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Re: Diabetes news for spring 2019

My cholestrol is always well below 200. I execise everyday ,and also walk, and watch my diet ,and portions, and I don't take statins, because I can't . All things in moderation works well for me

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Re: Diabetes news for spring 2019

THURSDAY, April 18, 2019 (HealthDay News) -- Some strains of Staph bacteria may slow the healing of diabetic foot ulcers, while other types of bacteria may promote healing, according to a new study.

The results suggest that monitoring the bacterial populations (microbiomes) of diabetic foot ulcers may help doctors decide the best way to treat them.

Up to one-quarter of diabetics will develop a foot ulcer, because high blood sugar causes numbness that reduces circulation and makes wounds go unnoticed. These foot ulcers, affecting between 4 million and 6 million Americans, cost the United States $9 billion to $13 billion annually.

Foot ulcers are the leading cause of amputations in diabetics. After an amputation, about seven out of 10 patients die, a rate higher than that of many cancers, the study authors noted.

"There's been very little innovation in treating these wounds," said study leader Lindsay Kalan. She is assistant professor of medical microbiology and immunology at the University of Wisconsin School of Medicine and Public Health, in Madison.

For the study, Kalan's team collected samples from foot ulcers on 46 patients immediately before debridement, a treatment to scrape away dead or infected tissue and promote healing.

New samples were then collected every two weeks for 26 weeks.

Staphylococcus aureus, a type of bacteria known to be resistant to antibiotics, was found in most of the wounds. Investigation revealed that some strains of S. aureus were found only in wounds that did not heal.

In follow-up experiments, the researchers found that those strains of S. aureus also slowed ulcer healing in mice.

The team also discovered that another common type of bacteria in diabetic foot ulcers -- Alcaligenes faecalis -- actually promotes healing.

Interestingly, patients who were given antibiotics had little change in their foot ulcer microbiomes. The researchers weren't surprised, noting that the drugs rarely improve ulcer outcomes.

On the other hand, debridement reduced the diversity of bacteria in ulcers that went on to heal -- a finding that could help guide the course of treatment, the study authors suggested in a university news release.

"If we can use the microbial community to tell within 24 hours that debridement wasn't effective and a patient needs to come back for more treatment, it would greatly reduce care time and the patient's time away from work," Kalan said.

The study was published April 18 in the journal Cell Host & Microbe.

-- Robert Preidt

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Re: Diabetes news for spring 2019

Metformin is the first-line medication for treatment of type 2 diabetes mellitus (T2DM). This commonly used medication has also been associated with lowering serum vitamin B12 levels. Although the British National Formulary documented this connection in the 1970s with a constellation of studies supporting this effect, recognition of this by most prescribers is lacking.1-17

Three theoretical mechanisms of action regarding the contribution of metformin to the lowering of B12, a water-soluble vitamin, have been postulated; it may be one or any combination of these that contributes to a diminished B12 level. The first posits that this is due to blocking by metformin of the calcium channels in the distal ileum that normally allow absorption of the vitamin B12-intrinsic factor (B12-IF) complex by altering the membrane potential.2 The hydrophobic tail of metformin binds to the hydrocarbon core of the cell membrane, imparting a net positive charge; this, in turn, repels calcium that is necessary for transporting B12 across the ileal-lumen interface.18 The second mechanism details the modification of normal bacterial flora, resulting in bacterial overgrowth and impeded passage of B12-IF into the bloodstream.19 A third pathway describes metformin changing the B12-IF complex by binding to it structurally.19 Each of these potential influences lessens the amount of B12 that passes through the distal ileal wall.13

Though poorly understood, low vitamin B12 levels cause a diminution of the myelin that coats the peripheral nerves, perhaps through the attenuated methylation of myelin, which subsequently disrupts the transmission of action potentials. Nonhomogeneous myelin manifests as peripheral neuropathy.8 Vitamin B12 functions as a coenzyme in the transfer of a methyl group from 5-methyl-tetrahydrofolate to tetrahydrofolate, creating methionine with the enzyme methionine synthase.20 Methionine and adenosine triphosphate are essential in assembling 5-adenosyl methionine, which is the primary methyl donor in the methylation reactions involving amines, proteins, and phospholipids (including sphingomyelin) in the myelin sheath. Thus, a deficiency of B12 leads to diminished methylation in myelin and, subsequently, the development of peripheral neuropathy.20 Once this process occurs, it is extremely difficult to reverse and correct. Low vitamin B12 levels that are symptomatic exhibit a confounding clinical similarity to diabetic peripheral neuropathy.5

