WOW! This is pretty amazing: 21 week old premature baby to go HOME!

[originalpckelly]

"MIAMI (AP) — A premature baby that doctors say spent less time in the womb than any other surviving infant is to be released from a Florida hospital Tuesday.

Amillia Sonja Taylor was just 9½ inches long and weighed less than 10 ounces when she was born Oct. 24. She was delivered 21 weeks and six days after conception. Full-term births come after 37 to 40 weeks.

"We weren't too optimistic," Dr. William Smalling said Monday. "But she proved us all wrong."

Neonatologists who cared for Amillia say she is the first baby known to survive after a gestation period of fewer than 23 weeks. A database run by the University of Iowa's Department of Pediatrics lists seven babies born at 23 weeks between 1994 and 2003.

Amillia has experienced respiratory problems, a very mild brain hemorrhage and some digestive problems, but none of the health concerns are expected to pose long-term problems, her doctors said."

http://www.usatoday.com/news/health/2007-02-20-tiny-baby_x.htm

[Fire Walk With Me]

1. How long until the enlistment officers start showing up?

goarmy.com

[originalpckelly]

2. What the hell?

:shrug:

[Fire Walk With Me]

6. Sarcasm.

[demrabble]

3. Who Paid?

Stories like this always sound really nice.

Until you consider the enormous amount of resources it took in order to make this happen.

It is one thing that will almost certainly never be available to poorm uninsured women.

And, if the doctors and hospital did this on a pro bono basis, it raises the question of why they couldn't do EVERY birth and every neonatal procedure on a pro bono basis.

[peace13]

5. And if insurance paid

then we all contributed so to speak.

[kestrel91316]

41. Except those of us who can't afford insurance...........

[colinmom71]

11. Premies like this in need of NICU care...

Are often automatically granted SSI Disability eligibility (depending on family financial threshholds), and thus are covered by Medicaid. If the parents have private health insurance through their employer, the infant may sometimes still recieve SSID and Medicaid as secondary coverage to the primary insurer. With my son who was born at 24 weeks, the nurses were in my hospital room with all the necessary paperwork for his birth certificate along with SSID, SS#, and Medicaid within 2 hours after I woke from anesthesia. Medicaid covered everything.

Also, a lot of hospitals that have level 3 NICU's also recieve charitable and supplemental donations for equipment from organizations like Children's Miracle Network, hospital foundations, etc. so there is *some* extra money to help those gaps where health insurance and Medicaid do not provide coverage. Any other overdrafts from there are usually written off/absorbed by the general hospital budget or left as debt until the parents/private insurance can catch up with the bills.

My son's final NICU bill came to about $250,000 (in 1995, and that's not including doctor's consultation fees), and that's only because he did not have any of the common complications that micro-premies often have, like brain bleeds and such. The rosy prognosis they're trying to push in this news article for this 22 weeker has no way of being known as accurate. Even with no major complications and having been considered as having an overall good prognosis, my son's prematurity has resulted in severe life-long and permanent disabilities.

[blogslut]

52. yep

Stuff definitely shows up later. My child (born @ 27 weeks) had that epiglottal thing with the projectile vomiting and loss of breath. Later, at age three a diagnosis of cerebral palsey. Vey mild but lifelong, nevertheless.

[theboss]

33. So...we should do a cost benefit analysis on sick people?

I think the issue of payment is separate from the issue of treatment. It's an important issue, but we should never ever take cost analysis into care decisions.

[demrabble]

49. What?

What in the world would possess you to make such a snarky post?

Please show me where I ever suggested that we should do a cost benefit analysis n sick people.

The question is asked was "WHO paid".

Not how much they paid.

[Orangepeel]

44. it still sounds nice to me.

they shouldn't save this baby because not every baby is saved?

I fully support universal health care but I don't see why the shameful fact that we don't have it means that doctors shouldn't have attempt to save this baby.

Besides, medical advances have benefits beyond the individual patient. Hopefully, one day soon when our society has advanced to the point when we all have excellent care, many babies will benefit from what was learned in this case.

[Horse with no Name]

60. Well at our hospital

We save every infant that is viable. Regardless of who pays--or not. That isn't a question that is ever asked.

