“Wellness” Is a Deep Subject

I just read an excellent article that I want to pass along to you:

A life of wellness… or not?

By Gilles Lamarche, DC

The term wellness has been utilized within the chiropractic profession for decades.

Now, when you look around, you will notice it being utilized in so many other industries, as well.

What is the definition of wellness? You hear it in the news, you read it on billboards, you see it on commercial signs, people talk about it in social settings and at work, but interestingly enough, there is no universally accepted definition.

You would think that the definition would certainly relate to health. The definition of health as described by The World Health Organization (WHO) is as follows:

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”1 This definition has not been amended since 1948.

If this is the case, then why are we such a sick society? Why have most healthcare practitioners not embraced the definition and what can you as a chiropractor do to help humanity discover improved health and well-being?

The goal is to get you to embrace this concept and serve your patients so they will get the “big idea.”

The WHO definition embraces total health, which can also be referred to as wellness — which in most circles is a tough word to define.

Charles B. Corbin of Arizona State University gives this definition: “Wellness is a multidimensional state of being describing the existence of positive health in an individual as exemplified by quality-of-life and a sense of well-being.” 

This is not much different than the definition written by WHO 60 years ago. Even though the words may be different, the concept is not. Wellness is an ongoing and active process of becoming aware and making consistent wise choices toward a more successful and fulfilling life.

If you break that down it means:

• Process shows that improvement is possible;.

• Awareness means we are seeking information on how to improve;

• Choice refers to having options, and our capacity to select options in our best interest; and

• Success is determined by each person. In the context of health, most would consider success to be related to the capacity of living a fulfilled life based on each individual’s expectations — living a life filled with joy, vitality, energy, and an overall sense of accomplishment.

The most commonly described subdimensions of wellness include: physical, mental, spiritual, social, occupational, financial, emotional, and family well-being.

Physical, mental, and spiritual well-being relate directly to the art, science, and philosophy of chiropractic. Since subluxations can be caused by physical, chemical, or emotional stresses, it makes sense to communicate a clear and consistent message relating to the appropriateness and effectiveness of chiropractic care in order to improve the health of the nation.(Read more at: chiroeco.com)

Posted via email from chiropractornews’s posterous

How to Avoid Winter Snow-Shoveling Injuries

If you live where it snows or if you’re planning to following the “chill” until you find a snowy scene for the holidays, here’s a little advice from the Foundation for Chiropractic Progress.

Every winter, millions of Americans grab their shovels and start digging their way out of the snow and into pain. Shoveling snow improperly can lead to potential spasms, strains, and aches. When shoveling snow, the Foundation for Chiropractic Progress suggests the following tips to maintain overall health:

- Always stretch and warm-up before shoveling
- Wear extra layers to maintain muscle warmth and flexibility
- Avoid sudden twisting and turning motions
- Limit the amount of weight lifted per load
- Bend your knees, not your back
– Take frequent breaks to avoid body fatigue

If you happen to experience discomfort or pain as a result of shoveling snow, please contact your local chiropractor.

To find out more information please visit the Foundation at www.yes2chiropractic.org or call 866-901-3427

Posted via email from chiropractornews’s posterous

Santa Clara Chiropractor: Chiropractic Care Can Take the Pain Out of Growing Older

There’s no denying the fact that as we age our body feels and acts differently than it used to when we were younger. It hardly seems right that as our mind appears to improve and become more “inventive,”  our body seems to become less “cooperative.” We’re stiff in the morning; certain activities during the day make us sore at night; and, if we’re not cautious, even something as simple as turning too hastily or bending over to pick up a dropped pencil, can send our back or some other muscle group into spasm. The good news is that there is help accessible that is not only beneficial in slowing down the aging process of the body, but can aid us in avoiding some of those problems completely.

Take arthritis for example. Most of us would agree that, barring pharmaceuticals, conventional medicine doesn’t address this age-related condition. What is the reason? It is because most medical doctors treat the symptoms of arthritis. The chiropractic approach is to uncover the origin of the condition and get rid of the pain at its source.  Chiropractors, like your Santa Clara Chiropractor, have been treating men and women suffering from pain caused by arthritis, and other age-related problems, for over a hundred years.

