VitaminBlog.com

Healthnotes Newswire (July 24, 2008)—Potatoes, often thought of as just a starch, are actually an important source of potassium; provide modest amounts of calcium, magnesium, phosphorus, and sulfur; and have small amounts of zinc, boron, copper, manganese, and iron. Cooking them reduces their mineral content, however, and a new study found that many of potatoes’ nutritious minerals are lost when they are cut into small pieces and then boiled. More nutritional value can be preserved by cooking them whole.

Heat depletes

In the study, published in the Journal of Food Science, six varieties of potato were washed and peeled, then cut into small cubes or shredded into strips. The potato cubes and strips were either placed in cold water overnight or boiled for ten minutes. Soaking resulted in minimal potassium loss, but boiling the potato cubes cut their potassium content by about 50%. Boiling shredded potatoes cost even more potassium—about 75% was lost. When potatoes in either form were soaked and boiled, the results were the same as when they were only boiled.

Other minerals showed similar trends: about 50% of the shredded potatoes and about 30% of the cubed potatoes lost their original sulfur, magnesium, zinc, and manganese during boiling. The amounts of phosphorus and iron were also significantly lower after boiling. Calcium, copper, and boron content were not consistently affected.

This degree of potassium loss was more dramatic than that seen in previous studies using whole peeled potatoes. Other research has shown that zinc and iron are preserved when the potato is boiled whole with its skin intact.

Why potassium matters

Potassium is necessary for maintaining normal fluid balance, acidity, and heart rhythm, and a healthy body keeps potassium carefully balanced with sodium. Although potassium is abundant in fruits and vegetables, many people don’t get enough from their diets, especially relative to sodium, an imbalance that is linked to high blood pressure.

For people with kidney disease, too much potassium can be more of a concern than too little. Soaking potatoes in cold water before cooking them, known as leaching, is a common practice among people with kidney disease on potassium-restricted diets, but this study’s results suggest that leaching is unnecessary. Simply cutting the potatoes into small pieces and boiling them has the same potassium-depleting effect.

Most of us, however, can and should eat lots of potassium-rich foods, including tomatoes, sweet potatoes, winter squash, avocadoes, oranges, bananas, and, of course, potatoes. “Although cutting potatoes into small pieces is appealing because it reduces cooking time, it is appears that this is not the most nutritious way to prepare them,” said study co-author Dr. Shelley Jansky of the US Department of Agriculture. “People who want to get the most out of their potatoes should boil them whole and unpeeled, or consider other cooking methods like baking or roasting.”

(J Food Sci 2008;75:H80–5)

Healthnotes Newswire (July 24, 2008)—People with type 2 diabetes are more likely to suffer from memory problems, especially right after eating. A new study in Nutrition Research found that taking antioxidant vitamins with food can help people with diabetes offset the memory-robbing effects of a heavy meal.

Putting antioxidants to the test

Diabetes is characterized by higher than normal blood sugar (glucose) levels. Long-term elevations in blood sugar increase the body’s production of free radicals—tissue-damaging compounds that cause many of the complications of diabetes including eye and kidney damage, heart disease, and memory impairment. Eating a meal increases free radical production in the body, and people with diabetes are particularly prone to the negative effects of this sudden rise.

In the new study, 16 adults with diabetes, on separate occasions, were given a high-fat high-carbohydrate meal or the same meal plus 1,000 mg of vitamin C and 800 IU of vitamin E. After eating, they took a series of tests to measure memory capacity.

After eating the test meal alone, the people had a harder time remembering words and information presented to them. Taking antioxidant vitamins with the meal prevented this from happening. “In adults with type 2 diabetes, co-consumption of antioxidant vitamins minimizes meal-induced memory impairment, implicating oxidative stress as a potential contributor to these decrements,” said the study’s authors.

Upgrade your diet for better health and sharper memory

While taking supplements can be useful in the short term, it’s a good idea to eat healthful foods that are naturally rich in antioxidants and other substances known to combat diabetes like fiber, magnesium, and chromium.

• Eat lower-fat meals. Limit packaged and snack foods, and cook foods at home to control the amount of fat, sugar, and other processed ingredients that go into a meal.

• Use unprocessed foods in meal preparation. Skip “white foods” like flour, rice, bread, potatoes, and sugar. Whole grains may be substituted for processed ones; these will not have the same detrimental effects on blood sugar and memory function.

