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Covid-19: Up to £10,000 fine for failure to self-isolate in England
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Category Archives: Nutrition
Declining Vibrational Mismatches
Do you ever get invitations that are vibrationally (or emotionally) out of sync with what you’d like to experience?
Do you get invited to boring events when you’re in the mood for some excitement?
Do you get invited to tediously slow experiences when you’d prefer faster pacing?
Do you get invitations that feel obligatory when you find freedom and flexibility more appealing?
Do you get sucked into disempowering invitations (like a pity party or whinefest) when you’re shifting into empowerment mode?
Why does this happen? Why do you get invitations like this?
The answer is pretty simple: You haven’t seriously opted out of them. You haven’t educated people to stop sending you those invites. People are inviting you because you’re letting them invite you.
During my 20s I used to get plenty of misaligned invitations. People would invite me to events that seemed disempowering, obligatory, slow, boring, tedious, and blah. The problem was that I kept saying yes to them. Even begrudgingly I’d still agree to show up now and then. I’d endure the events. I’d tolerate the invites. I trained people to feel okay with continuing to invite me or to feel entitled to obligate me.
At some point I finally realized how foolish that was and that it was just going to be endless if I didn’t make some changes. If I was running this ridiculous pattern in my 20s, I’d still be doing it in my 30s, 40s, and beyond if I didn’t cut it loose. So I updated expectations, first for myself and then by communicating them to others. I opted out of those mismatched invitations.
I prepared myself for a negative response, figuring it would eventually blow over and then I’d be free. All I needed to do was to get my message across. I didn’t need to get into long-winded explanations about it afterwards. And I didn’t need to own other people’s reactions.
And guess what happened? At first people squawked a little bit. And then they stopped inviting me – no more invites to hours-long boredomfests, no more obligatory rituals, no more disempowerment galleries to attend.
How long did it take? Oh… five or ten minutes to write an email and click send. Maybe I did that more than once for different people and situations.
How long does it take to write something like this?
After giving it some thought, I realize that these kinds of invitations are a mismatch for me. So I’d appreciate it if you wouldn’t send me more invites like this. I appreciate that you’re thinking of me and would like to spend time together. I just don’t feel aligned with engaging in these kinds of experiences. Hope you understand.
That’s a very basic version, so of course you can embellish with more details if you want.
When you opt out from misaligned invites, you can finally invest in doing what it takes to get yourself invited to aligned experiences. You’ll want something to replace that emptiness. You can seek out playful, fun, ambitious, purposeful, and growth-oriented invites – or whatever appeals to you.
Now it’s hard to remember getting the kinds of misaligned invites that used to be plentiful in my 20s. People just gave up – because I instructed them to give up. Even if they continued for a while, I had already moved on and wasn’t planning to show up, so sooner or later they were going to surrender to that fact. That’s the key – people will usually surrender when they can sense your certainty.
Which is better? To show up grudgingly to misaligned experiences, not being fully present and wishing you were somewhere else? Or to show up with gratitude, appreciation, excitement, and positive anticipation for an experience you’re eager to share with people? Which is more caring and compassionate? Which is more intelligent?
Which type of invitations are you currently getting? You know why you’re getting them. And you know what to do to change them if you want.
Go where your appreciation wants to go. Leave the misaligned invitations in the past, so your present and future can be rich in aligned ones.
Pets linked to maintaining better mental health and reducing loneliness during lockdown, new research shows
Sharing a home with a pet appeared to act as a buffer against psychological stress during lockdown, a new survey shows.
Most people who took part in the research perceived their pets to be a source of considerable support during the lockdown period (23 March — 1 June, 2020).
The study — from the University of York and the University of Lincoln — found that having a pet was linked to maintaining better mental health and reducing loneliness. Around 90 per cent of the 6,000 participants who were from the UK had at least one pet. The strength of the human-animal bond did not differ significantly between species with the most common pets being cats and dogs followed by small mammals and fish.
More than 90 per cent of respondents said their pet helped them cope emotionally with the lockdown and 96 per cent said their pet helped keep them fit and active.
However, 68 per cent of pet owners reported having been worried about their animals during lockdown, for example due to restrictions on access to veterinary care and exercise or because they wouldn’t know who would look after their pet if they fell ill.
