Category Archives: Healthy Aging

Healthy Sleep Habits

Healthy Sleep Habits

Sleep is one aspect of life whose essence is often easily overlooked. You think about a ball game that you simply cannot miss. Yet it is taking place from midnight. You say, “Anything else counts not, but the game.” So you stay up late into the night watching it. 4.00 AM and you are not yet asleep, and it is the eve of a Monday!

You are in the news industry. As the editor, you have to leave the newsroom after everything newsworthy has been captured in the day’s paper. Or, you are sitting for your end semester exams that begin in the morning. You do not feel well backed so you stay up late going through your notes.

The list of reasons we give for not sleeping is long. Apparently when daytime comes you often feel that grumpiness and wish to lock yourself up in the office. If you are a student you always doze off in front of the computer or your books.

In other words, the lack of sleep takes away your productivity. Bad mood; you will not be the smiling face that draws even the most uninterested customer, no! Fatigued, you will not pay attention to details at all. You may easily miss out a very important detail. In that state your mind is always foggy and if it was an exam you were staying up late for, chances are that you might end up not producing much after all because you just cannot think that well.

Good thing, you can always catch a bed and compensate for the lost sleep so that you feel better again. At certain instances, you can always rush for a cup of coffee and keep up with the prevailing circumstance. But, have you ever asked yourself what that behavior of keeping sleep a distance away have on your health?

Quality-Sleep

After missing sleep for some time, the mental effects of this sleeplessness become more serious. The fogging of your brain will become more pronounced, rendering it difficult for it to concentrate and make needed decisions. You will probably begin feeling down and may drop off at daytime. You also risk getting injuries and causing accidents at work or at home. If you drive, it is catastrophic!

Yet that is not it all! The range of health problems related to sleeplessness may surprise you if you realize them. You may probably not want to ever miss a night of sleep ever again over some series of night vigils or ball games, whatever your convincing reason is.

Health Implications

Poor Sleep patterns increase the risk for Ulcerative Colitis and Crohn’s Disease. Ulcerative colitis is a chronic autoimmune disease of the large intestine in which the gastrointestinal lining becomes inflamed and develops ulcers.

This is caused by an abnormal response by the body’s immune system. In patients with inflammatory bowel diseases, the immune system mistakes food, bacteria and other substances in the intestine for foreign or invading substances.

Ulcerative colitis only affects the large intestine whereas Crohn’s disease can affect any part of the GI tract. In addition, both short and long durations of sleep have important health implications and are associated with increased overall mortality. You have probably experienced the bad mood thing, fatigue and tiredness associated with lack of sleep. But what you might have never realized is the long-term health consequences which include chronic health conditions such as diabetes, cardiovascular disease, high blood pressure, and obesity. And now you know that these conditions may lead to some really shortened life expectancy!

  1. Weight gain and obesity

Studies have found a link between no-sleep and weight problems. These people who deny themselves the essential requirement- sleep, are more likely to have a higher body mass index (BMI) than normal. Such people are susceptible to obesity. But, how does this happen?

When you sleep less, it all begins with your appetite. It goes up! You may begin to eat uncontrollably, not because you want to or because your stomach becomes larger, no. This is something to do with the hormonal behavior in your system.

Leptin is the hormone that usually notifies the brain that you have eaten enough food and it is time to put food aside. This hormone apparently is secreted when we are asleep. Deny yourself the sleep and your appetite will have nothing to control it. Instead, you face the risk of higher levels of the hormone responsible for appetite stimulation: ghrelin.

Poor sleep therefore leads to uncontrolled food cravings that may eventually cause overweight as your body gains too much calories but is too tired to burn them off through exercise.

The little sleep may also upset the balance of other related hormones, for instance, little sleep will result in an increased production of cortisol. Hormone cortisol is normally referred to as the stress hormone. The secretion of insulin hormone may also increase following a poor sleep. Insulin which regulates glucose processing while promoting fat storage will therefore exist in large quantities, a condition that is associated with weight gain. This is a risk factor for diabetes.

  1. Immunity failure

With the altered behavior of the endocrine system, the body’s defense mechanism against infections is likely to be highly affected. This augments to the reason why doctors recommend bed rest for people who are sick. When you sleep, your body’s immunity has the advantage over invading microbes.

How do you identify a disturbed sleep then?

