The doctor will do nerve conduction tests first. The nerve conduction test for Martin-Gruber anastomosis is a procedure used to measure the speed at which electrical signals travel through the nerve that connects the ulnar nerve to the median nerve. A nerve conduction velocity (NCV) test measures how fast an electrical impulse moves through your nerve. By continuing to use our site, you agree to our use of cookies. Listened & answered questions. A technologist will perform the NCV test by placing several electrodes on the appropriate limb and applying a mild electric stimulus to the site. Book a lab test with Quest Diagnostics, a clinical laboratory offering a comprehensive array of routine and specialty lab testing services at 1700 N Rose Ave, Oxnard, CA, 93030. Any scripts or data that you put into this service are public. This test can cause some pain and discomfort. How the Test is Performed. 1600 N Rose Ave, Oxnard, CA. NCV Test. A damaged nerve may send a slower and weaker signal than a healthy one. Find a Location. New York City, NY. What Is Nerve Conduction Velocity (NCV) Testing? NCV and EMG tests are performed to determine whether symptoms like sciatica and weakness are caused by a nerve or muscle disorder. Our Research and Education in Muscular Dystrophy. 1 m Because the shortest time duration that can be detected is NOT less than the action potential time response of 1ms, according to Fig 1. The NCS, or nerve conduction (NERV kon-duc-shun) study exam, tests the health of the nerves outside the. The time from the onset of. (drugs taken for treatment of tuberculosis/ cancer) To book an “NCV test near me,” call Medintu at +919100445280, +919100907622 or visit. Nerve Conduction Velocity. A nerve conduction velocity (NCV) test — also called a nerve conduction study (NCS) — measures how fast an electrical impulse moves through your nerve. Heidari, completed a fellowship at University of Southern California Keck School of Medicine. Google Maps. It is a test for heteroscedasticity. James Sutton, MD is a neurology specialist in Oxnard, CA and has over 38 years of experience in the medical field. Two electrodes are placed on the skin over your nerve or over a muscle. Median nerve conduction velocity as a tool to detect subclinical neuropathy in type II diabetes mellitus. An EMG is an electrodiagnostic test that helps diagnose and assess nerve dysfunction by looking at the health of your muscles and the nerves that control them. Neda Heidari, MD is a neurology specialist in Ventura, CA. Int J. Normal nerve conduction velocity is between 50 and 60 metres per second. Call us on 08061970525 to know the lab options near your place in Delhi and make a booking at your convenient time. 00. nerve conduction velocity test. Anoop K. 1 Answer. [Medline] . You should contact the package authors for that. His office accepts new patients. Oxnard, CA 93030. The most common symptom was numbness (50%). Chiropractic. It is a safe, easy and painless test. Call 1800-572-0003 to Book your Scan OR 1) Leave your contact details, 2) We will reach out to you, 3) Lab details &. The NCV test cost in India varies from INR 6000 to INR 9000 ($75 - $112). 1 to 0. Your doctor might recommend a nerve conduction test along with an electromyography. However, any result has to be examined along with other information. At AccuHealth Diagnostics, the price of NCV tests is pretty reasonable. Often, nerve conduction studies are done before an electromyography (EMG). At Medintu, we specialize in Nerve Conduction Velocity (NCV) tests to evaluate nerve damage or dysfunction. **Note: A EMG/NCV Test cost in India at different locations may vary. Contact us at 702-936-3309 or visit us at 2480 Professional Court, Las Vegas, NV 89128. 2. 10m The answer key states that you somehow know the action potential time response is 1 msec. Poor CMAP was defined as <1 mV and poor NCV as <40 m/s 31. He is affiliated with medical facilities St. When your doctor orders an electrodiagnostic test, our friendly, accommodating and informed staff will schedule your examination at a time that is convenient for you and address your questions. The results from both sides of the body can be compared. 