Group releases list of 90 medical ‘don’ts’

Don’t use feeding tubes in patients with advanced dementia. Don’t use drugs to aggressively treat diabetes in those older than 65. Don’t automati­cally use imaging technology for minor head injuries in children and headaches in adults. And don’t give antacids to babies with reflux.

Those are among the 90 medical “don’ts” on a list being released Thursday by a coalition of doctor and consumer groups. They are trying to discourage the use of tests and treatments that have become common practice but may cause harm to patients or unnecessarily drive up the cost of health care.

It is the second set of recommendations from the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign, which launched last year amid nationwide efforts to improve medical care in the United States while making it more affordable.

The recommendations run the gamut, from geriatrics to opthalmology to maternal health. Together, they are meant to convey the message that in medicine, “sometimes less is better,” said Daniel Wolfson, executive vice president of the foundation, which funded the effort.

“Sometimes, it’s easier [for a physician] to just order the test rather than to explain to the patient why the test is not necessary,” Wolfson said. But “this is a new era. People are looking at quality and safety and real outcomes in different ways.”

The guidelines were penned by more than a dozen medical professional organizations, including the American Academy of Pediatrics and the American College of Obstetricians and ­Gynecologists.

The groups discourage the use of antibiotics in a number of instances in which they are commonly prescribed, such as for sinus infections and pink eye. They caution against using certain sedatives in the elderly and cold medicines in the very young.

In some cases, studies show that the test or treatment is costly but does not improve the quality of care for the patient, according to the groups.

But in many cases, the groups contend, the intervention could cause pain, discomfort or even death. For example, feeding tubes are often used to provide sustenance to dementia patients who cannot feed themselves, even though oral feeding is more effective and humane. And CT scans that are commonly used when children suffer minor head trauma may expose them to cancer-causing radiation.

While the recommendations are aimed in large part at physicians, they are also designed to arm patients with more information in the exam room.

“If you’re a healthy person and you’re having a straightforward surgery, and you get a list of multiple tests you need to have, we want you to sit down and talk with your doctor about whether you need to do these things,” said John Santa, director of the health ratings center at Consumer Reports, which is part of the coalition that created the guidelines.

Health-care spending in the United States has reached 17.9 percent of the nation’s gross domestic product and continues to rise, despite efforts to contain costs. U.S. health-care spending grew 3.9 percent in 2011, reaching $2.7 trillion, according to the journal Health Affairs.

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Singapore trade expands 1.1% in 2012

SINGAPORE: Singapore's total external trade rose by 1.1 per cent in 2012, a contrast to the 8.0 per cent rise seen in the previous year.

The trade growth is lower than the previously projected range of between 3.0 and 4.0 per cent, said IE Singapore in its news release on Friday.

This, IE Singapore said, is due to poor trade performance in 4Q 2012.

Total trade reached S$984.9 billion in 2012, higher than the previous year's achievement of S$974.4 billion.

On a year-on-year basis, Singapore's total trade dropped by 2.9 per cent in 4Q 2012, following the previous quarter's decrease of 2.2 per cent due to decreases in both oil and non-oil trade.

Non-oil domestic exports (NODX) rose by 0.5 per cent in 2012, following the preceding year's increase of 2.2 per cent, due to higher shipments of non-electronic exports.

IE Singapore said the 0.5 per cent growth is lower than their projected 2012 growth of 2.0 to 3.0 per cent. This is due to a worse than expected NODX's performance in 4Q 2012.

Looking ahead, IE Singapore said projected total trade for 2013 is maintained at between 3.0 and 5.0 per cent while projected NODX growth for 2013 is kept at between 2.0 and 4.0 per cent.

- CNA/fa

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British intel had warned of Indian Mujahideen attack

NEW DELHI: The British intelligence had warned India about a possible terrorist attack by the homegrown terror outfit, Indian Mujahideen (IM). The alert led to a general nationwide alert on Wednesday.

The British intelligence alert is believed to have been received by Indian agencies just as British PM David Cameron was about to land in Mumbai on Monday. The input did not speak of any specific movements of terrorists or any particular module. Sources said it may have been based on inputs gathered by the heightened British intelligence gathering in the region ahead of Cameron's visit.

On Wednesday, a general alert was issued by the Intelligence Bureau (IB) about a possible attack by the IM. The alert was based on the British input, and came after several weeks of silence about any IM activity.