Lead author, Dr Elena Ratschen from the Department of Health Sciences University of York said: “Findings from this study also demonstrated potential links between people’s mental health and the emotional bonds they form with their pets: measures of the strength of the human-animal bond were higher among people who reported lower scores for mental health-related outcomes at baseline.
“We also discovered that in this study, the strength of the emotional bond with pets did not statistically differ by animal species, meaning that people in our sample felt on average as emotionally close to, for example, their guinea pig as they felt to their dog.
“It will be important to ensure that pet owners are appropriately supported in caring for their pet during the pandemic.”
Co-author, Professor Daniel Mills from the School of Life Sciences at the University of Lincoln said: “This work is particularly important at the current time as it indicates how having a companion animal in your home can buffer against some of the psychological stress associated with lockdown. However, it is important that everyone appreciates their pet’s needs too, as our other work shows failing to meet these can have a detrimental effect for both people and their pets.”
Dr Ratschen added: “While our study showed that having a pet may mitigate some of the detrimental psychological effects of the Covid-19 lockdown, it is important to understand that this finding is unlikely to be of clinical significance and does not warrant any suggestion that people should acquire pets to protect their mental health during the pandemic.”
More than 40% of UK households are estimated to own at least one pet.
The study also showed that the most popular interaction with animals that were not pets was birdwatching. Almost 55 per cent of people surveyed reported watching and feeding birds in their garden.
The paper, “Human-animal relationships and interactions during the Covid-19 lockdown phase in the UK: investigating links with mental health and loneliness” is published in the journal PLOS ONE.
Story Source:
Materials provided by University of York. Note: Content may be edited for style and length.
Carriers of two genetic mutations at greater risk for illness and death from COVID-19
Tel Aviv University researchers suggest that carriers of the genetic mutations PiZ and PiS are at high risk for severe illness and even death from COVID-19. These mutations lead to deficiency in the alpha1-antitrypsin protein, which protects lung tissues from damage in case of severe infections. Other studies have already associated deficiency in this protein with inflammatory damage to lung function in other diseases.
The study was led by Prof. David Gurwitz, Prof. Noam Shomron, and MSc candidate Guy Shapira of TAU’s Sackler Faculty of Medicine, and published in The FASEB Journal on September 22, 2020.
The researchers analyzed data from 67 countries on all continents. Comparisons revealed a highly significant positive correlation between the prevalence of the two mutations in the population and COVID-19 mortality rates (adjusted to size of the population) in many countries, such as the USA, the UK, Belgium, Spain, Italy, and more.
Consequently, the researchers suggest that these mutations may be additional risk factors for severe COVID-19. They now propose that their findings should be corroborated by clinical trials, and if validated should lead to population-wide screening for identifying carriers of the PiS and/or PiZ mutations. Such individuals should then be advised to take extra measures of social distancing and later be prioritized for vaccination once vaccines are available. According to the researchers, these steps can be effective in reducing COVID-19 morbidity and fatality rates.
[Editor’s note: Please see the paper, referenced below, for precise figures of mutation and mortality rates.]
Prof. Gurwitz, Prof. Shomron, and Shapira conclude, “Our data analysis reveals a strong correlation between these mutations and severe illness and death from COVID-19. We call upon the research community to test our hypothesis against clinical data, and also call upon decision makers in every country to conduct population-wide screening for identifying mutation carriers and prioritize them for vaccination once COVID-19 vaccines have been approved. In the meantime, carriers should be notified that they may belong to a high-risk group and advised to maintain strict social isolation.”
Story Source:
Materials provided by American Friends of Tel Aviv University. Note: Content may be edited for style and length.
Last-resort life support option helped majority of critically ill COVID-19 patients survive
It saved lives in past epidemics of lung-damaging viruses. Now, the life-support option known as ECMO appears to be doing the same for many of the critically ill COVID-19 patients who receive it, according to a new international study.
The 1,035 patients in the study faced a staggeringly high risk of death, as ventilators and other care failed to support their lungs. But after they were placed on ECMO, their actual death rate was less than 40%. That’s similar to the rate for patients treated with ECMO in past outbreaks of lung-damaging viruses, and other severe forms of viral pneumonia.
The new study published in The Lancet provides strong support for the use of ECMO — short for extracorporeal membrane oxygenation — in appropriate patients as the pandemic rages on worldwide.
