Archive | September, 2018

Health Services Center in Winnipeg study: Hospital privacy curtains may harbor dangerous germs

30 Sep

Nursing School Hub.com reported in Top 10 Most Common Diseases Found in Hospitals:

1. Norovirus
Noroviruses are generally called “the flu” by many patients, most of whom believe that the symptoms of the resulting gastroenteritis are somehow linked to influenza itself. Norovirus infections typically result in diarrhea, vomiting, and the long-lasting feeling of an upset stomach. Though these symptoms are exceedingly unpleasant, and may last for several days at a time, healthcare professionals cannot treat them with antibiotic drugs. Patients, therefore, are advised to make sure that they attempt to eat meals at regular intervals, and they’re advised to stay hydrated so that the body does not suffer through the effects of dehydration after a few days of symptoms.
2. Mycobacterium abscessus
One of the most serious sources of hospital acquired infections is mycobacterium abscessus. This bacterium is generally known to be the cause of such serious illnesses as leprosy and tuberculosis, and it can be found in any number of compounds. The bacteria have been known to exist in soil, dust, or water, and it has even been known to infect medications and to reside on medical equipment. This represents a very serious concern in today’s busiest medical environments, and many hospitals have procedures in place specifically to prevent against the spread of this bacteria and the potential infection of new patients who come to the hospital with other ailments.
If infection from this bacteria does result, patients are most likely to notice irritable infections of the skin and soft tissues, though a slight minority may actually experience lung infections that can be quite serious and severe. Medical treatment is almost always required for a full and quick recovery from any kind of mycobacterium abscessus infection.
3. Klebsiella
Another very serious source of hospital acquired infections is the bacteria known as Klebsiella. This gram-negative bacteria almost always infects patients after a visit to the hospital, as it seems to be particularly at home on medical equipment in patient treatment areas. Infection by this bacteria can result in a number of serious ailments, including an infection of the bloodstream, infection of any open wounds or surgical sites, or the onset of a very serious form of pneumonia. Treatment is generally quick and straightforward, although some antimicrobial strains of the bacteria have required added research and more serious forms of treatment in a small minority of today’s patients.
4. Influenza
Without a doubt, one of the most common and persistent types of viral infection is influenza. The disease comes and goes with varying degrees of potency every year but most medical professionals estimate that between 5 percent and 20 percent of the American population is infected each year. Influenza is also responsible for annual hospitalization of as many as 200,000 Americans. Typically, those hospitalized by the disease are those at the extreme young or old ends of the spectrum, though it’s not entirely unheard of for healthy, young adult sufferers to experience complications. This community-based virus is easy to contract, especially when cases have been cited near the hospital’s location during the height of what is known as “flu season.”
5. Pseudomonas aeruginosa
Pseudomonas aeruginosa is an infection that results from a common form of bacteria more widely called just Pseudomonas. The infection is quite common in medical settings, though it targets a specific group of people. In almost every case, a bout of Pseudomonas aeruginosa is found in those patients who are already experiencing vastly weakened or suppressed immune systems as a result of a larger medical condition during their stay in a medical environment or long-term care facility. Treatment of this bacterial infection is generally pursed through the prescription of high dosage antibiotics, and the problem generally eases within 24 to 48 hours of first treatment.
6. Methicillin-resistant Staphylococcus aureus
Abbreviated as MRSA, this staph bacteria has evolved over time to become immune to many of the most popular antibacterial drugs. Indeed, MRSA can often not be treated with either penicillin or amoxicillin, with most patients requiring higher doses of more nontraditional antibiotics in order to defeat the condition. It often manifests itself in the form of a skin infection in most patients, and should be treated by a medical professional as soon as any signs or symptoms have been noticed by the patient. Staph bacteria does represent one of the most aggressive bacterial threats to the human body.
7. Vancomycin-resistant Enterococci
VRE is so named because this bacterial infection is resistant to the antibiotic vancomycin. Infections of this nature are most common in medical settings, especially when a patient is admitted to the hospital for long-term care and nursing. Most sufferers experience symptoms that affect the intestines, which can result in a case of upset stomach, minor vomiting, or even occasional diarrhea. The good news for those suffering from this bacterial infection, though, is that treatment is rather quick and easy with alternative antibiotics in heavier doses.
8. Tuberculosis (TB)
Most often, the transmission of tuberculosis in medical and nursing environments is done on a patient-to-patient basis. Typically, this is because one patient with the disease is simply not isolated from the rest of the hospital’s population. In other cases, it’s because the patient simply was not aware that they suffered from TB at the time of their admission to the facility. Most forms of TB can be treated and minimized, though particularly aggressive strains of the disease have shown a great deal of resistance to antibiotics that are typically used to treat the condition.
9. Vancomycin-intermediate or Vancomycin-resistant Staphylococcus aureus
Known in the medical community as either VISA or VRSA, these two diseases are actually quite common among those patients who have medical equipment attached to their body on a long-term or permanent basis. Those with kidney problems are particularly predisposed to infection, as are those patients who commonly use a catheter tube before, during, or after some kind of serious surgery.
The two forms of staphylococcus are so named because they are moderately or entirely resistant to the antibiotic vancomycin. Treatment can be conducted using other antibiotic drugs, however, and most patients are able to recover from this infection when it is caught early, treated effectively, and prevented on a proactive basis going forward. Unlike viral infections, however, bacterial infections can occur again at any time. For this reason, increased vigilance is urged of those who are connected to medical devices that penetrate the skin, enter the body, and assist with daily functions like kidney function, urination, and many others.
10. Staphylococcus aureus
In what might be the least invasive and least concerning disease commonly found in hospitals, Staphylococcus aureus is actually present in just under one third of the entire population. The condition is associated with negative effects on the skin, as it is typically a skin infection. The side effects of the disease most often manifest themselves in small, pimple-like growths that ebb and flow over the course of the infection. Treatment with antibiotics is effective in virtually every case, and this less severe form of staphylococcus can be eradicated in just a few days after treatment has commenced.
Plenty of Threats: A Bacterial or Viral Infection is All Too Common
The very nature of today’s hospitals means that patients are exposed more than ever to the potential for both viral and bacterial infections, placing their health at risk in at least ten ways during every visit. The good news is that virtually every common infection or disease transmitted at today’s hospitals can be treated with either extended vigilance or a robust dose of antibiotics. In fact, many of these diseases are considered relatively minor in the grand scheme of hospital infections and the diseases treated at today’s medical centers….. https://www.nursingschoolhub.com/most-common-diseases-found-in-hospitals/

An Elsevier reported study said hospital surfaces may harbor dangerous germs.

