Majority of children readmitted to hospital following transplant.


Nearly two-thirds of children receiving stem cell transplants returned to the hospital within six months for treatment of unexplained fevers, infections or other problems, according to a study performed at Dana-Farber/Children’s Hospital Cancer Center in Boston. Children who received donor cells were twice as likely to be readmitted as children who received their own stem cells.

“No one had ever looked at these data in children,” said Leslie E. Lehmann, MD, clinical director of pediatric stem cell transplantation at Dana-Farber/Children’s Hospital Cancer Center (DF/CHCC). “This is very important information and will allow us to counsel families appropriately, as well as try to devise interventions that reduce the rate of readmissions.”

The study by Lehmann and Harvard Medical School student David Shulman is being presented at the 26th annual meeting of the American Society of Pediatric Hematology Oncology in Miami, April 24-27.

A record review of 129 children from 2008 to 2011 revealed that 64 percent had at least one hospital readmission within 180 days of transplant. The source of the donor cells was a key predictor: 79 percent of patients receiving transplants from a related or unrelated donor were readmitted compared to 38 percent who received their own cells (autologous transplant). The mean number of readmissions was 2.4, indicating that for some children, discharge after transplant is just the beginning of a long process characterized by repeated hospital stays.

Fever without a documented source of infection accounted for 39 percent of the readmissions; 24 percent were for infections and 15 percent for gastrointestinal problems.

“Most of the patients went on to be successfully treated and ultimately did very well,” commented Lehmann.

“We hope these findings can eventually lead to identifying a group of low-risk children who could be managed at local hospitals rather than transplant centers, reducing costs and inconvenience to families.”

Lehmann said the goal is to identify which patients could be safely treated without requiring an admission to the hospital.

Source: Dana-Farber/Children’s Hospital Cancer Center

 

Moon Landing Faked!!!—Why People Believe in Conspiracy Theories.


moon-landing-faked-why-people-believe-conspiracy-theories_1New psychological research helps explain why some see intricate government conspiracies behind events like 9/11 or the Boston bombing

Did NASA fake the moon landing? Is the government hiding Martians in Area 51? Isglobal warming a hoax? And what about the Boston Marathon bombing…an “inside job” perhaps?

In the book “The Empire of Conspiracy,” Timothy Melley explains that conspiracy theories have traditionally been regarded by many social scientists as “the implausible visions of a lunatic fringe,” often inspired by what the late historian Richard Hofstadter described as “the paranoid style of American politics.” Influenced by this view, many scholars have come to think of conspiracy theories as paranoid and delusional, and for a long time psychologists have had little to contribute other than to affirm the psychopathological nature of conspiracy thinking, given that conspiricist delusions are commonly associated with (schizotype) paranoia.

Yet, such pathological explanations have proven to be widely insufficient because conspiracy theories are not just the implausible visions of a paranoid minority. For example, a national poll released just this month reports that 37 percent of Americans believe that global warming is a hoax, 21 percent think that the US government is covering up evidence of alien existence and 28 percent believe a secret elite power with a globalist agenda is conspiring to rule the world. Only hours after the recent Boston marathon bombing, numerous conspiracy theories were floated ranging from a possible ‘inside job’ to YouTube videos claiming that the entire event was a hoax.

So why is it that so many people come to believe in conspiracy theories? They can’t all be paranoid schizophrenics. New studies are providing some eye-opening insights and potential explanations.

For example, while it has been known for some time that people who believe in one conspiracy theory are also likely to believe in other conspiracy theories, we would expect contradictory conspiracy theories to be negatively correlated. Yet, this is not what psychologists Micheal Wood, Karen Douglas and Robbie Suton found in a recentstudy. Instead, the research team, based at the University of Kent in England, found that many participants believed in contradictory conspiracy theories. For example, the conspiracy-belief that Osama Bin Laden is still alive was positively correlated with the conspiracy-belief that he was already dead before the military raid took place. This makes little sense, logically: Bin Laden cannot be both dead and alive at the same time. An important conclusion that the authors draw from their analysis is that people don’t tend to believe in a conspiracy theory because of the specifics, but rather because of higher-order beliefs that support conspiracy-like thinking more generally. A popular example of such higher-order beliefs is a severe “distrust of authority.” The authors go on to suggest that conspiracism is therefore not just about belief in an individual theory, but rather an ideological lens through which we view the world. A good case in point is Alex Jones’s recent commentary on the Boston bombings. Jones, (one of the country’s preeminent conspiracy theorists) reminded his audience that two of the hijacked planes on 9/11 flew out of Boston (relating one conspiracy theory to another) and moreover, that the Boston Marathon bombing could be a response to the sudden drop in the price of gold or part of a secret government plot to expand theTransportation Security Administration’s reach to sporting events. Others have pointed their fingers to a ‘mystery man’ spotted on a nearby roof shortly after the explosions. While it remains unsure whether or not credence is given to only some or all of these (note: contradicting) conspiracy theories, there clearly is a larger underlying preference to support conspiracy-type explanations more generally.