There are no dependable inputs with agencies until now about any IM module being active of late, sources said. However, investigations of recent times have indicated that the entire network of the homegrown terror group may not have been unearthed.

The IM tentacles are not just limited to some Indian cities, but it also has very strong affiliations among the Indian diaspora. The activities of IM are believed to have regular funding from West Asian countries. Also, some of the first Indian terrorists to have emerged in the communally vicious times of the 1990s — mostly having undergone terror training in Pakistan — are now based in the Gulf region. Among them is C A M Basheer, a former senior SIMI leader.

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Turbulence Ahead for Weather Satellites

Jane J. Lee

Like a celestial version of Pixar's industrious robot Wall-E, environmental-monitoring satellites continually whiz overhead, quietly performing their allotted tasks of taking data and beaming the information down to climate researchers and weather forecasters.

But a recent U.S. Government Accountability Office (GAO) report highlights the fact that this monitoring network—which weather forecasters and climate researchers rely on—is in trouble.

That's because these U.S.-owned satellites are aging, and there are serious concerns about whether their replacements will be ready by the time they start to break down, said J. Marshall Shepherd, president of the American Meteorological Society and a professor at the University of Georgia in Athens. (Read about the history of satellites.)

The replacement program, known as the Joint Polar Satellite System (JPSS), has suffered under ballooning budgets, mismanagement, and political wrangling. That's partly what prompted the GAO to put weather data on its list of government operations at high risk.

The report stated that "potential gaps in environmental-satellite data beginning as early as 2014 and lasting as long as 53 months have led to concerns that future weather forecasts and warnings—including warnings of extreme events such as hurricanes, storm surges, and floods—will be less accurate and timely."

"But even a 17-month gap, [the shortest estimate for a potential data gap], dramatically affects weather forecast ability, which could lead to challenges to protecting life and property," Shepherd said.

If European models of superstorm Sandy—well known for their accuracy in predicting the monster storm's path—hadn't had information from polar-orbiting satellites, for instance, they would've shown Sandy staying harmlessly out to sea rather than turning inland toward New York and New Jersey. (Read about "Weather Gone Wild" in the September 2012 issue of National Geographic magazine.)

Basic research would also suffer from the loss of data, said Scott Rayder, senior adviser to the president of the University Corporation for Atmospheric Research. "Long-term weather data is climate data, so these [satellite] sensors are important in figuring out how the atmosphere works."

Cause for Concern

Information forecasters incorporate into their models comes from two sets of satellites run by the U.S. National Oceanic and Atmospheric Administration (NOAA) and NASA—geostationary satellites and polar-orbiting satellites, the American Meteorological Society's Shepherd explained.

Onboard instruments measure environmental factors including atmospheric moisture, sea surface temperature, and atmospheric ozone. This helps scientists keep tabs on things like precipitation and the health of the planet's ozone layer.

The current concern is focused on replacements for polar-orbiting satellites.

Traveling 517 miles (833 kilometers) above the Earth in a pole-to-pole direction every 90 minutes, NOAA's current crop of Polar Operational Environmental Satellites (POES) are nearing the twilight of their life cycles, Shepherd said.

The POES satellites were built with a two- to three-year operational lifetime in mind, said James Gleason, of NASA's Goddard Spaceflight Center in Maryland.

"And they've lasted a long time, some [for] more than a decade," he said. The most recent POES satellite, NOAA-19, was launched in 2009.

Dire Situation

NOAA has another polar-orbiting satellite, called Suomi NPP, that's also taking weather data. Launched in 2011, it was supposed to be a proof of concept in order to test instruments slated to fly on JPSS, said Shepherd.

But due to repeated delays in the JPSS program, NOAA is using Suomi NPP as an operational satellite. "It's working swimmingly," he said.

"We're pretty sure [Suomi] NPP will last until 2016," said NASA's Gleason, senior project scientist for JPSS.

But JPSS isn't scheduled to launch until early 2017—and that depends on what happens to funding in the federal budget and whether the sequester kicks in, Gleason said.

NOAA is currently working on a plan to bridge any gap, should it occur, in data from their satellites. One possibility includes using a fleet of satellites owned by the U.S. military, called the Defense Meteorological Satellite Program, to gather needed weather data.

