Inside sources within Asante have since disclosed details surrounding the reported deaths, per NBC5 News. It is alleged that up to 10 patients died of infections contracted at the hospital.

The sources claim the infections were caused by a nurse who purportedly substituted medication with tap water.

It is alleged that the nurse was attempting to conceal the misuse of the hospital’s pain medication supply — specifically fentanyl — and intensive care unit patients were injected with tap water, causing infections that resulted in fatalities.

Medford police have confirmed their active investigation into the situation at the hospital but have refrained from providing specific details.

The sources indicate that the unsterile tap water led to pseudomonas, a dangerous infection, especially for individuals in poor health, commonly found in a hospital’s ICU.

  • uservoid1@lemmy.world
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    11 months ago

    Why they didn’t use Saline which is safe and hardly controlled instead of… tap water?

    • Jiggle_Physics@lemmy.world
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      11 months ago

      Since she was stealing drugs I would imagine that it was due to saline being inventory controlled and would have further raised suspicion.

      • RaincoatsGeorge@lemmy.zip
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        11 months ago

        I work as a hospital supervisor. I honestly don’t know of any facility where you can’t get saline iv flushes. Most nurses have pockets full of them each shift. If you didn’t have that for some reason you could get sterile saline and draw it up yourself, also would be easily obtainable.

        My only thought here is that the person didn’t want to leave the room when administering drugs and so they used tap water as an easily sourced replacement for the drugs they was stealing since there is a sink is every room (at least in most hospital rooms).

        The real answer here is that drug addiction overrides rational thought and they either didn’t know or didn’t care that tap water is not safe at all for iv administration.

        We see lots of cases of diversion unfortunately because these drugs are just so damn addictive and there are only so many safe guards you can put in place to protect against it. At the end of the day no matter how many checks there are you will eventually have a clinical staff member drawing up the drugs and administering it. As long as this remains the case you will have people that abuse that weak link in the chain.

        • kent_eh@lemmy.ca
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          11 months ago

          The real answer here is that drug addiction overrides rational thought and they either didn’t know or didn’t care that tap water is not safe at all for iv administration.

          That’s the most likely answer.

      • YtA4QCam2A9j7EfTgHrH@infosec.pub
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        11 months ago

        I buy sterile saline all the time. I think they probably just didn’t give a damn.

        Imagine the pain those people went through when they didn’t get their pain meds.

        Fuck that nurse.

        • skydivekingair@lemmy.world
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          11 months ago

          New horror unlocked; medical care professionals injecting saline instead of pain meds. Complain of pain, anesthesiologist concludes I’m either faking or resistant. So either I wither in pain or they up the dosage. Let’s say the latter happens once or twice and then at shift change the new nurse isn’t a druggie piece of shit and gives the adjusted dosage in full and I overdose, maybe die.

          • LillyPip@lemmy.ca
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            11 months ago

            There are other, more sanctioned horrors if you’re ever in the position to need meds to deal with indescribable pain in a hospital.

            I once had major abdominal surgery and was on a morphine drip. Unfortunately I have a genetic defect that means I don’t metabolise drugs well, so even strong meds don’t work well and I’ve woken under anaesthetia twice.

            It turns out that if you push the button on the morphine machine too many times, its software assumes you’re a drug seeker and starts giving you less. So the more you need it to keep the pain relatively tolerable, the less it will give you.

            You don’t even have to have that genetic condition to wind up in a hell of the software’s making. I only learned that was the issue after being at a user experience conference where one of the presenters (pretty sure it was Alan Cooper but it may have been Steve Wozniak) talked about his experience with that machine after an accident that motivated him to research why his pain meds were inadequate, and how medical user experience is horribly abysmal.

            As far as I know, nothing has been done to address issues like that since.

            • skydivekingair@lemmy.world
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              11 months ago

              Yeah that sucks. I’ve been on the other end working with paramedics, nurses and docs and there are quite a few of those drug seekers. Like most things a few people have to ruin it for the rest.

              • LillyPip@lemmy.ca
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                11 months ago

                I’d rather 100 drug seekers get high than one person have to go through that kind of unrelenting, soul wrenching pain. There’s got to be a better way.

                • skydivekingair@lemmy.world
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                  11 months ago

                  Yeah that was my opinion until they described the very real risk of that high ending lives, and if you were administrating then your license is on the line for every death in your care. Should be a better way but now I understand the caution.