• Focus on antioxidant-rich foods. Great choices include berries, winter squash, cantaloupe, sweet potato, broccoli, tomatoes, oranges, pomegranate, artichoke, red grapes, nuts and seeds, sweet peppers, mango, legumes, whole grains, and dark green leafy veggies (kale, collards, chard).

(Nutr Res 2008;28:423–9)

Healthnotes Newswire (July 24, 2008)—The Journal of the American Medical Association reports that bright light may help improve symptoms caused by dementia such as altered moods, disturbed sleep, and the inability to carry out activities of daily living.

Dementia is a common condition worldwide, and Alzheimer’s disease is its most common form. Dementia impairs a person’s memory and ability to think normally and is often associated with changes in behavior, mood, sleep, and the ability to carry out activities of daily living such as bathing or eating. With few simple remedies available, these symptoms create challenges for people with dementia and their caregivers.

Testing showed some clear improvements

In this study, 189 elderly people with Alzheimer’s or other types of dementia were randomly assigned to receive bright light (indirect, ceiling-mounted, whole-day bright light), melatonin (2.5 mg per day), a combination of bright light and melatonin, or neither melatonin nor bright light. Treatments were given daily for an average of 15 months.

When compared with other treatments or no treatments, bright light was associated with no worsening of mental status, an improvement in depressive symptoms, and improved functioning. Melatonin alone improved the ability to fall asleep earlier and increased sleep duration but had an adverse effect on behavior and mood, and increased withdrawn behavior. Bright light plus melatonin improved sleep disturbances, improved agitated behavior and restlessness during sleep, and decreased the duration of awakenings during sleep.

The study’s authors concluded, “The simple measure of increasing the illumination level in group care facilities ameliorated symptoms of disturbed cognition, mood, behavior, functional abilities and sleep. Melatonin improved sleep, but its long-term use by elderly individuals can only be recommended in combination with light to suppress adverse effects on mood.”

People with dementia need structure and safety

Caring for a person with dementia can be challenging, but the following tips may help make it easier:

• It is important for caregivers to work closely with people who are highly trained and familiar with the specific challenges of dementia, such as geriatricians and/or social workers. These professionals can educate caregivers about ways to improve symptoms and keep a person with dementia safe from harming themselves or others. Medications may help improve symptoms or slow the condition’s progression, but many needed changes are often behavioral or environmental.

• A structured, supervised environment is important for people with moderate to severe dementia who cannot care for themselves. A stimulating and caring environment can help them stay active and functional for a longer period of time.

• Consider the following safety precautious if you are caring for someone with dementia: lock doors so that he or she cannot leave the house unsupervised and get lost; keep car keys in an inaccessible place; and put safety latches on appliances such as ovens. It is also a good idea to get a medical alert bracelet for the person under your care to wear.

(JAMA 2008;299:2642–55)

Healthnotes Newswire (July 17, 2008)—Everyone knows that fish is good for you, but it turns out that some is better than others for certain health needs and goals.

A new study, published in the Journal of the American Dietetic Association, analyzed 30 species of wild and farmed fish and found that while wild fish is generally more healthful than farm-grown, fish such as salmon and trout still maintain a beneficial fatty acid profile. Other farmed fish, such as talapia, do not, so while these may be incorporated into a regular diet as an occasional inexpensive, low-fat protein source, people wanting to maximize disease-fighting health benefits from fish will opt in favor of those with a better balance of fatty acids.

The ratio is the real measure of risk

A wealth of research shows that eating fish rich in omega-3 fatty acids may help prevent and treat diseases such as heart disease, diabetes, inflammatory and autoimmune diseases, and some cancers. However evidence increasingly points to the ratio of omega-3 to the less discussed omega-6 fatty acids in the diet as the indicator of disease risk.

• Fish with an omega-3 to omega-6 ratio of greater than one are considered beneficial because of their effect on the fatty acid profile of the entire diet.

• Fish with a ratio of 0.5 or lower are considered not protective against disease.

As a polyunsaturated fat, omega-6 also plays a role in supporting health, as long as it is consumed in moderation.