It may help more hospitals that have ECMO capability understand which of their COVID-19 patients might benefit from the technique, which channels blood out of the body and into a circuit of equipment that adds oxygen directly to the blood before pumping it back into regular circulation. Small studies published early in the pandemic had cast doubt on the technique’s usefulness.
Still, the international team of authors cautions that patients who show signs of needing advanced life support should receive it at hospitals with experienced ECMO teams, and that hospitals shouldn’t try to add ECMO capability mid-pandemic.
Global cooperation to achieve results
The study was made possible by a rapidly created international registry that has given critical care experts near real-time data on the use of ECMO in COVID-19 patients since early in the year.
Hosted by the organization called ELSO, for Extracorporeal Life Support Organization, the registry includes data submitted by the 213 hospitals on four continents whose patients were included in the new analysis. The paper includes data on patients age 16 or older who were started on ECMO between January 16 and May 1, and follows them until death, discharge from the hospital, or August 5, whichever occurred first. The team will present the findings at the ELSO Annual Meeting on Sept. 26.
“These results from hospitals experienced in providing ECMO are similar to past reports of ECMO-supported patients, with other forms of acute respiratory distress syndrome or viral pneumonia,” says co-lead author Ryan Barbaro, M.D., M.S., of Michigan Medicine, the University of Michigan’s academic medical center. “These results support recommendations to consider ECMO in COVID-19 if the ventilator is failing. We hope these findings help hospitals make decisions about this resource-intensive option.”
Co-lead author Graeme MacLaren, MBBS, of the National University Health System in Singapore, notes, “Most centers in this study did not need to use ECMO for COVID-19 very often. By bringing data from over 200 international centers together into the same study, ELSO has deepened our knowledge about the use of ECMO for COVID-19 in a way that would be impossible for individual centers to learn on their own.”
Insights into patient outcomes
Seventy percent of the patients in the study were transferred to the hospital where they received ECMO. Half of these were actually started on ECMO — likely by the receiving hospital’s team — before they were transferred. This reinforces the importance of communication between ECMO-capable hospitals and non-ECMO hospitals that might have COVID-19 patients who could benefit from ECMO.
The new study could also help identify which patients will benefit most if they are placed on ECMO.
“Our findings also show that mortality risk rises significantly with patient age, and that those who are immunocompromised, have acute kidney injuries, worse ventilator outcomes or COVID-19-related cardiac arrests are less likely to survive,” continues Barbaro, who chairs ELSO’s COVID-19 registry committee and provides ECMO care as a pediatric intensive care physician at U-M’s C.S. Mott Children’s Hospital. “Those who need ECMO to replace cardiac function as well as lung function also did worse. All of this knowledge can help centers and families understand what patients might face if they are placed on ECMO.”
“The lack of reliable information early in the pandemic hampered our ability to understand the role of ECMO for COVID-19,” says co-senior author Daniel Brodie, M.D., of New York Presbyterian Hospital. “The results of this large-scale international registry study, while hardly definitive evidence, provide a real-world understanding of the potential for ECMO to save lives in a highly selected population of COVID-19 patients.” Brodie shares senior authorship with Roberto Lorusso, M.D. of the Maastricht University Medical Center in the Netherlands and Alain Combes, M.D. of Sorbonne University in Paris.
A robust statistical approach
Because the ELSO database does not track what happens to patients once they are discharged to home, other hospitals, and long-term acute care or rehabilitation facilities, the study used a statistical approach based on in-hospital mortality up to 90 days after the patient was put ECMO. This also allows the team to account for the 67 patients who were still in the hospital as of August 5, whether they were still on ECMO, in the ICU or in step-down units.
Philip Boonstra, Ph.D., of the U-M School of Public Health, helped design the study using a “competing risk” approach, based on his experience handling the statistical design and analysis of long-term data from clinical trials for cancer.
“We used 90-day in-hospital mortality because this is the highest-risk period, and because it allows us to use the information we have to the fullest, even if we don’t know the final outcome for every patient,” he says.
Having data through August, when only a small number of the patients in the study remained in the hospital, was important — though data are missing on a small number of patients. And even though patients who were discharged to their homes or a rehabilitation facility will likely have a long recovery ahead after the intensive level of care involved in ECMO, they are likely to survive based on past data. However, the fate of those who went to LTAC facilities, which provide long-term care at a near-ICU level, is less certain.