Interestingly, belief in conspiracy theories has recently been linked to the rejection of science. In a paper published in Psychological Science, Stephen Lewandowsky and colleagues investigated the relation between acceptance of science and conspiricist thinking patterns. While the authors’ survey was not representative of the general population, results suggest that (controlling for other important factors) belief in multiple conspiracy theories significantly predicted the rejection of important scientific conclusions, such as climate science or the fact that smoking causes lung cancer. Yet, rejection of scientific principles is not the only possible consequence of widespread belief in conspiracy theories.  Another recent study indicates that receiving positive information about or even being merely exposed to conspiracy theories can lead people to become disengaged from important political and societal topics. For example, in their study, Daniel Jolley and Karen Douglas clearly show that participants who received information that supported the idea that global warming is a hoax were less willing to engage politically and also less willing to implement individual behavioral changes such as reducing their carbon footprint.

These findings are alarming because they show that conspiracy theories sow public mistrust and undermine democratic debate by diverting attention away from important scientific, political and societal issues. There is no question as to whether the public should actively demand truthful and transparent information from their governments and proposed explanations should be met with a healthy amount of scepticism, yet, this is not what conspiracy theories offer. A conspiracy theory is usually defined as an attempt to explain the ultimate cause of an important societal event as part of some sinister plot conjured up by a secret alliance of powerful individuals and organizations. The great philosopher Karl Popper argued that the fallacy of conspiracy theories lies in their tendency to describe every event as ‘intentional’ and ‘planned’ thereby seriously underestimating the random nature and unintended consequences of many political and social actions. In fact, Popper was describing a cognitive bias that psychologists now commonly refer to as the “fundamental attribution error”: the tendency to overestimate the actions of others as being intentional rather than the product of (random) situational circumstances.

Since a number of studies have shown that belief in conspiracy theories is associated with feelings of powerlessness, uncertainty and a general lack of agency and control, a likely purpose of this bias is to help people “make sense of the world” by providing simple explanations for complex societal events — restoring a sense of control and predictability. A good example is that of climate change: while the most recent international scientific assessment report (receiving input from over 2500 independent scientists from more than a 100 countries) concluded with 90 percent certainty that human-induced global warming is occurring, the severe consequences and implications of climate change are often too distressing and overwhelming for people to deal with, both cognitively as well as emotionally. Resorting to easier explanations that simply discount global warming as a hoax is then of course much more comforting and convenient psychologically. Yet, as Al Gore famously pointed out, unfortunately, the truth is not always convenient.

Source: scientific American

 

Low Melatonin Levels Linked to Diabetes, Study Finds.


Image112EMR-Melatonin-Cherry26jul00f1Having low levels of melatonin, a hormone that regulates sleep, may put you at risk for type 2 diabetes, according to a new study.

By Amir Khan, Everyday Health Staff Writer

People with low levels of melatonin, a hormone that helps regulate sleep and circadian rhythm, may be at a higher risk for type 2 diabetes than people with high levels, according to a new study published in the Journal of the American Medical Association.

Researchers from Brigham and Women’s Hospital in Boston looked at 370 women who developed diabetes while taking part in the Nurses’ Health Study, a long-term study on women’s health, alongside 370 healthy controls, and found that study participants with low levels of melatonin were at approximately twice the risk of developing type 2 diabetes when compared to participants with high levels, even after the researchers adjusted for other diabetes risk factors such as smoking, diet, and exercise.

