An In-Depth Look Into The Dietary Guidelines
1/16/2017An In-Depth Look Into theDietary GuidelinesToby Amidor, MS, RD, CDNToby Amidor, MS, RD, CDNDisclosures: Ambassador to National DairyCounsel Consultant to Beef ExpertBureau Member of Dannon YogurtBoard2Learning Objectives1. Understand the process of how the Dietary Guidelinesare created.2. Explain why modifications were made to the DietaryGuidelines.3. List three noteworthy changes to the Dietary Guidelines.4. Communicate healthy eating messages to their clientsthat are consistent with the Dietary Guidelines.31
1/16/2017Part 1: The Backstory4The Reality About half of all Americans adults have one or morepreventable chronic disease 117 million individuals About 2/3 of US adults are overweight/obese 155 million individuals These conditions have been highly prevalent for 2decades Poor dietary patterns, overconsumption of kcals, andphysical inactivity directly contribute to these disorders5The Reality Individual nutrition & physical activity behaviors arestrongly influenced by: Individuals Social surrounding Organizational systems Environmental systems Positive changes in all of the above could ultimatelyimprove health outcomes62
1/16/2017History of the Dietary GuidelinesPublished jointly: US Dept of Health & HumanServices USDA Intended for Americans 2 years The Dietary Guidelines Advisory Committee(DGAC): Nationally recognized health & nutrition experts Review, updated, and published every 5 years Scientific Report of the 2015 DGAC: Written as the basis for developing the DietaryGuidelines for Americans policy7How the DGA Are Established Written comments openeduntil 5/8/15 HHS and USDA hosted apublic oral commentmeeting on 3/24/15 Finally, the long awaitedrelease of the guidelines8Dietary Guidance MilestonesDietary Guidelines for Americans(HHS/USDA)Dietary Guidelines for Americans(USDA/HHS)19951980Dietary Guidelines for Americans(HHS/USDA)2005Dietary Guidelines for Americans(HHS/USDA)Dietary Guidelines for 95200020052010201519852000Dietary Guidelines for Americans(USDA/HHS)Dietary Guidelines for Americans(USDA/HHS)1977McGovern Report - Dietary Goals (6)Dietary Guidelines forAmericans (USDA/HHS)20101979Surgeon General's Report on HealthPromotionSlide courtesy of Roger Clemens, DrPH, CFS, CNS, FACN, FIFT, FIAFST93
1/16/2017History of Dietary MessagesGoals:1. Energy balance to avoid overweight2. Increase consumption of complex CHO and “naturallyoccurring sugars”3. Reduce consumption of refined and processed sugars,total fat, sat fat, cholesterol, and sodiumSenator George McGovern (1977)Chairman, Senate NutritionCommittee4. Increase consumption of fruits, vegetables, &whole grains5. Decrease consumption of Refined and processed sugars Foods high in total fat and animal fat Eggs, butterfat and high-cholesterol foods Salt and foods high in salt Choose low-fat and non-fat dairySenators George McGovern andRobert Dole (2008)World Food Prize Laureates10Recommendations Over 30 YearsYearWeightSugarFat1980Maintain ideal weightAvoid too muchAvoid too much1985Maintain desirable weightAvoid too muchAvoid too much1990Maintain healthy weightUse only in moderationChose diet low in fat1995Improve your weightChoose diet moderate insugarsChoose diet low infat2000Aim for a healthy weightChoose foods tomoderate sugar intakeChoose diet low infat2005Manage body weightNo guidanceChoose fats wisely2010Balanced calories tomanage weightReduce added sugarsConsume 10% calsfrom sat fat2015Achieve and/or maintaina healthy body weightLimit calories from addedsugarLimit calories fromsaturated fats11Why Are the Guidelines Important?Dietary Guidelines address significant nutritionrelated health issues facing the US population: Overweight, obesity and other diet-related chronic disease CVD, Type 2 DM, cancer Less than optimal dietary patterns in the US Contribute to poor pop health and high chronic disease risk Food insecurity Availability of nutritionally adequate foods limited or uncertain 49 million in US, including 9 million children124