Repetitive stresses, years of poor gait and incorrect posture, and inadequate movement cause wear of various joints over time and cause the arthritic changes the body experiences as you get older. Chiropractic adjustments bring back motion into your joints and ease any vertebral misalignments that may be creating irritation and restriction. In addition to causing arthritic changes in the spine and increasing pain, did you know that misaligned vertebra can also weaker your resistance and immunity? It’s an authoritative fact, and this could be one of the reasons why it may seem that as you age you develop more health issues and that it often takes longer for you to feel better again. According to research done on older individuals, those who received regular chiropractic care stayed healthier. In fact, you could say that, as you get older, chiropractic care is good for what ails you!

Chiropractors are experts when it comes to the health of the musculoskeletal system, from the small, growing frame of an infant to the full-grown body of a mature adult.  Your chiropractor understands the aging process and has special observational and diagnostic skills that assist in locating spinal misalignments and joint problems. In fact, a chiropractic examination can frequently reveal certain age-related changes before they’ve begun to create noticeable pain. Moreover, your Santa Clara Chiropractor can assess your posture and analyze your gait to identify inappropriate patterns that could cause more arthritic changes in the future.

So, if you have been feeling your age lately, but you’d like to feel a whole lot better, make an appointment with your Santa Clara Chiropractor today!

Dr. David Hoewisch is a chiropractor in Santa Clara, CA with over 25 years of experience helping thousands of patients get out of pain and get their lives back. His office is located at 1221 Lafayette St., Santa Clara, CA, 95050. Dr. Hoewisch has traveled around the world and is an avid outdoor enthusiast. He is a CODA (Child of Deaf Adults) and learned sign language at an early age. He treats many deaf patients in his clinic. For more information go to his website at http://www.santaclarachiropractor.net

Article Source: http://EzineArticles.com/?expert=David_Hoewisch

Technorati Tags: , , ,

Seattle Chiropractor: Why Is Foot Pain So Commonplace?

Seattle Chiropractic has treated many foot pain sufferers, and knows all too well how prevalent painful foot problems are nowadays. Here’s why: We all know that movement is good for the whole body, right? In fact, our overall good health is highly influenced by our getting regular physical exercise. If that’s true, why do so many individuals suffer from aches and pains in their feet? After all, our feet are made for walking, aren’t they? The answer, of course, is “yes,” but they aren’t designed for exploitation.

The normal, healthy individual takes 3,000-5,000 steps per day, not including activities like running and aerobic exercise. But, frequently those steps are made by people walking incorrectly, with poor gait patterns and bad posture.

Furthermore, a large number of individuals wear badly-designed, poorly-fitting shoes. Moving the body through space inappropriately on feet that are impeded from performing as they were meant to cannot help but to cause painful problems not only in a variety of places in the feet, but in other parts of the body, as well.  For example, if an individual over-pronates (walks like a duck) in shoes that are poorly-made or unevenly-worn, or in any pair of high heels, that individual is not only likely to develop foot and ankle problems, but will more than likely experience challenges in the back, knees and legs.

One of the most familiar foot problems is Plantar Fascitis (heel pain), which is generally caused by inflammation of the plantar fascia. The plantar fascia is a wonderfully-formed, multi-tasking band of connective tissue that encircles the muscles on the bottom of the foot, adheres the heel bone to the ball of the foot, sustains the arch, safeguards the foot, and absorbs shock. As you can see, the healthy function of the plantar fascia is crucial for pain-free walking and exercise.

There are many factors that can be considered reasons for the development of Plantar Fascitis. One factor is short and tight calf muscles. Undue stress on the smaller and weaker plantar muscles and fascia occurs when calf muscles get short and tight, exerting a strong pull on the back of the heel bone. What causes calf muscles to get short and tight? In addition to running and jumping activities such as aerobics, volleyball, running, basketball, and tennis, the wearing of high heels can produce the condition.

Other determinants that contribute to Plantar Fascitis include sudden strenuous activity after a period of prolonged inactivity, aberrant walking patterns (such as over-pronation), inappropriate footwear, walking on hard or uneven surfaces (especially barefooted), and obesity.

Once an individual develops Plantar Fascitis, the condition is often difficult to manage and can become intensely painful and constant. Plantar Fascitis won’t go away without appropriate treatment.