Science Daily reported in Hospital privacy curtains may harbor dangerous germs:

Without timely intervention, privacy curtains in hospitals can become breeding grounds for resistant bacteria, posing a threat to patient safety, according to new research published in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology (APIC).
The longitudinal, prospective, pilot study tracked the contamination rate of ten freshly laundered privacy curtains in the Regional Burns/Plastics Unit of the Health Services Center in Winnipeg, Canada. While the curtains had minimal contamination when they were first hung, the curtains that were hung in patient rooms became increasingly contaminated over time — and by day 14, 87.5 percent of the curtains tested positive for methicillin-resistant Staphylococcus aureus (MRSA), a pathogen associated with significant morbidity and mortality. In contrast, control curtains that were not placed in patient rooms stayed clean the entire 21 days.
None of the rooms where the curtains were placed were occupied by patients with MRSA. Four curtains were placed in a four-bed room; four were placed in two double rooms; and two controls were placed in areas without direct patient or caregiver contact. Researchers took samples from areas where people hold curtains, suggesting that the increasing contamination resulted from direct contact….
By day 21, almost all curtains exceeded 2.5 CFU/cm, the requirement for food processing equipment cleanliness in some locations, such as the United Kingdom….
The study authors acknowledge the small sample size of this pilot study and recommend additional research to understand the clinical consequences of contaminated curtains. https://www.sciencedaily.com/releases/2018/09/180927215701.htm

Citation:

Hospital privacy curtains may harbor dangerous germs
Date: September 27, 2018
Source: Elsevier
Summary:
Without timely intervention, privacy curtains in hospitals can become breeding grounds for resistant bacteria, posing a threat to patient safety, according to new research.
Journal Reference:
Kevin Shek, Rakesh Patidar, Zeenib Kohja, Song Liu, Justin P. Gawaziuk, Monika Gawthrop, Ayush Kumar, Sarvesh Logsetty. Rate of contamination of hospital privacy curtains in a burns/plastic ward: A longitudinal study. American Journal of Infection Control, 2018; 46 (9): 1019 DOI: 10.1016/j.ajic.2018.03.004

Here is the press release:

PUBLIC RELEASE: 27-SEP-2018 Hospital privacy curtains may harbor dangerous germs: New study
ELSEVIER
Arlington, Va., September 27, 2018 – Without timely intervention, privacy curtains in hospitals can become breeding grounds for resistant bacteria, posing a threat to patient safety, according to new research published in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology (APIC).
The longitudinal, prospective, pilot study tracked the contamination rate of ten freshly laundered privacy curtains in the Regional Burns/Plastics Unit of the Health Services Center in Winnipeg, Canada. While the curtains had minimal contamination when they were first hung, the curtains that were hung in patient rooms became increasingly contaminated over time – and by day 14, 87.5 percent of the curtains tested positive for methicillin-resistant Staphylococcus aureus (MRSA), a pathogen associated with significant morbidity and mortality. In contrast, control curtains that were not placed in patient rooms stayed clean the entire 21 days.
None of the rooms where the curtains were placed were occupied by patients with MRSA. Four curtains were placed in a four-bed room; four were placed in two double rooms; and two controls were placed in areas without direct patient or caregiver contact. Researchers took samples from areas where people hold curtains, suggesting that the increasing contamination resulted from direct contact.
“We know that privacy curtains pose a high risk for cross-contamination because they are frequently touched but infrequently changed,” said Kevin Shek, BSc, the study’s lead author in the article. “The high rate of contamination that we saw by the fourteenth day may represent an opportune time to intervene, either by cleaning or replacing the curtains.”
By day 21, almost all curtains exceeded 2.5 CFU/cm, the requirement for food processing equipment cleanliness in some locations, such as the United Kingdom.
“Keeping the patient’s environment clean is a critical component in preventing healthcare-associated infections,” said 2018 APIC President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC. “Because privacy curtains could be a mode of disease transmission, maintaining a schedule of regular cleaning offers another potential way to protect patients from harm while they are in our care.”
The study authors acknowledge the small sample size of this pilot study and recommend additional research to understand the clinical consequences of contaminated curtains.
###
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Patients have little information to guide them in their choice of hospitals regarding infection practices of hospital.

Reuters reported in ‘Superbug’ scourge spreads as U.S. fails to track rising human toll:

Fifteen years after the U.S. declared drug-resistant infections to be a grave threat, the crisis is only worsening, a Reuters investigation finds, as government agencies remain unwilling or unable to impose reporting requirements on a healthcare industry that often hides the problem…. https://www.reuters.com/investigates/special-report/usa-uncounted-surveillance/

Patients are on their own when asking about a particular hospital’s superbug and infectious control practices.

Resources:

Hospital Cleaning Best Practices: How to Keep Patients and Staff Safe https://www.kaivac.com/a_433-Hospital-Cleaning-Best-Practices-How-to-Keep-Patients-and-Staff-Safe

The most dangerous germs in the hospital may be those you bring with you http://www.sciencemag.org/news/2017/05/most-dangerous-germs-hospital-may-be-those-you-bring-you

How gloves & gowns can spread germs in hospitals http://www.healthcarebusinesstech.com/germs-gloves-gowns/

10 Ways to Stave Off Hospital Superbugs and Other Nasty Germs https://www.scientificamerican.com/article/10-ways-protect-yourself-superbugs/

Germs https://drwilda.com/tag/germs/
http://www.webmd.com/children/features/childhood-illnesses-get-the-facts

Where information leads to Hope. © Dr. Wilda.com

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BMJ Study: Sugar content of most supermarket yogurts well above recommended threshold

23 Sep

Cutting sugar in a child’s diet is important to improving the child’s health. Science Daily reported in ‘Healthy’ foods differ by individual:

Ever wonder why that diet didn’t work? An Israeli study tracking the blood sugar levels of 800 people over a week suggests that even if we all ate the same meal, how it’s metabolized would differ from one person to another. The findings, published November 19 in Cell, demonstrate the power of personalized nutrition in helping people identify which foods can help or hinder their health goals.
Blood sugar has a close association with health problems such as diabetes and obesity, and it’s easy to measure using a continuous glucose monitor. A standard developed decades ago, called the glycemic index (GI), is used to rank foods based on how they affect blood sugar level and is a factor used by doctors and nutritionists to develop healthy diets. However, this system was based on studies that average how small groups of people responded to various foods.
The new study, led by Eran Segal and Eran Elinav of the Weizmann Institute of Science in Israel, found that the GI of any given food is not a set value, but depends on the individual. For all participants, they collected data through health questionnaires, body measurements, blood tests, glucose monitoring, stool samples, and a mobile-app used to report lifestyle and food intake (a total of 46,898 meals were measured). In addition, the volunteers received a few standardized/identical meals for their breakfasts.
As expected, age and body mass index (BMI) were found to be associated with blood glucose levels after meals. However, the data also revealed that different people show vastly different responses to the same food, even though their individual responses did not change from one day to another.
“Most dietary recommendations that one can think of are based on one of these grading systems; however, what people didn’t highlight, or maybe they didn’t fully appreciate, is that there are profound differences between individuals–in some cases, individuals have opposite response to one another, and this is really a big hole in the literature,” says Segal, of Weizmann’s Department of Computer Science and Applied Math…. http://www.sciencedaily.com/releases/2015/11/151119133230.htm

Sugar can be problematic in an individual’s diet.

Jillian Kubala, MS, RD wrote in the Heathline article, 11 Reasons Why Too Much Sugar Is Bad for You:

Here are 11 reasons why eating too much sugar is bad for your health.
1. Can Cause Weight Gain
2. May Increase Your Risk of Heart Disease
3. Has Been Linked to Acne
4. Increases Your Risk of Diabetes
5. May Increase Your Risk of Cancer
6. May Increase Your Risk of Depression
7. May Accelerate the Skin Aging Process
8. Can Increase Cellular Aging
9. Drains Your Energy
10. Can Lead to Fatty Liver
11. Other Health Risks
Aside from the risks listed above, sugar can harm your body in countless other ways….
Summary Consuming too much sugar may worsen cognitive decline, increase gout risk, harm your kidneys and cause cavities

Many who are attempting a healthy diet include yogurt as a food choice. A BMJ study examines whether all yogurt choices are healthy.

Science Daily reported a BMJ, formerly British Medical Journal, study, Sugar content of most supermarket yogurts well above recommended threshold:

Yogurt may be an “unrecognised” source of dietary sugar, particularly for young children, who eat a lot of it, highlight the researchers.
The evidence suggests that yogurt and other fermented dairy products aid digestive and overall health. A good source of ‘friendly’ bacteria, they also contain protein, calcium, iodine and vitamin B.
UK and US dietary guidelines recommend low fat and low sugar dairy products, and the researchers wanted to assess how far yogurt products, particularly those marketed to children, meet these guidelines. Children up to the age of 3 in the UK eat more yogurt than any other age group.
They therefore assessed the nutrient content of almost 900 yogurts and yogurt products, which were available from five major UK online supermarket chains in October/November 2016. Between them, these chains account for 75 per cent of the market share.
All the products were grouped into eight categories: children’s, which included fromage frais; dairy alternatives, such as soy; desserts; drinks; flavoured; fruit; natural/Greek; and organic.
Low fat and low sugar were classified according to European Union regulations, currently used for the front of pack food traffic light labelling system used in the UK: 3 g of fat/100g or less or 1.5 g or less for drinks; and a maximum of 5 g of total sugars/100 g.
The sugar content varied enormously both within and across the categories, the analysis showed. But, with the exception of natural/Greek yogurts, the average sugar content of products in all the categories was well above the low sugar threshold.
Fewer than one in 10 (9%) qualified as low sugar, almost none of which were in the children’s category. This is “concerning,” given the rise in childhood obesity and the prevalence of tooth decay among young children, say the researchers.
Unsurprisingly, desserts contained the most total sugar, at an average 16.4 g/100 g, an amount that represents more than 45 per cent of energy intake. These were followed by products in the children’s, flavoured, fruit, and organic categories.
In these categories, total average sugars ranged from 10.8 g/100 g in children’s products to 13.1 g/100 g in organic products. This compares with an average of 5g /100 g for natural/Greek yogurts.
By and large, average fat content was either below or just above the low fat threshold. Desserts had the highest fat content and the broadest range, averaging 5.2 g/100 g.
This is an observational study, and as such, can’t establish cause, added to which it covered only products sold in five supermarket chains…. https://www.sciencedaily.com/releases/2018/09/180918195345.htm

Citation:

Sugar content of most supermarket yogurts well above recommended threshold
Organic products, perceived as healthier options, among some of the worst offenders
Date: September 18, 2018
Source: BMJ
Summary:
The sugar content of most types of yogurt is well above the recommended threshold, reveals an analysis of the nutrient content of available UK supermarket products. And organic varieties, often viewed as healthier options, contain some of the highest average sugar content, at 13.1 g/100 g, the findings indicate.
Journal Reference:
J Bernadette Moore, Annabelle Horti, Barbara A Fielding. Evaluation of the nutrient content of yogurts: a comprehensive survey of yogurt products in the major UK supermarkets. BMJ Open, 2018; 8 (8): e021387 DOI: 10.1136/bmjopen-2017-021387

Here is the press release from BMJ (British Medical Journal):