“This is the first time that an independent association has been established between nocturnal melatonin secretion and type 2 diabetes risk,” Ciaran McMullan, MD, study author and researcher in the renal division at Brigham and Women’s Hospital, said in a statement. “Hopefully this study will prompt future research to examine what influences a person’s melatonin secretion and what is melatonin’s role in altering a person’s glucose metabolism and risk of diabetes.”

Previous research done in rats has shown that taking a melatonin supplement protected them against diabetes, the researchers said, but they could not say for sure that it would have the same effect in humans.

Melatonin is produced in the pineal gland, which is located in the center of the brain, and can be measured through a blood, urine or saliva test. The hormone is only produced in the dark, and low levels have been linked to various conditions, including breast cancerovarian cancer, andinsomnia.

“Melatonin receptors have been found throughout the body in many tissues including pancreatic islet cells,” the researchers wrote in the study, “reflecting the widespread effects of melatonin on physiological functions such as energy metabolism and the regulation of body weight.”

While the researchers could not say for sure that there was a causal link between low melatonin levels and type 2 diabetes, they said previous research has shown that melatonin can play a role helping to regulate sugar levels in the body. When melatonin levels are low, the researchers continued, your blood sugar levels could be thrown off, raising your risk for diabetes.

In addition, they said that since melatonin helps regulate sleep and circadian rhythm, it’s possible that people with low melatonin levels wake up frequently during the night and sleep fewer hours, which could increase their risk.

“Sleep disruption may also be associated with diabetes,” the researchers wrote in the study. “For example, men who reported sleeping less than five hours per night were twice as likely to develop diabetes as those who reported sleeping seven hours per night.”

Although this is the first study to link melatonin to diabetes risk, some doctors use melatonin to treat patients who are already diagnosed with the condition. Michael Wald, MD, director of nutritional services at Integrated Medicine of Mount Kisco in Mount Kisco, NY, routinely gives his diabetic patients melatonin, and said it helps bring their blood sugar levels back into line.

“Several studies have noted that diabetes often have insomnia and it is this subgroup of diabetes that may benefit the most from melatonin supplementation,” said Dr. Wald. “In diabetics with low melatonin, taking slow-release melatonin seems to improve blood sugar levels. The diabetic blood sugar test, called hemoglobin A1c, is reduced in diabetics who take between 1 to 2 mg of melatonin two hours before bedtime.”

Giving patients melatonin, he added, not only helps their blood sugar levels, but also helps them sleep better, which can reduce the risks of other diseases as well.

“By improving sleep quality, melatonin may reduce the risk of many diseases that are associated with poor sleep quality,” Wald said, “including, but not limited to, cardiovascular disease, sleep apnea, nerve problems, depression and pain.”

Transplant doc, Nobel winner Murray dies in Boston.


Dr. Joseph E. Murray, who performed the world’s first successful kidney transplant and won a Nobel Prize for his pioneering work, has died at age 93.

Murray suffered a stroke at his suburban Boston home on Thanksgiving and died at Brigham and Women’s Hospital on Monday, hospital spokesman Tom Langford said.

Since the first kidney transplants on identical twins, hundreds of thousands of transplants on a variety of organs have been performed worldwide. Murray shared the Nobel Prize in Physiology or Medicine in 1990 with Dr. E. Donnall Thomas, who won for his work in bone marrow transplants.

“Kidney transplants seem so routine now,” Murray told The New York Times after he won the Nobel. “But the first one was like Lindbergh’s flight across the ocean.”

Murray’s breakthroughs did not come without criticism, from ethicists and religious leaders. Some people “felt that we were playing God and that we shouldn’t be doing all of these, quote, experiments on human beings,” he told The Associated Press in a 2004 interview in which he also spoke out in favor of stem cell research.

In the early 1950s, there had never been a successful human organ transplant. Murray and his associates at Boston’s Peter Bent Brigham Hospital, now Brigham and Women’s Hospital, developed new surgical techniques, gaining knowledge by successfully transplanting kidneys in dogs. In December 1954, they found the right human patients, 23-year-old Richard Herrick, who had end-stage kidney failure, and his identical twin, Ronald Herrick.

Because of their identical genetic background, they did not face the biggest problem with transplant patients, the immune system’s rejection of foreign tissue.

After the operation, Richard had a functioning kidney transplanted from Ronald. Richard lived another eight years, marrying a nurse he met at the hospital and having two children.