The signs and symptoms of a disturbed sleep include constantly feeling tired ranging from mild to severe cases, an irritable temper and feelings of moodiness, you could lose concentration and at times feel hallucinations and even memory loss, loss of coordination is common; and in severe cases the individual may encounter auto accidents. Other symptoms and signs include relationship problems, loss of appetite, absenteeism or tiredness at work and use of stimulants.

sleeping

How do you build good sleeping habit?

You could improve your sleep hygiene by establishing a regular bed time. You constantly retire to bed when that time reaches. It involves going to bet a specific time and waking up at an established regular time. For adults this interval should be about 7 to 9 hours of sleep.

You may also get rid of stimulants in your routine. Do not go for caffeine to boost your level of alertness. If you feel drowsy, just get yourself a nap. The rest will come later. In addition, you need a regular exercise schedule to get you tired so you can get some deep sleep.

When you are ready to go to bed, avoid computer games, TV or watching movies. These will rip you of your sleep. Other healthy steps include an improved diet and a cool sleep environment.

AwareMed uses the cognitive behavioral therapy as one of the principal treatments for insomnia and sleep disorders for our patients. This treatment is non-pharmacologic and addresses the sleep problems at the psychological and behavioral levels. Part of these include the above mentioned behaviors.

Healthy Sleep Habits

 

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Dark Chocolate May Reduce a Person’s Risk of Diabetes

Dark Chocolate May Reduce a Person’s Risk of Diabetes

It is general knowledge that diabetes is a sugar disease. Today, this sugar disease is a worldwide epidemic, mostly because of the increased sugar consumption among world populations. It is no longer accurate to categorize diabetes as a disease of the old folks. Everyone can be a victim of the same irrespective of your age.

You do not have to take tea with double the number of spoons of sugar recommended to be exposed to the risks of high sugar consumption. You get the sugar in your Coke, yoghurt, soda, fruit juice, corn syrup; you name them.

Your system then absorbs these sugars into your bloodstream where hormone insulin is expected to promote the subsequent absorption of that sugar from the bloodstream. A number of processes are then involved in the balance of the amounts of sugar in the gut, bloodstream and the nervous system in the form of an end product.

Dark Chocolate

Several organs of the endocrine system, the digestion system and the circulatory system all play interrelated roles in maintaining this body sugar equilibrium. It is in the event of failure of some of these processes that diabetes of either type 1 or type 2 is likely to occur.

Pancreas for instance may fail to secrete insulin responsible for the sugar regulation in the blood. The kidney too may be affected and subsequently fail to perform its osmoregulation function resulting with little or no reabsorption of blood sugars. All these conditions may result to diabetes.

The Diet Equation

The diet is the largest contributor of the sugars in the body that may be causative to high levels of blood glucose. Among these dietary contributors is chocolate. There is need however to understand that not all types of chocolate are poisonous to your body sugar equation. What you might have not known is that the dark sugar is quite the opposite. It may be an antidote to the sugar disease.

So how can the same cause of the disease be the same one to reduce the risks of getting it? Point is, the milk chocolate for instance will give you diabetes. Yet the dark chocolate whose main ingredient is cocoa will treat it. How many times have you put about two bars of chocolate in your shopping trolley? Chocolate has been associated with very many health related conditions. Among these, is causing diabetes by raising the sugar levels; so to most people it is better to avoid the chocolate. Others are weight gain and cardiovascular conditions such as cardiac arrest.

In as much as chocolate may not go down well with everyone due to this, the dark chocolate has its good side. It drastically reduces your chances of getting diabetes and earns you freedom from a life of constant dose of insulin supplements. Studies have shown that taking just the right amount of this chocolate option could do the trick very well. I am not talking about stacking yourself with bars and bars of chocolate every day.  Neither am I talking about craving the sweet thing every single hour. No. I am talking about a calculated dark chocolate containing 43 mg of magnesium per ounce.

