Centers for Disease Control
Centers for Disease Control
News Article | May 26, 2017
Columbia University dental researchers have found that frequent recreational use of cannabis—including marijuana, hashish, and hash oil—increases the risk of gum disease. The study was published in the March issue of the Journal of Periodontology. Periodontal (gum) disease is an inflammatory reaction to a bacterial infection below the gum line. Left untreated, gum disease can lead to receding gums and tooth loss. Longstanding periodontal disease has also been associated with a number of non-oral health issues, from preterm labor during pregnancy to heart disease. Jaffer Shariff, DDS, MPH, a postdoctoral resident in periodontology at Columbia University School of Dental Medicine (CDM) and lead author, noticed a possible link between frequent recreational cannabis use and gum disease during his residency at a community-based dental clinic in Manhattan. “It is well known that frequent tobacco use can increase the risk of periodontal disease, but it was surprising to see that recreational cannabis users may also be at risk,” said Shariff. “The recent spate of new recreational and medical marijuana laws could spell the beginning of a growing oral public health problem.” Shariff and colleagues from CDM analyzed data from 1,938 U.S. adults who participated in the Centers for Disease Control’s 2011-2012 National Health and Nutrition Examination Survey, administered in collaboration with the American Academy of Periodontology. Approximately 27 percent of the participants reported using cannabis one or more times for at least 12 months. Periodontal exams focus on a patient’s gum tissue and connection to the teeth. Among other assessments, periodontists look for plaque, inflammation, bleeding, and gum recession. The clinician uses a probe to measure the space between teeth and their surrounding gum tissue. Healthy gums fit a tooth snugly, with no more than one to three millimeters of space, known as pocket depth, between the tooth and surrounding gum tissue. Deeper pockets usually indicate presence of periodontitis. Among the study participants, frequent recreational cannabis users had more sites with pocket depths indicative of moderate to severe periodontal disease than less frequent users. “Even controlling for other factors linked to gum disease, such as cigarette smoking, frequent recreational cannabis smokers are twice as likely as non-frequent users to have signs of periodontal disease,” said Shariff. “While more research is needed to determine if medical marijuana has a similar impact on oral health, our study findings suggest that dental care providers should ask their patients about cannabis habits.” “At a time when the legalization of recreational and medical marijuana is increasing its use in the United States, users should be made aware of the impact that any form of cannabis can have on the health of their gums,” said Terrence J. Griffin, president of the American Academy of Periodontology.
News Article | May 10, 2017
Angelo Gaitas, a research assistant professor in the Electrical and Computer Engineering Department, along with Gwangseong Kim, a research scientist, are commercializing a device that reduces the screening process to just a few hours at the same cost as current devices. If you've ever suffered from food poisoning, you'll appreciate why it's so important to inspect food before it reaches the consumer. Food producers have to check for bacteria and signs of contamination before they are able to ship out any perishable food. Some common bacteria that can lead to foodborne illnesses include E.coli, salmonella and listeria. In fact, according to the Centers for Disease Control, each year, one in six Americans gets sick by consuming contaminated foods or beverages, that is 48 million people, out of whom 128,000 are hospitalized. Typically, the inspection process, which involves putting samples in a solution and placing it in an incubator to see if bacteria grows, takes anywhere from 18 hours to several days. The reason is that it takes time for bacteria to grow at detectable levels. Current detection techniques are limited – you may need about 1,000 to a million bacteria present, depending on the technique, in a small volume before bacteria can be successfully detected. To reach that level, it takes time. With this new device, food producers are able to run the whole solution through a smaller container inside the incubator oven. Antibodies in the device capture the target bacteria. This procedure allows bacteria to be concentrated in a smaller volume enabling same day detection. "We are focused on helping food producers reduce storage cost and get fresher food to consumers," Gaitas says. "We are addressing a major and well documented need in a very large market. There are about 1.2 billion food tests conducted worldwide and about 220 million tests in the United States." By shortening the detection time by one day, the team believes that the device can save the food industry billions. For example, meat producers, as a collective industry, could save up to $3 billion in storage costs by shortening the detection to one day. This device can also be used to expedite the detection of blood borne illnesses such as sepsis and viral infections; however, currently the commercial focus is on food due to the lower barriers to entry. Explore further: Detecting salmonella in pork meat twice as fast
News Article | May 9, 2017