More about the study and next steps
More than half of the patients in the study were treated in hospitals in the United States and Canada, including Michigan Medicine’s own hospitals. U-M’s Robert Bartlett, M.D., emeritus professor of surgery and a co-author of the new paper, is considered a key figure in the development of ECMO, including the first use in adults in the 1980s. Bartlett led the development of the initial guidance for the use of ECMO in COVID-19.
“ECMO is the final step in the algorithm for managing life-threatening lung failure in advanced ICUs,” says Bartlett. “Now we know it is effective in COVID-19.”
As of August 5, 380 of the patients in the study had died in the hospital, more than 80% of them within 24 hours of a proactive decision to discontinue ECMO care because of a poor prognosis. Of the remaining patients 57% had gone home or to a rehabilitation center (311 patients); had been discharged to another hospital or a long-term acute care center (277 patients). The rest were still in the hospital but had reached 90 days after start of ECMO.
The new study adds to the information used to create the ECMO COVID-19 guidelines published by ELSO, which is in part based on past randomized controlled trials of ECMO’s use in ARDS.
Barbaro and others are studying the longer-term effects of ECMO care for any patient; he leads a team that has recently received a National Institutes of Health grant for a long-term study of children who have survived after treatment with ECMO.
Meanwhile, the ELSO registry continues to track the care of patients placed on ECMO because of COVID-19. Christine Stead, the chief executive officer of ELSO, credits the rapid pivot and intense teamwork among ECMO centers and their staff for the strength of the new paper.
“We started with a WeChat dialogue with teams in China, who were able to share knowledge and help their counterparts in Japan be ready for the spread to their country,” she says. “We asked all the centers that take part in ELSO to change their practice, and begin entering data about patients as soon as they were placed on ECMO, rather than waiting until they were discharged from the hospital. This has allowed us to achieve something that will help hospitals make more informed decisions, based on meaningful data, as the pandemic continues.”
Advancing Your Goals and Your Processes
As we’re coming to the end of the third quarter of 2020, how are you feeling about the progress you’ve made during the last three months? Are you satisfied or dissatisfied? Or do you have mixed feelings?
I like to review each closing quarter to reflect on what I actually got done. Usually I’m pleased when I see what I completed and experienced. This is relatively easy for me since I habitually maintain a log of accomplishments and experiences on a quarter-by-quarter basis, so I review this list at the end of each quarter. I find it more useful to compare one quarter’s progress to the previous quarter instead of measuring progress against my actual goals. Then I can see if I’m improving quarter by quarter.
After this little review, I look ahead to the next quarter and think about what I’d like to experience next. Several days ago I set my goals for the fourth quarter of this year, so I can start thinking about them well before the quarter begins.
One feeling I have about the upcoming quarter is that it’s time to advance. The past quarter involved a lot of small projects, and in the new quarter I’m ready for bigger ones. The two big ones are to create and publish a new deep dive course on creative productivity and to write the first draft of a novel.
I’ve created courses before but never on this particular topic. I’ve never written a novel before. So these are both advancement goals. Just engaging with them involves stepping into new territory.
I love advancement goals because they aren’t just more of the same. They stretch our characters. They dance with risk. They require exploration and experimentation. And they deliver such a sweet sense of accomplishment afterwards.
With advancement goals I find it particularly important to frame them carefully. The process of achieving them is at least as important as the end result. I want the process of advancement to feel wondrous and rewarding, like Indiana Jones exploring a new temple in search of hidden treasures.
So the advance isn’t just about reaching the end goal. It’s important to advance the process too – to engage with life in new ways that feel purposeful and meaningful. Using the same old process to achieve a new result-based goal seems boring and not as growth-oriented. A machine can run the same algorithm repeatedly. As a human I want the process to grow and evolve with me each time. A stale process may be fine for a Roomba but not for a human being.
I don’t just want to create a new course and write my first novel. I want to advance the way I create courses, and I want to advance into fiction with a sense of appreciation and discovery. Ten years from now I want to remember that I loved creating the course and loved writing the novel. I want the memories of enjoyment and appreciation and wonder, not the memory of being stuck in a dull or stressful process. Remembering some struggle is okay too – I’d rather struggle a bit than be bored.