          • themeatbridge@lemmy.world
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            11 months ago

            That shit happens with surprising regularity. This nurse got caught because they uaed tap water and people died from infections.

            • skydivekingair@lemmy.world
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              11 months ago

              I know an eye for an eye and eventually we’re all blind, but I wish these people would have to deal with the pain they put on others.

        • Jiggle_Physics@lemmy.world
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          11 months ago

          Yes, it is partially this. They didn’t use what was on hand because of inventory control, but they didn’t care enough to buy some and sneak it into the scenario. This isn’t some sort of thought out heist or something. They are most likely an addict and this is a quick easy way to get drugs while being not very likely to make things more suspicious. Users inject with tap water all the time, it is super rare for the tap water to be the reason for infection and other medical complications. So she probably didn’t even realize this could be a possibility.

          • lolcatnip@reddthat.com
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            11 months ago

            If it’s that rare, I think the obvious inference is that she pulled the same shit on a lot more patients than just the 10 who died.

            • Jiggle_Physics@lemmy.world
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              11 months ago

              Oh guaranteed. Depending on how long her addiction out paced her income it could be 100s of patients or, maybe, dozens of patients 100s of times.

          • AA5B@lemmy.world
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            11 months ago

            she probably didn’t even realize this could be a possibility

            I may buy this idea for any ordinary junkie, but this is a nurse. If a nurse doesn’t know understand the need for injected things to be sterile, I’d say there’s an even bigger problem than a junkie killing people.

            • Jiggle_Physics@lemmy.world
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              11 months ago

              I have had nurses tell me shit that demonstrates a massive ignorance of what I would assume would be basic knowledge for a nurse in my life. I would not doubt that there are tons of nurses out there that think tap water, while not as stringently regulated as IV prepped fluids, would be fine. I have seen many people use for decades and none of them had this happen. All of those people primarily used tap water. Every time someone had an infection, or other disease, it was from re-used needles that weren’t sanitized.

            • HorseWithNoName@lemm.ee
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              11 months ago

              Users inject with tap water all the time, it is super rare for the tap water to be the reason for infection and other medical complications

        • skydivekingair@lemmy.world
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          11 months ago

          New horror unlocked; medical care professionals injecting saline instead of pain meds. Complain of pain, anesthesiologist concludes I’m either faking or resistant. So either I wither in pain or they up the dosage. Let’s say the latter happens once or twice and then at shift change the new nurse isn’t a druggie piece of shit and gives the adjusted dosage in full and I overdose, maybe die.

      • TimLovesTech (AuDHD)(he/him)@badatbeing.social
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        11 months ago

        But you can just walk into any drug store (probably some grocery stores) and buy enough to swap out the amount of fentanyl they are injecting I would imagine (since it’s potent stuff). Just someone that clearly didn’t think the plan all the way through, and likely has some debt or driving factor clouding their judgement.

        • Jiggle_Physics@lemmy.world
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          11 months ago

          They didn’t use what was on hand because of inventory control, but they didn’t care enough to buy some and sneak it into the scenario. This isn’t some sort of thought out heist or something. They are most likely an addict and this is a quick easy way to get drugs while being not very likely to make things more suspicious. Users inject with tap water all the time, it is super rare for the tap water to be the reason for infection and other medical complications. So she probably didn’t even realize this could be a possibility.

      • rtxn@lemmy.world
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        11 months ago

        I’m willing to bet you can just buy saline. Or make it at home, as long as it is kept sterile.

        • Slowy@lemmy.world
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          11 months ago

          Making it at home would have the same issues as tap water, sterile saline is probably autoclaved to sterilize it. But it is trivial to buy and even from the hospital supply I highly doubt it would be noticed if you wrote that you used an extra 10mL here and there.

          • Chetzemoka@startrek.website
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            11 months ago

            Gamma irradiated. And we definitely don’t track how many saline flushes we use. That would be such a futile chore, Sisyphus would pity you.

      • Ferris@infosec.pub
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        11 months ago

        You can give yourself a brain eating amoeba infection using tap water in a neti pot

        • AA5B@lemmy.world
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          11 months ago

          Yeah, my ex used one of these things a few times. She wouldn’t read directions, or listen to me after I did, so just used tap water. Luckily it never turned into a regular thing

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        11 months ago

        I don’t know this hospital, but I generally grab several when I come on shift, put them in my pocket, and end up accidentally taking home a few often enough that I’d end up being able to have squirt gun fights with them.