PUBLIC RELEASE: 18-SEP-2018
Sugar content of most supermarket yogurts well above recommended threshold
Organic products, perceived as healthier options, among some of the worst offenders
BMJ
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Yogurt may be an “unrecognised” source of dietary sugar, particularly for young children, who eat a lot of it, highlight the researchers.
The evidence suggests that yogurt and other fermented dairy products aid digestive and overall health. A good source of ‘friendly’ bacteria, they also contain protein, calcium, iodine and vitamin B.
UK and US dietary guidelines recommend low fat and low sugar dairy products, and the researchers wanted to assess how far yogurt products, particularly those marketed to children, meet these guidelines. Children up to the age of 3 in the UK eat more yogurt than any other age group.
They therefore assessed the nutrient content of almost 900 yogurts and yogurt products, which were available from five major UK online supermarket chains in October/November 2016. Between them, these chains account for 75 per cent of the market share.
All the products were grouped into eight categories: children’s, which included fromage frais; dairy alternatives, such as soy; desserts; drinks; flavoured; fruit; natural/Greek; and organic.
Low fat and low sugar were classified according to European Union regulations, currently used for the front of pack food traffic light labelling system used in the UK: 3 g of fat/100g or less or 1.5 g or less for drinks; and a maximum of 5 g of total sugars/100 g.
The sugar content varied enormously both within and across the categories, the analysis showed. But, with the exception of natural/Greek yogurts, the average sugar content of products in all the categories was well above the low sugar threshold.
Fewer than one in 10 (9%) qualified as low sugar, almost none of which were in the children’s category. This is “concerning,” given the rise in childhood obesity and the prevalence of tooth decay among young children, say the researchers.
Unsurprisingly, desserts contained the most total sugar, at an average 16.4 g/100 g, an amount that represents more than 45 per cent of energy intake. These were followed by products in the children’s, flavoured, fruit, and organic categories.
In these categories, total average sugars ranged from 10.8 g/100 g in children’s products to 13.1 g/100 g in organic products. This compares with an average of 5g /100 g for natural/Greek yogurts.
By and large, average fat content was either below or just above the low fat threshold. Desserts had the highest fat content and the broadest range, averaging 5.2 g/100 g.
This is an observational study, and as such, can’t establish cause, added to which it covered only products sold in five supermarket chains.
But write the researchers: “While yogurt may be less of a concern than soft drinks and fruit juices, the chief sources of free sugars in both children and adults’ diets, what is worrisome is that yogurt, as a perceived ‘healthy food,’ may be an unrecognised source of free/added sugars in the diet.”
This is particularly true of the organic yogurts analysed, they say. “While the organic label refers to production, the well documented ‘health-halo effect’ means that consumers most often underestimate the caloric content and perceive the nutritional contents of organic products, including yogurts, more favourably.”
They conclude: “Not all yogurts are as healthy as perhaps consumers perceive them, and reformulation for the reduction of free sugars is warranted.”
###
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system. https://www.eurekalert.org/pub_releases/2018-09/b-sco091418.php

Moi blogs about education issues so the reader could be perplexed sometimes because moi often writes about other things like nutrition, families, and personal responsibility issues. Why? The reader might ask? Children will have the most success in school if they are ready to learn. Ready to learn includes proper nutrition for a healthy body and the optimum situation for children is a healthy family. Many of society’s problems would be lessened if the goal was a healthy child in a healthy family.

Related:

Dr. Wilda Reviews Book: ‘Super Baby Food’ http://drwildareviews.wordpress.com/2013/09/11/dr-wilda-reviews-book-super-baby-food/

The Truth About Sugar                                                                            https://www.webmd.com/food-recipes/features/health-effects-of-sugar#1

Good & Bad Sugars                                                                     https://healthyeating.sfgate.com/good-bad-sugars-7608.html

A healthy child in a healthy family who attends a healthy school in a healthy neighborhood ©

Where information leads to Hope. ©

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Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
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Washington State University study: BPA replacements in plastics cause reproductive problems in lab mice

16 Sep

Brent A. Bauer, M.D. of the Mayo Clinic provides a concise description of bisphenol A (BPA):

What is BPA, and what are the concerns about BPA?
Answer From Brent A. Bauer, M.D.
BPA stands for bisphenol A. BPA is an industrial chemical that has been used to make certain plastics and resins since the 1960s.
BPA is found in polycarbonate plastics and epoxy resins. Polycarbonate plastics are often used in containers that store food and beverages, such as water bottles. They may also be used in other consumer goods.
Epoxy resins are used to coat the inside of metal products, such as food cans, bottle tops and water supply lines. Some dental sealants and composites also may contain BPA.
Some research has shown that BPA can seep into food or beverages from containers that are made with BPA. Exposure to BPA is a concern because of possible health effects of BPA on the brain, behavior and prostate gland of fetuses, infants and children. Additional research suggests a possible link between BPA and increased blood pressure.
However, the Food and Drug Administration (FDA) has said that BPA is safe at the very low levels that occur in some foods. This assessment is based on review of hundreds of studies.
The FDA is continuing its review of BPA, including supporting ongoing research. In the meantime, if you’re concerned about BPA, you can take these steps to reduce your exposure:
• Use BPA-free products. Manufacturers are creating more and more BPA-free products. Look for products labeled as BPA-free. If a product isn’t labeled, keep in mind that some, but not all, plastics marked with recycle codes 3 or 7 may be made with BPA.
• Cut back on cans. Reduce your use of canned foods since most cans are lined with BPA-containing resin.
• Avoid heat. The National Institute of Environmental Health Sciences, part of the National Institutes of Health, advises against microwaving polycarbonate plastics or putting them in the dishwasher, because the plastic may break down over time and allow BPA to leach into foods.
• Use alternatives. Use glass, porcelain or stainless steel containers for hot foods and liquids instead of plastic containers….. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/bpa/faq-20058331

A Washington State University study found there could be problems with some replacements to BPA plastics.

Science Daily reported in BPA replacements in plastics cause reproductive problems in lab mice:

Twenty years ago, researchers made the accidental discovery that the now infamous plastics ingredient known as bisphenol A or BPA had inadvertently leached out of plastic cages used to house female mice in the lab, causing a sudden increase in chromosomally abnormal eggs in the animals. Now, the same team is back to report in the journal Current Biology on September 13 that the array of alternative bisphenols now used to replace BPA in BPA-free bottles, cups, cages, and other items appear to come with similar problems for their mice….