Vitamin B12 also functions as a coenzyme that connects lipid to carbohydrate metabolism in the mitochondria by converting methylmalonic acid to succinate through the enzyme methylmalonyl-coenzyme A mutase.20 A deficiency in vitamin B12 can therefore result in symptoms of malaise and fatigue.

Which of the following factors does not negatively affect the absorption of vitamin B12 in patients with T2DM?
A vegetarian diet
Concomitant use of metformin and proton pump inhibitors
Exposure to sunlight
Alcohol consumption

Coexisting factors can affect the absorption of vitamin B12 in patients with T2DM. Patients who are vegetarian are known to be at risk for low vitamin B12 levels because of the absence of protein-bound vitamin B12 in plant-based foods.1 Additionally, the concomitant use of metformin with proton pump inhibitors and/or H2-antagonist medications can cause as much as a 65% and 25% reduction, respectively, in absorption of vitamin B12. This is due to the decrease in gastric hydrochloric acid, which is needed to cleave vitamin B12 from protein that is ingested.4 Similarly, alcohol use can deleteriously influence vitamin B12 levels.5

Until recently, no published guidelines existed regarding the monitoring and supplementation with exogenous cyanocobalamin, the manufactured form of vitamin B12, in patients with T2DM on long-term treatment with metformin.14,21 In 2018, the American Association of Clinical Endocrinologists and the American College of Endocrinology endorsed a comprehensive management algorithm for T2DM that calls for assessing the status of vitamin B12 levels in patients taking metformin and instituting supplementation if neuropathy develops.22

This article originally appeared on Clinical Advisor

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Re: Diabetes news for spring 2019

Harvard Heart Letter
Diabetes? Go nuts to lower your heart risk

Research we're watching

Published: May, 2019
A near-daily serving of nuts may lower the risk of cardiovascular disease in people with type 2 diabetes, new research suggests. The study, published online February 19 by Circulation Researchrelied on diet surveys from more than 16,000 people before and after they were diagnosed with type 2 diabetes, a condition that elevates the risk of heart disease. Researchers asked them about their nut-eating habits over a period of several years. People who ate five servings of nuts per week had a 17% lower risk of cardiovascular disease compared with those who ate less than a serving per week.

Chock full of unsaturated fat, fiber, and minerals, nuts can help control blood sugar, blood pressure, and cholesterol. Tree nuts, which include walnuts, almonds, and pistachios, seemed to offer the strongest benefits in the study. Peanuts, which aren't technically nuts but legumes, weren't quite as healthy. While this study can't prove cause and effect, eating a small handful of unsalted nuts on most days will likely help your heart, even if you don't have diabetes.

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NEW DELHI: Diabetes has reached epidemic proportions in Asia - led by India and China - and has dramatically increased the risk of premature death especially among women and middle-aged people, a significant study has found. 

India and China today have the highest diabetes burdens in the world. 

According to the World Health Organization (WHO), India has close to 62 million people living with the diseases and is projected to have close to 70 million diabetics by 2025. 

Throughout Asia, more than 230 million people are living with diabetes. 

"Given the increased prevalence of obesity and rapid adoption of a westernized lifestyle in Asia, that figure is expected to exceed 355 million by 2040," said the study led by the Vanderbilt University Medical Center in Nashville, Tennessee. 

