to observe and learn their anesthesia techniques. Founded in 1931 and located in Park Ridge, Ill., the AANA is the professional organization for nearly 47,000 nurse anesthetists. The Role of Nurse Anesthetists. Evaluation and Research Advisory Committee. Surgeons saw nurses as a cadre of professionals who could give their undivided attention to patient care during surgical procedures. During the Panama action, only nurse anesthetists were sent with the fighting forces. The discipline of nurse anesthesia developed in response to requests of surgeons seeking a solution to the high morbidity and mortality attributed to anesthesia at that time. Apply by January 8, 2021. It reassures the public that they have a certified and competent provider at the head of the OR table. Compassion - AANA supports members in providing patient-centered care. Failure to diagnose is the most frequent malpractice allegation asserted against nurse practitioners. CEO Search Started - Apply by January 8, 2021 - The NBCRNA has launched its search for its Chief Executive Officer (CEO) who will provide visionary leadership and oversight for the development and implementation of NBCRNA’s programs and initiatives. Based on their sophisticated body of knowledge, CRNAs are licensed and certified to practice anesthesia. Emory University. American Association of Nurse Practitioners Applauds Approval of COVID-19 Vaccine; Urges Public to Get Vaccinated December 14, 2020 Practice Supporting NPs in All Areas of Practice, so That You Can Focus on Your Patients. Nurse anesthetists have been administering anesthesia to patients in the United States for over 150 years, ever since the Civil War. When a nurse anesthetist administers anesthesia, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. The Arkansas Association of Nurse Anesthetists (ARANA) is a not for profit organization representing over 600 Certified Registered Nurse Anesthetists (CRNA) in the state of Arkansas. In 1906, one article documented more than 14,000 anesthetics without a single complication attributable to anesthesia. In 1914, Dr. George Crile and his nurse anesthetist, Agatha Hodgins, who became the founder of the American Association of Nurse Anesthetists (AANA), went to France with the American Ambulance group to assist in planning for the establishment of hospitals that would provide for the care of the sick and wounded members of the Allied Forces. Jennifer Brady, DNP, CRNA CRNA Staff AANA membership includes more than 50,000 CRNAs and SRNAs, representing over 90 percent of the nurse anesthetists in the United States. Alice Magaw documented the anesthesia practice outcomes at St. Mary's Hospital and reported them in various medical journals between 1899 and 1906. American Assembly for Men in Nursing. The history of Nurse anesthesia is a long and storied one full of success and trial. You’ll gain … American Association of Nurse Anesthetists is a trade / professional association based in Park Ridge, IL that was founded in 1939.  Nurse anesthetists have proven their worth across the battlefields of the world and throughout the health care centers of America. MoANA was founded in 1935 by 15 charter members, including Helen Lamb of St. Louis. The NBCRNA is dedicated to promoting patient safety by enhancing provider quality in the field of nurse anesthesia. They also provide pain management and emergency services, such as airway management. Founded in 1931, the American Association of Nurse Anesthetists (AANA) is the professional association representing Certified Registered Nurse Anesthetists (CRNAs) and student registered nurse anesthetists nationwide. South Carolina Association of Nurse Anesthetists. Download. The CRNA credential has afforded me the privilege to provide anesthesia care services to patients and to teach what I love to do. The Tennessee Association of Nurse Anesthetists (TANA) is a nonprofit corporation whose purpose is to advance the profession of nurse anesthesia, to advocate Certified Registered Nurse Anesthetists as high- quality anesthesia providers, to enhance the art and science of nurse anesthesia and to facilitate the provision of safe, accessible, affordable, high quality anesthesia care. Through education and advocacy, our goal is to allow the delivery of affordable, high quality, and accessible anesthesia … The NBCRNA is continually working to strengthen the nurse anesthesia credential and position the profession well for the future. American Assisted Living Nurses Association. The American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 53,000 members organized to raise and maintain … See latest updates and resources on COVID-19. The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) is the nation's certifying body for the initial and continued certification for the 54,000 Certified Registered Nurse Anesthetists. The International Federation of Nurse Anesthetists (IFNA) is an international organisation representing nurse anesthetists serving the public and its members. American Association for the History of Nursing. Certified Registered Nurse Anesthetists (CRNAs) working in collaboration with surgeons, physician anesthesiologists, and other qualified healthcare professionals administer more than 32 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2009 Practice Profile Survey. According to the American Association of Nurse Anesthetists (AANA), nurses first gave anesthesia to wounded soldiers during the Civil War. Professionalism - Demonstrating professionalism through education, accountability, and high standards of care. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals. The profession is one that is growing markedly and quickly, which means that an increase in … The longevity and growth of the specialty can be attributed directly to nurse anesthetists’ commitment to excellence and Patient safety and their willingness to provide services when and where needed, and the provision of those services at reasonable cost. Founded in 1931, the American Association of Nurse Anesthetists (AANA) is the professional association representing over 57,000 Certified Registered Nurse Anesthetists (CRNAs) and student registered nurse anesthetists nationwide. These professionals can also provide emergency services and pain management. CRNAs provide anesthetics to patients in every practice setting, and for every type of surgery or procedure. Recently, the American Association of Nurse Anesthetists (AANA) partnered with 24 national organizations and sent a letter to the U.S. Department of Health and Human Services supporting a path to permanently removing the burdensome supervision requirements … Compassion - AANA supports members in providing patient-centered care. 16.2.2019. Test your knowledge with these 13 questions that will help you familiarize yourself with the content you will find on the CPC Assessment. Nurses first provided anesthesia to wounded soldiers during the Civil War. In addition, they must meet the requirement of recertification every two years. Legislative Office 1122 Lady Street, Suite 1102 Columbia, SC 29201 Phone: (803) 931-0696 Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way. Nurse anesthetists provide anesthesia and related care before and after surgical, therapeutic, diagnostic and obstetrical procedures. The national office of the American Association of Nurse Anesthetists is located in Park Ridge, Ill. Certified Registered Nurse Anesthetists (CRNAs) are master’s and doctorate prepared advanced practice nurses who enjoy a high degree of autonomy and professional respect. CRNAs are anesthesia professionals who safely administer more than 40 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists … 8725 W. Higgins Road, Suite 525Chicago, Illinois 60631P (855) 285-4658  |  P (708) 667-0002  |  F (708) 669-7636, Certification inquiries ............... certification@nbcrna.comCPC inquiries ........................... CPC@nbcrna.comGeneral inquiries ...................... info@nbcrna.com, © 2020 The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). While there, Hodgins taught both physicians and nurses from England and France how to administer anesthesia. In 1975, the AANA was a leader among professional organizations in the United States by forming autonomous multidisciplinary councils with public representation for performing the profession's certification, accreditation, and public interest functions. It’s the only professional association devoted solely to VA CRNAs. Serving as pioneers in anesthesia, nurse anesthetists became involved in the full range of specialty surgical procedures, as well as in the refinement of anesthesia techniques and equipment. As of 2019 they had $31 million in revenue and $62 million in assets. Founded in 1931, the AANA has issued educational and practice standards and guidelines, developed and implemented a certification and mandatory recertification program, and developed a nationally recognized program for accreditation of nurse anesthesia educational programs. Career and Salary Overview for Nurse Anesthetists. The AANA is the sole professional association for the nation’s nurse anesthetists. American Association of Nurse Practitioners. Thatcher VS. History of Anesthesia with Emphasis on the Nurse Specialist. What does the CRNA credential mean to you? In the rapidly changing and increasingly complex nurse anesthesia practice environment, there is great demand for practitioners to remain updated in knowledge, understanding, and skills. The Missouri Association of Nurse Anesthetists (MoANA) includes more than 1,200 members. The American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 53,000 members organized to raise and maintain … In 1909, the first formal educational programs preparing nurse anesthetists were established. The CRNA credential represents the high standards that all CRNAs are expected to function at, and displays accountability to the public. In 1922, Alice Hunt, a nurse anesthetist at Peter Bent Brigham Hospital in Boston, was invited by Dr. Samuel Harvey, professor of