Compared to cancer and heart disease, influenza may seem relatively harmless, but it can be fatal, even for the young and healthy. While the exact number of influenza-associated deaths is not known, the Centers for Disease Control estimates the annual numbers could range, depending on the season, from a low four figures to as high as 56,000 (2012-2013) – and that's in the US alone. A swift diagnosis can make all the difference and scientists at the University of Notre Dame have come up with with an easy and novel way to spot the virus: a glow test. The influenza infection process begins when the virus enters the body and latches onto the cell lining of the respiratory tract. Key to this process are two spikey-looking proteins: hemagglutinin (HA) and neuraminidase (NA). In order for the virus to enter the cell, it must first attach itself to a receptor, which in this case is sialic acid, located on its surface. HA is responsible for this and once the virion has anchored itself to the receptor, it is then taken into the cell via a process known as endocytosis, after which it exploits the host cell's machinery to replicate itself. The newly formed viral particles that emerge are covered in sialic acid and this has to be removed before they exit the infected host cell to prevent them from clumping together. This is where NA comes in. It is essentially responsible for removing the sialic acid from the particles so they can invade other cells in the body. The test developed by Bradley Smith and his team at the University of Notre Dame is designed to detect the presence of neuraminidase. If it is present, it means that the patient has the virus and in cases where they have been given an NA-blocking antiviral drug, such as Tamiflu (Oseltamivir) or Zanamivir (Relenza), it means that the prescription has not been effective. The researchers developed a dye molecule to emit a red fluorescent light when NA is present and a blue one when it is not. In addition to testing for its presence, the test also allows doctors to see whether a prescribed drug is working. As the researchers note in the study, given that the efficacy window for drugs that inhibit NA is within 48 hours of the onset of influenza, it is critical for doctors to be able to quickly confirm a case of infection. On another note, when there is more than one treatment option, the test also helps them determine which drug would deliver better results for the patient. In experiments, samples containing the dye and NA were combined with both Tamiflu and Zanamivir and illuminated using either a hand-held lamp or blue laser pointer. A red glow meant the drug had failed to shut down the virus, while a blue one indicated the enzyme had been blocked and the patient was in the clear. "Viral cultures are the gold standard for diagnosis of influenza but take several days to develop," says Smith. "By targeting an enzyme inherent to the virus and identifying its presence in a sample, we can make a rapid determination of the influenza in a patient for an efficient and immediate diagnostic that would improve patient treatment and reduce overuse of antivirals." While still a work in progress, the researchers believe that with further optimization, the test kit could be developed for use in clinics and in patients' homes. Designed to be low cost and portable – the results of the test can easily be seen by the naked eye so no expensive equipment is required – the researchers say such a kit would not only help improve patient treatment, but also reduce the overuse of antiviral drugs. That said, given that there are several different strains of influenza virus and that there's always the possibility of new ones emerging, another goal for the researchers is to develop the test further so that it can differentiate between the different classes of mammalian, bacterial and viral NA. The study was published in the Journal of the American Chemical Society.
News Article | May 10, 2017
BALTIMORE--(BUSINESS WIRE)--VisibleThread, today announced findings from its website clarity review of 30 US Federal Agencies. Following the introduction of the Plain Writing Act 2010, VisibleThread first published this review in 2011 and then again in 2016. The 2017 analysis is a follow-up and comparison of federal agency websites indexed in 2016. The agencies with the overall best scores were: The National Archives, Centers for Disease Control and The Community Oriented Policing Service. To see the full list of agencies across each clarity category, view the report at: http://info.visiblethread.com/2017-US-Government-Index. The analysis measured up to 100 pages on each website, across these 4 dimensions: Why is this report relevant? Seven years ago, the passage of the Plain Writing Act 2010 mandated clear communications in materials for U.S. citizens. Under the Act, federal agencies are required to use writing that is concise, clear and appropriate for the audience. At a minimum, readers with a high school level of education should be able to understand the content that is written on government websites. “Clear communication saves agencies time and money, which is a win for both government and taxpayer,” said Fergal McGovern, CEO, VisibleThread. “In a time when policy favors fiscal conservatism, a focus on plain language helps agencies manage change and achieve greater compliance, when they typically have fewer resources.” Complex language can negatively impact communication with the public. The result is often unforeseen and unnecessary costs. VisibleThread’s report demonstrates examples of language that may have this unintended effect, similar to the following: “In accordance with 49 U.S.C. 24405(a)(7), a person or entity is ineligible to receive any contract or subcontract made with XYZ grant funds if a court or department, agency, or instrumentality of the Government decides the person intentionally - (A) affixed a "Made in America" label, or a label with an inscription having the same meaning, to goods sold in or shipped to the United States that are used in a project to which this subsection applies but not produced in the United States; or (B) represented that goods described in subparagraph (A) of this paragraph were produced in the United States.” VisibleThread’s solutions help organizations test & audit their written content for risk and content quality, with dramatically less cost. Customers include; Boeing, Intel, Accenture and Fannie Mae. Our software instantly finds brand compliance, poor readability and language risk issues within documents and entire websites. Customers produce better quality, more engaging content. Unlike consumer-grade analysis tools, VisibleThread processes hundreds of documents and web pages in minutes. Marketing, Sales and Risk/Contracts Teams in leading global organizations use VisibleThread.