Want To Keep Diabetes Away? Eat Walnuts, Apples, Carrots

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Foods For Diabetics

14 Nov, 2018
While being active, staying hydrated, and checking blood glucose levels can work wonders, it is important to stick to a dietary plan that will ward off diabetes in the long run. A recent study showed that antioxidant-rich walnuts can nearly halve the risk of developing Type-2 diabetes. For patients, the ideal diabetic diet plan would be to have 1200-1600 calories per day. It is recommended that diabetics should eat good carbs, fats, and healthy proteins, but in small portions. Doctors and dieticians share ultimate list of foods you must consume to  stay healthy. Also read: The comprehensive diabetes guide

The researchers found that patients with diabetes are at a substantially elevated risk of premature death. 

"The risk associated with diabetes is much higher than that reported by most previous studies conducted in the US and Europe," said the study's corresponding author Wei Zheng in a paper reported in the journal JAMA Network Open. 

The Vanderbilt-led research team pooled 22 prospective cohort studies in multiple countries from mainland China to Bangladesh. 

More than one million individuals were followed for an average of 12.6 years. 

Diabetes was associated with a nearly two-fold increase in the risk of death from all causes. 

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If you have already been diagnosed with diabetes, here are 10 things to keep in mind when you travel by air.

"The diabetes-related risk of death from all causes was particularly high for women and patients who were diagnosed with diabetes when they were middle-aged adults," the findings showed. 

This result is particularly relevant for certain racial and ethnic groups in the US, including Asian Americans, who are more susceptible to insulin resistance and are at higher risk of developing diabetes at a relatively lower obesity level than are people of European ancestry. 

"Whether this may increase their risk of premature death once they develop diabetes has not yet been determined," said Zheng. 

Lack of access to diabetes care in Asia may contribute to the unusually higher risk of premature death among diabetes patients in the study, the researchers noted. 

"There is an urgent need to implement diabetes management programmes tailored to Asian populations," they added. 

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Re: Diabetes news for spring 2019

The American Diabetes Association (ADA) published a new guidance report regarding individualization of nutrition goals in diabetes care, including strategies for weight management and the prevention of diabetes complications. For the first time, the updated report also includes nutrition interventions for adults diagnosed with prediabetes.

The panel reviewed more than 600 nutrition manuscripts published between 2014 and 2018 for the update, which has been incorporated into the ADA’s 2019 Standards of Medical Care.

A summary of the consensus recommendations follows.

●        There is no single recommended nutrition plan for patients with diabetes. Factors such as food availability, socioeconomic circumstances, and cultural preferences must be taken into consideration due to the broad spectrum of people affected by diabetes.

●        For people with or at risk for diabetes, evidence does not suggest an ideal caloric carbohydrates, protein, and fat intake. Various combinations of food groups are acceptable.

●        Current eating patterns, metabolic goals, and preferences should be assessed in order to personalize macronutrient distribution.

●        Management of weight was recommended as an essential component of care in people with type 1 diabetes (T1D) who are overweight or obese and subject to worsening of insulin resistance, glycemic variability, microvascular disease complications, and cardiovascular risk factors.

●        The panel emphasized that it is critical to maintain and sustain an eating plan that results in a deficit of energy, regardless of macronutrient composition or eating pattern to promote weight loss.

●        Healthcare providers are advised to focus on important dietary factors such as consuming nonstarchy vegetables; minimizing added sugars and refined grains; and choosing whole, unprocessed foods over processed foods.

●        The panel recommended replacing sugar-sweetened beverages with water when possible. They also noted that replacing sugar with sugar substitutes does not make an unhealthy option healthy.

●        Saturated fat should be replaced with unsaturated fat to reduce low-density lipoprotein cholesterol, total cholesterol, and the risk for cardiovascular disease.

●        Research indicates that reductions in hemoglobin A1c with medical nutrition therapy in type 2 diabetes (T2D) can be equal to or greater than reductions with medications.

●        Medical nutrition therapy can be important in the management and prevention of diabetes complications including gastroparesis, cardiovascular disease, and chronic kidney disease.

●        National data suggest that people with diabetes do not receive any formal diabetes education, so referring adults with T1D or T2D to personalized, diabetes-focused medical nutrition therapy upon diagnosis and throughout life is an imperative component of care.

For patients with prediabetes, the panel made the following recommendations.