The best fish for fending off disease

The authors of the study collected samples of commonly eaten fish—including tuna, snapper, mahi-mahi, cod, sole, halibut, haddock, talapia, swordfish, catfish, salmon, and trout—from distributors in the US and Chile, from fish farms in the US, Chile, Canada, Ecuador, Honduras, Norway, and New Zealand, and from supermarkets in the US. Some highlights of their findings include:

• Sockeye salmon, Coho salmon, Copper River salmon, and farmed rainbow trout had a beneficial fatty acid pattern—in other words, a high ratio of omega-3 to omega-6 fatty acids.

• Farm-raised Atlantic salmon had high levels of omega-3 fatty acids but their levels of omega-6 fatty acids were higher than those of the wild salmon, making their ratio slightly less favorable, though still healthy.

• Tuna, one of the most commonly eaten fish in the US, had a low level of omega-3 fatty acids, but it also had a low omega-6 level, so its ratio remained favorable.

• On the other end of the spectrum, farmed talapia and catfish had low levels of omega-3 and poor ratios of omega-3 to omega-6 fatty acids.

Balancing factors besides fatty acids also important

Of all the fish reviewed in this study, tilapia has received the most attention for its unfavorable fatty acid content. “All other nutritional content aside, the inflammatory potential of hamburger and pork bacon is lower than the average serving of farmed tilapia,” the article cautions. However, keep in mind that a fish not being highly protective against heart disease does not mean it needs to be avoided entirely. Other health factors, such as heavy metal contamination—which are high in otherwise healthful fatty fish like tuna, but low in less heart-healthy fish like tilapia—should also be taken into account.

To give the pros and cons of fish consumption some real world perpective, consider that eating moderate amounts of farmed tilapia is roughly equivalent to other staples of the average diet, and may be a reasonable option for some people. For those at risk for inflammatory diseases such as heart disease, fish with a good omega-3 to -6 ratio such as salmon or trout are the best choice.

(J Am Diet Assoc 2008;108:1178–85)

Healthnotes Newswire (July 17, 2008)—A new study has shown that education, combined with healthy behaviors such as eating fruits and vegetables each day, exercising, and keeping a food diary, are key ingredients for maintaining weight loss. While it is well known that such behaviors can help a heavy person lose weight, few large studies have looked at behavioral interventions for keeping weight off, which is critical for overweight people with high blood pressure or high cholesterol.

Healthy habits are key

The study, known as the Weight Loss Maintenance Trial, compared various strategies for maintaining weight loss over a 30-month period. All 1,684 participants were 25 years or older and were overweight or obese and taking medication for high blood pressure and/or high cholesterol. Each participant was encouraged to attend 20 weekly group educational sessions, restrict calories, use a daily food diary, exercise daily at a moderate to intense level, and follow the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, and low-fat dairy foods, and limits saturated fat, total fat, and cholesterol.

After two and a half years, people who lost the most weight (18.7 pounds [8.5 kg] or more) had, on average, attended more weekly educational sessions (15), exercised more (159 minutes per week), kept more food diary records (4.2 records per week), and eaten more fruits and vegetables (3.6 servings per day).

“A combined emphasis on dietary intake and physical activity is important to both short- and long-term weight loss goals,” said the study’s author, Jack Hollis, PhD, from the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. “Behavioral strategies to modify these health behaviors are important components of weight-loss interventions because they emphasize the individual’s ability to monitor and regulate behavior, and target the barriers to both initial weight loss and long-term maintenance.”

Smart slimming strategies

People with high blood pressure, high cholesterol, and diabetes are at high risk for cardiovascular diseases such as stroke or heart attack, but weight control can help prevent and treat these conditions. There is no quick fix for losing weight or maintaining weight loss. If you are overweight, start by eating right, exercising, keeping stress in check and seeing your doctor.

Here are some tips for losing weight and keeping it off:

• Eat an abundance of fruits and vegetables based on recommendations from your healthcare provider. Limit saturated fat and sugar and avoid “empty” calories that provide little or no nutrition such as some processed foods, snacks, and beverages.

• Get enough exercise. A report from the Institute of Medicine suggests that adults need 60 minutes of moderate physical activity every day in order to optimize health and prevent disease; children need a minimum of 90 minutes.

• Keep a diary to track your daily food and calorie intake and help you learn how to identify eating patterns and make healthy choices throughout the day.