        Essentially, nurses go through so many that you’d be hard pressed to control them. We use them for everything from checking the status of an IV line to cleaning a wound.

        • LanternEverywhere@kbin.social
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          11 months ago

          And even if they were inventoried (which they’re not) there still are always a zillion partially used bags littered everywhere, which in most cases are effectively still sterile.

    • tomkatt@lemmy.world
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      11 months ago

      Presumably because the saline quantities were tracked and documented just like the fentanyl was. Tap water isn’t a medical supply. Still completely fucking heinous either way.

      • roguetrick@kbin.social
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        11 months ago

        No hospital would be able to run by being restrictive with flushes. You just need to use so many of them for IV management and drug administration alone, not to mention all the other stuff we use them for. Essentially every time you put something into an IV line, you need to flush it to get the medication to the patient and you need to periodically flush it to keep it patent. I will document them for Inputs/Outputs with someone who has a heart/kidney problem, but that’s as far as it goes. Billing wise, it’s subsumed under how they bill for “nursing” as an average, so it’s not tracked for that either.

        • PutangInaMo@lemmy.world
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          11 months ago

          Yeah I was in the hospital a few weeks ago and had an IV drip in both arms. They were constantly flushing both lines, didn’t seem like they tracked or cared how many got used.

      • AA5B@lemmy.world
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        11 months ago

        I do think tap water is worse. These are people with medical experience, a big part of whose job is making sure they use sterile stuff. They know better. There’s no excuse. This is not just accidental

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      11 months ago

      Are we questioning the intelligence of a person stealing vital medication from patients and swapping it for something else?

      • roguetrick@kbin.social
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        11 months ago

        I’m just amazed. It’s frankly easier to use a flush than fooling with a sink. You need a flush anyway to administer the medication and I’d imagine most folks diverting IV meds are smuggling them out after transferring them into an empty flush in the first place. It almost makes me wonder if who did it isn’t a nurse. Like a pharm tech doing a batch of them at a sink before loading the pixis.

    • FlowVoid@lemmy.world
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      11 months ago

      Probably because they aren’t filling the containers at work, where they could be caught.

      Instead, they steal an empty container, take it home, fill it with water, bring it to work, swap it with a fentanyl container, take it home, use the fentanyl, fill the container with water, bring it to work, etc.

      • WhiteOakBayou@lemmy.world
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        11 months ago

        But even still why not use a flush to fill it. They are prefilled and everywhere. I’m a nurse and have worked with nurses caught diverting. This is extra fucked up. Put this guy under the jail.

    • Adalast@lemmy.world
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      11 months ago

      Or even just distilled water. Buy a jug for a couple bucks at the supermarket or distill it yourself for a few pennies worth of electricity. The woman didn’t deserve her degree if she thought tap water was safe to inject.

  • squirrelwithnut@lemmy.world
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    11 months ago

    So that nurse will be charged with 10 counts of murder on top of the federal drug crimes, right? …Right?

    • No_Eponym@lemmy.ca
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      11 months ago

      This is why we need to provide both careful vhetting and a positive work environment for folks like nurses, teachers, etc. These people literally hold our lives in their hands, the future of our kids, etc. It should be a high bar to get in, then we should treat them with the respect/compensation that their role deserves because you get what you pay for.

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        11 months ago

        Nursing supervisor here. Let me tell you a story just in case you might have been able to sleep tonight. I work in a long-term care facility, and most of our staff of nurses is from a staffing agency, which has the same effect as a union. Normally I’m all for unions, except many of these nurses feel incredibly entitled to work how and whenever they want. If I ask them to go fill a vacancy on a different unit that they don’t want to work on, they will just cry oppression, and threaten to leave that very minute, which they are able to do because they come from a staffing agency and not our facility. There is literally no scenario where we can just not have nurses, so we are forced to bend around backwards to let them have whatever they want, come on to shift as late as they want, etc, or we have no staff to run a facility and care for patients. At least in my area, shitty nurses are better than no nurses, and many of them choose to weaponize this fact. I’ll just reiterate that I am myself a working registered nurse, and these are the facts that I deal with everyday.