1/16/2017Why Are the Guidelines Important? Basis of federal nutrition policy, education, outreach, andfood assistance programs Used by consumers, industry, nutrition educators, and healthprofessionals They influence the DG other countries will have All federal dietary guidance for the public is required tobe consistent with the DG School policy school lunch programSNAPWIC13Dietary Guidelines for Americans:The Core of Nutrition Policy1990198019852010200019952005Slide courtesy of Roger Clemens, DrPH, CFS, CNS, FACN, FIFT, FIAFST14Part 2. Proposed Changes155
1/16/2017US Trends in Nutrient Intake & HealthData from: What We Eat in America survey Part of National Health and NutrientExamination Survey Examination of health conditions that mayhave nutritional origins16Shortfall Food GroupsUnder-consumed food groups: Vegetables: 90% of the US pop does not meet dailyvegetable intake recommendations Fruit: Only 15% of US pop meets the daily fruit intakerecommendation Whole grains: Across all ages and both sexes, nearly 100% ofthe pop consumes amounts below the recommendedintake levels Dairy: Age-relate decline in intake from adolescents withmore than 80% of the entire US pop not meeting the dailyrecommended dairy intake17Results in Nutrient Shortfalls Nutrients under-consumed relative toEstimated Average Requirements or AdequateIntake levels per IOM Vitamins A, D, E, C, folate, calcium, magnesium,fiber, potassium Females (adolescent pre-menopausal): iron Calcium, Vitamin D, fiber, potassium: ‘nutrients of public health concern’ Underconsumption linked to adverse healtheffects186
1/16/2017Recommendations for Shortfalls Composition of many food categories can beimproved to increase intake of vegetables,whole grains, and under consumed nutrients: i.e. burgers, sandwiches, desserts, beverages Take advantage of more opportunities toenrich meal choices with important foodgroups in all settings Home meals, restaurants, schools19Overconsumed Nutrients Nutrients overconsumed relative to Tolerable UpperIntake Levels per IOM or maximum standards: Saturated fat Sodium Refined grains Added sugars 90 % of males and females in all age groups exceed therecommended daily limits of solid fats and added sugars Nearly 100% of boys and girls ages 1-3 and 4-8 exceedrecommended limit for solid fats and added sugars20Does Where You Purchase Matter? The US purchases food for a variety of locations Supermarket Convenience stores Schools Workplace DGAC report determined no matter where food isobtained, the diet quality of the US pop does not meetthe recommendations (the same over and underconsumed nutrients and food groups)217
1/16/2017Total Plate vs. Single Nutrient Individual components of food, like saturatedfat or sugar, should not be demonized Look at the entire diet as a whole Ask client: Are portions appropriate Are there enough vegetables? Are you skipping meals?22Cholesterol“Available evidence shows no appreciablerelationship between consumption of dietarycholesterol and serum cholesterol, consistent withthe conclusions of the AHA/ACC report” Recommended 2015 guidelines not include previousrecommendation to limit intake 300mg/day Cholesterol is not a nutrient of concern foroverconsumption23Sustainability DGAC report suggests a diets higher in plant-based foods andlower in animal-based foods are more health promoting andassociated with less environmental impact than the current US diets Suggested lower environmental impact diets: Healthy U.S. style-pattern DASH Mediterranean-style pattern Vegetarian pattern Due to its higher intake of animal-based foods, the average US diethas a larger environmental impact (i.e. increasing greenhousegases, land/water/energy use) compared to suggested diets Note: no food group needs to be eliminated completely toimprove sustainability248
1/16/2017Sustainability: Fish Seafood important part of several recommendeddietary patterns Seafood industry rapidly expanding Safety concern of farm-raised vs wild-caughtseafood – but both are needed in order to supportmeeting seafood recommendations25Part 3: 2015 Dietary Guidelines forAmericans265 Overarching Guidelines1) Follow a healthy eating pattern across the lifespan2) Focus on variety, nutrient-dense food, and amount3) Limit calories from added sugars and saturated fats, andreduce sodium4) Shift to healthier food and beverage choices5) Support healthy eating pattern for all279