2 NCV test. NCV measures how fast electrical impulses travel through the nerves using small electric shocks on the skin’s surface to evaluate the nerves’ response. In a variation of electromyography, two electrodes are taped to the skin. The NCV test can be used to evaluate several conditions or diseases: Your doctor may also order a nerve. Call Directions. William Goldie, MD is a pediatric neurology specialist in Ventura, CA and has over 49 years of experience in the medical field. Dr. 1. Nerve conduction study. Services. Quality Care You Can Trust; PASADENA ; 2693 E WASHINGTON BLVD . They frequently treat conditions like Syncope and Myelopathy along with other conditions. He is affiliated with medical facilities St. EMG and NCV Facial Nerve Cost in Delhi. We performed a systematic review and subsequent meta-analysis of the last 30 years of NCS of immune-mediated neuritis in Lewis-rats. 1 m c)1m d) 10 m. last 7 days (22) last 2 weeks (40) last month (77) United States. The electromyogram (EMG) laboratory examination is a test that tells the doctor about your child’s nerve and muscle function. When EMG tests and nerve conduction studies are done together, it helps providers tell if your. What is the closest distance the electrodes used in a NCV test can be placed on a nerve in order to measure the voltage change as a response to the stimulus? a). OXNARD SANTA FE SPRINGS ; 300 E ESPLANADE DR. He is affiliated with medical facilities Community Memorial Hospital San. Liao an average 2. , STE. Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons). Nerve conduction studies help diagnose nerve damage or disease. EMG focuses on the electrical activity in your muscles, while NCN focuses on your peripheral nerves. Posts: 12,555 Prayers to those in need, may you be in helping hands. Any peripheral neuropathy can cause abnormal results. "Seema Diagnostics is good and reliable diagnostics centre and provide good quality and reliable reports. Nerve conduction velocity was recorded first, followed. In your specific case, there is some evidence for a non-constant variance of the. 2023. 3. The peripheral nerve connects the brain and spinal cord to the entire body as well as controls sensations and muscle coordination. bladder. He accepts multiple insurance plans, including Medicare. An NCV test can and usually is done at the same time as the EMG test. Call (310)652-6060 | Text (310)256-1161 | Email [email protected]% (n=48) were given. Dr. Turner. 013. A nerve conduction velocity (NCV) test, also called a nerve conduction study, detects nerve damage. The impulse may feel like an electric shock. Nerves are long fibres that run throughout your body and carry information from the brain or spinal cord to body tissues. This is a test that determines the health of muscles and the nerves that help control them. In most cases, both tests are performed. Nicolet VikingQuest b 2-9-15 Contact information. VC Star. These tests may be an. Nerve conduction velocity between 50 to 60 meters per second is considered normal. values Chisquare = 4. Any test must give “normal” values. Get an Appointment. When EMG tests and nerve conduction studies are done together, it helps providers tell if your. The default is set by the na. An EMG often is used with a nerve conduction study. A nerve conduction velocity test (NCV) is used to determine damage to the nerve and neuromuscular unit. Nerve conduction studies are done to: Find and evaluate damage to all the nerves that lead away from the brain and spinal cord to the smaller nerves that branch out from them. TEXAS. g. We were unable to find an outage for the number entered. Wires to the EMG machine (Picture 1) connect these electrodes. Electrodiagnostic testing assesses the integrity of lower motor neurons and is crucial to diagnosing motor neuron disease as oftentimes, neuroimaging, and laboratory studies are normal. A nerve conduction velocity (NCV) test measures how fast an electrical impulse moves through your nerve. 1m c. I do not own the rights to the images used in this video. Two electrodes are placed on the skin over your. John's Regional Medical Center. ncvTest(lm(interlocks ~ assets + sector + nation, data=Ornstein)) ncvTest(lm(interlocks ~ assets + sector + nation, data=Ornstein), . TCD Bubble Test View other providers who treat TCD Bubble. He graduated from University of Miami Miller School of Medicine in 1988. Nerve blocks can also treat chronic neuropathic pain such as pain caused by nerve damage or compression. Use this page to view details for the Local Coverage Article for Billing and Coding: Nerve Conduction Studies and Electromyography. 