Treatment of Acute and Chronic Bronchitis.

General description of the problem

Chronic bronchitis , bronchitis, smoker , recurrent bronchitis - all varieties of the same problem. It consists in an inflammation of the bronchial mucosa and bronchial walls.

Typically, acute bronchitis begins with inflammation, for example, during a viral infection. Shell bronchi swells, then a large amount of mucus. As a result of bronchial lumen narrowing worsens lung ventilation relevant department . Because of this, there may be stagnation . Deteriorating circulation in the affected bronchi , and as a consequence , joins a chronic infection that can exist there for a very long time.

It often happens that after the flu or any other viral infection cough still present in the form of residual effects , and can last for months or even years . Chronic bronchitis is a predisposing factor for graphical to the development of asthma and even pneumonia. So to cure chronic bronchitis is extremely important .

The main symptoms of chronic bronchitis :

1. Cough can be dry or wet. Often in the morning , with or without expectoration .

2 . Periodic fevers . Usually low , to 37.5 . But , if in case of a weakened organism , sometimes vice versa - the body temperature lowered .

3 . Discomfort in the chest and back between the shoulder blades (as if scratched inside). Usually characterized during exacerbations .

4 . Cough with copious phlegm after eating.

5 . If you put your palms on the chest so that the thumbs are facing up to , and take a deep breath , you can feel the vibration of the hands, " as if the air with the force of a viscous fluid passes chest ". Rales in the lungs, often heard even without stethoscope .

Of course, when the cough disturbs a long period , while the overall condition leaves much to be desired , it is important to visit a doctor and undergo additional testing . Many dangerous diseases occurs under the guise of chronic bronchitis (tuberculosis, pneumonia beginning , cancer )

Passage survey annually - is not a whim of doctors since the Soviet Union as an effective measure of prevention and prevention of diseases of the lungs, which can not be neglected .

Treatment bronihita .

If after the surveys banal presence of chronic bronchitis is beyond doubt , you should probably Activities treatment of this unpleasant disease. Treatment with antibiotics and drugs can help during the acute phase of the disease . But completely cure bronchitis is not always possible . Frequent relapses and constant presence of constant wheezing is an alarming sign , may be a harbinger of asthmatic disease and requires immediate comprehensive treatment.

What is it treated?

1. Drugs ( ACC , bronholitin , mukaltin etc.) well help to cope with the acute phase of the disease. There are also numerous in the sale of cough pills containing codeine ( Terpincod , Codelac ) . I would not advise them to get involved , because the abuse of these drugs ( which somehow sold without a prescription ) can develop a real addiction , from which it is very difficult to get rid of. In my experience, there were a few patients who had to go through a real \ " breaking \" after they refused admission Terpincod .

2 . If there are signs of bacterial infection ( leukocytosis high blood analysis , green phlegm ), the antibiotics do not be difficult . Consult with your doctor which antibiotic and what course to take .

3 . Maintain and restore drugs .

Without vitamins with bronchitis deal harder than with vitamins . First of all , as the lung tissue and the tissue lining the bronchi , contains many lipids ( special fat components ), you must take extra fat-soluble vitamins - vitamin E and E, lecithin, Vit. A dose of 10 to 000 IU , vitamin E at a dose - 400 IU . Of the water soluble vitamins - vit.S - 500 mg per day minimum ( anti-inflammatory action as well as increases the level of immunity ) and vit. In the group - preferably a complex in a dose of 50 mg per day. All vitamins are taken after meals , and course of treatment should be on average about 20 days .

Icelandic moss syrup . Taken according to the instructions as immune stimulant and anti-inflammatory factor. Sold in pharmacies .

Thoracic collection . According to the instructions .

4 . The nature of power .

Recommended once a week oily saltwater fish in any form ( mackerel, trout , salmon ) , as well as daily fresh vegetable salads with raw carrots instead of topping. Salads desirable to fill two tablespoons walnut (better cedar ) oil in combination with one spoon of granulated lecithin.

The food should be rich in calories , the presence in the diet of fatty pork in the form of salted bacon welcome ( about cholesterol until you think ) .

5 . Physiotherapy .