[peace13]

4. I am happy for baby and her parents.

Tears for those children born in this country that do not receive the needed level of medical care on a daily basis. I fear more fuel to the fire of 'yes a fetus is a baby'.....well, maybe if one has it's own private neonatal clinic and tens of hundreds of thousands of dollars to keep it alive.

[demrabble]

9. The Rich Will ALWAYS

The rich will always be able to afford abortions.

The rich will always be able to obtain treatment for seriously premature infants.

The poor, however, will not.

[napi21]

7. At first blush this story soundsvery good forMom & baby, but

almost instantly after a smile,I couldn't help wonder just what kind of life this little girl is going to have? Severe premies often have respeatory problems, heart problems etc., and the earlier the birth the higher the risk.

I hope I'm proven wrong and this little girl has a wonderful, happy, healthy life, but my rational brain is telling me different.

[colinmom71]

27. Respiratory issues are only one of the major concerns for this baby...

Granted, asthma and airway problems ARE serious health long term issues for preemies, but another problem faced here is likely exposure to ototoxic antibiotics such as vancomyacin and gentamyacin (often the first drugs used when preemies get infections that are feared as being antibiotic resistant). If she had a NEC (necrotizing enterocolitis - catastrophic infection of intestines) bout, I'd be surprised if she hadn't been given those drugs. Unfortunately, those drugs often cause deafness in neonates.

The high oxygen levels needed for the assisted respiration that helps micro-preemies live also often causes ROP (retinopathy of prematurity), an abnormal development of the blood vessels in the eyes. ROP of mild to moderate involvement can usually be successfully treated with laser surgery, but severe cases of ROP can cause retinal detachments and blindness.

The brain bleeds, even relatively mild ones, often cause varying degrees of brain damage and often results in one or some of the following - cerebral palsy, developmental delays/disbilities, learning disabilities, sensory integration dysfunction, behavior problems...

One little factoid that often goes unmentioned with micro-preemies is that even after being deemed healthy enough to be released from the hospital, about 10% of these neonates will not live to see their first birthday. This is often due to apnea and/or respiratory infections. Most will experience at least one or more repeat hospitalizations during that first year at home... Overall, survival rates favor African-American girls while white boys fare the worst. But as with everything, all kids are different and the severity of their complications in the NICU is a better indicator for overall survival and long term prognosis.

These are pretty much the major long term issues micro-premies face. They also often require years of Early Intervention and medical services like physical and occupational therapy, speech therapy, respiratory therapy, orthopedics, neurologists, and audiologists. You'll also find that most preemies often need some degree of special education services throughout the elementary school years and sometimes well beyond...

[Hekate]

69. The sad reality behind the so-called miracle of micro-preemie survival...

...is that sometimes mothers find themselves tethered to extremely damaged children for the rest of that child's life. Some marriages can and do fail to survive such a test.

Premature births are very much on the rise in the US, and medical science is not sure why. Some are due to the rise in assisted fertility and the consequent rise in multiple births, because twins and higher multiples usually outgrow their mothers' wombs before they are done gestating. However, the problem is far greater than just that.

Personally I think it's a combination of the usual suspects of poor diet and sub-par maternal health added to an increasingly polluted environment indoors and out.

Sorry to be so gloomy on a thread meant to celebrate one little baby's survival, but I'm very disturbed about the overall trend and would like to see our society address that in more effective ways than it has so far. Universal health care comes to mind....

Hekate

[OPERATIONMINDCRIME]

32. Better Some Life Than No Life. Smile Anyway. n/t

[breakaleg]

8. There was a study in the UK on severly premature babies and they concluded

that they grow up to have all kinds of developmental and learning difficulties that plague them throughout their entire lives. What they were saying is that these babies weren't meant to survive and they wonder if medicine has gone too far.

[pennylane100]

10. Lets hope this little baby beats the odds

and grows up healthy. The odds, however, are stacked against her. I do not believe in the power of prayer, but if any one reading this does believe, maybe you could say a prayer for her.

[moc]

15. At this point, her odds are pretty good. In the absence of severe

medical complications and in a supportive home environment, her developmental prospects are very good. Based on the limited information in the article, it looks like she had a grade 1 IVH (intraventricular hemmorhage) and perhaps a bout with mild NEC (necrotizing enterocolitis), but those are relatively mild complications in the NICU.

[hedgehog]

12. Wow - there are a lot of mean spirited people posting here.

Just what are you afraid of - that you might have to help pay for someone else's health care? That someone might reconsider having an abortion?