98537 Df = 1 p = 7. Many people suffer from muscle pain, numbness, or tingling that can be a result of multiple factors, including damage to the muscle tissue, nerve, or joints. (805) 744-2144. Nerve conduction studies can test sensory or motor nerve fibers and can determine both the speed of conduction as well as the amplitude of the electrical signal evoked following stimulation of a nerve. Veritaas Healthcare is a Multispecialty Clinic with consultations, path lab, radiology, dental, physiotherapy services etc under one roof. A nerve conduction velocity test is a day-care procedure. (805) 988-2775. Molnar also remains current with sports and orthopedic research. This process can be uncomfortable during the test. 2 NCV test. Dr. A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. - NCV studies are used mainly for evaluation of paresthesias (numbeness, tingling, burning) and/or weakness of arms and legs. Book an appointment now by visiting out website medintu. He graduated from University of Southern California Keck School of Medicine in 1995. 1700 N Rose Ave Ste 470, Oxnard CA 93030. Electrodiagnostic testing is the core diagnostic modality for patients with a suspected myopathy. Evaluation of proximal facial nerve conduction by transcranial magnetic stimulation. During the test, one or more small needles (also called electrodes) are inserted through the skin into the muscle. An EMG/NCV test can provide essential insights that help your Orlin & Cohen specialist make more accurate. This test is also called a nerve conduction study. GettyImages/Vadym Terelyuk. If the nerve is trapped, damaged or diseased then these signals will be slow. 05) and negative significant correlation between the duration and the amplitude (r=0. In the Tinel test, the doctor taps on or presses on the median nerve in your wrist. Telemedicine TeleNeurologist TeladocHow the Test Is Done Your child will lie on a table. VENTURA COUNTY AMBULATORY CARE URGENT CARE LOCATIONS: For pre-screening and appointment, call the hotline at 805-652-7660. Hotel to be announced. IT PEG Systems Specialist. Read on to learn about conditions that doctors may diagnose with an EMG. A nerve conduction velocity (NCV) test measures how fast an electrical impulse moves through your nerve. The. It is used to measure the muscle while at rest and then when the muscle is contracted. EMG uses an electrode. an optional data frame containing the variables in the model. They are regularly used to treat back and neck pain caused by herniated discs or spinal. View All Locations. R/ncvTest. This test is also called a nerve conduction study. What is nerve conduction velocity? Nerve conduction velocity (NCV) test is a measurement of the speed of conduction of an electrical impulse through a nerve. Dr. This helps your doctor know whether the problem is in the muscle itself or in the nerves that control the. Your peripheral nerves begin where the nerve root gets off from the spinal cord. Nerve conduction test and electromyography. g. What is an NCV Test? An NCV test is a diagnostic tool used to evaluate nerve damage or dysfunction. 1500+ EMG tests conducted yearly. How long the test takes. Bloom's focus is in the diagnosis and treatment of non-surgical musculoskeletal and neurologic disorders including neck and back pain, sports injuries, arthritis, joint pain and electrodiagnostics (EMG/NCV). See full list on linkneuroscience. She is affiliated with medical facilities such as St. With offices in Oxnard, California, Precision Medical Group, Inc is California's leader in providing high-quality,. St. It measures how fast an electrical signal can travel along a nerve or from the nerve to. Two electrodes are placed on the skin over your nerve or over a. Two electrodes are placed on the skin over your nerve or over a muscle. Using electrode patches, your nerve is stimulated, allowing the electrical impulse to be measured as the stimulus occurs. TCD Bubble Test View other providers who treat TCD Bubble. Sciatica Pain. An NCS tests how fast your nerves send signals to your muscles. This function is used to measure the amount. Adhesive patches called surface electrodes are placed on the skin over nerves or muscles at different spots. It is often followed by an electromyography (EMG) test, to exclude or detect muscle disorders. OXNARD, CA 9 3036 ; PASADENA . Values are trueNerve conduction studies measure how well individual nerves transmit electrical signals to the muscles. +12 more. NCV can identify nerve damage. John's Regional Medical Center and Saint Johns Hospital Camarillo. Resources. Peripheral nerves help control muscles and experience the senses in the human body. The aim of this study was to test the sensitivity of specific motor nerve conduction tests in comparison with, as well as in addition to, sensory nerve. A nerve conduction study, or NCS, is a test your doctor may use to diagnose damaged and destroyed nerves and come up with a pain relief plan. Find the location of abnormal sensations, such as numbness, tingling or pain. A complete EMG laboratory test takes about 1 hour. EMG-NCV testing for back and leg pain, and for neck and arm and hand pain, is the only objective test that can tell us how badly nerves are affected, can exclude damage to other nerves, and can tell whether irreversible damage has occurred. A nerve conduction velocity (NCV) test is used to assess nerve damage and dysfunction. A nerve conduction velocity (NCV) test measures how fast an electrical impulse moves through your nerve. A nerve conduction study measures how quickly impulses are transmitted along a nerve. 