The new findings were uncovered much as before as the researchers again noticed a change in the data coming out of studies on control animals. Again, the researchers traced the problem to contamination from damaged cages, but the effects this time, Hunt says, were more subtle than before. That’s because not all of the cages were damaged and the source of contamination remained less certain.
However, she and her colleagues were able to determine that the mice were being exposed to replacement bisphenols. They also saw that the disturbance in the lab was causing problems in the production of both eggs and sperm.
Once they got the contamination under control, the researchers conducted additional controlled studies to test the effects of several replacement bisphenols, including a common replacement known as BPS. Those studies confirm that replacement bisphenols produce remarkably similar chromosomal abnormalities to those seen so many years earlier in studies of BPA.
Hunt notes that the initial inadvertent exposure of their animals was remarkably similar to what might happen in people using plastics in that the exposure was accidental and highly variable. Not all of the animals’ cages were damaged, and so the findings differed among animals in different cages.
She adds that — although determining the levels of human exposure is difficult — their controlled experiments were conducted using low doses of BPS and other replacement bisphenols thought to be relevant to exposure in people using BPA-free plastics.
These problems, if they hold true in people as has been shown in the case of BPA, will carry over to future generations through their effects on the germline. The researchers showed that, if it were possible to eliminate bisphenol contaminants completely, the effects would still persist for about three generations… https://www.sciencedaily.com/releases/2018/09/180913113940.htm

Citation:

BPA replacements in plastics cause reproductive problems in lab mice
Date: September 13, 2018
Source: Cell Press
Summary:
Twenty years ago, researchers made the accidental discovery that BPA had leached out of plastic cages used to house female mice in the lab, causing an increase in chromosomally abnormal eggs. Now, the same team is back to report that the array of alternative bisphenols now used to replace BPA in BPA-free bottles, cups, cages, and other items appear to come with similar problems for their mice.
Journal Reference:
Tegan S. Horan, Hannah Pulcastro, Crystal Lawson, Roy Gerona, Spencer Martin, Mary C. Gieske, Caroline V. Sartain, Patricia A. Hunt. Replacement Bisphenols Adversely Affect Mouse Gametogenesis with Consequences for Subsequent Generations. Current Biology, 2018; DOI: 10.1016/j.cub.2018.06.070

Here is the press release from Washington State University:

WSU researchers see new plastics causing reproductive woes of old plastics
September 13, 2018

BPA has long been used in bottles, cups, medical and dental devices, and as coatings for food-can linings and cash register receipts.
By Eric Sorensen, WSU News

Washington State University researchers have found that plastic products meant to replace the chemical bisphenol A, or BPA, are also causing genetic abnormalities in mice.

The discovery is a déjà vu moment for Patricia Hunt, who 20 years ago linked abnormalities in egg chromosomes to BPA released by a harsh detergent used on her lab’s mouse cages. This time, she saw reproductive defects in control animals housed in plastic cages made with BPA alternatives.

“There’s growing evidence that many of these common replacements are not safe,” said Hunt, a professor in WSU’s School of Molecular Biosciences and lead author of a study in the latest Current Biology. “We stumbled on an effect yet again. This is a more stable plastic but it induced similar effects on the process of making eggs and sperm. Importantly, when we tested the chemicals in controlled experiments, we got similar results for each of them.”

BPA has long been used in bottles, cups, medical and dental devices, and as coatings for food-can linings and cash register receipts. After Hunt and other researchers began tying BPA exposure to developmental defects in numerous animal species, the U.S. Food and Drug Administration banned it in baby bottles and children’s drinking cups. The Washington legislature has also limited its use.
Hunt and her colleagues say mice exposed to the common BPA replacement bisphenol S, or BPS, underwent changes in the way the germ cells in their testes and ovaries copy and splice DNA while producing sperm and eggs. Both sexes had problems getting DNA to recombine correctly, leading to a reduction in viable sperm and an increase in abnormal eggs. Hunt and her colleagues had similar results with the replacements BPF, BPAF, and diphenyl sulfone.

“These findings add to growing evidence of the biological risks posed by this class of chemicals,” Hunt and her colleagues write.

Problems in the male germline lasted several generations after the initial exposure.
In addition to risking human reproductive health, the replacement plastics can also be compromising the integrity of biological research.

“It’s now becoming almost impossible to run experiments without contamination,” said Hunt, called the “accidental toxicologist” by Scientific American magazine. “And it’s not that I live under my own black cloud. It’s that I have a super sensitive system. A germ line is like the canary in the coal mine. As soon as something hits, we see it. Other investigators in my facility don’t see it but it doesn’t mean that it doesn’t impact their research.”

Hunt’s WSU colleagues in the research are Tegan Horan, a research intern and the paper’s first author, as well as scientific assistants Hannah Pulcastro and Crystal Lawson and former postdoctoral fellows Mary Gieske and Caroline Sartain. Joining them are Roy Gerona and Spencer Martin of the University of California, San Francisco.
The study was funded by the National Institutes of Health.
Media contact:
Patricia Hunt, professor, WSU School of Molecular Biosciences, 509-335-4954, pathunt@wsu.edu

The question is whether there are safe plastics.

Timothy Banas wrote in the Livestrong.com article, Which Plastic Containers Can I Safely Use?

Type 1: Polyethylene Teraphthalate – Do Not Reuse
You commonly find Type 1 plastic in bottles for juices, salad dressing, water, vegetable oil and mouthwash. Peanut butter and pickle jars often contain type 1 plastic as well. Polyethylene teraphthalate is light-weight, clear and smooth; its manufacturers intend it for a single use only.
While it does not contain bisphenol A or phthalates, it does contain antimony, a possible human carcinogen. Also, harmful bacteria can build up in it as you reuse it. Polyethylene teraphthalate containers may have the symbol “PET” on them.

Type 2: High-Density Polyethylene – Safe
Milk containers, detergent bottles, freezer bags and plastic grocery bags often contain high-density polyethylene, a relatively stiff plastic. Type 2 plastic neither contains bisphenol A nor phthalates. It is not known to contain other harmful chemicals. High-density polyethylene containers may have the symbol “HDPE” on them.
Type 3: Polyvinyl Chloride – Contains Phthalates
Polyvinyl chloride contains phthalates that can cause reproductive problems in animals and humans. Type 3 plastic can be plasticized or unplasticized; the former is clear and flexible, the latter is more rigid. Food containers commonly made with polyvinyl chloride include fruit juice bottles, cooking oil bottles and clear food packaging. Plasticized PVC pipes and siding contain phthalates as well. Polyvinyl chloride containers may have the symbol “V” on them.
Type 4: Low-Density Polyethylene – Safe
Frozen foods packaging and condiment squeeze bottles often contain Type 4 plastic because it is flexible and resistant to solvents. Type 4 plastic does not contain any known harmful chemicals. Low-density polyethylene containers may have the symbol “LDPE” on them.
Type 5: Polypropylene – Safe
Polypropylene containers do not leach harmful chemicals into foods or liquids. They commonly contain yogurt, medicine, drinks, ketchup and medicines. Type 5 plastic is flexible, hard and semi-transparent and has high resistance to solvents. Polypropylene containers may have the symbol “PP” on them.
Type 7: Polycarbonate
You should avoid type 7 plastic containers because they may contain bisphenol A that leaches into their contents. Type 7 plastics often have the symbol “PC” or “Other” on them. You will find polycarbonate plastics in 3- and 5-gallon water-cooler bottles; hard, plastic reusable water bottles; and to-go coffee mugs. Manufacturers use polycarbonate for these purposes because it is virtually shatter-proof…. https://www.livestrong.com/article/158674-which-plastic-containers-can-i-safely-use/

The Washington State University research indicates that this list may have to be studied further to determine safety.