I would expect this little girl to have developmental and health problems. However, I also recognize that my nephew born prematurely would have died if he had been born 10 or 20 years ago. This little girl as at the edge of the envelope, but the envelope has grown considerably large over the years thanks to the efforts of many to help these preemies. I had two sisters who died at birth who would have easily survived if born today.

Good luck to Amillia and her family.



On edit - there were some people who objected to treating the pain of child birth - it was God's will that women suffer during labor. There were others who fought against early attempts at vaccination. Disease was Nature's way of eliminating the unfit among us. That's not to mention the theory that we should eliminate the mentally ill and handicapped among us lest they hold society back!

[Marrah_G]

13. I am not sure what part of the country leaves premies to die

Here in Mass/RI every pregnant woman has the right to pre-natal care and no hospital would ever keep treatment from a premie.

My son was in NICU in Providence back in the 1992. We were on state healthcare and they fought like hell to keep him alive and the staff there were wonderful to us. He turned out just great. Now in the same bay of the NICU there were a few...yes a few, crack babies, fighting for life, abandoned by the mothers and they were treated just as well as my son. The nurses took extra special care with them in fact.

[Katherine Brengle]

21. Yep --

I wonder too. I'm sure there are places where this kind of care isn't available, but I live in MA too, and without insurance I had everything taken care of when I was pregnant and my daughter had complete care when she was born.

My friend just had her baby 6 weeks early with a couple of problems, and not only was everything paid for through MassHealth, but the baby was delivered and cared for at Women and Infants Hospital in Providence AND she was able to stay at the Ronald McDonald House so she could be close by without having to rent out a hotel room and pay for it.

[moc]

23. Doctors do have limits of when they will intervene. Generally speaking, if they

can't stop labor and a baby is delivered much before 23 weeks AND they are very sure of the dates of the pregnancy, they will not intervene.

As I posted below, this baby was almost a 24 weeker, not a 21 weeker.

[colinmom71]

28. It's much the same here in Georgia...

We have a special Medicaid pre-natal insurance program here called "Right From The Start" that gives pregnant women Medicaid coverage for pre-natal care at either 200% or 250% of the federal Medicaid income threshhold. Most OB/GYN firms participate in RFTS and the woman is allowed to pick her own OB/GYN practice. Most practices will refer healthy RFTS patients to the midwife unless the pregnancy begins to need more medical intervention (like gestational diabetes, pre-eclampsia, etc.).

RFTS covers the entire pregnancy care, hospital/delivery costs, post-partum care to 60 days after the birth, and covers the baby for the first year of life. The parents can re-apply for Medicaid or the state CHIP program for the child at one year if they lack health insurance coverage through their employer.

And yeah, my experience with my son inthe NICU was wonderful, at least as far as the quality of care and staff are concerned. All the staff was very loving with all the babies and insurance status was of supreme indifference to them all.

[moc]

14. This is majorly misleading. She's a 23 WEEKER, not a 21 weeker.

Actually, she's almost a 24 weeker. Notice, it says:

She was delivered 21 weeks and six days after conception.

Gestational age is calculated based on LMP (date of last menstrual period) NOT date of conception. In the case of IVF (such as this) when there is no LMP, gestational age is "back dated" to two weeks prior to conception.

Oy. :banghead:

[hedgehog]

16. She's still pretty marvelous.

Of course, any new born is amazing.

[moc]

20. Sure, she's amazing, but she didn't break the limit of 23 weeks

as the lower limit of viability. It's amazing when any of these very tiny babies survive, and this one appears to have done that with minimal complications. That is amazing. However, to imply they saved a baby younger than 23 weeks is misleading and I am concerned that others will misunderstand and assume a 21 weeker can be saved. For example, if a 21 weeker is spontaneously delivered, most hospitals will not intervene to try and intubate, etc because it is futile. Will parents now question this medical decision?

[OPERATIONMINDCRIME]

34. Self delete.

[demrabble]

17. Sounds Like Someone Had An Agenda Here.

It sure sounds to me like the people who reported that a 21-weeker was "saved" has a real big agenda.

Thanks for catching this, moc!

[moc]

22. That is my concern as well.

[RebelOne]

25. Did you read this part? It seems that the doctors know

the exact date of conception.