Is it really an advance if you’re seeking a result, but your process feels like a step backwards in terms of lifestyle enjoyment? Are you advancing towards a goal while feeling like you’re simultaneously retreating into stress, worry, and attachment? If so, can you really call that an advance?
When you advance towards a new goal, be sure to advance your process too. Set goals not just for outcomes but also to explore and improve your relationship with life. Make it part of your goal to advance your character too. Make it part of your goal to create memories you’ll cherish for years.
Don’t just advance towards a new goal. Also advance the way you set and achieve goals.
Health24.com | Coronavirus morning recap: Silk masks, life expectancy, and Europe’s second wave
LATEST SCIENCE AND RESEARCH
READ | Want a breathable, yet effective homemade mask? Use silk, study suggests
As masks are becoming mandatory all over the world, authorities have asked people to use homemade cloth masks instead of single-use surgical and N95 masks that are needed by medical staff.
Face coverings from all materials and shapes are being used. And while all face coverings offer a measure of protection against large and small respiratory droplets, a team of researchers from the University of Cincinnati wanted to examine the efficacy of different household fabrics.
The study, which was recently published in the journal PLOS ONE, wanted to determine what practices would be most effective in practice. The researchers examined cotton, polyester and silk by their resistance to the penetration of small and aerosolised water drops.
They also investigated the breathability of the fabrics, and how they would fare if they were washed repeatedly. In the laboratory, they used the materials as an overlaying barrier for respirators, as well as face coverings. The team then looked at the penetration and absorption of droplets – and observed that silk faired the best, both as a barrier and in terms of breathability.
“Cotton traps moisture like a sponge. But silk is breathable. It’s thinner than cotton and dries really fast,” said Patrick Guerra, an assistant professor of biology at UC’s College of Arts and Sciences.
It’s not only the fact that silk is dense and breathable that made the researchers take note.
Silk contains elements of copper from silk moths, which could contribute to fighting bacteria and viruses. Studies have shown that copper can kill bacteria and has antiviral properties.
READ | Coronavirus is expected to lower global life expectancy
Death and disease have been one of the hallmarks of 2020, and Covid-19’s global impact will be felt for years, maybe even decades to come.
In one of the many ways it has changed our lives, it might also have shifted the trajectory of human life expectancy around the world according to research published in PLOS ONE.
In real life, as of 22 September 2020, there have almost been one million global deaths in total as a result of Covid-19, with the US in the lead followed by Brazil, India, Mexico and the UK.
South Africa has had almost 16 000 deaths, although global totals are expected to be higher due to limited testing and reporting, unknown factors surrounding asymptomatic spread, and the fact that countries have different methods and criteria for counting Covid-19 deaths.
“Previous epidemics such as the 1918 influenza pandemic and the 2014 Ebola virus outbreak resulted in a drop in life expectancy at birth of as many as 11.8 years and 1.6–5.6 years in the USA and Liberia, respectively,” explain the researchers.
“In severely affected countries, an unprecedented surge in mortality from Covid-19 may result in significant years of life lost.” This is especially true when you think of the number of other life-threatening diseases that have taken a backseat in the pandemic, and might contribute to the decline in life expectancy.
Unfortunately, figuring out by how much the current pandemic will shorten our lives isn’t easy. While it disproportionately affects older sections of the population, people of all ages are affected.
CORONAVIRUS CASES LATEST
The latest number of confirmed cases is 668 529.
According to the latest update, 16 312 deaths have been recorded in the country.
There have been 599 149 recoveries.
So far, more than more than 4.11 million tests have been conducted, with 14 917 new tests reported.
Global cases update:
For the latest global data, follow this interactive map from Johns Hopkins University & Medicine.
Late on Friday night, positive cases worldwide were more than 32.38 million, while deaths were more than 985 000.
The United States had the most cases in the world – almost 7.02 million, as well as the most deaths – more than 203 000.
WHAT’S HAPPENING IN SA
Latest news:
READ | Mkhize disbands Ministerial Advisory Committee on Covid-19 ‘out of the blue’
Health Minister Zweli Mkhize has effectively disbanded government’s chief scientific advisory committee on Covid-19.
News24 has seen a letter sent to members of the Ministerial Advisory Committee on Covid-19 on Friday, dated 21 September, in which Mkhize expressed his “gratitude and appreciation” for the commitment and dedication of members.