The agency put out a call last year asking for suggestions on how the community could deal with a gap.

But as it stands right now, the situation is dire, said Shepherd.

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Las Vegas Shooting Launches Multi-State Manhunt

An argument in the valet area of a Las Vegas hotel led to a deadly drive-by shooting on the occupants of a Maserati on Vegas' glitzy strip, initiating a multi-state manhunt for the black Range Rover from which the shots were fired.

Three people were left dead in the attack, including two who died when their taxi was struck by the careening sports car and exploded into flames.

"What happened is not just tragic, but underscores the level of violence we see sometimes here in Las Vegas as well as across America," Las Vegas Metropolitan Sheriff Doug Gillespie said at a news conference today. "Clearly, the suspects in this shooting have no regard for the lives and safety of others."

The altercation took place in the valet area of the Aria resort and casino. Gillespie said there is currently "no indication" what the squabble was about.

Gillespie said that authorities do not know how many people are in the SUV, but that they are considered armed and dangerous. He warned members of the public to stay away from it.

"You should not take action," he said. "Instead, call your local police department and alert them to the whereabouts of the suspect vehicle."

Authorities in Nevada, Utah, Arizona and California are all on alert for the car.

"These individuals will be found," Gillespie said. "They will be prosecuted to the full extent of the law."

Steve Marcus/Las Vegas Sun/AP Photo

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The Range Rover SUV shot at two people in the Maserati, which caused a multi-car crash. Police have not released the model of the Maserati, but the price of a new Maserati ranges from $123,000 to $142,000.

Police said that they believe a group of men riding in a black Range Rover Sport SUV pulled up alongside the Maserati around 4:20 a.m. today and fired shots into the car, striking the driver and passenger, according to Officer Jose Hernandez of the Las Vegas Metropolitan police department.

The Maserati then swerved through an intersection, hitting at least four other cars. One car that was struck, a taxi with a driver and passenger in it, caught on fire and burst into flames, trapping both occupants, Hernandez said.

The SUV then fled the scene, according to cops.

Gillespie said investigators are in the process of gathering video footage from hotels, casinos and the taxi cabs that were at the intersection.

The driver of the Maserati died from his gunshot wounds at University Medical Center shortly after the shooting, according to Sgt. John Sheahan.

The driver and passenger of the taxi both died in the car fire.

At least three individuals, including the passenger of the Maserati, were injured during the shooting and car crashes and taken to UMC hospital for treatment.

Authorities said the Maserati passenger, identified only as a man, sustained only a minor injury to his arm. He is speaking to and cooperating with police.

They do not yet know whether the cars had local plates or were from out of state.

No bystanders were hit by gunfire, Hernandez said.

"We're currently looking for a black Range Rover Sport, with large black rims and some sort of dealership advertising or advertisement plates," Hernandez said. "This is an armed and dangerous vehicle."

The Las Vegas Convention and Visitors Authority had no immediate comment about the safety of tourists in the wake of the shooting today.

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Qantas reports sharp rise in first-half profits

SYDNEY: Australian flag carrier Qantas on Thursday reported that first-half net profit more than doubled to A$111 million (US$114 million), also announcing an upgrade to its fleet.

The result in the six months to December 31 was up 164 percent on the same period in the previous year and in line with guidance, "despite challenging conditions in international and domestic air travel markets."

Underlying profit before tax -- the airline's preferred measure of financial performance -- was A$223 million, up 10 percent.

Qantas also announced an order for five new Boeing 737-800s and the upgrade of 20 Airbus A330-200s and 10 A330-300s.

The additional Boeing 737-800 aircraft are for the flag carrier's domestic service and for delivery during 2014, the company said in a statement, adding that leases on two existing B737-800s would be extended this year.

"The refurbished aircraft will give Qantas International a truly world-class product in global aviation's most dynamic and competitive market," chief executive Alan Joyce told a press conference.

"Growing with Asia is a major priority for the Qantas Group and this investment underpins our commitment to the region."

Joyce said: "Older narrow body Boeing 737-400s will be phased out by the end of 2013 and Boeing 767s by mid-2015.

"We are simplifying our fleet and making better use of the greater flexibility and higher frequencies that the B737-800s provide, while investing in what will be the best domestic onboard product anywhere in the world with the A330s."