First of all - hlorofilipptom inhalation , or tincture Rotokanom Karmolis better nebulizer machine . Desirable to do in the appropriate inhalation medical facilities . Resolution stage , when the complaints is only prolonged cough , well helps power shower on the chest area and glenohumeral region . Often enough the two procedures that have prolonged cough is history . Dry heat sauna with essential oils of eucalyptus, juniper and mint work wonders .

6. Breathing exercises .

Need for improved ventilation and all hotel easily and the bronchial tree .

The above components of treatment for a long time isplzuet in my medical practice and , as a rule, quickly bring the desired result. However, symptoms such as prolonged cough , weakness , sweating, shortness of breath and other manifestations of bronchitis, may be signs of serious illness requiring special treatment and diagnosis.

Therefore, if for a long time you suffer simtomy above , or at least some of them , it is strongly recommended to consult the doctor conform . If you do not have time to go to clinics , can get detailed advice from our specialist physician.

In a burst of enthusiasm self still not forget about the good old traditional methods of diagnosis and doctors who are at the right moment can quickly determine the cause of the disease and prescribed treatment to improve the patient's condition .

Carpal Tunnel Syndrome - Pain in the Wrist

Tunnel syndrome or carpal tunnel syndrome - it's a pain in the hands, especially in the right hand due to long work at the computer. It gained the status of occupational disease geek (programmers, operators and people who are constantly working on the computer).

Wrist - a relatively small joint, around which focused a lot of delicate tissues: ligament, interconnecting the carpal bones, and tendons that connect the muscles of the forearm to the fingers. It is these tendons can become a cause overvoltage tunnel syndrome, which causes pain in the wrist.

Reasons of tunnel syndrome

 
The cause of the pain of carpal tunnel syndrome is a pinched nerve in the carpal tunnel. Trapping may be caused by swelling of the tendon extending in close proximity to the nerve, as well as swelling of the nerve. The reason of a pinched nerve in carpal tunnel syndrome is a constant static load on the same muscle, which can be caused by repetitive movements of a large number (for example, when working with a computer mouse) or uncomfortable position of hands, while working with a keyboard, in which the wrist is in constant voltage.
 

Tunnel Syndrome Symptoms

With the development of tunnel syndrome there is a constant pain and discomfort in the wrists, weakening and numbness of the hands , especially the palms. It should be noted that the pain in his hands can be caused not only by jamming carpal nerve, but also damage to the spine (low back pain, herniated disc) in which damaged nerve that goes from the spinal cord.

Inspection in carpal tunnel syndrome

Diagnosis is made by clinical examination by a neurologist. Of instrumental methods used electromyography, with which you can set the degree of damage to the muscles of the forearm.

Tunnel Syndrome Treatment

 
In acute pain, severe inflammation and severe tunnel syndrome conducted medication. It includes an introduction to the wrist area of corticosteroids (prednisolone, dexamethasone), the use of improving blood circulation (vasoactive) drugs (Trental, nicotinic acid), anti-inflammatory drugs (ibuprofen).  

 

This medication is prescribed by a doctor.

On the background of proper nutrition and adequate supply of all essential vitamins , trace elements and biologically active substances tunnel syndrome treatment becomes more effective, faster recovery and rehabilitation period and rehabilitation reduced. In the absence of effect of drug therapy tunnel syndrome there are indications for surgical treatment (endoscopic or open pit).

Prevention tunnel syndrome
 

For prevention tunnel syndrome should take care about the convenience of the workplace. When using the keyboard , hand bending angle at the elbow should be straight (90 °).  When working with a mouse brush should be straight and lie on the table as far as possible from the edge. Elbow thus should be on the table.

Desirable to have special support for the wrist ( mouse pad, keyboard or a specially shaped computer desk with special silicone pads , etc.). Chair or chair should have armrests.

Exercises for prevention tunnel syndrome.

-  Interrupt the process to perform a small set of exercises for hands :
-  Shake hands .
- Compress your fingers into fists (about 10 times )
- Rotate fists around its axis.
- Press down with one hand on the fingers of the other hand with the palm , as if twisting the wrist and palm outward.

These exercises you improve blood circulation in the muscles of the wrist and contribute to their tension, which is an important element in preventing tunnel syndrome.

Yoga for prevention tunnel syndrome.

In yoga, the most important exercise is wrist extension (adduction). If you sit up straight , hands on the chair arms , palms down, and then slowly raise the palm up, never taking his arm from the armrest - it will be adduction. Joint can perform the full range of motion only if these movements are performed regularly. Unfortunately, the adduction is performed less often. That is why there are problems , leading to the development tunnel syndrome.
 