Murray performed more transplants on identical twins over the next few years and tried kidney transplants on other relatives, including fraternal twins, learning more about how to suppress the immune system’s rejection of foreign tissue. One patient who received a kidney transplant from a fraternal twin in 1959, plus radiation and a bone marrow transplant to suppress his immune response, lived for 29 more years.

But it was the development of drugs to suppress the body’s immune response, a less radical approach than radiation, that made real breakthroughs in transplants possible. In 1962, Murray and his team successfully completed the first organ transplant from an unrelated donor. The 23-year-old patient, Mel Doucette, received a kidney from a man who had died.

Murray continued a long career in plastic surgery, his original specialty, and transplants. He was guided by his own deep religious convictions.

“Work is a prayer,” he told the Harvard University Gazette in 2001. “And I start off every morning dedicating it to our Creator.”

Murray told the Journal of the American Medical Association in 2004 that he continued to get letters from patients he helped years earlier and from relatives of those who died during the early efforts.

“They often say … that they are happy to have played some small part in the eventual success of organ transplants,” he said, praising the courage of his patients and their families.

Murray was honored at the 2004 Transplant Games, for athletes who have received organ transplants, along with Ronald Herrick, the man who had donated a kidney to his twin brother a half-century earlier.

Murray continued to support and mentor others at Brigham and Women’s Hospital after his retirement, hospital president Dr. Elizabeth Nabel said. An exhibit in the hospital’s library housing his Nobel Prize, she said, is framed by his own words: “Service to society is the rent we pay for living on this planet.”

Murray’s interest in transplants developed during his time in the Army during World War II when he was assigned to Valley Forge General Hospital in Pennsylvania while awaiting overseas duty. The hospital performed reconstructive surgery on troops who had been injured in battle.

The burn patients, who often were treated with skin grafts from other people, intrigued Murray.

“The slow rejection of the foreign skin grafts fascinated me,” Murray wrote in autobiography for the Nobel Prize ceremony. “How could the host distinguish another person’s skin from his own?”

The hospital’s chief of plastic surgery had performed skin grafts on civilians and noticed that the closer the donor and recipient were related, the slower the tissue was rejected. A skin graft between identical twins had taken permanently.

Murray said that was “the impetus” of his study of organ transplantation.

Murray was ever the optimist and kept on his desk a quotation, “Difficulties are opportunities,” his son Rick Murray said.

“It reflects the unwavering optimism of a great man who was generous, curious, and always humble,” Rick Murray said in a statement released by the hospital.

Source: Yahoo News

HIV vaccine ‘still a decade away’, say researchers.


An effective HIV vaccine may not be ready for another decade despite ongoing efforts by scientists around the world, AIDS Vaccine 2012 conference heard this week (9–12 September).

In 2009 a trial in Thailand, called RV144 and involving 16,000 volunteers demonstrated, for the first time, that a vaccine can protect against HIV infection in humans. The vaccine trial represented a milestone for HIV vaccine research: “until this point there was no proof of concept”, Bill Snow, director of the Global HIV Vaccine Enterprise, told the conference held in Boston, United States.

Further evidence of the vaccine’s effectiveness against HIV infection was published in Nature this week (10 September). Researchers examined the genetic sequences of HIV viruses in people who received the vaccine and those who received a placebo, and found the vaccine was most effective against HIV viruses with two specific genetic footprints.

“This was an independent confirmation of the efficacy of the vaccine,” Morgane Rolland, who led the research and is based at the US Military HIV Research Program, told SciDev.Net.

But despite the vaccine’s success, researchers are struggling to overcome research and manufacturing challenges, and say that the process of making it ready for roll-out is taking longer than expected.

Speaking at the Boston conference, Jerome Kim, who led the study in Thailand and is based at the US Military HIV Research Program, said: “We underestimated issues related to manufacturing [the vaccine product to be used in trials]”. Changes were made to increase the scale of the trial and guarantee the safety of the volunteers, prolonging the process.

In addition, researchers were not prepared for going to the next phase. The company that produced the component of the vaccine booster was small, and initially lacked capacity for producing the vaccine on a larger scale.

“The main reason for the delays in [further stage] RV144 trials is that they were not well prepared for success; nobody was ready for doing a follow-up study,” Snow told SciDev.Net.