The A330 reconfigurations and new orders will not affect planned capital expenditure of A$1.6 billion in 2012/13 and A$1.5 billion in 2013/14.

However, Qantas International reported an underlying before-tax loss of A$91 million in the six-month period, an improvement of A$171 million.

"Qantas International is well advanced in its turnaround plan," Joyce said.

"The 65 per cent improvement in Qantas International's underlying EBIT is testament to the steps taken to remove cost from the businesses, from closing down loss-making routes to retiring aircraft and consolidating operations."

Qantas is planning to broaden its reach in Asia as part of a strategy to turn around its struggling international arm.

The move is a consequence of its global alliance with Dubai-based Emirates, which means services to Asia will no longer be tied to onward links to Europe.

New direct destinations from Australia being considered include Beijing, Seoul, Mumbai, Delhi and Tokyo-Haneda at the same time as increasing capacity and frequency of flights to Hong Kong and Singapore.

Australia's competition watchdog last month gave Qantas and Emirates permission to launch their alliance in which the airlines will coordinate ticket prices and flight schedules.

Qantas will shift its hub for European flights to Dubai from Singapore and end a partnership with British Airways. The tie-up is seen as vital to the sustainability of Qantas, which last year posted its first annual deficit since privatisation in 1995 due to tough regional competition and high fuel costs.

- AFP/ac

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West Bengal govt plans to depoliticize students' union polls

KOLKATA: Increasing incidence of violence on campuses in West Bengal has forced the Mamata Banerjee government to explore ways to depoliticise students' union elections. The state education department has drawn up a draft guideline that proposes to delink student bodies from political parties and make college union polls a 'once-in-two-years' event.

Education minister Bratya Basu is expected to submit the draft to chief minister Mamata Banerjee early next week. "Only after the chief minister's go-ahead, a final draft will be prepared and placed before the cabinet for approval," Basu told TOI on Wednesday.

The proposal comes barely a week after a policeman was shot dead during clashes between students' groups in a city college.

Calcutta University vice-chancellor Suranjan Das, higher education council chairman Sugata Marjit and the education minister have put their heads together to draw up the draft which will be put on the higher education department website on Thursday for stakeholders to give their suggestions.

The guidelines loosely follow the model of Bengal Engineering and Science University (Besu) where the student union has been replaced by a senate with several associate societies or clubs. The move has gone a long way in calming the restive Besu campus.

The latest move has been welcomed by academics. "This is an excellent attempt by the education minister. All my life, I have tried to propagate the idea to delink college politics from party politics. This is a move in the right direction. Now, the question is to implement the draft proposals," said former principal of Presidency College Amal Mukhopadhyay.

According to the draft, college elections will not be fought on political symbols. The student union will be renamed student council and its president will be nominated by the senior most teacher of the college. The vice-president will be nominated by the teachers' council. In case of universities, the vice-chancellor will select the president. The two vice-presidents will be nominated by the executive council and the court - the two top bodies in university administration.

The draft provides for election to the post of general secretary, assistant general secretary and five other secretaries who would look after student activities such as culture, drama, sports, etc. All students would either vote to elect these representatives as in the case of Jawaharlal Nehru University or Jadavpur University or the general secretary would be elected from among class representatives as is done in Calcutta University.

In keeping with the recommendations of the Lyngdoh Commission, an election observer will oversee the process and complete it within a month. The observer may wind up the entire process within 15 days, if he deems it fit.

Primacy has been given to the elected representatives. The elected general secretary will represent students in the college governing body while the general secretary of the students' council will make way to the university's highest body - the executive council.

The purpose is to integrate the students' bodies in the overall academic system rather than turning them into power centres of political parties.

Trinamool Congress Chhatra Parishad leader Shanku Deb Panda, however, reacted cautiously to the move. "We will have to see how far the guidelines can be implemented," he said.

"I have already sent the draft of the students' senate in Besu to the committee formed by the state government and our ideas have been appreciated. We will now wait to read the draft as prepared by the higher education department," said Ajay Ray, vice-chancellor of Besu.

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The True Story of History's Only Known Meteorite Victim

The Russian meteorite, whose sonic boom damaged buildings and injured more than a thousand last week, is not the first to shatter a human life. (See pictures: "Meteorite Hits Russia.")

Take the true story of Ann Hodges, the only confirmed person in history to have been hit by a meteorite.