How the magnesium in dark chocolate helps with diabetes

The fourth most abundant mineral in your body, magnesium plays key roles in a number of essential processes in your body. As such, if you happen to have less of it, your body is not likely to function at its best. Insufficient amounts of cellular magnesium lay the ground for deterioration of appropriate metabolic function. This is what may typically melt down to serious health related problems.

dark chocolate

For diabetic conditions, the mineral plays a key role in preventing insulin dysregulation as well as type 2 diabetes. This is according to different recent studies on the causes and behavior of diabetes. Among the findings of these studies was that the people who take highest amounts of magnesium whether through supplements or natural sources reduced their risk of suffering metabolic problems by about 71 percent. This in essence decreases your chances of having a diabetic condition resulting from gut disorders. A study thus has concluded that this metal is essential for the protection of type 2 diabetes

Taking the dark chocolate guarantees your intake of this essential mineral in nice alternative: a sweet dark chocolate. As mentioned earlier, it is necessary to take caution not to get addicted to the chocolate and only stick to the recommended amounts. A doctor’s input would be highly valuable for a type 2 diabetic who wishes to go for this alternative remedy.

AwareMed is the best place to purchase magnesium. Here you will also have the merit of getting the health information from Dr. Dalal Akoury who has been in the practice for several years.

Dark Chocolate May Reduce a Person’s Risk of Diabetes

 

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Wrong Food Causes Joint Pain

Wrong Food Causes Joint Pain

Joint pain is a common complaint among many people. It not only slows you down but causes a
lot of discomfort. It can be caused by injury or disease. It is estimated that over 50 million Americans today are affected by joint pain. A joint refers to an area where two bones meet. These bones are separated by cartilages. The fact of the matter is that joint pain is no longer a disease of the old folks.

Joint pain has been linked to conditions such as arthritis, gout especially of the big toe, bursitis, and muscle pain. Other cause of joint pain include viral infections, fractures, overuse or straining of the joints, rheumatoid arthritis, osteomyelitis which is simply bone infections among others. Joint pain can affect more than one joint at a time. The most common complaints of joint pain are within the hip and shoulder region. However, it can affect any part of your body.

Joint pain can range from mild to very severe pain. It can last from a few days or even go on for several months a condition called chronic joint pain. Whether mild or severe the fact is that, joint pain can affect the quality of your life.

 

The most common cause of joint pain among a given number of populations is arthritis. It is a disorder of the joints that is caused by an inflammation on the joints. Patients with arthritis complain of pain on the affected joint. Other causative factors of arthritis may be straining of the joint, wear and tear of the muscle tendons of the joints, or fatigue.

Apart from the causes mentioned above, eating the wrong foods can also lead to joint pain. Research has shown that certain type of foods contribute to painful joints.

The Diet Question: Gluten

Eating the wrong diet may lead you to develop joint pain. Studies have shown that eating foods rich in gluten can cause inflammation. This inflammation is what causes pain especially on the knees and joints. You may experience actual physical pain in these areas. The joints especially are the ones highly likely to be affected by inflammation.

The most common source of gluten is wheat flour. Others are barley, rye and other foods made with these grains and any foods made with these grains.

Of the available sources of gluten, wheat is the most common that finds it way in most of our diets. Avoiding wheat may prove very difficult to most of us. This is because it would mean avoiding all those delicacies made from wheat flour. Am talking about pasta, bread, cookies, cakes, muffins, pastries, crackers, gravy, sauces, cereal and the list is endless. Beer is also a source of gluten.

joint-pain

You may have experienced pain in the joints at one time. What comes to our minds when that happens is that we are doing too much work or probably taking those many stairs to your office every day may be causing the pain. Well, this may be true since joint strain may eventually lead to joint pain. Past studies have shown that our diet is the main cause of most of the health problems we experience. This is not different from joint pain and the major cause of joint pain has its root with the gluten diet.

Going off gluten may prove next to impossible to most of us. This is because it is in all the good foods out there. But if something affects your health the best thing to do is cut it out.

Additional Facts about Joint Pain: Leaky Gut Syndrome

Digestive problems affect a number of people. Ever heard of leaky gut syndrome? The gut plays a major role in your overall health and well-being. When food is not being digested properly, it can lead to all kinds of unimaginable problems. For one, foods may fail to be properly digested. This would mean that little or no nutrients will be absorbed into the blood stream. When this happens, the body is derived of the essential nutrients it requires to stay healthy.

Leaky gut syndrome is a medical condition that affects the intestinal linings. It occurs when the permeability of the intestinal walls is increased. Due to this increased permeability, large molecules, antigens and toxins are allowed into the blood stream. These lead to inflammation.