1. 1 to 0. California DRE #1522444. 00. 13171 Mindanao Way, Marina Del Rey CA. That’s not bad considering this program costs the provider $0 to implement and the practice could schedule several tests per month if. Phone Icon. The electrical activity picked up by the. Patients with history suggestive of polyneuropathy (e. This course is an introduction to all theoretical and didactic components of the practice of dental hygiene, including disease transmission and prevention, universal precautions, record keeping documentation and protocol, and dental hygiene instrumentation for scaling and root planing. An EMG and NCV are often done together to determine if a child has a muscle disorder or a nerve disorder. In general, a nerve velocity of 50 to 60 m / sec is considered typical. He is affiliated with medical facilities St. Along with the NCV test, an EMG test is also done, the cost of which falls in the range of INR 1500 - INR 3000. An EMG often is used with a nerve conduction study. 11. Get complete information on the nerve conduction velocity (NCV) test: Procedure, uses, Test results interpretation, and normal range. To find out more about EMG/NCV testing and how it can help you, call Neurology Center of Las Vegas or book an appointment online today. 03104933 . values ## Chisquare = 46. Even if a person has nerve injury, normal results are still attainable. Your doctor may recommend this nerve conduction study to help diagnose nerve and muscle diseases and seizures. His office accepts new patients. Damage to the spinal cord and disk herniation (herniated nucleus pulposus) with nerve root compression can also cause abnormal results. PET-CT; MRI / MRA;We were unable to find an outage for the number entered. Scot Richardson, MD is a neurology specialist in Ventura, CA and has over 27 years of experience in the medical field. 2 NCV test. Electronic Mechanic. John's Regional Medical Center and Saint Johns Hospital Camarillo. Grade Modes: Letter Graded. John's Regional Medical Center and Saint Johns Hospital Camarillo. What Is a Nerve Conduction Velocity (NCV) Test? If you have numbness, tingling and/or burning sensations in your legs or arms, your doctor may order a nerve conduction velocity test (NCV) to determine if you've experienced nerve damage. Working hours: 08:00 AM to 1:00 PM. With an EMG, the process is a little more involved than an NCV. Of these 76 arms, 63. No cost COVID-19 testing for all community members. These nerves assist you to control your. 230003RP. you were to test the biceps, triceps and deltoid in the LEFT arm along with the LEFT cervical paraspinal muscles, you would use code 95885Nerve Conduction Velocity Test. 3. But other times, the doctor may have to directly. DLF City Phase 1, Gurgaon, 122002. We do the tests on our own patients (we're pain management as well as physical medicine/rehab), and we have specialists refer their patients to us just for EMG/NCV. Medicus Wellness Clinic is situated in Gajularamaram, Hyderabad. John's Regional Medical Center and Los Robles. tests performed on peripheral nerves to determine their response to electrical stimuli. constant voltage electric stimulator evokes a response from muscle (motor nerve study) or along the nerve (sensory nerve study) standard stimulus is 0. It relies on artificially generated electrical impulses delivered to the body to test how well the impulses travel through the neuromuscular network. The nerve conduction test is a highly valuable tool used in the medical industry. Nerve conduction studies is recommend for following diseases: Neuropathy in patients with diabetes mellitus. Location: Oxnard (The Nard), CA, USA. A nerve conduction velocity (NCV) test is a commonly used diagnostic test to check for nerve damage and dysfunction. For nerve conduction studies, the. 1. NCV Test in India Through LabsAdvisor. The location and structure of the inferior. It is used to diagnose several conditions including herniated disc disease, polyneuropathy, sciatic nerve issues, peripheral nerve issues, Charcot-Marie-Tooth (CMT) syndrome and Guillain Barre syndrome. The number of nerves and muscles your doctor tests will determine how long it will take. The distance. Patient Satisfaction. chisqTest