Many yoga asanas need to completely straighten the wrist. But always do it gradually. In order to carefully develop a " stale " wrist joint and prevent the emergence tunnel syndrome exists following exercise: your palms in front of chest and slowly and gently lowered them down toward the waist. Fingers while looking up. Do not let the base of the palm to the sides. Regular performance of this exercise for 2-3 minutes to help prevent the development of tunnel syndrome.

Food for the prevention tunnel syndrome
 

Effective impact on the joints provides proper nutrition. In addition , it is necessary to help the body get rid of harmful substances in the body glows and leading to disruption of joints.
Providing the body vital for healthy joints substances - one of the most important prevention of tunnel syndrome.

Beginning of the End : The Factors Leading to Alcoholism

Causes of alcoholism

Prerequisites alcoholism are various factors that can be grouped into four groups:

- Genetic factors,
- Physiological factors,
- Psychological factors,
- Social factors.

Our ancestors, watching the children born from alcoholic parents, noted the presence of a variety of physical defects, mental limitations. Children of alcoholics tend to have disease predisposing to the development of alcohol dependence.

The role of heredity as a factor leading to alcoholism , was confirmed in a comparative analysis of twins. Pairs of identical pathological cases than among fraternal . According to some scientists, researchers, enters the body of the embryo alters alcohol metabolism, thereby generating increased sensitivity to its components .

Physiological factor is determined by the ravages of alcohol metabolism. First, there is an imbalance of vitamins such as vitamin C and vitamin B. Second, there is a violation ratio of sodium and chloride in the blood. Mood swings in people who abuse alcohol, explains the quantitative change of adrenaline and adrenochrome .

Psychological factors definitely important for the pathogenesis of alcoholism because the consumption of alcoholic beverages has a stimulating effect on the body. Briefly be free from anxiety, tension, fear. It should be noted that the formation of alcohol dependence affects human temperament, his character .

By alcoholism can push to communicate the love and desire for solitude , that is, people of different warehouse the same risk of becoming alcoholics.

Drinking alcohol gives a feeling of relaxation, pleasure, even euphoria. The first category consists of dependent people for whom alcohol - a source of pleasure, carefree pastime. Horizons such people is limited , their interests are primitive. The second category is made ​​up of people who are in difficult living conditions. Their goal - to achieve inner peace , escape from problems with alcohol .

Importantly, as educated people, which grew up surrounded by. In some families formed personality that focus on non-stop enjoyment, in others - infantile personality. Not being able to withstand adversity, they need constant care.

It is also believed that the cause of alcoholism may be work related to strong drinks. In school-age children this disease occurs because of a desire to appear older. In rare cases, due to alcoholism protest against the ordinary.

The social factors are education, family and financial situation. According to statistics, more prone to alcoholism lonely divorced people. Changes in the financial position of the patient alcoholism observed in the late stage of the disease: reduced earnings or even lost. At the same daily doses of alcohol are not reduced.

All these factors create conditions for the spread of domestic drinking, which in most cases develops into chronic alcoholism . The boundary between these two diagnoses vague, so drinking carries the same threat as alcoholism .

Do Not Know Who Requested? Refer to your Subconscious

When the sphere of psychological aid was only beginning to emerge in post-Soviet space, most people were absorbed by the myths that the main function of a psychologist - to give advice that the psychologist - almost a magician and that he can see through people. A list of these myths can be continued, but their basic idea is that a psychologist - superman, able to solve any problems for the person.

To the present day some of these myths disappeared. On the forums you can see that it is now perceived as an assistant psychologist man in solving problems, but not as something separate that person does something instead. Gradually there is an understanding that the psychologist is intended to help a person to solve the problem itself , only specialist directs a person to the findings. And furthermore, that the psychologist - also people with their problems, fears, and even errors.

But myths just changed. Despite the fact that from a psychologist is no longer waiting ready tips There is still a belief that only a psychologist can help a person get out of a difficult situation. That is, without the personality psychologist growth, improvement and solution to many life crises seems inconceivable.