The inflammation of the lining of the intestines leads to destruction of microvilli. Microvilli serve a critical role of absorption and controlling what is absorbed by the blood and what will become waste. The damage of the microvilli prevent them from generating enzymes and other gut secretions which are required for the overall health of the digestive system and efficient absorption of nutrients.joint-pain

When this happens bacterial imbalance occurs in the gut. Normally our bodies have bacteria, some useful others harmful. Proper functioning of the digestive system creates a symbiotic relationship between these bacteria. When the permeability of the intestinal wall is destroyed this balance is offset. Pathogenic bacteria increase in the gut and it renders the useful bacteria completely useless. This imbalance is what leads to leaky gut syndrome.

Antibiotics, herbicides, insecticides, fungicides and pesticides are the major causes of leaky gut syndrome. A lot of foods that we take are grown with artificial fertilizers. These harbor a lot of toxins in the foods which are later taken in our body system. These toxins when they reach the gut end up destroying the lining of the gut leading to leaky gut syndrome.

Leaky gut syndrome has been associated with diseases such as arthritis, chronic fatigue, rheumatoid arthritis, acne, eczema, liver dysfunctions among others.

Just like gluten can cause inflammation leading to joint pain, leaky gut syndrome can also be a causative factor for aching joints. The best way to prevent leaky gut syndrome is by properly washing all fresh vegetables and food before cooking and eating.

At AwareMed we not only inform you about the causes of joint pain but we tell how you need to live in order to avoid it!

Wrong Food Causes Joint Pain

 

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Improving your Skin Texture: Rejuvenate!

Improving your Skin Texture by Exfoliating and Moisturizing – Procedures to Improve Skin Texture

Improving your Skin Texture

Improving your Skin Texture by Exfoliating and Moisturizing is very essential for the regeneration of a more vibrant and youthful skin.

When soldiers go to war, they wear all the necessary protective gears and arm themselves with sophisticated weapons. They take all the precautions and carry with the protective shields to protect them from the opponent’s missiles. In the same way your skin being the largest organ of the body, and most exposed need to be protected from both internal and external aggressions. As a person, your skin is your armor of defense protecting you from inside out. By the way, have you ever imagine how you would look like without your skin? Without it you would be nothing but a collection of muscles, bones and organs. We are not only appreciating the skin as the biggest organ in your body but it happens to be the most exposed to environmental dangers. The parts of your skin that don’t regularly get covered by clothing take a beating every single day and this affects the texture of your skin. This is why we want to discuss what to do towards improving your skin texture and we are going to look at exfoliation and moisturizing.

Improving your skin texture by exfoliation and moisturizing is very essential for various reasons. Like for instance, too much sun can make your skin peel off. And not just the sun, everything from the climate to the amount of pollution in the atmosphere around you can have an adverse effect on your skin texture. Therefore failure to protecting your skin against these toxic elements will result in premature aging. Keeping your skin tender and exciting isn’t easy at all. It will cost you money and time. I am not trying to scare you, but doing the right thing today will pay off and save you a great deal in the future. Taking care of your skin now will help you avoid a number of nasty skin conditions later in life, including skin cancer. Therefore it will be important that for you to avoid some of these life threatening health conditions, you need to consult with the skin care experts at AWAREmed Health and Wellness Resource Center under the able leadership of Doctor Akoury. At this facility the main objective is to transform each individual’s life through increasing awareness about health and wellness and by empowering individuals to find their own inner healing power. Dr. Akoury’s practices focuses on personalized medicine through healthy lifestyle choices that deal with primary prevention and underlying causes instead of patching up symptoms. Where else can you get such professionals? You may schedule for an appointment with doctor Akoury today for lasting solutions to your skin problems.

To keep your skin smooth, you need to exfoliate regularly and moisturize every day. It’s also important to wear sunscreen anytime you go outdoors, and drinking an adequate amount of water isn’t a bad idea either. Aside from all the outside factors that affect skin texture, your hormones and your diet can mess with your skin as well. If you’re doing everything you can and you’re still not happy with the way your skin looks, don’t worry. Besides scrubbing and moisturizing, altering your diet, and balancing your hormones, doctor Akoury will administer other treatment procedures including vampire facelift, Botox and many more that can help you achieve a brilliantly smooth skin texture and a minimal cost. All these procedures are channeled towards improving your skin texture and beauty.