Resources:

Safe Plastic Numbers (Guide)                                             http://www.babygreenthumb.com/p-122-safe-plastic-numbers-guide.aspx

Pots, Pans, and Plastics: A Shopper’s Guide to Food Safety https://www.webmd.com/food-recipes/features/cookware-plastics-shoppers-guide-to-food-safety#1

Which Plastics Are Safe?                                                  https://www.care2.com/greenliving/which-plastics-are-safe.html

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University of British Columbia study: Teen dating violence is down, but boys still report more violence than girls

8 Sep

Moi wrote about teen dating violence in Study: 1 in 3 teens are victims of dating violence: Many adults would be shocked by this report from the Chicago Tribune that many teens find dating violence normal:

Ed Loos, a junior at Lake Forest High School, said a common reaction among students to Chris Brown‘s alleged attack on Rihanna goes something like this:

“Ha! She probably did something to provoke it.” In Chicago, Sullivan High School sophomore Adeola Matanmi has heard the same. “People said, ‘I would have punched her around too,’ ” Matanmi said. “And these were girls!” As allegations of battery swirl around the famous couple, experts on domestic violence say the response from teenagers just a few years younger shows the desperate need to educate this age group about dating violence. Their acceptance, or even approval, of abuse in romantic relationships is not a universal reaction. But it comes at a time when 1 in 10 teenagers has suffered such abuse and females ages 16 to 24 experience the highest rates of any age group, research shows.
The teens interviewed by the Chicago Tribune placed little worth on their lives or the lives of other women. If you don’t as the old ad tag line would say “don’t think you are worth it” why would anyone else think you are worthy of decent treatment? https://drwilda.com/2013/08/05/study-1-in-3-teens-are-victims-of-dating-violence/

Rebecca Klein reported in the Huffington Post article, Sexual Violence Among Students Is A Significant Problem As Early As Middle School, Says Study:

A substantial amount of sexual violence in middle school takes place right under teachers’ noses in the classroom, according to a new study.
The study, conducted by researchers at the University of Illinois at Urbana-Champaign, found that 27 percent of surveyed girls and 25 percent of surveyed boys reported facing a form of sexual violence on middle school grounds in the past year. Most often, the sexual violence took place in school hallways or classrooms.
The study, which was conducted in the spring of 2008, surveyed 1,391 students from Midwestern middle schools in grades 5 through 8. Approximately half of the survey participants were female, 59 percent were African-American, and 41 percent were Caucasian. The researchers define sexual violence as “any act of a sexual nature that is accomplished toward another without his/her consent.”
The most common forms of sexual violence reported were physical sexual violence, rumor spreading, verbal sexual violence and homophobic sexual violence. However, in open-ended questions about the sexual violence, students were sometimes dismissive of the harassment, saying that the perpetrator was “joking” and that the incident was “not that bad or serious.”
http://www.huffingtonpost.com/2014/04/06/sexual-violence-middle-school_n_5101226.html?utm_hp_ref=education&ir=Education

Parents are essential in helping children have healthy relationships.

Science Daily reported in Parents may help prep kids for healthier, less violent relationships:

Warm, nurturing parents may pass along strategies for building and maintaining positive relationships to their kids, setting them up for healthier, less-violent romantic relationships as young adults, according to researchers.
Researchers found that when adolescents reported a positive family climate and their parents using more effective parenting strategies — like providing reasons for decisions and refraining from harsh punishments — those adolescents tended to go on to have better relationship problem-solving skills and less-violent romantic relationships as young adults…
https://www.sciencedaily.com/releases/2018/04/180427155748.

A University of British Columbia study reported in Canada that teen violence may be declining, but boys reported more violence than girls.

Science Daily reported in Teen dating violence is down, but boys still report more violence than girls:

When it comes to teen dating violence, boys are more likely to report being the victim of violence — being hit, slapped, or pushed — than girls. That’s the surprising finding of new research from the University of British Columbia and Simon Fraser University.
Overall, fewer teens are experiencing physical abuse from their dating partners, with five per cent of teens reporting dating violence in 2013, down from six per cent in 2003.
However, the researchers found 5.8 per cent of boys and 4.2 per cent of girls said they had experienced dating violence in the past year….
“Young people who experience dating violence are more likely to act out and take unnecessary risks, and they’re also more likely to experience depression or think about or attempt suicide,” Shaffer said. “That’s why it’s good to see that decline in dating violence over a 10-year span. It suggests that healthy relationship programs are making an impact among youth.”
The study is the first in Canada to look at dating violence trends among adolescents over time, and the first in North America to compare trends for boys and girls. Researchers analyzed data from three B.C. Adolescent Health Surveys involving 35,900 youth in grade 7 to 12 who were in dating relationships.
Elizabeth Saewyc, senior study author and UBC nursing professor, said the findings highlight the need for more support programs for both boys and girls in dating relationships.
“A lot of our interventions assume that the girl is always the victim, but these findings tell us that it isn’t always so,” said Saewyc. “And relationship violence, be it physical, sexual or other forms, and regardless who the perpetrator is, is never OK. Health-care providers, parents and caregivers, schools and others can protect teens from dating violence by helping them define what healthy relationships looks like, even before their first date.”
The study analyzed surveys conducted by the McCreary Centre Society, a community-based organization dedicated to adolescent health research in B.C. Results were published recently in the Journal of Interpersonal Violence…. https://www.sciencedaily.com/releases/2018/08/180829133154.htm

Citation:

Teen dating violence is down, but boys still report more violence than girls, British Columbia study finds
Date: August 29, 2018
Source: University of British Columbia
Summary:
When it comes to teen dating violence, boys are more likely to report being the victim of violence — being hit, slapped, or pushed — than girls. That’s the surprising finding of new research from British Columbia, Canada.
Journal Reference:
Catherine S. Shaffer, Jones Adjei, Jodi L. Viljoen, Kevin S. Douglas, Elizabeth M. Saewyc. Ten-Year Trends in Physical Dating Violence Victimization Among Adolescent Boys and Girls in British Columbia, Canada. Journal of Interpersonal Violence, 2018; 088626051878836 DOI: 10.1177/0886260518788367

Here is the press release from the University of British Columbia:

Teen dating violence is down, but boys still report more violence than girls

SCIENCE, HEALTH & TECHNOLOGY
Aug 29, 2018 | For more information, contact Lou Corpuz-Bosshart
When it comes to teen dating violence, boys are more likely to report being the victim of violence—being hit, slapped, or pushed—than girls. That’s the surprising finding of new research from the University of British Columbia and Simon Fraser University.
Overall, fewer teens are reporting experiencing physical abuse from their dating partners, with five per cent of teens reporting dating violence in 2013, down from six per cent in 2003.
However, the researchers found 5.8 per cent of boys and 4.2 per cent of girls said they had experienced dating violence in the past year.
First author Catherine Shaffer, a PhD student from SFU who was involved in the study, says more research is needed to understand why boys are reporting more dating violence.
“It could be that it’s still socially acceptable for girls to hit or slap boys in dating relationships,” she said. “This has been found in studies of adolescents in other countries as well.”
She added that the overall decline in dating violence, while small, is encouraging.
“Young people who experience dating violence are more likely to act out and take unnecessary risks, and they’re also more likely to experience depression or think about or attempt suicide,” Shaffer said. “That’s why it’s good to see that decline in dating violence over a 10-year span. It suggests that healthy relationship programs are making an impact among youth.”
The study is the first in Canada to look at dating violence trends among adolescents over time, and the first in North America to compare trends for boys and girls. Researchers analyzed data from three B.C. Adolescent Health Surveys involving 35,900 youth in grade 7 to 12 who were in dating relationships.
Elizabeth Saewyc, senior study author and UBC nursing professor, said the findings highlight the need for more support programs for both boys and girls in dating relationships.
“A lot of our interventions assume that the girl is always the victim, but these findings tell us that it isn’t always so,” said Saewyc. “And relationship violence, be it physical, sexual or other forms, and regardless who the perpetrator is, is never OK. Health-care providers, parents and caregivers, schools and others can protect teens from dating violence by helping them define what healthy relationships looks like, even before their first date.”
The study analyzed surveys conducted by the McCreary Centre Society, a community-based organization dedicated to adolescent health research in B.C. Results were published recently in the Journal of Interpersonal Violence.
Find other stories about: Catherine Shaffer, Simon Fraser University, Teen dating, Violence
Contact
Lou Corpuz-Bosshart
UBC Media Relations
Tel: 604-822-2048
Cel: 604-999-0473
Email: lou.bosshart@ubc.ca

Popular culture makes teens who are not involved in activities as “couples” seem like outcasts. Too often, teens pair up before they are mature enough and ready for the emotional commitment. The more activities the girl is involved in and the more sponsored group activities, where teens don’t necessarily have to be in dating relationships, lessen the dependence on an abusive relationship.

Related:

The ‘Animal House’ attitude of some college administrators doesn’t take rape seriously https://drwilda.com/2013/04/23/the-animal-house-attitude-of-some-college-administrators-doesnt-take-rape-seriously/

A tale of rape from Amherst: Sexual assault on campus https://drwilda.com/2012/10/27/a-tale-of-rape-from-amherst-sexual-assault-on-campus/

Sexual assault on college campuses

Sexual assault on college campuses

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University of Oxford study: Parental controls do not stop teens from seeing pornography

2 Sep

Technology can be used for information gathering and to keep people connected. Some people use social media to torment others. Children can be devastated by thoughtless, mean, and unkind comments posted at social media sites. Some of the comments may be based upon rumor and may even be untrue. The effect on a particular child can be devastating. Because of the potential for harm, many parents worry about cyberbullying on social media sites. Moi wrote about bullying in Ohio State University study:

Characteristics of kids who are bullies:
A Rotary Club in London has a statement about the Ripple Effect
Ripple Effect – Sending Waves of Goodness into the World
Like a drop of water falling into a pond, our every action ripples outward, affecting other lives in ways both obvious and unseen.
We touch the lives of those with whom we come into contact and, by extension, those with whom they come into contact.
When our actions spring from a spirit of kindness or compassion or generosity, we set into motion a “virtuous cycle” that radiates far beyond our ability to see, or perhaps even fully comprehend.
Just as a smile is infectious, so are more overt forms of service. Our objective — whether in something as formal as a highly-structured website development project or as casual as the spontaneous small kindnesses we share with strangers in hopes of brightening their day — is to send waves of positive change in the world, one act of service at a time.
Unfortunately, some children due to a variety of behaviors in their lives miss the message of the “Ripple Effect.” https://drwilda.com/2012/03/13/ohio-state-university-study-characteristics-of-kids-who-are-bullies/

In an attempt to mitigate the harmful effects of technology, some parents are using parental controls to establish boundaries for their children.

PC Magazine described Parental Controls in The Best Parental Control Software of 2018:
Web Filters, Time Limits, and Apps

At the very least, a good parental control tool features content filtering—the ability to block access to websites matching categories such as hate, violence, and porn. This type of filtering only really works if it’s browser-independent and works with secure (HTTPS) sites. With no HTTPS filtering, a smart teen could bypass the system using a secure anonymizing proxy website or even a different web browser in some cases. Most also have the option to permanently enable SafeSearch. Of course, the most capable solutions also keep a detailed log of your child’s web activity.
Access scheduling is another very common feature. Some applications let parents set a weekly schedule for device usage, some control internet use in general, and others offer a combination of the two. A daily or weekly cap on internet usage can also be handy, especially if it applies to all your kids’ devices….                                                       https://www.pcmag.com/article2/0,2817,2346997,00.asp

A University of Oxford study questioned the effectiveness of parental controls.