News Article | May 10, 2017
Paul J. Thuluvath, M.D., Medical Director for The Melissa L. Posner Institute for Digestive Health & Liver Disease, Chief of the Division of Gastroenterology, and head of The Center for Liver and Hepatobiliary Diseases at Mercy Medical Center, is encouraging the Maryland health care community to raise awareness about hepatitis C (HCV) and hepatitis C screening in light of recent Centers for Disease Control (CDC) recommendations about the disease. Mercy will be conducting a special digital public awareness campaign to encourage hepatitis C screening throughout the month of May which is National Hepatitis Awareness Month. “The CDC recommends that adults born 1945-1965—the “baby boomers”-- should receive one-time testing without prior ascertainment of HCV risk. In addition, all adults who are at risk for HCV infection, such as injection drug users and needle stick injuries, should be tested. Despite these recommendations, too few American baby boomers are being tested for hepatitis C,” Dr. Thuluvath said. “Of the estimated 3.5 million Americans who have the virus, 80 percent are baby boomers. Left untreated, hepatitis C can cause cirrhosis of the liver, liver cancer, and lead to death. Because hepatitis C is often a silent illness, with few symptoms, many with this contagious liver disease don’t even know they have it. May is National Hepatitis C Awareness Month, so an ideal time to emphasize education about HCV, its diagnosis and treatment,” Dr. Thuluvath added. “The hepatitis C virus, thanks to new clinical breakthroughs, is now a curable disease. But that cure can only be achieved if patients are tested, to know whether or not they have the virus,” Dr. Thuluvath concluded. “I’m very pleased to see others join our administration in helping educate the community about the risks associated with hepatitis C,” said Maryland Governor Larry Hogan. Gov. Hogan has been a strong supporter of health care education and initiatives, from his creation of the Maryland Heroin and Opioid Emergency Task Force and efforts to expand the state’s Good Samaritan Law and Prescription Drug Monitoring Program. “The Baltimore City Health Department has made considerable efforts to provide citizens with important information about the hepatitis C virus. We applaud the efforts of all those in the medical community who are working hard to beat hepatitis C,” said Baltimore City Mayor Catherine E. Pugh. Mayor Pugh has long been an advocate of health care education, authoring a series of children’s books advocating exercise and healthy eating, founding the celebrated annual runners’ event, the Baltimore Marathon, has been recognized as The Mental Health Associations Legislator of the Year, and more. Both Governor Hogan and Mayor Pugh cited how in 2014, the Baltimore City Health Department, the Maryland Department of Health and Mental Hygiene, the Johns Hopkins University School of Medicine, and the Baltimore County Health Department, received a multi-year grant from the Centers for Disease Control and Prevention to launch a regional initiative to expand HCV testing and treatment. People can contract the hepatitis C virus through contact with an infected person’s blood person. This may occur by sharing drug-injecting equipment, using cocaine, having sex, or getting a blood transfusion or organ transplant. It can also be spread by getting a tattoo with unsterile equipment. In rare cases, women with hepatitis C transmit the virus to their infants. Symptoms often do not develop until the disease is in its advanced stages and significant liver damage has already occurred. A world-renowned hepatologist, Dr. Paul Thuluvath provides patients with pioneering treatments and advanced technology to help them manage their illness. Dr. Thuluvath is also author of Hepatitis C: A Complete Guide for Patients and Families, a comprehensive guide to hepatitis C. He is a recognized national and international authority in liver and biliary diseases and dedicated to medical research and clinical trials that are advancing treatment possibilities for patients. Mercy Medical Center is a 143-year-old, university affiliated medical facility with a national reputation for women’s health care. Mercy is home to the acclaimed Weinberg Center for Women’s Health & Medicine and the $400+ million Mary Catherine Bunting Center. For more information, visit http://www.mdmercy.com, MDMercyMedia on Facebook and Twitter, or call 1-800-MD-Mercy.