Improving your Skin Texture by Exfoliating and Moisturizing – Exfoliating to Improve Skin Texture

You may not be aware that we’re continuously shedding our skin off and regenerating new ones. To be precise, we get rid of around 40,000 dead skin cells every minute. As soon as the dead cells are disposed the body produces new ones to take their place. Meaning that, our skin is constantly regenerating itself. This process helps us stay healthy and constantly gives us a chance to improve our skin texture. Exfoliating therefore helps us speed up this process of shedding dead skin cells. The shedding of dead skin cells is done in the following ways:

Manual exfoliation – You’ll need an exfoliating scrub for this method, which you can pick one up at almost any drug or beauty store. Exfoliating scrubs are soaps with small particles in it that feel like granules of sand. By gently washing your skin with an exfoliating scrub, you remove dead skin cells and reveal healthy new ones. While manual exfoliation is quite effective, it may not be the best type of exfoliation for everyone.

Enzyme exfoliation or chemical exfoliation – Some people have more sensitive skin than others and manual exfoliation can leave them sore and red. If you fall into this category, you might try enzyme exfoliation or chemical exfoliation instead. These types of exfoliation don’t require scrubbing. They rely on chemical reactions to dissolve dead skin cells. This type of exfoliation is often used with people who suffer bad acne. For some, the process is just as effective as manual exfoliation. The key is to determine which method works best for you to help in attaining the ultimate goal which is improving your skin texture for perfect beauty.

Improving your Skin Texture by Exfoliating and Moisturizing – Moisturizing to Improve Skin Texture

Doctor Akoury will tell you that for your skin to be happy skin it must be hydrated. The presence of proteins in our skin called collagen and elastin are very important because of the role they play to help give our skin its elastic properties Pickart. For instance pose and think about how often we have to stretch out the skin on our face. Whenever we make any facial expression there will be movement of the facial skin. It is the collagens and elastin which enables the face skin to fall back to position. However in their absence the facial skin and other body skin would sag as soon as we are done with the expression. The same would be applicable for our lips and our foreheads.

Improving your Skin Texture by Exfoliating and Moisturizing – So why do we get wrinkles?

Wrinkles will occur at some point of time in life even in the presence of collagen and elastin. This is so because, as we get older, collagen and elastin levels decrease in our body. It is the decrease of collagens and elastin that causes old age wrinkles and skin sagging all over the body. These unwanted side effects of aging can speed up greatly due to overexposure to the sun and other bad habits like smoking. However, the good news is that doctor Akoury in her several decades of practice in skin care medication, has helped so many people across the globe to have a more rejuvenated skin and facial looks. You can be part of this success only if you schedule for an appointment with doctor Akoury for a more tailored approach of medication. She will be able to help you slow down the appearance of wrinkles and even prevent them from appearing using the various treatment techniques available at AWAREmed Health and Wellness Resource Center. Some of those treatment techniques include Vampire facelift, exfoliation and moisturizing.

In doing all these it is necessary that you only use something that can help boost your collagen levels. For instance a good moisturizer will have vitamin E, antioxidants and Coenzyme Q10. Moisturizing every day will help keep your skin hydrated and promote healthy, smooth skin texture. Aside from exfoliating and moisturizing there are a number of procedures out there that can also help you in improving your skin texture effectively.

Improving your Skin Texture by Exfoliating and Moisturizing – Procedures to Improve Skin Texture

Improving your Skin Texture by Exfoliating and Moisturizing – Procedures to Improve Skin Texture

 

 

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Handling Holidays Stress by Healthy Eating during the season

Handling Holidays Stress by Healthy Eating during the season – What we need to correct

Handling holidays stress

Handling Holidays Stress by Healthy Eating during the season is the primary objective of everyone planning to go feasting during the holidays.Holid

We are now approaching that time when we want to do everything we have not done in the last eleven months in just a few days. We are accustom to accumulating activities and when we least expect we begin to get stressed up while trying to multitask to have everything done within that short time. If you are wondering of what am heading to, am simply trying to highlight handling holidays stress. The holidays and the stress that comes with them are around the corner if you were not aware. Truth be told, this is a very busy time of year. It comes with lots of activities like extra shopping, cooking, gatherings, and work related obligations… the list is endless. With all of these additional tasks all at the same time, the most common yet very important things we let slip are sleep and exercise; two things that rank as the best way to handling holidays stress.