1/16/2017Components of Healthy EatingPatternsA healthy eating pattern includes: A variety of vegetables from all the subgroups Dark green, red and orange, legumes, starchy, and other Fruit, especially whole fruit Grains, at least half which are whole grains Fat-free or low-fat dairy, including milk, yogurt, cheese and/orfortified soy beverages A variety of protein foods, including seafood, lean meats andpoultry, eggs, legumes and nuts, seeds, and soy proteins Oils28Components of Healthy EatingPatternsA healthy eating plan limits: Saturated Fats: Consume less than 10% calories/day Added Sugars: Consume less than 10% of calories/day Sodium: Consume less than 2,300 mg/day Alcohol: if consumed, then in moderation29Table A9-1.Alcoholic Drink-Equivalents of Select BeveragesDrink DescriptionDrink-EquivalentsbBeer, beer coolers, and malt beverages12 fl oz at 4.2% alcoholc0.812 fl oz at 5% alcohol (reference beverage)116 fl oz at 5% alcohol1.312 fl oz at 7% alcohol1.412 fl oz at 9% alcohol1.8Wine5 fl oz at 12% alcohol (reference beverage)19 fl oz at 12% alcohol1.85 fl oz at 15% alcohol1.35 fl oz at 17% alcohol1.4Distilled spirits1.5 fl oz 80 proof distilled spirits (40% alcohol)(reference beverage)1Mixed drink with more than 1.5 fl oz 80 proofdistilled spirits (40% alcohol) 1d3010
1/16/2017Alcohol ConsumptionDrink equivalents (ABV%*fl oz consumed)/0.6 fl ozExample: Light Beer 4.2% ABVDrink equivalents (0.042*12 fl oz)/0.6 fl ozDrink equivalents 0.8431Healthy Physical Activity PatternIn addition to consuming a healthy eating pattern, physical activityguidelines should be met.AgeRecommendations6-17 years 60 minutes or moreAt least 3 days/weekInclude aerobic, muscle strengthening, bone strengtheningEnjoyable and offer variety18-64 years Avoid inactivity. For substantial health benefits, at least 150 minutes/week ofmoderate-intensity, or 75 minutes of vigorous-intensity aerobicphysical activity/week For additional and more extensive health benefits, 300 minutes/week of moderate-intensity, or 150 minutes/week of vigorousintensity aerobic physical activity Include muscle-strengthening activities on 2 days/week65 years Follow adult patterns keeping safety in mind32Federal Physical Activity ResourcesProgram/InitiativeLead OfficeWebsitePhysical Activity Guidelinesfor AmericansOffice of DiseasePrevention & HealthPromotion gov (consumer)ODPHPwww.healthfinder.govLets Move!Office of the First Ladywww.letsmove.govI Can Do It, You Can Do ItPresident’s Council onFitness, Sports & Nutrition(PCFSN)www.fitness.govThe President’s ChallengePCFSNwww.presidentschallenge.orgPhysical Activity Guidelinesfor Americans Youth ity/guidelines.htmGo4Life (focused on olderadults)NIH National Institute onAginghttps://go4life.nia.nih.gov3311
1/16/2017Healthy Eating Pattern: US-Style Based on food guides USDA developed over past 30 years No change since 2010Food GroupServings (2000calories)Vegetables (c-eq/day) Dark-green vegetables (c-eq/wk) Red & orange vegetables (c-eq/wk) Legumes (c-eq/wk) Starchy Vegetables (c-eq/wk) Other vegetables (c-eq/wk)2½Fruits (c-eq/day)2Grains (oz-eq/day) Whole grains (oz-eq/day) Refined grains (oz-eq/day)6 1½5½1½54 3 334Healthy Eating Pattern: US-StyleFood GroupServingsDairy (c-eq/day)3Protein Foods (oz-eq/day) Seafood (oz-eq/wk) Meats, poultry, eggs (oz-eq/wk) Nuts, seeds, soy products (oz-eq/wk)5½Oils (g/day)27Limit on Calories for Other Uses (% of calories)14 8 26 535Cup and Ounce EquivalentsFoodAmount ½ cup green beans 1 cup spinach½ cup-eq vegetables ½ cup strawberries ¼ cup raisins½ cup-eq fruit ¾ cup 100% OJ¾ cup-eq fruit 1 slice bread ½ cup cooked brown rice1 oz-eq grains 6-oz fat-free yogurt 1½ oz cheddar cheese1 cup-eq dairy 2 large eggs 2T peanut butter 1 oz almonds2 oz-eq protein3612
1/16/2017Healthy Eating Pattern: US-StyleGuidelines specify: Fresh, frozen, canned count towards fruit and vegetables. Dried and 100% juice count towards fruit and vegetables. Most dairy choices should be fat-free or low-fat. Meats and poultry should be lean or low-fat and nuts unsalted. Legumes count as part of protein and vegetables, but should becounted in one group only.3738About Seafood Recommendation: 8 oz/week Average 250 mg/day EPA andDHA associated with lower riskof CVD Seafood higher in EPA/DHAand lower in mercuryrecommended Salmon Anchovies Herring Sardines Pacific oysters Trout Atlantic/Pacific mackerel3913