News Article | May 10, 2017
NEWPORT BEACH, Calif.--(BUSINESS WIRE)--Safety Net Connect (SNC), a leading provider of innovative healthcare technology for organizations assisting underserved populations, is pleased to announce that its electronic consultation “eConsult” system used by Los Angeles County Department of Health Services (LADHS) is engaged in a two-year-long University of California, Davis (UC Davis) study to measure the benefits of an integrative approach to tobacco cessation, in partnership with California Smokers’ Helpline (Helpline), a free, evidence-based smoking cessation program funded by the California Department of Public Health, the Centers for Disease Control, and First 5 California. This collaborative project, funded through a Community Practice-Based Research Planning Award from the Tobacco-Related Disease Research Program (TRDRP) of California, was launched with the aim of creating and fostering long-term sustainable partnerships to conduct cost-effective, high quality tobacco cessation programs that are replicable across clinics throughout California. Several months into the project, SNC’s eConsult technology has already demonstrated a positive change in the delivery of tobacco cessation services for underserved populations, while increasing access to evidence-based tobacco treatment. “The partnership with Safety Net Connect, the Los Angeles County Department of Health Services (LADHS), and the Helpline is a great opportunity to break down barriers to treatment, help smokers gain access to proven cessation methods, and positively impact the health and wellness of the low income patients served by LADHS,” says Gary Tedeschi, PhD, Clinical Director, California Smokers’ Helpline. How the Helpline and eConsult Work Together. As the nation’s second largest public health system serving 670,000 patients each year, LADHS has utilized SNC’s eConsult technology since 2014 to power its web-based care coordination platform that connects 5,000 primary care providers with community-based specialists, averaging 17,000 eConsult requests per month. Leveraging this industry-tested system, the UC Davis study expands the scope of eConsult for LADHS providers by offering direct referrals for its large population of tobacco-using patients – most of whom are low socioeconomic; linguistically, racially, ethnically, diverse; and geographically dispersed – to free, multilingual telephone-based tobacco cessation counseling services at the Helpline. In addition to improving access to care, the integration of LADHS/SNC eConsult and the Helpline facilitates an unprecedented connection between disparate electronic health records systems across LADHS and community clinic providers. “Working with Safety Net Connect has dramatically increased access to Helpline services among the hundreds of thousands of patients served by the Los Angeles County Department of Health Services,” says Antonio Mayoral, Director of Operations and Information Technology for the California Smokers’ Helpline. “We hope to have the opportunity to work with other providers throughout California who utilize Safety Net Connect’s eConsult solution.” “This is an exciting opportunity to expand access to services for everyone in the Los Angeles community who wants to pursue healthy lifestyle choices,” says Chris Cruttenden, President of SNC. “We are proud to partner with the Smokers’ Helpline and to expand our relationship with LADHS to include this important collaborative initiative.” The California Smokers’ Helpline (Helpline) is a free, evidence-based, telephone counseling program for quitting smoking, proven in clinical trials to double a smoker’s chance of quitting. Multilingual services include telephone counseling, self-help materials, chat, and text messaging. The Helpline is operated by the Moores UCSD Cancer Center under the direction of Shu-Hong Zhu, PhD, Professor of Family and Preventive Medicine and is funded by the California Department of Public Health, the Centers for Disease Control, and First 5 California. For more information, please visit www.nobutts.org. The Los Angeles County Department of Health Services (LADHS) is the second largest municipal health system in the nation. The LADHS mission is to ensure access to high-quality, patient-centered, cost-effective health care to Los Angeles County residents through direct services at DHS facilities and through collaboration with community and university partners. For more information, please visit www.dhs.lacounty.gov. Since 2009, Safety Net Connect (SNC) has partnered with public and private organizations to provide a multitude of successful and nationally recognized web-based healthcare solutions for underserved and safety net populations. SNC’s innovative solutions have reached over 5 million patients from clients such as Los Angeles Department of Health Services (LADHS), MedPoint, LA Care, Orange County Healthcare Agency, CalOptima, San Diego Healthcare Agency, and Cook County MHN (an Illinois Medicaid Project). For more information, please visit www.safetynetconnect.com.