“Your contribution has led to the containment of Covid-19 pandemic in South Africa and the reduction of mortality of the citizens of South Africa. The new members of the MAC will assume duty soon,” the letter reads.
The committee is chaired by Professor Salim Abdool Karim and was established early during the outbreak of Covid-19 in April to advise Mkhize.
Karim’s status as chairperson is unclear.
While it appears the entire 50-member MAC has been affected, at the time of writing News24 had confirmed that 14 members of the MAC had received letters, including South Africa’s Covid-19 vaccine trial leading researcher Professor Shabir Madhi, and CEO of the South African Medical Research Council Professor Glenda Gray.
The Gauteng provincial command council has noted a decline in new Covid-19 infections, but warned that the risk of transmitting the virus is still high as restrictions have been eased.
The country moved to Level 1 lockdown from Sunday at midnight.
“There has been a gradual but steady decline in [the] number of new infections and hospitalisations.
“Government and social partners continue to work hard to improve the capacity of the health care system to cope with the demand for hospital care now and post Covid-19,” the command council said in an update on Friday.
Despite this progress, residents of South Africa’s economic hub were reminded that the fight against the virus is far from over and the risk of transmission following the easing of restrictions still remains high.
The command council said: “There is still no vaccine, the only way we can contain the spread of Covid-19 is through non-pharmaceutical interventions. We all have to play our part to protect ourselves and those around us.”
WHAT’S HAPPENING IN THE REST OF THE WORLD
Latest news:
France and the UK recorded their highest daily Covid-19 cases since the global outbreak began, and the EU warned that some of its countries now have worse outbreaks than they had in March.
Stella Kyriakides, the EU’s health commissioner Stella Kyriakides warned on Thursday that in “some member states, the situation is now even worse than during the peak in March.”
Taken together, the developments point to the feared second wave of the pandemic having arrived in Europe.
There are differences from the first wave in spring. While infections have increased, the number of deaths has not risen so sharply.
Also, the ability of officials to test and keep track of the number of infections has increased, meaning that the daily figures are now a better reflection of how the virus is spreading.
In the first wave, testing systems were only able to capture a small portion of those infected.
READ | UK supermarkets are rationing toilet paper and hand sanitiser as fears of panic buying return
British grocery chains Tesco and Morrisons have started rationing essential items over fears that stricter lockdown measures will send shoppers into a panic.
Supermarkets limited sales of certain goods earlier in the pandemic, and Morrisons became the first major grocer to reintroduce these measures when it said on Thursday that customers could only buy three of certain products. These included pasta, soup, hand wash, and hand sanitiser, as well as multipacks of toilet paper and kitchen roll.
One checkout worker at Morrisons who wished to remain anonymous said customers had been stocking up on canned food and toilet roll. They described their store was “worse than a bad Christmas, it was horrible.”
Tesco imposed its own three-item limits on Friday morning for flour, dried pasta, toilet rolls, baby wipes, and anti-bacterial wipes, the grocer confirmed to Business Insider. The limit extends to a small number of products online, such as rice and canned vegetables, it added.
Prime Minister Boris Johnson announced stricter lockdown measures on Tuesday, including a 10 p.m. curfew for pubs and restaurants, and extending the use of face masks. Officer workers were also told to work from home wherever possible.
Social media users began posting images of empty shelves on Monday, when rumours of the stricter measures began to emerge, and toilet paper sales rose 23% in the week to Tuesday, The Guardian reported.
HEALTH TIPS (as recommended by the NICD and WHO)
• Maintain physical distancing – stay at least one metre away from somebody who is coughing or sneezing
• Practise frequent hand-washing, especially after direct contact with ill people or their environment
• Avoid touching your eyes, nose and mouth, as your hands touch many surfaces and could potentially transfer the virus
• Practise respiratory hygiene – cover your mouth with your bent elbow or tissue when you cough or sneeze. Remember to dispose the tissue immediately after use.
Image credit: Getty Images
Covid-19: What do scientists think of the PM’s plan?
The new coronavirus restrictions have been met with mixed reviews.
Coronavirus: Children behind rising demand for tests in England
Three times as many children under nine were tested in early September as in the previous two weeks.
Coronavirus: UK pledges £500m to global vaccine-sharing scheme
The PM will call on world leaders to set aside differences as he sets out plans to prevent future pandemics.