If you are suffering from heel pain, your chiropractor will be able to determine the reason for your problem and what chiropractic management would be most appropriate. Such care might include ultrasound therapy, laser, joint manipulation, Graston technique, muscle stretching and strengthening exercises, kinesio taping and, in some cases, orthotics.

Technorati Tags: , , , , ,

Pregnancy and Chiropractic Treatment

chiropractic and pregnancy

Are chiropractic adjustments safe during pregnancy To begin with, yes it is a smart decision to get your spine checked while you are pregnant. You’ve probably noticed that, your body is going through many changes, and these changes will continue as the pregnancy progresses. A subtle change is your body’s increased production of the hormone elastin. This hormone is designed to relax the tendons in the pelvis. this easing gives the pelvis more flexibility during the birthing process to make delivering the baby easier.

This process, despite the fact that its function is to assist the mother during labor, can produce much discomfort in the months leading up to the birth. As the pregnancy advances, more elastin is released, which allows the pelvis to become increasingly more unstable. In combination with the increased size of the baby and uterus, and you have the ingredients for severe low back pain. As an Oxnard Chiropractor, I currently have several pregnant patients coming into my office for symptoms associated with their pregnancy, but usually it is for their low back pain.

A bonus to seeing a chiropractor routinely during your pregnancy is that it has been shown to actually decrease labor time. Why is that you ask? Simply put, if the pelvis is aligned properly, the muscles contracting during the labor process are more efficient because they don’t have to fight past misaligned joints.

In answer to the second question above, by all means chiropractic care during your pregnancy is safe. Not only can chiropractic help you with your low back pain and other associated symptoms, such as heartburn, nausea, swelling, etc., but it is safe to both you and your baby. In addition, should the need arise, a trained chiropractor can assist a mother who has a breached baby. This is done by using the Webster Technique, a low force manipulation of the uterus that helps to get the baby into the appropriate position for birth. A simple Google search on the Webster Technique can give you much more information.

To summarize, chiropractic is both beneficial and safe in helping to relieve many of the discomforts of pregnancy. To any pregnant women out there reading this, please go to see your local chiropractor, or if you are close enough, look up your Oxnard Chiropractor. We can make you quite a bit more comfortable in the months of your pregnancy, and we can even make the labor process easier.

Technorati Tags: , , , ,

What You Ought to Know About “Tennis Elbow”

Tennis Elbow, the common name for elbow pain beginning on the outside, or lateral side, of the elbow arises when one or more tendons of the forearm muscles become irritated or inflamed. These tendons join to the bony protuberance close to the elbow joint, called the lateral epicondyle, ergo the medical name, “lateral epicondylitis,” in essence inflammation of the epicondyle. When the inflammation takes place on the inside, or medial side, of the elbow, the condition is usually referred to as “Golfer’s Elbow” or medical epicondylitis. Golfer’s Elbow, though, is not as prevalent as Tennis Elbow.

There are quite a few reasons for epicondylitis – not just tennis and golf – as any activity or sport that requires repetitive gripping of objects can result in this condition. Improper wrist and arm posture while carrying heavy bags, knitting, chopping food, and/or using a computer can also cause “tennis” or “golfer’s” elbow. Using awkward techniques when initiating any sport, experimenting with new rackets or clubs, or increasing the intensity or duration of an activity or exercise can also generate the affliction.

Epicondylitis can occasionally begin farther up the arm or even in the neck. If an individual has a disc condition or spinal subluxation, the nerves that give function to the forearm muscles may become irritated making the muscles tense and inserting heightened strain on the tendon attachment(s).  This produces a predisposition to elbow pain no matter the exacerbating cause. If ignored, joints of the elbow can become subluxated further, and even arthritis can be a complication of the condition. Evaluation and adjustments by a qualified chiropractor, such as your Mount Laurel Chiropractor can correct the problem and eliminate future complications.

Epicondylitis is a condition that rarely resolves of its own accord and so requires proper health management. A qualified professional such as a chiropractor can determine the exact cause of the problem and initiate the proper care and treatment. This might include modalities such as ultrasound, electro-therapy, massage, hot and cold therapies, bracing, and home stretching and exercises. Mount Laurel Chiropractic management has proved, in the majority of instances, to be extremely effective in the overall management of epicondylities.

Technorati Tags: , , , ,

Can Chiropractic Treatment Help Scoliosis?