Experts at AWAREmed Health and Wellness Resource Center under Doctor Akoury’s care reports that many people actually gains weight over the holidays, with the increased stress. Doctor Dalal Akoury the founder of this facility (AWAREmed Health and Wellness Resource Center) explains that Stress eating can be a major factor in weight gain. It normally sneaks in as grazing, night-time eating, extra snacking, or even binge eating. With any of these forms of stress eating, the food choices are likely to be unhealthy and the act of eating doesn’t satisfy the true needs of stress relief. So, how do you get through the holidays without putting on extra pounds?

Handling Holidays Stress by Healthy Eating during the season – Plan ahead

Take a few minutes today to plan how you are going to maintain your weight loss or continue to lose over the holidays (handling holidays stress). Make sure that you plan for the whole season and then reduce it down to smaller segments by months, weeks, and days and in that plan include:

  • Plan some stress relievers
  • Plan your exercise
  • Plan your meals
  • Plan your treats

Remember that if you fail to plan, you are actually planning to fail; therefore desire to plan nothing but to succeed.

Handling Holidays Stress by Healthy Eating during the season – Categorize the major events

Think about what your major obligations are like for instance:

  • Work and family get-togethers
  • Parties or dinners with friends
  • Shopping
  • Holiday celebration

Don’t let these activities sneak up on you. Instead, put them on your schedule of events in your calendar now and make a list of what you need to do and how to prepare for these obligations and when you need to start undertaking them.

Handling Holidays Stress by Healthy Eating during the season – Shopping

This is one of the major holidays headaches which when not properly addresses may cause you unnecessary stress. Therefore as a means of handling holidays stress, plan ahead when to shopping for gifts.

  • Make a list of those people you’re buying for gifts
  • Ensure that the gifts are within your budget
  • Decide in good time what you want to buy for them
  • Get to know where to get all these gifts

You can save time and money this way by not just wandering aimlessly through the shopping mall. And don’t wait until the last minute. Shopping on Christmas Eve is more stress than it’s worth.

Handling Holidays Stress by Healthy Eating during the season – Exercise and Stress Relievers

Plan your exercise and stress relievers. Exercise doesn’t have to be 30 minutes of cardio and 30 minutes of weights at the gym. For instance:

  • Ten minutes of exercise three times a day is just as beneficial
  • That might look like 10 minutes on the treadmill before work
  • Another 10 minutes of climbing stairs at lunch and
  • A final 10 minute walks with a friend in the evening

It can be walking through the neighborhood caroling with your family. It can be taking a stroll through the lights at the zoo. You could sign up for a 5k run or walk on almost any Saturday and even on Thanksgiving Day. Don’t forget that increased housework is increased activity as well. If you have guests coming, do an extra vacuuming for some additional calorie burn. All these done will go a long way in helping in handling holidays stress and weight gain effectively without much straining.

Handling Holidays Stress by Healthy Eating during the season Sleeping and Relaxing

Stress relief definitely comes from exercising, but also from relaxing and sleeping. Make sure your schedule you allocate for some time each week with no obligations. Use those nights to get to bed early so you are refreshed for the next day.

Handling Holidays Stress by Healthy Eating during the season – Food

Lastly, plan your food. During the holidays, there is an over-abundance of high sugar, high fat and high calorie foods. Many are very tasty, but probably not all are your favorites. If there is a special treat or dish that you only get this time of year, have a small serving of it, but don’t waste your treat on high calorie foods that you don’t enjoy or may have during other times of the year. And make the next meal or snack extra healthy that day; maybe even add in an extra 10 minutes to exercise to compensate for the added calories.

Finally remember, the holidays have special meaning and shouldn’t be stressful. Plan to avoid stress and be successful with your weight loss goals and you will have even more to celebrate. In case of any difficulties and you feel you are struggling with handling holidays stress, you may consult with doctor Dalal Akoury for her professional input and this will be very helpful for you and your family. Remember that doctor Akoury is offering her exclusive NER Recovery Treatment to everyone including other physicians and health care professionals through training, clinical apprenticeships, webinars and seminars. You can become part of the many success stories emanating from those people who have passed through her care by scheduling for an appointment with her today.

Handling Holidays Stress by Healthy Eating during the season – What we need to correct

 

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