• Join a support group for health lifestyle behaviors or share the experience with friends and family, which can help improve your chances for success.

(Am J Prev Med 2008;35:118–26)

Healthnotes Newswire (July 17, 2008)—If you are chronically tired, getting moving might be just the thing to put some pep in your step. A new study has found that exercise can improve energy and lessen feelings of tiredness in people who suffer from persistent fatigue.

The effects of exercise on people with certain chronic medical conditions (heart disease and cancer, for example) are well documented, but less is known about its role in improving stamina in people suffering from fatigue without an underlying disease. The new study aimed to determine how exercise affects feelings of fatigue and energy in young people with fatigue unrelated to a medical condition.

In the study, published in Psychotherapy and Psychosomatics, 36 sedentary people with persistent fatigue ranging in age from 18 to 35 were assigned to a low- or moderate-intensity exercise group, or to a no-treatment control group. The low-intensity group worked out on a stationary bicycle at 40% of their peak oxygen consumption (roughly equivalent to walking at a leisurely pace) and the moderate intensity group at 75% of their peak oxygen consumption (about the same as walking at a fast pace), for 30 minutes three times per week for six weeks.

Slow and steady the best bet for persistent fatigue

People in the low- and moderate-intensity exercise groups had a 20% improvement in energy levels after six weeks compared with levels at the beginning of the study. Low-intensity exercise decreased feelings of fatigue by 65%, compared with 49% in the moderate-intensity group. The changes in fatigue and energy levels were unrelated to changes in aerobic fitness. The authors suggested that energy and fatigue improvements are due to the direct effects of exercise on the central nervous system.

Exercise professionals agree

“I have found that maintaining a consistent exercise routine keeps me feeling well balanced and energized,” says Rachel Weisz-Nesshoever, Aerobic and Fitness Association of America certified group exercise instructor in Narragansett, Rhode Island. “Exercise has a way of lifting the spirits and combating fatigue. Sometimes people who are chronically tired tend to avoid exercising. What they don’t realize is that—if it’s done right—exercise can actually give you more stamina and energy to do the things you want to do.”

(Psychother Psychosom 2008;77:167–74)

Healthnotes Newswire (July 10, 2008)—Good news for your little juice lovers: Although several studies have suggested that drinking fruit juice might contribute to overweight in children, a review of 21 studies found that the link was not strong. “There is no systematic association between consumption of 100% fruit juice and overweight in children and adolescents,” said the study’s authors in the American Journal of Lifestyle Medicine.

The origins of overweight

While genetics play a role, diet and exercise patterns are also intimately involved in maintaining healthy weight. In a previous study, one researcher found that children who drank more than 12 ounces of fruit juice per day were more likely to be overweight than children who drank less juice. Since juice is the drink of choice for many youngsters, the new study compiled evidence from studies concerning juice consumption and overweight in children to try to answer the question: Does drinking juice make kids fatter?

Only 6 of the 21 studies reviewed found a relationship between drinking 100% fruit juice and overweight in children, none of which were based on a nationally representative sample. Those that found a relationship did so only in adolescent girls and children who were overweight to begin with. The other 15 studies—5 of which were based on nationally representative samples—found no relationship between drinking juice and becoming overweight.

The authors concluded, “The data do support consumption of 100% fruit juice in moderate amounts and suggest that consumption of fruit juice may be an important strategy to help children meet the current recommendations for fruit.”

“As the mother of one child who wants nothing to do with juice, and another who would drink it all day long, it is a relief to read this new study. I feel like it’s one less thing for me to stress about as a mom,” said Erin Goodman, founder of the Rhode Island Birth Network.

The importance of addressing obesity

According to the 2003-2004 National Health and Nutrition Examination Survey (NHANES), 17% of all children and adolescents are overweight. Among 2 to 5 year olds, the prevalence increased from 7 to 14% between 1988 and 2004; similar increases were seen among 6- to 19-year-olds in this time span, with an increase in the percentage of overweight children from 11 to 19%.

Says Dr. Matthew Baral, medical director of Hamilton Elementary School Clinic in Phoenix, “Eating the whole fruit is preferable to the juice, since the release of sugar in the bloodstream is somewhat blunted by the fiber in whole fruit. When consuming juice, dilute it with water to lessen the amount of sugar the child is getting.”