        Edit: in case it wasn’t clear, I’ll fight through the gates of hell and back for my nurses, and I frequently end up on a med cart to fill those vacancies I mentioned. The nursing shortage is really bad you guys.

        • AA5B@lemmy.world
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          11 months ago

          The nursing shortage is really bad you guys.

          I know, let’s use temporary nurses that aren’t as qualified: we can pay them less and no benefits. That will increase the number of nurses

        • Chetzemoka@startrek.website
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          11 months ago

          “I’ll fight through the gates of hell and back for my nurses”*

          *Except to advocate that our cheap ass private equity owned facility hire actual full time staff with benefits instead of outsourcing to a temp agency.

          Those agency nurses aren’t your enemy. They aren’t the reason you end up taking an assignment. That’s the fault of the corporation that owns you. And in all sincerity, good for those agency nurses demanding the working conditions that they want and refusing to accept whatever the facility wants to push on them.

          Sincerely, a hospital nurse having our union election on Jan 10

          (And I have stories too, you know. Like my supervisor who tonight simply lied to the overnight sup about our staffing situation and tried to leave two nurses alone to care for NINE patients on our critical care stepdown unit overnight.)

          The nursing shortage is at least partially artificial. There is a shortage of nurses who are willing to work in abusive conditions that exploit our legal, moral, and professional obligations to our patients to make their profit. Fight these corporations for safe working conditions and watch how many nurses return to the bedside.

          • stoicmaverick@lemmy.world
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            11 months ago

            This isn’t about some grandiose violation of workers rights. This is about people who would allow somebody’s incontinent, confused grandmother to sit in her own feces for an hour because she refuses to work near someone who criticized the condition of her car or some similar nonsense. She’s refusing to do parts of the job that she signed on to do simply because she doesn’t want to do it. That’s not being an empowered worker, or standing up for yourself, that’s just being a child.

            As for that line about advocacy. I have no more ability to enact changes like this than the janitors do. I’m not on the board of directors or anything, I just get placed as nursing supervisor periodically when I’m not doing my normal job.

            I’ll tell you right now, this place is not good. It’s run by an outfit called Genesis, and they’re terrible at everything, but there are residents here who don’t have anywhere else to go, so I take care of them to the best of my ability.

            • Chetzemoka@startrek.website
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              11 months ago

              Trust me, I started out my career working for a private equity owned SNF/LTC. Those places are horrifically terrible and should be outlawed.

              And your particular issue with this individual nurse isn’t really because they’re agency. We have that kind of problem with full time regular nurses in our hospital being unprofessional children. But also our hospital corporation likes to play on our compassion to exploit us when in reality, that grandmother sitting in her feces is their fault for refusing to staff our fucking hospital properly.

              • stoicmaverick@lemmy.world
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                11 months ago

                I absolutely agree that a major portion of the issue comes back to whoever is writing the checks for staffing and so forth, but consider the following as well: on occasion, some unions can be guilty of over lenience when it comes to accountability of the employees involved (ask me about some phone calls I overheard from one of my patients who was a union leader of the local chapter of the Teamsters Union), but on the whole the results are much better than for staffing agencies. The problem is because someone can’t just go to a different union if they don’t like the conditions, and everyone is on the same playing field. If a nurse works for a staffing agency, and feels that they are being oppressed by corrective actions because they don’t feel like coming in on time, or doing basic parts of their job, they can just choose to go to a different staffing agency with more flexible interpretations of policy, who will be happy to take them because reasons. It becomes a race to the top for facilities for patient survey scores, and a race to the bottom for staffing agencies for a accountability of their staff.

                • Chetzemoka@startrek.website
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                  11 months ago

                  they can just choose to go to a different staffing agency

                  That’s just free market labor. Shit hospital nurses are free to bounce from facility to facility as well. Welcome to America.

                  A union gives me more power to enact change inside my own corporation-owned facility. Staffing negotiations give me leverage to force staffing levels that keep my patients both safe and receiving the care that they need.

                  I had a woman sitting in her own feces for over an hour on Sunday because our hospital chooses not to staff the central stock room on weekends and holidays, and we were completely out of the only size briefs that would fit her. I checked the next unit over and they were out too. This is a standard item that should be stocked at all times. I had to ask one of our transporters hunt them down for us.

                  Part of our union contract will be to demand that our local unit supply rooms are stocked no less than once per day 365 days a year. It’s INSANE that an American hospital chooses to operate without that.