● Referral to an intensive behavioral lifestyle intervention program to improve eating habits, increasing physical activity to at least 150 min/wk, and a 7% to 10% loss of initial body weight if indicated.

● Counseling by healthcare providers should focus on prevention and diagnosis and treatment of disordered eating.

William Cefalu, MD, the ADA’s Chief Scientific, Medical, and Mission Officer, stated that the ADA “strongly encourages an individualized approach that includes regular review of nutrition status for all people living with diabetes. Reassessment of an individual’s nutritional plan is particularly important during significant life and health status changes… Working with a team of health providers including a registered dietician or certified diabetes educator is fundamental to effectively manage[ing] diabetes and prediabetes.”

Related Articles

• Metformin Use and Vitamin B12 Deficiency: Managing the Risks
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Re: Diabetes news for spring 2019

To do so, they examined a group of adults, aged 20 to 60. The subjects were required to eat breakfast meals over the course of three days. One meal contained one cup of raspberries, the second contained two cups of raspberries and the last contained no raspberries. The participants had their blood tested after each meal. 

After analyzing the results, they found that those who ate the most raspberries needed less insulin to manage their blood glucose. In fact, those who had two cups of raspberries included in a meal had lower glucose concentrations, compared to those who had no raspberries.

>> Related: Study finds diabetes drug may prevent, slow kidney disease


“People at risk for diabetes are often told to not eat fruit because of their sugar content. However, certain fruits – such as red raspberries – not only provide essential micronutrients, but also components such as anthocyanins, which give them their red color, ellagitannins and fibers that have anti-diabetic actions,” co-author Britt Burton-Freeman said in a statement. “For people who are at risk for diabetes, cardiovascular disease and other health risks, knowing what foods have protective benefits and working them into your diet now can be an important strategy for slowing or reversing progression to disease.”

About 34 percent of American adults were prediabetic in 2015, according to the Centers for Disease Control and Prevention. Patients with prediabetes are more likely to develop Type 2 diabetes, cardiovascular disease, Alzheimer’s disease and other illnesses.


The scientists said their findings are particularly beneficial to individuals who are obese or overweight with prediabetes. 

Related: Skip breakfast? Science says that may increase your Type 2 diabetes risk

They concluded, “a simple inclusion of certain fruits, such as red raspberries with meals, can have glucose lowering benefits with indications of improvements in insulin responses.”

Raspberries could help manage diabetes and prediabetes, according to the results of a new study.
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Diabetes is actually five separate diseases, research suggests



Scientists say diabetes is five separate diseases, and treatment could be tailored to each form.

Diabetes - or uncontrolled blood sugar levels - is normally split into type 1 and type 2.

But researchers in Sweden and Finland think the more complicated picture they have uncovered will usher in an era of personalised medicine for diabetes.

Experts said the study was a herald of the future of diabetes care but changes to treatment would not be immediate.

Diabetes affects about one in 11 adults worldwide and increases the risk of heart attack, stroke, blindness, kidney failure and limb amputation.

Type 1 diabetes is a disease of the immune system, which affects around 10% of people with the condition in the UK. It errantly attacks the body's insulin factories (beta-cells) so there is not enough of the hormone to control blood sugar levels.

Type 2 diabetes is largely seen as a disease of poor lifestyle as body fat can affect the way the insulin works.

The study, by Lund University Diabetes Centre in Sweden and the Institute for Molecular Medicine Finland, looked at 14,775 patients including a detailed analysis of their blood.


The results, published in The Lancet Diabetes and Endocrinology, showed the patients could be separated into five distinct clusters.

  • Cluster 1 - severe autoimmune diabetes is broadly the same as the classical type 1 - it hit people when they were young, seemingly healthy and an immune disease left them unable to produce insulin
  • Cluster 2 - severe insulin-deficient diabetes patients initially looked very similar to those in cluster 1 - they were young, had a healthy weight and struggled to make insulin, but the immune system was not at fault
  • Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and making insulin but their body was no longer responding to it
  • Cluster 4 - mild obesity-related diabetes was mainly seen in people who were very overweight but metabolically much closer to normal than those in cluster 3
  • Cluster 5 - mild age-related diabetes patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder


Prof Leif Groop, one of the researchers, told the BBC: "This is extremely important, we're taking a real step towards precision medicine.