Scoliosis: An Introduction

A normal spine appears straight, without much change from laterally, when the body is viewed from behind. But, if the spine is observed to have a lateral, or side-to-side, curvature, the individual might have a condition called scoliosis.The affliction shouldn’t be confused with unsatisfactory posture, although it oftentimes gives the appearance that the individual is leaning to one side. Scoliosis is a complicated deformity that is defined by both lateral curvature and rotation of the vertebra oftentimes causing a characteristic “rib hump” in the mid or thoracic spine. This is created by the vertebrae in the zone of the major curve rotating toward the concavity and pushing their fastened ribs posterior hence producing the distinctive rib hump seen in thoracic scoliosis. If the thoracic curve and rib rotation are severe, greater than 70 degrees, pulmonary and cardiac function can be interfered with. Often later in life in untreated severe idiopathic infantile and juvenile scoliosis patients, this intensity of curve and subsequent cardiac and pulmonary changes can be life threatening.

Anatomy

If one were to look at the trunk from a side view, the spine would reveal four normal curves: the cervical, thoracic, lumbar, and sacral. In the lower spine there is a normal “C-shaped” curve called swayback or lordosis, while the thoracic curve in the chest vicinity has a “reverse C” called a kyphosis. Hyperlordosis is the term used to describe heightened swayback, while increased kyphosis in the thoracic spine is called hyperkyphosis. Scoliosis changes generally accompany alterations from normal on a side view. Some round back deformities are simply due to bad posture and can often be eliminated with postural exercises. A small percentage of individuals with kyphosis have more rigid deformities than the postural type, which are seen in conjunction with vertebral deformity. This type of deformity, called Scheuermann’s kyphosis, is much harder to treat than postural kyphosis, and it’s cause is unknown.

Even a nonprofessional can help to identify a child or fully-grown individual with scoliosis just by viewing the person in a standing position, preferably bare-chested and in shorts, and observing the following:

  • One shoulder may be more elevated than the other.
  • One scapula (shoulder blade) may be higher or more conspicuous than the other.
  • With the arms hanging freely at the sides, there may be more area between the arm and the body on one side.
  • One hip may seem to be higher or more conspicuous than the other.
  • The head is not aligned with the pelvis.
  • One side of the back appears more raised than the other when the individual is observed from the rear and asked to flex forward until the the spine is horizontal.

The child or adult should be sent to a healthcare professional, such as a chiropractor, for further evaluation once scoliosis is identified. your chiropractor would be happy to help.

There are various origins and many kinds of scoliosis, however the most prevalent, by far, is Idiopathic Scoliosis, which accounts for approximately 85 % of all cases. “Idiopathic” means “no known cause” and is seen with equal occurrence in boys and girls in the mild or low curve magnitudes. This affliction can be sub-classified into infantile, juvenile and adolescent categories, based upon the age of onset. Idiopathic Scoliosis may be linked to genetic or hereditary influences as it frequently runs in families. However girls, for unknown reasons are five to eight times more likely than boys to have their curves develop in size and require treatment. As the term “Idiopathic Scoliosis” suggests, this class of scoliosis commonly happens when children are finishing their last major growth spurt. Unfortunately, at this age young people are hesitant to allow their body to be seen by parents and other adults, so it is wise to have this age group viewed on a regular basis.

If a scoliotic curve is found in the growing adolescent, it is vital that the curves be monitored for advancement by periodic examination and sometimes standing X-rays. In ninety percent of instances, the scoliosis is mild and does not require active treatment, though| increases in spinal deformity necessitate evaluation to determine if a brace or other treatment is required. In a small number of people, surgical treatment may be required.~Surgery may be necessary for a small number of individuals.

Brace support (orthosis) is recommended for newly-identified conditions of moderate scoliosis or abnormal kyphosis, as well as when an increase in scoliosis or kyphosis is identified in both juvenile and adolescent children. There are many kinds of braces, all created to prevent curves from increasing through the process of acting as a buttress for the spine during active skeletal growth. Braces normally will not make the spine completely straight, and cannot always keep a curve from increasing. However, bracing is effective in preventing curve progression in an impressive number of skeletally-immature adolescents.

Scoliosis has no simple resolution. The majority of cases, even though frequently monitored, are not actively treated. The usual medical treatment for moderate cases is a brace, whereas severe cases in some cases are treated surgically. You may want to see your local chiropractor first.