"Amillia is the first child for Eddie and Sonja Taylor of Homestead. She was conceived by in vitro fertilization, which made it possible to pinpoint her exact time in the womb, and was delivered by Caesarean section."

[moc]

26. Yes, I read that part. However, the fact remains that the limit of viability

is based on GESTATIONAL AGE not conceptional age. Gestational age is based on LMP. It's assumed that in natural conceptions, conception occurs on average 2 weeks after LMP. The lower limit of viability based on gestational age is 23 weeks. The lower limit of viability based on conceptional age is 21 weeks. This baby didn't break any records.

[OPERATIONMINDCRIME]

36. You Are Wrong. The Most Accurate Gestational Age There Is Would Be Date Of Conception.

Since most often this can't be proven, the general date is the LMP date. But with this type of in vitro fertilization the gestational age can be precise down to the hour. But it's still considered gestational age.

[moc]

43. Please don't tell me I'm wrong. I know what I'm talking about.

Perinatal epidemiology is one of the things I do for a living. (I have a doctorate in maternal and child health.)

I know that conceptional age is exact if based on IVF. That's not my point. The point is that the limit of viability, commonly seen as 23 weeks, is based not on conceptional age but on gestational age.

"Gestational age" is an epidemiological term that has a very specific definition. It is based on LMP because for the vast majority of births, we don't know when conception occurred. Gestational age is calcuated from LMP. Conceptional age is calculated from conception. This baby was 21 weeks 6 days CONCEPTIONAL AGE but she was 23 weeks 6 days GESTATIONAL AGE. The limit of viability is 23 weeks GESTATIONAL AGE which is the same as 21 WEEKS CONCEPTIONAL AGE. Got it?

If you're so knowledgeable, what are the other "types" of in vitro fertilization, pray tell?

[OPERATIONMINDCRIME]

46. Gestational Age Fluctuates Anyway. Conceptional Age Is The Most Accurate To Begin With.

Gestational age based on LMP, though most common, is also the most inaccurate. That is why throughout the pregnancy the dates are oftentimes moved as more precise measurements of gestational age become available, such as with ultrasounds etc..

In this case, exact date of conception is known so that is the most accurate mark to use to determine the gestational age. Furthermore, most of those children at 23 weeks gestational age had already had ultrasounds done to more precisely measure and calculate the gestational age, thereby making the old LMP date completely moot, and your argument completely moot as well.

This is being recognized by the medical community worldwide as a record breaking survival story. You think you're the only one who would've thought of this and oh gosh, you just gotta get it out there, they're making such a big mistake???? C'mon, give me a break. I'm sure their claim is accurate, the weight of 10 ounces lines up with it, the weight itself breaks records for viability (usually 14 oz's), and this is nothing short of a medical miracle. Why you're protesting with such a ridiculous point so much is a bit perplexing. I mean sheesh, just wish the child well and move on.

[moc]

48. Oh, for chrissakes. You're incredibly dense.

You insist on arguing about something you know nothing about. As I said, I have a doctorate in this stuff. I teach this stuff. I analyze birth certificate data. I deal with these terms every fricken day of my professional life and have for the last 15 years. I'm not pulling this out of my ass.

This is not about the precision by which gestational age is measured in this case or any other. It is about the terminology that is being used. If you use the term "gestational age", you are referring to the time since conception PLUS TWO WEEKS. That is the definition of the term. It is not up for negotiation. It has not been changed. These doctors did not make some incredible discovery. If you are talking about the time since conception, that is called CONCEPTIONAL AGE. That is the definition. It is not up for negotiation. This infant's CONCEPTIONAL AGE was 21w6d. That's what is says in the article. The limit of viability for the length of time between conception and birth, the CONCEPTIONAL AGE, is 21 weeks.

I don't have a problem wishing the child well. I have a problem with them claiming to break the limit of viability when they haven't. This has implications for other families whose preterm infant is delivered prior to 21 weeks CONCEPTIONAL AGE.

Oh, and for what it's worth, your ranting about ultrasounds is ridiculous and underscores that you don't know what you're talking about. I don't have time to rebut point by point as I have a meeting starting now.