1/16/2017About Meat Protein intake is marginal with manygroups As many as 45% of Americans 1 yearfail to meet protein recommendations A healthy dietary pattern consists of leanmeat There is confusion surrounding red meat40About MeatThe Committee reviewed evidence Variability of the food grouping, especially in the meat group For example, studies defined “total meat” as: Study A: Meat, sausage, fish, and eggs Study B: Red meat, processed meat, andpoultry Study C: Other combinations Lean meats were not consistently defined orhandled similarly between studies, so couldnot be parsed out41About MeatNHANES data reveals: 10% or less of saturated fat and total fat in theAmerican diet comes from beef 5% of calories in the American diet come frombeef Despite higher intakes of meat over the pastseveral decades, reports indicate that theproportion in total and saturated fat from meat,poultry and fish has slowly da-factbook-2001-2002.pdf4214
1/16/2017Defining “Lean Meat” Over 66% of beef cuts meet theguidelines for “lean”Examples: Thanks to increased trimmingpractices, the external fat in retailcuts has decreased by 80% in thepast 20 yrs 95% lean ground beef, Lean defined by USDA and FDA forfood label use: baked pork chop, lean Less than 10% fat by weight, orless than 10g of fat/100 gcooked broiled beef steak, leanonly eatenonly eaten roasted chicken breastor leg, no skin eaten smoked/cured ham,lean only eaten43About Dietary Fats Oils part of healthy eating pattern due to high vitamin Eand fatty acids Oils should replace solid fats Coconut, palm kernel, and palm oils are called oilsbecause they come from plants Solid or semi-solid at room temp due to high content of SCFA Considered solid fat for nutritional purposes44Healthy Eating Pattern:Mediterranean-Style Eating Pattern Adopted from the Healthy US-Style Pattern Groups modified to more closely reflect eating patternsassociated with positive health outcomes in the Mediterranean More fruits ad seafood, less dairy compared with US-StylePattern Less calcium and vitamin D due to less dairy4515
1/16/2017Food GroupServings (2000calories)Vegetables (c-eq/day) Dark-green vegetables (c-eq/wk) Red & orange vegetables (c-eq/wk) Legumes (c-eq/wk) Starchy Vegetables (c-eq/wk) Other vegetables (c-eq/wk)2½Fruits (c-eq/day)2½ (US 2)Grains (oz-eq/day) Whole grains (oz-eq/day) Refined grains (oz-eq/day)6Dairy (c-eq/day)2 (US 3)Protein Foods (oz-eq/day) Seafood (oz-eq/wk) Meats, poultry, eggs (oz-eq/wk) Nuts, seeds, soy products (oz-eq/wk)6½ (US 5½) 15 (US 8) 26 5Oils (g/day)27Limit on Calories for Other Uses (% of calories)13 (US 14) 1½5½1½54 3 346Healthy Eating Pattern: Vegetarian Used NHANES data from self-identified vegetarians todetermine eating patterns Meets the same nutrient and Dietary Guideline standards asthe Healthy US-Style Pattern Amount of soy products, legumes, nuts, seeds, and whole grainsincreased Amount of meat, poultry, and seafood eliminated Dairy and egg included47Food GroupServings (2000calories)Vegetables (c-eq/day) Dark-green vegetables (c-eq/wk) Red & orange vegetables (c-eq/wk) Legumes (c-eq/wk) Starchy Vegetables (c-eq/wk) Other vegetables (c-eq/wk)2½Fruits (c-eq/day)2Grains (oz-eq/day) Whole grains (oz-eq/day) Refined grains (oz-eq/day)6½ (US 6) 3½ (US 3) 3Dairy (c-eq/day)3Protein Foods (oz-eq/day) Eggs (oz-eq/wk) Legumes (oz-eq/wk) Soy products (oz-eq/wk) Nuts, seeds(oz-eq/wk)3½ (US 5½) 3 6 8 7Oils (g/day)27Limit on Calories for Other Uses (% of calories)15 (US 14) 1½5½1½544816
1/16/2017Hidden Components in EatingPatterns49Added Sugars WHO: Maximum 10% calories/day of added sugar Evidence suggests eating patterns with lower amounts ofadded sugar are associated with: Reduced risk of CVD Reduced risk of obesity Reduced risk of Type-2 diabetes Reduced risk of some forms of cancer505117