                  “The union” doesn’t do anything. WE are the union. I AM the union. I’m planning to be one of the people sitting right there at the negotiation table working on our contract. WE will be the ones negotiating how disciplinary grievances are handled and the union only exists to provide us with legal representation to ensure that OUR chosen contract terms are adhered to.

                  Why do American nurses in particular believe such heinous lies and propaganda about how unions work? You overheard some hearsay from someone about a union that doesn’t even represent nurses and you just swallowed that hook, line, and sinker?

          • stoicmaverick@lemmy.world
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            11 months ago

            It’s not even that. They are already in the building. I am just asking them to go and work on a different unit that had two people call out 15 minutes before shift start. I literally had a nurse look at me and say “I’m too valuable to be disrespected like that. If you don’t start treating me right, I’m walking out that same door I came in.” This was after I asked her to go do the exact same job she was doing on an adjacent unit where she didn’t like one of the aids there.

          • afraid_of_zombies@lemmy.world
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            11 months ago

            No. Working in the medical field shouldn’t mean having a destroyed personal life better fucking healthxare insurance complex refuses to train and retain more workers. Tell you what, the day I get to call up the CEO of Aetna or some other heakth insurance company and tell him he has to report to duty is the day you can demand thee same from nurses.

          • Chetzemoka@startrek.website
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            11 months ago

            Your hypothetical does not accurately reflect anything about how the healthcare system works.

            No transplant surgeon is getting a surprise shift. This is exactly why on-call shifts exist. There is already someone available who knows they need to be ready to go at a moment’s notice.

            And nurses don’t function the same as doctors. We are regular wage employees, just like anyone working retail. We absolutely do not have to be available whenever and wherever. They can (and do, constantly) ask us to pick up shifts. But we’re not obligated to come in on our scheduled days off.

            Healthcare corporations need to get their fucking staffing models together.

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    11 months ago

    It is alleged that the nurse was attempting to conceal the misuse of the hospital’s pain medication supply

    What a POS, but at least it was the result of regular ol drug addiction instead of some religious nut job making a “statement” that medications are “unholy and unnatural” or some bullshit.

    • ColeSloth@discuss.tchncs.de
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      11 months ago

      It unfathomably amazes me that someone intelligent and dedicated enough to get a nursing license was so stupid they didn’t know to use something sterilized to replace it with. Drugged up Addict or not.

      • HorseWithNoName@lemm.ee
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        11 months ago

        That’s literally what addiction does to people. It makes them unrecognizable. That doesn’t excuse it, but it’s just the way addiction works. So many comments deriding this person’s intelligence when it has zero to do with that.

        This is why addiction treatment and social services are so shitty in the US. People are so ready to insult others before trying to understand them, yet the solution to things like this require exactly that understanding. It’s like homelessness and NIMBYs. If they’re so concerned about the homeless encroaching on their property values, then they should take action to reduce its causes. But instead they’d rather blame, shame, and…expect them to disappear into thin air apparently.

      • Kbobabob@lemmy.world
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        11 months ago

        Why? I kinda wondered the same thing at first. It seems the religious nut jobs have no problem ending someones life if they don’t agree with what they believe.

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    11 months ago

    Oregonian, here. Kinda not surprised this happened in Medford. There are parts of the state that have a serious problem with fentanyl, almost as bad as in the rural south.

  • some_guy@lemmy.sdf.org
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    11 months ago
    • The Retrievals* is a great limited-run podcast about women suffering pain when a nurse was siphoning off fentanyl for personal use and replacing it with saline. Just wanted to shout out a tangential thing.
    • ReallyActuallyFrankenstein@lemmynsfw.com
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      11 months ago

      The sources claim the infections were caused by a nurse who purportedly substituted medication with tap water.

      Not even tangential, from this quote it appears to be the exact same situation - a nurse diverting the supply possibly for their own addiction (“attempting to conceal … misuse” certainly sounds like addiction rather than resale):

      The sources claim the infections were caused by a nurse who purportedly substituted medication with tap water. It is alleged that the nurse was attempting to conceal the misuse of the hospital’s pain medication supply — specifically fentanyl — and intensive care unit patients were injected with tap water, causing infections that resulted in fatalities.