On a clear afternoon in Sylacauga, Alabama (see map), in late November 1954, Ann was napping on her couch, covered by quilts, when a softball-size hunk of black rock broke through the ceiling, bounced off a radio, and hit her in the thigh, leaving a pineapple-shaped bruise.

Ann's story is particularly rare because most meteorites usually fall into the ocean or strike one of Earth's vast, remote places, according to Michael Reynolds, a Florida State College astronomer and author of the book Falling Stars: A Guide to Meteors & Meteorites.

"Think of how many people have lived throughout human history," Reynolds said.

"You have a better chance of getting hit by a tornado and a bolt of lightning and a hurricane all at the same time."

Out of This World

Before the meteorite slammed into Ann's living room, people in tiny Sylacauga and across eastern Alabama had reported seeing "a bright reddish light like a Roman candle trailing smoke," according to the web publication "The Day the Meteorite Fell in Sylacauga," which was produced by the Alabama Museum of Natural History in 2010.

Others saw "a fireball, like a gigantic welding arc," accompanied by tremendous explosions and a brown cloud. (See video: "Predicting Meteorite Impacts.")

A government geologist working in a nearby quarry was called to the scene and determined the object was a meteorite, but not everyone in town was so sure, according to the museum publication. Many thought a plane had crashed—others suspected the Soviets.

So many people flocked to Hodges's house that when her husband Eugene Hodges, a utility worker, returned home from work, he had to push gawkers off the porch to get inside.

Ann was so overwhelmed by the crowd that she was transferred to a hospital. With Cold War paranoia running high, the Sylacauga police chief confiscated the black rock and turned it over to the Air Force.

After the Air Force confirmed it was a meteorite, the question then was what to do with it. The public demanded the space rock be returned to Ann, and she agreed.

"I feel like the meteorite is mine," she said, according to the museum. "I think God intended it for me. After all, it hit me!"

Simple Country People

But there was a hitch. Ann and Eugene were renters, and their landlady, a recently widowed woman named Birdie Guy, wanted the meteorite for herself.

Guy obtained a lawyer and sued, claiming the rock was hers since it had fallen on her property. The law was actually on her side, but public opinion wasn't.

Guy settled out of court, giving up her claim to the meteorite in exchange for $500. Eugene was convinced the couple could make big money off the rock and turned down a modest offer from the Smithsonian.

But no one bit, and so the Hodges donated the meteorite to the natural history museum in 1956, where it's still on display. (Related: "Meteorites: Best Places to See Them Up Close.")

Ann later suffered a nervous breakdown, and in 1964 she and Eugene separated. She died in 1972 at 52 of kidney failure at a Sylacaugan nursing home.

Eugene suspects the meteorite and frenzy that followed had taken its toll on Ann. He said "she never did recover," according to the museum.

Ann "wasn't a person who sought out the limelight," added museum director Randy Mecredy. "The Hodges were just simple country people, and I really think that all the attention was her downfall."

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Armstrong Snubs Offer From Anti-Doping Officials

Lance Armstrong has turned down what may be his last chance at reducing his lifetime sporting ban.

Armstrong has already admitted in an interview with Oprah Winfrey to a career fueled by doping and deceit. But to get a break from the U.S. Anti-Doping Agency, all he had to do was tell his story to those who police sports doping. The deadline was today, and Armstrong now says he won't do it.

"For several reasons, Lance will not participate in USADA's efforts to selectively conduct American prosecutions that only demonize selected individuals while failing to address the 95 percent of the sport over which USADA has no jurisdiction," said Tim Herman, Armstrong's longtime lawyer. "Lance is willing to cooperate fully and has been very clear: He will be the first man through the door, and once inside will answer every question, at an international tribunal formed to comprehensively address pro cycling."

But the "international tribunal" Armstrong is anxious to cooperate with has one major problem: It doesn't exist.

The UCI, cycling's governing body, has talked about forming a "truth and reconciliation" commission, but the World Anti-Doping Agency has resisted, citing serious concerns about the UCI and its leadership.

READ MORE: Armstrong Admits to Doping

Livestrong, Elizabeth Kreutz/AP Photo

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U.S. Anti-Doping Agency officials seemed stunned by Armstrong's decision simply to walk away.