ncvTest. Best answers. Although, the NCV test charges may vary with location and hospital. CE Certified AC Clamp Meter for Testing AC CurrentResistance,AC/DC Voltage, , Diode and Continuity, Also Comes with. Dr. Dr. Your doctor may order an EMG alongside a nerve conduction. The NCV test helps your doctor differentiate between an injury to the nerve fiber and an injury to the myelin sheath which is the protective covering surrounding. NCV Test. During the test, your nerve is stimulated, often with electrode patches put on your skin. The nerve conduction velocity (NCV) test (also known as nerve conduction study or NCS), studies the speed at which electrical impulses move through the peripheral nerves. During the test, your nerve is stimulated, usually with electrode patches attached to your skin. 8. Electrodiagnostic testing, consisting of nerve conduction studies and needle electrode examination, serves as an extension of a neurologic examination for evaluating a variety of focal and generalized neuromuscular condi-tions. This test may. In this test, a needle is placed into a muscle and you are told to contract that muscle. Working hours: 8 AM to 2 PM. Cervical radiculopathy is most commonly precipitated by compression of a nerve root. Call 646-929-7800 or. This portion of the test usually takes 10 to 15 minutes and involves a small, thin sterile acupuncture electrode that is inserted. in or call +919100445280, +919100907622 and receive attractive discounts on NCV test cost. Bradley Hiner, MD is a neurology specialist in Oxnard, CA and has over 40 years of experience in the medical field. Okada E, Hasegawa T. 再来看一. The NCV and EMG tests can detect an injured nerve. EGFR T790M mutation was confirmed using either a cell-free EGFR test (48. Test: use the tester to check if there’s voltage in the wire or system you need to check; Check: test against a known voltage source again to ensure the tester’s batteries didn’t empty or that the tester didn’t malfunction. EMG (Electromyography) Neurologists use electromyography (EMG) to help diagnose injuries and conditions that affect your muscles and the nerves that control them, such as carpal tunnel syndrome and muscular dystrophy. Nerve conduction velocity (NCV) is a common measurement made during this test. , diabetes), radiculopathy. 8. Nerve conduction velocity (NCV): A physician applies small electrical currents to nerves to determine how well the body's electrical signals are traveling and whether or not there are any abnormalities. 8 (21 ratings) Dr. An EMG test involves inserting tiny needles into the muscles to record electrical activity. This part of the test usually takes 30 to 45 minutes. Generally, a normal NCV value is considered to be between 50 and 60 meters per second (m/s) for sensory nerves and between 40 and 50 m/s for motor nerves. test (mod, ~ assets+sector+nation, data=Ornstein) ## Non-constant Variance Score Test ## Variance. Electromyography. For diagnosing probable CIPNM, the peroneal motor NCS had a sensitivity of 94% (95% confidence interval (CI) 71–100%) and specificity of 91% (95% CI 82–96%), the sural sensory NCS had a. The test is often done at the same time as an EMG, in order to detect or rule out muscle disorders. The test is used to help detect neuromuscular abnormalities. An electrodiagnostic evaluation may not be necessary if the clinical presentation is clear; however, electrodiagnostic studies. 1000 to Rs. Despite recent advances in molecular genetics and significant improvement in imaging quality, it is still a pertinent part of the diagnostic process in most patients. This test measures how quickly the nerves in your arms and legs conduct electrical signals. NCV; Nerve conduction study (NCS) Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve. Heidari works at NedaMedica Laser in Ventura, CA with other offices in Oxnard, CA. All ITI Trades CBT Exam Nimi Mock Test. This process can be uncomfortable during. 1500 to Rs. and applied physiology to understand the test results, but all PNE reports should be written in terms that do not assume specialist knowledge. This test is also called a nerve conduction study (NCS). 