  • SuperCooch91@lemmy.world
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    11 months ago

    As awful as diversion is, and as awful as the choice to use tap water was…can we talk about why the tap water is full of pathogenic Pseudomonas?

    • Phoenixz@lemmy.ca
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      11 months ago

      Tap water is full of stuff that is never harmful for people to drink. Injecting it in your veins, though, is a very very bad idea making me wonder how the hell this nurse got her license. You can’t be THAT stupid

      • TheHarpyEagle@lemmy.world
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        11 months ago

        Seriously, couldn’t even be bothered to find some saline so these people in agonizing pain didn’t also have to die of terrible blood infections?

        I feel for all the other responsible medical workers who are already dealing with the most ornary customers in the world. This nurse, if they were aware, and all complicit staff have fucked their colleagues over.

      • SuperCooch91@lemmy.world
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        11 months ago

        I agree that tap water def shouldn’t go into your veins. I also recently did a six month long study on Pseudomonas, and pathogenic Pseudomonas specifically, and feel like I know enough about this bacterial family to be freaked out that that’s what was in the water and killed the people.

      • HorseWithNoName@lemm.ee
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        11 months ago

        wonder how the hell this nurse got her license. You can’t be THAT stupid

        Addiction changes people until they don’t even recognize themselves. It has nothing to do with smart vs stupid. They were obviously smart and competent enough to be given a license. It’s just that the person who did this doesn’t even resemble the person who got their nursing license anymore. If they’re able to get sober someday, they’ll be horrified at having to live with this the rest of their life.

        There’s a reason addiction is considered a disease. The problem is when people mistake this explanation as an excuse for the things people do while in their addictions. It doesn’t excuse it. I just wish more people would make an effort to understand how addiction actually works because if we made any effort as a society instead of constantly playing the bootstrap/blame game, we could deal with it more effectively and prevent shit like this.

        Also I don’t know anything about what’s in tap water, but when addicts use IV drugs that’s pretty much what they’re mixed with. Obviously there’s a lot of infections in that population, but also people who do it every day without tap water killing them.

    • ReluctantMuskrat@lemmy.world
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      11 months ago

      Just because you can injest something safely doesn’t mean it’s safe to inject. Your stomach acid and enzymes kill many pathogens in low concentrations so the fact that you can’t safely inject tap water doesn’t necessarily reflect badly on the water.

      Additionally I’m sure the water facet used to get the tap water wasn’t sterilized either. You wouldn’t want to touch a syringe to your water spigot before using it I’m sure, let alone inject the unsterilized water from it.

      • Agent641@lemmy.world
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        11 months ago

        Toilet water is not allowed. Water from the bowl at the dog park, also out. Voss is a maybe.

    • Smoogs@lemmy.world
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      11 months ago

      We do not for the same reason environments you live in also have Staphylococcus everywhere and it’s impossible to control but assuming you have an average working body and regularly wash your hands before touching things like a toilet handle and then your face you should be pretty safe. Your skin as the largest protective organ and immune system protect you from this. this goes the same for the assumption that you would ingest water as expected and your entire digestive system protects you a lot from what is in water. They do test water but they don’t test it for things you would come into contact when injecting which bypasses a lot of what your body would do already to protect yourself.

      This is why some products like netti potties might suggest distilled or boiled water before filling as it’s not a common way to consume water.

  • that guy@lemmy.world
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    11 months ago

    The opiate, fentanyl and meth epidemics are eugenics from the top down with how they’re laser targeted to certain locales that have been divested from. The healthcare industry is ripe with corruption by design. More for them, less for you, that includes years on your life.

    • xor@sh.itjust.works
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      11 months ago

      it’s not targeted, it’s just that drugs seem like a better idea the more miserable you are to begin with… so divested locales have it worse.

      also, the poorer you are the better drug dealing seems.

      • ChonkyOwlbear@lemmy.world
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        11 months ago

        It is targeted in the sense that conservative areas are less likely to have treatment programs, drug safety testing programs, clean needle programs, or safe use sites.

        • whereisk@lemmy.world
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          11 months ago

          Are you suggesting that conservatives are actively supporting and advocating for public health and mitigation measures such as you mentioned but are not getting them as part of a targeted campaign?

          • ChonkyOwlbear@lemmy.world
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            11 months ago

            No, I’m suggesting conservatives are actively supporting and advocating for the continued suffering and death of the poor who are overwhelmingly minorities.