Another reason for the delay was the decision to move later stage trials to South Africa, where the epidemic is severe. South Africa has more people living with HIV, estimated at 5.6 million, than any other country in the world, according to the Joint UN Programme on HIV/AIDS.

The trial in South Africa is expected to start next year, but scientists will need to adapt the vaccine for the particular HIV viruses circulating in the region.

“We have to be realistic on where the timeline will leave us; after three years of experience, we are less optimistic to have short-term results,” said Kim. “There is so much diversity [of the HIV virus], that it will never be possible to have a universal vaccine.”

Kim highlighted that a vaccine is unlikely to be ready before the next decade.

But Bruce Walker, a researcher at the Harvard University Center for AIDS Research and co-chair of the Boston conference, said “the HIV vaccine is a solvable problem, it is only an issue of human and funding resources”.

Source: http://www.scidev.net

 

Sleeping in Space.


How do astronauts sleep in space? A visiting sleep researcher is shedding light on the effects of spaceflight on astronauts’ sleeping patterns.

Dr Laura Barger, an instructor at Harvard Medical School’s Division of Sleep Medicine and an Associate Physiologist at Brigham and the Women’s Hospital in Boston, investigated the sleep of astronauts on Space Shuttle and International Space Station missions over the past decade, and is bringing her expertise to Melbourne.

A former Air Force Lieutenant Colonel, Dr Barger’s research interests have focused on the health and safety risks associated with unusual and extended work hours. As part of the Harvard Work Hours, Health and Safety Group, she has also studied medical residents, police officers, firefighters, federal air marshals, and mission controllers supporting the Phoenix Mars Lander mission.

Dr Barger said astronauts face a number of challenges when trying to sleep in space including unusual shift patterns, which could have similar effects observed in some shift workers on earth, a 90-minute light-dark cycle for every time astronauts orbit the earth and the physical ‘free-fall’ sleeping environment.

“We studied sleep aboard Space Shuttle and International Space Station Missions and found there is a vast amount of sleep deficiency among astronauts and a widespread use of sleep promoting medications during spaceflight,” Dr Barger said.

Dr Barger is in Melbourne with the support of the Harvard Club of Australia Foundation. She will work with Monash University sleep researchers, including Associate Professor Shantha Rajaratnam, also a member of the Harvard Work Hours, Health, and Safety Group, on the association between work hours, sleep deficiency and motor vehicle crashes.

“Across all occupations, one safety outcome we measure is the incidence of motor vehicle crashes. One goal of the Harvard Work Hours Health and Safety Group is to come up with a strategy for future research examining drowsy driving,” Dr Barger said.

In addition to undertaking research, Dr Barger will conduct a series of lectures and seminars at Monash, sharing her insight into the effects of spaceflight on sleep and the circadian timing system and the effects of extended work hours and sleep loss on health and safety.

Credit: http://www.monash.edu.au

Diabetes educators review 2012 National Standards.


Last revised in 2007, the National Standards for Diabetes Self-Management Education have served as the acceptable guide for providing consistency and quality through the delivery of diabetes education. At the American Association for Diabetes Educators annual meeting, certified diabetes educators discussed the recently updated standards, emphasizing support and a continuum of self-management, as well as a widened criterion for eligible instructors.

One obvious revision includes a change in the standard’s title. Formerly known as the National Standard for Diabetes Self-Management Education, the guide is now known as the National Standard for Diabetes Self-Management Education and Support (DSMES).

Donna Tomky, MSN, RN, C-NP, CDE, FAADE, immediate past president of AADE and nurse practitioner and diabetes educator from ABQ Health Partners in Albuquerque, NM, said support is a very important part of the change.

 

Donna Tomky

“It really defines those activities that assist the person with prediabetes or diabetes in implementing and sustaining the behaviors needed to manage his or her condition on an ongoing basis. It really looks at the continuum instead of just a one-time effort,” Tomky said during a presentation.

Tomky said there are misunderstandings surrounding the standards. For example, an RN, RD, pharmacist, medical director or CDE are not needed for a diabetes education program. The revisions will be published in the October issue of Diabetes Care, she said.

Co-presenter, Melinda Maryniuk, RD, Med, CDE, director of clinical education programs for the Joslin Diabetes Center in Boston, Mass., said the revisions are aimed to ensure wide applicability and to ensure quality care.

“There aren’t revolutionary new things that have come out, but we have more research to support the information,” Maryniuk said.