"In the ideal scenario, this is applied at diagnosis and we target treatment better."

The three severe forms could be treated more aggressively than the two milder ones, he said.

Cluster 2 patients would currently be classified as type 2 as they do not have an autoimmune disease.

However, the study suggests their disease is probably caused by a defect in their beta-cells rather than being too fat.

And perhaps their treatment should more closely mirror patients who are currently classed as type 1.

Cluster 2 had a higher risk of blindness while cluster 3 had the greatest risk of kidney disease, so some clusters may benefit from enhanced screening.

Better classification

Dr Victoria Salem, a consultant and clinical scientist at Imperial College London, said most specialists knew that type 1 and type 2 was "not a terribly accurate classification system".

She told the BBC: "This is definitely the future of how we think about diabetes as a disease."

But she cautioned the study would not change practice today.

The study was only on Scandinavians and the risk of diabetes varies considerably around the world, such as the increased risk in South Asians.

Dr Salem said: "There is still a massively unknown quantity - it may well be that worldwide there are 500 subgroups depending on genetic and local environment effects.

"Their analysis has five clusters, but that may grow."

Sudhesh Kumar, a professor of medicine at Warwick Medical School, said: "Clearly this is only the first step.

"We also need to know if treating these groups differently would produce better outcomes."

Dr Emily Burns, from Diabetes UK, said understanding the diseases could help "personalise treatments and potentially reduce the risk of diabetes-related complications in the future".

She added: "This research takes a promising step toward breaking down type 2 diabetes in more detail, but we still need to know more about these subtypes before we can understand what this means for people living with the condition."


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Consumption of propionate, an ingredient that’s widely used in baked goods, animal feeds, and artificial flavorings, appears to increase levels of several hormones that are associated with risk of obesity and diabetes, according to new research led by the Harvard T.H. Chan School of Public Health in collaboration with researchers from Brigham and Women’s Hospital and Sheba Medical Center in Israel.

The study, which combined data from a randomized placebo-controlled trial in humans and mouse studies, indicated that propionate can trigger a cascade of metabolic events that leads to insulin resistance and hyperinsulinemia — a condition marked by excessive levels of insulin. The findings also showed that in mice, chronic exposure to propionate resulted in weight gain and insulin resistance.

The study will be published online today in Science Translational Medicine.

“Understanding how ingredients in food affect the body’s metabolism at the molecular and cellular levels could help us develop simple but effective measures to tackle the dual epidemics of obesity and diabetes,” said Gökhan S. Hotamışlıgil, James Stevens Simmons Professor of Genetics and Metabolism and director of the Sabri Ülker Center for Nutrient, Genetic and Metabolic Research at Harvard Chan School.

The findings indicate that propionate may act as a “metabolic disruptor” that potentially increases the risk for diabetes and obesity in humans.
More than 400 million people worldwide suffer from diabetes, and the rate of incidence is projected to increase 40 percent by 2040 despite extensive efforts to curb the disease. The surging number of diabetes cases, as well as obesity, in the last 50 years indicate that environmental and dietary factors must be influencing the growth of this epidemic. Researchers have suggested that dietary components including ingredients used for preparing or preserving food may be a contributing factor, but there is little research evaluating these molecules.

For this study, the researchers focused on propionate, a naturally occurring short-chain fatty acid that helps prevent mold from forming on foods. They first administered it to mice and found that it rapidly activated the sympathetic nervous system, which led to a surge in hormones, including glucagon, norepinephrine, and a newly discovered gluconeogenic hormone called fatty acid-binding protein 4 (FABP4). This in turn led the mice to produce more glucose from their liver cells, leading to hyperglycemia — a defining trait of diabetes. Moreover, the researchers found that chronic treatment of mice with a dose of propionate equivalent to the amount typically consumed by humans led to significant weight gain in the mice, as well as insulin resistance.