Along with bracing, many other modalities have been used successfully like specialized exercise, electric stimulation of spinal muscles, nutritional programs, and chiropractic treatments. It appears that the most effective results have been sustained with a multi-faceted approach to the care of this condition.

There are chiropractors, that have expertise treating scoliosis cases.

Technorati Tags: , ,

Balance, Inner Ear Problems, and the Benefits of Chiropractic Care

Santa Barbara Chiropractor: 10 Most Frequent Questions

Managing and keeping body position while remaining still ormobile is the essential function of good balance. Good balance helps a person to walk without wobbling, arise from a sitting position without falling, and to climb stairs without tripping.

About 9 percent of adults, age 65 and older, report having challenges with balance. Good balance is vital in aiding an older person to stay independent, and to carry out daily chores and activities. Quite a few older individuals, however, suffer from dizziness, “wooziness,” and difficulties with balance.

The sensation by individuals that they, themselves, or objects are spinning is known as “vertigo.” About 40 percent of people nationwide will experience dizziness that is consequential enough to go seek out a health professional. And, among older adults, falls are the leading cause of extreme injury and deaths.

Balance and Inner Ear Challenges

Three types of balance disorders that are most familiar are benign paroxysmal positional vertigo, labyrinthitis, and Meniere’s disease, though there are quite a few other types of balance disorders. Of these three, benign paroxysmal positional vertigo is the most widespread. Its symptoms encompass a brief, intense feeling of vertigo with a change in head position, when rolling over to the left or right in bed or when getting out of bed, or when looking up for an object on a high shelf. This affliction is more likely to occur in people 60 and older, but it can also happen in younger individuals.

There are diverse causes for benign paroxysmal positional vertigo. Inner ear infection, head injury, or simply aging can cause the affliction. While it can be connected with other disease processes, often a simple Epleys procedure can eliminate the affliction. Your Santa Barbara Chiropractor has many years of experience in this procedure.

Labyrinthitis is an infection or iirritation of the inner ear that cause dizziness and loss of balance. It affects people|individuals of any age and the cause is currently undiscovered.

Ménière’s disease is a balance disorder that produces vertigo, hearing loss inconsistent, tinnitus (ringing or roaring in the ears), and a “full feeling” in the ear.

Even though those over 65 years are more likely to experience balance disorders, age is not the only cause for why these problems take place. Depending on the cause of the balance disorder, therapy will vary. Sometimes, there’s a simple answer to balance problems, such as simple exercises for vestibular rehab. A chiropractor is well-educated in assessing and treating a number of balance dysfunctions. Make an appointment with a health care professional, such as your Santa Barbara Chiropractor, if you have encountered, or are currently experiencing, dizziness, vertigo, or other abnormalities with balance.

Although some balance disorders are produced by challenges in the inner ear, other disorders may involve another area of the body, like the brain or the heart. Other components, besides aging and ear infection, may include head injury, certain medicines, challenges with blood circulation, upper respiratory infections, viral infections, stress, fatigue, smoking, alcohol use, stroke, high or low blood pressure, and heart disease.

Balance disorders created by high blood pressure can normally be managed by less sodium intake,maintaining a healthy weight, and exercise. To assist in making the symptoms of dizziness less acute, generally eating low-salt or salt-free foods, and avoiding caffeine and alcohol, will help.

Balance disorders are significant. It is the primary cause of falls and fall-related injuries in older people. It is essential to have a possible balance disorder accessed and treated as soon as possible.

If you can answer “yes” to any of these questions, you should discuss the symptom(s) with your chiropractor:

• Do you have the feeling of being “unsteady?”

• Does the room seem to spin around you?

• Is there ever a time when you feel as if you are moving when you know you are standing still?

• Do you lose your balance and/or fall?

• Do you feel as if you are falling?

• Does your vision ever become “blurred?”

• Do you ever feel disoriented, or lose a sense of time, place or identify?

Don’t wait until it’s too late! Call your chiropractor today.


Technorati Tags: , , , , ,

Chiropractic Treatment Can Reduce Your Child’s Earaches and Ear Infections

pediatric chiropractic

The most prevailing reason for visits to a pediatrician is earache. More than 70 percent of children will have had not less than one earache by the age of three, and almost one-third will have had three or more earache incidents. However, what might be unexpected is that earache is also the most common basis for children under the age of five years to be taken to the chiropractor’s office.