1/16/2017Added Sugars Two main sources of added sugar in US: Sugar-sweetened beverages Snacks and sweets Nutrient-dense foods where sugar naturally present toenhance palatability: Fruit (i.e. cranberries) Vegetables (i.e. rhubarb) Can also be added to whole grain breakfast cereals or fatfree yogurt as long as meets criteria for added sugar52Proposed new Nutrition Facts Panel53Caffeine Previously unexamined area Stimulant Evidence shows consumption of 3-5cups of coffee/day (or up to400mg/day caffeine) not associatedwith increased long-term health risks Consistent evidence indicates coffeeconsumption associated withreduced risk of diabetes (type 2) andCVD Moderate evidence for protectiveassociation between coffee intakeand Parkinson's disease5418
1/16/2017Caffeine If caffeine added to a food, it must be listed underingredient list Most caffeine comes from coffee, tea, and soda Limit consumption of high-caffeine energy drinks Be wary of: Added calories (milk, cream, sugar, dairy substitutes) Safety of high caffeine ( 400mg/day) intake Energy drinks alcoholic beverage pairings55Low/ No Calorie Sweeteners Replacing added sugars with high-intensity sweeteners mayreduce calorie intake in the short-term, yet questions remainabout their effectiveness as a long-term weight managementstrategy. US approved high-intensity sweeteners: SaccharinAspartameAcesulfame potassium (Ace-K)Sucralose Based on the available scientific evidence, these high-intensitysweeteners have been determined to be safe for the generalpopulation.56Part 4: Recommendations into Actions5719
1/16/2017How Should We Use the Guidelines? Gov’t use DG to develop research-based consumermessages for use by public and health educators The key to success in the DG lies in the ability tocommunicate them effectively to consumers Consumers want Specific actions they can relate to, individualize andincorporate into their lifestyle Positive information to keep them motivated to achieve ahealthy diet and lifestyle58History of MyPlate 1940s: A Guide to GoodEating (Basic Seven) 1956-1970: Food for Fitness,A Basic Food Guide (BasicFour) 1979: Hassle Free DailyFood Guide 1984: Food Wheel- APattern for Daily FoodChoices59History of MyPlate 1992: Food Guide Pyramid 2005: MyPyramid FoodGuidance System 2011: MyPlate6020
1/16/2017My Plate A comprehensive nutrition communicationsinitiative Meant to serve as a simple guide to helpconsumers choose healthful foods.Provides visual reminders to help consumersmake nutritious food choices and form healthfuleating habits consistent with Dietary Guidelines Latest update in response to a call to actionfrom the 2010 White House Child Obesity TaskForce to provide simple, useful advice thatconsumers can easily tive, online dietaryassessment and planning toolbased on age, gender andphysical activity level Provides user-friendly tipsand strategies for makingsmart choices from everyfood group Available in a variety oflanguages62Multi-Component Approach The Individual and family Level Communities Food environmentSocial environmentCultural environmentEconomics Industry and Government Food access in the community Food access atschool/worksite/child care Policy6321
1/16/2017Individual and Family LevelBehavior Change Strategies Reduce screen time Reduce frequency of eating out fastfood Increase frequency of family sharedmeals Self-monitoring of body weight Effective food label reading to targethealthy food choices64Empower Folks To Make Healthy ShiftsFrom .To .High calorie snacksNutrient-dense snacksFruit products withadded sugarFruitRefined grainsWhole grainsSnacks with addedsugarsUnsalted snacksSolid fatsOilsBeverages with addedsugarNo-added sugarbeverages65Motivating Parents to Make Positive Dietand Lifestyle ChangesDietary Guideline Alliance research foundthese messages testes best among Americanfamilies:Know your numberFun stuff counts as exerciseTake charge of your weightSmall steps big changesBase your plate on nutrient-rich foodsthat offer beneficial nutrients and fewercalories You are an important role model for yourchildren 6622
1/16/2017Family Meals Promising behavior change strategies to favorably affect arange of health-related outcomes, enhance theeffectiveness of interventions Limited studiesSuggest: “frequent consumption of family meals wasassociated with improved dietary intake, specifically anincrease in fruits and/or vegetables, and calcium- rich ormilk-based foods”67Communities Food environmento Facilitate access to healthy food Social environmento Address nutrition-related health problems (i.e.obesity/overweight, CVD, type 2 DM) Cultural environmento Immigrants at risk of losing healthier dietary patternscharacteristic of their cultural background Economicso Facilitate access to affordable food68Industry and Government Create/modify environmentalpolicies to improve availability andprovision of healthy foods andbeverages Increase opportunity for physicalactivity Increase parent engagement (inchild care and school settings) Educational approacheso i.e. school nutrition curriculum6923