News Article | May 10, 2017
THE state of Minnesota is in the throes of its biggest measles outbreak in 27 years. As of 5 May, 44 cases had been confirmed. Of these, 42 people were unvaccinated, and 38 belonged to the state’s Somali-American community. In 2008, some Somali parents raised concerns over what they perceived to be a high rate of autism in Somali-American children. A subsequent study by the University of Minnesota, the Centers for Disease Control, and the National Institutes of Health found that autism rates among Somalis in Minneapolis were in fact similar to those of the city’s white population. Nevertheless, the concerns of the Somali community prompted anti-vaccination groups to begin targeting Somalis in Minnesota. Former doctor Andrew Wakefield, who lives in Texas, visited Somali communities in Minnesota several times, speaking to parents. Wakefield’s discredited 1998 study suggested a link between autism and the measles, mumps and rubella (MMR) vaccine. Between 2004 and 2014, the MMR immunisation rate among 2-year-old Somali-Americans born in Minnesota dropped from 92 to 42 per cent. State officials are now recommending that every Somali-born child across the state receives the MMR booster shot as soon as possible, and the same applies to all other unvaccinated children older than 1 year living in the affected counties. This article appeared in print under the headline “Measles after MMR ‘scare'”
News Article | May 10, 2017
How To Do A Really Good Job Washing Your Hands If, like many of us, you are reading this article on the toilet — then we've caught you at the perfect time. When you're done with your business, perhaps you'll do a thorough hand washing. Or maybe just a quick rinse. Or maybe you'll skip it altogether. Failure to wash is a problem for ordinary folks. Germs on your unwashed hands can get into your body when you touch, say, your eyes or mouth. And into your food, too. It's a problem for health workers as well. The Centers for Disease Control estimates that medical staff only remember to do so about half the times they're supposed to. The CDC states: "This contributes to the spread of healthcare-associated infections that affect 1 in 25 hospital patients on any given day." Worldwide, one in 10 patients acquires an infection while receiving health care. So this month, the Centers for Disease Control is ramping up its campaign to get doctors, nurses and other medical staff to wash up. But the question for medical workers (and really, for everyone) is: Do you do a good job? CDC offers straightforward instructions: soap up, scrub and rinse. The process should take 35 seconds — about the time it takes to sing the alphabet song twice. The World Health Organization has its own instructions. The process takes a tiny bit longer – 42.5 seconds. And there are six very specific steps. WHO's technique is a deliberate process to get rid of germs in all the nooks and crannies of the hands. First, rub your palms against each other, then rub the back of each hand against your palms. Rub your palms together with your fingers interlaced, rub your palms against each other while your fingers are interlocked, rub your fingers around each of your thumbs, and finally, rub each palm with the tips your fingers. Both the CDC and WHO methods, which have been around for decades, are also taught at elementary schools (to germy kiddos) and restaurants (to staff who handle your food). Recently, researchers wanted to compare them to see which was the best way to minimize bacteria. In a small study recently published in the journal Infection Control and Hospital Epidemiology, researchers at the Glasgow Caledonian University in Scotland watched carefully as 42 doctors and 78 nurses cleaned their hands using either the CDC or WHO routine. They found that the WHO technique reduced the average bacterial count on the medical workers' hands slightly more than the CDC's method. In any case, both organizations' work really, really well, says study author says Jacqui Reilly, a professor of infection prevention and control at Scotland's Glasgow Caledonian University who led the study. The real issue is that health care workers aren't cleaning their hands as often and as thoroughly as they should — basically every time they touch their faces or touch anything that isn't sterile. And when it comes to doing a good job, even having a set of directions doesn't guarantee good results. In Reilly's study, only 65 percent of the 120 participants completed the two techniques properly, despite having instructions right in front of them. Reilly herself says she's been using the six-step method since she was first taught it at medical school. "I don't think about it consciously anymore," she says. She highly recommends you try it out after using the toilet. And if you don't, at the very least, she says, remember that "any time you wash your hands, it should take at least 15 seconds." And avoid the making the rookie mistake of rubbing soap onto dry hands and then rinsing it off. If you wet your hands, first, Reilly says, the water works to dislodge any microorganisms clinging onto your skin, so that the soap can scrub them off: "So always wet your hands first."