Help your child maintain a healthy weight

Here are some simple things that parents can do to help keep kids’ weight in a healthy range:

• Snack on fruits and veggies—Make a big fruit salad on the weekend; store in the fridge and eat all week. Keep ready-to-eat cut-up vegetables on hand for quick snacks. Baby carrots, snap peas, broccoli, and cauliflower are easy to eat on the go.

• Get moving in your free time—Set a positive example by making exercise a priority for the whole family.

• Limit TV time—Kids who watch more TV or eat while watching TV are more likely to become overweight.

• Avoid processed foods—Packaged snacks can contain hidden fats and sugar. Opt for home-baked goods to satisfy the urge to snack.

(AJLM 2008;doi:10.1177/1559827608317277)

Healthnotes Newswire (July 10, 2008)—For children with hyperactivity, eliminating food additives should be part of a standard treatment program, according to Andrew Kemp, MD, author of an editorial in the British Medical Journal and professor of pediatric allergies and immunology in Sydney, Australia. Despite the lack of agreement on the effect of dietary modifications on hyperactivity in children, increasing evidence suggests that eliminating food preservatives and artificial colorings from a child’s diet may help.

The roots of hyperactive behavior

When a child is hyperactive, parents and health professionals often look at a variety of factors that may be contributing to the child’s behavior, such as stress in the home or school environment, divorce, death of a loved one, and certain medical or psychiatric conditions. But something as simple as a child’s diet may also play a role. In fact, increasing scientific evidence suggests that food additives may increase hyperactivity in some children.

A study published in the Lancet found that artificial colors and/or sodium benzoate preservative in the diet led to increased hyperactivity in three-, eight-, and nine-year-old children who did not have attention deficit–hyperactivity disorder (ADHD). The study noted that food additives may increase hyperactivity in some children but not in others.

Various experts have weighed in about the impact of such additives on childhood hyperactivity. Dr. Kemp notes that a panel from the European Food Safety Authority acknowledged, after reviewing 22 studies and two meta-analyses from 1975 to 1994, that research provides evidence that food additives and colorings may affect activity and attention in children. However, a recent review of treatment for ADHD by the American Academy of Pediatrics Subcommittee did not review dietary modification as a treatment but supported stimulant medications.

Treatment options: drugs, behavioral therapy, diet—and ditching food additives

Currently, specific treatments for hyperactivity may include drugs, behavioral therapy, and dietary changes. Eliminating food additives is often regarded as an “alternative” rather than standard treatment for ADHD even though research has supported both drug therapy and dietary modifications, according to Dr. Kemp.

In advocating for diet modification as standard treatment, Kemp says, “In view of the relatively harmless intervention of eliminating colorings and preservatives, and the large numbers of children taking drugs for hyperactivity… an appropriately supervised and evaluated trial of eliminating colorings and preservatives should be part of standard treatment for individual children.”

Tips for parents

Parents with a hyperactive child may discuss these types of questions with their healthcare provider:

• Is increased stress causing the behavior? A divorce, loss, a move to another neighborhood, increased school workload, competitive activities, and many other factors can contribute to a change in your child’s behavior.

• Is your child getting enough exercise? A child may be labeled as “hyperactive” when in fact he or she is merely in need of more physical activity.

• Does your child have a supportive and nurturing environment at school that encourages individual learning styles? Again, a child may be labeled “hyperactive” if he or she does not conform to typical classroom standards.

• Any child with a significant change in behavior or persistent disruptive behavior should be evaluated by a physician to determine whether or not there is a medical cause. Evaluation by a physician or psychologist who is specifically trained in the area of hyperactivity may be helpful.

• Ask a physician or nutritionist who is aware of the effects of dietary factors on hyperactivity for suggestions in treating the behavior. Consider the role that food additives may be playing, and look for more fresh, unprocessed foods to enjoy with your family.

(BMJ 2008;336:1144; Lancet 2007;370:1560–67)

Healthnotes Newswire (July 10, 2008)—When applied to the skin, honey may help prevent and treat skin diseases caused by bacteria, according to a new study published in Clinical Infectious Diseases. As the number of antibiotic-resistant infections increases, alternative solutions are needed for infections.