Is this true? There are many so-called " therapies " - forms of assistance and support in the difficult stages of human life. And many of them do not imply the presence of a psychologist at all! Their list is very diverse, ranging from art therapy, books therapy or therapy with the help of animals to shopping therapy and even a confession from the priest (were healing role is played not by itself priest and religious- mystical process and self-awareness) .

So what helps the client ? It turns out that each has the resources to overcome the difficulties to solve psychological problems, but sometimes they use these opportunities to open, dig like a treasure. With this idea in solidarity all psychologists and specialist help in this case plays the role of a shovel. But now it becomes obvious that this " shovel " can be and other external influences on man. The main condition - these influences should be directed to the solution of human problems.

Furthermore (and, incidentally, it will confirm any psychologist ), there is such a thing as "transfer". Psychologist and client - a unique kind of relationship in which the person must adhere strictly to their roles. But sometimes it happens that the psychologist takes on a different role - a friend, teacher,  parent, and so on, and the client at the time, respectively, in the role of Comrade passes, student, child... In such circumstances, we are not talking about psychological help, these processes are difficult to catch, not all psychologists are able to detect a change of roles and come back.

Thus it appears that other mechanisms of psychological help without a second person with its own characteristics, fears, resentments and other personal deformities can have an even more effective assistance, or at least do no harm.

Probably already thinking about it and the authors of the " robot psychologist Froid ". The site www.froid.su users have the opportunity to consult in fact the program. As the site says , in the course of such consultation is subject to the same mechanisms that are used and psychotherapists in their work. This program can not be transferred to a person their stereotypes , as is the case with psychologists.

Needless to say that such forms of assistance can not replace a live person? Of course not. But another question : what the client needs ? Is it always necessary is a living person? Most likely, there are cases where assistance is indispensable living psychologist . By the way, the developers site www.froid.su stress that in some very complex problems , as well as mental illness consultation with the robot may not have expected aid .

But surely the capacity utilization of the client will give a positive result. Besides, independently thinking on his problem , the person becomes more adaptable to new problems , then it is easier to solve problems , as he learns the methods and practices that can be applied without a live specialist nearby.

Maybe it's time to think about how much a person is able to independently improve their lives . Many studies suggest that the subconscious mind is fraught with enormous resources and opportunities that a person uses his brain is not at full strength (5 to 10%). Maybe look into yourself , we will find more than a set of tips and opinions from other people's mouths.

Gallbladder disease : Symptoms And Features

Feature of gallbladder disease is chronic. Cholecystitis - it is always a slow-growing disease , it never occurs spontaneously, often goes hidden, but occasionally on the stage of deterioration, makes itself felt.

Symptoms of cholecystitis

Usually all patients experience nausea , morning vomiting of bile , bitterness appears in the mouth, discomfort in the right upper quadrant. Diagnose and identify the disease in this case should be a gastroenterologist. The clinic usually has modern equipment, which will allow for a full examination of the liver and gall bladder disease, and to identify at an early stage. If you do not start preventive treatment cholecystitis time, very likely to develop acute form.

Aggravation of gallbladder disease that causes the patient strong, excruciating pain in the epigastric region. Pain usually cutting, unbearable, can go to the region of the right shoulder blade, neck, shoulder, abdomen. When the location on the right side or during deep breath unpleasant feeling always intensifies.

As an exacerbation of cholecystitis may be nausea and vomiting of bile, not facilitating the patient's condition. Skin becomes pale yellow tint. In the right hypochondrium skin is inactive, palpation, tenderness, hypersensitivity can occur muscle contractions. Language dryish, with yellow -brown patina.

Differential diagnosis of gallbladder disease

Cholecystitis diagnosis is often difficult, as similar symptoms observed in patients with ischemic heart disease. The only difference may be moving pain in heart disease in the left arm, which is not typical for cholecystitis. Indirectly determine the cause of pain can be examining information about the origin and development of the disease. As a rule, increased gallbladder disease occurs after violation diet: eating fatty fried foods, smoked foods, alcohol, etc. The attack heart failure most often triggered by a stressful situation, trauma, strong nervous tension. Periholetsistit ( cholelithiasis ) can worsen after certain physical activities: bike rides, horseback riding, drive on rough roads, potholes. Paid gastroenterologist during the inspection will determine the exact cause of the pain and take urgent measures to eliminate it.