News Article | May 15, 2017
A massive invasion of Ticks is in full swing thanks to a warm winter and wet spring bringing with it major worries about infection from dangerous tick borne illnesses like Lyme Disease and the Powassan Virus. But, besides exhausting head to toe checks after every outdoor excursion, what really works in the war against ticks? Giroud Tree and Lawn shares Tick Control strategies to keep ticks out of the yard and off of people and pets. "Tick Control has never been more important," explains Lou Giroud, President of Giroud Tree and Lawn and ISA Certified Arborist. "With ticks expected to reach record numbers this summer, homeowners need to take extra precautions such as 100% Organic Tick Control treatments in the yard and establishing new outdoor habits for personal and pet safety." Here’s how to take control of ticks in the yard: 1. Property inspection: Have an ISA Certified Arborist inspect the yard and identify areas where ticks are likely to thrive. 2. Perimeter Clean-up: Ticks are shade lovers and can’t survive in the sun. The Centers for Disease Control (CDC) provides detailed recommendations for preventing ticks in the yard by creating a Tick Safe Zone including: 3. 100% Organic Tick Control: A PA licensed applicator needs to treat around the perimeter and other high risk areas. Giroud recommends using a 100% organic treatment made from essential oils including Peppermint and Cedar oils which are a natural repellent. 4. Deer Repellent: Deer are the primary carrier of ticks. Use a Deer Repellent treatment that is safe and water-resistant to deter deer from feeding on valuable plants! 5. Plant Selection: Have an ISA Certified Arborist identify plants that are attracting deer to the yard and suggest alternative plants. For personal and pet safety, follow these tips from the Centers for Disease Control (CDC). 1. Repel Ticks on Skin and Clothing: Use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours. Use products that contain permethrin on clothing. 2. Find and Remove Ticks from Your Body For more information on tick control actions contact Giroud Tree and Lawn at 215-682-7704 or go to: https://www.giroudtree.com/tick-control. About Giroud Tree and Lawn Giroud Tree and Lawn specializes in tree service, tree removal and lawn care programs that make customers love doing business with the company since 1974. Serving Bucks, Montgomery and Philadelphia Counties, the company offers professional tree and lawn evaluation, tree pruning, tree removal, insect and disease control, fertilizing, stump removal and traditional and 100% organic lawn programs to keep lawns healthy and green . Giroud Arborists are certified by the International Society of Arboriculture (ISA) and have the knowledge and experience required to properly diagnose, treat and maintain trees and lawn health. The company is Accredited by the Better Business Bureau and has been awarded the Angie's List Super Service Award® every year since 2005. The “Giroud Treework for Charity” program donates free tree care services to parks, historical sites and other non-profit organizations located in the Company’s service area. For more information, visit the company website at https://www.giroudtree.com or call 215-682-7704.
Roberts R.E.,University of Texas Health Science Center at Houston |
Duong H.T.,Centers for Disease Control
Sleep | Year: 2014
Study Objectives: To examine the prospective, reciprocal association between sleep deprivation and depression among adolescents. Design: A community-based two-wave cohort study. Setting: A metropolitan area with a population of over 4 million. Participants: 4,175 youths 11-17 at baseline, and 3,134 of these followed up a year later. Measurements: Depression is measured using both symptoms of depression and DSM-IV major depression. Sleep deprivation is defined as ≤ 6 h of sleep per night. Results: Sleep deprivation at baseline predicted both measures of depression at follow-up, controlling for depression at baseline. Examining the reciprocal association, major depression at baseline, but not symptoms predicted sleep deprivation at follow-up. Conclusion: These results are the first to document reciprocal effects for major depression and sleep deprivation among adolescents using prospective data. The data suggest reduced quantity of sleep increases risk for major depression, which in turn increases risk for decreased sleep.