Science Daily reported in Parental controls do not stop teens from seeing pornography:

The struggle to shape the experiences young people have online is now part of modern parenthood. As children and teenagers spend increasing amounts of time online, a significant share of parents and guardians now use Internet filtering tools (such as parental controls) to protect their children from accessing sexual material online. However, new research from the Oxford Internet Institute, University of Oxford has found that Internet filtering tools are ineffective and in most cases, were an insignificant factor in whether young people had seen explicit sexual content.

Though the use of Internet filtering tools is widespread, there has been no conclusive evidence on their effectiveness until now. “It’s important to consider the efficacy of Internet filtering,” says Dr Victoria Nash, co-author on the study. “Internet filtering tools are expensive to develop and maintain, and can easily ‘underblock’ due to the constant development of new ways of sharing content.
Additionally, there are concerns about human rights violations — filtering can lead to ‘overblocking’, where young people are not able to access legitimate health and relationship information.”
The research used data from a large-scale study looking at pairs of children and caregivers in Europe, comparing self-reported information on whether children had viewed online sexual content despite the use of Internet filtering tools in their household. A second preregistered study was then conducted looking at teenagers in the UK.
Results of the research indicate that Internet filtering is ineffective and insignificant to whether a young person has viewed sexually explicit content. More than 99.5 percent of whether a young person encountered online sexual material had to do with factors beside their caregiver’s use of Internet filtering technology….
The researchers agree that there should be more research done to solidify these findings. “More studies need to be done to test Internet filtering in an experimental setting, done in accordance to Open Science principles,” says Przybylski. “New technologies should always be tested for effectiveness in a transparent and accessible way.” https://www.sciencedaily.com/releases/2018/07/180712114610.htm

Citation:

Parental controls do not stop teens from seeing pornography

Date: July 12, 2018
Source: University of Oxford
Summary:
New research has found that Internet filtering tools are ineffective and in most cases, were an insignificant factor in whether young people had seen explicit sexual content.
Journal Reference:
Andrew K. Przybylski, Victoria Nash. Internet Filtering and Adolescent Exposure to Online Sexual Material. Cyberpsychology, Behavior, and Social Networking, 2018; 21 (7): 405 DOI: 10.1089/cyber.2017.0466

Here is the press release from the University of Oxford:

Parental controls do not stop teens from seeing pornography

RESEARCHSOCIETY#TWLTW

The struggle to shape the experiences young people have online is now part of modern parenthood. As children and teenagers spend increasing amounts of time online, a significant share of parents and guardians now use Internet filtering tools (such as parental controls) to protect their children from accessing sexual material online. However, new research from the Oxford Internet Institute, University of Oxford has found that Internet filtering tools are ineffective and in most cases, were an insignificant factor in whether young people had seen explicit sexual content.

Though the use of Internet filtering tools is widespread, there has been no conclusive evidence on their effectiveness until now. ‘It’s important to consider the efficacy of Internet filtering,’ says Dr Victoria Nash, co-author of the study published in Cyberpsychology, Behavior, and Social Networking.
‘Internet filtering tools are expensive to develop and maintain, and can easily ‘underblock’ due to the constant development of new ways of sharing content. Additionally, there are concerns about human rights violations – filtering can lead to ‘overblocking’, where young people are not able to access legitimate health and relationship information.’

The research used data from a large-scale study looking at pairs of children and caregivers in Europe, comparing self-reported information on whether children had viewed online sexual content despite the use of Internet filtering tools in their household. A second preregistered study was then conducted looking at teenagers in the UK.

Results of the research indicate that Internet filtering is ineffective and insignificant to whether a young person has viewed sexually explicit content. More than 99.5 percent of whether a young person encountered online sexual material had to do with factors beside their caregiver’s use of Internet filtering technology.
‘We were also interested to find out how many households would need to use filtering technologies in order to stop one adolescent from seeing online pornography,’ says co-author Professor Andrew Przybylski. ‘The findings from our preliminary study indicated that somewhere between 17 and 77 households would need to use Internet filtering tools in order to prevent a single young person from accessing sexual content. Results from our follow-up study showed no statistically or practically significant protective effects for filtering.’

‘We hope this leads to a re-think in effectiveness targets for new technologies, before they are rolled out to the population,’ says Nash. ‘From a policy perspective, we need to focus on evidence-based interventions to protect children. While Internet filtering may seem to be an intuitively good solution, it’s disappointing that the evidence does not back that up.’

The researchers agree that there should be more research done to solidify these findings. ‘More studies need to be done to test Internet filtering in an experimental setting, done in accordance to Open Science principles,’ says Przybylski. ‘New technologies should always be tested for effectiveness in a transparent and accessible way.’

Funding for this research was provided by the British Academy and Leverhulme Trust.
FOR FURTHER INFORMATION:
Cyberpsychology, Behavior, and Social Networking
All news
http://www.ox.ac.uk/news/2018-07-12-parental-controls-do-not-stop-teens-seeing-pornography

There is something to be said for Cafe Society where people actually meet face-to-face for conversation or the custom of families eating at least one meal together. Time has a good article on The Magic of the Family Meal http://content.time.com/time/magazine/article/0,9171,1200760,00.html It also looks like Internet rehab will have a steady supply of customers according to an article reprinted in the Seattle Times by Hillary Stout of the New York Times. In Toddlers Latch On to iPhones – and Won’t Let Go http://www.seattletimes.com/lifestyle/toddlers-latch-onto-iphones-8212-and-wont-let-go/ Stout reports:
But just as adults have a hard time putting down their iPhones, so the device is now the Toy of Choice — akin to a treasured stuffed animal — for many 1-, 2- and 3-year-olds. It’s a phenomenon that is attracting the attention and concern of some childhood development specialists.

Looks like social networking may not be all that social.

Related Links:

When You Don’t Like Your Teenager’s Friends

What to do When You Don’t Like Your Teenager’s Friends

Talking About Sexting
https://www.commonsensemedia.org/blog/talking-about-sexting

Teenage Girls and Cyber-Bullying
https://www.girlshealth.gov/bullying/

How to Get Your Teen to Open Up and Talk to You More (and Text A Little Less) https://www.hhs.gov/ash/oah/resources-and-training/for-families/conversation-tools/index.html

Where information leads to Hope. © Dr. Wilda.com

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