[colinmom71]

47. No they're not wrong...

Gestational age does begin at the last menstrual period before conception. However, with IVF procedures, gestation doesn't actually begin until the fertilized ova/ovum are implanted into the uterus (hopefully resulting in a viable pregnancy). There's about two weeks from the gestational process that's skipped with IVF, since the date of implantation is what is accurately known here.

What you're wanting more accurately described here is the baby's actual stage of *fetal development*, which is an accurate accounting of age from conception without accounting for the gestational lag inherent to calculating dates based on the LMP...

This particular baby, while she was born 21 weeks 6 days from implantation of the blastocyst, is actually more developmentally equivalent to a 23 weeks 6 day fetus where the two weeks gestational lag must be considered for typically conceived pregnancies. Had I conceived my son via IVF and we relied on the implantation date, then his 24 week birth could be termed at actually happening at 22 weeks if gestation was considered as beginning strictly at the implantation. But he would still have been born at the same *stage of fetal development* as a 24 weeks normally concieved pregnancy. Calling this baby a "miracle" 21 weeker is solely for sensationalism and is a complete misrepresentation when she is compared to other preemies developmentally...

[spoony]

61. Speaking of agendas

Why can't we simply be happy for this family?

[OmmmSweetOmmm]

18. I wish this treasure and her family well! Truly miraculous. eom

[Katherine Brengle]

19. WOW. It will be interesting to see how she fares...

I would imagine brain development could be an issue as she gets older, but this is just amazing.

[Clark2008]

24. I'm 24 weeks.

This story made me smile.

Of course, I'm not showing any signs that the baby's coming early, but this still rests my heart a lot. :)

[hedgehog]

29. I hope these next weeks go swiftly by.

I remember worrying about my children before they were born. I still check them even thought the youngest is 15 1/2!

[Madspirit]

30. Wonderful Miracle

My cousin was born at 24 weeks and he was fine after some problems in his first few months. His family is also very poor. They don't just save rich babies. What a crock.

...and it doesn't sound to me like the OP had an agenda. It just sounds like she is reporting a miracle. It does sound like some people here have an agenda though...that they are so afraid "choice" will be challenged they rather have had this baby die. Remember...it's called "choice" for a reason. This woman wanted her baby. No one is challenging anyone's right to abort theirs.

I wish this baby and her family...a wonderful life.
Lee

[zbdent]

31. It's a good thing she didn't end up in a fundie hospital ...

They'd have prayed over her the entire time she was in the womb ... but would they have employed "science" to save her life once outside the womb?

You have to wonder ...

[theboss]

35. What the fuck are you talking about?

Where are these "fundy" hospitals of which you speak?

[OPERATIONMINDCRIME]

37. Your Intolerance Is Totally Silly In This Context.

Why some always feel the need to take any uplifting news and twist it into something they can use to attack others is a pathetic mystery.

[Name removed]

57. Deleted message

Message removed by moderator. Click here to review the message board rules.

[OPERATIONMINDCRIME]

38. What An Awesome Story! God Bless That Child And The Family. 21 Weeks. Amazing!

[kath]

67. No, TWENTY-FOUR weeks.

Wow, just how many threads do you disrupt in any given day?!?!? Incredible.

[kestrel91316]

39. Will she be blind? How severe will her developmental disabilities be?

Will she ever have anything approaching a normal, productive, fulfilling life?

Or will she continue in a life full of suffering and medical woes until she dies, never knowing the meaning of anything, never really able to think or act consciously?

Time will tell. My guess is we won't hear much about her as she grows and it becomes obvious what a mess she is.

[OPERATIONMINDCRIME]

42. Well That's A Pretty Cynical And Negative Look At Things. Hopefully She'll Be Just Fine.

Holy dark negativity though. Sheesh, you always like that?

[kestrel91316]

54. There's an ugly truth behind a lot of these poor "miracle babies".

I just think the happy attitude this early on is wishful thinking.

[Quantess]

68. No, it's realistic.

Premature infants have the cards stacked against them, so to speak. They rarely get through childhood without a disability of some sort. I have a Master's degree in Speech Pathology.

[moc]

45. There's every reason to believe she'll be fine.

The developmental course of preterm infants after they leave the NICU is not a simple cause/effect association. Yes, there is a higher rate of disabilities. However, there is a complex interaction between biological risk and environmental risk that comes into play. In her favor are the facts that she's a girl and that she has minimal medical complications relative to many preterm infants of similar gestational age. If her home environment is supportive, there's no reason to believe she won't function in the normal range developmentally. In the first couple of years of life, she will likely achieve developmental milestones behind her peers, achieving them equivalent to a child 4 months younger. By the time she's in school, she'll very likely have caught up with her peers.