How Chiropractic Care Can Help Earache and Ear Infections

A pediatrician who determines that a child with an earache has a middle ear infection will usually prescribe antibiotics as a typical course of treatment. Current study, however, has ascertained that this is often misguided. Antibiotics are only effective against bacterial pathogens, and because the child’s middle ear infection may be caused by a virus, antibiotics are ineffectual. This may be the explanation for a child’s chronic ear infections.

One of the many assessments that a Honolulu chiropractor can make is whether the earache or ear infection is caused by inflamation of the small nerves in the spine, called free nerve endings.

An abnormal tension in the small muscles of the neck is produced when these nerve endings are inflammed. This muscle tension can put pressure on the lymphatic drainage ducts resulting in inadequate drainage from inside the ear, thereby stopping the body from being able to naturally correct the problem. Additionally, balance can also be affected.

Identification by a chiropractor of such a situation is made by the detection of increased tension in the neck and paraspinal muscles. Normally more tension is felt on the side of earache. The chiropractor also checks for spinal vertebrae that are either moderately out of alignment or are not moving within their normal range. This problem may have been the result of any one of the many bangs, jolts and falls that the majority of children experience in the early years of their life. Many times, a short course of spinal adjustments and manipulation of the neck muscles will assist in restoring normal lymph drainage. If your child is experiencing the pain of an earache or an ear infection, see your Honolulu chiropractor as soon as possible.

Advanced Research and Guidelines

According to the Centers for Disease Control (CDC), ear infection, the most prevalent childhood sickness after the common cold, accounts for nearly 30 million doctor visits every year. What’s more, at least 6 million courses of antibiotics are unnecessarily prescribed for the affliction.Not too long ago, the American Academy of Pediatrics (AAP) released new guidelines for treating pediatric ear inflammation, and definitively recommended a period of “watchful waiting” since, in many cases, infections clear up on their own, without medication.

The American Chiropractic Association (ACA) commends the AAP on the guidelines and underlines that chiropractic management is a “good first option” for treating ear infection conservatively. “Doctors of chiropractic have been treating children for decades with great success – helping them to avoid painful ear infections, antibiotic overuse and resistance, and ear tube surgery,” said ACA President Donald Krippendorf, DC. “Particularly when dealing with young children, drugs and surgery should be an absolute last resort.”

Technorati Tags: , , , , ,

Chiropractic and the Health of Your Children

Is It Safe To Adjust Children? FAQ#7

The negative effects of many medications on children’s health has many moms and dads concerned. Parents are increasingly asking, when given a prescription for a child’s periodic problem, “Is this really all I can do for my child? Isn’t there a safer alternative?”

Many children’s medications often not only mask a child’s symptoms, but can produce serious side effects. Today, parents are looking for health care alternatives for their children that encourage and sustain their child’s inherent ability to be healthy.

Chiropractic care is that option because it assists a child’s nervous system in functioning optimally. The immune system is directed by the nervous system. When it is functioning optimally, children stay healthier.  As far as a child’s health is concerned, “the best offense is a good defense.” Everyday, children are exposed to a huge variety of airborn, food-born, and contact bacteria. So many bacteria, in fact, that it would be inconceivable to immunize them against them all. Your Camarillo Chiropractor well-informed and has years of expertise when it comes to colds, sore throats, ear infections, fevers, colic, asthma, tonsillitis, allergies, bed-wetting, infections, pains, falls, stomach-aches, and the hundred and one little (and big) things children go through as they grow up.

The majority of illnesses that affect children are avoidable. The function of chiropractic manipulation is to remove interferences to the innate healing power running through the body. When that power is released, the healing results that take place many times appear to be profound.

Furthermore, a child is less inclined to be injured at play or in sports when his or her spine is in alignment. In addition, children who are brought in regularly for chiropractic care more often than not don’t experience as many “growing pains” as other children.

Each day at your Camarillo Chiropractor we are happy to see that more and more parents are bringing their children to our clinic to help to take care of the questions and concerns they have about their children’s health. Every child is entitled to manifest their absolute potential. Chiropractic adjustments for children at your chiropractor is safe, gentle and effective.

Technorati Tags: , ,