24/7 Appointment Helpline +91 40 4567 4567 A nerve conduction study (NCS) is a test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. Nerve conduction velocity (NCV) atau Anda kenal juga dengan sebutan nerve conduction study adalah tes untuk mengukur seberapa cepat impuls listrik bergerak melalui saraf Anda. [Google Scholar] Landau M, Barner KC, Campbell WW. Electromyography (EMG) and nerve conduction velocity (NCV) are electrodiagnostic tests that measure the electrical activity of muscles and nerves. Electromyography (EMG) measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle. EMG is often performed at the same time as a nerve conduction velocity (NCN). , STE. Using electrode patches, your nerve is stimulated, allowing the electrical impulse to be measured as the stimulus occurs. Previous studies have evaluated pre-test and post-test pain perception in relation to EMG, however, expected and experienced pain levels have not. In fact, in one 2014 study, researchers surveyed 200 people who received both EMG and NCV tests, and 58. In addition, side-to-side differences in onset latency, amplitude, and nerve conduction velocity (NCV) were analyzed. 5 star rating. Blood and urine were collected, test results came back quickly within 2 days because I did my test on a Friday. Neuropathic units: reduced recruitment or large units . Tarsal tunnel syndrome (TTS), first defined in 1962 by Keck 1 and Lam 2, is a compressive peripheral neuropathy of the posterior tibial nerve and its branches within the tarsal tunnel beneath the flexor retinaculum. Nerve conduction velocity tests to see how fast electrical signals move through a nerve. EMG and nerve conduction studies are used to help diagnose a variety of muscle and nerve disorders. now what? Justin Graff, M. Nerve conduction studies can be used to test how both sensory and motor nerves are working in different parts of the body. 2011; 8:216–221. His office accepts new patients. 850. So a practice using this EMG/NCV testing model would typically generate up to $2,000. , STE. Electromyography (EMG) measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle. An EMG test helps find out if muscles are responding the right way to nerve signals. NCV testWith a wealth of sports medicine experience and a unique talent for nonsurgical treatment of orthopedic injuries, he joined Southern California Orthopedic Institute in 1988. He is affiliated with St. Vital Imaging offers many services such as MRI / MRA, X-Ray, CT Scan, PET CT, EKG, Mammogram, Echocardiogram, Nuclear Medicine, Sleep Study, Bone Density, Arterial Studies & more. High-quality test assured – 1000s of positive. Considering that the results of nerve conduction studies in our populations are compatible with a diagnosis of CIPN, and that the pathophysiology of CIPN is related to damage or severance of long myelinated. CVS Health is offering lab COVID. He graduated from OHIO STATE UNIVERSITY in 1982. Other symptoms of small fiber neuropathy include: a tingling or prickling sensation. We can help you find a doctor. An EEG is used in the evaluation of various suspected brain disorders; seizures, stroke, transient. The sensory. No home preparation is necessary. The nerve conduction test was ok, the first part anyway. Usually NCV is. John's Regional Medical Center. The lowest Nerve Conduction Velocity test cost is ₹1275 only. Updated Jun 13, 2017A nerve conduction velocity (NCV) test — also called a nerve conduction study (NCS) — measures how fast an electrical impulse moves through your nerve. Two electrodes are placed on the skin over your nerve or over a muscle. We offer the best diagnostic and medical care at a affordable price in Bangalore. This test is also called a nerve conduction study. Extracted data showed considerable heterogeneity of recorded nerve conduction velocity (NCV) and compound muscle action potential. Key Takeaways. The most common treatable causes include diabetes mellitus, hypothyroidism, and nutritional deficiencies. . These disorders include a herniated disc, amyotrophic lateral sclerosis (ALS) myasthenia gravis. 3150 Pleasant View Road Middleton, WI USA 53562-3530 608-829-8500 1 800-356-0007It is an effective test that helps evaluate your nerve health. , positive Tinel’s, thenar muscle atrophy or paresthesias in the radial three digits). , STE. 850. Summary. 40, no. Clinic Directory: NMCI Medical Clinic is located throughout Northern California and the San Francisco Bay Area. You may have muscle soreness or bruising after the test at the site where the needle was inserted. John's Regional Medical Center and Los Robles Regional Medical Center. Electromyography (EMG) and Nerve conduction studies are diagnostic tests used to detect nerve and muscle disorders and to evaluate the functioning of your nerves and muscles. Learn more about our research and professional education opportunities. test. 3. A nerve conduction velocity (NCV) test — also called a nerve conduction study (NCS) — measures how fast an electrical impulse moves through your nerve. Injury to the nerves. Poor CMAP was defined as <1 mV and poor NCV as <40 m/s 31. How the Test will Feel. Patients rated Dr. Dr.