surgery, to join the Yale Medical School faculty as an instructor of anesthesia with academic rank. Landmark decisions in Kentucky (1917) and California (1936) established that they were, in fact, practicing nursing, not medicine. They are the sole anesthesia providers in nearly all rural hospitals, and the main provider of anesthesia to the men and women … Philadelphia: JB Lippincott Company. The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) is the nation's certifying body for the initial and continued certification for the 54,000 Certified Registered Nurse Anesthetists. American Association of Moderate Sedation Nurses. The NBCRNA is dedicated to promoting patient safety by enhancing provider quality in the field of nurse anesthesia. The CRNA credential is independence to offer the best of care to our patients based on their safety, and offer them personalized service seeing them holistically, emotionally, physically, and with a smile to let them know they are in good hands. American Association of Nurse Life Care Planners. Advocacy - Advancing CRNA practice and ensuring patient access to safe, cost-effective anesthesia care. According to a 1999 report from the Institute of Medicine, anesthesia care is nearly 50 times safer than it was in the 1980s. The International Federation of Nurse Anesthetists (IFNA) is an international organisation representing nurse anesthetists serving the public and its members. American Association of Nurse Anesthetists (AANA) Founded in 1931, the American Association of Nurse Anesthetists is the professional association representing nearly 54,000 certified registered nurse anesthetists and student registered nurse anesthetists nationwide. The Minnesota Association of Nurse Anesthetists is a statewide professional organization of Certified Registered Nurse Anesthetists (CRNAs) dedicated to promoting the profession of nurse anesthesia. We are dedicated to advancing and protecting the CRNA practice through professional advocacy and education; promoting practice excellence; ensuring patient safety; supporting members in personal wellness; and providing professional growth opportunities. Recommendations on Continous Professional Development 2012 353.11 KB. Founded in 1936, The Florida Association of Nurse Anesthetists (FANA) represents over 3,800 Certified Registered Nurse Anesthetists (CRNAs) in Florida. The NBCRNA is dedicated to promoting patient safety by enhancing provider quality in the field of nurse anesthesia. Nurse anesthetists were often appointed as directors of anesthesia services in both the public and private sectors. Professionalism - Demonstrating professionalism through education, accountability, and high standards of care. Fort Campbell, KY. "Maintaining CRNA credentials helps support our profession and visibility of the important work we do. Among the notable early programs of nurse anesthesia were: Johns Hopkins Hospital in Baltimore, the University Hospital of the University of Michigan in Ann Arbor, Charity Hospital in New Orleans, Barnes Hospital in St. Louis, and Presbyterian Hospital in Chicago. Nurses are consistently the most trusted profession, and I’m honored to do it at an advanced level. It established a mechanism for accreditation of nurse anesthesia educational programs in 1952, which has been recognized by the U.S. Department of Education since 1955. Despite a shifting economy and ever-changing job expectations, the strong CRNA credential continues to be recognized as validation of knowledge in the nurse anesthesia profession. The nurse anesthesia profession also supports public and institutional policy, which enables maximum utilization of CRNAs and their ability to work within their full and legal scope of practice. Because of their qualifications, CRNAs are eligible to receive reimbursement for their services directly from Medicare, Medicaid, the Civilian Health and Medical Program of Uniformed Services (CHAMPUS), and a multitude of private insurers and managed care organizations. CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities. Since World War I, nurse anesthetists have been the principal anesthesia providers in combat areas of every war in which the United States has been engaged. The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) is the nation's certifying body for the initial and continued certification for the 54,000 Certified Registered Nurse Anesthetists. We accomplish our mission through the development and implementation of credentialing programs that support lifelong learning among nurse anesthetists. Advocacy - Advancing CRNA practice and ensuring patient access to safe, cost-effective anesthesia care 1945 and instituted recertification... Including CRNAs and their physician counterparts documented the anesthesia practice outcomes at St. Mary 's Hospital reported. Their sophisticated body of knowledge, CRNAs are licensed and certified to as. Accounts for 32.8 % of all U.S. nurse anesthetists provide anesthesia and.. 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