Cholelithiasis

Development of jaundice after passing attack is characteristic of cholelithiasis. A similar phenomenon can also occur in patients with dyskinesia hypermotor. The appearance of the stool with a white- gray color, is a consequence of breach of the outflow of bile.

As for the pain attacks, the uncomplicated gallstone disease, they tend to have an abrupt onset and a sudden ending. After another flash, just a day later, the patient feels quite well.

Features of the course of diseases of biliary tract

If biliary tract diseases occur in the chronic form, it is often the standard symptoms characteristic of the disease, supplemented by unpleasant sensations that the patient is forced to endure:

    pain in the heart ;
    general weakness and fatigue ;
    digestive problems ;
    slight fever, characterized by resistance ( low-grade fever ).

Patient self difficult to understand that his anxious symptoms are a consequence of sluggish occurring in the body diseases such as dyskinesia, cholelithiasis or cholecystitis. The clinic does not always have enough competent doctors to conduct a comprehensive diagnosis and properly analyze the data . Often in such cases erroneously determined gastritis, rheumatism, cardiopsychoneurosis . The correct diagnosis in such symptoms can put only good gastroenterologist , who has extensive experience .

Hypertensive dyskinesia in most cases are mild and blunt pain in the right hypochondrium. Often accompanies such feelings nausea caused by eating , bad taste and odor of food intolerance. In old age may reduce the sensitivity . This leads to the fact that cholecystitis occurs without symptoms of pain.

In chronic diseases of biliary tract problem and can affect the stomach. In such cases, patients complain of a bitter taste in the mouth, belching, nausea, heartburn, as well as violations of the chair.

What are the Advantages of Treatment in Israel?

Israel is famous for a large number of scientists, advancing medicine forward. Each of them has contributed to the building of modern medicine. In the area of ​​innovation , Israeli experts have a large number of discoveries that are now widely used for treatment in Israel. Here are some of them: the treatment of tuberculous meningitis method vnepolovoe gene recombination , a technique of treatment of traumatic shock , to develop a method of electrotherapy of the heart and so on. In disciplines such as orthopedics , oncology , hematology, cardiac surgery and plastic surgery - no equal Israeli doctors. Due to the high level and quality of medical treatment in Israel is very popular throughout the world . After all, patients from other countries can benefit from the unique health care services in the resort part of the world , without the name of the language barrier ( the entire staff of the Israeli medical system is fluent in English , and a quarter of them - and Russian ) .

The uniqueness of treatment in Israel is still in its location on the shores of the Dead Sea. The country is at the lowest point of land - four meters below sea level . Consequently, the atmospheric layer , due to its thickness , removes harmful ultraviolet rays. It's no wonder the Israeli sun called the most affectionate - there can be an open space for a long time without fear of burns. Evaporation of the Dead Sea - a natural spray that promotes effective treatment in Israel.

Oncology treatment in Israel ( including the child ) has a special place in the world. Its distinguishing feature can be distinguished world wide medical plan during the drafting of the diagnosis and treatment of cancer. In this procedure, doctors are involved diagnostic imaging radiologists chemotherapists , surgeons , immunologists , psychologists and therapists . Thus, the choice of cancer treatment in Israel depends on the doctors' consultation and case. For the treatment of oncology apply the most modern productive techniques that combine radiotherapy and chemotherapy , as well as brachytherapy using SBRT, SIRT.

It is noteworthy that in contrast to other European countries and even CIS today another advantage treatment in Israel is its value, which is accessible at the level. Israeli Law is constructed so that an advantage in many cases , a patient lies on a side . Ministry of Health in Israel places high demands on professionals : their skills necessary to not only protect , but also reaffirm each year . And the money in clinics in Israel take exclusively for work performed and medicines .

Moment of Climax and Her Flow Following Predefined Genetically

Unfortunately, for some women, menopause proximity big disaster. They fearfully await the arrival of the manifestations of menopause - differential pressure , irritability, hot flashes, mood changes suddenly. If the right approach to this period of her personal life, it is not so scary and there is still many years of life that you have to live in a good mood. Menopause is a natural situation and programmed nature. Therefore, all changes in the body should be taken without panic, but just as vital moment.

Hormonal change in the female body and a small amount of female hormones - estrogen can assert itself in different ways. Of course, the heat can excite tributaries, hypertension and continuous pressure drops, sleep disturbance, urinary incontinence. Clearly, such features lower quality of life of the fairer sex. Besides immunity in older people working weaker and weaker. The immune system is no longer able to defend your own body to the fullest.