[kestrel91316]

55. I certainly hope so.

[theboss]

50. Remind me to never tell you when I'm in the hospital

Jeez, Louise. You'll put a pillow over my face while I'm sleeping.

Judge: Why did you kill him?
You: He had a kidney stone! What else was I supposed to do?

[spoony]

62. rofl :-)

:rofl:

[Madspirit]

53. My cousin is not a mess

and he was born at 24 weeks.

...you are ill.

Lee

[kestrel91316]

56. There are plenty of children like this who are, and will ever be,

a mess.

You are in denial about statistical realities.

[Madspirit]

58. Well

Like others said, hope you never visit me in the hospital. This baby may be fine. Sorry you wish it was dead. You do know...you sound almost gleeful about that possibility.

...and I understand the stats just fine. I stand by my pronouncement that you are ill.
Lee

[Madspirit]

59. Lastly

Oh yeah...and I actually know a number of disabled people, including blind and mentally retarded and NONE wish they had not been born.

I sure hope you don't work in a hospital.

Did Kevorkian die and elect you god?
Lee

[colinmom71]

63. OK, children are not "messes"...

Regardless of how disabled they may be. That's just crude.

And I'm sure as hell not in denial about the statistics concerning long term impacts on micro-preemies. I'm living the other side of that reality. I sincerely hope for the best for this family, but I do know that our journey may sadly also be theirs to share...

[LizW]

40. Another premie story

Not to go off on a tangent, but this made me remember. I've been reading the blog Red Hair, Black Leather for the last couple of years. Starting about this time last year, an amazing story unfolded there. It is all documented day by day and week by week, with wonderful writing and pictures. It's worth a read. Start with the Feb. 14, 2006 post.

http://redhairblackleather.blogspot.com/2006_05_28_archive.html

[Javaman]

51. That is one tiny kid. nt

[kskiska]

64. Burt Bacharach/Angie Dickinson's child comes to mind

She couldn't deal with her autism.

[dsc]

65. Of course I was called a liar and everything else for saying

that babies could survive at 23 weeks. I am sure those people will apologize. In all seriousness I am glad this kid is doing well.

[kath]

66. 22 weeks (NOT 21) would be the more accurate age, since she was

born 21 weeks and 6 days after in vitro conception. We don't think of a price of 21.99 as being 21 dollars.

But OF COURSE, in the interest of promoting the fundies' agenda, her gestational age in the headline, contrary to all mathematical rules of rounding, is given as 21 weeks.

Just realized this as well - something doesn't make sense here:
since gestational age is calculated from the 1st day of the last menstrual period (weirdly adding two weeks or so to a "pregnancy" before conception even occurs), if she was actually born 21 wks and 6 days post-*conception*, her GESTATIONAL AGE would actually be TWENTY-FOUR weeks (23 wks + 6 days), which is EXACTLY the cut-off for most abortion laws.

I will try to verify online if the 21wks,6 days post-CONCEPTION figure given in the article is correct. If so, she was a 24-weeker, which means all the fuss made about her is the usual tempest in a teapot, make-a-mountain-out-of-a-molehill deceptive bullshit that we've come to expect from the Reich Wing. A lot of fuss about NOTHING. Other 24-weekers have survived, but survival prior to that is exceedingly rare. Survival rate prior to that *without significant handicap* is vanishingly small.

And looking at the photo that is reportedly from "October", and so within a week of her birth, her skin looks fairly well-formed and not nearly as gelatinous as you would expect that of a 22-23 weeker to be. (Any neonatologists here?) Also looks like at least the left eye is partially open. At 22-23 weeks, the eyes would most likely still be fused, like that of a newborn kitten.

(And on a snarky side-note, it would be nice if the kids parents knew how to spell "Amelia". Poor kid will have to give the spelling of her name her whole life. I hate cre8tif spelling of baby names.)

<oops, on edit, I see that moc beat me to the punch on the dates thing. Thanks, moc, for your informative posts! That's what I get for reading the thread earlier, then coming back to post *without* checking to see if anyone had made my point in the interim. :-) )