Some research has already demonstrated that honey may help with wound healing. In the new study, Revamil, a medical-grade honey, was effective in killing or reducing many types of bacteria on the skin of healthy volunteers, including bacteria that are susceptible to or resistant to antibiotics.

Compared with the control group, bacteria on the forearm were reduced 100-fold after honey was applied for two days, and more than 80% of the honey-treated skin patches showed no evidence of bacteria compared with only 21% of the control patches. Test tube studies also showed that within 24 hours honey killed all antibiotic-resistant and -susceptible strains of Staphylococcus aureus, Staphylococcus epidermis, Enterococcus faecium, Escherichia coli, Pseudomonas aeruginosa, Enterobacter cloacae, and Klebsiella oxytoca.

The study’s authors commented that since very few new antibiotics are being developed, alternative solutions are needed. Honey, they said, could be helpful in treating wound infections and in preventing infection at skin sites where bacteria are likely to thrive, such as catheter sites in ill patients. Further research is needed to understand the potential role of medical-grade honey in preventing and treating skin infections.

Honey may kill or suppress bacteria growth because of its high sugar content, high acid content, natural production of hydrogen peroxide, or because of other actions related to flower or bee components. Though the authors warn that pulling a jar of honey off of the shelf to treat skin infections may not get the job done (Revamil is produced in a greenhouse under standardized conditions), evidence from other studies suggests that raw, unprocessed honey may be effective.

(Clin Infect Dis 2008;46:1677–82)

Healthnotes Newswire (July 3, 2008)—It’s well known that vitamin D is needed for proper bone growth in children and general bone health in children and adults, but it appears that adolescents worldwide are vitamin D deficient, and that current recommendations for daily D may not be enough for health and disease prevention. The good news: a recent study finds that giving teens higher amounts of vitamin D can raise them to healthy levels after one year of treatment.

The value of the “sunshine vitamin”

Vitamin D deficiency may lead to abnormal bone growth and development and to the development of chronic diseases in adulthood such as osteoporosis, cancer, and multiple sclerosis, and research suggests that the recommended daily intake of 200 IU of vitamin D may not be enough to prevent deficiency. The authors of this new long-term study suggest that a vitamin D blood level of 30 ng/ml (measured as 25-hydroxyvitamin D) is desirable based on expert recommendations, but many people have much lower levels. They tested a higher dose of vitamin D to see if it was safe for teens and effective in raising vitamin D levels.

In the study, 340 students, ages 10 to 17, were randomly assigned to take low-dose vitamin D3 (1,400 IU per week), high-dose vitamin D3 (14,000 IU per week), or placebo. After one year of treatment, adolescents who received the high-dose vitamin D had significantly higher blood levels (average, 38 ng/ml of 25-hydroxyvitamin D) compared with the levels in the low-dose vitamin D (17 ng/ml) and placebo groups (16 ng/ml).

The authors claim that vitamin D deficiency “is prevalent in children and adolescents worldwide.” They add that the high worldwide prevalence of vitamin D deficiency, the fact that many adult diseases begin in childhood because of vitamin deficiencies, and increasing evidence for the safety of higher doses of vitamin D should prompt a change in the current recommendations for an adequate daily amount. More research is needed to determine the safety of taking higher daily doses of vitamin D and to determine optimal levels for health and disease prevention.

Get your daily D

A person gets vitamin D several ways:

• Modest sun exposure (approximately 20 minutes per day)—people who get very little sun exposure, such as those who live in cloudy climates and at northern latitudes, may need to rely on diet and supplements to achieve adequate vitamin D levels

• Supplements such as vitamin D3 and cod liver oil—1 teaspoon of some brands provides 400 IU of natural vitamin D

• Some foods and beverages—fortified milk and cereal, fatty fish such as salmon and mackerel, and, to a lesser extent, eggs, beef, some cheeses, and other foods

According to the American Academy of Dermatology, most people get the current recommended amounts of vitamin D through incidental sun exposure. They recommend using sunscreen when outdoors in the sun and obtaining needed amounts of vitamin D through foods and supplementation. However, for those not likely to take supplements or deliberately get enough D in the diet, it is important to weigh the risks and benefits of sun exposure against your risks for bone disease and other health issues. Talk to your doctor about your vitamin D needs and what combination of sources might be best for you.

(J Clin Endocrin Metab 2008:doi:10.1210/jc.2007-2530)