To determine how the findings in mice may translate to humans, the researchers established a double-blinded, placebo-controlled study that included 14 healthy participants. The participants were randomized into two groups: One group received a meal that contained one gram of propionate as an additive and the other was given a meal that contained a placebo. Blood samples were collected before the meal, within 15 minutes of eating, and every 30 minutes thereafter for four hours.

The researchers found that people who consumed the meal containing propionate had significant increases in norepinephrine as well as increases in glucagon and FABP4 soon after eating. The findings indicate that propionate may act as a “metabolic disruptor” that potentially increases the risk for diabetes and obesity in humans. The researchers noted that while the U.S. Food and Drug Administration generally recognizes propionate as safe, these new findings warrant further investigation into propionate and potential alternatives that could be used in food preparation.

“The dramatic increase in the incidence of obesity and diabetes over the past 50 years suggests the involvement of contributing environmental and dietary factors. One such factor that warrants attention is the ingredients in common foods. We are exposed to hundreds of these chemicals on a daily basis, and most have not been tested in detail for their potential long-term metabolic effects,” said Amir Tirosh, associate professor of medicine at Tel Aviv University’s Sackler School of Medicine, director of the Division of Endocrinology at Sheba Medical Center, and research fellow at Harvard Chan School.

Other Harvard Chan School authors included Ediz Calay, Gurol Tuncman, Kathryn Claiborn, Karen Inouye, Kosei Eguchi, and Michael Alcala.

Funding for this study came from National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases grant K08 DK097145, as well as the Nutrition Obesity Research Center at Harvard grant P30-DK040561, the Cardiovascular, Diabetes and Metabolic Disorder Research Center of the Brigham Research Institute, and the Israeli Ministry of Health Research and Fellowship Fund.

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Re: Diabetes news for spring 2019

It may be appealing to think that standing instead of sitting will counter the damage regular, prolonged sitting inflicts on one's overall survival, but it also might be wrong, suggests an analysis based on a large cohort study.

To do that, it further suggests, one would have to replace the sitting time with exercise of at least moderate intensity, and with vigorous-intensity exercise if the goal is to diminish the excess cardiovascular (CV) mortality risk. But even walking seemed to help in the analysis.

When the numbers were crunched a different way, the excess all-cause and CV mortality risks caused by regular, prolonged sitting — 6 or more hours a day — were seen primarily in people who achieved less than 150 minutes per week of physical activity.

The excess risks were substantially countered in those who maintained the lower guidelines-recommended range of physical activity for improving survival, 150 to 200 minutes per week. And they were all but erased for those achieving the higher recommended physical activity range, at least 300 minutes per week.

"The key message from both of those analyses is that even meeting the lower physical activity recommendation seems to somehow offset the risks that come with sitting," Emmanuel Stamatakis, PhD, University of Sydney, Australia, told | Medscape Cardiology.

Those risks "cannot be seen outside the context of physical activity," he said. "Replacing sitting with standing is not enough. We need to be replacing sitting with movement. Even walking may do the trick in the case of all-cause mortality," said Stamatakis, who is lead author on the study published April 22 in the Journal of the American College of Cardiology (JACC).

TV and Computer Time

Opportunities for replacing sitting time with physical activity might well focus on what another research group described as "screen-based sedentary behaviors," that is, on "time spent sitting watching television or videos and computer use outside school or work."

Estimated total sitting time rose significantly for both adolescents and adults in the United States from 2001 to 2016 in an analysis based on the National Health and Nutrition Examination Survey (NHANES), reported April 23 in JAMA.

But the increase didn't occur across the board for all types of screen watching, observed the authors, led by Lin Yang, PhD, University of Calgary, Alberta, Canada. The estimated prevalence of television-viewing sitting time of at least 2 hours a day remained about stable overall throughout the period.

"Meanwhile, the estimated prevalence of computer use during leisure time of 1 h/day or more significantly increased among all age groups, with a more pronounced increase among adults," the group writes.

"The substantial rise in total sitting time among adolescents and adults appears to be attributable to sedentary behaviors other than television or video watching, which was likely driven in part by the observed increases in computer use.