"Over the last few weeks, he [Armstrong] has led us to believe that he wanted to come in and assist USADA, but was worried of potential criminal and civil liability if he did so," said Travis Tygart, CEO of the U.S. Anti-Doping Agency. "Today, we learned from the media that Mr. Armstrong is choosing not to come in and be truthful and that he will not take the opportunity to work toward righting his wrongs in sport."

Armstrong's ongoing saga plays out amid a backdrop of serious legal problems.

Sources believe one reason Armstrong wants to testify to an international tribunal, rather than USADA, is because perjury charges don't apply if Armstrong lies to a foreign agency, they told ABC News.

While Armstrong has admitted doping, he has not given up any details, including the people and methods required to pull off one of the greatest scandals in all of sport.

Armstrong is facing several multimillion-dollar lawsuits right now, but his biggest problems may be on the horizon. As ABC News first reported, a high-level source said a criminal investigation is ongoing. And the Department of Justice also reportedly is considering joining a whistleblower lawsuit claiming the U.S. Postal Service was defrauded out of millions of dollars paid to sponsor Armstrong's cycling team.

READ MORE: 10 Scandalous Public Confessions

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Education panel: To close achievement gap, urgent state, federal action needed

The nation must act urgently to close the achievement gap between poor and privileged children by changing the way public schools are financed, improving teacher quality, investing in early-childhood education and demanding greater accountability down to the local school board level, according to a report issued Tuesday by an expert panel.

Created by Congress in 2010 — with legislation sponsored by Reps. Michael M. Honda (D-Calif.) and Chaka Fattah (D-Pa.) — the Equity and Excellence Commission aimed to propose ways to improve public education for poor American children. The 27-member panel included, state and federal officials, civil rights activists and academics.

“This is about all levels of government,” said Christopher Edley Jr., dean of the University of California at Berkeley Law School and the commission’s co-chair. “This is a proposed agenda for everyone who’s concerned with the fate of our children and of our public education system.”

The panel released its recommendations to Education Secretary Arne Duncan.

In a telephone call with reporters, Honda said the goal is to focus the public’s attention on a national crisis. “This is not a minority issue. This is not a poverty issue. This is an American issue,” Honda said.

The achievement gap has proved to be a stubborn problem and one of growing concern among educators, policymakers and civic leaders. With enactment of the No Child Left Behind law in 2002, the federal government made closing the gap a priority and a reason for increased accountability in public education. A host of strategies has been deployed in schools across the country to attack the gap, but few have resulted in substantial progress.

Closely tied to race, the gap is creating an underclass that threatens the country’s long-term economic stability, the commission said.

A 2011 study of the country’s 21 largest urban school districts found that every city displayed a difference in performance between whites and blacks and between whites and Hispanics. That study was based on the 2011 National Assessment of Educational Progress, which includes federal reading and math exams taken regularly by fourth- and eighth-graders across the country.

“While some young Americans — most of them white and affluent — are getting a truly world-class education, those who attend schools in high poverty neighborhoods are getting an education that more closely approximates school in developing nations,” the commission wrote in its report.

More than 40 percent of U.S. children attend high-poverty schools and 22 percent of children are living below the poverty line, the government said.

Public schools in poor communities have fewer resources, less-experienced teachers and worse facilities than schools in more-affluent communities — an imbalance that must be corrected by state and federal action, the commission said.

“Ten million students in America’s poorest communities . . . are having their lives unjustly and irredeemably blighted by a system that consigns them to the lowest-performing teachers, the most run-down facilities, and academic expectations and opportunities considerably lower than what we expect of other students,” the commission wrote. “These vestiges of segregation, discrimination and inequality are unfinished business for our nation.”

The country’s primary method for funding public schools — property taxes — is one reason for disparate resources, the commission wrote. Communities with elevated real estate values can generate more money for schools, at a lower tax rate, than towns and cities with lower property values.

While the federal government pays about 10 percent of the cost of public education, about half comes from states and 40 percent comes from local communities.

The commission urged states and the federal government to send more tax dollars to high-poverty schools to compensate for the imbalance in local funding. But it stopped short of recommending a new way to fund schools that does not rely so heavily on property taxes.

In 1972, a federal commission convened by President Richard M. Nixon to address school funding concluded that as long as property taxes funded schools, poor and privileged children would be condemned to different educational outcomes.

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