In a survey of 225 public comment reviewers consisting of RNs, RDs, pharmacists, MD/DO/Endo, mental health professionals, and other providers, 82% said the standards were applicable to them, Tomky and Maryniuk said. Additionally, 74% agreed the document was clear. Many of the comments received mentioned satisfaction with a wider focus on support and prevention, while looking for more information.

Other revisions include increased clarity to ensure broad-based relevance in institutional and solo-based providers, an increased attention to behavior change and added examples of who can offer diabetes education, including occupational therapists and certified health education specialists. – By Samantha Costa

For more infromation:

Tomky D. #F03. Presented at: The American Association of Diabetes Educators 2012 Annual Meeting & Exhibition. August 1-4, 2012; Indianapolis.

Disclosure: Ms. Tomky and Ms. Maryniuk report no relevant financial disclosures.

Perspective

  • I attended this session so I could be as current and up-to-date with what the new standards will be forthcoming. I thought it was a great overview with realistic discussions in regard to the different organizations that I work with, and what challenges they might potentially have when it comes to interpreting the standards.

The fact that a credentialed CDE person who isn’t a nurse, dietician, or pharmacist can be in solo practice is really great. I have a lot of exercise physiology friends and I can’t wait to share that information with them. They will be so excited. They, too, are potentially masters-prepared and certified.

 

  • Source: Endocrine Today.

 

Diabetes educators review 2012 National Standards.


Last revised in 2007, the National Standards for Diabetes Self-Management Education have served as the acceptable guide for providing consistency and quality through the delivery of diabetes education. At the American Association for Diabetes Educators annual meeting, certified diabetes educators discussed the recently updated standards, emphasizing support and a continuum of self-management, as well as a widened criterion for eligible instructors.

One obvious revision includes a change in the standard’s title. Formerly known as the National Standard for Diabetes Self-Management Education, the guide is now known as the National Standard for Diabetes Self-Management Education and Support (DSMES).

Donna Tomky, MSN, RN, C-NP, CDE, FAADE, immediate past president of AADE and nurse practitioner and diabetes educator from ABQ Health Partners in Albuquerque, NM, said support is a very important part of the change.

 

Donna Tomky

“It really defines those activities that assist the person with prediabetes or diabetes in implementing and sustaining the behaviors needed to manage his or her condition on an ongoing basis. It really looks at the continuum instead of just a one-time effort,” Tomky said during a presentation.

Tomky said there are misunderstandings surrounding the standards. For example, an RN, RD, pharmacist, medical director or CDE are not needed for a diabetes education program. The revisions will be published in the October issue of Diabetes Care, she said.

Co-presenter, Melinda Maryniuk, RD, Med, CDE, director of clinical education programs for the Joslin Diabetes Center in Boston, Mass., said the revisions are aimed to ensure wide applicability and to ensure quality care.

“There aren’t revolutionary new things that have come out, but we have more research to support the information,” Maryniuk said.

In a survey of 225 public comment reviewers consisting of RNs, RDs, pharmacists, MD/DO/Endo, mental health professionals, and other providers, 82% said the standards were applicable to them, Tomky and Maryniuk said. Additionally, 74% agreed the document was clear. Many of the comments received mentioned satisfaction with a wider focus on support and prevention, while looking for more information.

Other revisions include increased clarity to ensure broad-based relevance in institutional and solo-based providers, an increased attention to behavior change and added examples of who can offer diabetes education, including occupational therapists and certified health education specialists. – By Samantha Costa

For more infromation:

Tomky D. #F03. Presented at: The American Association of Diabetes Educators 2012 Annual Meeting & Exhibition. August 1-4, 2012; Indianapolis.

Disclosure: Ms. Tomky and Ms. Maryniuk report no relevant financial disclosures.

Perspective

  • I attended this session so I could be as current and up-to-date with what the new standards will be forthcoming. I thought it was a great overview with realistic discussions in regard to the different organizations that I work with, and what challenges they might potentially have when it comes to interpreting the standards.

The fact that a credentialed CDE person who isn’t a nurse, dietician, or pharmacist can be in solo practice is really great. I have a lot of exercise physiology friends and I can’t wait to share that information with them. They will be so excited. They, too, are potentially masters-prepared and certified.

 

  • Source: Endocrine Today.