1/16/2017Part 4: What’s Next?70What’s Next? The 5 year process starts soonfor the 2020 DGA71Recommendations for 0-24 monthsBeginning in 2020, the Dietary Guidelines willaddress Americans of all ages, starting from birth. Current recommendations for this age group has beenextrapolated from adult recommendations Very few studies May not be enough time toget good studies in the nextfew years. Interesting stuff!7224
1/16/2017QuestionsConnect with me: Website: TobyAmidorNutrition.com Facebook: Toby Amidor Nutrition Twitter: @tobyamidor Instagram: @tobyamidor73Credit Claiming InstructionsYou must complete a brief evaluation of theprogram in order to download your certificate.The evaluation survey will be available onwww.CE.TodaysDietitian.com for 1 year followingthe live presentation.RDs should list CPE activity type 175 in theirprofessional development portfolio.7425
(HHS/USDA) 2005 Dietary Guidelines for Americans Dietary Guidelines for Americans (USDA/HHS) 2010 McGovern Report - Dietary Goals (6) 1977 Surgeon General's Report on Health Promotion 1979 Dietary Guidelines for Americans (USDA/HH
ST60 Depth instrument. Your ST60 Depth instrument provides depth information, plus maximum and minimum depth alarms. Switching on and off All the time that power is applied to the instrument, you can use the depth button to switch the instrument off and on as follows: † To switch the instrument off, hold down the depth button for approximately
depth buffer with the scene’s final depth values. Using this method, the rest of the scene can be rendered with depth test enabled and depth writes disabled. Note that it’s not necessary to render the entire scene in the Pre-Z pass as long as you keep track of what objects have been rendered to the depth buffer and
2. Using the SharkBite Depth and Deburr tool, deburr the tube ends and mark the PEX with the correct insertion depth. For 1/2" fittings, the pipe insertion depth is 15/16". For 3/4" fittings, the pipe insertion depth is 1-1/8". 3. Push the PEX into the fitting on the manifold until it reaches the depth mark. 4. The connection is now complete.
tentive and wary. The same animal may well look at other . 5 . WHY LOOk AT ANIMALS? species in the same way. He does not reserve a special look for man. But by no other species except man will the animal's look . be . recognised as familiar. Other animals are held by the look. Man becomes aware of himself returning the look.
focus and correspondence depth estimates. The depth-maps are compared both qualitatively and quantitatively. A qualitative comparison of the two algorithms can be made by examining the resulting depth-maps. The algo-rithm implemented in this paper is able to create a depth-map with m
which contains four different architectures i.e., the multi-modal fusion (MM), multi-scale fusion (MS), global con-text aggregation (GA) and spatial information restoration (SR) cells. 3.2. Depth Sensitive Attention We propose a depth-sensitive RGB feature modeling scheme, including the depth decomposition and the depth-sensitive attention module.
composing fragments in depth order. Depth peeling [Everitt01] [Mammen84] is a robust image-based solution to this problem which captures one layer of fragments each time the geometry is rendered (geometry pass). Besides order-independent transparency, depth peeling is useful for generating layered depth images and tracing bundles of rays. The major
network, which refines the surface normal from the given depth map. Then we explain the normal-to-depth network to update depth from the given surface normal map. It is followed by the overall architecture of our GeoNet, which utilizes these new modules. 3.1. Depth-to-Normal Network As aforementioned, learning geometrically consistent sur-