Common symptoms of hormonal changes in a woman's body a lot, but they are unique and do not necessarily appear all at once. However, menopause can prevent problems and, of course, necessary. Will provide an opportunity to support the body's metabolism low doses of female hormones. But quality of life is dependent not only on tablets. If the woman is active and exciting life, watching their health, well- nourished and quality rest, it is much easier going through menopause. If a woman is physically healthy and owns good adaptation ability, alteration of the hormonal system will happen in a few months, and quite easily.

If there are still some health problems , such as cardiovascular system, Transfer Factor is able to help, although healthy ladies this drug can help relive the moment of climax. Remember, complications of menopause fit to avoid, but do not expect them to be resolved by themselves. Should observe the menu a lot of walking outdoors, protect yourself from stress and anxiety, and be physically active during menopause held tolerated and without any problems.

Vitamin D Improves the Mood and Blood Pressure in Women with Diabetes

Supplementation with vitamin D significantly lower blood pressure and improve the mood of women with type 2 diabetes and depression , the researchers found Loyola University in Chicago in a new study . The results were presented at the 73rd Scientific Sessions of the American Diabetes Association .

Supplementation with vitamin D are a simple and effective therapy with minimal side effects , says Sue Penkofer (Sue Penckofer), lead author of the work. "We need to conduct randomized trials to determine the impact of vitamin D on the cardiovascular system of women with type 2 diabetes and their mood ," notes the author .

Penkofer received a grant from the National Institute of Research in 1.5 million dollars and four years of the study , which will involve 180 women with type 2 diabetes , the symptoms of depression and a lack of vitamin D. Within 6 months, half of the women will receive vitamin D ( 50,000 IU ) , the other half - the placebo .

Almost one in ten people in the U.S. suffer from type 2 diabetes and this number is projected to grow up to the one in four in 2050. At the same time , it should be noted that women suffer the disease as men . The reason for this phenomenon may be related to depression which affects 25 % of women with the disease . Depression prevents women eat right, exercise and even take drugs .

Many Americans do not get enough vitamin D, and people with diabetes are at especially high risk.

The first study included 46 Penkofer women whose average age was 55 years . Women suffered from diabetes for 8 years, and the level of vitamin D in them was extremely low (18 ng / ml). Within six months the women received a weekly dose ( 50,000 IU) vitamin D. The recommended dose for women from 51 to 70 years is 600 IU per day . As a result, the level of vitamin D in the blood reached an average of 38 ng / ml, and the mood of the patients improved significantly. Scientists conducted a survey on the psychological state of the participants and found that the rate of depression decreased from 26.8 to 12.2 (scale ranges from 0 to 60, the higher the score - the stronger the symptoms).

Blood pressure test also improved - diastolic blood pressure decreased from 140.4 mmHg up to 132.5 mm Hg, and weight decreased from an average of 102.56 kg to 101.42 kg.

All About Pediatric Dentistry

What doctor every child fears more than anything else? Of course, the dentist. Visiting the dentist's office usually conjures both adults and children with pain and fear, with strange and frightening medical instruments 

However, the current level of development of dentistry is so high that the vast majority of procedures and operations are carried out completely painless for the patient , so the fear of visiting the dentist can be left in the past. Of course, an adult to pull myself together much easier, children are experiencing this situation much worse, and visiting the dentist becomes serious stress for kids . In this regard, parents should carefully choose a dentist for your child, as this doctor should not just be a good specialist - he must also possess basic knowledge of child psychology , the ability to find a common language with the child, reassure him and save him from fear.

The best option - a specialized children's dental clinic in which there are doctors who are able to communicate with young patients . The correct choice of dental clinics is important - this is what you and your child will encounter many times in my life . Probably , there is no need to dwell on how important are healthy teeth for any child. From a young age need to pay special attention to proper dental care and immediate troubleshooting. One of the most common problems faced by almost all children and adolescents , it is considered an overbite . In order to eliminate this disadvantage , it is necessary to wear braces .

As you know, brace system Dr. Damon - it's the best way to correct the bite . The earlier treatment is started braces , the more likely a positive result . It is for this reason that children's orthodontist - it is one of the most important areas of pediatric dentistry .